Anxiety is a common psychological disorder that affects a large proportion of both adults and children, and is significantly disruptive to quality of life. While primary treatment options often include medication, adverse side effects have led to an increased use of alternative treatments. Individuals with anxiety have been shown to use significantly greater amounts of complementary or alternative medicine (CAM) compared to traditional therapies (1). The frequency of CAM usage in anxiety is relatively high, with one study estimating that approximately 57% of individuals who had experienced an anxiety attack in the previous year reported use of at least one CAM treatment (2). CAM options range from herbal supplements to physical interventions and are discussed below.

Alternative Treatments

Herbal remedies for anxiety have mixed empirical evidence and should be approached with caution. One herbal treatment for anxiety, kava, has been shown through multiple studies and reviews to have a beneficial effect on the reduction of anxiety compared to placebo (1). While there is some evidence of adverse side effects related to kava, including hepatotoxicity (liver damage), these are presumed to be rather rare (3). The effects of other herbs, including valerian and passiflora, have been studied in literature reviews yet no significant effects of these herbs have been solidly identified (1). A review of ashwagandha, a medicinal herb historically used in India, found a greater reduction of anxiety and/or stress compared to placebo groups in multiple studies, however further research is needed given the mixed quality of current literature (4). The use of cannabidiol (CBD) has grown in popularity in recent years, although there is only preclinical evidence in support of its anxiolytic effects (5). Future research examining the effect of chronic CBD use as well as its impact on symptoms in individuals with anxiety disorders is needed.

 

Nutritional Supplements

The effects of other nutritional supplements have also been researched. The amino acids L-lysine and L-arginine are thought to modify neurotransmitter levels associated with anxiety, and preliminary results showing significant decrease in anxiety symptoms and few side effects are encouraging (3). The empirical evidence for use of magnesium is mixed, although some studies have shown positive effects of magnesium in combination with other vitamins or minerals, indicating the potential for a positive synergistic influence (3). Additionally, inositol (a component of vitamin B) has been associated with decreased symptoms in individuals with panic disorder and obsessive-compulsive disorder (6). While its effectiveness in one study was similar to that of traditional medication, further research is needed to confirm these promising results (6).

A recent review of studies examining the anxiolytic effect of aromatherapy yielded significantly positive results, however differences in study design and quality ultimately lead to mixed conclusions (7). Another review of acupuncture treatment for generalized anxiety disorder (GAD) found insignificant positive results showing symptom alleviation, although more high-quality research is needed in order to determine actual effects (8).

Physical exercise may be a useful adjunct treatment for anxiety, and has been researched in those with social phobia, panic disorder, and GAD. A review of these studies found that while both aerobic and non-aerobic exercise led to significant reduction in anxiety symptoms, they were less effective compared to traditional medication (9). Research of yoga for the treatment of anxiety has positive preliminary results, although these should be interpreted with caution given mixed study quality (10). While the effect of meditation alone has received mixed evidence, mindfulness-based stress reduction (MBSR) is a popular therapeutic technique that incorporates many aspects of meditation and has been widely studied (10). Meditative therapies in general have been found to be better at reducing anxiety compared to wait list controls, but are not necessarily more efficacious than other therapeutic techniques (11).

Biologically based alternative treatment for anxiety includes repetitive transcranial magnetic stimulation (rTMS). A form of non-invasive brain stimulation, rTMS given in either high or low frequencies is thought to modify neuron excitability and plasticity (12). Results from studies of individuals with panic disorder and post-traumatic stress disorder (PTSD) are largely inconsistent, although future research is recommended given the non-invasive nature of rTMS combined with its potential benefits (12).

Biofeedback treatment has also been proven useful for anxiety reduction, including electromyography (EMG), heart rate variability (HRV), and neurofeedback (EEG) protocols. Multiple studies have found that all three of these biofeedback techniques led to significant symptom improvement in a number of anxiety disorders, including obsessive-compulsive disorder, GAD, panic disorder, and PTSD (13, 14).  Neurofeedback (training the EEG) has also been shown to be effective.  —  S Jacobs & L Thomas

 

References

  1. van der Watt, G, Laugharne, J, & Janca, A (2008). Complementary and alternative medicine in the treatment of anxiety and depression. Current opinion in psychiatry21(1), 37-42.
  2. Kessler, R, Soukup, J, Davis, R, Foster, D, Wilkey, S, Van Rompay, M & Eisenberg, D (2001). The use of complementary and alternative therapies to treat anxiety and depression in the United States. American Journal of Psychiatry158(2), 289-294.
  3. Lakhan, S, & Vieira, K (2010). Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutrition journal9(1), 42.
  4. Pratte, M, Nanavati, K, Young, V, & Morley, C (2014). An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). The Journal of Alternative and Complementary Medicine20(12), 901-908.
  5. Blessing, E, Steenkamp, M, Manzanares, J, & Marmar, C (2015). Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics12(4), 825-836.
  6. Saeed, S, Bloch, R, & Antonacci, D (2007). Herbal and dietary supplements for treatment of anxiety disorders. Am Fam Physician76(4), 549-56.
  7. Lee, Y, Wu, Y, Tsang, H, Leung, A, & Cheung, W (2011). A systematic review on the anxiolytic effects of aromatherapy in people with anxiety symptoms. The Journal of Alternative and Complementary Medicine17(2), 101-108.
  8. Pilkington, K, Kirkwood, G, Rampes, H, Cummings, M & Richardson, J (2007) Acupuncture for anxiety and anxiety disorders–a systematic literature review. Acupuncture in Medicine25(1-2), 1-10.
  9. Jayakody, K, Gunadasa, S, & Hosker, C (2014). Exercise for anxiety disorders: systematic review. Br J Sports Med48(3), 187-196.
  10. Saeed, S, Antonacci, D, & Bloch, R (2010). Exercise, yoga, and meditation for depressive and anxiety disorders. American family physician81(8).
  11. Chen, K, Berger, C, Manheimer, E, Forde, D, Magidson, J, Dachman, L, & Lejuez, C (2012). Meditative therapies for reducing anxiety: A systematic review and meta‐analysis of randomized controlled trials. Depression and anxiety29(7), 545-562.
  12. Zwanzger, P, Fallgatter, A, Zavorotnyy, M, & Padberg, F (2009). Anxiolytic effects of transcranial magnetic stimulation—an alternative treatment option in anxiety disorders?. Journal of neural transmission116(6), 767-775.
  13. Moore, N (2000). A review of EEG biofeedback treatment of anxiety disorders. Clinical electroencephalography31(1), 1-6.
  14. Schoenberg, P, & David, A (2014). Biofeedback for psychiatric disorders: a systematic review. Applied psychophysiology and biofeedback39(2), 109-135.