Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity.
Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity.
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DOI：
10.4088/jcp.12m08083
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发表时间：
2013-08
期刊：
影响因子：
--
通讯作者：
Simon NM
中科院分区：
文献类型：
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作者：
Hoge EA;Bui E;Marques L;Metcalf CA;Morris LK;Robinaugh DJ;Worthington JJ;Pollack MH;Simon NM
正念冥想作为一种治疗焦虑症的策略已经引起了越来越多的兴趣，但之前的研究受到方法学问题的限制，包括缺乏积极的对照组。这是第一个随机对照试验，比较了手动正念减压（MBSR）计划和广泛性焦虑障碍（一种以慢性担忧和生理亢奋症状为特征的障碍）的主动控制。2009年至2011年间，93名被诊断为广泛性焦虑症的患者被随机分为8周的正念减压疗法组或注意力控制、压力管理教育组。焦虑症状采用汉密尔顿焦虑量表（HAM-A，主要结局测量指标）、临床总体印象严重程度和改善（CGI-S和CGI-I）和贝克焦虑量表（BAI）进行测量。通过比较治疗前和治疗后的特里尔社会压力测试（TSST）中的焦虑和痛苦来评估压力反应。一项改进的意向治疗分析包括至少完成一次MBSR （N=48）或SME （N=41）的参与者，结果表明，两种干预措施在终点时均导致HAM-A评分显著降低，但差异不显著。然而，正念减压与CGI-S、CGI-I和BAI测量的焦虑程度的显著降低相关（均p <0.05）。在面对TSST压力挑战时，MBSR组的焦虑和痛苦评分也比SME组有更大的降低（P<0.05），积极自我陈述的增加也比SME组更大（P=0.004）。这些结果表明，正念减压疗法可能对广泛性焦虑症的焦虑症状有有益的影响，也可能改善实验室压力挑战中测量的压力反应和应对能力。
Mindfulness meditation has met increasing interest as a therapeutic strategy for anxiety disorders, but prior studies have been limited by methodological concerns, including a lack of an active comparison group. This is the first randomized, controlled trial comparing the manualized Mindfulness-Based Stress Reduction (MBSR) program with an active control for Generalized Anxiety Disorder, a disorder characterized by chronic worry and physiological hyperarousal symptoms. Ninety-three individuals with DSM-IV-diagnosed GAD were randomized to an 8-week group intervention with MBSR or to an attention control, Stress Management Education (SME) between 2009 and 2011. Anxiety symptoms were measured with the Hamilton Anxiety Scale (HAM-A, primary outcome measure), the Clinical Global Impression of Severity and Improvement (CGI-S and CGI-I), and the Beck Anxiety Inventory (BAI). Stress reactivity was assessed by comparing anxiety and distress during pre- and post-treatment Trier Social Stress Tests (TSST). A modified intent-to-treat analysis including participants who completed at least one session of MBSR (N=48) or SME (N=41) showed that both interventions led to significant reductions in HAM-A scores at endpoint, but did not significantly differ. MBSR, however, was associated with a significantly greater reduction in anxiety as measured by the CGI-S, the CGI-I, and the BAI (all Ps<0.05). MBSR was also associated with greater reductions than SME in anxiety and distress ratings in response to the TSST stress challenge (P<0.05), and a greater increase in positive self-statements (P=0.004). These results suggest that MBSR may have a beneficial effect on anxiety symptoms in GAD, and may also improve stress reactivity and coping as measured in a laboratory stress challenge.