Clinical Roundup: Selected Treatment Options for Anxiety

At the Center for Lifestyle Medicine of the Cleveland Clinic’s Wellness Institute, I and my colleagues use a comprehensive lifestyle intervention for participants with multiple chronic diseases, including anxiety. Our lifestyle prescription includes mind–body approaches consisting of therapeutic restorative Hatha yoga practice and behavioral health coaching, along with cooking, nutrition, and physical activity. The program, called Lifestyle 180,® consists of 72 hours of a group-based intervention over a 1-year period.1 While not formally designed for treatment of generalized anxiety disorders, each therapeutic lifestyle modality addresses key aspects of anxiety: chronic psychologic stress; poor diet; and physical inactivity. Patients learn and practice breathing techniques, meditation, and mindfulness practices, and perform simple yoga poses to elicit the relaxation response, the physiologic opposite of the fight-or-flight response. This may enable participants to become more aware of their feelings and thoughts, to recognize old thought patterns that no longer serve them, and release those unhelpful ways of thinking and believing, and thus, reduce psychologic distress and reduce symptoms of chronic stress and anxiety.2–4 Through education and hands-on practice, patients learn how to cook and eat a low-fat, whole-foods (100% whole grain) Mediterranean diet to increase intake of plant-derived antioxidant and anti-inflammatory compounds, and to enhance insulin sensitivity, thus potentially also reducing psychologic distress and anxiety.5,6 Engagement in physical activities—both aerobic and strength training—may also induce improvements in anxiety-related outcomes.7 In a study, participants who implemented these self-care behaviors had clinically and statistically significant improvements in biometric and laboratory outcomes in spite of decreased usage of medications.1 Although stateand/or traitanxiety status was not formally evaluated, participants reported significantly better mood, and improved perceived stress and overall quality of life.8 In addition, participants, who among other chronic conditions, also have generalized anxiety disorder, used less prescription medications for anxiety (manuscript in preparation).