NeuroImage Clinical
January 1, 2013
Britta K. Hölzel, Elizabeth A Hoge, Douglas N. Greve et al.
285 citations
Mindfulness training alters brain activity in regions involved in emotion regulation among people with generalized anxiety disorder (GAD). In a preliminary study, 26 GAD patients were randomly assigned to either an 8-week Mindfulness-Based Stress Reduction (MBSR) program or a stress management education control. At baseline, GAD patients showed higher amygdala activation than healthy participants when viewing neutral faces, indicating heightened reactivity to ambiguous stimuli. After both interventions, amygdala activation to neutral faces decreased. MBSR, but not the control, led to greater increases in ventrolateral prefrontal cortex (VLPFC) activity and strengthened amygdala-prefrontal functional connectivity. These brain changes correlated with reductions in anxiety scores, suggesting clinical relevance. The shift from negative to positive amygdala-prefrontal coupling may represent a unique mechanism of mindfulness.
Biological Psychiatry
January 1, 2024
Elizabeth A Hoge, Caroline H Armstrong, Mihriye Mete et al.
10 citations
Anxiety disorders are linked to heightened startle responses during unpredictable threat, a physiological marker called anxiety-potentiated startle (APS). In a study of 93 individuals with anxiety disorders and 66 healthy controls, APS was higher in the anxious group at baseline. After eight weeks of treatment with either escitalopram or mindfulness-based stress reduction, both treatment groups showed significantly greater reductions in APS compared to controls, with patients' APS levels falling into the range of healthy individuals. Fear-potentiated startle (FPS), a response to predictable threat, did not differ between groups at baseline nor change with treatment. These results validate APS as a biological correlate of pathological anxiety and provide evidence that mindfulness-based stress reduction can alter anxiety-related neurocircuitry similarly to medication.
October 3, 2019
Gaelle Desbordes, Tim Gard, Elizabeth A Hoge et al.
6 citations
Equanimity, an even-minded mental state toward all experiences regardless of their pleasantness, is proposed as a key outcome measure for contemplative research. While mindfulness has been used as a measurable outcome of meditation, it encompasses multiple components, some better characterized as equanimity. The article defines and discusses the inter-relationship between mindfulness and equanimity from classical Buddhist and modern psychology perspectives, reviews meditation techniques for cultivating equanimity, and examines psychological, physiological, and neuroimaging methods for assessing it. Equanimity captures potentially the most important psychological element in improving well-being and should be a focus in future research.
Journal of Mood and Anxiety Disorders
March 1, 2025
Diane Joss, Michael Datko, Charisma I Washington et al.
5 citations
Self-judgment, a symptom common to many psychological disorders, often follows childhood maltreatment and can make standard treatments less effective. In a pilot study of 24 adults with anxiety or depressive disorders (83% had multiple diagnoses), an eight-week mindful self-compassion program significantly reduced self-judgment and increased self-compassion. Participants who reported more childhood trauma improved more than those with less trauma. Brain scans showed that reduced self-judgment was linked to stronger connections between the posterior cingulate cortex and frontal regions involved in regulation and language, and weaker connections with the amygdala-hippocampal complex, suggesting the training lessens fear-related influences on self-referential thinking while boosting executive control.
Journal of Mood and Anxiety Disorders
June 1, 2024
Danielle Moskow Diamond, David Rosenfield, Nikki Kaiser et al.
5 citations
In generalized anxiety disorder, different treatments improve distinct aspects of mindfulness. A clinical trial randomly assigned 226 individuals with GAD to 12 weeks of Kundalini Yoga, cognitive behavioral therapy, or stress education. The Non-judge, Act with Awareness, and Non-react facets of mindfulness increased significantly during treatment, while the Observe and Describe facets did not. Improvement in Acting with Awareness was significantly greater for Kundalini Yoga than for cognitive behavioral therapy. These findings suggest that behavioral treatments can influence specific mindfulness components differently.
Journal of Affective Disorders
November 1, 2024
Anna C Oft, Samantha R Philip, Emily Holz et al.
4 citations
Among 67 adults with anxiety disorders, both escitalopram and mindfulness-based stress reduction (MBSR) reduced partial days of missed work due to health problems after 24 weeks. Only MBSR was linked to improved job performance over the same period. Neither treatment outperformed the other on any work-related outcome at the study's end. The findings suggest that MBSR may improve work performance as effectively as SSRI medication for people with anxiety disorders, offering an alternative for those seeking better anxiety symptoms and workplace outcomes.
Journal of Affective Disorders
September 1, 2025
Elizabeth A Hoge, Mihriye Mete, Amanda W Baker et al.
3 citations
For adults with anxiety disorders, Mindfulness-Based Stress Reduction (MBSR) delivered via videoconference was comparably effective to in-person MBSR, but MBSR-VC did not meet the threshold for non-inferiority compared to the antidepressant escitalopram (ESC) delivered by videoconference. In a randomized controlled trial with 202 participants, MBSR-VC and ESC-VC showed similar average improvement on the Clinical Global Impression of Severity scale (1.39 vs 1.51 points), but non-inferiority was not supported. In-person treatments had a greater impact on social anxiety than their video versions. ESC-VC received higher satisfaction ratings and had a greater effect on panic symptoms than MBSR-VC. Remotely delivered MBSR is a viable option for anxiety disorders, though social anxiety may benefit more from in-person care.
Neuroscience Letters
May 23, 2025
Diane Joss, Gunes Sevinc, John W. Denninger et al.
1 citation
Among 94 chronically stressed but otherwise healthy adults randomized to eight weeks of meditation, yoga, or stress education, only the meditation group showed a significant reduction in resting-state functional connectivity between the posterior cingulate cortex and the left hippocampus. Changes in this brain connectivity were correlated with improvements in perceived stress, allostatic load, and anti-inflammatory gene expression, suggesting that meditation's neural effects are closely linked to physical wellness biomarkers. No such changes occurred in the yoga or stress education groups, indicating this neurobiological mechanism may be unique to meditation training.
Journal of Psychiatric Research
June 1, 2026
Amanda W Baker, Samantha R Philip, Caroline H Armstrong et al.
An 8-week course of Mindfulness-Based Stress Reduction (MBSR) and the medication escitalopram both improved self-compassion in 198 adults with anxiety disorders, but MBSR was not generally superior to escitalopram. Two subscales showed differences: MBSR improved Common Humanity over time while escitalopram did not, and MBSR produced greater improvement in Mindfulness from baseline to post-treatment. All domains of self-compassion improved across both groups. The findings suggest that MBSR may offer specific benefits for enhancing mindfulness and common humanity, supporting its use when improving self-relational capacities is a treatment priority.
Frontiers in Psychology
February 11, 2020
Elizabeth A Hoge, Hannah E. Reese, Isabelle A. Oliva et al.
Mindfulness-based interventions are effective for many psychological conditions, but how they work is not well understood. This study examined whether changes in negative interpretation bias—measured by a homophone task—explain the link between mindfulness and anxiety in adults with Generalized Anxiety Disorder. Forty-two participants completed measures before and after Mindfulness-based Stress Reduction. Contrary to expectations, no indirect relationship was found between baseline mindfulness and anxiety through negative interpretation bias. Mindfulness-based Stress Reduction did reduce negative interpretation bias from before to after treatment, but changes in mindfulness did not relate to changes in anxiety through changes in interpretation bias. Overall, the results offer minimal support for the proposed pathway.
Psychiatry Research
January 25, 2017
Elizabeth A Hoge, E. Bui, Sophie A. Palitz et al.
Mindfulness-Based Stress Reduction (MBSR) lowers stress hormone and inflammatory markers more than an attention control class in adults with Generalized Anxiety Disorder (GAD). Seventy participants with GAD were randomly assigned to MBSR or a control class. Before and after the intervention, they completed the Trier Social Stress Test. The MBSR group showed a significantly greater reduction in adrenocorticotropic hormone (ACTH) and pro-inflammatory cytokine concentrations compared to the control group. These findings provide the first combined hormonal and immunological evidence that MBSR may enhance resilience to stress in people with GAD.
Brain, behavior, and immunity
August 1, 2013
Elizabeth A Hoge, Maxine M Chen, Esther Orr et al.
People who practice Loving-Kindness Meditation (LKM), a Buddhist-derived technique focusing on unselfish kindness toward all, tended to have longer telomeres—a cellular marker linked to slower aging—than non-meditators. In women, the difference was statistically significant even after accounting for body mass index and past depression. The study compared 15 LKM practitioners with 22 controls and found no significant differences in age, gender, race, education, or trauma exposure, though controls had higher BMI and lower rates of past depression. The results suggest LKM practice might influence telomere length, particularly in women, though the small sample size limits certainty.
Social Cognitive and Affective Neuroscience
March 1, 2010
Britta K. Hölzel, James Carmody, Karleyton C Evans et al.
Reductions in perceived stress after an 8-week mindfulness-based stress reduction intervention correlate with decreases in gray matter density in the right basolateral amygdala. Stressed but otherwise healthy individuals (N = 26) reported significantly less perceived stress after the intervention. The study demonstrates that neuroplastic changes are associated with improvements in a psychological state variable, not just with learning abstract information or motor and language skills.