Anxiolysis Alternatives
There are a number of effective, safe non-benzodiazepine approaches used to reduce anxiety, i.e., anxiolysis. Situational anxiety, such as that seen with grief reactions, should be treated with psychotherapy if needed. For anxiety associated with obsessive-compulsive disorder (OCD) or Post-Traumatic Stress Disorder (PTSD), benzodiazepines have been shown to be ineffective and are contraindicated. These two conditions are no longer considered to be anxiety disorders (see DSM-5), although anxiety is often present. Anxiety disorders are specifically defined as anxiety 1) lasting more than 6 months, 2) functionally limiting, and 3) exceeding the level of actual threat that is perceived.
Evidence-based data supports the use of non-benzodiazepine approaches for anxiety of various types. These approaches can be split into three groups. The first group consists of those treatments which can be self-directed on an as-needed basis after the patient receives training. This group of treatments includes:
- Exercise 1-4
- Movement Meditation 5,6
- Imagery 7-9
- Music therapy 8,9
- Mindfulness Based Stress Reduction (MBSR) 10-14
- Religious / Spiritual Interventions 15
- Relaxation / Breathing Interventions 16,17
- Biofeedback 17,18
While patients may already be familiar with some of these treatments, it is important for any treatments chosen that they receive training that is specific to the reduction of anxiety.
1 Ravindran. CAM as add-on to meds for mood disorders. J Affect Disord. 2013;150(3):707-19
2 Hale. Anxiety responses to exercise over 8w. J Sports Med Phys Fitness. 2002;42(1):108-12
3 Stonerock. Exercise as anxiety Rx. Ann Behav Med. 2015;49(4):542-56
4 Strickland. Anxiolytic effects of resistance exercise. Front Psychol. 2014;5:753
5 Rogers. Tai chi, qigong in elderly. West J Nurs Res. 2009;31(2):245-79
6 Wang. Tai chi effects on depression, anxiety, psych well-being. Int J Behav Med. 2014;21(4):605-17
7 Marc I. Mind-body Rx for anxiety in pregnancy. Cochrane Rev. 2011;(7):CD007559
8 McKinney. Imagery, music Rx effect on mood, cortisol. Health Psychol. 1997;16(4):390-400
9 McKinney. Guided Imagery, music Rx outcomes. J Music Ther. 2017;54(1):1-34
10 Goldin. MBSR effect on SAD. Emotion. 2010;10(1):83-91
11 Hofmann. Mindfulness Rx effect on anxiety, depression. J Consult Clin Psych. 2010;78(2):169-83
12 Marchand. Mindfulness as adjunct for psych disorders. Psych Clin North Am. 2013;36(1):141-52
13 Piet. Mindfulness Rx effect on anxiety, depression in cancer. J Consult Clin Psych. 2012;80(6):1007-20
14 Strauss. Mindfulness for current anxiety, depressive disorder. PLoS One. 2014;9(4):e96110
15 Gonçalves. Religious / spiritual interventions in mental health. Psychol Med. 2015;45(14):2937-49
16 Jerath. Breathing self-regulation for anxiety. Appl Psychophysiol Biofeedback. 2015;40(2):107-15
17 Biondi. Relaxation, biofeedback for anxiety, stress-related disorders. Riv Psychiatr. 2014;49(5):217-26
18 Schoenberg. Biofeedback for psych disorders. Appl Psychophysiol Biofeedback. 2014;39(2):109-35
