Summary: Study
reveals mindfulness-based stress reduction methods proved to be as
effective as antidepressants for relieving symptoms for those with
anxiety disorders.
Source: Georgetown University Medical Center
A
guided mindfulness-based stress reduction program was as effective as
use of the gold-standard drug—the common antidepressant drug
escitalopram—for patients with anxiety disorders, according to results
of a first-of-its-kind, randomized clinical trial led by researchers at
Georgetown University Medical Center.
The findings appear in JAMA Psychiatry on November 9, 2022, and follow the October 11, 2022, announcement by
the United States Preventive Services Task Force that, for the first
time, recommended screening for anxiety disorders due to the high
prevalence of these disorders.
“Our
study provides evidence for clinicians, insurers, and healthcare
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,” says Elizabeth Hoge, MD, director of the Anxiety
Disorders Research Program and associate professor of psychiatry at
Georgetown and first author.
“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 can be highly distressing; they include generalized anxiety,
social anxiety, panic disorder and fear of certain places or situations,
including crowds and public transportation, all of which can lead to an
increased risk for suicide, disability and distress and therefore are
commonly treated in psychiatric clinics.
Drugs
that are currently prescribed for the disorders can be very effective,
but many patients either have difficulty getting them, do not respond to
them, or find the side effects (e.g., nausea, sexual dysfunction and
drowsiness) as a barrier to consistent treatment.
Standardized
mindfulness-based interventions, such as mindfulness-based stress
reduction (MBSR), can decrease anxiety, but prior to this study, the
interventions had not been studied in comparison to effective
anti-anxiety drugs. Of note, approximately 15% of the U.S. population
tried some form of meditation in 2017.
The
clinicians recruited 276 patients between June 2018 and February 2020
from three hospitals in Boston, New York City and Washington, D.C., and
randomly assigned people to either MBSR or escitalopram. MBSR was
offered weekly for eight weeks via two and a half-hour in-person
classes, a day-long retreat weekend class during the 5th or 6th week,
and 45-minute daily home practice exercises.
Patients’
anxiety symptoms were assessed upon enrollment and again at completion
of the intervention at 8 weeks, along with post-treatment assessments at
12 and 24 weeks after enrollment.
The
assessments were conducted in a blinded manner—the trained clinical
evaluators did not know whether the patients they were assessing
received the drug or MBSR.
At
the end of the trial, 102 patients had completed MBSR and 106 had
completed their medication course. The patients were relatively young,
with a mean age of 33 and included 156 women, which comprised 75% of the
enrollees, mirroring the disease prevalence in the U.S.
The
researchers used a validated assessment measure to rate the severity of
symptoms of anxiety across all of the disorders using a scale of 1 to 7
(with 7 being severe anxiety). Both groups saw a reduction in their
anxiety symptoms (a 1.35 point mean reduction for MBSR and 1.43 point
mean reduction for the drug, which was a statistically equivalent
outcome), dropping from a mean of about 4.5 for both, which translates
to a significant 30% or so drop in the severity of peoples’ anxiety.
Olga
Cannistraro, 52, says she utilizes her MBSR techniques as needed, but
more than a decade ago, the practice transformed her life. She was
selected for an MBSR study after responding to advertisement asking, “Do
you worry?”
“I
didn’t think of myself as anxious—I just thought my life was stressful
because I had taken on too much,” she recalls. “But I thought ‘yeah, I
do worry.’ There was something excessive about the way I responded to my
environment.”
After participating in an earlier study led by Hoge, she learned two 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 life-long kind of training.
Instead of my anxiety progressing, it went in the other direction and
I’m very grateful for that.”
“It
is important to note 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,” Hoge said.
“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
points out that there are many phone apps that offer guided meditation,
however researchers don’t know how apps compare with the full
in-person, weekly group class experience.
Trial
enrollment was wrapping up as the COVID pandemic started in early 2020
but most enrollees completed their eight-week course of treatment before
the pandemic started.
Additionally,
the researchers conducted a second phase of the study during the
pandemic that involved moving the treatments to an online,
videoconference, and that will be the focus of future analyses.
The researchers also hope to explore the effects of MBSR on sleep and depression.
About this mindfulness and anxiety research news
Author: Press Office
Source: Georgetown University Medical Center
Contact: Press Office – Georgetown University Medical Center
Image: The image is in the public domain
Original Research: Closed access.
“Mindfulness-Based
Stress Reduction vs Escitalopram for the Treatment of Adults With
Anxiety Disorders: A Randomized Clinical Trial” by Elizabeth A. Hoge et al. JAMA Psychiatry
