JAMA: For the first time, it has been confirmed that mindfulness-based stress reduction (MBSR) is equivalent to escitalopram in reducing anxiety!

For contemporary young people, anxiety is probably the most common psychological state, and the decline in happiness caused by different sources of anxiety in life does not affect our mental health
all the time.
Severe anxiety can cause severe physical and mental distress, dysfunction, and even increase the risk of
suicide.
The main traditional therapies for anxiety disorders are generally drugs and cognitive behavioral therapy, but the side effects of drugs have plagued many patients, and the accessibility of cognitive behavioral therapy is not ideal
.
Therefore, the search for widely acceptable evidence-based treatment options for people with anxiety disorders has become the greatest need
.
In recent years, the use of meditation to relieve anxiety symptoms has become more popular, bringing great benefits to anxiety patients, and mindfulness intervention (MBI) is becoming a more acceptable way
to treat anxiety disorders.
In the United States, for example, about 15% of the population has tried meditation
.
Mindfulness meditation has been found to help reduce anxiety; A recent analysis of trials on anxiety disorders found significant benefits
of mindfulness meditation compared to usual care.
Although MBI has been shown to reduce anxiety, the relative effectiveness of MBI compared to standard treatments for anxiety disorders needs to be assessed, and comparisons have not yet been made
.
Mindfulness-based stress reduction therapy (MBSR) is the most widely studied area of MBI (over 1000 citations in PubMed).

Based on this, and to clarify whether MBSR should be considered a first-line intervention with an equivalent effect to gold-standard pharmacotherapy used in primary care, the team of Elizabeth A.
Hoge, MD, from the Department of Psychiatry at Georgetown University School of Medicine, compared MBSR to escitalopram, a drug treatment approved by the European Medicines Agency and the U.
S.
Food and Drug Administration for the treatment of anxiety.

They published their findings in
the prestigious psychiatric journal JAMA.

Prospective randomized clinical trials evaluated and compared the effects of MBSR and escitalopram in the treatment of anxiety disorders
.
The analysis of studies found that MBSR was not inferior to escitalopram
in the treatment of anxiety disorders.
In addition, MBSR was safe and well tolerated, with fewer
treatment-related adverse events compared with escitalopram.
The degree of symptom reduction in the escitalopram group (CGI-S mean 1.
4 points) was comparable to published studies that determined that escitalopram was more effective
than placebo.
For example, Davidson et al.
20 compared escitalopram with placebo for generalized anxiety disorder and found a 1.
4-point
reduction in CGI-S.
In another example, Asakura et al.
21 reported a 1.
1-point decrease
in CGI-S in a randomized clinical trial using escitalopram for social anxiety disorder.
To the authors' team's knowledge, this is the first study
to compare standardized, evidence-based MBI with first-line medications for anxiety disorders.
Costa et al.
found that experimental MBI based on exercise practice rather than traditional meditation performed comparable
to fluoxetine in patients with generalized anxiety disorder.
Compared with the MBI performed by the authors' team, participants in Costa et al.
had higher dropout rates (nearly 40% versus 25%), a smaller sample size (165 vs 276), a shorter intervention time (16 versus 27 hours), and a fundamentally different
structure and content.
Of course, this study has limitations
.
For example, the treatment in this study did not match in time and attention because participants in the MBSR group spent more time on treatment-related activities than participants in the escitalopram group, and this design only allowed for a single-blind procedure
.
However, this efficacy trial is intended to inform real-world clinical decision-making, rather than testing the theoretical efficacy of 2 time-matched groups and matched between the two groups with contact with the research group, clinical safety and assessment visits using the same procedure and conducted
by the same researchers.
Sleep medications and benzodiazepines are also allowed if stable for at least 4 weeks prior to entry; However, the use rate is extremely low (<5%) and varies
by group.
Other limitations include a predominantly female sample, a relatively high level of education, a lack of data on chronic diseases, and recruitment of academic medical centers in 3 cities, which may limit the generalizability
of findings.
In conclusion, mindfulness-based stress reduction therapy (MBSR) proved to be a well-tolerated treatment option in this research trial, with efficacy comparable to
first-line medications for patients with anxiety disorders.
A clear feature of anxiety disorders is problematic habitual thought patterns, while mindfulness training specifically focuses attention on the present moment; The practitioner will re-evaluate thoughts and feelings, a process that contributes to the practitioner's personal emotional regulation and reduces the response to thoughts and feelings
.
In addition, mindfulness is practiced with a non-judgmental, accepting attitude, which seems to increase self-acceptance and self-care
over time.
Therefore, mindfulness-based meditation offers an excellent option
for evidence-based treatment of anxiety disorders in adults.
Reference: Elizabeth A.
Hoge.
et al.
Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders A Randomized Clinical Trial.
JAMA Psychiatry.
2022.