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

MedlinePlus describes anxiety as a feeling of fear, dread, and uneasiness that can be a normal reaction to stress. Anxiety disorders are different: the anxiety does not go away and can get worse over time, interfering with work, school and relationships.

The main types start with generalized anxiety disorder. It means excessive worry about ordinary things on most days for at least six months. Panic disorder brings repeated, sudden attacks of intense fear. Phobias are intense fears of things that pose little real danger, and include social anxiety.

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.

NCCIH summarizes more recent analyses. One 2018 analysis of more than 12,000 people with psychiatric disorders found mindfulness-based approaches worked better than no treatment and about as well as established treatments such as cognitive behavioral therapy and antidepressants. A 2021 analysis of 23 studies 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. A 2020 review it cites found that 55 of 83 studies reported negative experiences related to meditation, and the most commonly reported negative effects were anxiety and depression.

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.