Mindfulness-Based Stress Reduction in the Treatment of Anxiety
By Jill Horn
The prevalence of anxiety disorders continues to increase, with a current estimate of 301 million global cases. Anxiety conditions include generalized anxiety disorder, panic disorder, specific phobias, and social anxiety disorder, all of which are characterized by problematic habitual thought patterns which negatively impact the individual’s quality of life, as well as performance in social context and at work. Patients with anxiety disorders often also experience sleep disturbances, headaches, depression, gastrointestinal symptoms, and cardiovascular complications.
“…while medications and psychotherapy are commonly used in anxiety treatment, 30-60% of patients are unable to achieve long-term remission.”
Traditional therapies for anxiety, as recommended by clinical practice guidelines, include cognitive behavioral therapy (CBT) and pharmacotherapy. However, while medications and psychotherapy are commonly used in anxiety treatment, 30-60% of patients are unable to achieve long-term remission. Furthermore, though it can be a very effective form of treatment, CBT may be difficult for patients to access due to an insufficient amount of healthcare providers professionally trained in this technique. In terms of pharmaceutical treatments, it is a common societal belief that psychiatric medication may be harmful to the body, or may interfere with daily activities. In recent years, contemplative techniques, in particular mindfulness-based interventions, have become increasingly popular and have been shown to be successful in the long-term treatment of anxiety disorders.
“The reappraisal of thoughts and feelings during MBSR has been shown to improve emotion regulation, with individuals becoming less reactive to what occurs in their mind and body.”
Mindfulness-based stress reduction (MBSR) specifically aims to focus the mind on the present moment. Individuals may allow themselves to see thoughts, emotions, and other sensations as transient mental phenomena instead of necessarily accurate reflections of reality. By focusing the mind on the present moment, MBSR aims to counteract deeply engrained maladaptive predictions about future events. This coping style, referred to as “catastrophizing”, assumes a high likelihood of worst-case outcomes of situations and is a major cause for anxiety. The reappraisal of thoughts and feelings during MBSR has been shown to improve emotion regulation, with individuals becoming less reactive to what occurs in their mind and body. The non-judgmental and accepting attitude, which is a critical component of mindfulness training, may help in the development of increased self-acceptance and self-compassion in the long run. In a clinical context, MBSR is the most used, standardized mindfulness intervention protocol. Traditional MBSR encompasses 8 weekly sessions of about 150 minutes, as well as an additional silent retreat day. In traditional MBSR, individuals will perform sitting and walking meditation, yoga asanas, and mindful relaxation techniques. Importantly, daily at-home practice is necessary for successful completion of the protocol.
“MBSR was also very well tolerated and safe, showing – as one would expect – fewer adverse events compared to the drug treatment.”
A variety of clinical studies have assessed the effectiveness of MBSR as a treatment for anxiety disorders, several of which have shown positive results. A recent study compared MBSR to daily ingestion of Escitalopram (Lexapro), a common anti-depressant/anti-anxiety drug. 45 minutes of MBSR training administered daily for one group of participants, versus 10mg of daily Escitalopram ingestion for the other group. The MBSR treatment showed non-inferiority to the drug treatment, meaning that the two groups showed similar improvements in symptoms of anxiety. MBSR was also very well tolerated and safe, showing – as one would expect – fewer adverse events compared to the drug treatment.
Another study found that MBSR training significantly reduced anxiety symptoms in patients with generalized anxiety disorder compared to an active control condition. Aiming at understanding the underlying biochemical pathways of MBSR in anxiety, the study investigated the effect of MBSR on stress and certain inflammatory markers in patients with generalized anxiety disorder. This well-controlled study looked at the pro-inflammatory cytokines IL-6 and TNF-alpha, as well as blood levels of adrenocorticotropic hormone, a hormone stimulating the release of a key stress hormone, cortisol. Study results showed an attenuation in stress markers as well as a reduction in cytokine levels following MBSR compared to the control condition. This study provides promising hormonal and immunological evidence supporting the positive effect of mindfulness-based interventions in the treatment of anxiety disorders.
“…MBSR is an accessible, low stigma, sustainable, and cost-effective treatment option for individuals with anxiety disorders.”
In summary, MBSR is an accessible, low stigma, sustainable, and cost-effective treatment option for individuals with anxiety disorders. Patients can learn the technique both in live sessions with a therapist, or via online training. A significant reduction in anxiety symptoms and stress markers, as well as noninferiority to drug treatment, have been shown in several well-controlled trials. MBSR paired together with CBT are effective non-pharmacologic treatment strategies for patients with anxiety disorders.
Jill Horn is a recent UCLA graduate with a degree in Neuroscience. She is deeply interested in the interconnectedness of body, mind, and spirit takes an integrative approach to health and well-being. She aspires to the public about a research-based lifestyle and mindset that promote health. Jill also deeply resonates with the One Health concept, which emphasizes the interdependence of the health of people and the health of our planet, given the climate crisis we are facing.