What Can CAM Do for Anxiety?

Désirée A. Lie, MD, MSEd


December 03, 2014

Emergence of Mindfulness-Based Stress Reduction

Compared with kava kava, mindfulness-based stress reduction (MBSR) therapies have generated less controversy, and in recent years, more evidence has emerged to support their efficacy in treatment of anxiety disorders.

For example, a 2012 systematic review and meta-analysis of mindfulness- and acceptance-based interventions for anxiety disorders found a positive treatment effect, with an advantage of individual over group treatment.[11] The four most rigorous RCTs cited in the analysis, which used proper randomization procedures, demonstrated superiority of the intervention over wait-list and placebo controls. For the 8-week-long MBSR interventions, Buddhist meditation practices were adapted to a secular format. Participants practiced mindfulness between sessions, aided by an instructor and audio recordings. The acceptance-based therapies that combined mindfulness with cognitive-behavioral therapy components were similarly effective in anxiety reduction.

Another review focused on meditative approaches that included transcendental meditation, yoga, qigong, tai chi, and guided imagery among patients with anxiety as a secondary rather than a primary diagnosis.[12] Included in that analysis were 36 RCTs conducted in the United States, Asia, Europe, and elsewhere; 40% of these studies were considered of good quality. Comparator groups included relaxation practice, attention control, exercise, and music therapy. Of the 36 RCTs reviewed, 25 reported statistically significant improvement in participants' anxiety symptoms after meditative approaches compared with control groups.

Not surprisingly, meditative and mindfulness-based therapies have also been found to be useful adjuncts to pharmacotherapy in the management of anxiety disorders,[13,14] and as standalone therapies without adverse effects in pregnant women with anxiety.[15]

Studies have shown the potential of yoga for alleviating anxiety. For instance, a systematic review of 16 RCTs and seven prospective controlled trials found yoga to be a viable alternative for managing anxiety symptoms among patients with medical conditions ranging from breast cancer to perimenopause, migraine, and multiple sclerosis, compared with healthy persons.[16]

In another recent review[17] of 27 studies published between 2010 and 2012,19 studies showed lower state or trait anxiety among yoga participants. The review encompassed many conditions, from anxiety as a primary diagnosis to anxiety secondary to cancer, depression, fibromyalgia, eating disorders, and arthritis. The duration of yoga as an intervention varied from a single session to 3 years of practice; overall, the evidence suggested that an average of 2-3 months of yoga practice was needed to sustain anxiety decline.


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