The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder

Hoge, Elizabeth A.; Bui, Eric; Palitz, Sophie A.; Schwarz, Noah R.; Owens, Maryann E.; Johnston, Jennifer M.; Pollack, Mark H.; Simon, Naomi M.

doi:10.1016/j.psychres.2017.01.006

Cited by 193Mindfulness and Compassion InterventionsStress Responses and CortisolAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder

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Hoge, Elizabeth A., Bui, Eric, Palitz, Sophie A., Schwarz, Noah R., Owens, Maryann E., Johnston, Jennifer M., Pollack, Mark H., Simon, Naomi M.·2018·Psychiatry Research

DOI 10.1016/j.psychres.2017.01.006PMC PMC5526744

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Abstract

Mindfulness-Based interventions have increased in popularity in psychiatry, but the impact of these treatments on disorder-relevant biomarkers would greatly enhance efficacy and mechanistic evidence. If Generalized Anxiety Disorder (GAD) is successfully treated, relevant biomarkers should change, supporting the impact of treatment and suggesting improved resilience to stress. Seventy adults with GAD were randomized to receive either Mindfulness-Based Stress Reduction (MBSR) or an attention control class; before and after, they underwent the Trier Social Stress Test (TSST). Area-Under-the-Curve (AUC) concentrations were calculated for adrenocorticotropic hormone (ACTH) and pro-inflammatory cytokines. MBSR participants had a significantly greater reduction in ACTH AUC compared to control participants. Similarly, the MBSR group had a greater reduction in inflammatory cytokines' AUC concentrations. We found larger reductions in stress markers for patients with GAD in the MBSR class compared to control; this provides the first combined hormonal and immunological evidence that MBSR may enhance resilience to stress.

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Anxiety reduction is associated with improved emotional resilience and concentration.
“Hoge et al. (2018) have shown that anxiety reduction is associated with improved emotional resilience and concentration.”
From The influence of teacher-guided mindfulness practice on inter and intra-personal abilities among Israeli Arab students (2024) · cites this paper as Hoge et al., 2018
The Introduction (page unavailable) reports a greater drop in anxiety ratings with mindfulness training, and the Discussion (page unavailable) says the findings suggest improved resilience to stress in patients with generalized anxiety disorder. The paper does not report improved concentration or establish that individual reductions in anxiety were associated with improved resilience. (LLM, conf=0.86)
Experimental — accuracy not yet measured
A similarly sized trial of mindfulness-based stress reduction for generalized anxiety disorder showed reductions in TNF-α, IL-6, and ACTH, but TNF-α was measured in the context of the Trier Social Stress Test, and this was interpreted as greater stress resilience.
“A similarly sized trial of mindfulness-based stress reduction for generalized anxiety disorder did show reductions in TNF-α, although TNF-α was measured in the context of a challenge, the laboratory-based Trier Social Stress Test (TSST). Similar differences were observed for interleukin-6 and adrenocorticotropic hormone (ACTH). This was interpreted as a greater increase in stress resilience, as”
From One-day acceptance and commitment therapy (ACT) workshop improves anxiety but not vascular function or inflammation in adults with moderate to high anxiety levels in a randomized controlled trial. (2021) · cites this paper as [44]
Mindfulness was assessed with the Five Facets of Mindfulness Questionnaire, a 39-item self-report measure of dispositional mindfulness.
“Mindfulness was assessed using the Five Facets of Mindfulness Questionnaire (FFMQ), a 39-item self-report measure of an individual’s tendency to be mindful in daily life.25”
From Mindfulness, Anxiety Symptoms, and Quality of Life in Heart Failure. (2020) · cites this paper as [25]
The Methods (sections 2.1–2.3; page unavailable) describe baseline questionnaires, the stress test, and the interventions, but do not identify the Five Facets of Mindfulness Questionnaire. Searches for FFMQ, its 39 items, and dispositional mindfulness found no passage in our copy describing the measure or saying it was used. (LLM, conf=0.72)
Experimental — accuracy not yet measured
This study builds on previous research that indicates that mindfulness-based interventions delivered in-person can decrease anxiety in individuals with moderate to severe anxiety and decrease physician burnout.
“This study builds on previous research that indicates that mindfulness-based interventions delivered in-person can decrease anxiety in individuals with moderate to severe anxiety (eg, generalized anxiety disorder) and decrease physician burnout [20,28,45,46].”
From Physician Anxiety and Burnout: Symptom Correlates and a Prospective Pilot Study of App-Delivered Mindfulness Training (2020) · cites this paper as [45]

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“Diver-gent results were obtained in generalized anxiety disorder (GAD) patients who demonstrated cortisol habituation from TSST1 to TSST2, regardless of whether they were assigned to an eight-week MBSR intervention or an active control group (Hoge et al., 2018).”
Influential
Mindfulness versus Physical Exercise: Effects of Two Recovery Strategies on Mental Health, Stress and Immunoglobulin A during Lunch Breaks. A Randomized Controlled Trial
Díaz‐Silveira, C., de la Hera, C. M. A., Burgos, F., Marcos, A., & Germán, M. Á. S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17082839 · Cited by 33 · see citing works
Psychoneuroendocrinoimmunology-based meditation (PNEIMED) training reduces salivary cortisol under basal and stressful conditions in healthy university students: Results of a randomized controlled study
Bottaccioli, A. G., Bottaccioli, F., Carosella, A., Cofini, V., Muzi, P., & Bologna, M. (2019) · EXPLORE · doi:10.1016/j.explore.2019.10.006 · Cited by 32 · see citing works
Effects of Psychological or Exercise Interventions on Problematic Mobile Phone Use: a Systematic Review and Meta-analysis
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Evaluation of plasma cytokines in patients with cocaine use disorders in abstinence identifies transforming growth factor alpha (TGFα) as a potential biomarker of consumption and dual diagnosis
Maza-Quiroga, R. M., García‐Marchena, N., Romero‐Sanchiz, P., Barrios, V., Pedraz, M., Serrano, A., Nogueira‐Arjona, R., Ruiz, J. J., Soria, M., Campos, R., et al. (2017) · PeerJ · doi:10.7717/peerj.3926 · Cited by 30 · see citing works
Mindfulness based art therapy study protocol to determine efficacy in reducing college stress and anxiety
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Emotion Regulation as a Pathway Connecting Early Life Adversity and Inflammation in Adulthood: a Conceptual Framework
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Associations Between Global Mental Health and Response to an App-Based Meditation Intervention in Myeloproliferative Neoplasm Patients
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Does inflammation link stress to poor COVID‐19 outcome?
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Comparative efficacy of psychological interventions on immune biomarkers: A systematic review and network meta-analysis (NMA)
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A Randomized Controlled Trial of a Mindfulness-Based Weight Loss Intervention on Cardiovascular Reactivity to Social-Evaluative Threat Among Adults with Obesity
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Transcendental meditation and hypothalamic-pituitary-adrenal axis functioning: a pilot, randomized controlled trial with young adults
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Impact of Heartfulness meditation practice on anxiety, perceived stress, well-being, and telomere length
Thakur, M. K., Patil, Y., Philip, S. T., Hamdule, T., Thimmapuram, J., Vyas, N., & Thakur, K. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1158760 · Cited by 27 · see citing works
Psychedelic Science, Contemplative Practices, and Indigenous and Other Traditional Knowledge Systems: Towards Integrative Community-Based Approaches in Global Health
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Underlying mechanisms of mindfulness meditation: Genomics, circuits, and networks
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Background
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Only Small Effects of Mindfulness-Based Interventions on Biomarker Levels of Inflammation and Stress: A Preregistered Systematic Review and Two Three-Level Meta-Analyses
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An 8‐Week Relaxation Program Consisting of Progressive Muscle Relaxation and Mindfulness Meditation to Reduce Stress and Attenuate Stress‐Driven Eating
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Effects of Meditation and Yoga on Anxiety, Depression and Chronic Inflammation in Patients with Parkinson’s Disease: A Randomized Clinical Trial
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Trends of Research on Mindfulness: a Bibliometric Study of an Emerging Field
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Effect of aerobic exercise, slow deep breathing and mindfulness meditation on cortisol and glucose levels in women with type 2 diabetes mellitus: a randomized controlled trial
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Combined Mindfulness‐Based Stress Reduction and Exercise Intervention for Improving Psychological Well‐Being in Patients With Non‐Small Cell Lung Cancer
Wang, Y., Zhang, X., Wang, X., Zhang, Y., Jin, Y., & Li, W. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.3023 · Cited by 18 · see citing works
Effects of nonpharmacological interventions on depressive symptoms and depression among nursing students: A systematic review and meta-analysis
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Examining virtual meditation as a stress management strategy on college campuses through longitudinal, quasi-experimental research
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Examining the Mediating Role of Stress in the Relationship Between Mindfulness and Depression and Anxiety: Testing the Mindfulness Stress-Buffering Model
Valikhani, A., Kankat, L. R., Hariri, P., Salehi, S. M., & Moustafa, A. A. (2019) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-019-00321-7 · Cited by 15 · see citing works
The Mediating Role of Mindfulness in the Relationship between Self-Efficacy and Early Maladaptive Schemas among University Students
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Cognitive and Affective Benefits of a Mindful State in Response to and in Anticipation of Pain
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Efficacy of mindfulness to regulate induced emotions in the laboratory: A systematic review and meta-analysis of self-report and biobehavioral measures
Zangri, R. M., Andreu, C. I., Nieto, I., González-Garzón, A. M., & Vázquez, C. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104957 · Cited by 17 · see citing works
Game-Based Meditation Therapy to Improve Posttraumatic Stress and Neurobiological Stress Systems in Traumatized Adolescents: Protocol for a Randomized Controlled Trial
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Autonomic Dysregulation in Child Social Anxiety Disorder: An Experimental Design Using CBT Treatment
Asbrand, J., Vögele, C., Heinrichs, N., Nitschke, K., & Tuschen‐Caffier, B. (2022) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-022-09548-0 · Cited by 13 · see citing works
Predictors of Mindfulness Meditation and Exercise Practice, from MEPARI-2, a randomized controlled trial
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Addressing the biological embedding of early life adversities (ELA) among adults through mindfulness: Proposed mechanisms and review of converging evidence
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White matter microstructure and serum biomarkers of inflammation in psychogenic non-epileptic seizures
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Mindfulness-based stress reduction combined with early cardiac rehabilitation improves negative mood states and cardiac function in patients with acute myocardial infarction assisted with an intra-aortic balloon pump: a randomized controlled trial
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Randomized Controlled Trial of Mindfulness Meditation for Generalized Anxiety Disorder: Effects on Anxiety and Stress Reactivity
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The effectiveness of mindfulness-based stress reduction on intolerance of uncertainty and anxiety sensitivity among individuals with generalized anxiety disorder
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Authors: Hoge, E. A., Bui, E., Palitz, S. A., Schwarz, N. R., Owens, M. E., Johnston, J. M., Pollack, M. H., & Simon, N. M.
Affiliations: Georgetown University Medical Center (US)
Massachusetts General Hospital (US)
Boston University (US)
Rush University Medical Center (US)
Harvard University (US)
Corresponding author: Hoge, Elizabeth A.
ORCID: Hoge, Elizabeth A.
Palitz, Sophie A.
Schwarz, Noah R.
Pollack, Mark H.
Simon, Naomi M.
Venue: Psychiatry Research
Publisher: Elsevier BV
Published: 2018-04
Volume: 262
Pages: 328-332
ISSN: 0165-1781 (ISSN-L)
DOI: 10.1016/j.psychres.2017.01.006
PMC: PMC5526744
OpenAlex: W2581630748
Cited by: 193
References: 38
Citations by year: 2026: 8 · 2025: 16 · 2024: 15 · 2023: 28 · 2022: 24 · 2021: 30 · 2020: 27 · 2019: 25 · 2018: 14 · 2017: 6
FWCI: 24.36
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Psychiatry Research (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: American Foundation for Suicide Prevention
Harvard University
Harvard Catalyst
National Center for Research Resources (UL1RR025758)
National Center for Complementary and Integrative Health (K23AT004432, L30 AT005427)
Topics: Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: mindfulness meditation, mindfulness-based stress reduction, generalized anxiety disorder, acute stress response, Trier Social Stress Test, ACTH, inflammatory cytokines, stress resilience, biomarkers, neuroendocrine stress response, inflammation
MeSH terms: Adaptation, Psychological, Adrenocorticotropic Hormone, Adult, Anxiety Disorders, Arousal, Female, Humans, Male, Middle Aged, Stress, Psychological, Tumor Necrosis Factor-alpha, Interleukin-6, Meditation, Mindfulness

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The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder

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