Sixty-two percent of adults in the United States utilize some form of complementary and alternative medical treatments; the most commonly used are mind-body therapies. Individuals diagnosed with a psychiatric illness may be more likely to use these therapies compared with the general population, especially patients with anxiety.
Evidence of efficacy for the interventions above has significant methodologic limitations. Further clinical trials are needed with larger sample sizes, more appropriate control groups, standardized interventions, and participants with higher levels of anxiety and diagnosed anxiety disorders at enrollment.
●Yoga – Yoga, a practice of breathing, mindfulness, spirituality, and body, has been shown in multiple clinical trials to reduce anxiety in practitioners compared with non-practitioners. Its effects compared with stretching and other physical exercise is unclear.
●Tai-chi – Tai chi is a form of mind-body exercise that originated in China and involves martial arts, meditation, and dance-like movements that focus on the mind and body connection. A meta-analysis concluded that tai chi reduced anxiety in trial participants compared with active and inactive controls.
●Physical exercise – Routine physical exercise is recommended for all adults by the US Department of Health and Human Services, among other groups, citing research findings of its beneficial health effects. Clinical trials suggest that exercise may decrease anxiety in patients with anxiety symptoms or disorders.
●Mindfulness meditation – Mindfulness meditation has been defined as paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally. Basic elements include self-regulation of attention and taking a nonjudgmental stance towards one’s experience. A meta-analysis of 47 trials with 3515 participants found that mindfulness meditation programs had moderate evidence of reducing anxiety.
●Spiritual meditation – Transcendental meditation and qigong meditation are forms of spiritual meditation that have been shown in clinical trials to reduce anxiety. There are fewer clinical trials of devotional meditation and anxiety; study of centering prayer and anxiety is limited to case reports/series.
●Adjunctive treatment – We are generally supportive of the physical, meditative, and spiritual/religious activities described in this topic. They may be helpful and are unlikely to be harmful. We would not encourage their use as a substitute for psychiatric treatment for anxiety disorders, because evidence of their efficacy is generally much weaker. These activities may be of use as adjunctive treatments or primary treatments in patients with relatively low anxiety (eg, beneath the diagnostic threshold of anxiety disorder diagnoses).