Mindfulness is as effective as a popular medication to reduce anxiety
Published December 2022
Staff Research and Content Writer
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Over 31 million Americans will experience an anxiety disorder at some point in their lives. However, less than half of those diagnosed with anxiety receive treatment to reduce their symptoms. The first-line (I.e., the most evidence-based) treatments for anxiety are medication and counseling such as Cognitive Behavioural Therapy. Escitalopram is the most commonly-prescribed medication for those with anxiety disorders in the US. However, while these treatments are effective, they are under-utilized and often inaccessible to many Americans.
New research from Georgetown University Medical Center compared the effectiveness of a mindfulness treatment to an antidepressant commonly used to treat anxiety disorders. The study found that Mindfulness-Based Stress Reduction (MBSR), a mindfulness program, was as effective as the antidepressant escitalopram (brand name Lexapro), in reducing anxiety symptoms.
What is mindfulness?
Mindfulness is the human ability to be fully present, aware of where we are and what we are doing, and not overly reactive or overwhelmed by what is going on around us. Mindfulness is often practiced through meditation, but you do not have to meditate in order to be mindful. Mindfulness involves being conscious of our thoughts and feelings purposefully and non-judgmentally. Anxiety is characterized by problematic thought patterns and rumination, and mindfulness can help us put some space between ourselves and our thoughts and enable us to calm our minds.
In recent years, mindfulness has grown in popularity as a potential treatment for anxiety. Previous research has found that mindfulness is well-tolerated, safe, and effective in reducing symptoms of anxiety when compared to a placebo (no treatment). However, it was not yet known if mindfulness was as effective as first-line anxiety treatments. It is important to understand how mindfulness compares to primary anxiety treatments so that health care professionals know to recommend it to patients.
This study was focussed specifically on Mindfulness-Based Stress Reduction (MBSR). MBSR is an eight-week mindfulness program that was created at the University of Massachusetts in the 1970s. This program was instrumental in popularizing mindfulness as a treatment for mental health challenges such as anxiety.
What did this study do?
This study aimed to compare the effectiveness of MBSR with the antidepressant escitalopram (Lexapro). 208 individuals participated in the trial, with half randomized to receive escitalopram and the other half participating in MBSR treatment. The 8-week treatment protocol for the MBSR group involved daily 45-minute mindfulness sessions, weekly 2.5 hour-long classes, and a day-long retreat in the fifth/sixth week. All treatments were conducted in-person. Those in the escitalopram group started on a dose of 10mg and the dose was increased at week 2 if it was well-tolerated and needed.
The MBSR lessons included:
- Breath Awareness: focusing attention on the breath and other physical sensations;
- Body Scans: directing attention to one area of the body at a time and observing how it feels; and
- Mindful Movement: stretching and movement designed to bring awareness to the body.
To determine the effectiveness of the treatments, clinicians assessed patients’ anxiety levels before and after they received treatment. They used the clinical Global Impression of Severity scale (CGI-S) to assess anxiety levels. CGI-S assesses the severity of anxiety symptoms on a scale from 1 to 7, with 7 being the most severe.
What were the findings?
In this study, those receiving MBSR treatment showed similar improvements in their anxiety symptoms compared to those receiving escitalopram.
At the beginning of the study, the MBSR group had an average CGI-S score of 4.44 and the escitalopram group had an average score of 4.51.
At week 8, the MBSR group showed an improvement of 1.35 points on the CGI-S scale and the escitalopram group improved by 1.43 points. This difference between the groups was determined to be non-significant, meaning that both groups showed similar improvements in anxiety symptoms over that time period.
The completion rates for both treatments were comparable at the end of the treatment period. However, those in the escitalopram group continued to take their medication for longer after the study concluded compared to the MBSR group. At week 24 follow-up, over half of participants were still taking escitalopram but only 28% were still practicing mindfulness exercises.
Despite this, at follow-up (week 12 and week 24), participants in both groups continued to experience similar levels of improvements in their anxiety symptoms. This suggests that both escitalopram and MBSR treatments are effective over the longer term, regardless of how long the treatment was continued for in the case of MBSR.
Of note, those in the MBSR group experienced fewer adverse effects compared to those taking escitalopram. 78.6% of escitalopram participants experienced at least one adverse effect (e.g., nausea, fatigue, sleep disturbances, or headaches), compared to only 15.4% in the MBSR group.
What are the key takeaways?
In this study, Mindfulness-Based Stress Reduction was found to be a well-tolerated and effective treatment to reduce symptoms of anxiety. Based on CGI-S scores, MBSR has a comparable level of effectiveness to the most commonly-used anxiety treatment, escitalopram. Those treated with MBSR also experienced significantly fewer negative effects compared to those given medication.
The authors of the study conclude that their results provide support for mindfulness meditation as an evidence-based treatment option for anxiety disorders. They suggest that this study be used to inform clinical decision making by health care professionals working with patients with anxiety.
Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. Published online November 09, 2022.
Mindful. Getting Started with Mindfulness. https://www.mindful.org/meditation/mindfulness-getting-started/
Medical News Today. 8-week mindfulness program ‘as effective’ as antidepressant for treating anxiety. https://www.medicalnewstoday.com/articles/8-week-mindfulness-program-as-effective-as-antidepressant-for-treating-anxiety
National Institutes of Mental Health. Any Anxiety Disorder. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder