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Unconventional therapies for stress and anxiety.

Anxiety and stress often involve a web of underlying causes, life issues, and manifestations in day-to-day life. Conditions as multifactorial as these may well benefit from multifactorial treatment approaches.

The "relaxation response"

One of the best ways to relieve stress is to use the normal body process known as the "relaxation response." This physiological process--which is the opposite of the "flight-or-fight" response--is essentially a state of deep rest that changes your physical and emotional response to stress. Due to longstanding cultural attitudes and conventional medicine traditions, this simple, inborn process may be relatively neglected and underused in the U.S.

The relaxation response has many proven beneficial effects. It decreases anxiety--and it lowers blood pressure, heart rate and oxygen consumption. Regular use of practices that produce the relaxation response may also alleviate insomnia, depression, pain and other conditions.

A simple way to elicit the relaxation response Basic meditation is a very simple way to elicit this response. Ideally it is done once or twice daily for 10 to 20 minutes.

* Sit in a relaxed position

* Close your eyes

* Repeat a word or sound as you breathe.

If your thoughts stray, which is normal, shift your attention back to the word/sound repetition. An essential component of producing the relaxation response is to interrupt the everyday train of thought. On rare occasions, the relaxation response can produce disturbing thoughts or fear of losing control, especially in people with serious psychiatric conditions, but for most it's well tolerated.


"Mind-body medicine"

A broad array of CAM therapies, known collectively as "mind-body" approaches, may also produce the relaxation response. These include:

* Formal meditation

In addition to the simple meditation technique described above, there are formal methods, including "mindfulness meditation" and "transcendental meditation" or TM. Classes in these techniques are often available in hospitals, health clubs and community centers.

* Guided imagery

With this approach, a person learns to create visual images that have relaxing effects. Books and audiotapes are available for instruction.

* Hypnosis

Focused concentration is used to produce a trancelike or hypnotic state in which the individual is vulnerable to suggestion, for example, to relax. Hypnosis is generally induced by a trained hypnotherapist, but individuals can also learn self hypnosis.

* Music therapy

Relaxation may be produced by creating or listening to music. This may be done independently or by working with a trained music therapist. A detailed review of music therapy and MS will appear in the fall issue of Momentum.

* Biofeedback

This technique uses machines to monitor bodily functions such as muscle tension or heart rate. During treatment, the individual consciously attempts to alter one of these presumably "involuntary" body processes. Relaxation may be promoted by decreasing heart rate for example. Biofeedback usually requires a trained therapist.

* Prayer

Prayer can be seen as a form of meditation, especially when it involves reciting words, either silently or aloud. Importantly, prayer is one of many components of religious belief and thus may not be effective if done independently of the other aspects of religious belief.

* Exercise and massage

Exercise may produce relaxation through two physiological mechanisms. The repetitive movements of some exercise, like the repetitive language of meditation, interrupt the daily train of thought and induce the relaxation response. Exercise also stimulates the body's production of endorphins and other compounds that have stress-relieving effects.

Conventional and unconventional forms of exercise, such as tai chi and yoga, are available at many community centers and health clubs and can be modified for those with disabilities. All programs should first be discussed with a knowledgeable health-care professional.

Massage is an ancient healing method that may relieve anxiety and produce the relaxation response. Most forms of massage currently used in the U.S. are derived from Swedish massage. Massage is generally well tolerated, but it should be avoided or used with caution by anyone with recent injuries, fever, infection, blood clots (thrombosis), jaundice, cancer, arthritis, or heart disease.

* Dietary supplements

A variety of dietary supplements are claimed to be effective for anxiety. Unfortunately, there is no strong evidence supporting any of them. Worse, some have serious toxicity.


Kava kava is an herbal product that may be effective for anxiety, but it has been associated with more than 60 cases of liver toxicity, some of which resulted in death or the need for a liver transplant. This herb is banned in Europe and Canada, but is still available in the U.S.

Skullcap, another herb, is claimed to have both anxiety-relieving effects and therapeutic effects on MS. There is no good evidence that it does either. Furthermore, it has been associated with four cases of liver toxicity, one of which led to death in a person with mild MS. Kava kava and skullcap should not be used.

Passionflower, valerian and theanine are also claimed to be effective for anxiety, but at this time, there is no convincing evidence that these supplements are effective.

The bottom line

There is no single "one-size-fits-all" treatment plan for anxiety and stress. That doesn't mean nothing can be done, but therapies should be personalized and should take into account individual differences. For those who are interested, CAM approaches, alone or in combination with conventional medications or psychotherapy, may be quite helpful. Before embarking on your strategy, discuss your situation with your healthcare provider.

Did you find this article helpful? Do you want more information on a specific CAM? If yes, which one?

Dr. Allen Bowling is medical director of the Multiple Sclerosis Service, Colorado Neurological Institute (CNI), and clinical associate professor, Department of Neurology, University of Colorado-Denver and Health Sciences Center. More information about CAM and MS may be found in his highly recommended book, Complementary and Alternative Medicine and Multiple Sclerosis (2nd edition, Demos Health) and on his Web site,


More information and listings of trained therapists are available from the following organizations:

Biofeedback: Association for Applied Psychophysiology and Biofeedback (; Biofeedback Certi. cation Institute of America (

Guided imagery: Academy for Guided Imagery (

Hypnosis: American Society of Clinical Hypnosis (

Massage: American Massage Therapy Association (; National Certi. cation Board for Therapeutic Massage and Bodywork (

Meditation: Meditation Society of America (

Music therapy: American Music Therapy Association (

Tai chi: American Tai Chi Association (

Yoga: American Yoga Association (american; International Association of Yoga Therapists (

by Allen C. Bowling, MD, PhD
COPYRIGHT 2009 National Multiple Sclerosis Society
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2009 Gale, Cengage Learning. All rights reserved.

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Author:Bowling, Allen C.
Geographic Code:1USA
Date:Jun 22, 2009
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