8‑week Mindfulness-Based Stress Reduction (MBSR) course found to be as effective as Lexapro (escitalopram) to treat adults with anxiety disorders, and with far fewer side effects

Cred­it: Brain­Post, with data from Hoge et al (2022)

Anx­i­ety is the most com­mon psy­chi­atric dis­or­der, with over 301 mil­lion ?peo­ple affect­ed around the world. Whether extreme anx­i­ety aris­es in social sit­u­a­tions, is trig­gered by a par­tic­u­lar pho­bia, or man­i­fests as a gen­er­al unease in the world, it can severe­ly affect people’s every­day func­tion­ing and lead to high lev­els of distress.

Luck­i­ly, there are good treat­ments for anx­i­ety, includ­ing Cog­ni­tive Behav­ioral Ther­a­py (or CBT) and var­i­ous phar­ma­ceu­ti­cal drugs. Still, CBT takes a high­ly-trained ther­a­pist to admin­is­ter and can be lengthy and expen­sive, mak­ing it inac­ces­si­ble to many peo­ple who need it. And, while drug ther­a­pies can work well and are often cov­ered by insur­ers, they may not be accept­able for peo­ple who wor­ry about the poten­tial side effects of putting a drug in their body.

Now a new paper sug­gests an alter­na­tive, effec­tive treat­ment for anx­i­ety suf­fer­ers: Mind­ful­ness-Based Stress Reduc­tion (MBSR). It adds to the case that health insur­ers should cov­er MBSR as a treat­ment for anx­i­ety (just as oth­er treat­ments are cov­ered), as long as we bear in mind its limitations.

In this study, 276 patients with an anx­i­ety dis­or­der were ran­dom­ly assigned to either an eight-week course of MBSR or a well-known anti-anx­i­ety drug, Lexapro (with ongo­ing mon­i­tor­ing). The MBSR course, devel­oped by Jon Kabat-Zinn, involved intro­duc­ing peo­ple to a vari­ety of med­i­ta­tion prac­tices (like mind­ful breath­ing, body scans, walk­ing med­i­ta­tion, and lov­ing-kind­ness med­i­ta­tion) and hav­ing them med­i­tate dai­ly at home to improve their skills. Over­all, the train­ing is designed to help peo­ple learn how to pay atten­tion to the present moment and accept what­ev­er sen­sa­tions, thoughts, and feel­ings arise with­out judgment.

Dur­ing the treat­ment time, peo­ple in both groups report­ed how anx­ious they felt and whether or not they were expe­ri­enc­ing any side effects. After­wards, they were fol­lowed for six months to see how they fared, but with­out the con­trol of the ini­tial eight-week treatment—meaning, they were free to con­tin­ue with the drug or med­i­ta­tion, or try anoth­er form of treatment.

Results showed that at the end of eight weeks, both groups had equal reduc­tions in their anx­i­ety symp­toms, sug­gest­ing that MBSR may work as well as Lexapro for peo­ple with anxiety.

“Med­i­ta­tion, when done in this par­tic­u­lar way as a dai­ly prac­tice, is very effec­tive in treat­ing anx­i­ety, as effec­tive as a drug,” says the study’s lead author, psy­chi­a­trist Eliz­a­beth Hoge of George­town University.

Besides reduc­ing anx­i­ety, MBSR also had few­er prob­lem­at­ic side effects than Lexapro: 79% of patients in the Lexapro group report­ed at least one side effect dur­ing the course of their treat­ment, while only 5% of the MBSR patients did (and that was lim­it­ed to increased anx­i­ety). Side effects in the Lexapro group, how­ev­er, includ­ed oth­er things, like poor sleep, nau­sea, jit­ter­i­ness, sweat­ing, headaches, delayed orgasms, and decreased libido. While 10% of the Lexapro group dropped out of treat­ment dur­ing the tri­al due to side effects, none dropped out of the MBSR treat­ment for that reason.

This sug­gests that MBSR may be a good alter­na­tive for those suf­fer­ing from anx­i­ety who don’t want to risk tak­ing drugs.

“Side effects are com­mon with many of the SSRI anti­de­pres­sants [like Lexapro], and we don’t know exact­ly why,” says Hoge. “For some peo­ple, those side effects are tol­er­a­ble; but for oth­ers, they’re total­ly unac­cept­able, and a med­i­ta­tion train­ing may be a great option.”

Why does med­i­ta­tion have these effects on anx­i­ety? Hoge believes that it’s because of the way anx­ious people’s minds work and how med­i­ta­tion coun­ter­acts that. She points to how peo­ple with anx­i­ety are more like­ly to over-iden­ti­fy with their thoughts and feel­ings and become alarmed by them, lead­ing to cat­a­stroph­ic think­ing. Med­i­ta­tion helps peo­ple feel a bit more dis­tant from their expe­ri­ences with­out cling­ing to them, she says, help­ing peo­ple to cope better.

“All of the med­i­ta­tion prac­tices involve pay­ing atten­tion to the present moment, but in a par­tic­u­lar way—with open­ness and accep­tance,” she says. “What­ev­er men­tal phe­nom­e­non aris­es spon­ta­neous­ly in the moment, you can accept it and let it pass.”

Anoth­er rea­son that med­i­ta­tion helps, she sus­pects, is that it trains peo­ple to be more self-com­pas­sion­ate. Many peo­ple with anx­i­ety or depres­sion are hard on them­selves, which com­pounds their prob­lems, and med­i­ta­tion may fos­ter more self-kindness.

“There’s an implic­it sug­ges­tion of self-com­pas­sion in med­i­ta­tion instruc­tions, which tell you to pay atten­tion to your thoughts, feel­ings, sen­sa­tions, mem­o­ries, or what­ev­er with­out judg­ing them,” she says. “That’s a great way for peo­ple to prac­tice being open and accept­ing of them­selves and their experiences—of being kind.”

Hoge’s study shows basi­cal­ly equiv­a­lent long-term out­comes for both MBSR and Lexapro, at least over the first six months. But she doesn’t think that proves much. It’s hard to know if peo­ple did oth­er things to com­bat their anx­i­ety after the inter­ven­tion was over, and that will col­or the lon­gi­tu­di­nal results.

In addi­tion, both drugs and MBSR can have declin­ing effec­tive­ness over time, as drugs may lose their poten­cy and peo­ple doing MBSR may start slack­ing off on their dai­ly prac­tice. So, though both treat­ments seem to have some stay­ing pow­er, it’s hard to con­clude that from her study alone.

Also, MBSR train­ing can be some­what cum­ber­some. It takes time, ener­gy, and com­mit­ment to prac­tice regularly—one of the rea­sons that the over­all dropout rates in Hoge’s exper­i­ment were sim­i­lar for MBSR and Lexapro. How­ev­er, Hoge warns against assum­ing oth­er quick-fix mind­ful­ness programs—like online apps or short­er classes—will be as effec­tive as Lexapro against severe anx­i­ety. Apps don’t encour­age peo­ple to devote enough time to med­i­ta­tion, she says, and there’s no human inter­ac­tion com­po­nent in the training—something she thinks makes a difference.

“I don’t want peo­ple to think med­i­ta­tion is just as easy as tak­ing a drug—like, they’re going to do Calm or Head­space and get relief,” she says. “Those might be bet­ter than nothing—I don’t real­ly know. But an in-per­son class is real­ly the gold standard.”

Instead, she com­pares the ben­e­fits of med­i­ta­tion train­ing to those of phys­i­cal exercise—another behav­ioral inter­ven­tion that requires per­se­ver­ance, but pro­vides a lot of relief from psy­chi­atric symp­toms with­out the use of medication.

“There’s great data now show­ing that aer­o­bic exer­cise pro­tects against depres­sion and anxiety—almost as good as drug treat­ment,” she says. “It takes work to go run­ning or do what­ev­er exer­cise you do every day or near­ly every day. But, for some, it’s worth it.”

Anoth­er prob­lem? MBSR is not free, and insur­ers gen­er­al­ly won’t cov­er it, says Hoge. This she would like to see change, and the results from her exper­i­ment may help move things in that direc­tion. By adding to a grow­ing body of research show­ing the men­tal health ben­e­fits of prac­tic­ing mind­ful­ness meditation—and pro­vid­ing evi­dence from a high­ly con­trolled, clin­i­cal trial—she hopes insur­ers will change their minds and start pay­ing for MBSR.

Though she advo­cates for MBSR as a treat­ment option, Hoge rec­og­nizes that it may not be for every­one. But, giv­en that patients in her study were ran­dom­ly assigned to do MBSR with­out choos­ing it and it was still effec­tive against their anx­i­ety, one has to won­der how much bet­ter results might have been if peo­ple select­ed it as their treat­ment of choice.

For now, there’s not enough research to say one way or the oth­er. But stud­ies like this one are good news for anx­i­ety sufferers.

“When peo­ple can come into a clin­ic and be seen by a psy­chol­o­gist or psy­chi­a­trist and giv­en a full evaluation—where the [pro­fes­sion­al] can dis­cuss with the patient the option of med­ica­tion, psy­chother­a­py, or meditation—that will be a good thing,” says Hoge.

— Jill Sut­tie, Psy.D., serves as a staff writer and con­tribut­ing edi­tor for Greater Good. Based at UC-Berke­ley, Greater Good high­lights ground break­ing sci­en­tif­ic research into the roots of com­pas­sion and altru­ism. Copy­right Greater Good.

The Study:

Mind­ful­ness-Based Stress Reduc­tion vs Esc­i­talo­pram for the Treat­ment of Adults With Anx­i­ety Dis­or­ders: A Ran­dom­ized Clin­i­cal Tri­al (JAMA Psy­chi­a­try). Key Points:

Ques­tion: Is mind­ful­ness-based stress reduc­tion non­in­fe­ri­or to esc­i­talo­pram for the treat­ment of anx­i­ety disorders?

Find­ings: In this ran­dom­ized clin­i­cal tri­al of 276 adults with anx­i­ety dis­or­ders, 8‑week treat­ment with mind­ful­ness-based stress reduc­tion was non­in­fe­ri­or to escitalopram.

Mean­ing: In this study, mind­ful­ness-based stress reduc­tion was a well-tol­er­at­ed treat­ment option with com­pa­ra­ble effec­tive­ness to a first-line med­ica­tion for patients with anx­i­ety disorders.