A randomized controlled trial comparing mindfulness to escitalopram for anxiety: In-person and remote, synchronous delivery pre and post COVID-19 pandemic.
Elizabeth A Hoge, Mihriye Mete, Amanda W Baker, Kristin L Szuhany, Caroline H Armstrong, Margot H Steinberg, Mary Ann Dutton, Eric Bui, Naomi M Simon
Journal of Affective Disorders September 1, 2025 DOI: 10.1016/j.jad.2025.04.145 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Longitudinal Peer reviewed |
|---|---|
| Sample size | 202 |
| Population | Adults with anxiety disorders |
| Interventions | Mindfulness-Based Stress Reduction Escitalopram |
| Topics | Meditation Anxiety |
| Keywords | Anxiety disorders Comparative effectiveness Escitalopram Telehealth |
| Citations | 3 |
| Registration | NCT03522844 |
| Key findings | Videoconference-delivered MBSR was comparable to in-person MBSR for anxiety disorders, but did not demonstrate non-inferiority to videoconference-delivered escitalopram. |
Abstract
During the pandemic, a randomized controlled trial (RCT) of Mindfulness-Based Stress Reduction (MBSR) versus the antidepressant, escitalopram (ESC) added a second phase using a synchronous, videoconference (VC) format for both interventions, enabling randomized and naturalistic comparisons. The original in-person RCT demonstrated non-inferiority of MBSR to ESC. In the second phase, we hypothesized that MBSR-VC would be non-inferior to ESC-VC, and that MBSR-VC would be non-inferior to in-person MBSR (MBSR-IN). Adults with anxiety disorders were recruited for a 3-center RCT. Primary (Clinical Global Impression of Severity: CGIS) and secondary outcomes (satisfaction, other measures for anxiety subtypes) were compared between MBSR-IN vs MBSR-VC, ESC-IN vs ESC-VC and MBSR-VC vs ESC-VC. MBSR-VC (n = 100) and ESC-VC (n = 102) did not significantly differ in mean CGI-S change at endpoint (1.39 vs 1.51, p = 0.17) but non-inferiority of MBSR-VC was not supported. MBSR did not vary by delivery format (VC: 1.3 vs. IN: 1.3, p = 0.77) and MBSR-VC's non-inferiority to MBSR-IN was demonstrated within the pre-specified margin of -0.40 (95 % CI: -0.34 to 0.25). ESC-IN and ESC-VC were not significantly different in CGI-S change in unadjusted comparisons (1.4 vs 1.5, p = 0.53), but the average CGI-S at endpoint was significantly lower in the ESC-VC group in a multivariable longitudinal model. Other findings included in-person treatments having a greater impact on social anxiety compared to their VC version, ESC-VC having higher satisfaction ratings and a greater impact on panic symptoms than MBSR-VC. Remotely delivered MBSR demonstrated comparable effectiveness to in-person MBSR for anxiety disorders, providing support for this delivery approach. Social anxiety symptoms improved more with in-person care. Clinicaltrials.gov: NCT03522844.
Comparable studies
Other randomized controlled trials on anxiety, most cited first.
Citations in the library
Cited by 2
Cites 11
- How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective Perspectives on Psychological Science October 14, 2011
- Home practice in Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction: A systematic review and meta-analysis of participants' mindfulness practice and its association with outcomes Behaviour Research and Therapy May 10, 2017
- Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry January 1, 2023
- A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders Scientific Reports October 14, 2021
- The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review Mindfulness September 24, 2020
and 6 more in the library