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:: July/August 2007 Volume 6/Number 6
Research Review:
Anxiety
By Felicia M. Tomasko
 Anxiety is a heightened response of the nervous system that can affect all aspects of the bodymind. Excessive worry, rumination, inability to concentrate, a racing heartbeat, overwhelming feelings of fear, sleep disturbances, immune system suppression and disruption of the digestive system ranging from lack of hunger to overeating are only a few of the potential symptoms people experience. Since the sympathetic nervous system, or fight or flight response is overactive, anxiety can affect all systems and take many forms with varying intensities.
The experience of anxiety can be a result of situations, such as going to the dentist or flying in a plane. Anxiety can arise from specific fears and phobias, life crises or as a result of trauma or circumstances like serving in combat. Returning veterans are often treated for anxiety and related disorders. Generalized anxiety disorder occurs when a person experiences anxiety without an identifiable cause.
Anxiety often coexists or is combined with other factors including addictions and substance abuse, physical illnesses and other psychological disorders and mental illnesses, such as depression.1 The effects of anxiety can be paralyzing. According to National Institutes of Health statistics, more than 40 million Americans experience anxiety severe enough to require intervention.
Childhood and Anxiety
In children, anxiety is often a cofactor in other conditions, including Attention Deficit Hyperactivity Disorder (ADHD); up to 24% of kids with ADHD often experience anxiety, exacerbating the negative impact from both conditions.2 The anxiety children experience interferes with their ability to allocate or focus their attention.3 In susceptible children, the feelings of anxiety can impact them more severely as they get older; anxiety is one of the factors contributing to loneliness experienced in adolescence.4 While high-quality studies are scarce, exercise shows promise in reducing anxiety in children5 and improves their self-esteem.6
Yoga and Meditation
The wide variety of practices utilized in yoga, from asana (posture) to breathing and meditation is helpful for reducing anxiety in a number of situations.7 Transcendental Meditation, relaxation techniques and Kundalini yoga are practiced with positive results. Although often studied and discussed together, meditation and relaxation techniques are different practices; both show efficacy in reducing anxiety.8 Unlike pharmaceutical drugs, adverse side effects are rare when meditation practices are chose carefully and taught with proper supervision.9
While a number of different practices are utilized therapeutically to reduce anxiety and adjust the sympathetic nervous system response, specific techniques are used in Kundalini yoga with good effect for reducing anxiety and related disorders.10 Sudarshan Kriya Yogic breathing, taught in the Art of Living courses, is effective in reducing anxiety.11
People managing situational anxiety benefit from yoga and mediation. One documented example is found in the musicians in the Tanglewood summer program in Massachusetts who demonstrated reductions in performance anxiety with the practice of yoga and meditation at the Kripalu Center.12 People serving as caregivers for family members with dementia reported reduced anxiety after participating in a yoga and meditation program.13
Acupuncture and Chinese Medicine
One component of the practice of Chinese medicine, acupuncture, demonstratively reduces anxiety.14 Auricular acupuncture, the use of needle points around the ear, is as effective as pharmaceutical medication for reducing anxiety during dental visits.15 Acupuncture is shown to reduce the anxiety commonly experienced by children before surgery or medical procedures.16 Preoperative anxiety is also an issue for adults, both acupuncture and acupressure techniques reduce preoperative anxiety.17,18 Acupressure reduces anxiety felt by parents before their children have surgery.19 Study of auricular acupressure utilized in ambulances and emergency transport reduces patient anxiety.20
Since anxiety represents an overactivation of the body’s stress response, it can negatively affect the immune system. Acupuncture improves several markers of the cellular immune system response; the results persist one month after the end of a complete round of treatment.21
Ayurveda
From an Ayurvedic perspective, anxiety is generally a disturbance of the vata dosha, or air and ether elements. Along these lines, therapies that calm vata and soothe an irritable nervous system are necessary.
The rejuvenative and nervous system tonic ashwagandha (Withania somnifera) has an anxiolytic, or anxiety-reducing action, comparable to anti-anxiety medications, without the accompanying side effects.22 Jatamansi (Nardostachys jatamansi) and tagara root (Valeriana wallichi), both related to the Western herb valerian, have a long history of traditional use for reducing anxiety and calming vata. Gotu kola or brahmi (Centella asiatica) is used in Ayurveda, Chinese medicine and other Asian systems. Recent research confirms its efficacy for reducing anxiety.23
Shirodhara, a traditional treatment used in Ayurveda, involves pouring warm, sometimes medicated oil, on the third eye or in patterns on the forehead. When EEG measurements were taken of people undergoing shirodhara, the brain wave patterns they exhibited were similar to those seen in deep states of meditation. People’s heart rates slowed and theta waves (active in meditation) increased.24
Massage
Used in systems of traditional medicine worldwide, and integrated in modern medical settings, massage is important for reducing anxiety. From an Ayurvedic perspective, massage directly calms the vata dosha and provides relief to an overactive nervous system. Research confirms these ancient practices.
In children, massage is demonstrated to reduce anxiety.25 The use of massage therapy techniques also reduces anxiety after surgery or other medical procedures for all ages. 26,27 Mothers who massage their babies experience reduction in their own levels of stress hormones.28
Herbal Therapies
Anxiolytic herbs, or botanicals that reduce anxiety, have been in use throughout systems of herbalism for millennia, including the already-mentioned sciences of Ayurveda and Chinese Medicine. Some common herbs used to reduce anxiety demonstrate these effects in clinical trials. These include: lemon balm (Melissa officinalis), valerian root (Valeriana officinalis), kava (passion flower (Passiflora incarnata) and combinations of these herbs.29,30,31,32,33 A combination of valerian and lemon balm is effective and well-tolerated in children.34
Other herbal therapies are beneficial. In Kampo, traditional Japanese medicine, the preparation Kamishoyosan (KSS), containing Gardenaiae fructus, reduces anxiety.35 The scent of lavender promotes a feeling of calm and enhances relaxation, integral for alleviating anxiety.36 Orange and lavender essential oils reduce anxiety at the dentist office.37
Nutrition
Caffeine intake and coffee consumption can increase symptoms related to anxiety.38 Essential fatty acids, the omega 3 and 6 oils found in vegetable oils such as flax, hemp, evening primrose and others, are shown to be beneficial in regulating nervous system function and including anxiety reduction.39
Conclusion
Whether situational or without any clear cause, short-term or long-lasting, anxiety can be a difficult and debilitating experience. A number of holistic therapies provide a mechanism for the body to tap into its own healing potential and access the ability to relax and calm the nervous system.
The suggestions given here are not a substitute for professional medical advice. If you or someone who know is experiencing anxiety that interferes with everyday life, be sure to consult with a medical professional.
References
1 National Institute of Mental Health, NIH Publication No. 06-3879. Anxiety Disorders.
2 Schatz, D.B., Rostain, A.L. 2006. AHDH with comorbid anxiety: a review of the current literature. Journal of Attention Disorders. 10(2):141-9.
3 Puliafaico, A.C., Kendall, P.C. 2006. Threat-related attentional bias in anxious youth: a review. Clinical Child and Family Psychological Review. 9(3-4):162-80.
4 Mahon, N.E., Yarcheski, A., Yarcheski, T.J., Cannella, B.L., Hanks, M.M. 2006. A meta-analytic study of predictors for loneliness during adolescence. Nursing Research. 55(5): 308-15.
5 Larun, L, Nordheim, L.V., Ekeland, E., Hagen, K.B., Heian, F. 2006. Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database of Systematic Reviews. Jul 19:3:CD004691.
6 Ekeland, E., Heian., F., Hagen, K.B., Abbott, J., Nordheim, L. 2004. Exercise to improve self-esteem in children and young people. Cochrane Database of Systematic Reviews. 1():CD003683.
7 Kirkwood, G., Rampes, H., Tuffrey, V., Richardson, J., Pilkingon, K. 2005. Yoga for anxiety: a systematic review of the research. British Journal of Sports Medicine. 39:884-891.
8 Arias, A.J., Steinberg, K., Banga. A., Trestman, R.L. Systematic review of the efficacy of meditation techniques as treatments for medical illness. Journal of Alternative and Complementary Medicine. 12(8): 817-32.
9 Krisanaprakornkit, T., Krisanaprakornkit, W., Piyavhatkul, N., Laopaiboon, M. 2006. Meditation therapy for anxiety disorders. Cochrane Database of Systematic Reviews. Jan 25 (1): CD004998.
10 Shannahoff-Khalsa, D.S. 2004. An introduction to Kundalini yoga meditation techniques that are specific for the treatment of psychiatric disorders. 10(1):91-101.
11 Brown, R.P., Gerbarg, P.L. 2005. Sudarshan Kriya Yogic Breathing in the treatment of stress, anxiety and depression. Part II—clinical applications and guidelines. Journal of Alternative and Complementary Medicine. 11(4):711-7.
12 Khalsa, S.B., Cope, S. 2006. Effects of a yoga lifestyle intervention on performance-related characteristics of musicians: a preliminary study. 12(8):CR325-31.
13 Waelde, L.C., Thompson, L., Gallagher-Thompson, D. 2004. A pilot study of yoga and meditation intervention for dementia caregiver stress. 60(6):677-87.
14 Gibson, D., Bruton, A., Lewith, G.T., Mullee, M. 2007. Effects of acupuncture as a treatment for hyperventiliation syndrome: a pilot, randomized crossover trial. Journal of Alternative and Complementary Medicine. 13(1):39-46.
15 Karst, M., Winterhalter, M., Munte, S., Francki, B., Hondronikos, A., Eckhardt, A., Hoy, L., Buhck, H. Bernateck, M. Fink., M. 2007. Auricular acupuncture for dental anxiety: a randomized controlled trial. Anesthesia and Analgesia. 104(2):295-300.
16 Wright, K.D., Stewart, S.H., Finley, G.A., Buffett-Jerrott, S.E. 2007. Prevention and intervention strategies to alleviate preoperative anxiety in children: a critical review. Behavior Modification. 31(1):52-79.
17 Agarwal, A., Ranjan, R., Dhiraaj, S., Lakra, A. 2005. Acupressure for prevention of pre-operative anxiety: a prospective, randomised, placebo controlled study. Anaesthesia. 60(10):978-81.
18 Paraskeva, A., Melemeni, A., Petropulos, G., Siafaka, I., Fassoulaki, A. 2004. Needling of the extra 1 point decreases BIS values and preoperative anxiety. American Journal of Chinese Medicine. 32(5):789-94.
19 Wang, S.M., Gaal, D., Maranets, I., Caldwell-Andrews, A., Kain, Z.N. Acupressure and preoperative parental anxiety: a pilot study. Anesthesia and Analgesia 101(3):666-9.
20 Kober, A., Scheck, T., Schubert, B., Strasser, H., Gustorff, B., Bertalanffy, P, Wang, S.M., Kain, Z.N., Hoerauf, K. 2003. Auricular acupressure as a treatment for anxiety in prehospital transport settings. Anesthesiology. 98(6):1328-32.
21 Arranz, L., Guayerbas, N., Siboni, L., De la Fuente, M. 2007. Effect of acupuncture treatment on the immune function impairment found in anxious women. 35(1):35-51.
22 Bhattacharya, S.K., Bhattacharya, A., Sairam, K., Ghosal, S. 2000. Anxiolytic-antidepressant activity of Withania somnifera glycowithanolides: an experimental study. Phytomedicine. 7(6):463-9.
23 Bradwejn, J., Zhou, Y., Koszycki, D., Shlik, J. 2000. A double-blind, placebo-controlled study on the effects of Gotu Kola (Centella asiatica) on acoustic startle response in healthy subjects. Journal of Clinical Psychopharmacology. 20(6):680-4.
24 Uebaba, K., Feng-Hao, Xu, Tagawa, M., Asakura, R., Itou, T., Tatsue, T., Taguchi, Y., Ogawa, H., Shimabayashi, M., Hisajima, T. Using a healing robot for the scientific study of shirodhara. Engineering in Medicine and Biology Magazine. 24(2):69-78.
25 Beider, S., Moyer, C.A. 2007. Randomized controlled trials of pediatric massage: a review. Evidence Based Complementary and Alternative Medicine. 4(1):23-34.
26 Pellino, T.A., Gordon, D.B., Engelke, Z.K., Busse, K.L., Collins, M.A., Silver, C.E., Norcross, N.J. 2005. Use of nonpharmacologic interventions for pain and anxiety after total hip and total knee arthroplasty. Orthopedic Nursing. 24(3):182-90.
27 McCaffrey, R., Taylor, N. 2005. Effective anxiety treatment prior to diagnostic cardiac catheterization. Holistic Nurse Practitioner. 19(2):70-3.
28 Fujita, M., Endoh, Y., Saimon, N., Yamaguchi, S. 2006. Effect of massaging babies on mothers: pilot study on the changes in mood states and salivary cortisol levels. Complementary Therapies in Clinical Practice. 12(3):181-5.
29 Kennedy, D.O., Little, W., Haskell, C.F., Scholey, A.B. 2006. Anxiolytic effects of a combination of Melissa offinalis and Valeriana officinalis during laboratory induced stress. Phytotherapy Research. 20(2):96-102.
30 Miyasaka, L.S., Atallah, A.N. Soares, B.B. 2006. Valerian for anxiety disorders. Cochrane Database of Systematic Reviews. 18(4):CD004515.
31 Miyasaka, L.S., Atallah, A.N., Soares, B.G. 2007. Passiflora for anxiety disorder. Cochrane Database of Systematic Reviews. 24(1):CD004518.
32 Ernst, E. 2002. The risk-benefit profile of commonly used herbal therapies: gingko, St. John’s Wort, ginseng, echinacea, saw palmetto and kava. Annals of Internal Medicine. 136(1):42-53.
33 Akhondzadeh, S., Naghavi, H.R., Vazirian, M., Shayeganpour, A., Rashidi, H., Khani, M. 2001. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. Journal of Clinical Pharmacy and Therapeutics. 26(5):363-7.
34 Muller, S.F. Klement, S. 2006. A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children. Phytomedicine. 13(6):383-7.
35 Torjjzuka, K., Kamiki, H., Ohmura, N.Y., Fujii, M., Hori, Y., Fukumura, M., Hirai, Y., Isoda, S., Nemoto, Y., Ida, Y. 2005. Anxiolytic effect of Gardenaie Fructus-extract containing active ingredient from Kamishoyosan (KSS), a Japanese traditional Kampo medicine. Life Science. 77(24):3010-20.
36 Field, T., Diego, M., Hernandez-Reif, M., Cisneros, W., Feijo, L., Vera, Y., Gil, K., Grina, D., Claire, He Q. 2005. Lavender fragrance cleansing gel effects on relaxation. International Journal of Neuroscience. 115(2):207-22.
37 Lehrner, J., Marwinski, G., Lehr, S., Johren, P., Deecke, L. 2005. Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office. Physiology and Behavior. 86(1-2):92-5.
38 Broderick, P., Benjamin, A.B. 2004. Caffeine and psychiatric symptoms: a review. Journal of the Oklahoma State Medical Association. 97(12):538-42.
39 Buydens-Branchey, L., Branchey, M. 2006. n-3 polyunsaturated fatty acids decrease anxiety feelings in a population of substance abusers. Journal of Clinical Psychopharmacology. 26(6):661-5.
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Copyright © 2002-2006
LA Yoga Ayurveda & Health Magazine
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