Effects of nonpharmacological therapies on anxiety and cortisol: A meta-analysis

BACKGROUND: Although pharmacotherapy is considered the standard of care for the treatment of anxiety, a subset of the patients remains resis­tant or intolerant to iatrogenic adverse effects. Nonpharmacological and nonpsychotherapeutic interventions, sometimes referred to as “comple­mentary treatments,” have emerged as possible alternatives in the treat­ment of anxiety. We conducted a meta-analysis of placebo-controlled studies to assess the efficacy of nonpharmacological therapy on anxiety. In addition, because serum and salivary cortisol levels are elevated dur­ing anxiety, we conducted a separate meta-analysis of pre- and post-treatment cortisol levels.

METHODS: A search was conducted to identify randomized controlled tri­als published from January 2010 to May 2017 that measured the effects of nonpharmacological therapies on State Trait Anxiety Index (STAI) scores and cortisol levels before and after treatment.

RESULTS: Four studies met the criteria for inclusion. Our meta-analysis reveals that participants receiving nonpharmacological therapy had a statistically significant decrease in STAI scores (d = –.340; 95% confidence interval [CI], –.639, –.041; P = .026), but no statistically significant decrease in cortisol levels (d = –.085; 95% CI, –.396, .226; P = .591) after intervention.

CONCLUSIONS: Our meta-analysis data suggest that “complementary” therapies improved the clinical manifestations of anxiety and thus may be useful as adjunctive approaches to drug treatment.

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