Anxiety and Complementary Health Approaches

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What’s the Bottom Line?

How much do we know about the effectiveness of complementary and integrative health approaches for anxiety?

There is a growing body of research examining how some complementary and integrative approaches may help reduce anxiety or help people cope with it.
- Some studies have focused on the anxiety that people experience in everyday life or during stressful situations, while others have focused on anxiety disorders.
- Some complementary health approaches may help to relieve anxiety during stressful situations such as medical procedures.

There have been some studies showing yoga is helpful for managing anxiety symptoms, but it is not clear if yoga is effective for anxiety disorders. More high-quality research is needed.
Some studies have shown mindfulness-based practices may be as effective as established treatments for managing anxiety symptoms, but more research is needed.

Hypnosis has been studied for anxiety related to medical or dental procedures. Some studies have had promising results, but the overall evidence is not conclusive.
There is some evidence that listening to music may help reduce anxiety for people undergoing medical procedures.
Although some studies suggest that complementary health practices such as acupuncture, tai chi, and qigong may reduce anxiety, more high-quality studies involving larger numbers of people are needed before definite conclusions can be reached.

How much do we know about the safety of complementary and integrative health approaches for anxiety?

In general, the psychological and physical approaches discussed in this fact sheet have good safety records. However, that doesn’t mean that they’re risk free for everyone. Your age, health, special circumstances (such as pregnancy), and medicines or supplements that you take may affect the safety of complementary approaches.
Dietary supplements may have side effects, and some may have undesirable interactions with medicines.
As with any physical activity, practices that involve movement, such as yoga, may involve some risk of injury.

What Is Anxiety and Why Is It Important?

Anxiety is a feeling of worry, nervousness, or fear about an event or situation. It’s normal for people to feel anxious in response to stress. But anxiety disorders are different. For people with anxiety disorders, the feeling of anxiety becomes a severe, persistent problem that’s hard to control and affects day-to-day life, like going to work or school, or spending time with family or friends.

About 19 percent of U.S. adults had an anxiety disorder in the previous year, and an estimated 31 percent have an anxiety disorder at some time in their lives. Anxiety disorders are generally treated with psychotherapy, medication, or both.

However, there is growing acceptance and use of complementary and integrative approaches, and it is estimated that nearly 43 percent of people diagnosed with anxiety disorders use them. If you think you may have an anxiety disorder, talk with your health care provider. The National Institute of Mental Health has more information on anxiety disorders and other mental health disorders.

Recognize When You Need More Help

If you are struggling to cope, or if the symptoms of your anxiety won’t go away, it may be time to talk to a professional.

If you are in immediate distress or are thinking about hurting yourself, call, text, or chat 988. This 3-digit number will route you to the 988 Suicide & Crisis Lifeline, which is now active across the United States. The Lifeline provides 24-hour, confidential support to anyone in suicidal crisis or emotional distress.

If you or someone you know has a mental illness, is struggling emotionally, or has concerns about their mental health, there are ways to get help. Read more about getting help.

About Complementary Health Approaches

Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be:

Nutritional (e.g., special diets, dietary supplements, herbs, probiotics, and microbial-based therapies).
Psychological (e.g., meditation, hypnosis, music therapies, relaxation therapies).
Physical (e.g., acupuncture, massage, spinal manipulation).
Combinations such as psychological and physical (e.g., yoga, tai chi, dance therapies, some forms of art therapy) or psychological and nutritional (e.g., mindful eating).

Nutritional approaches include what the National Center for Complementary and Integrative Health (NCCIH) previously categorized as natural products, whereas psychological and/or physical approaches include what was referred to as mind and body practices.

What the Science Says About Complementary Health Approaches for Anxiety

Psychological and Physical Approaches

Acupuncture

There is some limited evidence that acupuncture may help reduce anxiety symptoms, but overall, the quality of the studies that have been conducted is low.

A 2022 review of 27 randomized controlled trials (1,782 total participants) concluded that acupuncture relieved anxiety symptoms better for people with generalized anxiety disorder and with fewer side effects than the other treatments it was compared with, most of which were medications. However, the authors noted that more high-quality clinical trials are needed.
In 2021, researchers from China analyzed 12 studies with a total of 916 patients and found that acupuncture therapy prior to surgery may help reduce anxiety. The authors concluded that more research is needed because of the small number of people studied and low quality of evidence.

Safety

Relatively few complications from using acupuncture have been reported. However, complications have resulted from use of nonsterile needles and improper delivery of treatments. When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, and injury to the central nervous system.

Visit the NCCIH website for more information on acupuncture.

Hypnosis

Hypnosis has been studied for anxiety related to medical or dental procedures. Some studies have had promising results, but the overall evidence is not conclusive.

A 2022 review of 19 trials found hypnotherapy helped to reduce dental anxiety and fear during dental treatment. However, the reviewers noted that despite the reported positive effects of hypnotherapy treatments, the results varied widely.
The 2023 joint guideline issued by the Society for Integrative Oncology and the American Society for Clinical Oncology recommends that hypnosis may be offered to people with cancer to improve anxiety symptoms during cancer-related diagnostic and treatment procedures.

Safety

Hypnosis is a safe technique when practiced by a trained, experienced, licensed health care provider.

Visit the NCCIH website for more information on hypnosis.

Mindfulness Meditation

Some studies suggest that mindfulness-based practices may be as effective as or more effective than some established treatments for reducing anxiety, but more research is needed.

Mindfulness-based stress reduction. A 2023 randomized controlled trial involving 208 participants with anxiety disorders found that mindfulness-based stress reduction is not less effective than escitalopram, a commonly prescribed medication for treating anxiety disorders. A 2021 trial in 108 adults with generalized social anxiety disorder found that cognitive behavioral group therapy (a type of psychotherapy) and mindfulness-based stress reduction may be effective treatments with long-term benefits. Both treatments may help people regulate their emotional responses.
Mindfulness-based meditation.
- A 2019 analysis of 29 studies (3,274 total participants) showed that use of mindfulness-based practices among people with cancer significantly reduced anxiety and other types of distress. However, most of the participants were women with breast cancer, and the effects may not be similar for other populations or other types of cancer.
- In a 2014 review of 8 studies with a total of 647 participants, researchers found that mindfulness meditation programs showed moderate evidence for improving anxiety when compared to non-specific controls, such as education or attention control. An additional 11 studies with 691 participants were evaluated and showed insufficient evidence that mindfulness was more or less effective compared to specific controls, such as exercise, progressive muscle relaxation, or cognitive behavioral group therapy.
Comparison of mindfulness-based interventions. A 2021 review of 23 studies with 1,815 adult participants diagnosed with anxiety disorders, such as generalized anxiety disorder or social anxiety disorder, found acceptance- and mindfulness-based interventions resulted in short-term reduction in anxiety. The researchers recommended further high-quality studies.

Safety

Meditation is generally considered to be safe for healthy people.
A 2019 review found no apparent negative effects of mindfulness-based interventions for patients with anxiety disorders.

Visit the NCCIH website for more information on mindfulness and meditation.

Music-Based Interventions

There is evidence from studies of people with various health problems and those undergoing medical treatment that listening to music can reduce anxiety.

A 2013 review of 26 studies involving a total of 2,051 participants found that listening to recorded music significantly reduced anxiety in people who were waiting to have surgery. However, there was potential for bias in most of the studies because the investigators who performed the studies knew which participants had listened to music.
A 2021 review of 17 studies involving a total of 1,381 participants evaluated the effect of music-based interventions on anxiety in adults with cancer. Some studies involved listening to recorded music; other studies used more complex interventions. The findings from the review suggested that music-based interventions may have a large anxiety-reducing effect. However, there was a high risk of bias in the studies.
A 2015 review of 5 studies (290 participants) in people who were having dialysis treatments suggested that listening to music reduced anxiety. However, these studies have limitations because of their small size and high risk of bias.
A 2018 review concluded that it’s unclear whether listening to music is helpful for dental anxiety. Some studies have suggested that listening to music as a distraction may not be adequate to reduce anxiety in children or highly anxious adults who are having dental care. More active types of music-based interventions (for example, a music-assisted relaxation technique that’s taught to the patient in advance) might be helpful in dental settings but have not been evaluated in formal studies.

Safety

In general, research studies of music-based interventions have not shown any negative effects.
However, listening to music at too high a volume can contribute to noise-induced hearing loss. You can find out about this type of hearing loss on the National Institute on Deafness and Other Communication Disorders website.

Visit the NCCIH website for more information on music and health.

Relaxation Techniques

Relaxation techniques may reduce anxiety in people with chronic medical problems and those who are having medical procedures. However, cognitive behavioral therapy may be more helpful than relaxation techniques in treating at least some types of anxiety disorders.

The 2023 joint guideline issued by the Society for Integrative Oncology and the American Society for Clinical Oncology recommends that relaxation therapies may be offered to people with cancer to improve anxiety symptoms during cancer-related diagnostic and treatment procedures.
A 2018 review of 50 studies with 2,801 participants found relaxation techniques to be less effective than cognitive behavioral therapy for treating post-traumatic stress disorder and obsessive-compulsive disorder. Additionally, relaxation techniques may be less effective after one year for panic disorders, but there is not enough evidence to conclude that it is less effective than cognitive behavioral therapy for other anxiety disorders.

Safety

Relaxation techniques are generally considered safe for healthy people. However, occasionally, people report negative experiences such as increased anxiety, intrusive thoughts, or fear of losing control.
There have been rare reports that certain relaxation techniques might cause or worsen symptoms in people with epilepsy or certain psychiatric conditions, or with a history of abuse or trauma.

Visit the NCCIH website for more information on relaxation techniques.

Yoga

Yoga is an ancient and complex practice that has become popular as a way of promoting physical and mental well-being. There have been some studies showing yoga is helpful for managing anxiety symptoms, but the evidence is inconclusive for effects of yoga on anxiety disorders. More high-quality research is needed.

A 2019 review of 38 studies (2,295 participants) of yoga for anxiety symptoms found that yoga had a substantial beneficial effect, with the greatest effects seen in studies performed in India. The studies included a variety of different groups of people, including healthy people such as students and military personnel, patients with various physical or mental health conditions, and caregivers.
A 2021 review looked at the evidence on yoga for people who have been diagnosed with anxiety disorders. Although the reviewers identified some promising results, they concluded that there is insufficient evidence to recommend the routine practice of yoga as primary treatment for patients with anxiety disorders.
A 2021 study of Kundalini yoga for generalized anxiety disorder (226 participants, 155 of whom completed the study), supported by NCCIH, found that Kundalini yoga improved symptoms but was less helpful than cognitive behavioral therapy, an established first-line treatment for this condition.

Safety

Yoga is generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor.
As with other forms of physical activity, injuries can occur. The most common injuries are sprains or strains.

Visit the NCCIH website for more information on yoga.

Other Psychological and Physical Approaches

Massage Therapy, Tai Chi, and Qigong

Although some studies suggest that complementary health practices such as massage therapy, tai chi, and qigong may reduce anxiety, more high-quality randomized controlled trials that include larger numbers of people are needed before definite conclusions can be reached.

Safety

The risk of harmful effects from massage therapy appears to be low. However, there have been rare reports of serious side effects such as a blood clot, nerve injury, or bone fracture.
Tai chi is generally considered a safe activity. A 2019 review of 24 studies (1,794 participants) found that most reported adverse events were minor, such as musculoskeletal aches and pain. The review also found that in studies of people with heart failure, people in tai chi groups experienced fewer serious adverse events than people receiving no intervention.
Qigong is generally considered safe, although there have been some reports of qigong-induced mental disorders that resulted from unrealistic expectations or inappropriate practice of qigong.

Emotional Freedom Technique/Acupoint Tapping

Emotional freedom technique (EFT), also known as acupoint tapping, involves tapping specific acupressure points on the body with your fingertips while repeating a word or phrase. There is some evidence that it may be effective for reducing anxiety, but more research is needed.

A 2015 review of 14 studies (658 participants) showed a significant decrease in anxiety scores. However, the authors stated that more research comparing EFT to standard care and cognitive behavioral therapy is needed to be conclusive.
A 2020 study of 72 nurses caring for COVID-19 patients in a Turkish hospital found that a brief, single session of online group EFT significantly reduced anxiety as well as stress and burnout. The researchers noted that while the intervention was successful and easy to provide, the long-term effects are unknown.

Safety

EFT is generally considered to be safe.

Nutritional Approaches

Chamomile

Two studies, both supported by NCCIH, suggest that a chamomile dietary supplement might be helpful for generalized anxiety disorder, but the studies are preliminary, and their findings are not conclusive.
A 2019 review of three randomized controlled trials of chamomile showed no significant reduction in state, or situational, anxiety.

Safety

Chamomile is relatively safe, although some side effects such as headache, dizziness, lingering taste, and digestive and musculoskeletal problems have been reported.

Kava

Kava supplements may have a small effect on reducing anxiety, but they have been linked to a risk of severe liver injury.
A 2018 review of 12 studies suggested that kava may be an effective treatment for generalized anxiety disorder, but the authors noted that more research is needed. A 2018 review of 11 studies found kava may be a short-term treatment for anxiety symptoms.

Safety

Commonly reported side effects include gastrointestinal symptoms, fatigue, headaches, muscle aches, and trembling and shakiness.
The use of kava supplements has been linked to a risk of severe liver damage, and more research is needed.

Lavender

Studies of a lavender oil product that is taken orally (by mouth) have suggested it might be beneficial for anxiety, but because of limitations of the research, including the small size of the studies, no definite conclusions can be reached about its effectiveness.
A 2019 analysis of 65 randomized controlled trials (7,993 participants) and 25 nonrandomized studies (1,200 participants) assessed the effects of lavender in any form on anxiety. The analysis suggested that lavender taken orally may be an effective treatment for anxiety. Lavender essential oil used for massage may also be effective, but it is unclear if the benefit is from the oil or the massage. The review was limited by the low quality of available studies.

Safety

Lavender oil is generally considered safe when used orally, with massage, or when inhaled.

Melatonin

Melatonin supplements appear to be helpful in reducing anxiety before surgery, but it’s unclear if they help to lower anxiety after surgery.

A 2020 review looked at 27 studies of melatonin for treating anxiety before surgery, anxiety after surgery, or both. Twenty-four of the studies compared melatonin with placebo, and 11 compared it with a benzodiazepine antianxiety medicine. Based on evidence from 18 studies, melatonin probably reduces anxiety before surgery, when compared to a placebo. Melatonin might also reduce anxiety after surgery to a small extent, but the evidence for this was of lower quality and came from a smaller number of studies (seven for anxiety immediately after surgery, two for delayed anxiety). The effects of melatonin on anxiety may be similar to those of benzodiazepines before surgery (based on seven studies) and immediately after surgery (three studies).

Safety

For melatonin supplements, particularly at doses higher than what the body normally produces, there’s not enough information yet about possible side effects to have a clear picture of overall safety. Short-term use of melatonin supplements appears to be safe for most people, but information on the long-term safety of supplementing with melatonin is lacking.

Also keep in mind:

Interactions With Medicines

As with all dietary supplements, people who are taking medicine should consult their health care providers before using melatonin. In particular, people with epilepsy and those taking blood thinner medications need to be under medical supervision when taking melatonin supplements.

Possible Allergic Reaction Risk

There may be a risk of allergic reactions to melatonin supplements.

Safety Concerns During Pregnancy or While Breastfeeding

There’s been a lack of research on the safety of melatonin use during pregnancy or while breastfeeding.

Safety Concerns for Older People

The 2015 guidelines by the American Academy of Sleep Medicine recommend against melatonin use by people with dementia.
Melatonin may stay active in older people longer than in younger people and cause daytime drowsiness.

Melatonin Is Regulated as a Dietary Supplement

In the United States, melatonin is considered a dietary supplement. This means that it’s regulated less strictly by the Food and Drug Administration (FDA) than a prescription or over-the-counter drug would be. In several other countries, melatonin is available only with a prescription and is considered a drug.

Products May Not Contain What’s Listed on the Label

Some melatonin supplements may not contain what’s listed on the product label. A 2017 study tested 31 different melatonin supplements bought from grocery stores and pharmacies. For most of the supplements, the amount of melatonin in the product didn’t match what was listed on the product label. Also, 26 percent of the supplements contained serotonin, a hormone that can have harmful effects even at relatively low levels.

Visit the NCCIH website for more information on melatonin.

Passionflower

A small amount of research suggests that passionflower might help to reduce anxiety and anxiety before a dental procedure, but conclusions are not definite.

Safety

Passionflower is considered to be safe when used orally.

Valerian

There’s not enough evidence to allow any conclusions about whether valerian is helpful for anxiety.

Safety

Research suggests that valerian is generally safe for short-term use by most adults; the safety of long-term use of valerian is unknown.

NCCIH-Funded Research

NCCIH is supporting several research projects related to anxiety, including:

A study of mindfulness training delivered via mobile health to reduce depression and anxiety.
A study of neural mechanisms and sex differences in responses to mindfulness-based stress reduction in people with generalized anxiety disorder.
An evaluation of three bioenergetic supplements—creatine, cyclocreatine, and acetyl-L-carnitine—in people with depression and anxiety.

More To Consider

If you’re considering a practitioner-provided complementary health practice such as acupuncture or hypnotherapy, ask a trusted source (such as your health care provider or nearby hospital) to recommend a practitioner. Find out about the training and experience of any complementary health practitioner you’re considering. To learn more, see NCCIH’s resources on how to find a complementary health practitioner.
Keep in mind that “natural” does not always mean safe. Also, a manufacturer’s use of the term “standardized” (or “verified” or “certified”) does not necessarily guarantee product quality or consistency. Dietary supplements can cause health problems if not used correctly. Your health care provider can advise you.
If you are pregnant, nursing a child, or considering giving a child a dietary supplement, it is especially important to consult your (or the child’s) health care provider.
Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

Telecommunications relay service (TRS): 7-1-1

Website: https://www.nccih.nih.gov

Email: info@nccih.nih.gov (link sends email)

Know the Science

NCCIH and the National Institutes of Health (NIH) provide tools to help you understand the basics and terminology of scientific research so you can make well-informed decisions about your health. Know the Science features a variety of materials, including interactive modules, quizzes, and videos, as well as links to informative content from Federal resources designed to help consumers make sense of health information.

Explaining How Research Works (NIH)

Know the Science: How To Make Sense of a Scientific Journal Article

Understanding Clinical Studies (NIH)

PubMed®

A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed.

Website: https://pubmed.ncbi.nlm.nih.gov/

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Acknowledgments

NCCIH thanks David Shurtleff, Ph.D., NCCIH, for his review of the 2024 update of this fact sheet.

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Last Updated: September 2024