Effects of MBSR and escitalopram on self-compassion in anxiety disorders

Self-compassion is recognized as important for psychological well-being and has been linked to reduced anxiety levels. Mindfulness-based interventions, such as the 8-week Mindfulness-Based Stress Reduction program (MBSR), have shown promise in treating anxiety disorders, but no studies to date have compared the effects of MBSR to the gold-standard medication treatment (escitalopram) on self-compassion or its subscales. The primary aim of this study was to examine the effects of MBSR versus escitalopram on self-compassion (total score and subscales) in adults with anxiety disorders.

We conducted a comparative effectiveness trial, delivering escitalopram versus MBSR virtually over 8 weeks for anxiety disorders in 198 adults. We assessed the impact of each treatment on self-compassion and its subscales using the Self-Compassion Scale. Baseline group differences were tested using chi-square tests for categorical variables and t-tests for continuous variables. We used longitudinal mixed-effects models to test whether MBSR produced greater improvements in self-compassion than escitalopram at each assessment point.

Contrary to our hypothesis, MBSR did not demonstrate greater improvement in self-compassion compared to escitalopram at each assessment point. All domains of self-compassion improved over time when across treatment groups. Additionally, both treatment groups showed improvements in most subscales. Two of the subscales showed differences in response by treatment group. In the mixed model predicting the Common Humanity subscale, participants in the MBSR group evidenced an improvement in Common Humanity over time whereas the escitalopram group remained relatively unchanged in Common Humanity over time (Estimate = -0.34, t = -2.44, 95% CI = [-0.61, -0.06], p = 0.016). In the mixed effects model predicting Mindfulness, the MBSR group evidenced greater improvement in Mindfulness between baseline and post-treatment than the escitalopram group (Estimate = -0.26, t = -2.05, 95% CI = [-0.51, -0.01], p = 0.042).

Although meditation was not generally superior to medication for improving self-compassion among individuals with anxiety disorders, several significant improvements were found across both interventions, and meditation may be more effective for promoting two self-compassion subscales-mindfulness and common humanity. MBSR's facet-specific benefits support its use where enhancing self-relational capacities is a treatment priority.