Anxiety disorders are linked to heightened startle responses during unpredictable threat, a physiological marker called anxiety-potentiated startle (APS). In a study of 93 individuals with anxiety disorders and 66 healthy controls, APS was higher in the anxious group at baseline. After eight weeks of treatment with either escitalopram or mindfulness-based stress reduction, both treatment groups showed significantly greater reductions in APS compared to controls, with patients' APS levels falling into the range of healthy individuals. Fear-potentiated startle (FPS), a response to predictable threat, did not differ between groups at baseline nor change with treatment. These results validate APS as a biological correlate of pathological anxiety and provide evidence that mindfulness-based stress reduction can alter anxiety-related neurocircuitry similarly to medication.
For adults with anxiety disorders, Mindfulness-Based Stress Reduction (MBSR) delivered via videoconference was comparably effective to in-person MBSR, but MBSR-VC did not meet the threshold for non-inferiority compared to the antidepressant escitalopram (ESC) delivered by videoconference. In a randomized controlled trial with 202 participants, MBSR-VC and ESC-VC showed similar average improvement on the Clinical Global Impression of Severity scale (1.39 vs 1.51 points), but non-inferiority was not supported. In-person treatments had a greater impact on social anxiety than their video versions. ESC-VC received higher satisfaction ratings and had a greater effect on panic symptoms than MBSR-VC. Remotely delivered MBSR is a viable option for anxiety disorders, though social anxiety may benefit more from in-person care.