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Integrative Approaches to Anxiety: Easing the Fear

Integrative Approaches to Easing Anxiety

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What is anxiety?

Like other emotions, fear is a normal part of being human. It is a reaction to danger or something we believe to be either physically or emotionally threatening. It increases our awareness of the environment. It reminds us to protect ourselves. However, when fear is out of balance, it shifts towards anxiety and should be treated if it is:

  • Intense (you feel it more than most people)
  • Chronic (you feel it many times during the day or most days of the week)
  • Limiting (it makes it hard to connect with others or do daily tasks).

Anxiety is the most common mental health problem in the world.1 One in every 25 people are currently experiencing an anxiety disorder, and the percentage of people who have it has increased since before the COVID-19 pandemic;1,2 about 1 in 3 people will have it at some time in their lives.3 Treating anxiety can be challenging because the fear may affect a person’s ability to trust others and to try new treatments. Living with a constant sense of being in danger is exhausting.

Anxiety and health problems

People with anxiety go to medical visits three to five times more than the average.4 Sixty percent of those with anxiety will have other problems that are linked to it, such as irritable bowel syndrome (IBS)5, depression6, substance use7, gastroesophageal reflux (GERD)8, posttraumatic stress disorder (PTSD)9, or obesity.10

Symptoms of anxiety include2:

  • Tiring easily
  • Restlessness
  • Poor concentration
  • Sweats
  • Irritability
  • Headaches
  • Muscle tension
  • Trembling
  • Sleep problems
  • Fast heartbeat
  • Poor memory

A person with anxiety usually sees several medical providers before the right diagnosis is made. At first, they usually do not know their symptoms are caused by anxiety. Only 1 in 4 people with an anxiety disorder get treatment for it, even though there are many treatments that have been shown to help.2

What causes anxiety?

There is no one molecule, part of the brain, or gene problem that is “the cause” of anxiety. It is probably best to think of anxiety as a group of symptoms that can have many different causes.11 Generalized anxiety, panic attacks, social anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and phobias are all unique conditions even though they are all called anxiety disorders. In truth, each person may have a different mix of causes for their anxiety.12

To manage anxiety, it can help to choose one or more approaches that impact each of the following four areas, trying one option at a time, and adding new ones as needed. Explore what mix of treatments works best for you, noting that each person will have a unique combination they find most supportive.

  1. Mind-Body Issues. Your mind and body have an important connection. When we feel anxious, we may notice symptoms in our body. Working with those symptoms can help decrease anxiety, and also, working with our stress and patterns of thinking can decrease those physical symptoms. How we deal with stress, how aware we are of our surroundings, and paying attention to our patterns of thinking can all affect how anxious we feel.
  2. Body Chemistry. Part of anxiety is genetic. Treatments that help one person in a family may help their relatives too. Different forms of anxiety are linked to different chemical imbalances in the body. Levels and impact of chemical signals such as norepinephrine, dopamine, serotonin, and gamma-aminobutyric acid (GABA) can affect anxiety. Foods, dietary supplements, and medications can help balance the levels of those chemical signals

People with anxiety may also have more or less activity in certain parts of their brain than other people. Some of these parts of the brain include the amygdala (a major emotion processing center), the prefrontal cortex, and the hippocampus (where memories are processed).13

    3. Past Experiences. Experiencing intense trauma or many episodes of less intense trauma increases the risk of having anxiety. How our parents dealt with stress, how we were treated during   childhood, and whether or not we were bullied may all affect our anxiety later in life.14,15,16

    4. Current Environment and Lifestyle. Of course, anxiety is due to more than what happened in the past. Many people have very stressful lives in the present. How we respond to stress – and how much stress we live with every day – is also linked to anxiety levels.17

What can help me with my anxiety?

The following suggestions are based as much as possible on the latest findings from medical research. They tend to be very safe and have helped many people work with anxiety. Whenever you are thinking about trying something for your anxiety, ask yourself these questions:

  1. Is it effective? How do I know that?
  2. Is it safe?
  3. Is it available nearby? Can I access it? How much does it cost?
  4. Is using it OK based on (is it consistent with) my beliefs and values?

All of these suggestions are tied into a Whole Health approach. To learn more see, Whole Health: Integrative Care Starts with Me.

1. Mind-Body

Mind-body approaches are vital for treating anxiety. Whenever possible, these should be a part of your personal treatment plan. Studies show many different mind-body approaches can work, but different people are helped by different ones, so you may have to try several before you know what works best for you. A 2016 review found that they help a variety of people, including those who may not have access to as many resources.18

Psychotherapy and counseling

Psychotherapy is well-studied, and we know it is helpful for anxiety.19 Behavioral therapy offers people ways to change actions that are not helpful. Cognitive behavioral therapy (CBT) expands on that by helping people pay attention to their thinking patterns and change them so that they are more helpful. Psychotherapy can also help medications for anxiety work better. People with anxiety should make it a point to find a therapist, if possible. This should be a person who is not emotionally connected to them. Most therapists can offer a variety of different tools. Digital psychotherapy (seeing someone online) is also helpful.20

Mindfulness-based interventions

Being mindful means being able to pay attention to what is happening in the present moment, without getting caught up in our thoughts, emotions, or sensations. Mindfulness-based interventions seem to be as helpful for anxiety as psychotherapy21 and have the same level of benefit as some medications.22 Mindfulness meditation lowers blood levels of chemicals linked with stress.23 Online mindfulness training can be helpful too.24 There are a number of smart phone apps that can help guide mindfulness practices as well. One example is the Healthy Minds App (developed by Healthy Minds Innovations—a nonprofit organization affiliated with the Center for Healthy Minds at the University of Wisconsin-Madison.

Mindfulness-Based Stress Reduction (MBSR) is one of the most common approaches to mindfulness. It is a course that teaches different kinds of meditation and has been shown to reduce anxiety symptoms in young people.25 More data is needed to show if it is helpful in older people.26 It is worth trying.

For more information on MBSR, consider reading one of these books:

  • Mindfulness for Beginners
  • Full Catastrophe Living
  • Wherever You Go, There You Are

These are books by Jon Kabat-Zinn, who created MBSR courses for health care settings. Another book, which takes a Zen approach to anxiety, is The Fear Book, by Cheri Huber. A more in-depth book to consider is The Mindful Way Through Anxiety by Susan Orsillo and Lizabeth Roemer.

Mindfulness courses are offered at many medical centers. Any type of meditation, from seated insight meditations to various forms of yoga, walking meditations, or body scans, can be helpful. For more information, see the Mindful Awareness Module.

Progressive Muscle Relaxation (PMR)

PMR involves learning how to squeeze and relax the muscles in your body in order. This relaxes the body, which can reduce anxiety.27 To learn more, see the handout Progressive Muscle Relaxation and Progressive Relaxation. Progressive relaxation is similar, except you focus your mind on various muscle groups without moving them.

Biofeedback

More research is needed, but biofeedback shows some promise for people with anxiety.28 During biofeedback, you learn how to stay more relaxed using “feedback” from your body. The therapist will show how you can change your breathing rate, pulse, blood pressure and other measurements to reduce anxiety. For more information, check out Biofeedback.

Breathing exercises

Breathing in certain ways can help you activate your vagus nerve, which can help you get out of being in ‘fight or flight.’ There are many exercises to choose from. Try a few, and then pick a one you can use whenever you need to. A popular one is the 4-7-8 breath. Inhale through your nose for a count of 4 (you decide how fast to count). Hold the breath for the count of 7. Finally, exhale for the count of 8. Repeat this cycle four times. Do it for no more than eight cycles. For more information, see Breathing and Health.

Creative arts therapies

Visual arts, music, dance, and other creative pursuits can also be helpful, especially when done with a therapist who can help you use them to work with anxiety.29,30

2. Body Chemistry

Medications

Medications for anxiety can be helpful. They are especially worth considering for a short time if you need help settling down enough to be able to explore other treatments. However, it is important to avoid the common trap of “covering up the symptoms” by using medications without ever really going deeper to explore the reasons the anxiety exists. Drugs have a role in anxiety treatment but should not be the only thing used. Classes of medications that are often used include beta blockers, serotonin reuptake inhibitors (SSRIs), benzodiazepines, and some antihistamines as well as others.

Nutrition

We still have much to learn, but what we eat and drink seems to affect anxiety levels. A large 2021 review of 1,541 articles found that what we eat can affect anxiety levels in many ways.31

For example, anxiety levels seem to be lowered by:

  • Eating more fruits and vegetables
  • Eating fewer calories
  • Getting omega-3 fatty acids in the diet (e.g., through fish, leafy greens, etc.)
  • Eating breakfast
  • Probiotic foods (foods that contribute to healthy gut microbes)
  • Getting enough minerals, like zinc32, magnesium, manganese, copper, and selenium in the diet
  • Ketogenic diets

Anxiety levels seem to be raised by:

  • An overall unhealthy diet
  • Not enough protein in the diet
  • High fat intake
  • High intake of unhealthy carbohydrates and sugars
  • Not getting enough of the amino acid tryptophan (found in foods like eggs, dairy products, various seeds and nuts, and chicken)

Consider using some of the following nutrition tools, which studies show can be helpful:

  • Monitoring glycemic index and glycemic load. Some people find that they have more anxiety within a few hours of eating, as their blood sugars drop in response to insulin, the chemical in the body that helps it absorb glucose. It may be helpful to try eating multiple small meals, which include both proteins and complex carbohydrates (whole grains). Often, the simple carbohydrates from foods such as sweetened beverages, white breads, donuts, and pastries can lead to greater imbalances in sugar levels. Eat less of them. For more information, see Managing Carbohydrates for Better Health.
  • Eating to reduce inflammation. Depression is tied to higher inflammation in the body, and it may be that anxiety is too.33,34 An anti-inflammation diet might be helpful, as part of an overall anti-inflammatory lifestyle, although more research is needed. See The Anti-Inflammatory Lifestyle.
  • Eliminating certain foods. It might be worth avoiding certain foods for a few weeks in the following situations: 1) if you feel that these foods increase your anxiety, 2) if you crave certain foods or 3) if you rely on this food as ‘comfort foods’ when feeling anxious.
  • If symptoms go away but then come back when a food is added back to the diet, that food may be part of the problem. For more information, see The Elimination Diet.

A recent review found that eliminating gluten in the diet or eating a low FODMaP diet helped reduce anxiety for many people.35 FODMaP stands for a variety of different sugars that can be taken out of the diet and may be especially helpful to eliminate in patients with irritable bowel syndrome. See The Low FODMaP Diet.

  • Reducing caffeine. People with anxiety are more sensitive to caffeine, especially in doses of more than 400 mg a day.36 (A cup of coffee has about 100 mg.) It helps to completely remove caffeine from what you eat. Try this for a few weeks and see if you notice a difference. You may develop a headache for a few days, as your body withdraws from caffeine, but this should clear up with time.
  • Managing the Microbiome. Studies are finding a link between what organisms live in our gut and anxiety.37 There is still much to learn, but taking a probiotic in the form of food or a supplement may be helpful. To learn more, go to Promoting a Healthy Microbiome with Food and Probiotics.
Dietary and Herbal Supplements38

Several supplements seem helpful for anxiety. It is best to ensure you are getting these in your diet first, and then you can take supplements if needed. A good multivitamin is one option. Specific dietary and herbal supplements that might help include:

  • Ashwagandha (Withania somnifera) is an herb that has been used in Ayurveda for over 2,000 years. The research to date shows that it has benefit for both stress and anxiety.39 A standard dose in an adult is 1-2 grams of dried root taken 2-3 x per day or 500mg of standardized extract 2 x daily. It tends to be quite safe.
  • B Complex Vitamins. Thiamine (Vitamin B1) at 250 mg daily may help with anxiety, but research is limited. Vitamin B6 helps your body make serotonin. B6 and B12 both affect levels of S-adenosylmethionine (SAMe), which is known to improve mood problems. B6 also helps with synthesis of a GABA, another chemical in the nervous system.40 B complex supplements are worth trying for at least six weeks. If you take B6 supplements, it is important to make sure the total you take each day is less than 100 mg to avoid harm to your body.
  • Folic Acid. Folic acid (folate) seems to help antidepressants and some supplements work better. A dose of 400-800 micrograms daily may be helpful, but there is not a lot of research focused on its use for anxiety.
  • Kava Kava (Piper methysticum). This supplement, native to the South Pacific, has been found in several studies to help with anxiety.41 It changes levels of GABA, norepinephrine, serotonin, and dopamine in the brain. There are reports of people who have had liver failure associated with kava use, but it is thought that for many of these people, the kava was contaminated. It usually takes 1-8 weeks for kava to reach full effect. Some experts suggest that liver function tests be checked 8 weeks after you start kava. Some sources say it should be used for no more than 3 months. Do not take kava if you have liver problems or if you take any medications that may harm the liver. It may be best to use it under the supervision of a clinician provider familiar with its use. The dose for a tincture of kava lactones is 50-70 mg three times a day.
  • L-theanine is an amino acid found mainly in tea. It may have a beneficial effect for people with anxiety.42 Dosing is 200-400 mg daily. In most studies it has been used for up to 8 weeks.
  • Lavender (Lavandula) essential oil. This seems to have a strong immediate effect on people.43 You can place a drop or two of lavender oil on a cotton swab and inhale for 3 minutes at a time, a few times a day (including bedtime). Do not use if it causes allergy symptoms.
  • Omega 3’s. Omega-3 fatty acids must be obtained through the diet. The limited research we have so far shows they have promise for helping with anxiety at doses of 2 grams daily.44 Most forms have both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). From a few studies investigating the use of fish oil and other omega 3 sources for depression, it appears that omega-3 fatty acids may have positive effects on the body’s nervous system. They tend to be quite safe. You can read more at Omega-3 Fatty Acids: FAQs.
  • Passion Flower (Passiflora incarnata). Passion flower has been found to impact our ability to relax and can aid with sleep. You can take this in a tea (1-2 tsp of dried flowering herb, except roots, per 2 cups of near boiling water, steeped for 5-10 minutes then strained). In capsules, a typical adult dose is 350-500mg 1-2 x per day.45
  • Valerian (Valeriana officinalis). This supplement works especially well for insomnia.46 A standard dose is 150-300 mg in the morning and 300-600 mg in the evening.
  • Vitamin D. Vitamin D has a favorable effect on anxiety, based on available research.47 It can help to aim for a blood level that is in the higher end of normal range. Every 100 International Units taken can increase the vitamin D level in the blood by 1 ng/ml (the units it is measured in in many countries). For more information, see NIH Factsheet on Vitamin D.
  • Other supplements. Many supplements that are used for depression, such as SAMe, St. Johns wort, and 5-HTP, are also used for anxiety. Research for their use for anxiety alone is limited, but given that depression and anxiety are often closely linked, it may be worth considering these supplements. More information can be found at Integrative Approaches to Depression.

NOTE: Dietary supplements are intended to supplement the diet. They are not medicines and are not intended to treat, diagnose, mitigate, prevent, or cure disease. In some cases, dietary supplements may have unwanted effects, especially if taken before surgery or with other dietary supplements or medicines, or if you have certain health conditions. Also, supplements are not regulated with the same degree of oversight as medications. Products vary greatly in terms of accuracy of labels, presence of contaminants, and the validity of claims on the label. Work with your health care provider to determine how best to achieve optimal health.

3. Past Experiences

How we experience stress is influenced by how we saw our parents and others deal with stress when we were growing up. It is also shaped by traumatic events from the past (including various forms of abuse). Many of the items listed in the mind-body section can be useful for exploring these issues. Some therapies help people work through difficult past experiences. This can lead to lower anxiety levels. Examples include body work, energy medicine, psychoanalysis, journaling, and many others. For more information on journaling, see Using Journaling to Aid Health. Family counseling may be helpful in some situations. Consider working with a counselor with expertise in helping trauma survivors. Clinicians skilled in trauma-informed care can be helpful.48

4. Environment and Lifestyle

Changing our surroundings and self-care practices can help with anxiety. Here are some tips. Again, it may help to work on one thing at a time.

Find meaning and purpose

As you might expect, studies show that having a sense of meaning and purpose in life is tied to much lower levels of anxiety.49 It can help to take some time to ask yourself what matters most to you and explore what gives you, or could give you, a strong sense of purpose. This may or may not be tied to spirituality or religion for any given person but may be related to things such as service to community or commitment to family.

Connect with others

Being lonely is associated with higher levels of anxiety.50 Feeling like you have more support from others is tied to lower levels in the studies we have so far.51 Joining local organizations that may be of interest to you or attending community events may help you to meet people with whom you have things in common. You might also consider making it a goal to reach out once per week to one person that you care about.

Increase exercise

Some research shows that exercise can help with anxiety, but we still need to learn more.52 A large review in 2020 found that being active helped older people with anxiety.53 High-intensity exercise seems to have more benefit than low-intensity.54 Walking, a popular and easy way to be active, seems to be helpful.55 Given that exercise helps with so many other health issues as well, it is worth doing, even if just for short periods of time.56 While any movement that brings peace and/or joy is worthwhile, some specific forms include:

  • Yoga. Yoga can be both a form of physical activity and a mind-body approach. It shows promise in research and is very safe with a trained instructor, but it is still not clear how much it helps people with anxiety.57 If you choose to do it, start gently. It helps to do it in a class.
  • Tai Chi. Tai chi, which involves a series of gentle, flowing movements, has shown some promise for helping people with anxiety, in addition to its many other benefits, like preventing falls in older people.58
Minimize substance use

Many people with anxiety (as many as 30%) use alcohol or other potentially addictive substances to control symptoms. If this describes you, the hope is that as you try some of the other treatments listed above, you can cut back or totally stop using tobacco, alcohol and other drugs. Look for things that can take their place and not harm your health.

  • Stop tobacco and other sources of nicotine. They are tied to worse anxiety.59
  • Avoid alcohol. Anxiety can worsen alcohol-related problems, and vice versa.60 Alcohol decreases serotonin levels in the brain, which can make anxiety worse.
  • Stop recreational drugs. 17% of people with anxiety use these substances. You can become addicted to these drugs, and they may cause side effects, including making anxiety and other mood symptoms worse.7 Anxiety leads to higher levels of cannabis use, and cannabis may increase anxiety.
  • Get good sleep
  • 50% of people with anxiety have sleep problems. Problems with one causes problems with the other.61 For suggestions related to improving sleep, see Improving and Maintaining Healthy Sleep Habits.
  • Do a media fast
  • Time spent listening to, reading, or watching the news is linked to anxiety.62 A media fast can help. Spend a certain amount of time (a week is a good start) without watching, reading, or listening to the news. Many people find this extremely helpful, and studies show anxiety levels go down.
  • Manage technology use
  • Some studies indicate that high levels of smartphone use are linked to increased anxiety and depression.63,64 The same seems to be true with high levels of video game and social media use.65
  • Get enough time in nature
  • Increasing time in natural settings (e.g. green spaces like parks or blue spaces, which include bodies of water) can decrease anxiety levels, at least short-term.66 Forest bathing (spending time in the woods) also reduces anxiety.67
  • Keep your work life healthy
  • Feelings about work and amount of work (including work addiction) are linked to higher levels of anxiety.68 Financial need can make our work choices limited. Being aware of this impact and setting boundaries where we can may be beneficial.

What About Other Therapies?

In addition to the suggestions described above, it is reasonable to explore other approaches as well. It would be worth thinking about the following:

  • Acupuncture. Studies on acupuncture for anxiety are limited, but an overall review of the research suggests that acupuncture is promising for anxiety.69,70 It is suggested that more than 5 sessions are needed to have the most effect. More research is needed to fully justify the use of acupuncture. Many people find that acupuncture can be extremely relaxing.
  • Energy medicine. Biofield therapies, like therapeutic touch, healing and reiki, may be helpful.71 They tend to be quite safe. See the Mental Help Website for more information.
  • Bodywork such as therapeutic massage and myofascial release can also provide relaxation. One study of 39 women being treated for breast cancer found that bodywork reduced both anxiety and nausea.72

The information in this handout is for general education. It is not meant to be used by a patient alone. Please work with your health care practitioner to use this information in the best way possible to promote your health and happiness.

For more information

ORGANIZATION

TITLE

DESCRIPTION

Osher Center for Integrative Health

Osher Center for Integrative Health Resource Library

A variety of Integrative Whole Health handouts

Anxiety Disorder Association of America

ADAA

A variety of resources on anxiety (personal stories, webinars, therapy)

US Department of Veteran’s Affairs

Anxiety Overview

More information on anxiety, mental health, and other health resources

What we know about integrative health care has come to us thanks to the efforts, experiences, and collective wisdom of people from many cultures and backgrounds. We wish to acknowledge all the healers, researchers, patients, and peoples who have informed the content of this tool.

Author(s)

This handout was adapted for the Osher Center for Integrative Health at the University of Wisconsin-Madison from the original by Adam Rindfleisch, MD, Professor in the Osher Center for Integrative Health, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health.

Originally Created: March, 2010; Updated: July 2024

References

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Keywords:
Anxiety, Easing Anxiety, Approaches to Anxiety, Integrative Health handout 
Doc ID:
150644
Owned by:
Sara A. in Osher Center for Integrative Health
Created:
2025-05-12
Updated:
2026-03-09
Sites:
Osher Center for Integrative Health
Clean URL:
https://kb.wisc.edu/osher/integrative-approaches-to-anxiety-handout