A mindfulness meditation course may be just as effective at reducing anxiety as regular medication, according to a new study.
The investigation, published Nov. 9 in JAMA Psychiatry, involved a group of 276 adults with untreated anxiety disorders. Half of the patients were randomized to take 10 to 20 mg of escitalopram, the generic form of Lexapro, a common medication used to treat anxiety and depression. The other half were assigned to an eight-week mindfulness-based stress reduction course.
The results were surprising: both groups experienced a reduction of around 20% in their anxiety symptoms over the 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 that she hopes the research can open up more treatment options for anxiety patients.
“Lexapro is a great drug; I prescribe it a lot,” he said. “But it’s not for everyone.”
Meditation could be prescribed instead of medication for patients who experience severe side effects or have allergies to anti-anxiety medications, for example, Hoge says. And starting to meditate could also be a first step for people who have untreated anxiety and are wary of medication.
But the research shouldn’t be a trigger for patients to stop taking their medications without consulting a doctor. “If someone is already taking medication, they can try meditation at the same time,” Hoge said. “If they want to come off the medication, they need to talk to their doctor.”
There may be undetermined factors that make some patients respond better to meditation. Hoge says that after data collection ended, participants were given the option to try the treatment option they hadn’t been assigned. According to Hoge, some patients who had been assigned to the meditation group found that the drug was actually much more effective for them, and vice versa.
Hoge says future research could explore “what are the predictors of response across different treatments,” studying which patients benefit more from meditation versus medication. Physicians could then prescribe different treatment regimens based on the profiles of their patients.
And he 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 is research to support its use,” he said. “If they know it’s as effective as the drug they pay for, why don’t they pay for this too?”
Patients assigned to the meditation group were asked to attend an in-person group mindfulness meditation class once a week. Each class lasted about two and a half hours and was held at a local clinic. They were also asked to meditate alone for about 40 minutes a day.
Hoge likened 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 people who are so overworked that they should spend 45 minutes a day meditating is the ‘Let them eat cake’ of psychotherapy,” she wrote in response to Hoge’s post, also published in JAMA Psychiatry.
Arpaia says she has worked to find less time-consuming mindfulness methods to help patients manage their anxiety. One technique she teaches is called “one breath reset” which helps patients calm down over the course of a single breath.
But despite his reservations, “it’s always interesting to see meditation work, and it works just as well as medication,” he said. “My hope would be that people realize that there are other things besides drugs that can work.”
“My other hope would be that they realize that if sitting down and following your breath makes you feel relaxed, great, but it doesn’t make everyone feel relaxed. Find something that does. Read a book, go for a walk, spend time gardening,” 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 draws on some Buddhist teachings.
“It’s like a skill that you practice,” Hoge said. “People learn to have a different relationship with their thoughts. In practice, we train people to just let thoughts go, be patient and kind with thoughts, just let them go.”
The “practice of doing that over and over allows people to put a little bit of distance between themselves and their thoughts,” he said.
Patients shouldn’t expect meditation, or medication, to completely eliminate their anxiety, according to Hoge. “It’s normal to have anxiety,” he said. “But we can make him calm down a bit.”
“People think that meditation is difficult, that you have to keep your mind free from thoughts,” he 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 that meditation can help interrupt the feedback loops that fuel anxiety.
“Anxiety tends to be something that feeds on itself,” he said. “What happens is that a person becomes anxious, which affects their cognitive and social skills. As the person begins to feel more affected, that creates anxiety.”
Anxiety isn’t the only challenge that meditation could help patients address.
A study published in the American Journal of Nursing in 2011 found that an eight-week mindfulness program was as effective as antidepressants in preventing a relapse of depression.
Hoge said different meditation programs might be appropriate to help treat depression and ADHD, among other conditions.
“I think there’s a lot of promise there,” he said.