This Is What Researchers Say About Non-Drug Anxiety Treatments

This week’s guest post was written by AG contributor Kate. Kate is a writer, blogger, and psychiatry researcher living in San Francisco. She is passionate about mental health and utilizing science to develop evidenced based approaches to psychological health.

“The only thing we have to fear is fear itself” – Franklin D. Roosevelt

We should learn to accept our fears and overcome them so they don’t hold us back. We have to accept that everything is going to be okay. I hear rhetoric about conquering fear and anxiety all the time. But how do we do this? I’ve tried so hard to fight my anxiety, but it’s exhausting and doesn’t seem to work. I have driven myself to panic about the fact that I wasn’t conquering it, and I have gone from just worrying about life stressors (a breakup, a move, challenges at work) to worrying that I could never conquer my anxiety. And while I’m able to use some thought interruption techniques in certain situations, this cognitive behavioral approach has its limitations for my smart little brain that’s always trying to figure things out and prepare me for the worst. Because I am a scientist by day, I turned to the experts for advice and reviewed research on anxiety interventions.

There are two conventional non-medication approaches:

1)     Cognitive Behavioral Therapy, or CBT, is the most widely-used therapy for anxiety disorders. It involves thought interruption and reframing of negative patterns and distortions. I think the benefits of this approach are its aims to have a more rational approach to situations, but sometimes it’s hard to identify a distortion and know that it is a distortion, not reality. This technique often requires feedback from others in order to assess one’s thoughts and behaviors for skewedness and sometimes cannot be done while alone.

2)     Another method is to reduce the physiological symptoms. Anxiety involves an activation of the fight-or-flight response in situations where there is a perceived threat or fear. Heart rate ramps up, hormones are released, and so on. Breathing exercises aim to get your body to relax, thus leading to a calming of your thoughts before they snowball, resulting in unmanageable anxiety. However, in the moment of an anxiety attack, the idea of patiently taking deep breaths can be too overwhelming and this is a technique that must be learned with a lot of practice. I know I typically prefer a more proactive strategy because in trying times, my patience is sparse.

Mindfulness has gained popularity as an alternative method of calming anxiety and is my personal favorite (although I feel that I use a mixture of all of the above). It attacks the anxiety problem from two angles: working on the thought content and on the physiological response. I love that it can be used in the moment of an anxiety attack, can be incorporated into any lifestyle with personalized activities, and is preventative of future anxiety through mindful habits.

What is mindfulness? A specific form of meditation, it is a way of observing the present moment in a nonjudgmental way. Researcher and clinician John Astin describes it as helping “a person develop a stance of detached observation towards the contents of consciousness.” It involves nonjudgmental, nonreactive, moment-to-moment awareness of mental states and experiences. Meditation, in one form or another, has been practiced for several thousand years, particularly in Eastern religions. Research across studies, in different countries and cultures, all show many positive effects of mindfulness- and meditation-based treatment.

In addition to calming thoughts, mindfulness has a positive effect on our physiology. In their 2007 study, Hyuk Lee and colleagues found that “meditation affects the endocrine system by inducing a progressive decrease in serum thyroid-stimulating hormone, growth hormone, and prolactin levels, and also acts on the immune system to increase the number of CD3+ lymphocytes and the antibody response to influenza vaccine.” Quite simply, beyond also controlling breathing and heart rate, calming your frenzied mind actually induces long-term changes in physiology and immune response to stress. Dr. Paul Grossman’s comprehensive review of published studies on mindfulness showed that “mindfulness results in acute and long-term improvement in physical and emotional well-being in a broad range of medical disorders.”

A few of my favorite advantages of mindfulness are that it:

1)     Can be practiced anywhere (poor man’s therapy).

2)     Can be done alone or around others in practically any situation (busy gal’s therapy).

3)     Can be incorporated into daily routines once you learn the basic techniques (lazy man’s therapy).

4)     Improves not only anxiety and stress symptoms but also ability to sustain attention and resist distraction.

5)     Allows distancing from self-critical cognitions and intentionally deploying objective focus.

One mindfulness session can help in the moment, however, across the board, research studies show that for a dramatic decrease in anxiety, one should practice mindfulness regularly for at least eight weeks. For the greatest benefit, I would recommend identifying some mindfulness exercises that you feel would work best for you and practicing those exercises on a consistent, daily basis for at least two months. If you would like some help setting up your goals for this new habit, I recommend Gretchen Rubin’s checklist for forming a habit (see here).

While there are many different approaches to mindfulness, below are some specific examples of exercises to try. These are all based on empirical studies that have found significant reductions in anxiety symptoms:

• Body Scan: Starting from the head and moving down your body, allow yourself to experience how each body part feels, focusing on one at a time, becoming aware of sensation of touch or pressure.
• Sitting or Walking Meditation: Sit quietly, breathing in and out, observing content of thoughts.
• Progressive Muscle Relaxation: Tense muscles one at a time, then relax, moving down the body.
• Mindful eating – Explore the food with all sensations: first sight and smell, then taste and texture, paying close attention to all sensory aspects of the food.
• Mindful Breathing: Breath becomes sole object of concentration.
• Conduct a routine activity with full awareness.
• Pleasant and Unpleasant Events Calendar – Every day record one event that makes you feel pleasant and unpleasant (one of each). Become fully aware of all aspects of those feelings (emotions, bodily sensations, muscular activity, thoughts, and sensory input).
• Listening Exercise – Actively focus attention to voice, tone, and content while ignoring all extraneous input.
• Flexibility of Attention – Start with a pleasant activity, add thoughts of a stressful event (such as imagining social situation for social anxiety), then add the stressful situation (go into social situation), meanwhile constantly redirecting attention to the pleasant task with all its sensory aspects.

I must emphasize that if you are going to do this, you must stick with it. You could think of it as a two-month-long boot camp to tackle your anxiety. Mindfulness increases relaxation in the short-term, but if you do the work to maintain the habit, you’ll be able to reap the long-term benefits.

Research studies that I reviewed also utilized CDs for guided mindfulness sessions at home. Here are a few resources to try:

• Headspace App
• Stop, Breathe, & Think App
• Calm App UCLA Audio Files

The best part about mindfulness is that you can do it on your own and figure out what works best for you through some trial and error. If you prefer to read some instructions and proceed that way – that’s excellent. If you would like active, structured guidance, then there are resources for that too.

I am currently practicing the pleasant and unpleasant events calendar, progressive muscle relaxation, and mindful eating. I have noticed that I have become more in tune with myself. For example, through progressive muscle relaxation, I am quicker to notice when my muscles tense up. As soon as I notice this, I make sure to take a break from what I’m doing and practice progressive muscle relaxation. I am able to catch anxiety before it ramps up. Before, I would not even realize the stress was piling up until it resulted in panic. Catching anxiety earlier and taking active steps to practice mindfulness has alleviated a lot of my fears of not meeting deadlines or of negative evaluation, as instead I focus on tasks at hand with less stress.

In addition to the links above, here are resources I utilized in my research:

Bögels, S. M., Sijbers, G. F. V. M., & Voncken, M. (2006). Mindfulness and task concentration training for social phobia: A pilot study. Journal of Cognitive Psychotherapy, 20(1), 33-44.

Craigie, M. A., Rees, C. S., Marsh, A., & Nathan, P. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder: A preliminary evaluation. Behavioural and Cognitive Psychotherapy, 36(05), 553-568.

Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., & Haglin, D. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of anxiety disorders, 22(4), 716-721.

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of psychosomatic research, 57(1), 35-43.

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of consulting and clinical psychology, 78(2), 169.

Kim, Y. W., Lee, S. H., Choi, T. K., Suh, S. Y., Kim, B., Kim, C. M., … & Song, S. K. (2009). Effectiveness of mindfulness‐based cognitive therapy as an adjuvant to pharmacotherapy in patients with panic disorder or generalized anxiety disorder. Depression and anxiety, 26(7), 601-606.

Koszycki, D., Benger, M., Shlik, J., & Bradwejn, J. (2007). Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder. Behaviour Research and Therapy, 45(10), 2518-2526.

Lee, S. H., Ahn, S. C., Lee, Y. J., Choi, T. K., Yook, K. H., & Suh, S. Y. (2007). Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder. Journal of Psychosomatic Research, 62(2), 189-195.

Peterson, L. G., & Pbert, L. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry, 149, 936-943.