Mindfulness exercises can be as effective as anxiety drugs, study shows

The meditation room at Glenstone, a private contemporary art museum in Potomac, Md. MUST CREDIT: Photo for The Washington Post by Goran Kosanovic

Practicing mindfulness to relieve anxiety can be just as effective as medication, new research shows.

A recent study published in JAMA Psychiatry showed that people who received eight weeks of mindfulness-based interventions experienced a decrease in anxiety that matched those who were prescribed escitalopram, a common anti-anxiety medication that is often prescribed under the brand name Lexapro.

A seven-point scale was used to assess anxiety among 208 participants, with a score of seven representing extreme anxiety and a score of one being normal. In both the medication and the mindfulness groups, the average score after treatment dropped from a moderate level of anxiety to a mild level of anxiety.

Both groups began the study with similar baseline scores (4.44 in the mindfulness group and 4.51 in the medication group.) By the end of the study, anxiety scores in both groups had declined to an average of 3.09 on the anxiety scale, a statistically similar change that showed the treatments to be equally effective.

Mindfulness practices such as breathing exercises have been used to treat anxiety for a long time, but this is the first study showing how effective they can be in comparison with standard treatments for anxiety disorders, said the study’s lead author, Elizabeth Hoge, who is a psychiatrist and director of the Anxiety Disorders Research Program at Georgetown University.

She believes the findings help support the use of mindfulness as a viable intervention that may be better than traditional treatments for some people, such as those who aren’t comfortable seeing a psychiatrist or who experience negative side effects from medication.

“We can’t yet predict who will do better with which type of treatment,” Hoge said. “But there’s nothing that says you couldn’t do both at the same time.”

Mindfulness treatments used in the study included breath awareness exercises, which involve paying attention to your breath as you allow thoughts to rise, then pass through your mind before letting them go. Importantly, the practice isn’t about trying to change your breath, Hoge said, but about focusing on your breath as a way to ground yourself if any anxious thoughts arise.

Participants also completed exercises such as a body scan, which involves paying attention to different parts of the body, and mindful movement, which includes stretching the body into different positions and noticing how each movement feels.

Those who received the eight-week mindfulness intervention attended a weekly 2.5-hour-long class with a mindfulness teacher, completed daily at-home exercises for 45 minutes, and attended a one-day mindfulness retreat five or six weeks into the course.

The reason mindfulness may help with anxiety is that it can interrupt a negative feedback loop in the brain, said Jud Brewer, director of research and innovation at Brown University’s Mindfulness Center and chief medical officer at Sharecare, a digital health company. Brewer believes that anxiety is a habit driven by negative reinforcement in the brain.

When we have a situation or thought that triggers our anxiety, worrying about it can feel rewarding in the brain, he said. “It can give people a sense of control even though they don’t have any more control than if they didn’t worry,” Brewer said.

Trying to stop worrying using willpower doesn’t work, he said, because it doesn’t change the way your brain works. But mindfulness can help train your brain to have new habits because it helps you to recognize that worrying is not rewarding and provides an alternative sense of control that feels better than worrying, Brewer said. He helped develop an app for mindfulness training called Unwinding Anxiety and in a small, randomized study, showed that using the app significantly reduced people’s anxiety.

Other studies have shown that practicing mindfulness can rewire the brain, leading to long-term changes in behavior and thinking, said Sara Lazar, an associate professor at Harvard Medical School.

In people who worry a lot, a part of the brain called the default mode network can become overactive, causing their minds to wander toward negative or anxious thoughts more often, Lazar said. But research shows that meditation and mindfulness exercises can help turn off this part of the brain and make it less active by training people to refocus, she explained.

Mindfulness training also has been shown to reduce activity in the amygdala, a part of the brain that helps regulate fear, stress and other emotions, she said. And, her research suggests that these types of changes can be long lasting.

“People who go through these programs, even if they discontinue, continue to report benefits months later,” Lazar said. “It’s like learning to ride a bike, even if you stop, you can do it again.”

Julie Rose, 48, of Provo, Utah, decided to try mindfulness in 2018 when she realized that while medications helped with her anxiety, she needed additional coping strategies. She was finding it hard to focus at her job as a podcast host and had trouble sleeping. Her anxious thoughts “gripped” her, she said, and trying to control them by ignoring them or redirecting her anxious energy wasn’t helping.

She signed up for eight weeks of mindfulness classes. At first, she didn’t feel like the breathing or bodily awareness exercises were working – she still had anxious thoughts and felt like she couldn’t quiet them.

Then after a few weeks, she realized that though she couldn’t stop her anxious thoughts, with meditation, she could acknowledge them in a way that they passed more easily and quickly. On days that she meditated, she slept better and felt better overall, she said.

“I used to think this was stupid but it really works,” she said. “It allows the anxiety to keep on moving right on through me.”

The more someone practices mindfulness, the more they will benefit, but even doing a few short exercises a few times a week can lessen anxiety, said Katherine Cullen, a licensed psychotherapist at Juniper Therapeutic Services in New York. While many studies on mindfulness involve a more significant time investment of over eight weeks, Cullen often suggests her patients start small with a simple breathing exercise for two minutes a few times a week.

She said that, at first, mindfulness exercises may feel uncomfortable, because people aren’t used to dealing with their emotions or anxious thoughts.

“Think of it like exercise. You might go for a walk after being inactive for a while and it might feel uncomfortable,” she said. “The key, like with exercise, is to be consistent about it.”

If someone is interested in trying mindfulness exercises, she advised they shouldn’t change their medications without consulting their prescribing physician or psychiatrist, and they should look for a practitioner or coach who is certified in Mindfulness Based Stress Reduction, which is an evidence-based form of mindfulness training. People can also try searching for centers affiliated with the nonprofit, Buddhist organization Insight Meditation Society, many of which offer donation-based mindfulness classes.

“If you’re new to mindfulness and have never done it before, I would strongly encourage you to do it with someone else,” Cullen said. “It’s really helpful to have someone there to actively guide you through it and answer any questions you might have.”



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