A comparison of Online, In-Person Mindfulness Based Stress Reduction (MBSR) Programs, and First-Line Medication (Escitalopram) Therapy and their impact on Sleep Quality among persons with Anxiety Open Access

Abstract

Rationale: There is a need to identify the effectiveness of interventions for anxiety and the impact on sleep. This study sought to examine MBSR and Escitalopram treatments in a clinical trial of anxiety diagnosed patients. This analysis compares treatment effectiveness exploring changes in sleep outcomes between the in-person and online phases.

Methods: Between June 2018 and February 2022, anxiety-diagnosed patients participated in a randomized clinical trial, Treatments for Anxiety: Meditation and Escitalopram (TAME), comparing Mindfulness Based Stress Reduction (MBSR) interventions to Escitalopram. The first half, conducted in-person, demonstrated both treatments as equally effective to reduce anxiety symptoms. Evaluations were conducted in-person or online, per study phase. Due to the COVID-19 pandemic, the interventions transitioned online. The 275 in-person cohort and 202 online cohort participants were randomized 1:1 with a respective 208 and 150 total participants completing the protocol. The 8-week exposures to each treatment were compared in a single blind, randomized clinical trial at baseline and weeks 4, 8, 12, and 24. Participants were examined with CGI-S, PROMIS-T Sleep Disturbance, and PSQI questionnaires.

Results: The mean CGI-S score reductions after 8-weeks of exposure were 1.35 for in-person MBSR, 1.43 for in-person Escitalopram, 1.18 for online MBSR, and 1.63 for online Escitalopram. The mean difference between online treatment groups was 0.45 (p=0.01) with greater reductions from the Escitalopram group. Although the online score difference was significant compared to the in-person equivalent (p=0.03), the change from baseline was insignificant (p=0.22). The two MBSR cohorts had no significant score difference effects over the measured periods.

All treatments and cohorts significantly decreased PROMIS-T Sleep Disturbance and PSQI at the conclusion of the study (p=<0.01). Using PROMIS-T, the sleep score differences between the MBSR groups were significantly different (p=0.03) at the week 8 study endpoint with a mean difference of 2.09. However, no other score differences between treatment type or exposure method during the duration of the study were significant.

The model development of PROMIS-T Sleep Disturbance and PSQI score changes during the study determined CGI-S difference was significantly associated with sleep improvement outcomes.

Conclusion: Although CGI-S differences were noted between the online exposed Escitalopram group with lower reductions compared to other treatment exposures, sleep disturbance changes remained similar for each exposure group. CGI-S reductions significantly lowered sleep disturbance across all exposures and models though treatment and in-person exposures were not significant.

Table of Contents

Table of Contents

Introduction……………………………………………………………………………….…1-2

Literature Review…………………………………………………………………………...2-21

Anxiety Background & Overview…………………………….……………………...3-8

Anxiety Treatment…………………………………………………………………….8-12

Anxiety and Sleep……………………………………………………………….…...12-14

In-person and Online Anxiety Treatment and Education Comparison……………….14-16

Comparative Anxiety Treatment and Sleep Studies…………………………...…….16-21

Materials & Methods………………………………………………….……………………21-25

           Study Design………………………………………………………………………….21-22

           Interventions………………………………………………………………………....22-23

Outcomes…………………………………………………………………………….….23

Data Analysis………………………………………………………………………....24-25

Results……………………………………………………………………………………….25-50

           Background and Demographic Data………………………………………………….25-29

           Part 1: Online and In-person Anxiety CGI-S Change by Treatment Exposure…...….30-33

Part 2: Anxiety Treatment Impact on PROMIS-T Sleep Disturbance and PSQI Sleep Scores…….………………………………………………………………………...…33-42

Part 3: Model Development for Sleep PROMIS-T Sleep Disturbance and PSQI Scores with Treatment and CGI-S Change…….……………….……………………………42-50

Discussion……………………………………………………………………………………50-56

Conclusion………………………….……………………………………………………….57-58

References……………………………………………………………………………….….59-66

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health Health Sciences, Mental Health
Keyword	Anxiety Treatment MBSR Escitalopram Anxiety Sleep
Committee Chair / Thesis Advisor	Victoria Pak, Emory University

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