Public Health Report : Tai Chi for Anxiety
Author : Eric L. Zielinski
Regarded by the National Institute of Mental Health as a “normal reaction to stress and can actually be beneficial in some situations,” anxiety is troublesome when it becomes chronic or gets excessive. The body’s natural stress response is not designed to maintain the energy associated with constant anxiety and the immune system will quickly suffer for it. Ultimately, if anxiety continues unchecked, it may produce a cascade of harmful effects leading to chronic disease processes like diabetes, cancer, and heart failure. The medical approaches to managing anxiety vary, although most rely heavily on medications with dangerous side effects to mask symptoms instead of managing the primary cause. Gladly, science has taken a good look at holistic approaches like Tai Chi and the medical community is starting to take notice of its positive effects on mental health.
Typical anxiety disorders include generalized anxiety disorder, obsessive-compulsive disorder panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias (social phobia, agoraphobia, and specific phobia). According to the National Institute of Health,
“Approximately 40 million American adults ages 18 and older, or about 18.1 percent of people in this age group in a given year, have an anxiety disorder. Anxiety disorders frequently co-occur with depressive disorders or substance abuse. Most people with one anxiety disorder also have another anxiety disorder. Nearly three-quarters of those with an anxiety disorder will have their first episode by age 21.5.”
Anxiety is complicated and the more psychologists narrow its diagnostic definition, the messier the situation gets. There are two different ways to view these staggering numbers. One, these numbers are validation that our current sedentary lifestyle filled with processed foods has contributed to a number of chronic diseases like mental disorders and people are suffering at alarming rates because of it. Two, these numbers are misleading as too many people are being clumped into a mental disorder because diagnostic criteria continues to tighten up. In either case, the reality lies in the fact that regardless whether or not people are actually depressed, 15 million Americans have found valid reason to go to their doctor for help and, therefore need help.
Still not quite fully understood, the American Psychological Association describes anxiety as,
“An emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.”
Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice to treat anxiety. Serotonin is the neurotransmitter and hormone that is responsible for happiness. It also plays key roles in the regulation of learning, sleep and constriction the blood vessels. Since low levels of serotonin in nerve synapses are believed to cause mood disorders like anxiety, SSRI’s work by blocking or delaying the re-absorption of serotonin so that synaptic levels are increased. Consequently, more serotonin is released and mood heightens.
Common SSRIs used to treat anxiety are:
According to the U.K. National Health Service, common side effects to SSRI’s affect 10 percent and include the following:
More dangerous side effects are believed to only affect one percent of people and are:
Lastly, “serotonin syndrome” is an uncommon, but serious set of side effects linked to SSRIs. According to the NHS, “It occurs when levels of serotonin in your brain become too high. It is usually triggered when you take an SSRI in combination with another medication (or substance) that also raises serotonin levels, such as another antidepressant or St John’s Wort.”
Although none of these drugs have been approved by the Food and Drug Administration (FDA) for stress management, millions of American use them daily. According to the U.K.’s National Health Service (NHS), “It is important to persist with treatment, even if you are affected by side effects, as it will take several weeks before you begin to benefit from treatment. With time you should find that the benefits of treatment outweigh any problems related to side effects.”
Mind-body enthusiast will be delighted to learn that “alternative” therapies are gaining headway into mainstream practices. Even the Mayo Clinic recommends Tai Chi to help reduce anxiety! This is especially exciting because the Complementary and Alternative Medicine (CAM) agenda has had a challenging road to travel as it has substantiated its position in the Western health care model. Studies, like the ones below, helped pave the way.
• Ever since a 1989 study published in the Journal of Psychosomatic Research, the psychological benefits of those practicing Tai Chi has been extensively researched. In this now classic text, La Trobe University researchers assessed 33 Tai Chi novices and 33 regular practitioners. It was observed in both groups that, “Tai Chi raised heart rate, increased noradrenaline excretion in urine, and decreased salivary cortisol concentration. Relative to baseline levels, subjects reported less tension, depression, anger, fatigue, confusion and state-anxiety, they felt more vigorous, and in general they had less total mood disturbance.”
• To compare studies targeting Tai Chi and Qigong and identify the physical and psychological health outcomes shown to be associated with them in adults older than 55, University of Arizona and Arizona State researchers evaluated 36 research reports with a total of 3,799 participants and observed the following: “Significant improvement in clusters of similar outcomes indicated interventions utilizing [Tai Chi and Qigong] may help older adults improve physical function and reduce blood pressure, fall risk, and depression and anxiety. However, as researchers indicated, “Missing from the reviewed reports is a discussion of how spiritual exploration with meditative forms of [physical activity] an important component of these movement activities, may contribute to successful aging.”
• Not only a complication of falls, it has been shown that depression can cause falls which highlights their bidirectional relationship. Thus, excessive fear of falling – also associated with depression – greatly increases one’s likelihood to fall. According to University of Toronto researchers, “Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways.” To complicate matters, anti-depressant medications can increase the risk of falls thereby putting an elderly individual battling depression between a rock and a hard place. University of Toronto researchers highlight this challenging interplay in an article they published this past year in the American Journal of Geriatric Psychiatry and thus recommend that,” Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers.”
• An article in Journal of Alternative and Complementary Medicine from 2005 reports on Tai Chi’s effectiveness on improving quality of life and anxiety in HIV/AIDS patients. Thirty-eight people with advanced HIV (AIDS) were randomized to one of three groups: Tai Chi, aerobic exercise or control. The two experimental groups exercised twice weekly for 8 weeks. In addition to “significant improvements” in overall functional measures and overall health, the results of the data analysis revealed that the exercise groups “showed significant main effect for time in confusion-bewilderment and tension-anxiety.” In other words, “This study shows that [Tai Chi] and [aerobic exercise] improve physiologic parameters, functional outcomes, and [quality of life].”
• Just recently, the Journal of Investigative Medicine published in article in which University of New Mexico researchers conducted a literature review evaluating how people with post-traumatic stress disorder (PTSD) respond to mind-body practices like Tai Chi. Of the 96 articles identified, 16 were used for the review and the researchers discovered, “Mind-body practices incorporate numerous therapeutic effects on stress responses, including reductions in anxiety, depression, and anger, and increases in pain tolerance, self-esteem, energy levels, ability to relax, and ability to cope with stressful situations. In general, mind-body practices were found to be a viable intervention to improve the constellation of PTSD symptoms such as intrusive memories, avoidance, and increased emotional arousal.” The authors encouraged readers, clinicians and patients to explore individualized treatment plans “enhanced by mind-body interventions as part of ongoing self-care.”
• In 2010, BMC Complementary and Alternative Medicine published an article from Tufts University School of Medicine researchers that systematically reviewed the effects of Tai Chi on stress, anxiety, depression and mood disturbance in eastern and western populations. In total, of the 29 articles they found, 19 were evaluated and highlighted the anxiety-reducing ability of Tai Chi. Of significant interest is an eight-study group reflecting data from 359 participants with “symptomatic osteoarthritis, healthy adults, elderly with cardiovascular disease risk factors, individuals with fibromyalgia, and adolescents with ADHD found that Tai Chi practiced 2 to 4 times a week (30 to 60 minutes/time) for 5 to 24 weeks was associated with a significant reduction in anxiety.” For one activity (i.e. Tai Chi) to affect such a wide variety of health concerns points to the unbelievable, global benefits Tai Chi has on the body, mind and spirit. This realization cannot be stressed enough as there are only a few interventions that can accomplish this!
In the same paper, researchers evaluated five studies in which 1091 health adults were recruited and placed into three groups: Tai Chi, routine or moderate aerobic exercise, and a sedentary control group. It was determined that those participating in Tai Chi received a statistically significant decrease in tension-anxiety compared to the aerobic and sedentary groups.
It is vital to note that of those people who were in the Tai Chi group, it was reported that they practiced Tai Chi between six months and 14 years. Subsequently, the importance of maintaining Tai Chi as a way of life – and not a one-time deal – is suggested by these findings.
As it becomes more prevalent in our stressed-out culture, more people are searching for natural ways to alleviate and manage the anxiety that has become almost unavoidable today. Thankfully, researchers have evaluated Tai Chi and other natural therapies to offer an alternative approach. The results are quite promising and it’s nice to see science catch up to what millions of people have known of for thousands of years.
The Journal of Alternative and Complementary Medicine
Western Journal of Nursing Research
BMC Complementary and Alternative Medicine
Journal of Alternative and Complementary Medicine
American Journal of Geriatric Psychiatry
Journal of Investigative Medicine
Journal of Psychosomatic Research
Public Health Report : Tai Chi for Anxiety
Author : Eric L. Zielinski