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National Center for Complementary and Integrative Health

NCCIH Clinical Digest

for health professionals

Mind and Body Approaches for Stress and Anxiety: What the Science Says

January 2024

Clinical Guidelines, Scientific Literature, Info for Patients: 
Mind and Body Approaches for Stress and Anxiety

yoga at home

Relaxation Techniques

Relaxation techniques may be helpful in managing a variety of stress-related health conditions, including anxiety associated with ongoing health problems and in those who are having medical procedures. Evidence suggests that relaxation techniques may also provide some benefit for symptoms of post-traumatic stress disorder (PTSD) and may help reduce occupational stress in health care workers. For some of these conditions, relaxation techniques are used as an adjunct to other forms of treatment.

What Does the Research Show?

  • Biofeedback for anxiety and depression in children. A 2018 systematic review included 9 studies—278 participants total—on biofeedback for anxiety and depression in children and adolescents with long-term physical conditions such as chronic pain, asthma, cancer, and headache. The review found that, although biofeedback appears promising, at this point it can’t be recommended for clinical use in place of or in addition to current treatments. 
  • Heart rate variability biofeedback. A 2017 meta-analysis looked at 24 studies—484 participants total—on heart rate variability (HRV) biofeedback and general stress and anxiety. The meta-analysis found that HRV biofeedback is helpful for reducing self-reported stress and anxiety, and the researchers saw it as a promising approach with further development of wearable devices such as a fitness tracker.
  • Progressive muscle relaxation. A 2015 systematic review, which included two studies on progressive muscle relaxation in adults older than 60 years of age, with a total of 275 participants, found that progressive muscle relaxation was promising for reducing anxiety and depression. The positive effects for depression were maintained 14 weeks after treatment.
  • PTSD. A 2018 meta-analysis of 50 studies involving 2,801 participants found that relaxation therapy seemed to be less effective than cognitive behavioral therapy for PTSD and obsessive-compulsive disorder. No difference was found between relaxation therapy and cognitive behavioral therapy for other anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias. The review noted, however, that most studies had a high risk of bias, and there was a small number of studies for some of the individual disorders.
  • Anxiety in people with cancer. In the 2023 joint guideline issued by the Society for Integrative Oncology and the American Society for Clinical Oncology on integrative oncology care of symptoms of anxiety and depression in adults with cancer, relaxation therapies may be offered to people with cancer to improve anxiety symptoms during active treatment (Type: Evidence based; Quality of evidence: Intermediate; benefits outweigh harms; Strength of recommendation: Moderate). 

Safety

  • Relaxation techniques are generally considered safe for healthy people. In most research studies, there have been no reported negative side effects. 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. 

Yoga, Tai Chi, and Qigong

A range of research has examined the relationship between exercise and depression. Results from a much smaller body of research suggest that exercise may also affect stress and anxiety symptoms. Even less certain is the role of yoga, tai chi, and qigong—for these and other psychological factors. But there is some limited evidence that yoga, as an adjunctive therapy, may be helpful for people with anxiety symptoms.

What Does the Research Show?

  • Yoga for children and adolescents. Findings from a 2021 meta-analysis and systematic review of 10 trials involving a total of 1,244 adolescents suggest a potential beneficial effect of tai chi and qigong on reducing anxiety and depression symptoms, and reducing cortisol level in adolescents. However, nonsignificant effects were found for stress, mood, and self-esteem. A 2020 systematic review of 27 studies involving the effects of yoga on children and adolescents with varying health statuses, and with varying intervention characteristics, found that in studies assessing anxiety and depression, 58 percent showed reductions in both symptoms, while 25 percent showed reductions in anxiety only. Additionally, 70 percent of studies included in the review that assessed anxiety alone showed improvements. However, the reviewers noted that the studies included in the review were of weak-to-moderate methodological quality. 
  • Yoga, tai chi, and qigong for anxiety. A 2019 review concluded that yoga as an adjunctive therapy facilitates treatment of anxiety disorders, particularly panic disorder. The review also found that tai chi and qigong may be helpful as adjunctive therapies for depression, but effects are inconsistent.
  • Yoga for anxiety. A 2021 randomized controlled trial examined whether Kundalini yoga and cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) were each more effective than a control condition (stress education) and whether yoga was inferior to CBT for the treatment GAD. The trial found that Kundalini yoga was more efficacious for generalized anxiety disorder than the control, but the results support CBT remaining first-line treatment. A 2018 systematic review and meta-analysis of 8 studies of yoga for anxiety (involving 319 participants with anxiety disorders or elevated levels of anxiety) found evidence that yoga might have short-term benefits in reducing the intensity of anxiety. However, when only people with diagnosed anxiety disorders were included in the analysis, there was no benefit. 

Safety

  • Yoga is generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor. However, as with other forms of physical activity, injuries can occur. The most common injuries are sprains and strains. Serious injuries are rare. The risk of injury associated with yoga is lower than that for higher impact physical activities.
  • Older people may need to be particularly cautious when practicing yoga. The rate of yoga-related injuries treated in emergency departments is higher in people age 65 and older than in younger adults.

Meditation and Mindfulness-Based Stress Reduction

Some research suggests that practicing meditation may reduce blood pressure, anxiety and depression, and insomnia.

What Does the Research Show?

  • Mindfulness-based stress reduction. A 2023 randomized controlled trial involving 208 participants found that mindfulness-based stress reduction (MBSR) is noninferior to escitalopram, a commonly used first-line psychopharmacologic treatment for anxiety disorders. A 2021 randomized controlled trial of 108 adults with generalized social anxiety disorder found that cognitive behavioral group therapy and MBSR may be effective treatments with long-term benefits for patients with social anxiety networks that recruit cognitive and attention-regulation brain networks. The researchers noted that cognitive behavioral therapy and MBSR may both enhance reappraisal and acceptance emotion regulation strategies.
  • Mindfulness-based meditation. A 2019 review concluded that as monotherapy or an adjunctive therapy, mindfulness-based meditation has positive effects on depression, and its effects can last for 6 months or more. Although positive findings are less common in people with anxiety disorders, the evidence supports adjunctive use. A 2019 analysis of 29 studies (3,274 total participants) showed that use of mindfulness-based practices among people with cancer significantly reduced psychological distress, fatigue, sleep disturbance, pain, and symptoms of anxiety and depression. However, most of the participants were women with breast cancer, so the effects may not be similar for other populations or other types of cancer. A 2014 meta-analysis of 47 trials in 3,515 participants suggests that mindfulness meditation programs show moderate evidence of improving anxiety and depression. But the researchers found no evidence that meditation changed health-related behaviors affected by stress, such as substance abuse and sleep.
  • Mindfulness-based programs for workplace stress. A 2018 systematic review and meta-analysis of nine studies examined mindfulness-based programs with an employee sample, which targeted workplace stress or work engagement, and measured a physiological outcome. The review found that mindfulness-based interventions may be a promising avenue for improving physiological indices of stress. 

Safety

  • Meditation is generally considered to be safe for healthy people.
  • A 2019 review found no apparent negative effects of mindfulness-based interventions and concluded that their general health benefits justify their use as adjunctive therapy for patients with anxiety disorders.

Hypnotherapy

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.

What Does the Research Show?

  • A 2022 systematic review and meta-analysis of 19 trials found positive effects of hypnotherapy for reducing dental anxiety and fear during dental treatment. However, the reviewers noted that despite positive effects of hypnotic interventions in the systematic review, the results of the meta-analysis are very heterogeneous. 
  • 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 (Type: Evidence based; Quality of evidence: Intermediate; benefits outweigh harms; Strength of recommendation: Moderate).

Safety

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

References

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH’s Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH website at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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