Mindfulness-Based Stress Reduction on Par with Escitalopram for Anxiety Disorders

Both clinician-rated and patient-reported outcomes suggested that mindfulness-based stress reduction (MBSR) was well-tolerated with comparable effectiveness to the first-line medication escitalopram for patients with anxiety disorders in a US randomized clinical trial. The trial included 276 participants (women 75%, men 25%; mean age 33 years; Asian 19%, Black 15%, Hispanic 9%, White 60%, other race or ethnicity 6%) randomized 1:1 to 8 weeks of the weekly MBSR course or the escitalopram (10-20 mg/d). Weekly 2.5-hour long classes were given once a week, and one day-long weekend class during the 5^th or 6^th week. The classes instructed participants in the theory and practice of several forms of mindfulness meditation: a body scan (directing attention to one body part at a time and observing how that body part feels); breathing awareness (attention focused on the breath and other physical sensations); and mindfulness stretching exercises designed to bring awareness of the body and current experience of movement. Didactic teaching of the theory of mindfulness and experiential practice are both utilized during weekly classes and at-home CD-guided practice sessions. The trial found that MBSR was noninferior to escitalopram with fewer adverse events for the treatment of anxiety disorders based on a clinician-rated primary outcome of anxiety scale, as well as similar patient-reported anxiety and depression outcomes and disorder-specific clinician-rated anxiety measures. The findings are consistent with previous work demonstrating the efficacy of mindfulness for panic and social anxiety disorders. Problematic habitual thought patterns characterize anxiety disorders. Mindfulness training specifically focuses the mind on the present moment; thus, individuals practice seeing thoughts and sensations as merely transient mental phenomena and not necessarily accurate reflections of reality. This reappraisal process improves emotion regulation, and individuals become less reactive to thoughts and sensations. In addition, mindfulness is practiced with a nonjudgmental, accepting attitude, which over time appears to increase self-acceptance and self-compassion. MBSR may be a more acceptable option for anxiety disorders considering various challenges with medications and cognitive behavioral therapy. Source: https://jamanetwork.com/