Does meditation help anxiety? What the research shows

Meditation and mindfulness are widely used to manage stress and worry, through classes, books and apps. For people with a diagnosed anxiety disorder, the harder question is how meditation compares with the treatments doctors already use.

A randomized trial published in JAMA Psychiatry tested exactly that. An 8-week mindfulness course reduced anxiety about as much as escitalopram, a common antidepressant used for anxiety. Earlier reviews found smaller average benefits across many kinds of meditation program, and meditation is not free of unwanted effects.

What anxiety disorders are

Everyone feels anxious at times, and in the right amount anxiety is useful. Anxiety disorders are different. A 2017 review in Nature Reviews Disease Primers describes their essential features as excessive and enduring fear, anxiety or avoidance of perceived threats. They can include panic attacks. The review notes that they are the most common mental disorders in many Western countries, and a leading cause of disability.

The main types include generalized anxiety disorder, which means constant worry about everyday things. Panic disorder brings sudden attacks of intense fear. Social anxiety and specific phobias are the others. Most anxiety disorders are never found or treated, the review adds, and without treatment they tend to last, with symptoms that come and go.

What meditation and mindfulness practices are

The National Center for Complementary and Integrative Health (NCCIH) notes that meditation has a history that goes back thousands of years, with many techniques that began in Eastern traditions. Mindfulness practices train attention on the present moment.

The version tested in the trial was mindfulness-based stress reduction (MBSR), a structured group course taught in weekly classes over eight weeks. It is one of the most studied forms of mindfulness training.

What the TAME meditation trial found

The TAME trial (Treatments for Anxiety: Meditation and Escitalopram) recruited 276 adults with a diagnosed anxiety disorder at three US academic medical centers between 2018 and 2020. They were randomly assigned to the weekly MBSR course or to escitalopram, at 10 to 20 mg a day, for eight weeks. Interviewers who did not know which treatment each person had rated their anxiety.

The trial used a noninferiority design, meaning it tested whether the course was no worse than the drug by more than a set margin. Anxiety was scored on a 7-point clinician scale, and both groups started at about 4.5. Among the 208 people who completed the trial, it fell by 1.35 points with MBSR and 1.43 points with escitalopram. The difference was well within the margin, and the authors found that MBSR was noninferior to escitalopram.

Side effects differed sharply. At least one study-related adverse event occurred in 78.6% of people assigned to escitalopram and 15.4% of those assigned to MBSR. Ten people, or 8%, stopped the drug because of adverse events, against none in the course.

What earlier meditation research found for anxiety

A 2014 review in JAMA Internal Medicine pooled 47 trials with 3,515 participants that compared meditation programs with active control activities. It found that mindfulness meditation programs had moderate evidence of improved anxiety, depression and pain, with effects that were small to moderate in size. It found no evidence that meditation programs were better than any active treatment, such as drugs, exercise or other behavioral therapies.

Reviews limited to people with diagnosed conditions show larger improvements. A 2010 meta-analysis in the Journal of Consulting and Clinical Psychology of 39 studies with 1,140 participants found that mindfulness-based therapy was moderately effective for improving anxiety overall, with larger improvements in people with anxiety and mood disorders. Most of those studies measured change before and after treatment, without a comparison group, which tends to make effects look bigger.

A larger 2018 analysis in Clinical Psychology Review pooled 142 groups with 12,005 people with mental health conditions. It sorted each comparison by how strong the other treatment was. Mindfulness beat no treatment and weaker options. Against proven therapies such as cognitive behavioral therapy and medication, mindfulness conditions did not differ from evidence-based treatments. NCCIH also cites a 2021 analysis of 23 studies which found that only some types of mindfulness approaches were as effective as cognitive behavioral therapy for anxiety disorders.

What health sources say about meditation safety

NCCIH states that meditation and mindfulness practices usually are considered to have few risks. It adds that few studies have looked for harmful effects, so definite statements about safety are not possible.

The most thorough look at harms is a 2020 systematic review in Acta Psychiatrica Scandinavica of 83 studies with 6,703 people who meditated. In 55 of the studies, at least one participant had an adverse event. Overall about 8% of participants were affected, 3.7% in experimental studies and 33.2% in observational ones, and the most common problems were anxiety, depression and unusual thinking experiences. The authors concluded that adverse events during or after meditation are not uncommon and may occur in individuals with no previous history of mental health problems.

The TAME trial compared meditation with a prescription medicine, and changing any prescribed treatment is a decision made with the prescriber. Do not stop a prescribed medicine without talking to the prescriber.

What the meditation research cannot tell us

TAME lasted eight weeks, with follow-up to 24 weeks, and compared MBSR with one drug. Its participants were mostly young, with an average age of 33, and 75% were women, recruited at urban academic centers. People willing to be randomly assigned to meditation may also be more open to it than most, and participants knew which treatment they were getting.

The trial tested an in-person, instructor-led course. It does not show that apps, short sessions or occasional meditation have the same effect, or how well people keep practicing after a course ends.

What the meditation evidence adds up to

In one well-run trial, adults with anxiety disorders did about as well with a structured mindfulness course as with a first-line antidepressant, and reported far fewer side effects. Across many trials of different meditation programs, benefits for anxiety are real but modest, and not larger than other active treatments.

Meditation is generally considered low risk, but harms have been studied less than benefits. How anxiety is treated for any one person depends on the type and severity of the anxiety, other conditions and their preferences, and is worked out with their clinician.