Mindfulness and medication work equally well to suppress anxiety, new research shows
A course in mindfulness meditation may be just as effective in reducing anxiety as conventional medication, according to a new study.
research, published November 9 in JAMA Psychiatry, included a group of 276 adults with untreated anxiety disorders. Half of the patients were randomized to take 10 to 20 mg of escitalopram, a generic form of Lexapro, a common drug used to treat anxiety and depression. The other half were assigned to an eight-week mindfulness-based stress reduction course.
The results were astonishing: both groups experienced a reduction in anxiety symptoms of about 20% over an eight-week period.
Elizabeth Hoge, lead author of the study and director of the Anxiety Disorders Research Program at Georgetown University Medical Center, told CNN she hopes the research will open up more treatment options for anxiety patients.
“Lexapro is a great drug; I often rewrite it,” she said. “But it’s not for everyone.”
Meditation could be prescribed instead of medication for patients who experience serious side effects or have allergies to anti-anxiety medications, for example, Hoge says. And starting meditation could be the first step for people who have untreated anxiety and are wary of medication.
But the research should not be a trigger for patients to stop taking their medication without consulting a doctor. “If someone is already taking medication, they can try meditation at the same time,” Hoge said. “If they want to stop taking their medication, they should talk to their doctor.”
There may be undetermined factors that make some patients respond better to meditation. Hoge says that after data collection was complete, participants were given the option to try a treatment option that was not assigned to them. Some patients who were assigned to the meditation group found that the drug was actually much more effective for them, and vice versa, according to Hoge.
Hoge says further research could investigate “what are the predictors of response to different treatments,” studying which patients benefit more from meditation versus medication. Clinicians could then prescribe different treatment regimens based on patient profiles.
And she hopes the research will lead to more insurance companies covering meditation courses as a treatment for anxiety.
“Usually insurance companies are willing to pay for something when there’s research to support its use,” she said. “If they know it’s as effective as the drug they’re paying for, why wouldn’t they pay for this?”
Patients assigned to the meditation group were asked to attend a weekly group mindfulness meditation class in person. Each class lasted about two and a half hours and was held at a local clinic. They were also asked to meditate on their own for about 40 minutes a day.
Hoge compared the time commitment to “taking an exercise class or an art class.”
But according to Joseph Arpaia, an Oregon-based psychiatrist who specializes in mindfulness and meditation, the daily time commitment is probably too much for many patients dealing with anxiety.
“Telling overworked people to spend 45 minutes a day meditating is the ‘Let them eat cake’ of psychotherapy,” he wrote in response to Hoge’s publication, also published in JAMA Psychiatry.
Arpaia says he has been working to find less intense mindfulness methods to help patients manage their anxiety. One technique he teaches is called the “one-breath reset,” which helps patients calm down in one breath.
But despite his reservation, “It’s always interesting to see how meditation works, and it works just as well as drugs,” he said. “I hope people realize that there are things besides drugs that can work.”
“My other hope would be that they realize that sitting and following your breath makes you feel relaxed, great, but it doesn’t make everyone feel relaxed. Find something that works. Read a book, go for a walk, spend time in the garden,” he said.
Patients assigned to the meditation group participated in a specific program called mindfulness-based stress reduction, first developed by Jon Kabat-Zinn in the 1970s. The program is secular, but based on some Buddhist teachings.
“It’s like a skill you practice,” Hoge said. “People learn to have a different relationship with their thoughts. In practice, we train people to simply let go of thoughts, be patient and gentle with thoughts, just let them pass.”
“The practice of doing it over and over allows people to put a little distance between themselves and their thoughts,” she said.
According to Hoge, patients shouldn’t expect meditation — or medication — to completely eliminate their anxiety. “It’s normal to have anxiety,” she said. “But we can tone it down a bit.”
“People think meditation is hard, that you have to clear your mind of thoughts,” she said. “That is not the case. You are still meditating even if you have thoughts. Just having the intention to meditate counts.”
And Arpaia says meditation can help disrupt the feedback loops that fuel anxiety.
“Anxiety is something that feeds on itself,” he said. “What happens is that the person becomes anxious, which impairs their cognitive and social skills. As a person begins to feel weakened, it creates anxiety.”
Anxiety is not the only challenge that meditation can help patients with.
Study published in the American Journal of Nursing in 2011 found that an eight-week mindfulness program was as effective as antidepressants in preventing depression relapse.
Hoge said that various meditation programs may be appropriate to help treat depression and ADHD, among other conditions.
“I think there’s a lot of promise there,” she said.
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