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msmurdock t1_ivrcnf4 wrote

Reply to comment by fotogneric in New study (n=276) finds that a standardized mindfulness program is as effective as a common antidepressant (Escitalopram) at treating anxiety, with both treatments leading to about a 30% reduction in symptoms. by fotogneric

The study used a total of 276 patients...which basically means nothing.

It used one drug, Lexapro, for anxiety... It's an SSRI, which is effective for some, but not even close to most folks with anxiety disorders.

And they gave the Lexapro folks no support other than the drug. Even though it's meant to be used alongside therapy.

So. The headline actually should be: Tiny study suggests this particular MBSR program we are not sharing with you is equally as effective as trying a single med with no therapy on anxiety."

Science!

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dadaesque t1_ivrn9xa wrote

What are you on about?

How did you get that 276 is “tiny” for an RCT? Unless you’re expecting a very small effect (in which case you probably aren’t bothering with an RCT) ~200 certainly isn’t tiny.

And what do you want them to do, test it against every single drug that is used for anxiety? That would mean dozens of comparison groups, which would necessitate thousands if not tens of thousand of participants and would basically guarantee some significant effect somewhere. Lexapro is a first line treatment for anxiety which makes it a reasonable choice as a comparison group, which was offered without therapy since that would have been a confound.

MBSR is a standardized protocol that is widely used in therapy and research and can go look up yourself.

The headline is perfectly fine.

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Karma_collection_bin t1_iy2642k wrote

Yes and there is literally at least one well-respected completely free MBSR course online!

https://palousemindfulness.com/

(I have no affiliation and do plan to do this one once I am done working my way through Healthy Minds Innovations app's full guided meditation program - also free & actually well done, zero adverts - not MBSR though, though skills and effects would overlap, I'd imagine).

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Feralpudel t1_ivrq1wf wrote

I’ll quibble some but then add another concern.

That’s not a small sample size for an RCT. And the main problem with small sample size is power—i.e., you run the risk of finding no significant difference between groups when in fact one exists.

As for the choice of Lexapro for the control arm, I understand there’s a long tradition among pharma companies for choosing a weak sister drug at the lowest credible dose for the comparison arm.

Of course there’s also a long tradition of antidepressants being no better than placebo in trials. That’s partly because they tend to be inconsistently effective treatments, but also because there is usually a large placebo effect in trials of antidepressant drugs as well.

So that makes me think it would have been useful to have a placebo arm as well as a drug arm, to try and measure the true placebo effect. Otherwise I’m unconvinced that we weren’t just seeing all placebo effect in both arms. That said, a 30 percent improvement is a pretty large effect size.

I’d be interested in whether the study reported any adverse effects in the MM arm. There is increasing awareness of the risk of serious adverse effects of meditation in some subjects. Although serious effects (e.g., psychotic breaks) have tended to occur in intense retreat settings, they’ve also been reported for one of the more tradition-based non-dual apps (Waking Up). (I use and recommend the app; arguably it has caused some of the same issues as real meditation because it IS real meditation.)

One can tell a story that anxious persons might be at higher risk of adverse events while meditating.

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Gmork14 t1_ixzppkx wrote

I definitely had some negative reactions when I was learning to meditate. Panic attacks, specifically.

Not knowing any better I pushed through and kept practicing. Eventually learned to sit with it and it got better. But it was a rough start, and I wonder sometimes if I’m not noticing more subtle ill affects.

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StreetCornerApparel t1_iy0s4ik wrote

Anxiety is one of those things where sometimes being present with yourself isn’t easy, at least at first.

When I first started meditating I felt similar panic reactions, but when I kept going I found peace in being alone with myself for those moments, and my general anxiety levels dropped off majorly. I was having two to five panic attacks a day prior to meditation, and now have maybe 1, and sometimes none. I think massage helped a ton too though.

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Karma_collection_bin t1_iy277s6 wrote

>Otherwise I’m unconvinced that we weren’t just seeing all placebo effect in both arms. That said, a 30 percent improvement is a pretty large effect size.

I mean, it could be both, right? e.g. maybe it's 5 or 10% placebo & then the rest is the drug or MBSR. And the cool thing is that people "in real life" can of course do both drug & MBSR.

​

I wonder also if these tools would have greater effect together simply the sum (adding the % decreases together)?

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