‘Mindfulness meditation worked just as well as medication’: Elizabeth Hoge, professor of psychiatry

Elizabeth Hoge, director, Anxiety Disorders Research Program and professor of psychiatry at Georgetown University Medical Center in Washington DC, conducted a first-of-its-kind study with 276 patients that showed a meditation technique called Mindfulness Based Stress Reduction (MBSR) practised for eight weeks was as effective as taking an antidepressant called escitalopram for anxiety. In an email interview, she elaborates on why meditation works:

In simple terms, what was your trial testing, and what was the key finding?

We wanted to find out how a standardized mindfulness meditation class compared to the medication escitalopram, which is a common antidepressant used for anxiety disorders. We recruited patients with anxiety disorders and randomly assigned them to one of those two treatments. We followed their anxiety symptoms throughout the study and found that the mindfulness meditation worked just as well as the medication. This helps provide evidence that mindfulness meditation training is a reasonable treatment approach for anxiety disorders.

How do you define meditation in a clinical context, and what is the mechanism of its relationship with anxiety?

What we did for the research study was to use a standardized class that taught Vipassana-style meditation in a group format. Some therapists use meditation exercises in their individual psychotherapy but that is different from what we did. Regarding the mechanism, science is not completely worked out but it appears that meditation helps with psychological decentering, which means that it creates some distance between the person and their worry thoughts. This helps the individual see thoughts just as passing events of the mind rather than actual truths and helps them not identify too closely with the thought.

What does eight weeks of MBSR actually involve, in terms of time commitment and structure. And is that realistic for someone who'd otherwise just take a pill?

The MBSR class is 2.5 hours each week, and includes meditation exercises that participants do at home to practice. Thus, it is a lot of effort, but we found that people who put in the most meditation practice got more out of the class. For people who don’t have the energy or inclination to do the work of meditation, the antidepressant might be a better option. The difference is that when they stop the pill, the symptoms might come back, but when they learn meditation, they can do that practice for the rest of their lives for free.

What's the strongest, most replicated finding in meditation neuroscience today, and separately, what's a widely repeated claim the evidence doesn't actually support?

The strongest finding is probably that regular meditation practice reduces stress. It seems to create more peace and helps people cope with external stress.

One claim that people might make about meditation is that it trains people to clear their mind and not have any thoughts. I don’t think that is possible; it is human to continually have thoughts. The point is to change the relationship to those thoughts. Too often, people give up because they think that they can't meditate because they cannot clear their mind of thoughts. But that's unrealistic; the human mind is a thought machine. Instead, the point is to be aware of the thoughts as they arise, and see them as just thoughts and let them pass away and move on.