How do integrative experts manage anxiety?
Both medical groups and integrative experts provide recommendations for managing anxiety. Learn more about the approaches and meanings of recommendations: Integrative Oncology Programs and Expert Guidelines ›
Clinical practice guidelines
2013 evidence-based clinical practice guidelines provide these weak recommendations with moderate quality evidence for managing anxiety.
Massage therapy when anxiety is not controlled by usual care, and as part of a multi-modality cancer supportive care program
Mind-body approaches as part of a multidisciplinary approach:
- Mindfulness-based stress reduction (MBSR)
- Music therapy
- Psychosocial approaches, including cognitive behavioral therapy, relaxation training, imagery/visualization, psychoeducation, and behavioral approaches
A dose of moderate-intensity aerobic training three times per week for 12 weeks or twice weekly combined aerobic plus resistance training for 6 to 12 weeks can significantly reduce anxiety in cancer survivors during and after treatment.
Based on sufficient evidence, it does not appear that resistance training alone reduces anxiety.
The 2022 NCCN Guidelines® on Survivorship include a recommendation to develop a plan for regular physical activity and healthy nutrition as part of management and treatment of anxiety, depression, and distress.
The 2017 SIO clinical practice guidelines regarding people with breast cancer provide these recommendations to professionals for managing anxiety during and after treatment for breast cancer. This set of guidelines has been endorsed by the American Society of Clinical Oncology (ASCO).1Lyman GH, Greenlee H et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. Journal of Clinical Oncology. 2018 Sep 1;36(25):2647-2655.
Offer or provide this modality (high certainty that the net benefit is substantial):
Offer or provide this modality (high certainty that the net benefit is moderate):
- Music therapy
- Stress management (longer group programs are likely better than self-administered home programs or shorter programs)
Offer or provide this modality for selected patients, depending on individual circumstances (Moderate certainty that the net benefit is small):
Therapies with insufficient evidence to make a recommendation with anxiety:
- Art therapy
- Electrical nerve stimulation
- Healing touch
- Myofascial release
- Tai chi
The 2009 SIO guidelines for complementary therapies and botanicals provide these recommendations for managing anxiety with cancer.
Mind-body therapies: support and psychotherapy approaches as part of a multidisciplinary approach (strong recommendation, high-quality evidence):
- Cognitive-behavioral therapy
- Cognitive-behavioral stress management (CBSM)
- Support groups
- Supportive/expressive therapy
Other mind-body therapies as part of multimodality treatment (strong recommendation, moderate-quality evidence):
- Music therapy and other forms of expressive arts therapies
- Relaxation techniques
- Tai chi
Energy therapies (strong recommendation, moderate-quality evidence), including Therapeutic Touch™, healing touch and reiki
- Polarity therapy
- External qigong
Massage therapy delivered by an oncology-trained massage therapist as part of multimodality treatment (strong recommendation, low- or very low-quality evidence)
This 2023 guideline makes recommendations for managing anxiety symptoms among people with cancer.
Recommended both during and after cancer treatment
Mindfulness-based interventions (MBIs) (strong evidence)
Reflexology (weak evidence)
Yoga among people with breast cancer (moderate evidence, but only weak evidence regarding other types of cancer)
Recommended during cancer treatment
Hypnosis (moderate evidence)
Lavender essential oil inhalation (weak evidence)
Music therapy or music-based interventions (moderate evidence)
Relaxation therapies (moderate evidence)
Recommended after cancer treatment
Acupuncture (weak evidence)
Tai chi and/or qigong among people with breast cancer (weak evidence)
Inconclusive evidence to make recommendations for or against use
- Autogenica relaxation technique which involves a series of attention-focusing exercises designed to induce relaxation and enhance the body's self-healing powers training
- Dance/movement therapy
- Energy healing
- Expressive writing
- Healing touch
- Laughter therapy
- Light therapy
- Music therapy and music-based interventions after cancer treatment
- Nutritional interventions
- Other natural products and supplements
Published programs and protocols
These protocolsa package of therapies combining and preferably integrating various therapies and practices into a cohesive design for care, programs, and approaches by leaders in integrative cancer care provide guidance for managing anxiety.
We do not recommend specific integrative protocols or programs but provide information for you to evaluate with your healthcare team.
Lise Alschuler, ND, FABNO, and Karolyn Gazella
Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010
Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions including anxiety.
Keith Block, MD
Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.
The integrative Block Program has recommendations to people who are at different places along the cancer continuum:
- Those who’ve been recently diagnosed
- Those in treatment
- Those who’ve concluded treatment and need to remain vigilant to prevent recurrence
Lorenzo Cohen, PhD, and Alison Jefferies, MEd
Cohen L, Jefferies A. Anticancer Living: Transform Your Life and Health with the Mix of Six. New York: Viking. 2018.
This book introduces the concept of the Mix of Six, which is identical to six of our 7 Healing Practices › Dr. Cohen and Ms. Jefferies explain that while each plays an independent role, the synergy created by all six factors can radically transform health, delay or prevent many cancers, support conventional treatments, and significantly improve quality of life.
Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO
Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Medicatrix Holdings Ltd. 2020.
This book provides information on the treatment of 24 cancers, plus the most effective treatments of the most common symptoms affecting cancer patients while they undergo chemotherapy, radiotherapy, or surgery.
David Servan-Schreiber, MD, PhD
The relaxing breath
Shanti Norris, a yoga teacher who works with people with cancer, explains: “One cannot feel anxious as long as one is breathing slowly and deeply.” These are her instructions for managing stress with “The Relaxing Breath”2Norris S. Progressive Relaxation. Smith Center for Healing & the Arts. Viewed April 18, 2018.
- Sit in a comfortable position or lie on your back on the floor. Take a moment to get comfortable. Feel your body. Take a deep breath or two.
- Now take a breath by inhaling into the nose and exhaling out the mouth. The exhalation is like an audible sigh: AAAHHH! Do this three or four times. In through the nose and out through the mouth. AAHH. This is the most relaxing breath.
- Continue for one to two minutes.
- Let the breath come back to normal.
Practitioners of traditional Chinese medicine and Ayurveda offer therapies and approaches to manage anxiety.
Learn more about traditional medicine and how to find practitioners: Finding Integrative Oncologists and Other Professionals ›
|1||Lyman GH, Greenlee H et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. Journal of Clinical Oncology. 2018 Sep 1;36(25):2647-2655.|
|2||Norris S. Progressive Relaxation. Smith Center for Healing & the Arts. Viewed April 18, 2018.|