Mindfulness-Based Stress Reduction Found Effective Treating Anxiety Disorders

A randomized clinical trial published in JAMA Psychiatryindicates that a guided mindfulness-based stress reduction program may be as effective as escitalopram for patients with anxiety disorders. The data were released shortly after the United States Preventive Services Task Force recommended screening for anxiety disorders due to their high prevalence.

“Our study provides evidence for clinicians, insurers and health care systems to recommend, include and provide reimbursement for mindfulness-based stress reduction as an effective treatment for anxiety disorders because mindfulness meditation currently is reimbursed by very few providers,” said first study author Elizabeth Hoge, MD, director of the Anxiety Disorders Research Program and associate professor of psychiatry at Georgetown, in a press release. “A big advantage of mindfulness meditation is that it doesn’t require a clinical degree to train someone to become a mindfulness facilitator. Additionally, sessions can be done outside of a medical setting, such as at a school or community center.”

Anxiety disorders include generalized anxiety, social anxiety, panic disorder, and fear of certain places or situations, including crowds and public transportation. These disorders contribute to an increased risk of suicide, disability, and distress, and are commonly treated in psychiatric clinics.

Currently prescribed medications for anxiety disorders can be very effective; however, many patients have difficulty gaining access to these drugs, do not respond to them, or find adverse effects to be a barrier to adherence. Standardized mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR), can lower feelings of anxiety; however, previous studies have not compared these interventions with effective anti-anxiety drugs.

The clinicians recruited 276 patients between June 2018 and February 2020 from 3 hospitals in Boston, New York City, and Washington, DC, and randomly assigned them to either MBSR or escitalopram. MBSR was offered weekly for 8 weeks via 2 and a half-hour in-person classes, a daylong retreat weekend class during the fifth or sixth week, and 45-minute daily home practice exercises.

Symptoms of anxiety were assessed at enrollment and at completion of the intervention at 8 weeks, along with post-treatment assessments at 12 and 24 weeks after enrollment. For the blinded assessments, trained clinical evaluators did not know whether the patients they were measuring received the drug or MBSR.

By the end of the study, 102 patients had completed MBSR and 106 had completed their medication course. The patients were relatively young, with a mean of 33 years, and included 156 women, who represented 75% of the enrollees.

Using validated assessments, the researchers measured the severity of symptoms of anxiety across all the disorders using a scale of 1 to 7, with 7 being severe anxiety. Both groups experienced decreased anxiety symptoms, dropping from a mean of about 4.5 for both, which translates to an approximately 30% reduction in the severity of peoples’ anxiety.

After participating in a previous study and again in the current study, enrollee Olga Cannistraro said she learned 2 key MBSR techniques.

“It gave me the tools to spy on myself. Once you have awareness of an anxious reaction, then you can make a choice for how to deal with it. It’s not like a magic cure, but it was a lifelong kind of training. Instead of my anxiety progressing, it went in the other direction, and I’m very grateful for that,” Cannistraro said in a press release.

Hoge said it is important to highlight that although mindfulness meditation works, not everyone is willing to invest the time and effort to successfully complete all of the necessary sessions and do regular home practice, which enhances the effect.

“Also, virtual delivery via videoconference is likely to be effective, so long as the ‘live’ components are retained, such as question-and-answer periods and group discussion,” Hoge said in a press release.

Hoge added that there are phone apps available that offer guided meditation, but the researchers do not know how the apps compared with the full in-person, weekly group class experience.

Most enrollees completed their 8-week course of treatment before the COVID-19 pandemic started. Further, the research team conducted a second phase of the study during the pandemic that involved reorganizing the treatments to an online video conference, which will continue to be analyzed in future analyses. The effects of MBSR on sleep and depression will also be analyzed in future studies.

REFERENCE

Mindfulness-Based Stress Reduction is as Effective as an Antidepressant Drug for Treating Anxiety Disorders. Georgetown University Medical Center. November 9, 2022. Accessed November 10, 2022. https://gumc.georgetown.edu/news-release/mindfulness-based-stress-reduction-is-as-effective-as-an-antidepressant-drug-for-treating-anxiety-disorders/