Other Treatments - Treating Anxiety: Mental Health

Content provided by the Faculty of the Harvard Medical School

Other treatments

A variety of other techniques may be helpful in treating anxiety disorders. In mild cases, these treatments sometimes reduce or eliminate symptoms by themselves. In moderate or severe cases, patients may receive better results if they use them as supplements to proven treatments.

Meditation

Meditation is used in a variety of ways to improve physical and mental health, including in the treatment of generalized anxiety, phobias, and obsessive-compulsive disorder. With standard meditation, a person typically chooses a word, sound, or short phrase (sometimes called a mantra) and repeats it with each breath while sitting in a relaxed position with eyes closed, calmly dismissing distracting thoughts and feelings. In the slightly different mindfulness meditation, there is less emphasis on the mantra. Practitioners sit and remain aware of their breathing while observing thoughts and feelings as they come and go in a quiet and detached way. If they notice that their attention is wandering, they are supposed to observe the process without trying to disengage from it and simply return to awareness of their breathing. The aim is to suspend habits of selecting, judging, and interpreting, and attend to the present moment without allowing oneself to be distracted by fantasies, memories, and anxieties.

There is evidence that these practices have distinct effects on the brain. In one study, brain scans indicated that Buddhist monks who were longtime meditators, compared with controls who had just a week of training, showed a high proportion of a type of brain wave that reflects large-scale coordination of neural circuits. In another study, researchers measured brain electrical activity before, immediately after, and four months after a two-month course in mindfulness meditation. They found persistent increased activity on the left side of the prefrontal cortex, which is associated with joyful and serene emotions. Studies are now looking at the effects of meditation on the amygdala, the brain's fear center, and the caudate nucleus, which is associated with obsessional thoughts and compulsive behavior.

It's becoming increasingly common for meditation to be combined with psychotherapy, especially cognitive behavioral therapy. This development makes good sense, since both meditation and cognitive share the common goal of helping people move away from self-defeating thoughts.

Biofeedback

Biofeedback involves taking measures of specific body functions, such as heartbeat or breathing, and feeding them back to an individual in the form of sounds or lights. The idea is to become aware of the body's responses and learn to control them using relaxation and cognitive techniques. While biofeedback is often used to treat panic disorder, there's little research showing how effective it is or how long it should be used.

Hypnosis

Hypnosis is sometimes used in conjunction with cognitive behavioral therapy to treat anxiety and other psychological disorders. It can help individuals focus their attention, rethink problems, relax, and respond to helpful suggestions. There's no magic in hypnosis. It relies mainly on your ability to concentrate and on the trust you have in the therapist. The benefit of hypnosis for treating anxiety is unclear. In some people, it may help relieve certain phobias and sleep problems. But there has been little research, and some of the studies reporting a benefit from hypnosis have had methodological flaws. A highly controversial approach to treating post-traumatic stress disorder uses hypnosis to recover memories, with the intent of confronting them directly. However, whether such memories are factually correct or represent subconscious fears or even suggestions from the therapist is difficult to ascertain.

If you are interested in hypnosis, discuss it first with your psychiatrist or psychologist. The American Society of Clinical Hypnosis is an association for health professionals who are skilled in this method (see "Resources").

Additional relaxation techniques

In addition to meditation, biofeedback, and hypnosis, other relaxation techniques that may ease anxiety include progressive muscle relaxation, deep breathing, and visualization. Progressive muscle relaxation allows you to relax your entire body by tensing and relaxing various muscles in sequence. Deep breathing, also known as diaphragmatic breathing, is a technique that slows respiration, leading to relaxation. The idea is to replicate the type of breathing you do when you sleep (slow and exclusively from the diaphragm — the muscle between the abdomen and the chest), instead of the type you do when awake (faster and using the chest muscles as well as the diaphragm). Visualization, also known as imagery, is a form of meditation that helps you remove yourself mentally from stress. For more details on these techniques, consult your local library or an instructor trained in stress reduction.

Eye movement desensitization and reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is a popular but controversial variation on exposure therapy for post-traumatic stress disorder. Methods differ among practitioners, but in general a patient recalls and describes a traumatic memory while the therapist moves a finger back and forth in front of the individual's face. The patient is to keep his or her eyes on the finger and concentrate on any changes in thoughts and feelings. Next, the patient takes a deep breath, imagines the event, and repeats a comforting thought, such as "I'm safe," while still following the moving finger. This process continues until the memory isn't frightening anymore.

Proponents of EMDR say that it can shorten the time needed for exposure therapy. But carefully controlled studies have not been encouraging. For example, EMDR has been found no better than a placebo for panic disorder. A 2001 analysis of studies of this method, in the Journal of Consulting and Clinical Psychology, found that EMDR does relieve post-traumatic stress disorder, but that it's no more effective than conventional exposure therapy. This study and another analysis, published in 2000 in Psychological Medicine, found that the eye movements were unnecessary; EMDR was just as effective with fixed eyes. If so, that suggests that what's useful in the therapy is the behavioral desensitization and that the eye movements may be superfluous.

Transcranial magnetic stimulation

Transcranial magnetic stimulation, or TMS, is a technique in which an electrical coil, generally in the shape of a figure eight, is placed on the patient's scalp, producing a series of strong magnetic fields. This in turn causes an electrical current to flow in the brain, increasing activity in places where it's thought to be unusually low in patients with various psychiatric disorders.

Unlike the conventional use of electricity to shock the brain directly, TMS does not induce a seizure. No anesthesia is necessary, the patient is fully awake during the procedure, and memory is not affected. Typically, high-frequency magnetic impulses are applied for a half-hour a day, five days a week, for two or more weeks.

So far, research on TMS has largely focused on depression and schizophrenia, and results have been inconsistent. The technique also has been used to treat anxiety disorders, including generalized anxiety, post-traumatic stress disorder, and obsessive-compulsive disorder. Its effectiveness has yet to be demonstrated, but some doctors may recommend its use because the risk of side effects is minimal.

Exercise

If you exercise regularly, you know that a good workout can help you feel less stressed and better able to cope with problems. But can exercise help relieve anxiety disorders?

Some research shows that physical activity can modestly reduce anxiety symptoms. Exercise also boosts self-esteem slightly and improves social interaction skills, both of which can help reduce anxiety. Just how exercise helps isn't known, but researchers believe a combination of factors probably come into play. Exercise increases endorphins, natural chemicals that act like painkillers. And when done with a friend or in a class, it can promote social interaction.

While it's fair to say that exercise benefits mind and body, studies reporting that it reduces anxiety should be viewed with caution. For one thing, few of these studies used subjects diagnosed with anxiety disorders. Instead, they relied on participants' self-reports of anxiety symptoms. It's unclear whether the reported benefits would hold true for people with anxiety disorders. Furthermore, the studies didn't differentiate among types of exercise, intensity, or duration, so it's impossible to recommend a specific regimen. Despite the unknowns, people with anxiety should try to exercise regularly in addition to adhering to proven treatment programs.

Besides boosting your mood, regular exercise offers a host of other benefits, such as lowering blood pressure, protecting against heart disease and cancer, and helping prevent diabetes.

Last updated:	September 05, 2008