- Anxiety is the most common mental health challenge in the U.S., with 34% of the population affected by an anxiety disorder during their lifetime.
- A new scientific study is the first to directly compare meditation/mindfulness to medication for the treatment of anxiety.
- The results found that the two decidedly different methods can work equally well to reduce anxiety symptoms.
Anxiety is the most common mental health challenge in the U.S. Approximately 34 percent of the population is affected by an anxiety disorder during their lifetime.  An estimated 19 percent of U.S. adults age 18 and older had any anxiety disorder in the past year. 
Anxiety disorders include generalized anxiety disorder (GAD), social anxiety, panic disorder, obsessive-compulsive disorder (OCD), phobias (such as agoraphobia), and post-traumatic stress disorder (PTSD). Generalized anxiety disorder is characterized by excessive worry that is difficult to control, along with physical symptoms including restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance. Although approximately 6.8 million adults in the U.S. are affected by GAD, less than half (43 percent) receive any form of treatment. 
Considerable research has shown that meditation and other mindfulness practices can be extremely effective at helping to reduce anxiety but what was not known is how they compare to standard treatment using medication... until now.
The results of the first scientific study that directly compared meditation/mindfulness—specifically mindfulness-based stress reduction (MBSR)—to medication for anxiety were just published in JAMA Psychiatry. This research found the two decidedly different methods work equally well in terms of reducing symptoms. 
This randomized clinical trial followed 276 patients diagnosed with GAD in which half were given an antidepressant medication commonly prescribed for anxiety—escitalopram (brand name Lexapro) and the other half participated in a mindfulness-based stress reduction program. After eight weeks, participants in both groups reported a 30 percent decline in their anxiety levels as measured using a standardized assessment instrument. Their anxiety levels continued to decrease through the completion of the 24-week study.
These results are especially timely in that this past September, an influential U.S. health task force recommended routine anxiety screening for adults, and numerous reports suggest global anxiety rates have increased recently, related to worries over the pandemic, political and racial unrest, climate change, inflation, and other financial uncertainties.
Side effects were significantly more common among those who received medication; nearly 80 percent of the participants experienced at least one side effect, such as trouble sleeping, nausea, headaches, decreased libido, and increased anxiety. In comparison, the mindfulness group reported a single side effect: increased anxiety in approximately 15 percent of the participants.
However, taking a pill is convenient and easy, requiring virtually no time and only the need to remember to take it. Mindfulness-based Stress Reduction is a structured eight-week program that includes guided and self-practice and requires a substantial initial time commitment: Participants attended twice-weekly two-and-a-half-hour group classes for eight weeks and were asked to meditate at home for 45 minutes each day for the entire study period.
Anxiety usually comes more from our thoughts rather than from actual experiences.
The human mind produces a continuous waterfall of thoughts, the majority of which have nothing to do with our present-moment circumstances. These thoughts grab our attention and carry it away like a leaf on a stiff wind. In this field of relentless mental activity, our thoughts combine in the form of stories our head tells us—stories that are convincing and seductive, and so we tend to believe them.
Because our thinking determines our perception of reality, to an impressive extent how we think determines our reality, or at the very least significantly influences it. For the most part, anxiety doesn’t so much come from our experiences—it comes from how we think about our experiences; the stories that our thoughts create about our experiences. Many of these stories are compelling tales that pull us back into the past or propel us forward into the future, about to-do lists, what-ifs, and all manner of concerns about the future, including things that might or (in all likelihood) might not happen later today, tomorrow, in two weeks, in six months, or years from now.
Typically, anxiety is generated by a sense of “threat.” It makes no difference whether the threat is real or imagined: through the mind-body connection, thinking about potential threats activates the fight or flight reaction in the sympathetic division of the autonomic nervous system and revs up anxiety. Mindfulness practice makes the thought-generated stories that fuel anxiety less powerful. It does this by helping us discern the difference between the reality of our experiences (what is actually happening) and the stories that our minds tell us about that reality (what we tell ourselves about what is happening)—stories that frequently contribute to, if not create, anxiety.
Through mindfulness practices, you can develop greater present-moment awareness, along with the ability to direct—and keep—your attention where you want it to be. Since most of the time, this moment right here and right now is essentially safe, training the mind to bring attention to the present moment can also help significantly reduce anxiety.
Mindfulness increases our capacity to bear anxiety.
Naturally, we want to rid ourselves of uncomfortable feelings, including anxiety. But paradoxically, the stronger our desire to not experience a particular feeling, the more intensely we are likely to experience it. As a result, most attempts to avoid anxiety only end up increasing and prolonging it. A central focus of mindfulness practice is to learn to accept the full range of our emotional experience, whether positive or painful.
Instead of trying to get rid of anxiety, the goal is to increase the capacity to bear it—by observing it, being present with it, allowing it, co-existing with it, and ultimately making peace with it. Moving toward accepting difficult, uncomfortable emotions rather than fighting against them creates a fascinating form of freedom: the thoughts and the emotions they fuel arise and we can simply become aware of them and move through them, and this helps us move beyond them.
This new research empirically demonstrates there are alternatives to treat anxiety that don’t involve medication, with its range of side effects, and that can be just as effective. Mindfulness practice is not about learning how to control our thoughts and emotions; it’s about learning and applying the awareness and skills so that they don’t control us.
Copyright 2022 Dan Mager
 Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults with Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. Published online November 09, 2022. doi:10.1001/jamapsychiatry.2022.3679