29 - Complementary and alternative medicine approaches to the treatment of anxiety  pp. 336-347

Complementary and alternative medicine approaches to the treatment of anxiety

By Sapana R. Patel, Anthony J. Tranguch and Philip R. Muskin

Chapter Abstract

This chapter reviews the four general domains of Complementary and alternative medicine (CAM) therapies for anxiety disorders. Mind-body interventions constitute a major portion of overall CAM use, with about 17% of adults. The CAM domain of biologically based practices for the treatment of anxiety disorders includes a wide range of dietary supplements such as botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, and functional foods. Manipulative and body-based practices encompass several heterogeneous CAM interventions and therapies. These include massage therapy, reflexology, acupressure, and other practices. Energy medicine includes putative energies, which have defied measurement by reproducible methods. Clinicians should remain alert for reliable updates as new information becomes available on evidence based treatments. This can be done by searching databases such as Medline, the Cochrane Collaboration, and the National Center for Complementary and Alternative Medicine (NCCAM) website for information on the latest research on each CAM modality.


energy medicine; anxiety disorders; complementary and alternative medicine; biologically based practices; NCCAM; mind-body interventions;
Abdou A. M. , Higashiguchi S. , Horie K. , et al. (2006). Relaxation and immunity enhancement effects of gamma-aminobutyric acid (GABA) administration in humans. Biofactors, 26, 201–208.
Akhondzadeh S. , Naghavi H. R. , Vazirian M ,. et al. (2001). Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. Journal of Clinical Pharmacy and Therapeutics, 26, 363–367.
Alladin A. (2008). Cognitive Hypnotherapy: an Integrated Approach to the Treatment of Emotional Disorders. Chichester: Wiley.
Arambula P. , Peper E. , Kawakami M. , & Gibney K.H. (2001). The physiological correlates of Kundalini yoga meditation: a study of a yoga master. Applied Psychophysiology and Biofeedback, 26, 147–53.
Astin J.A. (1998) Why patients use alternative medicine. JAMA, 279, 1548–1553.
Bandelow B. , Wedekind D. , & Leon T. (2007). Pregabalin for the treatment of generalized anxiety disorder: a novel pharmacologic intervention. Review of Neurotherapeutics, 7, 769–781.
Barnes P.M. , Powell-Griner E. , McFann K. , & Nahin R.L. (2004). Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report, 343.
Beauchaine T.P. (2001). Vagal tone, development, and Gray's motivational theory: toward an integrated model of autonomic nervous system functioning in psychopathology. Development and Psychopathology, 13, 183–214.
Benjamin J. , Levine J. , Fux M. , et al. (1995). Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder. American Journal of Psychiatry, 152, 1084–1086.
Bisson J. , & Andrew M. (2007). Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, (3), CD003388.
Blier P. , & Bergeron R. (1996). Sequential administration of augmentation strategies in treatment-resistant obsessive–compulsive disorder: preliminary findings. International Clinical Psychopharmacology, 11, 37–44.
Boswell P. C. , & Murray E. J. (1979). Effects of meditation on psychological and physiological measures of anxiety. Journal of Consulting Clinicial Psychology, 47, 606–607.
Brom D. , Kleber R. J. , & Defares P. B. (1989). Brief psychotherapy for posttraumatic stress disorders. Journal of Consulting and Clinical Psychology, 57, 607–612.
Broota A. , & Sanghvi C. (1994). Efficacy of two relaxation techniques in examination anxiety. Special section: relaxation techniques and psychological management. Journal of Personality and Clinical Studies, 10, 29–35.
Brown R. P. , & Gerbarg P. L. (2005). Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression. Part II – clinical applications and guidelines. Journal of Alternative and Complementary Medicine, 11, 711–717.
Brown R. P. , Gerbarg P. L. , & Muskin P. R. (2008). Alternative treatments in psychiatry. In A. Tasman , J. Kay , & J. C. Lieberman , eds., Psychiatry, 3rd edn. London: Wiley, pp. 2318–2353.
Brown R. P. , Gerbarg P. L. , & Muskin P. R. (2009). How to Use Herbs, Nutrients and Yoga in Mental Health Care. New York, NY: Norton.
Bryant R. A. , Moulds M. L. , Guthrie R. M. , & Nixon R. D. (2005). The additive benefit of hypnosis and cognitive–behavioral therapy in treating acute stress disorder. Journal of Consulting and Clinical Psychology, 73, 334–340.
Callahan R. , & Trubo R. (2002). Tapping the Healer Within: Using Thought-Field Therapy to Instantly Conquer your Fears, Anxieties, and Emotional Distress. New York, NY: McGraw-Hill.
Carbonell J. L. , & Figley C. (1999). A systematic clinical demonstration of promising PTSD treatment approaches. Traumatology, 5, 32–48.
Cardeña E. , Maldonado J. R. , van der Hart O. , & Spiegel D. (2009). Hypnosis. In E. B. Foa , T. M. Keane , M. J. Friedman , & J. A. Cohen , eds., Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies, 2nd edn. New York, NY: Guilford Press.
Connor K. M. , Payne V. , & Davidson J. R. (2006). Kava in generalized anxiety disorder: three placebo-controlled trials. International Clinical Psychopharmacology, 21, 249–253.
Das Y. T. , Bagchi M. , Bagchi D. , & Preuss H. G. (2004). Safety of 5-hydroxy-l-tryptophan. Toxicology Letters, 150, 111–122.
Druss B. G. , & Rosenheck R. A. (1999). Associations between use of unconventional therapies and conventional medical therapies. JAMA, 282, 651–656.
Eisenberg D. M. (1997). Advising patients who seek alternative medical therapies. Annals of Internal Medicine, 127, 61–69.
Ernst E. (2001). Yoga (section 3). In E. Ernst , ed., The Desktop Guide to Complementary and Alternative Medicine: an Evidence-Based Approach. Edinburgh: Mosby, pp. 76–78.
Evans S. , Ferrando S. , Findler M. , et al. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 22, 716–721.
Feinstein D. , Eden D. , & Craig G. (2005). The Promise of Energy Psychology: Revolutionary Tools for Dramatic Personal Change. New York, NY: Jeremy P. Tarcher/Penguin.
Field T. , Hernandez-Reif M. , Diego M. , Schanberg S. , & Kuhn C. (2005). Cortisol decreases and serotonin and dopamine increase following massage therapy. International Journal of Neuroscience, 115, 1397–1413.
Field T. , Schanberg S. , Kuhn C. , et al. (1998). Bulimic adolescents benefit from massage therapy. Adolescence, 33, 555–563.
Fux M. , Benjamin J. , & Belmaker R. H. , (1999). Inositol versus placebo augmentation of serotonin reuptake inhibitors in the treatment of obsessive–compulsive disorder: a double-blind cross-over study. International Journal of Neuropsychopharmacology, 2, 193–195.
Fux M. , Levine J. , Aviv A. , & Belmaker R. H. (1996). Inositol treatment of obsessive–compulsive disorder. American Journal of Psychiatry, 153, 1219–1221.
Garner B. , Phillips L. J. , Schmidt H. M. , et al. (2008). Pilot study evaluating the effect of massage therapy on stress, anxiety and aggression in a young adult psychiatric inpatient unit. Australian and New Zealand Journal of Psychiatry, 42, 414–422.
Gibson D. , Bruton A. , Lewith G. T. , & Mullee M. (2007). Effects of acupuncture as a treatment for hyperventilation syndrome a pilot, randomized crossover trial. Journal of Alternative and Complementary Medicine, 13, 39–46.
Hollifield M. , Sinclair-Lian N. , Warner T. D. , & Hammerschlag R. (2007). Acupuncture for posttraumatic stress disorder: a randomized controlled pilot trial. Journal of Nervous and Mental Disease, 195, 504–513.
Horowitz S. L. (1970). Strategies within hypnosis for reducing phobic behavior. Journal of Abnormal Psychology, 75, 104–112.
Jamieson G. A. (2007). Hypnosis and Conscious States: the Cognitive Neuroscience Perspective. Oxford: Oxford University Press.
Kabat-Zinn J. (1990). Full Catastrophe Living: Using the Wisdom of your Body and Mind to Face Stress, Pain and Illness. New York, NY: Bantam Doubleday Dell.
Kabat-Zinn J. , Chapman A. , & Salmon P. (1997). Relationship of cognitive and somatic components of anxiety to patient preference for different relaxation techniques. Mind Body Medicine, 2, 101–109.
Kabat-Zinn J. , Massion A.O. , Kristellar J. , et al. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry, 149, 936–943.
Kahn R. S. , & Westenberg H. G. (1985). L-5-hydroxytryptophan in the treatment of anxiety disorders. Journal of Affective Disorders, 8, 197–200.
Kahn R. S. , Westenberg H. G. , Verhoeven W. M. , Gispen-de Wied C. C. , & Kamerbeek W. D. (1987). Effect of a serotonin precursor and uptake inhibitor in anxiety disorders; a double-blind comparison of 5-hydroxytryptophan, clomipramine and placebo. International Clinical Psychopharmacology, 2, 33–45.
Kaplan Z. , Amir M. , Swartz M. , & Levine J. (1996). Inositol treatment of post-traumatic stress disorder. Anxiety, 2, 51–52.
Kessler R.C. , Soukup J. , Davis R. B. , et al. (2001). The use of complementary and alternative therapies to treat anxiety and depression in the United States. American Journal of Psychiatry, 158, 289–294.
Kirkwood G. , Rampes H. , Tuffrey V. , et al. (2005). Yoga for anxiety: a systematic review of the research evidence. British Journal of Sports Medicine, 39, 884–891.
Kirsch I. , Montgomery G. , & Sapirstein G. (1995). Hypnosis as an adjunct to cognitive–behavioral psychotherapy: a meta-analysis. Journal of Consulting and Clinical Psychology, 63, 214–220.
Krisanaprakornkit T. , Krisanaprakornkit W. , Piyavhatkul N. , & Laopaiboon M. (2006). Meditation therapy for anxiety disorders. Cochrane Database of Systematic Reviews. (1), CD004998.
Lake J. H. , & Spiegel D. , eds. (2007). Complementary and Alternative Treatments in Mental Health Care. Washington DC: American Psychiatric Press.
Lee S. H. , Ahn S. C. , Lee Y. J. , et al. (2007). Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder. Journal of Psychosomatic Research, 62, 189–195.
Lehrer P. M. , Woolfolk R. L. , Rooney A. J. , McCann M. B. , & Carrington P. (1983). Progressive relaxation and meditation: a study of psychophysiological and therapeutic differences between two techniques. Behavour Research and Therapy, 21, 651–662.
Maison A. , Herbert J. R. , Werheimer M. D. , & Kabat-Zinn J. (1995). Meditation, melatonin and breast/prostate cancer: hypothesis and preliminary data. Medical Hypotheses, 44, 39–46.
Marks I. M. , Gelder M. G. , & Edwards G. (1968). Hypnosis and desensitization for phobias: a controlled prospective trial. British Journal of Psychiatry, 114, 1263–1274.
Miyasaka L. S. , Atallah A. N. , & Soares B. G. (2006). Valerian for anxiety disorders. Cochrane Database of Systematic Reviews, (4), CD004515.
Miyasaka L. S. , Atallah A. N. , & Soares B. G. (2007). Passiflora for anxiety disorder. Cochrane Database of Systematic Reviews, (1), CD004518.
Moyer C. A. , Rounds J. , & Hannum J. W. (2004) A meta-analysis of massage therapy research. Psychological Bulletin, 130, 3–18.
Muskin P. R. , ed. (2000). Complementary and Alternative Medicine and Psychiatry. Washington, DC: American Psychiatric Association.
National Center for Complementary and Alternative Medicine (NCCAM) (2004a). Backgrounder: Manipulative and Body-based Practices: an Overview. Bethesda, MD: NCCAM.
National Center for Complementary and Alternative Medicine (NCCAM) (2004b). Backgrounder: Energy Medicine: an Overview. Bethesda, MD: NCCAM.
Pérez de Albéniz A. , & Holmes J. (2000). Meditation: concepts, effects and uses in therapy. International Journal of Psychotherapy, 5, 49–59.
Palatnik A. , Frolov K. , Fux M. , & Benjamin J. (2001). Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. Journal of Clinical Psychopharmacology, 21, 335–339.
Patel S. R. , Carmody J. , & Simpson H. B. (2007). Adapting mindfulness based stress reduction for the treatment of obsessive compulsive disorder: a case report. Cognitive and Behavioral Practice, 14, 375–380.
Pilkington K. , Rampes H. , & Richardson J. (2006). Complementary medicine for depression. Expert Review of Neurotherapeutics, 6, 1741–1751.
Pittler M. H. , & Ernst E. (2003). Kava extract for treating anxiety. Cochrane Database of Systematic Reviews, (1), CD003383.
Raghuraj P. , & Telles S. (2008) Immediate effect of specific nostril manipulating yoga breathing practices on autonomic and respiratory variables. Applied Psychophysiology and Feedback, 33, 65–75.
Raskin M. , Bali L. R. , & Peeke H. V. (1980). Muscle biofeedback and transcendental meditation. A controlled evaluation of efficacy in the treatment of chronic anxiety. Archives of General Psychiatry, 37, 93–97.
Sahasi G. , Mohan D. , & Kacker C. (1989). Effectiveness of yogic techniques in the management of anxiety. Journal of Personality and Clinical Studies, 5, 51–55.
Schoenberger N. E. (2000). Research on hypnosis as an adjunct to cognitive–behavioral psychotherapy. International Journal of Clinical and Experimental Hypnosis, 48, 154–169.
Schruers K. , van Diest R. , Overbeek T. , & Griez E. (2002). Acute l-5-hydroxytryptophan administration inhibits carbon dioxide-induced panic in panic disorder patients. Psychiatry Research, 113, 237–243.
Schwartz G. E. , Davidson R. J. , & Goleman D. J. (1978) Patterning of cognitive and somatic processes in the self-regulation of anxiety: effects of meditation versus exercises. Psychosomatic Medicine, 40, 321–328.
Shannahoff-Khalsa D. S. (2003). Kundalini yoga meditation techniques for the treatment of obsessive–compulsive and OC spectrum disorders. Brief Treatment Crisis Intervention, 3, 369–82.
Shannahoff-Khalsa D. S. , Ray L. E. , Levine S. , et al. (1999). Randomized controlled trial of yogic meditation techniques for patients with obsessive–compulsive disorder. CNS Spectrum, 4, 34–47.
Shapiro F. (1989). Efficacy of the eye movement desensitization: a new treatment for post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 20, 211–217.
Shapiro F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures, 2nd edn. New York, NY: Guilford Press.
Spates C. R. , Koch E. , Cusack K. , Pagoto S. , & Waller S. (2009). Eye movement desensitization and reprocessing. In E. B. Foa , T. M. Keane , M. J. Friedman , & J. A. Cohen , eds., Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies, 2nd edn. New York, NY: Guilford Press.
Spiegel D. , Frischholz E. J. , Maruffi B. , & Spiegel H. (1981). Hypnotic responsivity and the treatment of flying phobia. American Journal of Clinical Hypnosis, 23, 239–247.
Spiegel H. , & Spiegel D. (2004). Trance and Treatment: Clinical Uses of Hypnosis, 2nd edn. Washington DC: American Psychiatric Publishing.
Testerman J. K. , Morton K. R. , Mason R. A. , & Ronan A. M. (2004). Patient motivations for using complementary and alternative medicine. Complementary Health Practice Review, 9, 81–92.
Thomas D. , & Abbas K. A. (1978). Comparison of transcendental meditation and progressive relaxation in reducing anxiety. British Medical Journal, 2, 1749.
Toneatto T. , & Nguyen L. (2007). Does mindfulness meditation improve anxiety and mood symptoms? A review of the controlled research. Canadian Journal of Psychiatry, 52, 260–266.
Volz H. P. , & Kieser M. (1997). Kava-kava extract WS 1490 versus placebo in anxiety disorders – a randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiatry, 30, 1–5.
Watkins J. G. (1992). Hypnoanalytic Techniques: the Practice of Clinical Hypnosis, Volume II. New York, NY: Irvington.
Wells S. , Polglase K. , Andrews H. B. , Carrington P. , & Baker A. H. (2003). Evaluation of a meridian-based intervention, emotional freedom techniques (EFT), for reducing specific phobias of small animals. Journal of Clinical Psychology, 59, 943–966.
Wilkinson S. , Barnes K. , & Storey L. (2008). Massage for symptom relief in patients with cancer: systematic review. Journal of Advanced Nursing, 63, 430–439.
Wilson H. B. (2000). The specific effects model: relaxation and meditation effects on cognitive and somatic anxiety. Unpublished dissertation, Ohio University, Athens, Ohio.
Witte S. , Loew D. , & Gaus W. (2005). Meta-analysis of the efficacy of acetonic kava-kava extract WS® 1490 in patients with non-psychotic anxiety disorders. Phytotherapy Research, 19, 183–188.
Yapko M. (2003). Trancework, 3rd edn. New York, NY: Brunner-Routledge.
Yook K. , Lee S. H. , Ryu M. , et al. (2008). Usefulness of mindfulness based cognitive therapy in the treatment of insomnia in patients with anxiety disorders: a pilot study. Journal of Nervous and Mental Disease, 196, 501–503.