Summary and Case Resolution
In summary, among the herbal therapies, kava kava remains the most promising for the treatment of anxiety disorders. There is expanding evidence on the benefits of different types of meditative therapies, whereas the evidence for the efficacy of acupuncture remains to be proven for primary anxiety disorders.
Ms Johnson's current anxiety symptoms appear to be secondary to the recent stress and trauma of a divorce rather than to a primary anxiety disorder. Because she is adjusting well to her new life and her anxiety is secondary, a trial of alternative therapy is reasonable.
The choice of activities is diverse—from yoga and mindfulness-based stress reduction classes to imagery and self-meditation using tapes—and relatively low in cost, with minimal side effects compared with medications. It is likely that she can find something within this range that suits her schedule and lifestyle preferences.
Exercise of any kind in groups (hiking, or gym activities, such as yoga or biking) would be a simple starting recommendation to expand her current social contacts and to maintain mental health. Among the complementary and alternative therapies for anxiety symptoms, the meditation and mindfulness-based approach may be best suited to her. This approach also has other medical and physiologic advantages.
Acupuncture is likely to be more costly and could be a second option. Although shown to be effective, kava kava, with its potential liver toxicity, may be reserved for a later time if these other choices fail. The physician should follow up with Ms Johnson within 1-2 months to reassess her symptoms and her chosen modality. If symptoms persist or worsen, then consider a referral for continuation of cognitive-behavioral therapy.
Medscape Family Medicine © 2014
Cite this: What Can CAM Do for Anxiety? - Medscape - Dec 03, 2014.