From the Guidelines
The most effective pre-pharmacological intervention for anxiety is cognitive behavioral therapy (CBT), specifically individual sessions based on the Clark and Wells model or the Heimberg model, as it has shown superiority in clinical and health-related economic effectiveness 1. When considering pre-pharmacological interventions for anxiety, several strategies can be employed to manage symptoms before resorting to medications like anxiolytics.
- Cognitive behavioral therapy (CBT) is a highly recommended approach, with individual sessions being prioritized over group therapy due to its superior effectiveness 1.
- If face-to-face CBT is not feasible, self-help with support based on CBT principles is also suggested, although the strength of recommendation and certainty of evidence are considered weak and low, respectively 1.
- Other psychological interventions, such as those based on CBT principles, have been found to be efficacious in primary care settings, offering a solid starting point for interventions that need to be widely applicable across a range of anxiety presentations 1.
- The content of these interventions often includes elements that can be explained or demonstrated quickly, such as relaxation exercises, and are amenable to at-home skill practice, making them an excellent fit for primary care-based anxiety interventions 1.
- Primary care patients have been found to be receptive to learning about symptoms, problems, and coping skills, which further supports the use of CBT-based interventions in this setting 1.
From the Research
Pre-Pharmacological Interventions for Anxiety
Pre-pharmacological interventions for anxiety include various mind-body practices and lifestyle modifications. Some of the key interventions are:
- Breathing exercises: Deep-breathing exercises have been shown to reduce stress and improve well-being 2
- Meditation: Mindfulness meditation has been found to have positive effects on depression and anxiety disorders, and can be used as an adjunctive treatment 3, 4
- Exercise: Regular exercise, particularly high-energy exercise, has been shown to reduce symptoms of depression and anxiety disorders 3, 5, 4
- Yoga: Yoga has been found to have positive effects on depression and anxiety disorders, and can be used as a monotherapy or adjunctive therapy 3, 4, 6
- Cold-water immersion: Cold-water exposure has been found to have a positive effect on stress reduction and well-being 2
- Lifestyle modification: A range of lifestyle factors, including dietary modification, adequate relaxation/sleep, social interaction, and reduction of recreational substances, can contribute to the prevention and management of depression and anxiety disorders 5
Key Findings
Some key findings from the studies include:
- A 10-day mind-body program consisting of deep-breathing exercises, cold-water exposure, and mindfulness meditation was found to improve symptoms of stress, well-being, and depression 2
- Exercise and yoga have been shown to have therapeutic effectiveness superior to no-activity controls and comparable with established depression and anxiety treatments 3
- Mindfulness-based meditation has been found to have positive effects on depression and anxiety disorders, and can be used as an adjunctive treatment 4
- Kundalini yoga was found to be efficacious for generalized anxiety disorder, but was not found to be as effective as cognitive behavioral therapy 6
Intervention Strategies
Some potential intervention strategies for anxiety include:
- Implementing a regular exercise routine, such as high-energy exercise or yoga
- Practicing mindfulness meditation or other mind-body practices, such as deep-breathing exercises or cold-water immersion
- Modifying lifestyle factors, such as diet, sleep, and social interaction, to contribute to the prevention and management of depression and anxiety disorders
- Using cognitive behavioral therapy or other established treatments for depression and anxiety disorders, in conjunction with pre-pharmacological interventions 6