From the Guidelines
Non-pharmacological management of anxiety, stress, and depression should prioritize cognitive behavioral therapy (CBT) and unified protocols that combine treatments for depression and anxiety, as these approaches have been shown to be effective in reducing symptoms and improving quality of life. The most recent and highest quality study, published in 2023 in the Journal of Clinical Oncology 1, recommends treating depressive symptoms first, or using a unified protocol that combines CBT treatments for depression and anxiety. This approach is supported by the American College of Physicians, which recommends nonpharmacologic treatments, including psychotherapy, exercise, and complementary and alternative medicine, as effective options for managing major depressive disorder 1. Additionally, a 2021 study published in Pharmacological Research recommends psychological counseling, mental health education, and non-drug treatments such as Tai Chi, breathing relaxation training, and mindfulness training for anxiety, fear, depression, and other adverse mental states 1.
Some key non-pharmacological management options for anxiety, stress, and depression include:
- Regular physical exercise, such as 30 minutes of moderate activity 5 times weekly
- Mindfulness meditation, practiced for 10-20 minutes daily
- Cognitive Behavioral Therapy (CBT), which helps identify and restructure negative thought patterns
- Adequate sleep hygiene, including consistent sleep schedules and avoiding screens before bedtime
- Social connection through regular meaningful interactions with supportive individuals
- Stress reduction techniques, such as deep breathing, progressive muscle relaxation, and guided imagery
- Limiting alcohol, caffeine, and recreational drugs, which can exacerbate symptoms
- Establishing daily routines with regular meals, exercise, and relaxation to create predictability and reduce anxiety.
These approaches can be used alone for mild symptoms or alongside medication for more severe cases, and work by addressing the biological, psychological, and social factors that contribute to mental health conditions.
From the Research
Non-Pharmacological Management Options
- Cognitive Behavioral Therapy (CBT) is a widely recommended non-pharmacological treatment for anxiety disorders, stress, and depression 2, 3, 4, 5, 6
- CBT can be provided in primary care settings and may include psychoeducation, exercise prescription, and psychosocial support 2
- Exercise, such as aerobic training, can be recommended as an adjunctive treatment for anxiety 2
- Relaxation techniques, such as deep breathing, exposition, cognitive restructuring, problem-solving, and mindfulness, can be practiced in a self-help format 2
- Non-pharmacological therapies, including CBT, may have more long-lasting effects compared to medication, although medication may act more quickly in reducing symptoms 3
Treatment for Specific Conditions
- For generalized anxiety disorder, CBT may be the preferred first-line treatment 3
- For major depressive disorder, CBT can be recommended as monotherapy or in combination with pharmacologic treatment 5
- For anxiety disorders, including specific phobias, agoraphobia, panic disorder, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), CBT has shown efficiency and effectiveness in meta-analyses 4
Considerations for Treatment
- The choice of treatment should be personalized and based on discussion of potential treatment benefits, harms, adverse effect profiles, cost, feasibility, patients' specific symptoms, comorbidities, concomitant medication use, and patient preferences 5
- Treatment components, such as exposure therapy, mindfulness, and acceptance-based treatments, can be linked to basic science and may be effective in treating anxiety disorders 6