A randomized controlled study of naturopathic vs psychotherapeutic care for anxiety
A fascinating paper from the latest PLoS ONE compares the efficacy of naturopathic versus psychotherapeutic treatment of mild to severe generalized anxiety.
The Canadian study provides preliminary evidence that a naturopathic intervention was more effective than traditional psychotherapy in alleviating the symptoms of anxiety (using patient-reported measures only).
You can find the details online at PLoS ONE.
Reader Clint Armitage comments as follows:
I would posit that the perceived benefit generated in this study was more to do with the therapeutic affect of the breathing technique rather than the effect of the herbal "medicine" – and on that point I am reminded of something I read recently – what do they call natural substances that have been scientifically "proven", well they call those things medicine!
I am not saying that Naturopathic substances have no appreciable benefit, or promise of possible application and utility but I dont think that the study adequately demonstrated that the natural substance was the determinant of the difference between the treatment and control groups – both received the breathing techniques, and both groups reported a drop in anxiety levels (Final BAI scores decreased by 56.5% (p<0.0001) in the NC group and 30.5% (p<0.0001) in the PT group) – this would suggest to add credence to my position that the breathing was the magic ingredient not any root based substance.
The difference between the percentage reduction in anxiety from the NC and the PT groups, could be from some other variable besides the placebo versus the active "natural" pill remedy. That the two groups exhibited a statistically significant difference does not necessarily demonstrate the efficacy of the ingestion of the non placebo – this could be due to expectation biases (mentioned) or due to problems in the randomisation process of assigning a specific person to the treatment or control group (with a small sample size, there will be levels of randomness that may not have the numbers to effectively randomise the groups).
Otherwise, it is a nice study – would be good for teaching purposes. I am inclined to get off the skeptic high horse, and say that if root juice or rubbing Vicks on the soles of your feet makes you feel better, ie that it works, then go for it!
I can only get the abtract, but this study seems to be what I was looking for – some significant relationship between breathing and stress reduction (without root juice).
Clark DM, Salkovskis PM, Chalkley AJ. Respiratory control as a treatment for panic attacks. J Behav Ther Exper Psychiatry 1985; 16: 23-30.
They do mention the difficulties in controlling for extraneous variables. Welcome to science, it ain't easy!
I know from my personal experience that structured breathing has a wonderful effect on anxiety attacks – if performed regularly, and if you catch yourself in the very first stage of the attack (before it has flooded you, or taken over completely, and that can be like 10 seconds before it has you) and if you can recognize the symptoms, and immediately practice the breathing techniques, then it can stave off a full blown decompensation. If you don't catch it quickly enough, Alprazolam is handy, but addictive.
Daniel Goleman, in his fantastic book Emotional Intelligence, writes about an emotional hijack – a chilling elucidation of a very real experience for anxiety sufferers.
As far as I know, the breathing (deep and slow) acts upon the vasovagal tone, and helps to prevent syncope:
Regardless of the trigger, the mechanism of syncope is similar in the various vasovagal syncope syndromes. In it, the nucleus tractus solitarius of the brainstem is activated directly or indirectly by the triggering stimulus, resulting in simultaneous enhancement of parasympathetic nervous system (vagal) tone and withdrawal of sympathetic nervous system tone.
This results in a spectrum of hemodynamic responses:
1. On one end of the spectrum is the cardioinhibitory response, characterized by a drop in heart rate. The drop in heart rate leads to a drop in blood pressure that is significant enough to result in a loss of consciousness. It is thought that this response results primarily from enhancement in parasympathetic tone.
2. On the other end of the spectrum is the vasodepressor response, caused by a drop in blood pressure without much change in heart rate. This phenomenon occurs due to vasodilation, probably as a result of withdrawal of sympathetic nervous system tone.
3. The majority of people with vasovagal syncope have a mixed response somewhere between these two ends of the spectrum.
It is interesting to have personal, anecdotal evidence of something, but to be unable to find a good study, with adequate control of extraneous variables, demonstrating 1. that breathing techniques have a significant effect on anxiety, and 2. a clear scientific basis for the precise mechanism.
Thanks for the study – interesting.
nothing more to see. please move along.