Objective
The objective of this study was to examine the effectiveness of a meditation-based stress management program in patients with anxiety disorder.
Methods
Patients with anxiety disorder were randomly assigned to an 8-week clinical trial of either a meditation-based stress management program or an anxiety disorder education program. The Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the State–Trait Anxiety Inventory (STAI), the Beck Depression Inventory, and the Symptom Checklist-90—Revised (SCL-90-R) were used to measure outcome at 0, 2, 4, and 8 weeks of the program.
Results
Compared to the education group, the meditation-based stress management group showed significant improvement in scores on all anxiety scales (HAM-A, P=.00; STAI state, P=.00; STAI trait, P=.00; anxiety subscale of SCL-90-R, P=.00) and in the SCL-90-R hostility subscale (P=.01). Findings on depression measures were inconsistent, with no significant improvement shown by subjects in the meditation-based stress management group compared to those in the education group. The meditation-based stress management group did not show significant improvement in somatization, obsessive–compulsive symptoms, and interpersonal sensitivity scores, or in the SCL-90-R phobic anxiety subscale compared to the education group.
Conclusions
A meditation-based stress management program can be effective in relieving anxiety symptoms in patients with anxiety disorder. However, well-designed, randomized, and controlled trials are needed to scientifically prove the worth of this intervention prior to treatment.
Meditation includes techniques such as listening to breathing, repeating a mantra, detaching from thought processes, focusing attention, and bringing about a state of self-awareness and inner calmness [1]. In Asia, many forms of meditation have been developed among Taoists, Buddhists, and traditional Chinese medicine practitioners throughout history [2]. Meditation has been recently classified as a technique that induces a set of integrated physiological changes, termed relaxation response [3], and is now an accepted and effective complementary treatment for many psychosomatic disorders, such as chronic pain, fibromyalgia, cancer, epilepsy, and psoriasis [4], [5], [6], [7] and [8].
Meditation affects the endocrine system by inducing a progressive decrease in serum thyroid-stimulating hormone, growth hormone, and prolactin levels [9], and also acts on the immune system to increase the number of CD3+ lymphocytes and the antibody response to influenza vaccine [10] and [11].
Group sessions of meditation-based stress management can be effective in teaching people how to take better care of themselves, live healthier lives, and adapt more effectively to stress. Of a variety of possible meditation programs, the mindfulness-based stress reduction (MBSR) program of Kabat-Zinn [12] is a well-defined, systematic, and patient-centered approach that uses relatively intensive training in mindfulness meditation as the core of the program.
Anxiety disorders, such as panic disorder and generalized anxiety disorder, are chronic and recurrent [13]. Patients with anxiety disorder are usually prescribed anxiolytics, unless contraindicated. However, a combination of pharmacotherapy and other kinds of treatment, such as cognitive therapy and cognitive–behavioral therapy, should be considered for these patients to maximize their chance of adapting successfully to social and occupational environments.
Miller et al. [14] and Angst and Vollrath [15] showed that the MBSR program could effectively reduce symptoms of anxiety and panic, and could help to maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia. MBSR may provide a good candidate program for patients with anxiety disorder who do not want pharmaceutical medication, are pregnant, or want additional treatment. However, this study was limited by the noninclusion of either a randomly selected comparison group to test for placebo effects or a control group to test for concomitant medication effects [14] and [15]. Therefore, a carefully controlled trial should be implemented before this kind of stress management program is applied to patients with anxiety disorder. We have previously assessed the effectiveness of a newly developed meditation-based stress management program, which uses meditation techniques that are widely practiced among Koreans to improve health, in a preliminary trial on a group of pregnant women [16]. The meditation in this program was not the same as that used in the MBSR regime, although the programs have mindfulness meditation in common. We therefore aimed here to scientifically demonstrate the effectiveness of our group meditation program for stress management in patients with anxiety disorder.
