Jennifer Middleton, MD, MPH
Posted on November 21, 2022
Although pharmacologic treatment options exist for generalized anxiety disorder (GAD), patients concerned about medication side effects may inquire about alternatives to prescription medications. Studies have already demonstrated that psychotherapy and physical exercise are two such alternatives, and now mindfulness-based stress reduction (MBSR) is poised to join the list.
MBSR is a “formal eight-week program” consisting of weekly 2.5 hour classes, 45-minute daily meditation assignments, and a full-day weekend retreat (usually in the fifth or sixth week). MBSR participants learn meditation techniques, including breath awareness, body scanning, and mindful movement. In this noninferiority study, single-blinded researchers randomized 276 participants 18 to 75 years of age with GAD to either MBSR or escitalopram (starting at 10 mg and increased to 20 mg if tolerated); 206 participants completed the study. Participants were followed for 24 weeks, and their anxiety symptoms were assessed using the Clinical Global Impression of Severity scale (CGI-S), a 7-point scale where clinicians “rate the severity of the patient’s illness at the time of assessment, relative to the clinician’s past experience with patients who have the same diagnosis.” The researchers specified a noninferiority margin of –0.495, and, after 24 weeks, “[t]he difference between groups was −0.07 (0.16; 95% CI, −0.38 to 0.23; P = .65), where the lower bound of the interval fell within the predefined noninferiority margin of −0.495.”
The researchers concluded that MBSR is a reasonable alternative to escitalopram, but they also acknowledged that it may not suit all patients, as 13 (11%) participants in the MBSR group reported worsening of their anxiety. Nine of the 12 participants who dropped out of the MBSR arm additionally had difficulty attending all of the MBSR sessions, presumably due to the intense time commitment required. This study suggests that we should counsel patients interested in MBSR about the time commitment and potential for worsening anxiety symptoms.
It’s also important to note that while MSBR teaches and incorporates many fundamentals of meditation, it’s unknown whether meditation alone (without MBSR) would be equally effective. That said, MBSR may not be accessible to many people because of both its time commitment and its cost (live and online programs can cost between $300 and $1,000, though some insurance companies are beginning to cover some of this cost). Although meditation can have many benefits, patients interested in learning about meditation through lower cost alternatives (such as apps, books, and videos) may find some benefit for their GAD symptoms but, perhaps, should not necessarily expect symptom improvement equivalent to that found in this study.
This recent AFP article on “Generalized Anxiety Disorder and Panic Disorder in Adults,” which is included in the AFP By Topic on Anxiety Disorders, includes an in-depth overview of GAD diagnosis and treatment. Here’s a recent FPM article on “Five Mobile Apps for Mindfulness,” and there’s also an AFP By Topic on Complementary and Alternative Medicine that includes a subsection on Mind-Body Modalities if you'd like to read more.
Sign up to receive twice monthly emails from AFP. You'll get the AFP Clinical Answers newsletter around the first of the month and the table of contents mid-month, shortly before each new issue of the print journal is published.