Complementary approaches for stress and anxiety: the evidence

Many people look beyond standard care when stress or anxiety will not ease. The NHS describes herbal medicines and complementary therapies as treatments that are not part of standard medicine, and it notes that they are not tested in the same way as standard medicines. That one fact explains why the evidence behind them varies so widely.

This page summarises what a few public health bodies and one systematic review say. The editors do not sell, recommend or rate any remedy, product or practitioner, and nothing here is advice for your situation. If you use any of these approaches, tell your health care providers, and do not stop a prescribed treatment without talking to a doctor first.

Mind and body practices

The US National Center for Complementary and Integrative Health (NCCIH) reviews each practice separately, and its wording is careful. On mindfulness meditation, it says some studies suggest it may work as well as established treatments, but that more research is needed. For a closer look at that question, see does mindfulness work for anxiety.

Yoga has helped with anxiety symptoms in some studies, but NCCIH says the evidence is inconclusive for anxiety disorders. In one trial it cites, Kundalini yoga helped but was less effective than cognitive behavioral therapy. Acupuncture gets a cautious line: there is "some limited evidence" that it may reduce anxiety symptoms, but study quality is low, and NCCIH adds that when it is not delivered properly it can cause serious adverse effects, such as infections.

Massage therapy may reduce anxiety according to some studies, though NCCIH says more high-quality randomized controlled trials are needed. Relaxation techniques may reduce anxiety in people with chronic medical problems, and for some anxiety disorders NCCIH says cognitive behavioral therapy may be more helpful. Listening to music can reduce anxiety for people undergoing medical treatment. Some readers use simple exercises such as the paced breathing timer on this site, which is an exercise and not a treatment.

These practices generally have good safety records, but NCCIH notes exceptions. Some people report increased anxiety with relaxation techniques, and rare reports link them to symptoms in people with epilepsy or certain psychiatric conditions. The page on mindfulness risks and limits covers similar cautions.

Natural products

Supplements raise a different question, because strength and purity can vary. NCCIH states that "natural" does not always mean safe. Its summary of individual products is as follows.

• Melatonin supplements appear to be helpful in reducing anxiety before surgery, but NCCIH says there is not enough information yet about side effects, and long-term safety is unknown. Some products did not match what was listed on the label.
• Chamomile might be helpful for generalized anxiety disorder, but NCCIH calls the studies preliminary and not conclusive.
• Oral lavender may be an effective treatment for anxiety, but the review NCCIH cites was limited by the low quality of available studies.
• Kava may have a small effect on anxiety, but kava supplements have been linked to a risk of severe liver damage.
• For passionflower, a small amount of research suggests it may reduce anxiety. For valerian, NCCIH says there is not enough evidence to say whether it helps.

NCCIH advises extra care if you are pregnant, nursing, or giving a supplement to a child, and recommends talking to a health care provider first. People with epilepsy or those taking blood thinners should use melatonin only under medical supervision, according to the same page.

Homeopathy: what the reviews found

Homeopathy is a system developed in Germany more than 200 years ago. NCCIH describes two guiding ideas, "like cures like" and a "law of minimum dose," and notes that many products are so diluted that no molecules of the original substance may remain. The NHS describes it as using very watered-down mixtures made from plants, animals or minerals.

The evidence summaries are consistent, though people hold strong views on both sides. NCCIH's bottom line is that there is little evidence to support homeopathy as an effective treatment for any specific health condition. It also quotes a 2015 Australian government assessment, which concluded there was "no reliable evidence that homeopathy is effective for any health condition." That assessment was by the National Health and Medical Research Council (NHMRC). The NHMRC reports that a complaint about the conduct of the review was investigated by the Commonwealth Ombudsman, which made no adverse findings about the review or the NHMRC.

For anxiety specifically, a 2006 systematic review in the journal Homeopathy searched major databases and found eight randomised controlled studies. Its authors concluded that the evidence on benefit is limited, because trials reported contradictory results, were underpowered, or gave too little detail about their methods. They also said it was not possible to draw firm conclusions either way. That is an older review, and the editors did not find a Cochrane review on homeopathy for anxiety to cite.

On safety, NCCIH says some products labelled homeopathic may contain substantial amounts of active ingredients and could cause side effects and drug interactions. It also says it is important not to use homeopathy to replace proven conventional care.

If you already use something

Tell your health care providers about every supplement, herbal product and therapy you use, including ones that seem harmless. For homeopathic products, NCCIH suggests bringing the product with you when you visit a provider. The NHS says plainly: do not stop taking any prescribed medicine without first talking to your doctor, and ask a GP about symptoms that do not go away or keep coming back.

Stress that lingers, or anxiety that interferes with daily life, deserves a conversation with a professional rather than a search for the right product. When self-help is not enough describes signs that it is time to do that. For how the editors weigh claims like these, see evidence notes.

The short version

Evidence ranges from modest and mixed for some mind and body practices to limited or absent for others, and the agencies cited here describe it that way. Homeopathy has no reliable evidence of benefit for any condition in the reviews above. Tell your health care providers about anything you use, and keep prescribed treatment going unless a doctor advises otherwise.