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by Elizabeth Hoge, MD and Caroline Armstrong, BA

“Mindfulness” has become a bit of a buzz word in recent years. It’s not unlikely that you, or a friend or family member, may have tried out a meditation class, downloaded the app Headspace or Calm, or participated in a workplace-sponsored mindfulness training. So perhaps you already have a little bit of knowledge about mindfulness, which can be described as paying attention to one’s thoughts and feelings in a way that is kind, curious, and grounded in the present moment. 

Even though all the hype around mindfulness can sometimes make it seem like it’s more of a trend than a treatment, there is evidence that practicing mindfulness can alleviate some physical and mental health problems. In particular, an eight-week course called Mindfulness-Based Stress Reduction has been shown to improve a variety of physical and mental health conditions, including anxiety. In this group class, students learn meditation techniques and principles for living mindfully, and they practice the things they have learned by meditating daily. Most teachers agree that regular practice lays the foundation for mindful living: By regularly bringing intentional awareness to one’s breath and feelings in one’s body, one can train their brain to be aware of thoughts and emotions, too. This can help one respond to all kinds of difficult feelings, physical and emotional, in a more useful way than reacting automatically or without awareness.

Since many of the benefits of mindfulness have been brought to light, I’ve been asked on multiple occasions by my patients with anxiety, “Should I try mindfulness to help my anxiety?” I have answered this question by replying that practicing mindfulness certainly could lead to an improvement in anxiety symptoms, since it can potentially break habitual thought processes and patterns that exacerbate anxiety.  However, researchers don’t yet know if mindfulness training is as effective as other standard treatments for anxiety, such as medication or cognitive-behavioral therapy, which are considered to be the standard, first-line treatments. For this reason, mindfulness practice isn’t typically prescribed as a primary treatment for anxiety. 

This lack of knowledge about how useful mindfulness compares to other anxiety treatments is why my research team at Georgetown University Medical Center, Massachusetts General Hospital, and New York University Langone Health is conducting a large-scale clinical trial comparing the effectiveness of mindfulness meditation (specifically, Mindfulness-Based Stress Reduction) to “gold-standard” treatment of medication (specifically, the antidepressant drug Lexapro which has FDA approval for use in generalized anxiety disorder). My colleagues and I want to be able to answer the question, “Should I try mindfulness to help my anxiety?” with a clearer answer—we want to be able to tell our patients whether mindfulness meditation is or isn’t likely to help as much as gold-standard treatment. 

This is such an important question to answer because many people are resistant to taking medication or beginning psychotherapy due to availability, stigma, or side effects associated with those treatments. If mindfulness meditation is really as effective as these other treatments, people who are reluctant about medication or therapy would be able to confidently pursue mindfulness practice as treatment for their anxiety. Additionally, insurance companies might be interested in paying for Mindfulness-Based Stress Reduction classes for patients struggling with anxiety, which would make this treatment far more accessible. 


If Mindfulness-Based Stress Reduction turned out not to be as effective as medication overall, this would still useful information. Researchers could investigate what types of symptoms or what kinds of patients are more likely to benefit from mindfulness practice than others.
    
We don’t know yet if Mindfulness-Based Stress Reduction is an equally effective alternate treatment for anxiety. In the meantime, if you’re interested in mindfulness meditation, it’s worth learning more, potentially enrolling in a Mindfulness-Based Stress Reduction class, Mindfulness-Based Cognitive Therapy, or even going to an online yoga class which includes meditation—in addition to pursuing treatment we currently know works very well for anxiety, such as medication or cognitive-behavioral therapy.  If you are already engaged in psychotherapy, you can talk to your therapist about whether mindfulness training might be helpful for you.  When we finish our study, we will be able to say something about how mindfulness training stacks up with the best of the best treatments for anxiety, so stay tuned!


If you reside in New York, Massachusetts, Maryland, Virginia, or the District of Columbia and experience anxiety, you may be eligible to participate in our research study. Please visit https://clinicaltrials.gov/ct2/show/NCT03522844 to learn more and contact the study team if you are interested in participating. 


About the Authors

Elizabeth Hoge, MD

Dr. Elizabeth Hoge is the Director of the Anxiety Disorders Research Program at Georgetown University Medical Center.  Her research focuses on treatments for anxiety disorders, including medication, psychotherapy and mindfulness, and the examination of biomarkers of anxiety, stress, and trauma.  She has over 50 publications in the medical research literature and is on the Scientific Council of the Anxiety and Depression Association of America.

Caroline Armstrong

Caroline Armstrong, B.A. works at Georgetown University Medical Center as a research assistant and coordinator for the study comparing the effectiveness of Mindfulness-Based Stress Reduction and pharmacotherapy for anxiety. She holds a BA in Psychology and English from Duke University, where she contributed to research on adolescent friendships, perfectionism, and treatment for anhedonia. 

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