Effectiveness of a meditation-based stress management program as an

adjunct to pharmacotherapy in patients with anxiety disorder

Journal of Psychosomatic Research 62 (2007) 189– 195Sang Hyuk Lee & etal

Presenter: M. Saffari

Introduction

• Meditation includes techniques such as listening to breathing, repeating a mantra, detaching from thought processes, focusing attention, and bringing about a state of self-awareness and inner calmness.

• Meditation has been recently classified as a technique that induces a set of integrated physiological changes, termed relaxation response and is now an accepted and effective complementary treatment for many psychosomatic disorders, such as chronic pain, fibromyalgia, cancer, epilepsy, and psoriasis

• Group sessions of meditation-based stress management can be effective in teaching people how to take better care of themselves, live healthier lives, and adapt more effectively to stress.

• Patients with anxiety disorder are usually prescribed anxiolytics, unless contraindicated. However, a combination of pharmacotherapy and other kinds of treatment, such as cognitive therapy and cognitive–behavioral therapy, should be considered for these patients to maximize their chance of adapting successfully to social and occupational environments.

• We therefore aimed here to scientifically demonstrate the effectiveness of our group meditation program for stress management in patients with anxiety disorder.

Methods

• Subjects:• The study involved 46 patients with anxiety

disorder.• Subjects were recruited, through

advertisement, among patients who were on treatment on an inpatient or an outpatient basis at the Department of Psychiatry, Pochon CHA University College of Medicine from March 2003 to August 2003.

• Subjects were between 20 and 60 years of age and fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for generalized anxiety disorder or panic disorder

• Written informed consent was obtained after a full description of the study had been presented to the subjects.

• Prior to the study, the subjects were treated with the antidepressant paroxetine (20 mg/day), sertraline (50–100 mg/day), or fluvoxamine (50–100 mg/day) and with the anxiolytic alprazolam (0.125–0.5 mg/day).

• Exclusion criteria included any history of substance abuse or dependency, other psychiatric comorbidities, significant medical problems (such as diabetes mellitus, hypertension, tuberculosis, hepatitis, or pregnancy), and involvement in litigation or compensation.

intervention

• Subjects were randomly assigned to either the meditation program or the education program.

• Three subjects in the meditation group and two subjects in the education group dropped out during the study; thus, data from 21 meditation group subjects and 20 education group subjects were used for the final analysis.

• Subjects in the meditation group underwent weekly sessions of meditation treatment for 8 weeks, while the education group subjects received weekly sessions of general information on anxiety disorder.

• Both groups were assessed at baseline (0 week) and at 2, 4, and 8 weeks by self-report measures such as the Beck Depression Inventory (BDI), the State–Trait Anxiety Inventory (STAI), and the Symptom Checklist-90—Revised (SCL-90-R), as well as by a subjectblinded psychiatrist using a clinician-rated scale such as the Hamilton Depression Rating Scale (HAM-D) or the Hamilton Anxiety Rating Scale (HAM-A).

Meditation program

• A psychiatrist and two meditation specialists with 5 years of education and training experience conducted the program.

• The meditation program consisted of a training program that can be performed by anxious patients, together with the psychiatrist’s complementary instruction on stress management in anxiety disorder.

• At the end of each session, homework and an audio CD were given to participants.

Education program

• The education program consisted of a presentation from the psychiatrist and education about the biological aspects of anxiety disorders, lasting for 1 h, once a week.

Results

• Sociodemographic characteristics• There were no significant differences between

groups in sociodemographic characteristics such as age, gender, education level, marital status, occupation, religion, and income. The baseline scores for each scale were also not significantly different between the two groups.

Sociodemographic characteristics of patients with anxiety disorder:the meditation-based stress management group versus the education

control group

• Comparison of anxiety scale scores between the meditation group and the education group

• Statistically significant decreases in anxiety scores over time were revealed for HAM-A, STAI, and the SCL-90-R,anxiety subscale (P=.00).

• Compared to subjects in the education group, those in the meditation group showed greater improvement in anxiety scores. Differences between the two groups remained significant even after the Time.Treatment interaction was considered.

• Comparison of depression scale scores between the meditation group and the education group

• The results show that the 8-week programs both induced statistically significant decreases in the depression scale scores over time: HAM-D ,BDI and SCL-90-R depression subscale (P=.00).

• Comparative changes in depression scores between the two groups showed different results for different scales.

• After the Time.Treatment interactions were considered, the meditation group showed a significant improvement in HAM-D scores (P=.01), but there were no significant differences between groups in BDI (P >.05) or the SCL-90-R depression subscale (P >.05).

Scores on anxiety scales over time of patients with anxiety disorder: themeditation-based stress management program group versus the education

control group

Discussion

• The findings revealed significant decreases in anxiety scale scores for patients with anxiety disorders undergoing the meditation-based program compared to patients with anxiety disorders undergoing the education program. These results are consistent with previous studies suggesting that meditation can relieve anxiety in patients with anxiety disorders.

• Depression scores showed different results with different scales.

• According to HAM-D, the meditation group showed significant improvement, but the BDI and SCL-90-R depression subscales showed no significant differences between the two groups.

• This particular finding is inconsistent with a previous study that was performed without a control group which argued that meditation significantly improved both HAM-D and BDI scores in patients with anxiety disorders.

• We can therefore infer the following in our findings.

• First, there is a possibility that depressive symptom scores do not reveal significant decreases when compared to a control group.

• Second, the meditation program of this study might differ significantly from that used by Kabat-Zinn et al.

• Third, because our program. was conducted for only 8 weeks, the effects on depression may not have reached significance compared to the control group.

• Fourth, the number of study participants was fairly low, possibly resulting in contradictory results. However,

• considering that the MBSR program of Kabat-Zinn was quite similar to our program in that they both included exercises such as stretching, relaxation, and suggestion, and that both programs were run for 8 weeks, we conclude that the first assumption is the most likely.

• This study had the following limitations: • First, the administered medication might have

affected the results. However, carrying out an experimental study with little verification, free of pharmacotherapy, would be subject to ethical controversy, and discontinuation of the medications of patients who are stabilized by such medications is problematic. For these reasons, subjects were limited to patients with stabilized symptoms. However, delayed effects of the medication cannot be ruled out.

• Second, the control group underwent an educational program. A true control group for the meditation program, which would accurately control for placebo effects, would have been a mimic or a sham program.

• Finally, there was no follow-up study to assess the long-term effects of the interventions. We observed maintenance of effects in some of the subjects, but objective data collection was not possible.

The End

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