An anxiety disorder involves apprehensive or uneasy thoughts or fears about what may happen so that a person feels troubled, worried or has an uneasy feeling. This fear and mental tension makes them emotionally unstable, irritable and fatigued.

Some people feel uncertain about going to a health professional for help. The costs and time involved in seeing a health professional can also be a concern and they may try to deal with the condition themselves.

Certain herbs have been thought to ease anxiety disorders. Three Cochrane reviews which evaluated herbal medicines are summarised in this overview.

Health professionals often treat anxiety disorders with commercial drugs, or with other therapies combined with drugs. But these drugs may have unpleasant side effects, especially in children. Three reviews examine non-drug treatments for anxiety.

Many people think that a psychiatrist is the best person to treat anxiety disorders. Increasingly, though, people are turning to other health practitioners for help with anxiety. Two Cochrane reviews discuss the roles of other professionals.

We present some of the evidence from Cochrane systematic reviews about complementary and supplemental therapies for anxiety disorders. This evidence comes from carefully-done systematic reviews of information in the medical literature evaluating healthcare treatments. Trials are only included in these reviews if they meet pre-defined standards of high quality.

KAVA EXTRACT VERSUS PLACEBO FOR TREATING ANXIETY 

Kava extract comes from the dried roots of a pepper shrub, Piper methysticum. Kava has long been used in the South Pacific and Europe for its relaxing effects. Other names for kava include kava-kava, kawa, kavain, and Rauschpfeffer. It is widely available as an herbal supplement in pill form, sometimes on its own and sometimes mixed with other substances.

Kava is easily available without a prescription, and so many people have tried using it for relief of anxiety. Various studies have shown that kava has some benefit in relieving anxiety, without some of the side effects of conventional drugs such as drowsiness or developing tolerance to the drug over time. The Cochrane review authors examined these studies and others in their systematic review to find out how effective and safe kava is when compared with placebo (no treatment) for anxiety.

What the synthesised research says

Twelve randomised controlled trials showed that kava is more effective than placebo in treating anxiety. The trials did not compare kava with conventional anti-anxiety drugs, so it is impossible to tell if kava is more or less effective or safe than other medications. The systematic review found only minor side effects from kava, but other research has raised concerns about kava’s safety.

How it was tested

The Cochrane researchers looked for randomised controlled trials comparing people who received oral preparations containing only kava to people who received placebo. To find these studies, they searched medical databases, and contacted researchers and manufacturers of kava products. The researchers found 12 such studies, with a total of 700 patients. These studies showed that kava was more effective than placebo in reducing anxiety, although the effect was mild. Seven of the studies used a test called the Hamilton Anxiety Scale to measure improvement. The authors of the Cochrane review recommend that more research be done on kava with a larger number of patients included.

Side effects and general cautions

The randomised controlled trials considered in the review used kava over the short-term, lasting from 1 to 24 weeks. Only 700 patients were included, so rare side effects or side effects of long-term use may have been missed in these studies. Reported side effects included fatigue, headaches and gastrointestinal complaints.

In Europe, several cases of severe liver damage have been reported after use of products containing kava. The U.S. Food and Drug Administration has issued warnings about kava, and the supplement has been taken off the market in some countries. Since herbal supplements are not regulated in many countries, and may interact with other drugs, consumers should consult with a health professional before using kava.

Source

MH Pittler, E Ernst. Kava extract versus placebo for treating anxiety. The Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003383. DOI: 10.1002/1465158.CD003383.

Other source: E Basch et al. Kava (Piper methysticum G. Forst). Natural Standard patient information. December 1, 2006. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-kava.html (Accessed March 23, 2007)

PASSIFLORA FOR ANXIETY DISORDER

Dried parts of the passion flower, Passiflora incarnata, have traditionally been used as a sedative and for gastrointestinal conditions. The plant producing the passion flower is related to, but not the same species as that producing the passion fruit. Extract of passiflora is available as an herbal remedy.

Passiflora is available without a prescription, and so many people have tried using it for relief of anxiety. However, few studies have examined its effectiveness or safety.

What the synthesised research says

There is not enough evidence from randomised controlled trials to recommend the use of passiflora for anxiety.

How it was tested

The Cochrane researchers looked for controlled trials comparing people who received passiflora in any form to people who received other drugs for anxiety. To find these studies, they searched medical databases, and contacted study authors and manufacturers of passiflora products. They found 2 studies with a total of 198 participants. One study showed no difference between passiflora and a commonly used class of anti-anxiety drugs, benzodiazepines. The other study showed slightly better job performance and less drowsiness from passiflora when compared with the drug mexazolam, but the effect was very slight.

Side effects and general cautions

No major side effects were noted in the 2 studies in the Cochrane review; however, few patients were included in these studies. Passiflora is generally considered safe, but reported side effects have included rapid heart rate and rhythm, nausea, vomiting, and drowsiness. Herbal supplements are not regulated in many countries, and they may contain more than one herbal substance or a dosage different than listed on the packaging. Many herbal substances can interact with other drugs or herbs. For these reasons, consumers should consult with a health professional before using passiflora.

Source

Miyasaka LS, Atallah AN, Soares BGO. Passiflora for anxiety disorder. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004518. DOI: 10.1002/14651858.CD004518.pub2.

Other source: E Basch et al. Passion flower (Passiflora incarnata L.). Natural Standard patient information. October 1, 2006. (Accessed March 23, 2007)

VALERIAN FOR ANXIETY DISORDERS 

The herb valerian (Valeriana officinalis) has been used in Europe and Asia to treat insomnia, anxiety, and other conditions for over 2,000 years. It is a popular herbal supplement in North America, Europe and Japan, generally in pill form. It is known for its strong smell.

Valerian is widely available without a prescription, and so many people have tried using it for relief of anxiety. However, little research has been done on its effectiveness or safety.

What the synthesised research says

There is not enough evidence from randomised controlled trials to recommend valerian for treatment of anxiety.

How it was tested

The Cochrane review authors searched for controlled trials comparing people who received valerian to people who received other drugs or no drugs for anxiety. To find these studies, they searched medical databases, and contacted study authors and manufacturers of valerian supplements. They found only one study with 36 participants. The study compared people receiving valerian, the drug diazepam, and placebo (no treatment). There was no difference found between members of the valerian and placebo groups on the Hamilton Anxiety Scale, a common measurement of anxiety. The diazepam was found to be somewhat more helpful than placebo or valerian. The review authors recommend that more research be done on valerian and anxiety, since this study was very small.

Side effects and general cautions

In the study the Cochrane review considered, no side effects of valerian were noted. The study only ran for 4 weeks and had very few participants, so long-term or rare side effects could have been missed. Other sources report that, while generally considered safe, valerian may cause sedation, headache, stomach upset, dizziness, low body temperature, or with long-term use, insomnia. When suddenly stopping the drug after taking high doses, confusion, rapid heartbeat, and other symptoms may occur.

Herbal supplements are not regulated in many countries, and they may contain more than one herb or a dosage different than listed on the packaging. Many herbal substances can interact with other drugs or herbs. For these reasons, consumers should consult with a health professional before using valerian.

Source

Miyasaka LS, Atallah AN, Soares BGO. Valerian for anxiety disorders. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004515. DOI: 10.1002/14651858.CD004515.pub2.

Other source: E Basch et al. Valerian (Valeriana officinalis L.). Natural Standard patient information. October 1, 2006. (Accessed March 23, 2007)

COGNITIVE BEHAVIOURAL THERAPY FOR ANXIETY DISORDERS IN CHILDREN AND ADOLESCENTS

Between 5 to 18% of children and adolescents have anxiety disorders. These young people are often treated with anti-anxiety drugs, but often drugs are not thoroughly studied in children, or have intolerable side effects. A number of studies suggest that cognitive behavioural therapy (CBT) is effective for treating anxiety disorders in young people.

Cognitive behavioral therapy helps people to recognize how certain thoughts may be negatively affecting them, and teaches techniques to substitute negative thoughts and behaviours for more positive ones. This behavioural therapy is usually given over 10 to 20 weekly sessions. The therapy requires a certain level of cognitive development, so it may be inappropriate for use in very young children.

What the synthesised research says

In young people aged 6 to 19 years, randomised controlled trials show that cognitive behavioural therapy is effective in treating anxiety when compared to being on a waiting list (no treatment) or an attention control (a therapist had them keep a diary or talked with them, but did not use the actual therapy). No difference in effectiveness was found between individual, group, and family therapy sessions.

How it was tested

The Cochrane researchers searched the medical literature for randomised controlled trials comparing children or adolescents with a diagnosis of anxiety who received cognitive behavioural therapy to those who were put on a waiting list or attention control. Thirteen studies were found; these included 498 children who got therapy, and 311 other children who were in control groups. 56% of children who participated in the therapy improved, while only 29% of children in control groups did so.

Side effects and general cautions

No negative effects of cognitive behavioural therapy were seen in the studies included in the Cochrane review. However, the therapy only worked for around half of patients. This review did not compare young people receiving therapy with young people receiving anti-anxiety drugs, other types of talk therapy, or a combination of drugs and cognitive behavioural therapy or other therapy. Thus, general conclusions about the best therapy for anxiety in children and adolescents cannot be drawn from this Cochrane review.

Source

James A, Soler A, Weatherall R. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004690. DOI: 10.1002/14651858.CD004690.pub2.

EXERCISE IN THE PREVENTION AND TREATMENT OF ANXIETY AMONG CHILDREN AND YOUNG PEOPLE

Depression and anxiety are common conditions in children and adolescents. These young people are often treated with drugs, but often drugs are not thoroughly studied in children, or have intolerable side effects. Many families may be unable to afford the money or time involved with talk therapies, and some people are reluctant to see a health professional for other reasons. Exercise is inexpensive, has few negative side effects, and can be done without the supervision of a health professional. It has a variety of health benefits, and may help treat and/or prevent anxiety or depression in young people.

Research in adults has shown that exercise can have beneficial effects on mental health. Some dated studies in children have also suggested positive effects of exercise on specific conditions such as depression, anxiety, and hyperactivity. The authors of this Cochrane review set out to find newer research on children and adolescents.

What the synthesised research says

Randomised controlled trials show that exercise has a modest benefit in reducing depression and anxiety in the general population of children and adolescents aged 11 to 19 years, when compared with no treatment. However, the evidence is unclear whether exercise helps prevent anxiety or depression from developing, or if it treats existing anxiety or depression, or both.

How it was tested

The Cochrane review authors searched the medical literature for randomised controlled trials comparing young people under 20 who participated in vigorous exercise programs with their peers who did not. Sixteen studies with a total of 1191 participants were included in the review. Eleven of the studies compared vigorous exercise with no treatment; 6 of these found less anxiety in the exercise group, while 5 found less depression in the exercise group. Five other studies compared vigorous exercise with lower intensity exercise; no difference was found. Four studies also compared exercise with psychosocial interventions [such as CBT], and found no difference between the groups.

The authors note that most of the research participants were college students, and the kinds of exercise, types of young people and different measurements used in each study varied widely. They conclude that more research needs to be done before recommending exercise as a treatment for anxiety or depression in young people.

Side effects and general cautions

No side effects were noted in the studies in the Cochrane review. While exercise is generally beneficial, some forms of exercise can cause negative side effects in some people. This is especially true of people with a known medical issue, such as a heart disorder or asthma. Many groups recommend consulting with a health professional before starting a new exercise program.

Source

Larun L, Nordheim LV, Ekeland E, Hagen KB, Heian F. Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004691. DOI: 10.1002/14651858.CD004691.pub2

MEDITATION THERAPY FOR ANXIETY DISORDERS

People can meditate without the supervision of a health professional, and has been used for centuries as a calming technique and spiritual practice. Meditation is not known to have side effects, unlike many of the available anti-anxiety drugs.

Studies have demonstrated that meditation can reduce arousal state, both during meditation and after repeated practice. The physical and mental relaxation that results may relieve anxiety disorders. Many health professionals are using meditation in treating patients with anxiety disorders, and people are also using it as a self-help technique.

There are many types of meditation. Concentrative meditation includes Transcendental Meditation (TM), and relaxation response or Bensonian meditation; these two techniques involve focusing the mind on a single object. Another kind of meditation, mindfulness meditation (also called insight meditation), involves keeping the mind open to whatever thoughts may come up rather than focusing on one thing. Some kinds of yoga, such as Kundalini Yoga, involve meditation.

What the synthesised research says

Randomised controlled trials do not provide enough evidence to recommend meditation as a treatment for anxiety disorders.

How it was tested

The Cochrane review authors searched medical databases to find randomised controlled trials comparing patients with a diagnosis of anxiety disorders who underwent meditation with their peers who received some other treatment or no treatment. The authors found 2 studies with a total of 76 participants. In one study, Transcendental Meditation showed reduced anxiety symptoms compared to electromyography-biofeedback and relaxation therapy. The other study compared Kundalini Yoga with relaxation and mMindfulness meditation, and found no difference between the two groups. Both studies were small, and 33% to 44% of participants in the studies dropped out. Because of these factors, meditation cannot be recommended as a treatment for anxiety disorders, but more research should be done on this widely used therapy.

Side effects and general cautions

Neither study found that meditation had side effects, although the studies were small and many participants dropped out. The participants who chose to drop out may have experienced some unpleasant effects, since they did not keep meditating. The studies ran from 12-18 weeks, so there might be more negative or positive effects from meditation seen over a longer time period.

Source

Krisanaprakornkit T, Krisanaprakornkit W, Piyavhatkul N, Laopaiboon M. Meditation therapy for anxiety disorders. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004998. DOI: 10.1002/14651858.CD004998.pub2.

PSYCHOLOGICAL THERAPIES FOR GENERALISED ANXIETY DISORDER  

Generalised anxiety disorder involves excessive worry or anxiety about everyday life. Often drugs are prescribed for anxiety, but drugs may have unwanted side effects and may not help in all cases. Psychological therapies, including cognitive behavioural therapy (CBT), psychodynamic therapy and supportive therapy, offer alternatives to drug treatments for generalized anxiety.

For this review, psychological therapy refers to cognitive therapy, psychodynamic therapy, and supportive therapy. All of these forms of therapy involve the client talking with a therapist once or a few times a week for several weeks or months. Previous research has shown that cognitive behavioural therapy is beneficial for generalised anxiety, but psychodynamic and supportive therapy have not been studied as well, even though these therapies are widely used.

What the synthesised research says

Randomised controlled trials show that cognitive berhavioural therapy is effective in reducing symptoms of generalized anxiety in adults over the short term when compared with no treatment. More research is needed on psychodynamic therapy and supportive therapy for general anxiety.

How it was tested

The Cochrane researchers searched the medical literature for controlled trials which compared adults diagnosed with generalised anxiety disorders who underwent psychological therapy with their peers who were assigned to either: a) treatment as usual (any non-psychological therapy, including medication); b) waiting list for psychological therapy; or c) a different kind of psychological therapy. The researchers found 25 studies with 1305 participants. Thirteen of the studies showed that CBT was more effective than treatment as usual or waiting list in reducing anxiety symptoms. Six of the studies compared CBT with supportive therapy; no difference was seen, but it was difficult to compare the groups in these studies. Only one study compared CBT and psychodynamic therapy, with no significant difference found. None of the studies looked at the long-term effectiveness of CBT or other therapies. The researchers conclude that more research should be done on the effectiveness of psychodynamic and supportive therapies for generalized anxiety, and comparing these therapies with CBT.

Side effects and general cautions

No side effects of the therapies were noted in the studies. Some studies did find that older people and those going to group CBT sessions were more likely to drop out of therapy.

Source

Hunot V, Churchill R, Silva de Lima M, Teixeira V. Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001848. DOI: 10.1002/14651858.CD001848.pub4.

PARAPROFESSIONAL CARE FOR ANXIETY AND DEPRESSIVE DISORDERS

Anxiety and depression are common conditions. There are not enough mental health professionals to meet growing needs or they are not available to people. Paraprofessionals might be able to help some people with anxiety or depression. 

Paraprofessionals can include anyone who is not qualified as a psychiatrist, psychologist, counselor, social worker or nurse. People who coordinate self-help or bibliotherapy (reading to provide emotional growth and health) groups are usually paraprofessionals. Paraprofessionals may be volunteers or paid workers, and in many contexts they are trained by mental health professionals. Some research suggests that paraprofessionals are effective in providing psychological treatment.

What the synthesised evidence says

There is not enough evidence to determine how paraprofessionals compare to professionals in treating anxiety and depression. However, studies showed some benefit of seeing a paraprofessional compared with receiving no treatment.

How it was tested

The Cochrane review authors searched the medical literature for randomised controlled trials which compared the effects of treatments given by paraprofessionals with treatments given by mental health professionals, as well as with no treatment. The authors found 5 studies, each of which compared paraprofessionals with professionals (total number of participants: 106) as well as comparing paraprofessional treatment with no treatment (total number of participants: 220). No differences were found between professionals and paraprofessionals. Three studies showed that paraprofessional treatment was better than no treatment.

Side effects and general cautions

No negative effects of paraprofessional treatment were noted in the reviews. However, there were few studies included with a small total number of participants. Some patients with anxiety or depression may be better helped by a professional, particularly if drugs are needed for effective treatment since only licensed professionals can prescribe medication.    

Source

den Boer PCAM, Wiersma D, Russo S, van den Bosch RJ. Paraprofessionals for anxiety and depressive disorders. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004688. DOI: 10.1002/14651858.CD004688.pub2.

PSYCHOSOCIAL INTERVENTIONS DELIVERED BY GENERAL PRACTITIONERS 

Many people visit their general practitioner or physician (GP) for help with mental health problems. This may be due to their familiarity and comfort with the GP, or concerns about cost and waiting time to see a psychiatrist or other specialist. Since GPs are not specialised in mental health and are often very pressed for time, they need effective, efficient interventions for helping patients with mental health concerns.

Psychosocial interventions focus on dealing with problems through psychological rather than medical means. Many people prefer psychosocial interventions to avoid the side effects of taking drugs for a mental health condition. These include counselling, problem-solving therapy, cognitive behavioural therapy, and psychotherapy.

What the synthesised research says

Some evidence shows that problem-solving treatment for depression may be an effective technique for GPs. There is not enough evidence for other psychosocial interventions that might be used by GPs.

How it was tested

The Cochrane researchers searched the medical literature for controlled trials which compared psychosocial interventions by GPs for any condition with other treatments for that condition. Eight studies were identified, with a total of 2114 participants. The health conditions addressed included depression, smoking, alcohol usage, and depression expressed in physical symptoms (somatisation disorder). Only depression was found to be helped by psychosocial techniques guided by a GP. 

Side effects and general cautions

No negative effects of psychosocial therapies were noted in the reviews. The included studies varied widely in terms of treatments provided and conditions addressed, making it difficult to draw conclusions from the review. While anxiety is a common problem that many people see their GP about, no studies focused on anxiety were found for this review. More research should be done on GPs’ treatment of anxiety.

Source

Huibers MJH, Beurskens AJHM, Bleijenberg G, Schayck CP van. Psychosocial interventions delivered by general practitioners. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003494. DOI: 10.1002.14651858.CD003494.