Mindfulness vs medication for the body, mind, and soul

The number of people with high anxiety, 301 million according to the Institute for Health Metrics and Evaluation, is greater than the entire population of Brazil. It’s a staggering number. There are many options for how you can manage high anxiety. How do you choose which option will help you, personally? We’ll look at one studying comparing a mindfulness practice to a type of medication, to see which one is more effective. We’ll pay particular attention to how both treatments affect the body, mind, and soul.

How are those 301 million people coping? One of the beautiful things about being alive in 2024 is the number of quality treatment options to help people regulate the emotion of anxiety. Not all of these options are designed to reduce anxiety; many treatments, such as the one I practice with DBT or dialectical behavior therapy, is aimed more at helping you manage anxiety, not get rid of it entirely. Anxiety is a healthy part of a full emotional range, at least until it rises to overwhelming levels.

If you are someone who feels like your anxiety gets out of control, then you might consider taking medication, trying therapy, perhaps doing some combination of both, using exercise to regulate it… there are as seemingly as many options out there as there are people in the world. It can be overwhelming to try and narrow down which technique is actually going to be helpful for you, personally.

That’s where the research comes in. If there is already good data out there on which treatments work most effectively, that’s useful information to have! One problem though: many of the research is based on work with participants who are male, heterosexual, white, abled, English-speaking, and middle class. So where is the evidence that what works for them will work for you, if that’s not how you move through the world?

Another issue with the research on anxiety: most of that research compares a given therapy treatment to “treatment as usual.” Not my favorite comparison group. When they say “treatment as usual” it typically refers to whatever the study participants were doing before they entered the study. So it could be medication, a different kind of therapy, sitting on a waitlist, actively avoiding treatment entirely, or all of the above. This type of research is necessary, and it does show that mindfulness treatments are superior to “treatment as usual.” But the question lingers, is this just because “treatment as usual” is easy to surpass?

The study that I’m getting into with you today was published in JAMA Psychiatry in 2023, and it’s titled “Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial.” Instead of comparing to the elusive “treatment as usual,” this is what we in research call the gold standard. One of the things I look for when reading psychology research is the magic letters RCT, randomized control trial. This means that instead of comparing the treatment you want to look at, in this case eight weeks of mindfulness therapy, to “treatment as usual,” you compare your treatment to a consistent alternative. Your participants, hopefully a big number of them, are randomly sorted into whether they receive the treatment you are studying, or the alternative. Because it’s randomized, we can say with some certainty that this group got better or stayed the same not by chance, not because everyone in this group happens to be great at taking drugs or physically healthy or any other change circumstance.

And who was included in this research? It was overwhelmingly a White sample. The participants were 208 people 18 to 75 years old who had a current diagnosis of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. In terms of their racial backgrounds, 127 of the participants were White, 41 were Asian, 31 were Black, 17 were Hispanic, and 8 identified their race as “other.” This could limit the generalizability of the study among people of color.

Comparing Mindfulness to Medication

So what were the two groups that this study compared? In the right corner, we have MBSR: Mindfulness Stress Reduction. stepping up at 8-weeks long for 2.5 hours a week, plus a day long retreat and daily practice exercises, Coming from the group of Mindfulness Based Interventions, MBSR is a pretty heavy hitting therapy treatment when it comes to symptom relief. Think breath work, body movement, and body scans. And in your left corner, we have Escitalopram, an FDA-approved SSRI medication coming in at 10mg a day week one and then bumped up to 20mg a day starting week two for some participants.

Our two contenders faced off over the course of several months, hoping for a shot at reducing the anxiety of 200+ patients and earning the title Baddest B in the Mental Health Toolbox (I’m assuming). Study was 59% white people, with the largest minority group being Asian people at 20%.

Mindfulness Based Stress Reduction

A bit of background on MBSR: mindfulness treatments for anxiety have been around for a long time, and research has shown their effectiveness over and over again. In fact, this study mentions that 15% of Americans have tried mediation at least once, according to the National Center for Health Statistics. I love the way this study gets into the mechanics of this treatment. One of the most powerful elements of mindfulness is the non-judgemental stance, which requires people to let go of self criticism. In the words of the study, the practice of quieting the self critical voice can “increase self-acceptance and self-compassion.” Let’s look under the hood at how exactly mindfulness breaks through the anxiety cycle: “Problematic habitual thought patterns characterize anxiety disorders, and mindfulness training specifically focuses the mind on the present moment; thus, individuals practice seeing thoughts and sensations as merely transient mental phenomena and not necessarily accurate reflections of reality.” This reappraisal process “improves emotion regulation,” so that people grow “less reactive to thoughts and sensations.”

Impact on Mind, Body, and Soul

And what did those mindfulness treatments produce? Who comes out on top in mindfulness versus medication? IT’S A TIE! To borrow their phrasing, “MBSR was shown to be a well-tolerated treatment option with comparable effectiveness to a first-line medication for patients with anxiety disorders.” MBSR worked just as well as medication did, with fewer side effects.

Key takeaway time: what does this mean for you, if you are struggling with anxiety symptoms? It means there are at least two rock solid options for how you can manage that anxiety.

Now it wouldn’t be true dialectical thinking to look at these two contenders like two fully separate options, so let’s acknowledge that many people find relief with a combination of both. No one treatment is superior in all ways, and no one treatment is going to work for every single one of us in the 301 million. This study ultimately demonstrates that for those who have access to them, there are at least two solid options for coping with anxiety. And that’s not nothing. Click here if you are curious to learn more about how mindfulness is taught in DBT, Dialectical behavior therapy.