Effects of mindfulness meditation and citalopram on worry and brain activation in patients with Generalized Anxiety Disorder(GAD)

Anthony B.

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Effects of mindfulness meditation and citalopram on worry and brain activation in patients with Generalized Anxiety Disorder(GAD)

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Abstract

Generalized anxiety disorder (GAD) is a type of anxiety disorder that affects over four million Americans in any year (NIMH, 2000). There is much research that shows anxiety can lead to a magnitude of health ailments, including cardiovascular disease, hypertension, suppressed immune system, and depression (Krisanaprakornkit et al., 2006). For this study, functional magnetic imaging (fMRI) and self-report questionnaires will be used to measure the effects of auditory statements describing a personal worry in patients with GAD before and after anxiety therapy with citalopram - a serotonin reuptake inhibitor (Hoehn-Saric, Schlund, and Wong, 2004) - mindfulness-based meditation, or a combination of the two. Purpose: The purpose of this research proposal is to investigate the efficacy of mindfulness-based stress reduction (MBSR) as a treatment for generalized anxiety disorder and determine how it compares with the effectiveness of anxiolytic therapy (citalopram).

Introduction and statement of the problem
Background and significance (review of the literature)
Research design and methods
Treatment protocol
1. Citalopram and the Mindfulness Based Stress Reduction (MBSR) program
Timetable
References

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[...] Journal of Clinical Psychiatry 49, 293–301 Hoehn-Saric Schlund MW and Wong SHY (2004) Effects of citalopram on worry and brain activation in patients with generalized anxiety disorder. Psychiatry Research: Neuroimaging 131:11-21 Kabat-Zinn J (1990) Full catastrophe living: using the wisdom of your body and mind to face stress, pain and illness. New York: Delacorte Kabat-Zinn Massion AO, Kristeller Peterson LG, Fletcher KE, Pbert Lenderking WR and Santorelli SF (1992) Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. [...]

[...] Archives of General Psychiatry 50, 884–895 Speca Carlson LE, Goodey Angen M (2000) A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med 62:613–22. Spielberger CD (1983) State-Trait Inventory. Palo Alto, CA: Consulting Psychologists Press Spielberger CD, Gorsuch RL and Lushene RE (1970) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo Alto, CA Tacón AM, McComb Caldera Y and Randolph P (2003) Mindfulness meditation, anxiety reduction, and heart disease. [...]

[...] In addition, a booklet containing information relevant to each weeks instruction, including a bibliography for those wishing to pursue relevant themes in greater depth, and an audiotape with a relaxation induction program on one side and a guided meditation on the other. A fundamental principle unifying the program components is that management of awareness (i.e., mindfulness) can have lasting benefits relating to the control of anxiety in the future (Speca et al., 2000). Changes in self-ratings of anxiety/tension versus relaxation and ratings of discomfort versus pleasantness before the scans (baseline), and, retrospectively, while hearing the ‘worry' or ‘neutral' sentence will be examined. [...]

[...] Results of previous investigations suggest citalopram is effective in the treatment of a variety of anxiety disorders, including generalized anxiety disorder (Varia and Rauscher, 2002). Design: Functional magnetic resonance imaging (fMRI) will be conducted at Emory University on a Siemens Trio 3T scanner. Activation will be assessed based on blood oxygenation level-dependent (BOLD) response. The stimuli will consist of two auditory statements, a ‘neutral' statement and an individualized ‘worry' statement. Auditory stimuli will be presented to subjects through headphones during imaging. [...]

[...] Before this study, there was limited research that mostly employed positron emission tomography (PET) to examine patients with GAD (Buchsbaum et al., 1987; Wilson and Mathew, 1993; Wu et al., 1991); still, even those few studies did not focus on excessive worrying, the most prominent symptom of GAD. Hoehn-Saric, Schlund, and Wong suggested that exposure to personal worry may be the clinically most appropriate symptom provocation to investigate patients with GAD (2004). Furthermore, relaxation therapy is a common behavioral approach to treat anxiety which emphasizes the development of a relaxation response to counteract the stress response of anxiety. [...]

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