If you take a lap around the internet, you’ll find countless treatments for anxiety. With so much information out there, figuring out what will have the best chance to work is a tall order.
This article presents a menu of natural evidence-based behavioral strategies and supplements that treat anxiety.
What is Anxiety?
Anxiety is a group of mental disorders including social anxiety, generalized anxiety, panic, PTSD, OCD, and phobias [R].
Common anxiety symptoms include inner turmoil, nervous behavior, and rumination [R].
Flawed processing of threat is the hallmark characteristic of anxiety [R].
While it is certainly helpful to experience fear and vigilance in response to an actual threat, someone with anxiety will interpret non-threatening signals as threatening, thus maintaining an unnecessarily high state of worry and arousal [R].
Underlying this exaggerated fear response is a network of brain structures that function improperly in response to stimuli. The amygdala, which controls fight-or-flight threat response, is often overactive [R].
On the contrary, the prefrontal cortex, which inhibits the fear-generation of the amygdala, is underactive [R].
Impaired activity of the hippocampus, striatum, anterior cingulate cortex, and insula can also be involved in anxiety [R].
These neural malfunctions are accompanied by disturbances in neurotransmitters (serotonin, norepinephrine, dopamine, GABA), neurotrophic factors (nerve growth factor, BDNF), the HPA axis, immune function, heart rate variability, and cognitive function [R].
Anxiety problems are real and can become worse if not treated with a holistic approach. That’s why we put together a Free eCourse on conquering stress and anxiety, getting better sleep, and living the healthy life you desire.
Now that we know what we’re up against, here are some tools you can use to overcome anxiety.
1) Cognitive Behavioral Therapy (CBT)
CBT is the most widely used evidence-based strategy for reducing anxiety [R].
People who do CBT aim to develop coping strategies to solve current problems and modify unhelpful cognitive patterns (thoughts, beliefs, and attitudes), behaviors, and emotions [R].
CBT is traditionally delivered face-to-face by therapists but is also performed on the internet with or without (self-guided) therapist involvement.
Because therapist involvement is not feasible or preferred for some people, self-guided CBT can also be used. Self-guided internet-based CBT reduced general anxiety, social anxiety, fear of public speaking, and depression in studies of 235, 81, and 127 people [R, R, R].
CBT reduces cognitive reappraisal frequency, subtle avoidance, cognitive distortions, safety behaviors, and rumination [R].
These changes may be due to CBT reducing activity in the amygdala and hippocampus, which are involved in emotional processing, and increasing prefrontal cortex and anterior cingulate cortex activity, which perform cognitive processing [R].
How to Implement
MoodGYM is a freely available and moderately effective online cognitive behavioral therapy program for anxiety [R].
Self-guided CBT is often not as effective as in-person CBT, but still, has a positive effect on anxiety according to a meta-analysis [R].
The biggest challenge of self-guided CBT is low participant adherence to the protocol [R]. Individuals who want to perform self-guided CBT should consider their commitment to the program before starting.
2) Mindfulness Meditation
Mindfulness is simply paying full attention to what’s happening in the present moment [R]. It can be performed throughout the day by being in-tune to what you are experiencing, although it is often developed through meditation.
Meditation is a type of mental training that aims to improve attentional and emotional control [R].
Meditation can be attention-focused (transcendental and mantra meditation) or awareness-focused (mindfulness meditation) [R]. These three types are the most-studied forms of meditation for anxiety. Mindfulness meditation is the only form of meditation that reliably improves anxiety [R].
The goal of mindfulness meditation is detached self-observation. Think of it as becoming a “witness” rather than a “judge” of events that happen about you (sounds, thoughts, etc.).
During mindfulness meditation, you concentrate on one main object (usually your breath) to stabilize your attention and then expand your awareness to body sensations, thoughts, memories, emotions, perceptions, intuitions, etc. This expansion happens gradually over a number of meditation sessions [R].
Single twenty-minute sessions of mindfulness meditation reduced state anxiety among 15 healthy subjects [R].
Mindfulness-based stress reduction lowered social anxiety with the same effectiveness as CBT in a study of 108 participants [R].
A systematic review of scientific literature showed that mindfulness-based cognitive therapy effectively reduces anxiety [R].
Mindfulness meditation improves attention and emotion self-control [R], both of which are important for a healthy mood.
Increased dorsolateral prefrontal cortex activation follows a mindfulness-based stress reduction program in people with social anxiety [R]. The dorsolateral prefrontal cortex is involved in working memory, cognitive flexibility, and planning [R].
In a mindfulness-based stress reduction program, participants lowered amygdala activation, ventrolateral prefrontal cortex activation, and increased functional connectivity between amygdala and prefrontal cortex regions [R]. These changes are associated with decreased anxiety symptoms.
How to Implement
Many websites and apps provide guidelines for meditation.
A large body of evidence supports the benefits of yoga in reducing anxiety [R].
Yoga improved mood, quality of life, and anxiety compared to a walking group in a study of 34 participants [R].
Yoga practice reduced anxiety in 300 individuals [R].
Participation in a 2-month yoga class lessened perceived anxiety in 65 women suffering from anxiety disorders [R].
Among 20 patients with hypertension, yoga lowered blood pressure, stress, anxiety, and negative emotions [R].
In 238 individuals with hypertension, hatha yoga was associated with decreased heart rate, blood pressure, anxiety, and perceived stress [R].
Iyengar yoga lowered blood pressure, anxiety, and perceived stress and improved mood and sleep quality in 20 women with restless-leg syndrome [R].
Trauma-sensitive yoga lowered PTSD symptoms, depression, and anxiety in women with PTSD stemming from intimate-partner violence [R].
A group yoga therapy program lowered anxiety and stress in those with PTSD [R].
Yoga appears to reduce anxiety by improving HPA-axis function and increasing GABA.
A single yoga session increased GABA among 8 yoga participants [R].
Just a single bout of aerobic exercise reduced anxiety sensitivity in a randomized controlled trial of 21 adults [R].
Exercising on a treadmill at 70% of maximum heart rate for 20 minutes 3 times/week lowered anxiety sensitivity in 19 adults [R].
In a study of 24 women, the most substantial decrease in state anxiety happened following 20 minutes of aerobic exercise at roughly 90% maximal heart rate [R].
Both aerobic exercise and resistance training reduced anxiety sensitivity, but only aerobic training lowered the anxiety-related sensations after inhalation of carbon dioxide (a common task for inducing anxiety in research studies) in a 77-person study [R].
High-intensity interval training alleviated anxiety symptoms in 20 schizophrenic patients [R].
Although exercise promotes inflammation in the short-term, exercise results in chronic anti-inflammatory and antioxidant effects in the brain [R].
Because neuronal inflammation and oxidative stress contribute to anxiety [R], the anti-anxiety effect of exercise is likely due in part to its protective effect on inflammation and oxidative stress.
Aerobic exercise increased BDNF in 12 panic disorder patients compared to 12 control patients [R].
5) Heart Rate Variability Biofeedback Training
Heart rate variability measures how much your heart rate deviates compared to average.
A higher heart rate variability (more inconsistent, e.g. varying between 50 to 75 bpm while at rest) is desirable and indicates a dominance of the rest-and-digest nervous system.
A lower heart rate variability (e.g. staying between 65 and 70 bpm like a metronome) indicates a dominance of the fight-or-flight nervous system which is associated with stress and inflammation [R].
A higher heart rate variability is linked to good health [R].
Individuals with greater heart rate variability have better emotional control [R].
Most forms of anxiety are associated with low heart rate variability [R].
Heart rate variability biofeedback training involves breathing for a period of time (suggested 20 minutes twice per day) at the frequency at which maximum heart rate variability is generated voluntarily for each individual (usually this is between 4.5 and 6.5 breaths per minute) [R]. This breathing frequency is termed “resonance” breathing.
Most recently, a meta-analysis showed that heart rate variability biofeedback training considerably reduces anxiety and perceived stress [R].
Heart rate variability is associated with the amygdala and medial prefrontal cortex, which, together, are responsible for perceptions of threat and safety [R].
This type of training involves slow diaphragmatic breathing which stimulates the vagus nerve from the gut to the brain. Vagal pathways to the brain affect brain areas controlling mood (locus coeruleus, insula, hippocampus, and amygdala) [R].
Heart rate variability is also tied to the inflammatory system [R]. Increasing heart rate variability reduced inflammation in studies of 45 and 11 people [R, R]. Inflammation is often present in anxiety disorders [R, R].
How to Implement
Use biofeedback to find your resonance breathing frequency (which never changes) and spend 10-20 minutes per day breathing at this frequency.
One way to receive biofeedback on your heart rate is by using a heart rate monitor (chest strap or finger sensor) which syncs to a smartphone app.
The iThlete app has been validated for accuracy [R]. Other common apps include Bioforce, HeartRate+, and Sweet Beat/DailyBeat, but have not been validated.
The app HRV4Training does not require a heart rate monitor and has been validated [R].
Biofeedback training requires equipment that may be costly.
6) Applied Relaxation
Applied relaxation is the development of relaxation skills through diaphragmatic breathing and progressive muscle relaxation. These techniques are applied in response to early signs of anxiety [R].
Applied relaxation reduced general anxiety, excessive worry, tension, and thought suppression in studies of 41, 26, and 18 adults with general anxiety [R, R, R]. In some cases, these improvements were maintained for one year.
In a case study, those who practiced applied relaxation became more accepting, mindful, and non-judgmental of their perceptions and thoughts [R]. Development of these characteristics was associated with lower anxiety.
There is also some evidence that applied relaxation improves anxiety by reducing muscle tension [R]. However, more research is needed to fully support this claim.
How to Implement
Computer-delivered applied relaxation was as effective as therapist-guided applied relaxation in reducing emotional stress and improving relaxation as shown by a study of 60 adults [R].
7) Cognitive Bias Modification
Whereas cognitive behavioral therapy (CBT) teaches people to deal with thoughts as they arise, cognitive bias modification attacks thoughts earlier in the cognitive process. Biases toward a threat that are commonly found in anxious individuals include:
- Attention bias: preferentially paying attention to threatening information.
- Interpretation bias: comprehending emotionally ambiguous information as threatening rather than neutral.
- Memory bias: storing and/or retrieving threatening information more often than neutral/positive information [R].
Cognitive bias modification is the practice of “re-training” the above biases using computerized tasks. Cognitive bias modification lowers anxious behavior at clinically-relevant levels [R].
Cognitive bias modification may be more effective than CBT in some cases. In one year following an intervention, cognitive bias modification showed a greater decrease in negative automatic thoughts than CBT and control groups in a 240-person study [R].
However, internet-based attention bias modification combined with internet-based CBT did not improve social anxiety more than internet-based CBT alone in a randomized controlled trial of 133 participants [R].
Electrode brain monitoring suggests cognitive bias modification improves top-down processes (via the prefrontal cortex) that control emotions [R].
How to Implement
Cognitive bias modification is best performed under the direction of a therapist. It is a relatively new technique and has not yet been shown effective in self-guided settings.
8) Healing your Gut Microbiome
There is a strong connection between gut microbiota and brain function [R].
People who have inflammatory diseases of the gut frequently also have anxiety [R], and those with anxiety have high rates of GI disorders [R]. In fact, GI disorders are the second most commonly-occurring health condition in individuals with anxiety, besides migraines [R].
When inflammatory/GI diseases are resolved, anxiety often subsides as well [R].
In mice, consumption of 50% lean beef compared to normal mice food improved the diversity of fecal bacteria and reduces anxiety-like behaviors [R].
In a case study, dietary changes and probiotics reduced an individual’s anxiety from moderate to very low, with favorable changes in gut microflora composition [R].
In a population-based study, 5,286 individuals took a food sensitivity blood test and were asked to make dietary changes based on foods that showed elevated antibody response. Among those who reported psychological issues and followed the dietary recommendations, 40% showed psychological improvement [R].
Specific probiotics will be discussed in the Supplements section of this article.
Anxiety demonstrates a clear seasonal pattern, as people with anxiety report worse symptoms in winter compared to any other time of year [R].
Individuals exposed to UVA radiation (wavelength of sunlight) showed elevated serotonin and reported feeling less nervous compared to those who did not receive UVA radiation in a 53-person study [R].
Interestingly, the first enzyme in serotonin production – tryptophan hydroxylase – is found in human skin [R].
Bright light exposure also produces neurogenesis in the adult rat brain and lowers anxiety and depression [R].
10) Sauna Use
Far-infrared sauna therapy plus exercise improved emotional and psychological status in 45 patients with fibromyalgia [R].
Supplements That Reduce Anxiety
11) Cannabidiol (CBD)
CBD is one of the most common chemicals in cannabis and hemp. It is non-psychoactive and most-commonly available for use as CBD oil.
CBD lowered anxiety and distress brought on by public speaking in a study of 24 individuals with social anxiety disorder [R].
CBD also reduced anxiety caused by the use of THC in 8 participants [R].
CBD also binds to cannabinoid (CB1) receptors, which are frequently found in the hippocampus and amygdala, regions involved in emotional control [R].
CBD lowers activity in the amygdala and increases prefrontal cortex activation, two structures commonly involved in anxiety [R].
Activation of CB1 receptors also influences GABA and glutamate systems [R].
12) Ashwagandha (Withania somnifera)
Ashwagandha is an Indian herb usually consumed as ashwagandha root extract.
Ashwagandha is considered an “adaptogen,” a nontoxic substance that corrects imbalances in the hormonal and immune systems to restore functions disturbed by chronic stress [R].
Ashwagandha reduced mood fluctuations and anxiety in 51 women with menopausal syndrome [R].
Extracts of ashwagandha may be useful in anxiety disorders for psychiatric practice [R].
13) Kava (Piper methysticum)
Kava is a plant grown in South Pacific islands, generally consumed as tea or supplement.
In animals, Kava’s anti-anxiety effects are powerful and comparable to benzodiazepines [R].
A comparison of herbal anti-anxiety remedies shows that Kava is more effective than most herbal supplements in reducing anxiety [R].
There have some been reports linking kava with liver toxicity (11 liver failure cases leading to liver transplants, including 4 deaths). While the toxicity of kava alone is quite small, it may interact with other drugs or increase the toxicity of other substances [R, R].
The beneficial impact of probiotics on mental health is gaining prominence given the influence of gut microbiota. “Psychobiotics” describe a class of probiotics that benefit those with psychiatric illness by producing and transporting neurotransmitters [R].
Lactobacillus and bifidobacterium are two types of bacteria that have been studied in the treatment of anxiety [R]. Lactobacillus and bifidobacterium inhabit the gut and are involved in carbohydrate energy conversion [R, R].
A probiotic supplement including L. plantarum lowered gut-related anxiety in a study (DB-RCT) of 84 IBS patients [R].
Chronic L. plantarum intake increased dopamine and serotonin levels, and reduced anxiety-like behaviors in mice. It also lowered inflammatory cytokines and increased anti-inflammatory cytokine levels of mice subjected to early life stress [R, R].
A probiotic capsule containing L. rhamnosus and other bacteria strains lowered anxiety in a study (DB-RCT) of 70 people [R].
L. rhamnosus supplementation reduced anxiety and depressive behaviors, and altered brain GABA gene activity in mice [R].
L. helveticus protected against the negative effect of a Western-style diet on anxious behavior in mice [R].
L. fermentum reduced anxiety-like behavior brought on by antibiotics in mice [R].
L. helveticus and B. longum taken daily for 30 days decreased anxiety, hostility, and cortisol in 25 individuals [R].
15) Lemon Balm
Lemon balm (Melissa officinalis) is traditionally consumed as a tea and is known for its calming properties. It contains many psychoactive chemicals [R], with rosmarinic acid as its most psychoactive compound [R].
Supplementation ranging from 300-1,600 mg of lemon balm extract improved anxiety, stress, insomnia, memory, mood, and mental processing in human studies of 20, 18, 20, and 20 participants [R, R, R, R].
17) 5-Hydroxytryptophan (5-HTP)
5-HTP is a naturally-occurring amino acid and precursor of serotonin. It is available over-the-counter as a dietary supplement.
Six weeks of 5-HTP supplementation decreased anxiety by increasing blood BDNF and serotonin in 15 young adults with anxiety due to unreciprocated romanticism [R].
A single 200-mg dose of 5-HTP alleviated panic attacks in a study of 24 patients with panic disorder [R].
5-HTP exerts its beneficial effects primarily by raising brain serotonin levels [R].
Apigenin reduces anxiety without sedation when normal amounts are taken [R].
Inositol has 50% of the sweetness of table sugar and can be used as a sweetener as a powder or taken as a supplement in capsules.
20) Theanine And Green Tea
Daily L-theanine supplementation reduced anxiety in a study (DB-RCT) of 20 schizophrenic patients [R] and helped relaxation in 20 healthy individuals.
L-theanine increases brain GABA, dopamine, and serotonin in animals [R].
21) Purple Passionflower
Purple passionflower (Passiflora incarnate) is a flowering vine native to the southeast United States.
Purple passionflower reduced anxiety similar to a benzodiazepine in 18 patients with generalized anxiety disorder [R].
Purple passionflower supplementation before surgery lowered anxiety in 30 surgery patients in a study (DB-RCT) [R].
A single 5,000 mg dose of purple passion flower reduced heart rate after public speaking, while 500 mg for 6 days lowered blood pressure during the public speaking exercise in a 30-person study (DB-RCT) [R].
22) Black Seed (Black Cumin)
Black seed (Black Cumin, Nigella sativa) is a flowering plant native to south and southwest Asia.
Black seed stabilized mood, decreased anxiety, and improved cognitive function in 24 adolescent males [R].
Thymoquinone, a major component of Nigella sativa, increased GABA activity in mice [R].
23) Bacopa Monnieri
Bacopa monnieri is an herb generally taken in capsule or powder form. It should be taken with a meal because it is fat soluble.
Supplementation with 300 mg bacopa monniera for 12 weeks improved state anxiety compared to placebo in a human study (DB-RCT) [R].
Bacopa supplementation reduced cortisol and stress in 17 healthy humans [R].
Bacopa also reduced mixed anxiety-depressive disorder in mice [R].
Bacopa increased norepinephrine, serotonin, and dopamine in rat brains, and normalized blood corticosterone previously compromised by stress [R].
Case studies show improvements in depression, anxiety, and sleep within one week of magnesium supplementation [R].
25) Fish Oil/Omega-3 Fatty Acids
Low levels of omega-3 fatty acids were associated with social anxiety in a 49-person study [R].
Omega-3 supplementation of 2.5 grams/day reduced anxiety symptoms and interleukin-6 in 34 healthy participants in a study (DB-RCT) [R].
Supplementation with 3 grams omega-3 lowered anxiety in 11 substance abusers in a study (DB-RCT) [R].
EPA (an omega-3 fatty acid) increased hippocampal neurogenesis in animals [R].
26) Gotu Kola
Gotu kola (Centella asiatica) is a plant found in South Asian wetlands used as a culinary vegetable and medicinal herb.
Compared to placebo, Gotu kola prevented people from being easily startled in a study of 40 adults [R].
In rat brain, Gotu kola activated glutamic acid carboxylase, an enzyme that increases GABA levels [R].
27) Ginkgo Biloba
Supplementation of 240 or 480 mg Ginkgo biloba daily for 4 weeks lowered anxiety symptoms compared to placebo in a 107-person study [R].
Ginkgo biloba extract reduced anxiety, depression, and dementia in elderly patients [R].
28) Skullcap Herbs
Skullcap herbs include American (Scutellaria lateriflora) and Chinese (Scutellaria baicalensis) skullcap herbs. They contain bioactive flavonoids, which act as potent antioxidants with numerous health benefits [R].
American skullcap decreased anxiety in 19 adults compared to placebo [R].
Chinese skullcap supplementation reduced stress-induced anxious behaviors and blood corticosterone in animals [R].
Wogonin, the primary active flavonoid in Chinese skullcap, reduced anxiety-like behavior and enhances GABAA receptor activity in mice [R].
29) Magnolia Bark
Magnolia bark (Magnolia officinalis) is used in traditional Chinese medicine. Its active compounds include honokiol and magnolol, located in the bark of the tree [R].
Hops (Humulus lupulus) are a flavoring and preserving ingredient of beer that has sedative properties.
Non-alcoholic beer containing hops consumed with dinner for 14 days lowered anxiety and improved sleep in studies of 17 and 16 participants [R, R]. In the 16-person study, overnight serotonin levels were also reduced in the treatment group, suggesting a possible role of hops in the serotonin-melatonin pathway vital to circadian rhythm [R].
Adding a small amount of beer to frog egg cells elicited a strong GABAA response, and adding a small amount of hops strengthened GABAA receptor transmission [R].
Valerian (Valeriana officinalis) is a flowering plant, previously used in perfumes, that is usually supplemented as a tea or an extract of the root.
Valerian supplementation of 500 mg twice daily for 60 days reduced anxiety, stress, and depression in a study of 33 individuals [R].
The anti-anxiety effects of valerian appear due to its ability to increase the strength of GABAA signaling [R].
For more science-backed tips and tricks on how to start living a happier and healthier lifestyle, check out my book SelfHacked Secrets. Here I’ve compiled all of my research and what I’ve learned from helping over 1,000 patients fix their chronic health issues.