A Complete Guide to Managing Anxiety Naturally

• Which non-drug tools have real evidence behind them?
• Where do I start?

By Dr. Douglas Cowan, Psy.D., MFT

About 18 percent of US adults have an anxiety disorder in a given year (1). That is nearly one in five. Anxiety is also among the most treatable conditions in mental health.

Many people want to try natural approaches first, or want something to add to the care they already have. That is a wise instinct. This guide covers the tools I have used most in thirty-five years of practice, ranked by how strong the research is. You deserve to know which is which.

What is happening in the brain

Anxiety starts in the nervous system. The brain’s alarm center fires too easily, stays on too long, and does not get enough calming signals from the thinking brain. Stress hormones rise, sleep suffers, the gut gets upset, and attention narrows toward danger.

No single tool fixes all of that. The best plans use several, in the right order. Build the foundation first, then add regulation skills, then deeper work.

Foundation: sleep, movement, food

1. Sleep. One night of lost sleep raised anxiety in healthy adults in a major review, and deep sleep helped calm it (2). Keep the same bed and wake times, even on weekends. Turn screens off an hour before bed, and keep the room dark and cool.

2. Movement. A 2023 review of 97 reviews found that exercise reduced anxiety symptoms about as much as therapy or medication, and that all kinds of activity helped (3). Higher effort helped more. Twenty minutes of brisk activity, most days, is a great goal.

3. Food. The brain runs on what you feed it. Eat regular meals with protein, plenty of plants, and enough water. Cut back on sugar and heavy caffeine, which can make jittery feelings worse.

Regulation: strong evidence

4. Slow breathing. In a trial of five minutes a day for a month, a breathing practice with a long exhale lifted mood more than mindfulness meditation (4). A review of controlled trials found that breathwork reduces stress and anxiety (5). Try four counts in, six counts out. See our breathing guide.

5. Mindfulness. In an eight-week trial of adults with anxiety disorders, mindfulness-based stress reduction worked about as well as a common anxiety medication (6). Mindfulness is not relaxation. It is learning to watch thoughts and feelings without being swept away.

6. Grounding. Feet on the floor. Five things you see, four you hear, three you touch. Grounding pulls attention back from imagined futures to the present moment.

Deeper work: strong evidence

7. Cognitive behavioral therapy (CBT). CBT has some of the strongest evidence of any anxiety treatment (7). It teaches you to test anxious thoughts and to face feared things in small steps. A skilled therapist is worth finding. Large reviews find that psychotherapy and medication both help anxiety disorders (8).

Early or modest evidence

8. Omega-3 fats. A large review linked omega-3 intake with modest lower anxiety, especially in people with clinical anxiety, though study quality varied (9). Fatty fish twice a week is a safe place to start. Ask your doctor before taking supplements.

9. Magnesium. A systematic review found that the research is limited and of mixed quality, so I treat it as a maybe (10). Ask your doctor first, especially if you take other medicines.

10. Tapping (EFT). A review of trials suggests tapping can lower anxiety, and the authors note that more rigorous studies are needed (11). It is simple, safe, and portable, so I am comfortable suggesting it as a coping skill.

11. Neurofeedback and CES. Some people explore these with a qualified provider when anxiety is strong or lasting. The research is still growing. A 2018 review of cranial electrical stimulation found some signs of benefit for anxiety and rated the evidence low in strength (12). Read our article on neurofeedback for anxiety.

Meaning and connection

For many people, faith and community are part of what steadies them. Research on religion and health finds that, for many people, spiritual practice and a supportive faith community are linked with better mental health (13). Prayer, gratitude, worship, and time with people you love all calm the body as well as the spirit.

Start today

• Pick one foundation item: a bedtime, a walk, or a protein breakfast.
• Practice 4-in, 6-out breathing for five minutes tomorrow morning.
• Write down three things you are grateful for tonight.
• Call a therapist who treats anxiety with CBT.
• Take our GAD-7 check-in to see where you are starting.

You are not broken. A brain under heavy load can be helped, and the right inputs, repeated, change it. Five percent calmer today, five percent calmer tomorrow. The small gains add up.

You have more tools than you think, and you can start with one.

This article is for education and is not a substitute for professional diagnosis or treatment. Do not stop any medication without talking with your prescriber. If you are in crisis, call or text 988 in the United States.

References

1. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627. https://doi.org/10.1001/archpsyc.62.6.617
2. Ben Simon, E., Rossi, A., Harvey, A. G., & Walker, M. P. (2020). Overanxious and underslept. Nature Human Behaviour, 4(1), 100-110. https://doi.org/10.1038/s41562-019-0754-8
3. Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., et al. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: An overview of systematic reviews. British Journal of Sports Medicine, 57(18), 1203-1209. https://doi.org/10.1136/bjsports-2022-106195
4. Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895. https://doi.org/10.1016/j.xcrm.2022.100895
5. Fincham, G. W., Strauss, C., Montero-Marin, J., & Cavanagh, K. (2023). Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-022-27247-y
6. Hoge, E. A., Bui, E., Mete, M., Dutton, M. A., Baker, A. W., & Simon, N. M. (2023). Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders. JAMA Psychiatry, 80(1), 13-21. https://doi.org/10.1001/jamapsychiatry.2022.3679
7. Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440. https://doi.org/10.1007/s10608-012-9476-1
8. Bandelow, B., Reitt, M., Röver, C., Michaelis, S., Görlich, Y., & Wedekind, D. (2015). Efficacy of treatments for anxiety disorders: A meta-analysis. International Clinical Psychopharmacology, 30(4), 183-192. https://doi.org/10.1097/YIC.0000000000000078
9. Su, K.-P., Tseng, P.-T., Lin, P.-Y., Okubo, R., Chen, T.-Y., Chen, Y.-W., et al. (2018). Association of use of omega-3 polyunsaturated fatty acids with changes in severity of anxiety symptoms: A systematic review and meta-analysis. JAMA Network Open, 1(5), e182327. https://doi.org/10.1001/jamanetworkopen.2018.2327
10. Boyle, N. B., Lawton, C., & Dye, L. (2017). The effects of magnesium supplementation on subjective anxiety and stress: A systematic review. Nutrients, 9(5), 429. https://doi.org/10.3390/nu9050429
11. Clond, M. (2016). Emotional Freedom Techniques for anxiety: A systematic review with meta-analysis. Journal of Nervous and Mental Disease, 204(5), 388-395. https://doi.org/10.1097/NMD.0000000000000483
12. Shekelle, P. G., Cook, I. A., Miake-Lye, I. M., Booth, M. S., Beroes, J. M., & Mak, S. (2018). Benefits and harms of cranial electrical stimulation for chronic painful conditions, depression, anxiety, and insomnia. Annals of Internal Medicine, 168(6), 414-421. https://doi.org/10.7326/M17-1970
13. Koenig, H. G. (2012). Religion, spirituality, and health: The research and clinical implications. ISRN Psychiatry, 2012, 278730. https://doi.org/10.5402/2012/278730