Outcomes of Self-help Efforts in Anxiety Disorders

Amy J Morgan; Anthony F Jorm

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459. 

In This Article

Physical Methods

Crenotherapy

Description Crenotherapy is treatment incorporating mineral water, mud and vapor. Different methods of application include mud poultice, water massage, mobility pool or jet spray.

Therapeutic Mechanism This treatment seeks to replenish the body's supply of important elements such as selenium, calcium and copper.

Review of Efficacy One RCT has recently been conducted in 237 patients with generalized anxiety disorder. Participants were randomized to 8 weeks of crenotherapy or paroxetine with a 24-week follow-up.[76] The study found that crenotherapy was significantly superior to paroxetine at 8 weeks in reducing anxiety symptoms.

Safety Issues No safety issues are currently known.

Conclusion One study shows promising effects of crenotherapy for generalized anxiety disorder; however, the study requires replication before firm conclusions can be made.

Exercise

Description The two main types of exercise are aerobic (exercises the heart and lungs; e.g., jogging) and anaerobic (strengthens muscles; e.g., weight training).

Therapeutic Mechanism The therapeutic mechanism is unclear. There is some preliminary supporting evidence for the downregulation of 5-HT2C receptors or GABAA receptors, enhancement of slow-wave sleep, enhancement of perceived coping ability, change in focus from ruminations and worries, or as a form of interoceptive exposure to feared internal stimuli (e.g., shortness of breath) under controlled conditions, particularly for panic disorder.[77]

Review of Efficacy Wipfli et al. analyzed RCTs of exercise for anxiety in a recent meta-analysis.[78] The overall effect size of exercise compared with no treatment (49 studies) was SMD = 0.48 (95% CI: 0.33–0.63) and was 0.19 (p < 0.05) for exercise versus other anxiety-reducing interventions such as CBT, relaxation and stretching or yoga (27 studies). However, these meta-analyses were mostly comprised of nonclinical samples. When restricted to the three trials in clinical samples, the effect size was 0.52 (95% CI: 0.17–0.87). However, little information regarding these trials was reported, and it is not clear whether these trials were in patients with anxiety as well as clinical depression. The definitive RCT of exercise in patients diagnosed with an anxiety disorder remains that conducted by Broocks (included in the aforementioned meta-analysis).[79] It evaluated 10 weeks of regular aerobic exercise (running) against clomipramine (112.5 mg/day) or placebo pills in 46 patients diagnosed with panic disorder. Drop-outs were more common with exercise (31%) and placebo (27%) than with clomipramine (0%), but last-observation-carried-forward analyses indicated that exercise was more effective than placebo, but less effective than clomipramine.

Safety Issues There is a risk of injury when exercising, especially for those who are overweight, have a chronic health condition, or have not exercised regularly for a long time.

Conclusion Although exercise for anxiety in nonclinical samples has been well researched and appears effective, it has been less frequently researched in patients with anxiety disorders. The little evidence available suggests it is effective.

Yoga

Description Yoga exercises the mind and body through physical postures, breathing techniques and meditation. Each posture is held for a period of time and synchronized with breathing.

Therapeutic Mechanism The therapeutic mechanism is not yet clear. However, similar to exercise, it may be through biochemical or physiological mechanisms, through feelings of mastery from learning difficult postures, or through distraction from negative thoughts.

Review of Efficacy A systematic review of yoga for anxiety and anxiety disorders concluded that it is not possible to determine whether yoga is effective, but that there are encouraging results.[80] Only three RCTs for anxiety diagnoses (obsessive–compulsive disorder, anxiety neurosis and psychoneurosis) were found. These showed positive effects when doing yoga, but only one trial was methodologically rigorous. To our knowledge there have been no further RCTs of yoga for anxiety disorders that have been published.

Safety Issues There is a shortage of information on safety issues of yoga for anxiety disorders. However, as it is a form of exercise, there is potential for injury, and certain postures are not recommended during pregnancy. In addition, case reports suggest it may be contraindicated for anyone with a history of psychotic or personality disorder.[80]

Conclusion The few RCTs evaluating yoga for anxiety disorders report efficacious results; however, there is a need for further well-conducted trials before firm conclusions can be made.

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