Hypnotherapy

Efficacy 
The available evidence suggests hypnotherapy to be effective for anxiety. Results were reported in seven RCTs and one CCT ranging from 30 to 201 participants, five out of the eight trials were conducted among paediatric populations.

Safety 
Generally considered safe when administered by qualified professionals. Contraindications include acute psychoses, severe personality disorders and an inability to be hypnotized.  

Read the full version of the Hypnotherapy summary. 

Mindfulness

Efficacy
Breast cancer: The available evidence suggests mindfulness-based stress reduction (MBSR) to be effective for anxiety in women with breast cancer. The results were derived from six systematic reviews with a range of 7 to 14 trials of mixed study design.  

Mixed cancer types: The evidence suggests MBSR to be effective for short-, medium-, and long-term effects of anxiety. The evidence is based on three SRs (n=7 RCTs, n=27 RCTs, n=28 RCTs) and one RCT (n=51).  

Mindfulness-based cognitive therapy (MBCT): The evidence suggests MBCT to be effective for reducing/improving anxiety. The results are reported in two RCTs (n=74, n=137).

Safety
MBSR and MBCT are generally considered safe in supportive cancer care. However, no rigorous assessment of the safety of mindfulness-based approaches in cancer patients is available.

Read the full version of the  Mindfulness summary. 

Music interventions 

Efficacy 
There is some evidence that music intervention can improve anxiety (7 SRs) although the overall evidence is conflicting (one overview of SRs). Effects appear similar for music therapy or music medicine, and for patient or researcher selected music. 

Safety 
Generally considered safe with no safety issues on record. Caution is advised for acutely distressed and/or emotionally fragile patients, particularly in patients with serious and life-threatening cancers. 

Read the full version of the Music interventions summary. 

Yoga 

Efficacy
Breast cancer: The available evidence suggests yoga to be effective for anxiety. According to five SRs, including 7 to 26 RCTs, the effect of yoga appears better for anxiety than psychosocial/educational interventions but no better than no treatment.  

Other cancers: The available evidence suggests that yoga is effective on anxiety in the short term, based on four small RCTs including 40 to 70 participants.  

Safety
Generally considered safe when administered by a qualified practitioner. Few adverse events are reported in clinical trials and serious adverse effects appear to be rare. Overall injury rates are comparable to other exercise types. 

Read the full version of the Yoga summary.

Acupuncture

Efficacy
Only few trial data are available. One RCT (n=173) conducted among patients with non-small cell lung cancer (NSCLC) or mesothelioma found acupuncture to be effective for anxiety related to breathlessness. 

Safety 
Generally safe when administered by a professional qualified practitioner. Mild adverse effects, such as pain or bleeding at the site of acupuncture, can be expected in about 10% of all cases; serious complications seem to be very rare. 

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Aromatherapy 

Efficacy
There is evidence of possibly beneficial but small effects of aromatherapy massage, but currently insufficient evidence of consistent effects of inhalation aromatherapy on reducing anxiety. This is based on two SRs (n=19 mixed design studies, n=43 mixed and 3 additional RCTs n=39, n=42, n=57). 

Safety
Generally safe and only associated with minimal adverse effects when used in appropriate dilutions.  Allergic reactions can occur with all oils. Should not be used undiluted.  

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Autogenic therapy 

Efficacy
Although research suggests autogenic therapy to be effective for anxiety among women with breast cancer, the reported results are based on two RCTs (n=60, n=31), which both have significant methodological limitations. 

Safety
The safety of autogenic therapy has not been systematically assessed. No adverse events were reported in the studies analysed for this summary. Concerns exist for children under the age of five, individuals with schizophrenia, or who are actively psychotic. 

Read full version of Autogenic therapy summary. 

Biofeedback 

Efficacy
Only very few data are available on the effect of biofeddback on anxiety. One RCT (n=81) reported that patients who took relaxation training but not biofeedback experienced a reduction in anxiety. 

Safety
Biofeedback is generally considered safe, and no adverse events have been reported in the included studies. Some concerns for individuals with a history of psychiatric illness. 

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Ginseng 

Efficacy
Only very few trial data are available. One RCT (n=60) lower anxiety scores were reported among those who took ginseng.  

Safety
Generally considered safe with only minor adverse drug reactions reported.  
Mainly gastrointestinal intolerances, headaches, and sleep disorders have been reported. These are dose-dependent, infrequent, and transient. 

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Massage (Classical/ Swedish) 

Efficacy
 Although some clinical trials have reported encouraging results based on seven SRs ranging from 4 to 19 mixed design studies, the net benefit is anticipated to be small and individual trials reported in the systematic reviews have small sample sizes and are low quality/at high risk of bias.  

Safety
Generally considered safe when administered by a qualified professional. Contraindications include strong forceful massage in patients suffering from haemorrhagic disorders, low platelet counts, and blood thinning medication. 

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Mindfulness 

Efficacy
Children and adolescents: The available evidence suggests mindfulness to be effective for anxiety in mixed types of cancer. The evidence is from a SR (2 RCTs), but the findings are limited by methodological flaws of the studies included.  

Safety
Mindfulness-based stress reduction (MBSR) and Mindfulness-based cognitive therapy (MBCT) are generally considered safe in supportive cancer care. However, no rigorous assessment of the safety of mindfulness-based approaches in cancer patients is available.  

Read full version of  Mindfulness summary. 

Progressive Muscle Relaxation (PMR) 

Efficacy
Although findings suggest PMR to be effective for anxiety, all trials have methodological limitations. This is based on one SR (n=12 RCTs) and five additional RCTs, including between 45–147 participants.  

Safety
Generally considered safe when administered by a qualified practitioner. 
Some concern has been raised about the use of relaxation therapy interventions among individuals who have a history of psychiatric disorders.  

Read full version of Progressive Muscle Relaxation summary. 

Qigong 

Efficacy
The evidence is contradictory on the effect of qigong on anxiety; a recent SR (n=17 mixed-design studies) found that qigong reduces anxiety, but the review had several methodological limitations. In another two SRs (n=11 RCTs, n=23 mixed design studies) the results were mixed,  

Safety 
Generally considered safe when administered by a qualified practitioner. As it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis or musculoskeletal difficulties. 

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Reiki 

Efficacy
A review (n=7 mixed-design studies) found reiki may be beneficial in reducing anxiety in patients with different illnesses, including cancer. One RCT (n=110) and a CCT (n=18) also found significant reductions in anxiety. The quality of the reported cancer studies is too low for any conclusions to be made. 

Safety
Generally considered safe when administered by a qualified practitioner. 

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Tai chi 

Efficacy
Tai chi slightly reduced the symptoms of anxiety in breast cancer patients compared with exercise training or usual care but studies were at high risk of bias. The results are derived from one SR including 2 RCTs.  

Safety
Generally considered safe when administered by a qualified practitioner.  As it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis, or musculoskeletal difficulties. 

Read full version of Tai chi summary. 

Homeopathy 

Efficacy
The available evidence suggests homeopathy not to be effective for anxiety. In a RCT (n=53) and an observational matched-pair cohort study (n=639) among breast cancer patients and patients with various cancers, no differences were seen between homeopathy and placebo.  

Safety
Generally safe, and there are no serious direct risks associated with homeopathy. There are indirect risks if homeopathic preparations are used in place of conventional cancer treatment. 

Read full version of Homeopathy summary.