new research reveals 30 critiques

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05-02-2023 STRONG FEMALE LEAD

New research reveals the 30 critiques holding women back from leadership that most men will never hear

Three female PhDs say their research demonstrates that practically any characteristic can be proclaimed problematic to question a woman’s competence and suitability for leadership.

[Images: akinbostanci/Getty Images; Leontura/Getty Images]

BY  Amber L. Stephenson ,  Amy Diehl ,  and  Leanne M. Dzubinski 6 minute read

A recent study of the 33 biggest multilateral institutions found that of 382 leaders in their history only 47 have been women. And the percentage of women running Fortune 500 companies has only just recently crested a meager 10%.

As researchers we wondered why institutions consistently fail to promote women to top jobs. Our recent study of 913 women leaders from four female-dominated industries in the U.S. (higher education, faith-based nonprofits, law, and healthcare) sheds light on this pernicious problem. As we found, there’s always a reason why women are “never quite right” for leadership roles.

Women are criticized so often and on so many things that they are acculturated to receiving such disparagement, taking it seriously, and working to make improvements. And any individual woman may take it personally, believing the criticism directed at her to be warranted.

But our research reveals that the problem lies elsewhere. Virtually any characteristic can be leveraged against a woman in a discriminatory fashion. Such criticisms often relate to facets of women’s identity in an overt or subtle way, such as race , age , parental status , attractiveness , and physical ability .

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30 Criticisms That Hold Women Leaders Back, According to New Research 

Lauryn higgins.

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While women have been making strides in the fight for gender equity and equality in the workplace for decades, they still continue to earn less, face discrimination, and struggle to be promoted to top leadership positions. 

Researchers Amy Diehl , Ph.D., Leanne Dzubinski, Ph.D., and Amber Stephenson, Ph.D. set out to understand why this is. What they found was that women can be criticized, critiqued, and held back in their careers for virtually any reason. 

Their study looked at 913 women leaders in four female-dominated fields—higher education, faith-based nonprofits, law, and healthcare—since gender bias research often focuses on male-dominated fields, such as STEM. 

Using a measurement tool they previously created called the Gender Bias Scale for Women Leaders, the researchers compared women leaders’ perceptions and experiences of bias. 

Their process involved asking open-ended questions, including what types of biases the leaders had faced in the workplace other than gender and what additional factors had influenced their work experiences.  

What they found were 30 common personality traits and identity-based characteristics that the women leaders reported were used against them at work. These were:

• Attractiveness
• Communication style
• Cultural identity
• Dietary restrictions
• Employment history
• Gender conformance
• Intellectual ability
• Marital status
• Nationality
• Occupational position
• Parental status
• Personality traits
• Physical ability
• Political preferences
• Residential location
• Sexual orientation
• Veteran status

A consistent challenge that emerged for women was their age, explains Diehl. Some reported being considered too young to lead, while others said being too old hindered them from advancing in their career. Parental status, choosing to have children or not, was another point of criticism for women. The report stated that a higher-education leader described how people assume she “can’t take on a bigger role ‘because of the kids,’” which made her feel that she needed “to work extra hard” to show that she could succeed as both a mother and leader.  “The sheer breadth of the different characteristics that women reported being criticized about highlights that it is socially normative for men to receive less criticism and scrutiny in the workplace compared to women, and reminds us of the persistent gender disparities in evaluation and expectations,” says Diehl.

The researchers found that there was no “sweet spot” where a woman could position herself without being criticized. Women were either too young or too old, too attractive or not attractive enough, too educated or not educated enough. Introverted women were not seen as leaders and extroverted women were viewed as aggressive. They ultimately found that women leaders were “never quite right.”

And while these problems not only affect women’s success in the workplace, businesses have a financial interest in ensuring gender equity. Organizations that fail to promote and support women in their top roles miss out on performance gains . 

Here are some steps she recommends to take if you are facing gender bias in the workplace:

1. Be prepared. Gender bias happens. Know about it, and know names for it, so when it happens to you or someone around you, you can name and identify what happened. Being able to name and identify what happened helps you process the experience. It also gives you vocabulary to report the incident if needed. 

2. Don’t take it personally. Gender bias is built into organizations, and it’s not personal to you. You didn’t cause it, and you aren’t responsible for it. People engaging in bias were socialized to think and behave that way. Give yourself permission to let it go instead of trying to figure out how to “fix yourself.”

3. Build a support network . Have people, inside and outside of work, who you enjoy being with. They can be a sounding board to discuss bias when it happens, and they can also be people who you enjoy and who help you disconnect from work. They may also be good connections if the time comes when you need options. 

5. Know your alternatives. Some workplaces just won’t improve, and the time may come when you need to make a change. That’s okay. Sometimes the best thing you can do for yourself is to walk away.

Like many issues of bias, gender-bias has the potential to persist, but can be counteracted through enhanced awareness and information, explains Stephenson , who is associate professor of management and director of healthcare management programs in the David D. Reh School of Business at Clarkson University. “Recognition and visibility of the problem are crucial to addressing it and mitigating its harmful effects.”

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New Research Reveals the 30 Critiques Holding Women Back From Leadership that Most Men Will Never Hear

Published on June 6, 2023

A recent study of the 33 biggest multilateral institutions found that of 382 leaders in their history, only 47 have been women. And the percentage of women running Fortune 500 companies has only just recently crested a meager 10%.

As researchers, we wondered why institutions consistently fail to promote women to top jobs. Our recent study of 913 women leaders from four female-dominated industries in the U.S. (higher education, faith-based nonprofits, law, and healthcare) sheds light on this pernicious problem. As we found, there’s always a reason why women are “never quite right” for leadership roles.

Women are criticized so often and on so many things that they are acculturated to receiving such disparagement, taking it seriously, and working to make improvements. And any individual woman may take it personally, believing the criticism directed at her to be warranted.

But our research reveals that the problem lies elsewhere. Virtually any characteristic can be leveraged against a woman in a discriminatory fashion. Such criticisms often relate to facets of women’s identity in an overt or subtle way, such as race , age , parental status , attractiveness , and physical ability .

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Hey bosses: Here’s what Gen Z actually wants at work

Amelia Dunlop & Michael Pankowski

• Workplace culture
• Diversity and inclusion

New research reveals a disconnect between what Generation Z  actually  wants at work and what their bosses  think  they want. As Gen Z increasingly enters the workforce, here are key challenges and gaps that leaders should address to support their newest generation of workers.

Who is Gen Z?

Gen Z is one of the main drivers of change in today’s workplace. Defined as the generation of individuals born between 1997 and 2012 (who in 2023 are between the ages of 10 and 25), Gen Z grew up with smartphones and social media, along with the associated conveniences and pitfalls. They are often the trendsetters, the trend-enders, the influenced, and the influential.

Gen Zers are no strangers to using their voices and the technology at their fingertips to shape the world around them. But as Gen Z enters a workforce dramatically altered by the pandemic, how does their impact translate to the workplace, and how can their bosses create a space for them to thrive?

We went right to the source and surveyed Gen Zers to better understand their perspectives. Do they really want it all? What can we learn from this generation about the future of work? New research from Deloitte Digital explores just this.

As the saying goes, “You don’t quit a job; you quit your boss.” If you work with Gen Z, we encourage you to read on and learn how to create a healthy and winning work experience for you, your employees, and your customers.

Where do Gen Z and their bosses lack alignment?

Our research found a number of areas where Gen Z workers and their bosses share priorities and a number of areas where they differ. Both groups, for example, place value on cultivating working relationships, flexibility in the workplace, and more. Despite these alignments, the survey data also reveals challenges between Gen Z and other generations. This insight provides a great opportunity for improvement and establishes the building blocks to develop fruitful relationships.

3 MAIN CHALLENGES FOR GEN Z AND THEIR BOSSES

1. CONTRASTING VIEWS ON THE IMPORTANCE OF EMPATHY

Gen Z workers highly value empathy from their bosses and consider it a prerequisite to engagement at work, but bosses do not place as high of a value on demonstrating empathy.

According to our research, Gen Zers ranked empathy as the second most important trait in a boss, while bosses ranked it, on average, a distant fifth.

We heard from Clara, a shift supervisor from Illinois who echoed our survey data when describing her experience working for a large wholesale retailer. “Our employee survey asks a question like, ‘Do you feel respected?’ and I thought to myself, ‘No!’ I have never gotten that respect since the management has more of a ‘Do your job and get it done’ mentality,” she said. She felt that the focus was more on productivity measures than who she is as a person.

2. DIVERGENT VIEWS ON THE IMPACT OF WORK ON MENTAL HEALTH

Gen Z workers feel that they are not getting the mental health support they need in the workplace and believe their ideas about how work impacts their mental health differ from those of their bosses.

Our survey uncovered that less than half of Gen Zers say their boss helps them maintain a healthy workload, and 28% say they struggle with their mental health because of their boss.

We connected with Alexa, a technical account manager, and she shared how easily work can become all-consuming—especially when you’re working from home. “I want to leave work at work and not feel like I have to think about it; I don’t want to feel overwhelmed,” said Alexa. Your workload impacts your mental health, and Alexa believes bosses can help Gen Zers maintain a healthy workload by providing support and engaging in purposeful conversations about their careers, interests, and skills.

3. DISPARATE VIEWS ON THE IMPORTANCE OF WORK TO PERSONAL IDENTITY

Gen Z workers and their bosses place different values upon work as part of their identities.

Our research found that 61% of Gen Zers already in the workforce feel that work is a significant part of their identity, while 86% of bosses say that work is a significant part of their identity.

We heard from Steve, a sales development rep, and he shared that the transition into the workforce not only impacts how he spends his time but also fundamental parts of his identity. “I’m struggling a lot with the idea of ‘you are not your job,’ because if I’m working all these hours in a week at my job then where does my job fall within my life? At first, I went into my job thinking it was just a paycheck, but now it may be something more,” he shared. Like Steve, many Gen Zers question the role of work in their overall identity, while for their bosses, it's much clearer that work is, indeed, a significant part of their identity.

Other areas that lack alignment include rewards and recognition, and training.

Without a concerted effort to understand the needs and motivations of Gen Z workers like Clara, Alexa, and Steve, bosses risk disconnected workers and increased attrition. Addressing these challenges is essential to help the Gen Z workforce remain productive, committed, and connected to their roles and teams. 

What can leaders do to bridge the gap with Gen Z?

The gap between a leader and their Gen Z employee may fall into one of three categories: a knowledge, alignment, or execution gap. A knowledge gap describes bosses not fully understanding what Gen Z wants. An alignment gap describes bosses understanding what Gen Z wants but disagreeing with them. An execution gap describes both groups agreeing that a change is necessary but lacking clarity on how to deliver that change.

Each of these gaps has different implications for what leaders and members of Gen Z can do to address them.

Our research reveals that more than 7 in 10 bosses are excited about the ways the workplace will change as Gen Z makes up an increasingly greater portion of it. So, what can a leader do to bridge these gaps?

• Get curious.  Explore a similar line of research with your workforce to understand what would elevate their experiences and build the trust of Gen Z specifically. 
• Connect. Be intentional about creating opportunities for connection between members of Gen Z and other generations.
• Co-create.  More than other generations, Gen Z wants to have their voices heard. They want agency to create a future that they find meaningful. Enlist their energy and problem-solving skills.
• Build a culture of reverse-mentoring. Many organizations typically have older employees who mentor Gen Zers. In the same way, leaders can promote a culture in which Gen Zers reverse-mentor their mentors, helping these more senior employees better understand Gen Z.
• Ask the influencers.  Tap into influential members of Gen Z inside and outside their organization to help test ideas and shape the future culture of the workforce.

What's next?

Each challenge and gap represents an opportunity to forge connections—a chance to craft the workplace of the future together. Above all, we can’t say that Gen Z wants it all, but we can say that they want to be seen for who they authentically are, heard, supported, and given the space and opportunity to thrive as they develop their personal and professional selves. To learn more about how bosses can take action to  elevate the experience  of Generation Z at work and how to apply this research to improve your intergenerational professional relationships, check out the full report below.

Amelia Dunlop   is the chief experience officer for Deloitte Digital, where she helps companies tackle their toughest problems and develop winning strategies that combine innovation, creativity, and digital strategy. Amelia is also the author of  Elevating the Human Experience: Three Paths to Love and Worth at Work  and co-author of  The Four Factors of Trust: How Organizations Can Earn Lifelong Loyalty—both bestselling books. She received Consulting Magazine’s 2020 Top Women in Technology Award for Excellence in Innovation. 

Michael Pankowski   is an analyst at Deloitte Digital. He is a thought leader on Gen Z and a co-author of the book  Engaging Gen Z: Lessons to Effectively Engage Generation Z Via Marketing, Social Media, Retail, Work, and School . He has presented on Gen Z at global and national conferences including PRWeek Connect, PRDecoded, and SportsPro OTT Summit USA, and his thought leadership on this space can be found in Ad Age, PRWeek, Forbes, Insider, and Money.com.

Geordie Marriner  is a senior consultant at Deloitte Digital. He is experienced in human-centered design, end-user research, and analytics and reporting. Geordie received an MS in Design Innovation and MBA from Northwestern University. 

Steven Hatfield  is a principal with Deloitte Consulting and serves as the global leader for Future of Work for the firm. He has more than 20 years of experience advising global organizations on issues of strategy, innovation, organization, people, culture, and change. Hatfield has significant experience in bringing to life the ongoing trends impacting the future of work, workforce, and workplace.

Kristin Starodub  is a principal within Deloitte’s Human Capital practice. She thrives on designing and delivering large, complex, global human capital and workforce experience transformation solutions by more strategically leveraging modern workforce technology solutions. 

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Research Revealed

You never know how a discovery may affect future research—and as much as they try to anticipate the contribution or future application of a paper, neither do editors.

When journals only focus on significance of advance and priority of discovery, valuable information is excluded from the scientific record. Rigorous research that adds supporting evidence, re-examines and broadens our understanding leads to a stronger foundation of knowledge. But without the right ways to share it, many important insights could remain hidden from public view, buried in filing drawers and hard drives. 

At PLOS, we’re committed to helping researchers share more of their science—including contributions that might otherwise be excluded from the scientific record. We use journal policy, specialized articles types, and unique editorial selection criteria to help ensure that important advances receive the respect and attention they deserve. Here’s how:

1. The PLOS-wide Complementary Research (or “Scooping”) Policy

Sometimes, two research groups independently achieve similar results around the same time. When that happens, it can be difficult for the second group to publish their work, because it may no longer meet the novelty requirements for selective journals.

At PLOS, we see complementary findings as a positive, reinforcing the validity of both studies. That’s why all of our journals—even the most selective—offer scooping protection to ensure that complementary results will not be rejected for novelty within six months of a similar preprint or publication by another group.

Read more about the PLOS Complementary Research Policy .

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What's your "scooping" experience?

2. registered reports and preregistered research articles.

Preregistration is the practice of formally depositing a study design in a repository and submitting it for peer review at a journal prior to conducting experiments, data collection or analysis. Evaluating study designs supports a strong methodological approach, increases the credibility and reproducibility of results, and helps address publication bias. Accepted study design protocols receive a provisional acceptance for the future research article reporting the results—so researchers can proceed with the study knowing that the work will be publishable, no matter the outcome. Preregistration can be especially beneficial for Early Career Researchers, and anyone conducting high risk/high reward research. PLOS offers two options for researchers seeking to preregister their work: Registered Reports ( PLOS ONE ) and Preregistered Research Articles ( PLOS Biology ). 

Read more about the value of preregistered research .

“Preregistering the analysis that you’re going to do beforehand doesn’t mean that you can’t do exploratory analysis later, but it does mean that people know what you’re actually going to do before you do it. And it means that you’ve had to think through that process.”

Mark Williams, Macaquarie University, Academic Editor, PLOS ONE

Will you preregister your research?

3. incremental advances, negative, and null results.

With all the pressure to publish exciting and impactful new results, incremental advances, negative and null outcomes can get left behind—and left out of the scientific record. Over the long term, this creates knowledge gaps in the literature that can undermine credibility, slow progress, and waste resources.

Small advances, negative outcomes, and inconclusive results do matter. Seemingly minor findings can have major impacts down the line. Small discoveries can plant the seeds for future investigations. In demonstrating what doesn’t work, negative and null results can point the way toward alternative solutions which may prove more effective—not to mention saving other research groups time and resources.

All PLOS journals will consider meaningful negative and null outcomes if the research question they answer is sufficiently relevant to the field—but we also publish several journals that make incremental, negative and null results essential to their mission and editorial vision: PLOS ONE , PLOS Global Public Health , PLOS Climate , and PLOS Water .   Each of these journals is built on the editorial philosophy that all rigorous, well-conducted research has value, and should be preserved as a part of the permanent scientific record—including replication studies, as well as negative, and inconclusive results.

Read more about PLOS ’s approach to negative and null results .

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Yvonne Fondufe-Mittendorf, University of Kentucky

Should all research be shared?

4. that hard-to-place research article.

Interdisciplinary research and studies from emerging fields can be difficult to place in many field-specific journals. Small or specialized editorial boards may lack the expertise necessary to evaluate the work from different angles, scope may rule some excellent research out if it is perceived to be on the edge of the field.  PLOS ONE ensures this research finds a home and is discoverable to readers everywhere. Because of the journal’s inclusive scope, commitment to rigor instead of novelty or impact, and our broad network of editorial board members with expertise in more than 200 disciplines, all research in the sciences and related disciplines can be evaluated and shared with readers around the world.

Read more about PLOS ONE ’s scope .

“My questions are often much bigger than I can answer. Our PLOS ONE  article …  required molecular geneticists, population ecologists in Eurasia and North America, geographical statisticians, climate ecologists, and worldwide citizen scientists. True interdisciplinary research is rare. Few reviewers are available with the proper mindset, but reviewers and editors with these views are critical to the success of these papers. “

Beth Middleton, US Geological Survey, Wetland and Aquatic Research Center

Is your research cross-disciplinary?

Bonus: ensuring research reaches the broadest audience.

Even when published, research may remain out of view from audiences who need it. Broadly, Open Access licensing, article promotion and indexing all help ensure published (or preprinted!) research is available to as many people as possible. But where and how research is shared still shapes who sees it.

Many journals are built with a specific community in mind, catering to researchers in a specific field as both authors and readers eager to stay up-to-date on progress from their peers or dive deeper into discoveries and techniques that directly impact their own research. These journals are helpful spaces for building networks and sparking discussions that accelerate progress in a given field—but some topics are too big to tackle from within just one discipline or have far-reaching implications beyond a single field of study.

Multidisciplinary journals bring different viewpoints, skillsets and analytical approaches together, encouraging collaboration and conversation amongst research groups and decision-makers working to solve similar challenges. Many of our journals consider multi- or inter- disciplinary research in order to present a robust view of the field and it is a centerpiece of the mission for PLOS Climate, PLOS Global Public Health, and PLOS Water. These journals bridge gaps between related fields, consider social, economic, and behavioral factors that affect these issues, and bring regional perspectives together to address global challenges. By bringing together this work in a single venue, readers get a more holistic view of the topics and challenges in these areas, and how they might inform each other to foster more creative solutions, robust decision-making, or deepen existing knowledge.

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Are there more ways PLOS could help to facilitate the sharing of high quality research that would ordinarily remain hidden? Share your thoughts in the comments.

Written by Veronique Kiermer and Iain Hrynaszkiewicz Earlier this month the Open Science Monitoring Initiative shared a draft of Open Science monitoring…

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30 New Books Critics Think You Should Read Right Now

Nbcc board members review this year’s nbcc award finalists.

Every year, in the weeks leading up to the National Book Critics Circle Awards, the NBCC board members take the time to  review and appreciate  the  thirty finalists , recognized in Autobiography, Biography, Criticism, Fiction, Nonfiction, and Poetry. Needless to say, these thirty books make a pretty good reading list.

This year’s National Book Critics Circle Awards will be held at the New School in New York City on March 21. In the meantime, see what the NBCC’s board members have to say about all of the finalists below:

AUTOBIOGRAPHY

Susan Kiyo Ito, I Would Meet You Anywhere: A Memoir (Mad Creek Books, an imprint of The Ohio State University Press)

Susan Ito’s heart-rending and courageous memoir holds a secret at its core. At nineteen, as a transracial adoptee raised by nisei parents, she sleuths out the identity of her Japanese-American birth mother, defying laws that keep adoption records sealed. Their fraught first meeting is the beginning of decades of emotional ebbs and flows, as Ito’s biological mother cuts off contact with her repeatedly to maintain anonymity and avoid naming the man who fathered her. What sustains Ito: Marriage, motherhood, advocating for adoptees, and writing her own story. I Would Meet You Anywhere illuminates the complexities of identity, family, and belonging.

David Masumoto, with artwork by Patricia Wakida, Secret Harvest: A Hidden Story of Separation and the Resilience of a Family Farm (Red Hen Press)

Secret Harvests limns the compounded tragedy of the Japanese internment for one family, when a cognitively disabled member, herself disabled via the racism of inadequate medical care–was separated and “lost” to the family during World War II. David Mas Masumoto uncovers the smallest thread of the story and achieves the seemingly impossible feat of reconnecting the lost family member whose story had been lost to racism but also family shame. In stark, stunning prose combined with Patricia Wakida’s evocative woodcut prints, Secret Harvests manages to take absence and turn it into presence, illuminating the hard-won resilience and joys as well as the darker corners of the author’s family history—and that of our nation as well.

Ahmed Naji, translated by Katharine Halls, Rotten Evidence: Reading and Writing in an Egyptian Prison (McSweeney’s)

Ahmed Naji’s eloquent, and at times searingly funny, memoir of his time spent in an Egyptian prison, Rotten Evidence , reveals the importance of literature as a form of self-liberation. Naji was convicted of “violating public modesty” after an excerpt from his novel Using Life was published in a journal in Egypt. Naji recounts his experiences in detail, from the mundane daily indignities of incarceration to the camaraderie that develops between prisoners. The memoir is also an erudite literary text as Naji expounds on works of Egyptian literature, the Arabic language itself, and the limits imposed by successions of authoritarian governments. Katharine Halls’s lively translation captures Naji’s distinctive voice, by turns intellectual, enraged, sardonic; Naji comes across as someone who remarkably can always crack wise about his bully jailers and the ignorance of his government’s censors.

Safiya Sinclair, How to Say Babylon: A Memoir (Simon & Schuster)

How to Say Babylon , Safiya Sinclair’s lyric memoir, is intimate, unforgettable and a shining example of why poets should write prose. The Eden of Sinclair’s Jamaican childhood is irrevocably altered under her father’s strict Rastafarian upbringing which first constrains, and then threatens, her life. Her poetic soul is matched by her resilience and perseverance and is the foundation of her courageous expressions of individuality and agency. Sinclair expertly weaves moments both harrowing and idyllic in a way that is candid, yet still generous to even those who have harmed her, which speaks both of her sensitivity and strength, and makes this memoir singular, universal and transporting.

Matthew Zapruder, Story of a Poem: A Memoir (Unnamed Press)

Matthew Zapruder’s Story of a Poem pursues two questions simultaneously: what makes a poem work, and what makes a life matter. If those questions seem to belong to different realms of meaning, it is the quiet brilliance of this book to convince you of their interdependence. The story is of the creation and revision of several poems—messy, developing drafts included—and the equally messy process of understanding a child whose autism diagnosis wrenches the author’s first draft of parenthood into a new shape—all while the air outside darkens with wildfire smoke. It is rare to see the competing calls to creativity and care explored so literally, and with such urgency and tenderness, as they are here.

Jonathan Eig, King: A Life (Farrar, Straus and Giroux)

In his sweeping biography of Martin Luther King Jr. Jonathan Eig recovers the civil rights leader from “the gray mist of hagiography.” Eig traces the arc of “Little Mike,” son of a Georgia sharecropper, to national prominence as an eloquent advocate for Black rights, as well as a crusader against the Vietnam War and poverty, all the way to Memphis and the Lorraine Motel balcony. Building on more than 200 interviews and recently released FBI files, Eig recently made national news by debunking a famous quotation about Malcolm X attributed to King, tracking fissures in the civil rights movement, and revealing King’s womanizing. With the velocity of a thriller, Eig evokes King in all his complexity, an imperfect but extraordinary man.

Gregg Hecimovich, The Life and Times of Hannah Crafts: The True Story of the Bondwoman’s Narrative (Ecco)

The Bondwoman’s Narrative , written in the mid-nineteenth century and believed to be the first novel by a Black woman, caused a sensation when it was authenticated and published by Henry Louis Gates Jr. in 2002. Until now, however, the author’s identity remained  a mystery. In this compelling new biography, Hecimovich combs through public records, handwritten diaries, almanacs, wills, and slave inventories and invites readers into his search, even the dead ends,  to reveal Crafts as the former Hannah Bond, a child traumatically separated from her enslaved mother, who learned to read and write before escaping to the North and completing the book. Hecimovich convincingly demonstrates that Crafts’ writing was influenced by popular literature, in particular Dickens’ Bleak House , yet stands, sui generis , as what he calls “one of the most powerful imaginative records we have of slavery.”

Yunte Huang, Daughter of the Dragon: Anna May Wong’s Rendezvous with American History (Liveright)

Daughter of the Dragon provides a riveting glimpse into the life of the beguiling actress Anna May Wong, one of Old Hollywood’s most recognizable faces. The book is the triumphant capstone to an ambitious trilogy: here, as in previous installments on Charlie Chan and the original Siamese twins (both NBCC finalists), Huang shines his spotlight upon a single, iconic figure in order to reveal a bigger picture. This dramatic account of Wong’s ascent to silver screen stardom—and subsequent descent into alcoholism and oblivion—thoughtfully illuminates the crucial role played by Asian Americans in the spectacle of modern culture.

Rachel Shteir, Betty Friedan (Yale University Press)

In Betty Friedan , Rachel Shteir investigates the life, work and complex legacy of the trailblazing feminist. While Friedan remains respected for her contributions to early second wave feminism, her resistance to intersectional feminist work leaves her out of sync with contemporary feminist activism. The first biography of Friedan in a generation, drawing on extensive research and interviews with Friedan’s contemporaries, Shteir examines the ways in which Friedan’s early years growing up Jewish in the midwest and living in the shadow of her mother’s thwarted education, shaped her ambition, career trajectory and personal life. The determination that led Friedan to become a forceful national leader also closed her off from compromise and evolution. In this timely, important biography, Shtier makes the case that her impact remained crucial to social change in 20th century America.

Jonny Steinberg, Winnie & Nelson: A Portrait of a Marriage (Knopf)

Jonny Steinberg’s deeply insightful, painstakingly researched Winnie and Nelson: A Portrait of a Marriage unmasks the Mandelas, sliding past their public mythos, and the simpler romantic narrative they told each other, to reveal the emotional labyrinth beneath. Steadily, through newly recovered material about the couple’s conversations – gathered by eavesdropping Afrikaner prison guards – Steinberg reveals how incarceration, torture, infidelity, and time itself, changed both husband and wife and their political stances. We’re left with a strong sense of the horrors they endured during apartheid, and the tenderness that remained between them at the end, even after they had inflictied pain on one another, and enduried so much cruelty and torture. With its exploration of two radically different approaches to apartheid, this beautiful biography speaks movingly to present-day struggles for racial justice.

Nicholas Dames, The Chapter: A Segmented History from Antiquity to the Twenty-First Century (Princeton University Press)

1.) One of the most thrilling things a book of criticism can do is answer a question that you didn’t know you had. 2.) The question in The Chapter is particularly delicious, because you likely accept chaptering as a matter of course, without asking why books are split up. 3.) Nicholas Dames roams wonderfully from the Gospels to, in a particular highlight, George Eliot. He explores time, transitions, and the literal manufacturing of books. 4.) Dames is also a clear, lucid writer. 5.) The critical cliché in this case is true: after reading The Chapter , you will never quite read anything else the same way.

Myriam Gurba, Creep: Accusations and Confessions (Avid Reader Press)

Creep is the very rare book of essays that could easily read as a single full-length study. Across her works to date ( Mean , Dahlia Season ) Myriam Gurba has developed a control over tone that lets her combine all of Creep’s elements—the creeping presence of Richard Ramirez, the itching fear of lice, anti-Mexican racism everywhere, cold Joan Didion beside the hot Los Angeles strawberries, Gurba teaching her high school students that that rape is about geography, not sex—into a coherent portrait in local sensibility. Creep is a tricky book that reads easy.

Naomi Klein, Doppelganger: A Trip into the Mirror World (Farrar, Straus and Giroux)

Naomi Klein has long challenged readers to look at the way we live from a slightly skewed angle in hopes of ultimately making the world more just. In this masterwork of storytelling, reporting, criticism, and analysis, she uses the idea of the twin, or the fun house version of our own world, to explore how truth works—or doesn’t—in today’s political and cultural climate. “It’s tough to live in a moment when so many truths that had been sold as settled suddenly become wobbly,” she writes. In this time of uncertainty we’re lucky to have her be one of our guiding voices.

Grace E. Lavery, Pleasure and Efficacy: Of Pen Names, Cover Versions, and Other Trans Techniques (Princeton University Press)

Pleasure and Efficacy provides a groundbreaking study of the idea of gender transition in the modern era. Grace E. Lavery, a literary scholar and prominent activist, marshals a kaleidoscopic array of examples—from pseudonyms to psychoanalysis to The Silence of the Lambs —in support of her claim that sex change is possible. By turns playful and polemical, Lavery unpacks complex theoretical texts with an efficacy that is as astonishing to behold as it is pleasurable to read: a bold affirmation of the trans condition.

Tina Post, Deadpan: The Aesthetics of Black Inexpression (NYU Press)

Deeply researched and refreshingly lucid, Tina Post’s Deadpan arrives as one of the most original and affecting aesthetic surveys in recent memory. Long consigned to the realm of play-it-straight humor, the book recontextualizes the act of withholding to taxonimize its origins and uses—specifically the tact it assumes when intersecting with blackness. Refusing to differentiate between “embodied blackness (or blackness as performed by black people) and symbolic blackness (or blackness in the cultural imaginary),”  the author instead maps the many tributaries connecting the one to the other, illuminating how specimenization, perceived threat, gradients, and the tension between excess and absence evolve and get repurposed by black and white artists alike.

Teju Cole, Tremor (Random House)

In Cole’s triumphant return to fiction, the critic, novelist, and photographer finds new possibilities for autofiction. The book is dense with digressions on art and colonialism from Tunde, the Harvard-photography-professor narrator (one chapter takes the form of a lecture implicating an audience of museum patrons in the legacy of cultural appropriation). But it’s more than a vehicle for ideas. Rather, the story is about what these ideas mean for Tunde as he considers his own degrees of privilege and the exploitative nature of photography while reckoning with memories of growing up in Nigeria and of an old friend whose occasional presence adds to Tremor ’s elegiac and haunting quality.

Daniel Mason, North Woods (Random House)

A house surrounded by an apple orchard in Western Massachusetts provides the setting for Daniel Mason’s ghostly masterpiece. Told in vivid overlapping stories, spanning from the Puritan colonial era to the future, the novel lays bare the poisonous American obsession with property and its deleterious effect on ecological succession. Beauty, humor, and violence surface in the lives of the house’s colorful inhabitants over the years: spinster sisters, ambitious farmers, a painter harboring a secret desire, and a troubled young man, among others. The bold accordion-like structure of North Woods (letters, songs, and poetry are mixed with conventional narration) traces an erosion of humanity even as its players yearn for a better future.

Lorrie Moore, I Am Homeless if This Is Not My Home (Knopf)

Lorrie Moore’s I Am Homeless If This Is Not My Home is hilarious and beautifully written, which is no surprise coming from Moore, whose short stories and novels have delighted readers since 1985’s Self-Help . The surprise is in the absolute boldness of this novel—a zombie road trip is interspersed with letters from an innkeeper written just after the Civil War. Even more astounding is the beating heart of the work—amid the chaos and contortion of the plot, this is a tender and poignant examination of grief, loss, and memory. It’s a wonderfully elusive book from a master of form, packing multitudes into just under 200 pages.

Marie NDiaye, translated by Jordan Stump, Vengeance Is Mine (Knopf)

At the heart of Marie NDiaye’s hypnotic and ingenious literary thriller is a sensational legal case: Maître Susane is hired to represent a wealthy man’s wife, who has been accused of murdering the couple’s three children. Susane, who has never tried a murder case and is of a working-class background, believes she met Principaux, her client’s husband, decades earlier when she was ten years old. NDiaye, who began publishing her slippery and original fictions three decades ago at 17, entwines subtle mysteries with depictions of harrowing violence. Elliptical and lyrical, Vengeance Is Mine amounts to a disquieting exhumation of the past and its tight, invisible hold on the present.

Justin Torres, Blackouts (Farrar, Straus and Giroux)

Justin Torres radically experiments with the biographical fiction genre to stunning effect. Structured like an exquisite nesting doll of stories, the novel follows the arrival of the young exhausted narrator at the Palace, a convalescent home where he has come to help Juan finish his erasure project involving Sex Variants , a real-life 1941 collection of anonymous interviews with gay and lesbian people. Contributions by queer journalist Jan Gay were uncredited, and Juan and the narrator work together to highlight this unjustly forgotten legacy, as Juan prods the narrator for details of his own clouded past. Blackouts is a tour de force of desire and reclamation.

R oxana Asgarian, We Were Once A Family (Farrar, Straus and Giroux)

Asgarian draws on her background as a Houston court reporter for her astonishing debut. The book is a meticulous, harrowing, and deeply empathetic investigation of the story behind the deaths of a married white Portland, Ore., lesbian couple and their six Black Texas-born adopted children from a cliffside car crash in Mendocino County, Calif., that was ruled a murder-suicide. Asgarian provides a blistering indictment of the Houston family court, child protection agencies, and adoption agencies that wrest children such as the victims away from their birth families, and of the media’s focus, in looking for answers to explain the crime, on the psychology of the adoptive mothers rather than the structural conditions impacting the children’s birth families.

Kerry Howley, Bottoms Up and the Devil Laughs (Knopf)

You might not expect to be moved by a book whose title refers to a conspiracy theory about how Monster Energy Drinks are actually vehicles for Satan. But Bottoms Up and the Devil Laughs is a clear-eyed and nuanced accounting of the ways in which our modern security state reduces human beings into little more than unending terabytes of data. Kerry Howley interprets such data in a way that is distinctly human and deeply generous; she distills small, telling details from a larger story about conspiracy theorists and whistleblowers and everyone in between, while still allowing her narrative to meander and digress in surprising and revelatory ways.

Dina Nayeri, Who Gets Believed? (Catapult Books)

In Who Gets Believed? , Dina Nayeri ( The Ungrateful Refugee ) collates data from real situations where the stakes of personal credibility are high and their outcomes apparently arbitrary. She connects a refugee whose story is rejected on absurd grounds to her own skepticism, as a Christian child refugee in the United States, of the thrashing antics of the girls around her in church. Nayeri exploits her heterogenous life experience (a management consultancy interlude is among the book’s oblique surprises) to compose a work something like philosophy, one that forces old conceptual questions back into conversation with their crucial roles in daily life.

Jeff Sharlet, The Undertow (W. W. Norton)

In “The Undertow: Scenes From a Slow Civil War,” journalist and author Jeff Sharlet takes readers on a chillingly urgent tour of Donald Trump’s America. Sharlet gives us much more than soundbites as he immerses himself in Trump rallies, a men’s rights conference and a prosperity Gospel megachurch, and as he talks in depth with conspiracy theorists, white nationalists and acolytes of Ashli Babbitt, the woman shot on Jan. 6, 2021, as she tried to break into the U.S. Capitol, “transformed” after her death, Sharlet writes, into “yet another flag, like a new tarot card in the deck of fascism.”

Christina Sharpe, Ordinary Notes (Farrar, Straus and Giroux)

From the glimmering mosaic of Christina Sharpe’s Ordinary Notes emerges a luminous vision of a mind and life, “ordinary” only in the sense that it contains the matter of her daily reckonings, the memories of an extraordinary mother, the “antiblack notes” that have impinged on her and all Americans’ experience of life, and the lovely counter-notes—the lessons, the art, the courageous voicings—that create a new understanding of the world: “All of our renewed power to refuse the concentric senses of the ruinous.”

Saskia Hamilton, All Souls (Graywolf Press)

In the exquisite and profoundly affecting All Souls , completed just before her death, Saskia Hamilton wonders if writing can be “a form of practice or of preparation for death” and answers with a meditation on all the things that mattered deeply to her: family, memory, art, and literature. What she creates is something surpassingly rare, a kind of auto-elegy that is all the more moving for being devoid of sentimentality and self-pity, a vision of a brilliant mind mulling over the shards of what she knows, trying to see into and past death, not to vanquish it but to capture life, “caught in the far gone far alone glance / of mortality.”

Kim Hyesoon, translated by Don Mee Choi, Phantom Pain Wings (New Directions)

With stunning originality and audacity, Kim Hyesoon creates an alternative imaginative universe that reflects a consciousness battered by and overcoming life’s agonies: the aftereffects of war and dictatorship, the oppressions of a patriarchal society, the death of a father. In Don Mee Choi’s powerful translation of Phantom Pain Wings , the presence of the multi-faceted creature called “bird”—nemesis, inner daemon, doppelganger, muse—reverberates outward until, as with all great poetry, it assumes the fragile, mortal proportions of art itself: “I thought about bird flying freely in the ruins / bird that will fall if I don’t keep writing.”

Romeo Oriogun, The Gathering of Bastards (University of Nebraska Press)

“Perhaps exile is us running through history // I have not to give, even my body is empty of a country.” So begins Romeo Oriogun’s breathtaking The Gathering of Bastards , a multitemporal saga of migration charted against journeys of queerness and subsequent exile. Nigerian-born Oriogun’s poems are rooted between boundaries, engaging with war and dictatorship while employing a lyricism that instills a sense of magical possibility. Despite repeated losses, Oriogun pens an expansive dream of freedom: “Having known that there is no home apart from terror, / I lend my voice to our survival. I demand a wild life.” Through the wild lives of these poems, Oriogun offers readers a profound communion.

Robyn Schiff, Information Desk (Penguin Books)

With a sweep that encompasses the intelligence, eroticism, and callousness of the Western art canon, Robyn Schiff’s Information Desk presents a mundane setting for the epic: the eponymous desk at the Metropolitan Museum of Art, where the poet worked in her youth. Yet for all its cataloguing of the indignities of the role, Schiff’s epic poem refuses to stay grounded, taking readers on a whorl through art history, her personal relationships, and the behavior of parasitic wasps. What unites these topics is the symbiotic relationship the subjects have with their muses (or hosts). Like the book itself, these relationships are sometimes beautiful, oftentimes brutal, and alluring in their observation that not all monuments are erected on equal footing.

Charif Shanahan, Trace Evidence (Tin House)

“Dear one: I was trying to enter my own life, I felt outside my own life. I was / Looking, trying to find a door.” In the searching intimacies of Trace Evidence, Charif Shanahan uncovers his own hard-earned definitions of identity amidst the dislocations of a life at the margins–postcolonial, queer, biracial–in order to inhabit life on his own terms. A near-fatal accident in Morocco, the home country of his mother, becomes the focal point for gorgeously frank and delicate lyrics that both query and implore: “Is it possible my function is to hold / All the intricate, interstitial pain / And articulate clarity? / Tie a boat to my wrist, I sprout wings.”

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'Very Bad News' For Trump: Lawrence O'Donnell Says Ruling Could Backfire Quickly

Overnight Editor, HuffPost

MSNBC ’s Lawrence O’Donnell on Monday predicted that the Supreme Court decision granting Donald Trump complete immunity for “official” acts while in office could backfire in a matter of weeks.

“The very bad news for Donald Trump in this decision today, and for candidate Trump ― very, very bad ― is that Mike Pence is going to walk into a federal courtroom, raise his right hand, take an oath to tell the truth and testify against Donald Trump in this case in September,” he predicted.

O’Donnell said the court granted Trump absolute immunity on a single paragraph (his conversation with the attorney general) in his indictment in the case regarding Jan. 6, 2021. The court ordered an evidentiary hearing for the rest of the case to determine if those other acts are official or unofficial, and therefore protected by immunity or not.

He said Judge Tanya Chutkan will oversee that hearing, which will be “exactly like a prosecution” as special counsel Jack Smith calls witnesses and lays out his evidence.

“You’re gonna see this incredible Jan. 6 hearing on steroids, possibly for six, eight weeks, September [to] October, maybe,” he said.

See the full discussion below:

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Report critiques inclusion among film critics

Films like  Crazy Rich Asians , The Spy Who Dumped Me , BlacKkKlansman , and  The Happytime Murders  are poised to provide a much-needed dose of diversity to theaters this summer. But as audiences look to critical reviews to determine if these movies are worth the ticket price, what perspectives are available? A new study reveals that the film reviewers are unlikely to be as diverse as the casts they are critiquing.

The report, titled “ Critic's Choice? ” is the first from Associate Professor of Communication  Stacy L. Smith  and the  USC Annenberg Inclusion Initiative  to investigate inclusion among film reviewers, and examines access and opportunity for film critics. The report uses reviews of the 100 top grossing films of 2017 posted on the site Rotten Tomatoes to assess gender and race/ethnicity of critics, finding that reviewers are overwhelmingly white and male.

Only 22.2 percent of the 19,559 reviews evaluated were written by females, with 77.8 percent crafted by male critics. This represents a gender ratio of 3.5 males to every 1 female reviewer. White critics wrote 82 percent of the reviews and critics from underrepresented racial/ethnic backgrounds authored 18 percent. However, when the researchers examined both gender and underrepresented status, they found that white male critics wrote substantially more reviews (63.9 percent) than their white female (18.1 percent) or underrepresented male (13.8 percent) peers. Underrepresented female critics only wrote 4.1 percent of reviews included in the sample.

“The very individuals who are attuned to the under and misrepresentation of females on screen and behind the camera are often left out of the conversation and critiques,” said Smith, founder and director of the Annenberg Inclusion Initiative. “The publicity, marketing, and distribution teams in moviemaking have an opportunity to change this quickly by increasing the access and opportunities given to women of color as film reviewers.”

Similar results emerged when the researchers focused on individuals Rotten Tomatoes designated as “Top Critics.” Of the 3,359 reviews by top critics, 76 percent were written by males and 24 percent by females. Underrepresented top critics wrote 11.2 percent of the reviews compared to 88.8 percent by white top critics. When gender and underrepresented status were examined simultaneously, top film reviews written by white males outnumbered those by underrepresented females by nearly 27 to 1, as reviews by women of color amounted to only 2.5 percent of those by top critics while white males wrote 67.3 percent. White females wrote 21.5 percent and underrepresented male critics 8.7 percent of top reviews.

“Even among top critics, the words of white and male critics fill a greater share of the conversation than females and people of color,” said Marc Choueiti, the study’s lead author. “Re-examining the definition of a top critic or simply casting a wider net can be the opportunity to open up and diversify the voices heard in the critic space.”

The researchers assessed the percentage of female and underrepresented film reviewers for each movie studied. Not one of the 100 films achieved gender-balance in the critics pool. The 36 female-driven movies in 2017 the team identified were similarly imbalanced. Seventy percent of these films were reviewed by groups of critics in which women amounted to less than 30 percent of reviewers. Most of the 24 films with underrepresented leads were assessed by a group of critics in which 20 percent or fewer reviewers were from underrepresented backgrounds.

The percentage of women and people of color reviewing as top critics per film was also calculated. While a handful of female-driven movies achieved proportional representation of female top critics, none featured underrepresented critics in proportion to the population. Most strikingly, women of color were completely absent as top critics from 45 of the 100 films analyzed, 19 or 52.8 percent of the female-driven films assessed, and 9 or 37.5 percent of the movies with underrepresented lead characters.

“This report reveals the absence of women of color working as reviewers—especially on movies built around female and underrepresented leads,” Smith said. “We have seen the ramifications of an industry in which the content sold to audiences is created and reviewed by individuals who are primarily white men. Creating inclusive hiring practices at every stage of the filmmaking and review process is essential to meeting business imperatives and ensuring that we see diverse perspectives reflected in society.”

Critics may review multiple films throughout the year, so the researchers measured the number of individual film critics. Of the more than 1,600 individuals working throughout the year, white males were roughly half (53.2 percent), white females about a quarter (23 percent), underrepresented males were 14.8 percent, and underrepresented females were 8.9 percent of all critics. The numbers were similar for individual top critics.

It’s no surprise then, that across all critics, white males wrote the highest average number of reviews each year, at 14.3. Underrepresented male critics composed an average of 11.1, white females an average of 9.4, and underrepresented females only 5.6 reviews on average.

The authors propose several solutions for groups that work with or educate critics. Most notably, they offer a set of target inclusion goals for the field. “Groups should think of the phrase 30/30/20/20—this is the U.S. population breakdown for white males, white females, underrepresented males and underrepresented females,” Smith said. “It sets a clear goal for groups who want to make sure that their ranks reflect the world in which we live.”

The report is the latest from the USC Annenberg Inclusion Initiative, and the first in a series of reports on critics. The second report will focus on differences in review content by reviewer gender and/or race/ethnicity, and a third report will examine relationships to box office performance. The newest report can be found online  here .

In the News

June 11, 2018 | Associated Press | Study finds that film critics are almost 80 percent male

June 11, 2018 | Hollywood Reporter | Film Critics Even Less Diverse Than Films, Study Finds

June 11, 2018 | Variety | Movie Critics Are Mostly White Men, Study Shows

June 13, 2018 | Hollywood Reporter | Sundance, Toronto to Allocate 20 Percent of Credentials to Underrepresented Critics, Says Brie Larson

June 13, 2018 | Los Angeles Times | Crystal + Lucy Awards: Honoree Brie Larson questions the lack of diversity among film critics

What you eat at 40 may affect how healthy you are at 70

If you eat well now, you may live better later. A diet rich in fruits and vegetables, whole grains and unsaturated fats in midlife can improve the chances of good mental, physical and cognitive health decades later, a new report shows.

A study presented at a major nutrition conference Tuesday builds on years of research that a daily diet filled with highly nutritious foods can reduce the risk of developing common chronic diseases and help maintain cognitive functioning in older age.

Harvard researchers analyzed 30 years of data on over 106,000 participants from the Nurses’ Health Study and the Health Professionals Follow-Up Study . The study included 70,467 women and 36,464 men. At the beginning of the study in 1986, the participants were at least 39 years old and free of chronic disease.

As part of the long-term study, the participants filled out an extensive food frequency questionnaire every four years, from 1986 to 2010, registered dietician Anne-Julie Tessier, lead author and research associate at Harvard School of Public Health, said.

The Harvard researchers tracked every participant’s personal diet over time to see how well they matched to eight highly nutritious dietary patterns.

The diets they compared the food questionnaires to included:

• The D ASH d iet , a meal plan intended to prevent or lower blood pressure by focusing on vegetables, fruits and whole grains. The eating plan, developed by the National Institutes of Health, is considered a flexible diet because it doesn't eliminate any food groups and also helps with weight loss.
• The alternative healthy eating index (AHEI) — which closely adheres to to the U.S. dietary guidelines by encouraging more legumes, nuts and vegetables and lower amounts of red meat and processed meats. The research found the strongest correlation between the AHEI diet and healthier aging, Tessier said.
• The planetary health diet , an eating plan that minimizes animal products and emphasizes fruits, vegetables, whole grains, and healthy fats. It allows modest amounts of meat and dairy.

Overall, they found that a higher intake of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy had greater odds of aging well. People whose diets consisted of more trans fats, sodium, red and processed meats had lower odds of healthy aging. 

What is 'healthy aging'?

Based on the women and men's self-reports in the database, the researchers interpreted “healthy aging” as surviving to at least age 70 and having good cognitive function, mental health, physical function — and being free of chronic diseases, such as diabetes, heart disease, stroke, kidney failure and most cancers.

After analyzing the 30-year data, the researchers found approximately half of the participants had died, with only 9% surviving to age 70 or older free of disease and unimpaired physical and cognitive health. 

However, the participants who most closely adhered to a healthy eating pattern were associated with 43% to 84% greater chances of aging well compared with those who did not.

What we eat now affects how we feel later

The new research has limitations. Similar to most nutrition research, the study is observational and based on self-reports. It doesn’t prove that following a nutritious dietary pattern closely will lead to longer life or healthier aging. It hasn’t yet been published in a journal but is currently under peer review, Tessier said.

Yet numerous studies have already demonstrated that diet and physical activity reduce the risk of all of these conditions and thus can increase the likelihood of "healthy aging," Dr. R. Sean Morrison, chair for the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai Hospital, said.

“It’s important to take into consideration that those who have healthy diets are more likely to exercise, more likely to live in socially advantaged neighborhoods, have access to support that others do not have, and are likely to have better access to health care,” said Morrison, who was not associated with the new study.

Latest news on nutrition and diet

• Vegetarian and vegan diets linked to lower risk of heart disease, cancer and death, large review finds.
• Nutritionists and dietitians reveal the foods they avoid in their own lives.
• How gut bacteria may trigger binge eating or weight gain.

In fact, the researchers analyzed variables that could potentially influence the results, including BMI, ancestry, smoking status, alcohol intake, physical activity, medical and family history, socio-economic status, marital status and whether participants were living alone, Tessier noted. 

“We were surprised by the strength of the association between healthy eating patterns in midlife and a healthy later life, even after considering several other factors, like physical activity, that are also known to impact health,” she added.

Dr. Lawrence Appel, professor of medicine at the School of Medicine at John Hopkins University, who was not part of the research, said the study results support previous findings. Appel's research focuses on preventing chronic diseases through nutritional approaches and was the lead author in the study that coined the DASH diet.

“This study joins a chorus of other studies that link healthy dietary behaviors earlier in life with better health, decades later,” he said.

For Mount Sinai's Morrison, "the bottom line for healthy aging —which we have known for a long time — is to eat a healthy diet, exercise, avoid tobacco products, use sunscreen, get enough sleep, and participate in social activities.

Shiv Sudhakar, M.D., is an infectious disease specialist and health contributor to NBC News Health. He works in addiction medicine, so is very passionate about decreasing substance abuse, combating homelessness and improving mental health. 

• Introduction
• Conclusions
• Article Information

MBSR indicates mindfulness-based stress reduction.

Effect sizes and noninferiority confidence intervals of primary outcome for mindfulness-based stress reduction (MBSR) vs escitalopram (week 8 end point). Difference is the improvement in MBSR minus improvement in escitalopram. Shaded region indicates region of noninferiority. ITT indicates intent-to-treat; PP, per-protocol.

Predicted Clinical Global Impression Severity scale (CGI-S) score based on a linear mixed model adjusted by age, sex, race, site, and total number of secondary diagnoses. MBSR indicates mindfulness-based stress reduction.

Study protocol and statistical analysis plan

eTable 1. Comparison of Baseline Characteristics between Completers and Non-Completers

eTable 2. Sensitivity Analyses: Comparison of Baseline Characteristics between Participants with and without Week 8 CGI-S data

eTable 3. Non-Inferiority Hypothesis Testing with ITT sample at Endpoint (week 8)

eTable 4. Estimated Group Differences at each Time Point Based on a Linear Mixed Model Adjusted by Age, Sex, Race, Site, Baseline Severity (High vs Low) and Total Number of Secondary Diagnoses

eTable 5. Adverse Events Table: Escitalopram Group

eTable 6. Adverse Events Table: MBSR Group

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Hoge EA , Bui E , Mete M , Dutton MA , Baker AW , Simon NM. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders : A Randomized Clinical Trial . JAMA Psychiatry. 2023;80(1):13–21. doi:10.1001/jamapsychiatry.2022.3679

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Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders : A Randomized Clinical Trial

• 1 Department of Psychiatry, Georgetown University Medical Center, Washington, DC
• 2 Caen University Hospital & UNICAEN, INSERM, U1237, PhIND, NEUROPRESAGE Team, Caen, France
• 3 Medstar Health Research Institute, Hyattsville, Maryland
• 4 Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston
• 5 Department of Psychiatry, New York University Grossman School of Medicine, New York

Question   Is mindfulness-based stress reduction noninferior to escitalopram for the treatment of anxiety disorders?

Findings   In this randomized clinical trial of 276 adults with anxiety disorders, 8-week treatment with mindfulness-based stress reduction was noninferior to escitalopram.

Meaning   In this study, mindfulness-based stress reduction was a well-tolerated treatment option with comparable effectiveness to a first-line medication for patients with anxiety disorders.

Importance   Anxiety disorders are common, highly distressing, and impairing conditions. Effective treatments exist, but many patients do not access or respond to them. Mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR) are popular and can decrease anxiety, but it is unknown how they compare to standard first-line treatments.

Objective   To determine whether MBSR is noninferior to escitalopram, a commonly used first-line psychopharmacological treatment for anxiety disorders.

Design, Setting, and Participants   This randomized clinical trial (Treatments for Anxiety: Meditation and Escitalopram [TAME]) included a noninferiority design with a prespecified noninferiority margin. Patients were recruited between June 2018 and February 2020. The outcome assessments were performed by blinded clinical interviewer at baseline, week 8 end point, and follow-up visits at 12 and 24 weeks. Of 430 individuals assessed for inclusion, 276 adults with a diagnosed anxiety disorder from 3 urban academic medical centers in the US were recruited for the trial, and 208 completed the trial.

Interventions   Participants were 1:1 randomized to 8 weeks of the weekly MBSR course or the antidepressant escitalopram, flexibly dosed from 10 to 20 mg.

Main Outcomes and Measures   The primary outcome measure was anxiety levels as assessed with the Clinical Global Impression of Severity scale (CGI-S), with a predetermined noninferiority margin of −0.495 points.

Results   The primary noninferiority sample consisted of 208 patients (102 in MBSR and 106 in escitalopram), with a mean (SD) age of 33 (13) years; 156 participants (75%) were female; 32 participants (15%) were African American, 41 (20%) were Asian, 18 (9%) were Hispanic/Latino, 122 (59%) were White, and 13 (6%) were of another race or ethnicity (including Native American or Alaska Native, more than one race, or other, consolidated owing to low numbers). Baseline mean (SD) CGI-S score was 4.44 (0.79) for the MBSR group and 4.51 (0.78) for the escitalopram group in the per-protocol sample and 4.49 (0.77) vs 4.54 (0.83), respectively, in the randomized sample. At end point, the mean (SD) CGI-S score was reduced by 1.35 (1.06) for MBSR and 1.43 (1.17) for escitalopram. The difference between groups was −0.07 (0.16; 95% CI, −0.38 to 0.23; P  = .65), where the lower bound of the interval fell within the predefined noninferiority margin of −0.495, indicating noninferiority of MBSR compared with escitalopram. Secondary intent-to-treat analyses using imputed data also showed the noninferiority of MBSR compared with escitalopram based on the improvement in CGI-S score. Of patients who started treatment, 10 (8%) dropped out of the escitalopram group and none from the MBSR group due to adverse events. At least 1 study-related adverse event occurred for 110 participants randomized to escitalopram (78.6%) and 21 participants randomized to MBSR (15.4%).

Conclusions and Relevance   The results from this randomized clinical trial comparing a standardized evidence-based mindfulness-based intervention with pharmacotherapy for the treatment of anxiety disorders found that MBSR was noninferior to escitalopram.

Trial Registration   ClinicalTrials.gov Identifier: NCT03522844

Anxiety disorders are the most common type of mental disorder, currently affecting an estimated 301 million people globally. 1 Generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia are anxiety disorders associated with considerable distress, impairment in functioning, and increased risk for suicide. 2 , 3

Effective treatments for anxiety disorders exist and include medications and cognitive behavioral therapy, but not all patients have access to them, respond to them, or are comfortable seeking care in a psychiatric setting. For example, nearly one-third of people surveyed in 1 study 4 believed that psychiatric medication would interfere with daily activities, and about one-fourth believed it is harmful to the body. Further, roughly two-thirds of patients who do start taking an antidepressant discontinue it. 5 While cognitive behavioral therapy is also effective, it can be difficult for patients to access due to a lack of health care professionals trained in this technique. 6 These challenges support a need for additional evidence-based treatment options for patients with anxiety disorders with broad acceptability.

Mindfulness-based interventions (MBIs) may be seen as a more acceptable option given that mindfulness meditation has recently become more popular. For example, in the US, approximately 15% of the population has tried meditation. 7 Mindfulness meditation has been found to help reduce anxiety; a recent meta-analysis 8 of trials with anxiety disorders found a significant benefit with mindfulness meditation compared with treatment as usual. While MBIs have been shown to decrease anxiety, 9 , 10 the need to assess the relative effectiveness of MBIs compared with standard therapies for anxiety disorders has been emphasized. 11 Mindfulness-based stress reduction (MBSR) is the most widely researched MBI (over 1000 citations in PubMed) and is available internationally. 12

To our knowledge, no clinical trial comparing an evidence-based MBI, such as MBSR, with a first-line pharmacological treatment for anxiety disorders has been published. To clarify whether MBSR should be considered an alternative first-line intervention comparable to a gold-standard pharmacotherapy used in primary care, our aim was to compare MBSR with escitalopram, an European Medicines Agency– and US Food and Drug Administration–approved pharmacotherapy for the treatment of anxiety and hypothesized that MBSR would be noninferior to escitalopram.

Our study protocol and analysis plan are published in full elsewhere and in Supplement 1 . 13 Treatments for Anxiety: Meditation and Escitalopram (TAME) is a prospective randomized 2-arm parallel-group controlled single-blinded (blinded raters, with unblinded providers and participants) trial to evaluate the relative effectiveness of 8 weeks of MBSR vs escitalopram. Recruitment and enrollment occurred at 3 US hospital sites in Boston, Massachusetts, New York, New York, and Washington, DC. The study was approved by each institution’s institutional review board and overseen by an independent data and safety monitoring board. All participants provided written informed consent. The study followed the Consolidated Standards of Reporting Trials ( CONSORT ) reporting guideline.

Eligible participants were aged 18 to 75 years with a current primary diagnosis of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia, as determined by structured psychiatric diagnostic interviews performed by trained clinicians. 14 A diagnosis was determined primary (using clinical judgment with participant input) as the condition with the most severe symptoms and that caused the greatest amount of interference and distress for the patient in their daily life. Eligibility criteria have been described elsewhere 13 and were selected to include a generalizable population of adults with anxiety disorders. Briefly, major exclusion criteria included lifetime bipolar disorder, psychotic disorders, or obsessive compulsive disorder as well as current anorexia or bulimia nervosa, posttraumatic stress disorder, substance use disorders, or significant active suicidal ideation or behaviors. Participants must not have completed MBSR or equivalent training in the past year or had an ongoing daily meditation practice. Patients taking psychiatric medications were excluded except for trazodone (if 100 mg or less), sleep medications (zolpidem and eszopiclone), and benzodiazepines, if at stable dose 4 weeks prior to baseline. Recruitment included online, print, and radio advertisements.

Potential participants deemed eligible on phone screening were scheduled for an in-person consent and structured interview with a study clinician. The study statistician (M.M.) made a computer-generated concealed block randomization schedule that was stratified by site and baseline anxiety severity (low = Clinical Global Impression of Severity [CGI-S] 15 score ≤4; high = CGI-S >4). The randomization schedule was programmed into the study electronic data capture software (Research Electronic Data Capture [REDCap] version 12.4.12). The baseline CGI-S score for each participant was entered into REDCap, which then assigned the treatment group. In this single-blinded trial, the computer-generated randomization assignment was revealed through REDCap to the research assistant, who then relayed the assignment to the site study clinician, but all symptom severity ratings for the primary outcome were performed by independent evaluators who were blinded to treatment allocation.

The CGI-S is a widely used treatment-sensitive instrument that assesses overall severity of symptoms on a scale from 1 (not at all ill) to 7 (among the most extremely ill). 15 Independent evaluator ratings were performed at baseline (week 0), midtreatment (week 4), end point (posttreatment week 8), and follow-up (weeks 12 and 24). Study participants were instructed and reminded not to disclose their treatment group to the independent evaluator. A random 5% of independent evaluator sessions were corated, yielding a CGI-S interrater reliability of κ = 0.80. Participants also met at weeks 1, 2, 4, 6, and 8 (end point) and follow-up visits (weeks 12 and 24) with an unblinded study clinician for safety monitoring, including assessment of adverse events, clinical worsening, and emerging suicidality, with referral if needed to the most appropriate level of medical care based on clinician judgment.

MBSR is a manualized 8-week protocol with weekly 2.5-hour long classes, a day-long retreat weekend class during the fifth or sixth week, and 45-minute daily home practice exercises. 16 Study participants received MBSR classes at clinic and community sites. Qualified instructors taught the theory and practice of several forms of mindfulness meditation, such as breath awareness (focusing attention on the breath and other physical sensations), a body scan (directing attention to one body part at a time and observing how that body part feels), and mindful movement (stretching and movements designed to bring awareness to the body and increase interoceptive awareness). A qualified MBSR instructor (M.A.D.) reviewed audio recordings from a representative session from every MBSR teacher to ensure treatment fidelity. Participants’ class attendance was recorded by the MBSR teacher or through self-report to the unblinded study clinician.

Escitalopram was initiated at 10 mg daily orally and increased to 20 mg daily at week 2 if well tolerated or delayed if not. Adherence was measured by pill count and patient report. Medication management visits with a study clinician (M.D. or N.P.) occurred at weeks 1, 2, 4, 6, and 8 (end point). After end point, patients wishing to continue taking escitalopram were assisted in doing so.

The primary outcome measure was the CGI-S 15 scale for anxiety, assessed by trained clinicians. Our primary patient-reported outcome was the Overall Anxiety Severity and Impairment Scale (OASIS). 17

The sample size was determined using a noninferiority margin based on previous similar studies. 13 Following published guidelines and taking into account the minimal clinically important difference change score for the CGI-S, we adopted a noninferiority margin of −0.495 as the largest clinically acceptable margin. 13 To be more conservative for the sample size estimation, we reduced the margin to −0.33, which generated a target randomized sample size of 368 providing 80% power with a 1-sided type I error of 0.025 (or equivalently with 95% CI) for a noninferiority test. However, due to the SARS-Cov-2 pandemic, we had to stop enrollment at 276. After discussion with the data and safety monitoring board and trial sponsor, it was determined that since 276 randomized participants (with 208 participants who completed the trial) still provided 80% power to determine noninferiority with our clinically acceptable a priori margin of −0.495, we thus confirmed this margin, clarified the sample size and margin on ClinicalTrials.gov, agreed not to attempt to reopen enrollment after the pandemic, and moved forward with data analysis.

The per-protocol analysis was prespecified as primary, and the intent-to-treat (ITT) sample as secondary, as is typical for noninferiority trials, to account for the increased chance of evidence in favor of noninferiority in ITT analyses. 18 Participants completing at least 6 of the 9 MBSR sessions 19 or at least 6 weeks of escitalopram use with nonmissing end point CGI-S data were considered to have completed the trial.

Baseline characteristics of the participants were summarized using descriptive statistics for all randomized participants as well as for those who completed the trial by treatment groups and are presented in Table 1 . We collected data on race and ethnicity as required by our trial sponsor; these data were collected using a multiple-choice self-report form based on the National Institutes of Health standard enrollment table. Treatment group differences at baseline were tested using 2-sample t tests, χ 2 , and Fisher exact tests as appropriate. Baseline characteristics were also compared between those who completed the trial and those who did not using similar bivariate statistical tests (eTable 1 in Supplement 2 ) to evaluate whether characteristics of those who did not complete the trial were significantly different at baseline compared with those of participants who did complete the trial.

Primary outcome assessment at end point was first conducted for the sample of participants who completed the trial consistent with the primary preplanned analysis and then as planned for all randomized participants (ITT sample) by imputing end point scores for those who did not complete the trial and were without week-8 data. The change in the outcome indicating the amount of improvement was computed by subtracting the end point score from the baseline score. Endpoint CGI-S data were imputed using multiple imputation with multivariate normal regression methods combining 50 imputed samples after establishing that missingness was at random. The multivariate normal regression model for imputation included age, employment status, race, sex, site, use of benzodiazepines, primary diagnosis, total number of secondary diagnoses, baseline CGI-S score, and high vs low severity used in stratification. Secondary analyses of the primary outcome were conducted using linear mixed models to further examine the trends in CGI-S in the ITT sample, including data for baseline and weeks 4, 8, 12, and 24. The mixed models with random effects at participant level were adjusted by age, race, sex, site, baseline severity variable used for stratification, and the number of secondary diagnoses and included interactions between treatment group and time indicators entered as dummy variables with baseline as the reference category. Predicted margins were computed at each time point for both treatment groups. The patient-reported outcome measure OASIS was described and analyzed using similar methods. Safety outcomes were assessed for all randomized participants. All analyses were conducted in Stata version 15 (StataCorp; commands: mi impute , mi estimate , xtmixed , margins , contrasts , marginsplot ) by coinvestigator statistician M.M.

Of 430 adults who consented and were assessed by study clinicians, 276 met study criteria (mean [SD] age, 33 [13] years; 156 [75%] female; 32 (15%) African American, 41 (20%) Asian, 18 (9%) Hispanic/Latino, 122 (59%) White, and 13 (6%) of another race or ethnicity, including Native American or Alaska Native, more than one race, or other, consolidated because of low numbers in these groups and because test results based on percentages become misleading when the distribution of observations across categories is highly disproportionate). Participants were randomized to MBSR (n = 136) or escitalopram (n = 140). In the escitalopram group, 33 participants either did not begin or only partially received treatment, and 1 missed the end point study visit, and in the MBSR group, 34 participants either did not begin or only partially received treatment, resulting in a final sample of 208 participants. See Table 1 for participant characteristics and Figure 1 for the CONSORT diagram. Participants were enrolled between June 6, 2018, and February 11, 2020.

Baseline demographic characteristics were similar between the per-protocol and ITT samples (eTable 1 in Supplement 2 ) and by treatment group within each sample ( Table 1 ). Clinical severity at baseline was in the moderate to markedly ill range and did not differ by treatment group. Baseline mean (SD) CGI-S score was 4.44 (0.79) for MBSR and 4.51 (0.78) for escitalopram in the per-protocol sample and 4.49 (0.77) vs 4.54 (0.83) in the randomized sample.

Primary outcome analyses in those who completed the trial at week 8 showed noninferiority for CGI-S score improvement with MBSR compared with escitalopram. Specifically, at week 8, the MBSR group improved by a mean (SD) 1.35 (1.06) and the escitalopram group by 1.43 (1.17) points. The difference between the groups in the primary CGI-S outcome at week 8 (change in MBSR minus change in escitalopram) was −0.07 (95% CI, −0.38 to 0.23; P  = .65). The confidence interval crossed zero, suggesting that the change was not significantly different between groups. The lower end of this 97.5% (−0.38) was smaller than the prespecified noninferiority margin of −0.495, indicating noninferiority of MBSR compared with escitalopram ( Figure 2 ). CGI-S outcomes for each time point by treatment are reported in Table 2 .

Sensitivity analyses in the ITT sample at week 8 using imputed data also showed a noninferiority of MBSR compared with escitalopram based on the improvement in CGI-S score (eTable 3 in Supplement 2 ). We had 222 observations for CGI-S at week 8 regardless of participants’ completion status. Sensitivity analyses comparing baseline characteristics between participants with and without week 8 data suggested no systematic differences in missingness patterns (eTable 2 in Supplement 2 ). Multiple imputation was thus performed to impute CGI-S score for participants with no end point assessment. Results summarized over 50 imputed samples generated a mean (SE) of 3.16 (0.11) for MBSR and 3.12 (0.11) for escitalopram at week 8. The difference between groups was estimated using a linear regression model of CGI-S score on treatment group indicator using imputed samples with no other covariates. The CGI-S score was smaller on average by 0.04 points for the ESC group, but the difference was not statistically significant (95% CI, −0.33 to 0.26, P  = .81). The mean (SE) improvement in the MBSR group was 1.34 (0.10) and 1.43 (0.11) in the escitalopram group. The difference between the groups was estimated to be −0.09 (95% CI, −0.39 to 0.20). The confidence interval crossed zero, indicating no difference between the groups. In addition, the lower end of this 97.5% CI (−0.39) was smaller than the prespecified noninferiority margin of −0.495, showing that MBSR was noninferior to escitalopram.

Next, we examined the primary outcome at follow-up and found that both the MBSR and escitalopram groups continued to improve in the follow-up period ( Table 2 ). The mean (SD) CGI-S score for those who completed treatment was 2.89 (1.09) in MBSR and 2.95 (1.07) in escitalopram (difference = −0.07; P  = .67) at week 12, and 2.92 (1.17) in MBSR and 2.92 (1.03) in escitalopram (difference = 0.00; P  > .99) at week 24.

Longitudinal data were analyzed using a linear mixed model of CGI-S in the ITT sample with random effects at participant level, pooling data across 5 time points: baseline (n = 276), week 4 (n = 226), week 8 (n = 222), week 12 (n = 211), and week 24 (n = 202). The model estimates are presented in eTable 4 in Supplement 2 showing the predicted mean differences with 95% CIs between groups at each time point. Group trajectories over time, based on predicted means, are illustrated in Figure 3 . Results show that the adjusted mean difference between the groups was −0.07 points (95% CI, −0.31 to 0.17; P  = .55) at week 8, further confirming the noninferiority of MBSR to escitalopram. Baseline mean (SD) scores for OASIS were 9.2 (2.9) in MBSR and 9.5 (3.0) in escitalopram with no statistically significant difference ( P  = .48). At the primary end point (week 8), treatment groups were not significantly different either (5.8 [3.8] in MBSR vs 5.2 [3.5]; P  = .21).

The results of the linear mixed models for outcomes are presented in eTable 4 in Supplement 2 . The predicted differences between the groups at week 4 show that participants in the escitalopram group experienced larger improvements in the short term by OASIS score (mean, 1.2; 95% CI, −2.02 to −0.35; P  = .01) in escitalopram. The treatment groups were not significantly different at end point on OASIS score (−0.7; 95% CI, −1.51 to 0.17; P  = .12).

No serious adverse events occurred during the study across the 2 arms. At least 1 study-related adverse event occurred for 110 participants randomized to escitalopram (78.6%) and 21 participants randomized to MBSR (15.4%) ( P  < .001). Adverse events (considered possibly or definitely related to study treatment) that occurred in 5% or more of participants in the escitalopram group were insomnia or sleep disturbance (n = 51; 41%), nausea (n = 44; 35%), fatigue (n = 33; 26%), headache (n = 23; 18%), somnolence (n = 18; 14%), anorgasmia or delayed orgasm (n = 14; 11%), abnormal dreaming (n = 11; 9%), decreased appetite (n = 11; 9%), jitteriness (n = 11; 9%), decreased libido (n = 9; 7%), dizziness/lightheaded/faint (n = 8; 6%), increased sweating (n = 8; 6%), and anxiety (n = 7; 5%). The only adverse event (possibly or definitely related to treatment) that occurred in 5% or more of participants in the MBSR group was increased anxiety (n = 13; 11%). A full list of adverse events across treatment arms is reported in eTables 5 and 6 in Supplement 2 .

No participants discontinued due to clinical worsening or emerging suicidality. The completion rate (completing at least 6 of the 9 MBSR sessions or at least 6 weeks of escitalopram) for participants was 75% for MBSR (n = 102) and 76.5% (n = 106) for escitalopram. At 12-week follow-up, 75 (78%) of the escitalopram group reported continued treatment, and 48 (49%) in MBSR had continued meditating (defined as at least 4 days a week). By 24-week follow-up, 53 (52%) were still taking escitalopram while 27 (28%) in MBSR were still doing regular mindfulness meditation.

Our prospective randomized clinical trial found that MBSR was noninferior to escitalopram for the treatment of anxiety disorders. In addition, MBSR was safe and well tolerated, with fewer adverse events associated with treatment compared with escitalopram. The magnitude of symptom reduction in the escitalopram group (mean of 1.4 points on the CGI-S) was comparable to published studies that established escitalopram as more effective than placebo. For example, Davidson et al 20 compared escitalopram with placebo for generalized anxiety disorder and found a decrease of 1.4 points on the CGI-S. In another example, Asakura et al 21 reported a decrease of 1.1 points on the CGI-S in a randomized clinical trial using escitalopram for social anxiety disorder.

To our knowledge, this is the first study comparing a standardized evidence-based MBI with a first-line medication for anxiety disorders. Costa et al 22 compared an experimental MBI based on movement exercises rather than the traditional sitting meditation, with fluoxetine in patients with generalized anxiety disorder and failed to show noninferiority. Compared with our MBI, the dropout rate in Costa et al 22 was higher (nearly 40% vs 25%), the sample size was smaller (165 vs 276), the intervention length was shorter (16 hours vs 27 hours), and the intervention structure and content were fundamentally different. We are unaware of other noninferiority studies comparing MBIs with medications in anxiety disorders. Strengths of our study include a carefully diagnosed and well-characterized patient sample, trained clinical raters blinded to treatment allocation doing assessments, and a prespecified clinically meaningful noninferiority margin.

This study has limitations. Treatments in this study were not matched for time and attention, as participants in the MBSR group spent more time engaged in treatment-related activities than those in the escitalopram group, and this design allowed only for single-blinding procedures. However, this comparative effectiveness trial was designed to inform clinical decision-making in the real world rather than test the theoretical efficacy of 2 time-matched arms, and contact with the research study team was matched between the groups, with the clinical safety and assessment visits using the same procedures and carried out by the same members of the study staff. Sleep medications and benzodiazepines were also allowed if stable for at least 4 weeks prior to entry; however, the rate of use was minimal (<5%) and did not vary by group ( Table 1 ). Other limitations include a sample that was predominantly female with a relatively high education level, the lack of data on disorder chronicity, and recruitment at 3 urban academic medical centers, which may limit the generalizability of the findings.

In this trial, an MBSR was shown to be a well-tolerated treatment option with comparable effectiveness to a first-line medication for patients with anxiety disorders. Problematic habitual thought patterns characterize anxiety disorders, and mindfulness training specifically focuses the mind on the present moment; thus, individuals practice seeing thoughts and sensations as merely transient mental phenomena and not necessarily accurate reflections of reality. 23 This reappraisal process improves emotion regulation, and individuals become less reactive to thoughts and sensations. 24 In addition, mindfulness is practiced with a nonjudgmental, accepting attitude, which over time appears to increase self-acceptance and self-compassion. 25

Of note, MBSR in this trial was delivered in person, with trained meditation teachers available weekly to answer questions and guide practices, limiting any extrapolation in support of mindfulness apps or programs that are delivered over the internet. Future studies should assess the clinical effectiveness of virtual delivery of MBSR, other MBIs, and of mindfulness apps.

Although replication in different settings is warranted, this study’s finding of the noninferiority of MBSR to a first-line pharmacotherapy for treatment of anxiety provides support for mindfulness meditation as an evidence-based treatment option for adults with anxiety disorders.

Accepted for Publication: September 21, 2022.

Published Online: November 9, 2022. doi:10.1001/jamapsychiatry.2022.3679

Corresponding Author: Elizabeth A. Hoge, MD, Department of Psychiatry, Georgetown University Medical Center, 2115 Wisconsin Ave NW, Ste 200, Washington, DC 20007 ( [email protected] ).

Author Contributions: Drs Hoge and Mete had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design : Hoge, Bui, Mete, Dutton, Simon.

Acquisition, analysis, or interpretation of data : All authors.

Drafting of the manuscript : Hoge, Bui, Mete, Simon.

Critical revision of the manuscript for important intellectual content : All authors.

Statistical analysis : Mete.

Obtained funding : Hoge, Bui, Dutton, Simon.

Administrative, technical, or material support : Hoge, Bui, Baker, Simon.

Supervision : Hoge, Bui, Dutton, Baker, Simon.

Conflict of Interest Disclosures: Dr Bui reports grants from the National Institutes of Health and the US Department of Defense, licenses or royalties from Springer and Wolters Kluwyer, and consulting fees from Cereval Therapeutics. In the past 3 years, Dr Simon reports grants from the American Foundation for Suicide Prevention, the US Department of Defense, the Patient-Centered Outcomes Research Institute, the National Institutes of Health, and Cohen Veterans Network; grants from the New York University Innovation Fund (partial support for mindfulness-based stress reduction classes and escitalopram during the conduct of the study); consulting fees from Engrail Therapeutics, Bionomics Limited, BehavR LLC, Vanda Pharmaceuticals, Praxis Therapeutics, Cerevel, Genomind, and Wiley (deputy editor Depression and Anxiety ); royalty fees from Wolters Kluwer (UpToDate), APA Publishing ( Textbook of Anxiety, Trauma and OCD Related Disorders , 2020); and spousal equity in G1 Therapeutics and Zentalis outside the submitted work. No other disclosures were reported.

Funding/Support: This research was supported by the Patient-Centered Outcomes Research Institute (PCORI; CER-2017C1–6522).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 3 .

Additional Contributions: We thank the study participants, the mindfulness-based stress reduction teachers, and the research staff and the New York University Innovation Fund for partial support for study treatments.

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5 New Books We Recommend This Week

Suggested reading from critics and editors at The New York Times.

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It’s Independence Day, when Americans traditionally gather to grill meat and blow things up while they celebrate the nation’s founding — but in our recommended books this week, we’re casting an eye on more recent history: Tom McGrath’s “Triumph of the Yuppies” looks back to the “greed is good” era of the 1980s and shows how it marched unimpeded to the present day, while John Ganz’s “When the Clock Broke” finds the roots of today’s culture wars and ascendant right wing in the seemingly quieter politics of the early 1990s. Also up: the biography of an influential book editor, a novel set on a small Welsh island in the 1930s, and a graphic novel that explores themes of independence and self-invention. Happy reading, and Happy Fourth. — Gregory Cowles

TRIUMPH OF THE YUPPIES: America, the Eighties, and the Creation of an Unequal Nation Tom McGrath

In this breezy history, McGrath sets out to explain why the United States suddenly fell in love with finance while inequality skyrocketed in the 1980s. He follows a series of colorful figures in their pursuit of crass materialism, including the junk bond king Michael Milken and the former yippie activist Jerry Rubin.

“Graduating from an elite college and moving to the city to try to get rich has become so common that we barely notice it. The ultimate triumph of the yuppies is that we don’t even call them yuppies anymore.”

From Jacob Goldstein’s review

Grand Central | $32

WHEN THE CLOCK BROKE: Con Men, Conspiracists, and How America Cracked Up in the Early 1990s John Ganz

The 1990s marked the end of the Cold War and the beginning of Clintonian “triangulation,” giving the impression of a bland consensus coalescing around a political middle. But as Ganz shows, the early part of the decade was also a time of social unrest and roiling resentments. His vibrant narrative account captures an emerging “politics of despair” that would eventually benefit the far right.

“Captures the sweep of the early ’90s in all its weirdness and vainglory.... Ganz recounts all of this with a formidable command of the history. But he also has the skills of a gifted storyteller — one with excellent comedic timing, too — slipping in the most absurd and telling details.”

From Jennifer Szalai’s review

Farrar, Straus & Giroux | $30

WHALE FALL Elizabeth O’Connor

Brief but complete, blunt but exquisite, Connor’s debut is set in the fall of 1938 on an unnamed Welsh island with a population of 47, including the bright and restless 18-year-old Manod, her mysterious younger sister and her lobster fisherman father. Unsettling disruptions to the landscape include a whale corpse washed up on the beach and English ethnographers who enlist Manod’s help but woefully distort island life in their work.

“An example of precisely observed writing that makes a character’s specific existence glimmer with verisimilitude. … Understanding is hard work, O’Connor suggests, especially when we must release our preconceptions.”

From Maggie Shipstead’s review

Pantheon | $27

THE EDITOR: How Publishing Legend Judith Jones Shaped Culture in America Sara B. Franklin

This essential if adulatory biography argues that Jones has been given short shrift, credited mostly as the culinary editor who championed Julia Child, but who did much more to burnish Knopf’s exalted reputation in the book business.

“Jones’s contribution to the history of regular old literature has often been minimized or outright erased. … She burnished and sustained Knopf’s reputation as the most prestigious publishing house in the country while also earning it piles of money.”

From Alexandra Jacobs’s review

Atria | $29.99

VERA BUSHWACK Sig Burwash

In this graphic novel debut, Burwash transports the reader to Nova Scotia by exploring the lives of a nonbinary protagonist named Drew and their alter-ego, Vera Bushwack (a chainsaw-wielding, chaps-wearing nonbinary hero of sorts), as they work to clear land in order to build a cabin in the woods, exploring gender, independence and several other big themes along the way.

“Burwash gives the book’s art a lovely personality. It is surprisingly plastic; sometimes their renderings of Drew and her environs are simple contours, sometimes the images are drawn from such a height that they’re almost maps.”

From Sam Thielman's graphic novels column

Drawn & Quarterly | $29.95

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More From Forbes

What is swisstainable a rail tour of switzerland reveals the answer.

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Tour guide Rob Early (left) with John and Dianna Mellers on a train from Visp, Switzerland to ... [+] Geneva.

Dianna and John Mellers had no idea what Swisstainable meant until they landed in Zürich for a one-week train tour of Switzerland.

That’s when their tour guide, Rob Early, started to talk about Switzerland's ambitious sustainability initiatives meant to encourage visitors to experience nature, Swiss culture, local products — and to stay longer.

The Swiss even have a word for it: Swisstainable .

"We didn't realize we were on a sustainability tour," says John Mellers, an engineer from Oviedo, Fla.

It's a common reaction. Technically, Mellers and his wife were on Trafalgar's Contrasts of Switzerland tour. But it's a rail tour with an agenda. Along the way, there are stops that showcase Switzerland's next-level commitment to sustainability, including in Zürich , Switzerland's financial capital, St. Moritz, Zermatt, Geneva and Lucerne.

It turns out Swisstainability is a thing, with clearly defined goals that challenge the way visitors think about their environment. Organizers hope tour participants will come away with ideas about how to improve sustainability back home, but it is all done in such an understated way that if you're not paying attention, you could miss the message.

An electric taxi in Switzerland's famous Zermatt ski area with the Matterhorn behind it. Zermatt is ... [+] one of the most sustainable mountain resorts in the world, having banned all gas-powered cars from its roads.

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Best covid travel insurance plans, why a swisstainable tour.

Trafalgar already had a popular one-week train tour, but when Switzerland rolled out its Swisstainable designation, it saw an opportunity to explore ways to reduce its footprint even further. It decided to turn its train tour into a Swisstainable adventure.

How do you make a tour Swisstainable?

• Use the train. In the past, guests' luggage didn't come on the train with them because there was no storage space. Instead, Trafalgar used trucks to transport the suitcases to the next hotel. In becoming a Swisstainable tour, it found a way to also have the luggage delivered by train.
• Emphasize local food. Most of the meals on Trafalgar's Swisstainable itinerary are locally sourced or from the neighboring region. Most of the food is organic and the majority of restaurant providers have some sort of management system in place to reduce, recycle or upcycle their waste. The whole point of sustainability in tourism is making it accessible for guests so that it is enjoyable.
• Screen your partners. The tour operator also screened its hotel and restaurant partners to make sure they were dedicated to sustainability. Switzerland offers numerous ways to certify a company's sustainability. Trafalgar says it was keen to reduce the impact of its passengers while promoting local food and experiences.

But what's it like to be on a sustainability tour?

Maxime Sother, owner of Château de Malessert, an organic winery near Geneva, Switzerland.

What does a Swisstainable tour do?

Trafalgar's Swisstainable tour shows off some of Switzerland's marquee destinations with a sustainability angle. Among the highlights are Switzerland's famous Glacier Express, which has a strong reputation for sustainability, and Zermatt, which has banned gas-powered vehicles in the city.

There's also a tour of Château de Malessert, a sustainable family winery near Geneva. Maxime Sother, the winery's owner, says when he took over in 2020, he removed chemical pesticides and created his own oak barrels in an effort to become sustainable.

As he wrapped up a tour of his family farm on a recent summer afternoon, Sother said the goal wasn't to create a wine that people wanted to enjoy because they were sustainable, but to make wines that were excellent — and happened to be sustainable.

"It has to be good wine," he says.

For visitors from the United States, it's sometimes difficult to wrap their heads around the sustainability imperatives driving Swiss tourism. They struggle to understand why there are no washcloths in their bathrooms or why there is a $5 deposit for a second room key. (If you don't return it to be recycled, they charge you $5.)

"But then there's that lightbulb moment," says Early, the Trafalgar tour guide.

It can happen any time. On the Mellers' tour in late June, it was the moment participants saw the flooded Matter Vispa River in the iconic ski area of Zermatt.

Other times, it happens more slowly — as in, during the eight-hour train ride on the iconic Glacier Express train between St. Moritz and Zermatt. There, you can see the magnificent glaciers of the Swiss Alps, which are slowly receding as temperatures warm. If you're a skier, you can bemoan the fact that year-round skiing, long a staple of the Swiss mountain experience, may soon be a thing of the past.

Early says a Swisstainability tour is full of "aha" moments when many group members understand that climate change is happening. There's a sense of urgency that if the tourism industry doesn't get sustainability right, there might not be anything left to sustain.

The Glacier Express near St. Moritz, Switzerland.

Taking sustainability ideas home

Early says people want to take some of the ideas home with them.

"There's the 'I wish they did this in America' moment," he says.

Most of those comments are reserved for the Swiss railroad system. It is fast, efficient, expensive and runs on 95% sustainable energy. When a flooded river and a train accident disrupted the Mellers' rail tour on several occasions, the Swiss railroads were lightning-fast in their recovery.

"I really liked the Swiss trains," says Dianna Mellers, who has traveled throughout Europe by rail. "They were really the best we've seen."

John Mellers says he was impressed by Switzerland's sustainability efforts and that many were import-worthy. Mellers, who works in the energy sector, says there's a tendency elsewhere to impose ideas about sustainability — particularly green energy — on other places. He says he was impressed by the way Switzerland leaned toward hydroelectric and nuclear power, both of which are non-carbon-emitting forms of energy.

But Switzerland's ideas suggest a more incremental approach to sustainability that could be copied by other destinations.

A low-key approach to sustainability

Like the Swiss themselves, a Swisstainability tour is modest and understated. There are no declarations of impending doom or lectures about destroying the planet. It's more "show" than "tell."

And really, all it takes to change your mind about sustainability is a week spent using Switzerland's fast and always-punctual trains. Or seeing a disappearing glacier. Or witnessing firsthand what an alpine village without cars feels like.

Sadly, some Swiss sustainability initiatives are unlikely to gain traction elsewhere. For example, the country's almost obsessive recycling programs probably would never work in the United States. And banning gas-powered cars from a city might be impractical in most major tourist destinations.

If nothing else, Switzerland's low-key approach to sustainability is a worthy tourist attraction in and of itself. And in a time when some people are thoughtlessly booking the same old vacations, what's the harm in challenging your conventions?

This is part two of a series on sustainable tourism in Switzerland. Here’s part one on Zürich’s sustainability efforts. Next up: Grindelwald tries to take sustainability to new heights.

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