A Recent Study Reveals Mindfulness is Comparable to Popular Drug for Treating Anxiety

Mindfulness-based stress reduction is just as effective as a gold-standard antidepressant for the treatment of anxiety, and comes with fewer side effects.

It’s not a stretch to say that anxiety helps to keep you alive. The emotion of fear developed in humans as a response to threats to our safety. In the face of imminent danger, our body redistributes blood to the muscles and pumps up our heart rate, all in an effort to face the threat and fight, or high tail it out of there.

But for over 300 million people worldwide, anxiety can sometimes be misplaced. When a nervous system perceives threats that are not life-or-death, people can fall into a difficult pattern of chronic fear and stress.

The good news is that there are effective treatments for anxiety disorders, including medication and psychological therapy. Unfortunately, not all people can access the help they need, due to sky-high waitlists and a lack of publicly funded services. Medication, while easy to access and proven effective for many, can come with pesky side effects.

Dr. Elizabeth Hoge, Associate Professor and Director of the Anxiety Disorders Research Program at Georgetown University School of Medicine, has been treating people with anxiety disorders for 20 years. She’s prescribed many different types of medication, psychotherapy, and a combination of both for her patients.

When Hoge learned about mindfulness meditation earlier in her career, a lightbulb went off. “The idea that people could have a different relationship with their thoughts—it seemed like that would be potentially helpful for patients with anxiety,” she says.

When Hoge learned about mindfulness meditation earlier in her career, a lightbulb went off. “The idea that people could have a different relationship with their thoughts—it seemed like that would be potentially helpful for patients with anxiety,” she says.

How Mindfulness Measures Up to Anxiety Meds 

Hoge began by studying the Mindfulness-Based Stress Reduction (MBSR) program compared to an “attention control,” which was a departure from the common practice of comparing mindfulness to a waitlist control. Hoge says the field can’t rely on a waitlist control, because there are too many effects of the treatment and placebo that can’t be teased out. In the “attention control,” the structure of the program was the same, but the participants learned about wellness rather than mindfulness.

Results showed that MBSR was effective in reducing anxiety. The next step was to compare MBSR to the gold standard treatment: an antidepressant. In a randomized controlled trial from three different urban centers in the United States, Hoge and the study team randomized 276 adult patients with clinical anxiety to either eight weeks of MBSR or the antidepressant escitalopram (commonly known as Lepraxo). In the MBSR group, patients participated in a weekly 2.5 hour class, a daily 45-minute meditation practice at home, and a day-long retreat weekend.  

The researchers chose to measure equivalence rather than superiority, given that they weren’t looking to prove whether one treatment was better than the other. This is a common type of analysis when comparing two different interventions where one has already been deemed effective. “The drug works really well,” says Hoge. “I wasn’t willing to say that meditation would be better than the drug.”

As the researchers expected, the trial revealed that mindfulness was not worse than the drug and both groups experienced improved symptoms. However, side effects from the antidepressant were more troublesome (with common side effects of escitalopram including headaches, nausea, diarrhea, and insomnia, according to the National Alliance on Mental Illness). At least one adverse event was recorded for 78.6% of those in the escitalopram group, compared to 15.4% of participants from the MBSR group.

The trial revealed that mindfulness was not worse than the drug and both groups experienced improved symptoms. However, side effects from the antidepressant were more troublesome.

Hoge says one thing that surprised her was the rate of drop-out in both groups. “I have had a lot of complaints from patients over the years about medication. And they dropped out because they had medication side effects. But we actually had just as much drop out from the meditation group.”

The main reason for the drop-out in the MBSR group was scheduling and time constraints. MBSR includes eight weekly classes, daily meditation practice, and a full weekend retreat, which is a lot to squeeze in for a person who may work shifts or has family or other caregiving responsibilities.

This begs the question of whether a less intensive mindfulness practice could yield the same results, perhaps through a mindfulness-based app. But Hoge says no, the data does not currently support apps for treating anxiety.

“The things that go on during meditation training can’t all be measured scientifically, and there are probably aspects that are important that we don’t [yet] understand,” she says. These include the availability of a trained teacher to guide participants and the interaction between participants, which could be motivators to stick with the meditation practice.

Improving Access to Help for Anxiety

Though there’s no strong evidence to support app-based meditation for anxiety, the issue of cost for the in-person MBSR program can be a barrier. Fees range widely, but Hoge says people generally pay between $300 and $500. She suggests that those who are looking for an alternative could check out insight meditation centers, which operate in most cities in North America on a donation basis. Some meditation centers also have bursary programs for MBSR and other courses.

A key piece of knowledge that emerged from Hoge’s study is that there are likely individual factors that impact how well both treatments work. Hoge recalls participants at her site who chose to cross over to the other treatment when the study was finished and found immediate relief for their symptoms.

“The next step for the research is to find out what variables we can measure that will help us predict which type of patient gets better—[and with] which type of treatment,” she says.

Personalizing treatment means less trial and error for patients, and ultimately, an easier path to improved mental health.

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  • Mindful Staff
  • January 20, 2023