Introduction 

This study was published in 2013 in The Journal of Clinical Psychiatry and sought to understand the effects of mindfulness meditation on generalized anxiety disorder (GAD). There have been previous studies on the effects of mediation on GAD, but this is the first to include an active control group comparison. Many previous studies also studied meditation in conjunction with cognitive therapy, and this study tests the effects of meditation alone. This study found that mindfulness meditation does reduce symptoms in people with GAD. This could prove to be a viable form of treatment for GAD with more research (Hoge, E. A.). 

Background

GAD is a disorder that is characterized by extreme worry and anxiety that interferes with daily life. It has a lifetime prevalence rate of 5.7% and people of all ages can develop GAD. Symptoms can fluctuate and outside stressors, such as school, work, or family, often make them worse. GAD is often treated with cognitive behavioral therapy (CBT) and medication in some cases (Generalized Anxiety). Many people with GAD do not seek treatment because of the cost and stigma surrounding therapy. Meditation could be a less expensive and accessible treatment option if it proves to help reduce anxiety symptoms. This study used a mindfulness-based stress reduction (MBSR) program, hypothesizing that it would reduce anxiety symptoms. A MBSR program consists of 2.5 hours a week for 8 week and a 1 day retreat. People in the program are taught mindfulness meditation techniques as well as simple yoga stretches. MBSR has also been studied with effects to depression, chronic illness and pain, and other disorders (Niazi, A. K.). 

Anxiety disorders, including GAD, are known to effect multiple areas of the brain. The amygdala is the most commonly identified structure to be hyperactive in anxiety. The amygdala is associated with processing emotional and social stimulation. The anterior cingulate cortex (ACC), insula, amygdala, dorsolateral prefrontal cortex (dlPFC), parahippocampal gyrus, and the medial aspects of the bilateral orbitofrontal cortex (OFC) are associated with the anticipation of negative events, a large part of anxiety symptoms (Schmidt, C. K.). Some of these brain areas can be seen in part A of figure 1. Part C of figure 1 shows the activation levels of the amygdala and insula in different types of anxiety. Red shows hyperactivity and blue shows hypoactivity (Etkin, A.). 

During meditation, an experienced meditator can decrease activation in their amygdala. This is shown in part B of Figure 1. The blue areas are the activation areas, and the chart shows the relationship between activation and amount of meditation practice. This means that the deep concentration achieved with meditation could reduce emotional reactive behaviors associated with the amygdala (Davidson, R. J.). 

Methods 

89 participants were recruited over the phone and must have a current diagnosis of GAD and scored 20 or above on the Hamilton Anxiety scale (HAM-A). People were excluded if they had a significant amount of meditation or yoga experience, were taking medication, had cognitive therapy for anxiety, or had another mental diagnosis that was the primary over GAD. The participants were randomly assigned to the MBSR group or the active control stress management education (SME) group. Participant’s anxiety levels were measured using the HAM-A assessment, Clinical Global Impression of Severity (CGI-S) and Improvement (CGI-I) assessment, and the self-reported Beck Anxiety Inventory (BAI) assessment. There was also a sleep quality assessment using the self-reported Pittsburgh Sleep Quality Index (PSQI) test. Their stress reactivity was tested using the Trier Social Stress Tests (TSST) before and after the 8 week treatment (Hoge, E. A.). The TSST require participants to wait in a waiting room for 45 minutes, then prepare and give a speech and answer math problems in front of a group introduced as “evaluators” as well as a camera. There is a 20 minute rest period afterwards (Birkett M. A.). 

The MBSR program consisted of 8 weeks of weekly group classes, a day retreat, and daily at home activities. Some techniques learned include breath awareness, Hatha yoga, and body-scanning. These increase awareness of the present moment in a non-judgmental space. These exercises also guide participants through their thoughts, feelings, and body awareness in a kind, accepting way. The SME program also consisted of 8 weeks of group classes, a day retreat, and daily at home practices, except there was no meditation component. Participants were taught various topics related to stress like physiological effects, sleep hygiene, time management, nutrition, etc. They also had a light exercise component using resistance bands (Hoge, E. A.). 

Results 

This study found that both the MBSR program and SME program reduced scores on the HAM-A, GCI-S, and BAI tests. The MBSR program reduced scores on the three anxiety tests by a greater amount than the SME program indicating that mindfulness meditation is helpful in reducing symptoms of GAD. A repeated measure analysis of variance (ANOVA) test was performed with time as the repeated measure and the test as the treatment arm. With the HAM-A test, the difference in baseline and endpoint scores significant, but there was no significant difference between the MBSR group and the SME group. With the CSI-S and BAI tests, the difference between baseline and endpoint scores was found to be significant and the MBSR group had a significantly larger decrease in scores than the SME group (Hoge, E. A.). The scores for each test for the two groups are found in Table 1, as well as the results from the ANOVA test. Figure 1 gives a visual representation of the changes test scores over the course of treatment for the two groups. 

Table 1. Shows the scores from the three anxiety measures before and after treatment, as well as the results of the ANOVA tests for both treatment groups, taken from (Hoge, E. A.).  

Using the CGI-I test, people in the MBSR group responded with a ranking of “very much improved” or “much improved” more often the people in the SME group. The change in baseline and endpoint scores for the PSQI test were found to be significantly improved in both the MBSR and SME treatment groups. The MBSR group had a greater improvement in scores than the SME group, indicating that the meditation was helpful in improving sleep quality. 

Conclusion 

This study found significant decreases in GAD symptoms according to most measures, CGI-S, CGI-I, BAI, and PSQI, but not all, HAM-A, although there was an insignificant decrease. This indicates that MBSR is an effective treatment to reduce anxiety symptoms in people with GAD compared to SME. One explanation for the HAM-A not showing a significant reduction of symptoms is that it mostly measured somatic symptoms, and if most of the improvements were psychological, this might not be accurately reflected in this test. Another possible explanation is that participants experienced a decrease in symptom distress, but not necessarily symptom severity. This could be why self-reported measures of anxiety showed a significant decrease in symptoms, but not other tests like HAM-A. They found a greater decrease of reported distress and anxiety after the TSST in the MBSR treatment group, than the MSE treatment group. This indicates that MBSR could increase resilience or coping with anxiety creating situations. It is hypothesized that mindfulness meditation has these positive effects on people with GAD because it teaches non-judgment, self-compassion, and awareness of the present moment. These techniques may help people with GAD let negative thoughts go before they start ruminating and have a more positive view of themselves. This increase in personal positivity could be beneficial to everyone, not just those with GAD, as everyone feels anxiety sometimes. More research is still required as this study had a small sample size and because some participants had comorbid depression diagnosis and some were taking medication, the results may not be fully generalizable. This study shows promising evidence for the use of mindfulness meditation as an effective treatment for people with GAD (Hoge, E. A.). 

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[+] Other Work By Teyline McLean