In a study published Wednesday in JAMA Psychiatry, researchers found that mindfulness-based stress reduction (MBSR) programs may be an effective treatment option for patients with anxiety disorders.

Study details and key findings

For the study, researchers conducted a randomized clinical trial of 208 adults with anxiety disorders.

Of those, 102 participants received treatment through an eight-week MBSR program that included "weekly 2.5-hour long classes, a day-long retreat weekend class during the fifth or sixth week, and 45-minute daily home practice exercises," according to the study authors. The program teaches individuals to focus on breathing and direct attention to one body part at a time and encourages them to try to focus on what is happening in the present.

The other 106 participants received a daily dose of 10 to 20 mg of a common antidepressant called escitalopram, also known as Lexapro.

To evaluate patients' anxiety symptoms before and after treatment, researchers rated symptom severity on a seven-point scale. At the onset of the trial, the MBSR group had an average score of 4.44 and the group that received escitalopram had a score of 4.51.

Participants were evaluated by a blinded clinical interviewer at the start of the trial, after eight weeks, and at follow-up visits at 12 and 24 weeks.

After receiving eight weeks of treatment, both groups saw around a 20% reduction in symptom severity. On average, participants who underwent MBSR reported a 1.35-point reduction in symptom severity, and those who received escitalopram reported an average 1.43-point reduction.

On average, study participants were 33 years old. Seventy-five percent of participants were women, 15% were Black, 20% were Asian, 9% were Hispanic, 59% were white, and 6% identified as another race or ethnicity. They were recruited from three hospitals across New York City, Boston, and Washington, D.C., between June 2018 and February 2020.

Almost 80% of participants who received escitalopram reported at least one side effect, including sleep issues, nausea, headaches, decreased libido, and increased anxiety. While most side effects were considered mild, 8% of the patients treated with the antidepressant left the trial because of adverse events. 

However, those in the MBSR program only reported one side effect—increased anxiety, which was reported by about 15% of the participants.

Commentary

According to Craig Sawchuk, a psychologist at the Mayo Clinic, who was not involved in the study, the results in this study mirror other studies that have evaluated anxiety treatments.

"The fact that we found them to be equal is amazing because now that opens up a whole new potential type of treatment," noted Elizabeth Hoge, lead study author and director of the Anxiety Disorders Research Program at Georgetown University Medical Center.

The study "shows there are alternative options that don't involve medicine to help treat anxiety, that are just as effective,"added Lindsey McKernan, an associate professor of psychiatry and behavioral sciences at Vanderbilt University Medical Center, who was not involved in the study.

"It does suggest that both treatments are helpful, and about equally so," said Michael Mrazek, a research associate professor at the University of Texas, Austin and the co-founder of the Center for Mindfulness & Human Potential at the University of California, Santa Barbara.

"Importantly, the study shows that MBSR can achieve similar outcomes with tremendously fewer side effects," Mrazek added.

In addition, the study could help expand access to MBSR treatments. "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," Hoge said.

"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," she added. 

However, Joy Harden Bradford, a psychologist in Atlanta, said, "The thing I would hate to have happen is for people to pit medication against the mindfulness-based resources." For example, someone who has panic attacks may have a quicker reduction in those attacks with escitalopram, rather than waiting weeks for meditation practices to take hold, she added.

In addition, "Not everyone can clock out at 5 o'clock to get to the 6 o'clock [meditation] meeting," Harden Bradford said.

"For both treatments, we had people who said, 'This really worked,'" said Hoge. Still, "[i]t 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," she added. 

For some people, "[i]t might be easier to remember to take a medication one time per day," rather than incorporating a 45-minute meditation session into a daily routine, Sawchuk said. (Fulton, "Shots," NPR, 11/9; Edwards, NBC News, 11/9; Melillo, "Changing America," The Hill, 11/9; Hoge et al., JAMA Psychiatry, 11/9)