Mind-body therapies can help teens with anxiety

Mind-body therapies—biofeedback, mindfulness, yoga, and hypnosis - provide a promising approach to the very common problem of anxiety in adolescents, according to a review in the March issue of The Nurse Practitioner.

"A growing body of evidence supports the implementation of mind-body therapy as a low-risk and cost-effective strategy in the management of anxious teenagers," write Bernadette Fulweiler RN, MSN, CPNP-PC, and Rita Marie John DNP, EdD, CPNP-PC, DCC, of Columbia University School of Nursing, New York. They highlight the role of pediatric nurse practitioners (NPs) in integrating screening and treatment for adolescents with anxiety.

Mind-Body Therapies—Promising Approach to Dealing with Teen Anxiety

Anxiety affects approximately one-third of US adolescents, with more than eight percent experiencing severe impairment in daily functioning. "Whereas anxiety and fear are typical reactions to the academic, social, and developmental challenges common during the adolescent years, clinical or pathological anxiety is excessive, persistent, and disruptive," according to the authors. While anxiety is often situational and time-limited, many teens develop chronic anxiety lasting six months or longer.

But currently recommended treatments for adolescent anxiety—cognitive behavioral therapy and/or antidepressant medications—have important limitations. They are expensive, often difficult to obtain, and in the case of antidepressants, can have side effects. Studies suggest that most adolescents with mental health disorders, especially anxiety disorders, do not receive any form of mental health care.

"Mind-body therapies encompass self-regulation and positive thinking...to help promote self-control, physical health, and emotional well-being," Ms. Fulweiler and Dr. John write. They reviewed and analyzed published research on mind-body therapy for anxiety in teens, focusing on four approaches:

• Biofeedback techniques enable individuals to increase self-awareness and physical control through feedback on biological measures. The review identified four studies of biofeedback approaches, showing significant reductions in anxiety and stress in teens receiving heart-rate variability (HRV) monitoring and video game-based biofeedback.
• Mindfulness techniques incorporate aspects of meditation, body scanning, and mindful breathing to help focus attention on the present moment and separate from negative thoughts. Six studies showed positive effects of mindfulness approaches for teens with anxiety, including school-based programs in high-risk populations
• Yoga is one of the most popular mind-body therapies, with positive physical and mental effects including reduced anxiety. "Low in cost, easy to implement, and accessible to individuals of all physical fitness levels, yoga has become an increasingly popular anxiety management tool," the authors write. They cite five studies, including four randomized trials, reporting positive effects of yoga in school settings.
• Hypnosis incorporates imagery and relaxation techniques to help control stress responses. The review identified three studies of hypnosis techniques to reduce stress in adolescents, including a telehypnosis intervention to reduce anxiety-related absences in high school students.

Mind-body therapies can help to meet the "dire need" for affordable and accessible mental health strategies in pediatric primary care, Ms. Fulweiler and Dr. John believe. But they note some persistent barriers to integrating mind-body medicine in primary care, including constraints on time, finances, and administrative support.

Nurse practitioners can play a vital role in screening for anxiety in adolescent patients at every health visit and creating a personalized plan to combat anxiety, when present. While NPs are highly supportive of complementary and alternative medicine practices, they need ongoing education regarding the benefits and methods of integrating mind-body medicine into patient care.