Telemedicine refers to the remote delivery of medical or health-related treatment through the Internet. It has become increasingly common and acceptable since the COVID pandemic. It is especially useful when travel to a treatment-delivery site is difficult or inconvenient. Research studies are beginning to employ videoconference-delivered mindfulness training as a treatment of convenience. It allows patients to receive treatment in the comfort of their own homes without requiring travel time. Little is known, however, about whether videoconferencing Mindfulness-Based Stress Reduction (MBSR) is as effective as traditional in-person MBSR. 

In the initial phase of a study, Hoge et al. [Journal of Affective Disorders] tested the efficacy of traditional MBSR compared with in-person medication management with escitalopram for anxiety disorders. The previously published results of the initial phase of the trial showed that MBSR was non-inferior to escitalopram. “Non-inferiority” is a technical term meaning an intervention is not unacceptably worse than a comparison treatment, although it does not imply treatment equivalence. Before the initial phase results were analyzed, the COVID pandemic regulations forced the researchers to shift the study to remote, synchronous videoconferencing. This allowed them to compare the efficacy of escitalopram and MBSR when delivered remotely and in person.

In the second phase of the study, 202 adults with clinically diagnosed anxiety disorders (average age = 35 years old; 76% female; 71% White) received random assignment of MBSR by videoconference (MBSR-VC) or videoconference-delivered escitalopram medication check-ins (escitalopram-VC). This second-phase cohort was then compared to the first-phase cohort of 276 adults with anxiety disorders (average age = 33 years; 75% female; 60% White) who received traditional MBSR or in-person escitalopram medication check-ins. 

The primary outcome was self-reported anxiety, assessed at baseline, mid-intervention, post-intervention, and at 1- and 3-months following the intervention. Secondary outcomes included self-reported social anxiety and panic disorder, and participants completed satisfaction surveys. MBSR followed the standard format of eight weekly 2.5-hour group sessions, a day-long retreat, and intensive home practice.

The results showed no significant difference in score improvement between MBSR-VC and remote escitalopram-VC on the primary anxiety measure at post-treatment. A statistical test of MBSR-VC non-inferiority to escitalopram-VC proved inconclusive. This was because, although the observed difference between the groups’ scores was small and below the prespecified non-inferiority margin, the upper boundary of the margin of error slightly exceeded that margin.

Despite the lack of group difference on the primary anxiety measure, participants in the escitalopram-VC group experienced significantly greater improvement on the secondary measure of panic attacks, and treatment satisfaction was significantly higher for the escitalopram-VC group (85 vs. 78 on a 100-point scale) than for the MBSR-VC group.

There was no significant difference in improvement on the primary anxiety scores between MBSR-VC and traditional MBSR, and MBSR-VC was found to be non-inferior to traditional MBSR. However, social anxiety symptom scores improved more in the traditional MBSR group than in the MBSR-VC group. Additionally, the MBSR group engaged in significantly more home practice (694 minutes) than the MBSR-VC group (478 minutes).

While the amount of MBSR-VC home practice was not significantly associated with symptom improvement, it was significantly associated in the traditional MBSR group. The escitalopram-VC group had better outcomes than the in-person escitalopram group at post-treatment and 1- and 3-month follow-ups.

The study suggests that although traditional MBSR did not prove non-inferior to ESC-VC, their outcomes on the primary anxiety measure did not differ significantly. Further, MBSR-VC was found to be non-inferior to traditional MBSR. The study suggests videoconference-delivered MBSR is an acceptable substitute for in-person MBSR for patients with generalized anxiety and panic disorder, but not for those with social anxiety.

The study is limited because assignment to videoconference and in person groups was not random. Synchronous videoconferencing involves real-time engagement with a group and teacher, thus results of this study are not generalizable to asynchronous telemedicine mindfulness modules that lack real-time interpersonal engagement.

Reference:

Hoge, E. A., Mete, M., Baker, A. W., Szuhany, K. L., Armstrong, C. H., Steinberg, M. H., Dutton, M. A., Bui, E., & Simon, N. M. (2025). A randomized controlled trial comparing mindfulness to escitalopram for anxiety: In-person and remote, synchronous delivery pre and post COVID-19 pandemic. Journal of Affective Disorders. 

Link to study