Stress and anxiety

Summary
Acupuncture is a traditional form of treatment that began in China thousands of years ago. Thin needles are inserted into the skin at special points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.

Evidence
Acupuncture seems to help with short-term anxiety – for example, before a test or going to the dentist. But it is not clear whether it works for people who have long-term anxiety problems.

Safety
Acupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally).

Cost
A session may cost £40-£60. Frequency of treatment will depend on you and your practitioner.

Find out more
The following professional organisations can help you find a qualified practitioner:
Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society

Summary
AT classes require time and discipline, but may have greater benefits than simple muscle relaxation. In AT classes you learn to create feelings of warmth and heaviness throughout your body, and this is said to bring about very deep physical relaxation, mental peace and a quietening of negative thoughts. AT uses simple phrases that you repeat to yourself as you release tension from each part of your body.

Evidence
There is some research indicating that autogenic training reduces stress and may help with anxiety disorder. The research suggests that it is more effective if you learn the method in a class.

Safety
AT is best learned from an experienced teacher in a small class. There are no safety issues, though anyone with a long-term mental health problem should get advice from their psychiatrist before starting AT.

Cost
You will have to pay for the classes but once you have learned this technique you can practise it at home at no cost.

Further information
The British Autogenic Society (BAS) is the professional and educational organisation for autogenic therapists in the UK.

Summary
A hypnotised person is awake, alert and focused, but also more susceptible to suggestion. The therapist therefore uses suggestions to bypass the conscious mind in order to bring about changes in behaviour, emotions or attitudes. Hypnosis is used to help people stop smoking or cope with stress or phobias, and the side-effects of therapeutic treatments, and to promote healing.

Evidence
Research has been carried out on hypnosis for different types of anxiety problems. So far, it is still not clear whether hypnosis helps to ease anxiety. But learning a self-hypnosis technique for relaxation might help a person cope better with stress.

Safety
The safety and effectiveness of hypnotherapy largely depends on the skill of the practitioner and how you feel about working with them. It is unlikely that hypnotherapy will be formally regulated in the foreseeable future. Those who are doctors or psychologists have strong regulatory organisations (see below). Use cautiously if you have a longstanding mental illness or seizures.

Cost
A session may cost £40-£60. Frequency of treatment will depend on you and your practitioner.

Find out more
All full members of British Society of Clinical and Academic Hypnosis hold a medical or dental professional qualification in addition to their hypnotherapy training.
The National Council for Hypnotherapy and
The Hypnotherapy Association both claim to register approved hypnotherapists.

Summary
There are many different types of massage, some more vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils.

Evidence
Massage may help you feel more relaxed for a time, and boost your sense of well-being. But there is very little good research to say whether it helps with long-term anxiety problems.

Safety
Massage is safe if carried out by qualified massage therapists, and it rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage.

Cost
Monthly cost will depend on how regularly you receive treatments.

Further information
It is important to find a qualified practitioner such as one registered with The General Council for Soft Tissue Therapies.

Summary
MBSR is a structured programme taught in groups, usually weekly for eight or so weeks. The systematic series of lessons and homework tasks are designed to help you develop enhanced awareness of what is going on in your body and mind from moment to moment. This awareness is believed to reduce anxiety and negative thoughts, improve mood, and enhance vitality and people’s ability to cope. Over the last two decades, several research reports seem to have supported many of these claims. Home practice is an important part of the course, and participants need to do 40 to 60 minutes of this, six days per week, between each class.

Evidence
A review of research into MBSR concluded that it could reduce stress levels in healthy people. MBSR appears to be helpful for people with chronic health problems, even hard-to-treat health problems such as severe chronic pain and panic disorder.

Safety
MBSR is generally safe unless you have a severe or long-standing mental health problem.

Cost
A course might cost £10 to £30 a week, including course materials. The Mental Health Foundation have designed an affordable online course (see below). Once you have learned the technique, there are no ongoing costs.

Further information
Be Mindful from the Mental Health Foundation offer Mindfulness courses and also provide a list of MBSR programmes and practitioners throughout the UK.

Summary
When people think of ‘talking therapies’ they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says “CBT can help you to change how you think (‘cognitive’) and what you do (‘behavioural’)”. For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

Evidence
There is good evidence that psychological therapy based on CBT helps people who suffer from long-term anxiety.

Safety
CBT techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.

Cost
In most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions

Further information
It is important to find a qualified counsellor or psychologist. Contact The British Psychological Society.

Summary
Tai chi is also known as ‘moving meditation’. It is a series of slow, graceful, controlled movements, which develop strength, balance, posture and inner peace. It is a discipline that has to be learned in a class from a teacher and can then be practised at home.

Evidence
There is some good evidence that tai chi helps improve well-being, including anxiety, mood and self-esteem. It could be part a useful useful treatment package for anxiety disorders.

Safety
Tai chi is safe for most people. Though tai chi is slow and gentle, anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise and build up gently.

Cost
Once you have learned the movements, you can do the exercises at home, at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services. You can also contact the The Tai Chi Union.

Summary
Yoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.

Evidence
Some studies have shown that people who practise yoga have lower anxiety levels. But better studies are needed to be certain that yoga helps in anxiety disorders.

Safety
Yoga is generally safe when practised appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.

Cost
You will have to pay for the classes but once you have learned this technique you can practise it at home at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services. To find a qualified teacher near you see also the The Yoga Alliance
and the The British Wheel of Yoga.