This article is written by Zhiling Trowbridge MD
Dr. Trowbridge is a medical acupuncturist and family medicine physician in Grand Rapids, MI. She provides medical consultation and treatments for patients struggling with chronic disease, pain, and or other mood disorders including, anxiety, depression, and PTSD.
About 19% of the American population suffers from anxiety with a greater prevalence in women at 23.4%. Anxiety disorder can come in a multitude of forms such as generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety disorder, and situational anxiety disorder
GAD is the most common form of anxiety disorder and leads to excessive worry or perseveration about events, situations, etc. It may present with a persistent sense of anxiety without any underlying cause, an inability to let go or calm down even when it feels like it would be appropriate to do so.
The neurobiology of the brain is a main target for pharmaceutical treatment for anxiety disorder.
Conventional treatments for anxiety include SSRI (e.g. sertraline, citalopram, escitalopram, fluoxetine) along with behavioral therapy. This can be a highly effective treatment approach especially if done in combination.
HPA dysregulation is a common pattern seen in patients who have suffered from extended periods of anxiety and stress. This is likely associated with the close relationship between the limbic system (hippocampus), hypothalamus, and adrenal glands. Long-term effects of high stress or high cortisol affect hormonal production, thyroid function, immune system regulation, and cardiovascular health. Learn more about the stress cycle.
Individuals may also struggle with different layers of physical symptoms that are harder to manage while coping with GAD. These symptoms may include headache, insomnia, gastrointestinal symptoms, musculoskeletal pains, and or higher amounts of use of alcohol or other substances. Anxiety may also come about after a traumatic event or long-term illness such as cancer, heart attack, or stroke.
An integrative approach to anxiety may be warranted in these cases where multiple factors at play have led to the development of generalized anxiety or other anxiety disorders.
Mindfulness for Anxiety
Mindfulness is the cognitive practice of becoming more emotionally aware along with creating cognitive flexibility in response to physical or emotional symptoms. Mindfulness-Based Stress Reduction is one of the most well-researched programs that provides an 8-week course to individuals to support a wide range of symptoms including anxiety and chronic pain. The focus is on learning mindfulness practices through cognitive changes, movement via yoga, guided meditation, and deep breathing techniques. Practice in these areas helps a person understand a sense of non-judgment and cognitive flexibility, becoming more aware of both the negative AND positive aspects of daily life. Improvements in mood, immune function, and chronic pain tolerance are some of the benefits of MBSR.
Herbs for Anxiety
Herbal supplements are one of the most commonly explored aspects of complementary alternative medicine by the general population. Some well-known herbal medicines also are used to promote calm or improve energy, such as chamomile and ginseng, respectively. Though there is a lack of research (mostly due to limited research funding) behind the use of herbal medicine in place of prescription medication, some herbal treatments may be useful to take even in conjunction with a prescription anti-anxiety medication. This should be reviewed and monitored with a trained physician.
Patients should be encouraged to discuss their use of supplements with their physicians or healthcare providers to review the risk of side effects and the quality of herbal products used. This certainly is a caveat as a majority of physicians also need more training and understanding of the use of common herbal supplements, which is generally lacking in most allopathic medical school training.
Classes of herbs such as adaptogens and nervines may be the most useful place to start in addressing anxiety. Some need to be taken regularly while others are used as needed. Adaptogens are a class of herbs that are classified for their wide-ranging effects influencing a person’s tolerance to stress modulating cortisol production, thyroid function, blood sugar control, and lipid production. They tend to improve a patient’s resiliency and improve stress response.
Examples of adaptogens include ashwagandha, schisandra, reishi, tulsi, and turmeric.
Examples of nervines: are lemon balm, lavender, hops, chamomile, and kava.
Nutrition for Anxiety
The Mediterranean or anti-inflammatory diet can positively impact multiple physiological functions that may perpetuate anxiety. These diets focus on increasing omega-3-rich foods in daily nutrition. Omega-3-rich foods include nuts, seeds, leafy greens, fruits, vegetables, and oily fish. Patients are encouraged to lower their intake of refined sugars, refined carbohydrates, and omega-6-rich foods such as those containing saturated fats, i.e. beef, eggs, dairy, and processed foods. Improved omega 6 to omega 3 ratio lowers the inflammatory response re-routing inflammatory cascades to a less exaggerated response during times of infection or other attacks that require an immune response.
In addition, a higher emphasis on plant-based, whole foods also leads to higher fiber intake and promotes a phytonutrient-rich diet. This tangentially can influence the gut-brain axis promoting a healthier bacterial commensal balance possibly influencing mood.
Exercise for Anxiety
Physical exercise has been associated with the influence of neuroplasticity (the ability of the brain to adapt and repair after injury). Improved cognitive function along with the prevention of dementia is enhanced with regular physical exercise. The Department of Health and Human Services, Physical Activity Guidelines for Americans, recommends 150 minutes of moderate-intensity exercise. Calculating your target heart rate (based on your age range) can help you determine how to reach moderate intensity in your regular exercise.
Hypnosis for Anxiety
A therapeutic practice that involves placing a patient in a trance state engaging the limbic system to create subconscious connections using new and old memories of the past. Generally, individuals consult with a hypnotist to discuss what they are interested in achieving during therapy. This may include a change in behavior, improvement in a health problem, or a better understanding of past or current issues. Trance can be a calming state but is considered a hyperstate of deep focus. Some individuals are more hypnotizable than others but if there is a strong desire to be hypnotized that may also be sufficient to achieve predetermined goals under hypnosis. Hypnosis can be utilized to support anxiety relief and or phobias. Repeated treatment sessions may be necessary to experience long-term effects.
Cranial Electrical Stimulation (CES) Therapy for Anxiety
CES requires an external unit and is considered a low-risk therapy for individuals seeking adjunctive support for the anxiety state. Low-intensity electrical current is sent through the skin typically via clips attached to head/ear lobes. CES therapy can last for 20-60 minute sessions and repeated sessions can lead to cumulative improvement in symptoms. CES can be self-administered after appropriate instruction on its use is provided by a trained professional. In a study on college students during the COVID pandemic, the students were instructed CES unit along with access to an online program providing cognitive behavior therapy (CBT). Students after 6 weeks of treatment with the CES device had significant improvements in anxiety scores and symptoms.
Acupuncture for Anxiety
Acupuncture is an ancient therapeutic approach using fine needles placed on the skin typically following predetermined lines of energy called meridians in Traditional Chinese Medicine. Modern medical research has found acupuncture point locations have close ties with the activation of the myofascial system and can influence peripheral and central nervous system changes, along with musculoskeletal pain and joint pain. Acupuncture can be used for anxiety, especially in settings of acute/chronic pain, cancer, PTSD, and generalized anxiety disorder.
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The contents of this article, such as text, graphics, images and other material are intended for informational and educational purposes only and not for the purpose of rendering medical advice. The contents of this post are not intended to substitute for professional medical advice, diagnosis or treatment.
Please consult your physician for personalized medical advice. Always seek the advice of a physician or other qualified healthcare provider with any questions regarding a medical condition. Never disregard or delay seeking professional medical advice or treatment because of something you have read on this post.
