Attenuation of Anxiety-Potentiated Startle After Treatment With Escitalopram or Mindfulness Meditation in Anxiety Disorders.
Elizabeth A Hoge, Caroline H Armstrong, Mihriye Mete, Isabelle A. Oliva, Sara W. Lazar, Tiffany R Lago, Christian Grillon
Biological Psychiatry 2024 DOI: 10.1016/j.biopsych.2023.06.003 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 159 |
| Population | Individuals with anxiety disorders and healthy control individuals |
| Interventions | escitalopram mindfulness-based stress reduction |
| Duration | 8-week treatment |
| Topics | Anxiety Meditation |
| Keywords | Anxiety-potentiated startle Escitalopram Fear-potentiated startle Mindfulness meditation Rdoc Unpredictable threat |
| Citations | 10 |
| Key findings | Anxiety-potentiated startle (APS) was higher in individuals with anxiety disorders than in healthy controls at baseline, and both escitalopram and mindfulness-based stress reduction treatments significantly reduced APS compared to no treatment, bringing patients into the range of controls. |
Abstract
Biological markers for anxiety disorders may further understanding of disorder pathophysiology and suggest potential targeted treatments. The fear-potentiated startle (FPS) (a measure of startle to predictable threat) and anxiety-potentiated startle (APS) (startle to unpredictable threat) laboratory paradigm has been used to detect physiological differences in individuals with anxiety disorders compared with nonanxious control individuals, and in pharmacological challenge studies in healthy adults. However, little is known about how startle may change with treatment for anxiety disorders, and no data are available regarding alterations due to mindfulness meditation training. Ninety-three individuals with anxiety disorders and 66 healthy individuals completed 2 sessions of the neutral, predictable, and unpredictable threat task, which employs a startle probe and the threat of shock to assess moment-by-moment fear and anxiety. Between the two testing sessions, patients received randomized 8-week treatment with either escitalopram or mindfulness-based stress reduction. APS, but not FPS, was higher in participants with anxiety disorders compared with healthy control individuals at baseline. Further, there was a significantly greater decrease in APS for both treatment groups compared with the control group, with the patient groups showing reductions bringing them into the range of control individuals at the end of the treatment. Both anxiety treatments (escitalopram and mindfulness-based stress reduction) reduced startle potentiation during unpredictable (APS) but not predictable (FPS) threat. These findings further validate APS as a biological correlate of pathological anxiety and provide physiological evidence for the impact of mindfulness-based stress reduction on anxiety disorders, suggesting that there may be comparable effects of the two treatments on anxiety neurocircuitry.
Comparable studies
Other randomized controlled trials on anxiety, most cited first.
Citations in the library
Cites 9
- Effects of mindful-attention and compassion meditation training on amygdala response to emotional stimuli in an ordinary, non-meditative state Frontiers in Human Neuroscience 2012
- Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training NeuroImage: Clinical 2013
- Mindfulness meditation training alters stress-related amygdala resting state functional connectivity: a randomized controlled trial Social Cognitive and Affective Neuroscience June 5, 2015
- Common and Dissociable Neural Activity After Mindfulness-Based Stress Reduction and Relaxation Response Programs Psychosomatic Medicine April 11, 2018
- Treatment for anxiety: Mindfulness meditation versus escitalopram (TAME): Design of a randomized, controlled non-inferiority trial. Contemporary Clinical Trials February 19, 2020
and 4 more in the library