An Integrative Medicine Team Approach to Treating Anxiety

Anxiety disorders are the most common mental health disorders – impacting nearly 30% of adults and between 15% to 30% of children and adolescents at some point in their lives. 

Symptoms of anxiety disorders can interfere with school, work, relationships, and more and can include feelings of uneasiness, fearfulness, worry, difficulty concentrating, headache, racing heart, etc. The great news is that anxiety disorders are treatable; it's possible to heal anxiety disorders so that people can go on to live a life filled with an abundance of calm and full control over their moods. Effective treatments for anxiety include therapy, mindfulness, nutrition, medication, exercise, coaching, herbal medicines, and more. 

In this article, we'll cover integrative medicine treatments for anxiety and explain how a team approach that combines integrative medicine with conventional techniques can help many people lead productive and happy lives!

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What is Anxiety?

Anxiety is a feeling of apprehension or unease. It can be a natural reaction to stress or danger and can even be beneficial if it alerts us to a threat or helps us pay attention to a risk in our environment that's truly life-threatening. When anxiety becomes chronic or occurs outside of threatening situations, however, it can impact a person's day-to-day living and is designated as a disorder that needs to be treated and healed.

Anxiety disorders can present in several ways:

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) impacts 2% of U.S. adults. It's characterized by excessive worry about a variety of events or activities that happen most days of the month for at least six months.

Panic Disorder

Panic disorder, found in 2-3% of U.S. adults, includes repeated and recurrent episodes of panic, including chest pain, heart palpitations, shortness of breath, dizziness, and abdominal distress.

Social Anxiety Disorder

Social anxiety disorder, found in 7% of U.S. adults, is mainly characterized by persistent fear of being watched and judged by others that can be so intense that a person avoids life situations that are beyond their control.

Phobias

Specific phobias, found in 8-12% of U.S. adults, include intense fear or aversion to very specific situations or even objects that are out of proportion to the actual danger from the situation or object, such as heights, flying, spiders, blood, and others.

What Does Anxiety Feel Like?

Anxiety disorders create feelings of a constant overwhelm, much more so than typical feelings like nervousness. Feelings and symptoms vary by type, but most people with anxiety disorders are uneasy, fearful, irritable, or restless; they also tend to worry a lot and have difficulty concentrating. These feelings are often accompanied by the quick onset of physical symptoms such as muscle tension, headache, chest pain or racing heart, stomach pain, trembling, or sweating.

Specific signs, symptoms, and feelings can be powerful clues to the type of anxiety disorder:

Generalized Anxiety Disorder

People with generalized anxiety disorder (GAD) often describe muscle tension or feeling like their shoulders are always "up by their ears." Symptoms can also include feeling restless, easily fatigued, wound up, or on edge. 

Panic Disorder

Most people know what a panic attack feels like - it's terrifying. Symptoms of a panic attack can include a pounding or racing heart, sweating, and feeling out of control or doomed. It may also include hyperventilation and the sense that it's hard to breathe.

Social Anxiety Disorder

People with social anxiety disorder may feel nervous around people or when out in public and may blush or sweat, adopt a rigid body posture, speak softly, have difficulty with eye contact, and may feel very self-conscious.

Phobias

Specific phobias stem from excessive or irrational worry about a specific feared situation or object, resulting in intense anxiety upon encountering or taking active steps to avoid that specific situation. People may experience all the symptoms above when they encounter the thing they're afraid of.

What Causes Anxiety?

Although the root causes of anxiety disorders are unknown, it's often a combination of factors that leads to an anxiety disorder diagnosis. The following frequently present as causes of anxiety:

Medical Issues

Practitioners will look for diseases that mimic anxiety symptoms, like arrhythmia, thyroid issues, dysbiosis, or chronic pain. Hyperthyroidism or Graves' disease can cause someone to sweat and feel anxious without a known trigger and can also include other symptoms like insomnia and weight loss.

Genetics

Anxiety disorders can run in families; one study found a heritability of approximately 30% for GAD.

Exercise

A sedentary lifestyle, characterized by low physical activity/exercise levels, is linked with increased anxiety. Many Americans have a sedentary lifestyle due to the nature of their work or commute - most of their day may be spent sitting. Over time, without added movement, this type of movement pattern can lead to anxiety.  

Substance Abuse

Substance abuse, particularly alcohol abuse, is linked with anxiety.

Sleep

People with insomnia or poor sleep are 17 times more likely than those without a sleep issue to experience anxiety. Improving sleep improves mental health conditions, including anxiety.

Micronutrient Insufficiencies and Dietary Patterns

A nutrient-poor diet that results in micronutrient deficiencies can increase the risk of GAD, panic attacks, and other mental health disorders. Inflammatory dietary patterns high in sugars, fried foods, refined grains, and beer are more associated with anxiety symptoms than diets like the Mediterranean diet, which includes an abundance of fruits, vegetables, nuts, seeds, whole grains, beans, lentils, and meats.

Neurotransmitter Imbalances

Imbalances in gamma-aminobutyric acid (GABA), dopamine, serotonin, norepinephrine, and excessive histamine levels are linked with excessive anxiety because of how they affect receptor sensitivity and signaling, as well as a host of other bodily functions like breathing, sleeping, and more.

Environment

Experiences such as trauma, abuse, exposure to stressful events, and other negative situations can increase the risk of anxiety disorders throughout the lifespan.

Specialty Labs to Test for Root Cause of Anxiety

There are no specific texts for anxiety, but there are a number of lab tests to help practitioners rule out other conditions while doing a deep dive into the possible causes of anxiety. Combined with conventional tests, functional testing helps pinpoint the root causes of anxiety to create a plan to treat and calm anxiety.

Complete Blood Count 

Also known as a CBC, a complete blood count can detect immune system dysfunction or nutrient deficiencies like iron-deficiency anemia, which is linked with GAD. 

Thyroid Panel

A thyroid panel measures thyroid hormones like TSH, T3, and T4, which control metabolism. Hyperthyroidism can cause symptoms of anxiety. 

Complete Metabolic Panel

A comprehensive metabolic panel is abbreviated CMP and can detect liver and kidney issues that can affect brain and mental health.

Electrocardiogram

If a person has cardiac symptoms associated with their anxiety, a practitioner may order an electrocardiogram (ECG) to rule out heart problems or refer to a cardiologist. 

Genetic Tests 

Genetic tests can analyze multiple genes to determine single nucleotide polymorphisms that can contribute to a person's vulnerability to mood disorders. These tests can even predict how a person will respond to certain medications that can be used to treat anxiety.

Digestive Tests

Stool tests, like the GI-Effects, help practitioners assess digestive function, intestinal inflammation, and the intestinal microbiome to assess digestion and absorption, which can impact nutrient status and play a role in the pathophysiology of anxiety.

Neurotransmitter tests 

These tests can assess the body's ability to secrete and metabolize neurotransmitters like serotonin, dopamine, and GABA. Others combine neurotransmitter and micronutrient tests in one. Still, more can analyze genes like MTHFR to determine how someone might be metabolizing important nutrients and neurotransmitters.

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How to Calm Anxiety 

The optimal way to calm anxiety is to integrate conventional and functional medicine approaches into a personalized plan that works for a person's unique temperament, lifestyle, and circumstances. Creating a treatment plan based on how a person presents, taking a deep dive into the possible reasons behind those signs and symptoms, and then ordering targeted labs to get to the root cause will point practitioners to the best combination of treatments that a person can use to calm anxiety. Below are some modalities that can increase peace and decrease stress and tension.

Conventional Treatment for Anxiety

Conventional treatments for anxiety include psychotherapy and medications, as well as lifestyle changes and coping skills that people with anxiety can use in the moment to manage symptoms as they arise. Medications are not generally a cure for anxiety but can help to manage the symptoms of anxiety while the root cause is identified and healed. Therapy is a wonderful way to explore, understand feelings and behaviors, and gain coping skills.

Medications

Antidepressants may help manage anxiety symptoms by helping the brain use certain chemicals to control mood or stress.

Anti-anxiety medications like benzodiazepines work by reducing the symptoms of anxiety. Using these in combination with antidepressants may speed symptom recovery.

Beta-blockers, traditionally used for high blood pressure, can help relieve the physical symptoms of anxiety: shaking, racing heart, and blushing. 

It's worth reiterating here that if anxiety is caused by another medical condition, such as hyperthyroidism, then medications to treat that condition can lessen anxiety. 

Psychotherapy

The most common form of psychotherapy for anxiety is cognitive-behavioral therapy (CBT). It helps people identify negative thoughts and behaviors and provides them with strategies for managing and changing them in the moment and proactively. The gold standard treatment for anxiety includes at least eight weeks of CBT weekly. 

Other forms of therapy can help people more intensively when they need it. People can get therapy for 9 hours per week (known as IOP or intensive outpatient therapy), 30-40 hours per week (known as partial hospitalization), or participate in multiple outpatient group sessions per week if they need more than 1 hour of care with a therapist each week, or want to make faster progress. With one week of IOP, for instance - which is 9 hours of therapy - a person can theoretically achieve the same or better results than they could in 8 weeks of 1-hour weekly therapy. Talk about making a difference fast! 

One of my favorite techniques that I've seen our therapists at Sanare use with clients is skills-practicing sessions. They'll walk clients through what to do when they feel a panic attack or anxiety coming and practice how to deal with it in the moment. Therapists can employ tools like using a sour candy or textured object in the hand to help people ground using their senses, be with clients as they learn to journal or challenge negative thoughts, and teach breathing techniques to manage hyperventilation symptoms to prevent them from co-opting someone's physiology.

Functional Medicine Treatment for Anxiety

Functional medicine is a holistic approach to treating anxiety by addressing the root causes and focusing on lifestyle modifications, nutrition, supplements, and other integrative modalities to reduce the symptoms and heal the whole person. There are also whole-person health benefits to getting regular exercise, getting enough sleep, and seeking a work-life balance. In general, these approaches benefit multiple areas of health beyond mental health, including cardiovascular health, metabolic health, and more.

Nutrients and Dietary Patterns

Key nutrients and dietary patterns that are able to treat or reduce the symptoms of anxiety include: 

Omega-3 fatty acids have been shown to help alleviate the symptoms of anxiety, yet over two-thirds of U.S. adults don't consume enough omega-3s. Top sources of omega-3s include chia seeds, flax seeds, walnuts, salmon, and more. Supplementation may be a good option if you can't or won't consume these foods.

Iron is involved in synthesizing feel-good neurotransmitters such as serotonin, dopamine, and norepinephrine. Iron deficiency anemia (IDA) has been linked to low levels of serotonin and is associated with anxiety. Supplementation may decrease these risks. 

Magnesium is a powerful mineral involved in a multitude of the body's functions. Supplementation has been shown to benefit mild anxiety by inducing a calming state and relieving symptoms; studies show that it's particularly helpful when combined with vitamin B6.

B vitamins are important in synthesizing neurotransmitters and are key to how the body functions, including the brain and nervous system. They are thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), vitamin B6, folate (B9), and vitamin B12. B vitamins are water-soluble, so the body can't store them, and they need to be replenished daily. Studies show they're necessary for brain function and may help with anxiety. 

GABA metabolism issues are involved in anxiety thanks to its control over the hyperactivity of nerve cells. Interestingly, nutrient deficiencies, including B vitamins, can deplete GABA, indicating supplementation as a way to treat anxiety.

An anti-inflammatory dietary pattern is also proven to reduce anxiety and add calm. Making the change to an anti-inflammatory diet can be easy, fun, and delicious if you follow the tips in this awesome article on the Mediterranean diet.

Herbal Medicines

Herbal medicines are the original pharmaceuticals and can be powerful allies in reducing symptoms of anxiety. Herbs that reduce anxiety are called "anxiolytic" herbs, which literally means to "cut" "anxiety" in Latin. Like many modern-day anxiety pharmaceutical medications, anxiolytic herbs can also come with powerful side effects if used improperly and may interact with other medications or supplements. Always talk with your practitioner before adding herbs to your routine. I advise my clients to start using these herbs at night after we've ensured they're safe to take. This way, they help people to sleep better and reduce anxiety the next day without making them sleepy during work or school hours.

Some anxiolytic herbs include:

Passionflower, a beautiful purple flowering plant, was identified in a study as being as effective as benzodiazepines in eliminating anxiety symptoms without the risk of side effects.

Kava root has been studied as an alternative to benzodiazepines and has been used for centuries by Pacific Islanders as part of cultural and healing ceremonies to reduce anxiety and allow for increased capacity for interpersonal connection. It has been shown to relieve the symptoms of anxiety without sedative effects typical of many anxiety medications. It can cause liver damage if used in excessive amounts long-term and is not safe for people with compromised liver function. 

Lavender oil was found to be as effective at reducing anxiety as the popular benzodiazepine Ativan in an RCT.

Bacopa was found to reduce anxiety in older adults in one RCT.

Saffron, a spice, can reduce anxiety and sleep disturbances in people with type 2 diabetes and is also used to treat other mental health disorders like depression.

Ashwagandha was found in a 2022 systematic review to significantly reduce anxiety and perceived stress at doses between 300mg and 12,000mg per day. Individual dosing will depend on your unique physiology and needs.

Integrative Modalities

Integrative medicine and modalities bring together traditional and complementary alternative medicine with conventional medicine to help the mind and body heal. They enable each person to embrace the techniques that most resonate with them as they journey to calm anxiety.

Acupuncture is believed to help with anxiety by improving the flow of energy, or qi, in the body. It is thought to reduce the effects of stress hormones, provide a calming effect, and increase the production of endorphins, hormones that help reduce pain and promote a sense of well-being. Acupuncture can also help to reduce the emotional and physical symptoms associated with anxiety, such as insomnia, headaches, and muscle tension.

Mediation, or mindfulness meditation, focuses on tuning into the present moment with intention. It's a technique people can use to observe thoughts, emotions, and other feelings with no judgment. One benefit is that meditation stimulates the vagus nerve, which has been shown to relieve anxiety. 

Breathing techniques also stimulate the vagus nerve. Paced breathing can influence brain electrical activity, creating positive emotional and cognitive benefits. 

Yoga is a form of exercise and mindfulness that includes a combination of postures, or asanas, intentional breathing, and meditation. Studies have shown positive results in reducing anxiety and stress and promoting relaxation when practiced regularly. 

Biofeedback is a form of mindfulness that involves seeing anthropomorphic measures on a computer screen (heart rate, breath rate, temperature, etc.) and learning to control them with focused intention and changes to posture and breathing. Biofeedback has been found to significantly reduce stress and its associated symptoms.

Forest bathing, or spending time in nature, is also proven to reduce anxiety and improve mental health.

Exercise and Movement

Regular exercise can help reduce anxiety by releasing mood-boosting endorphins in the body. Almost any form of exercise that resonates will work: aerobic and resistance exercises effectively reduce anxiety as they benefit overall physical well-being.

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Summary

An integrative team approach to treating anxiety includes identifying the root causes and combining conventional medicine — therapy and medications — with functional tools like nutrition, herbs, supplements, and mind-body integrative modalities to help people thrive! If you want proof, check out Libby's story of how she healed her anxiety fast using an integrative medicine approach.