Identifying complementary and alternative medicine recommendations for anxiety treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines

Fei-Yi Zhao; Gerard A Kennedy; Peijie Xu; Russell Conduit; Yan-Mei Wang; Wen-Jing Zhang; Hui-Ru Wang; Li-Ping Yue; Yu-Ling Huang; Yin Wang; Yan Xu; Qiang-Qiang Fu; Zhen Zheng

doi:10.3389/fpsyt.2023.1290580

Identifying complementary and alternative medicine recommendations for anxiety treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines

Front Psychiatry. 2023 Dec 12:14:1290580. doi: 10.3389/fpsyt.2023.1290580. eCollection 2023.

Authors

Fei-Yi Zhao^#^{1

2}, Gerard A Kennedy^#^{3

4

5}, Peijie Xu^#⁶, Russell Conduit^#⁴, Yan-Mei Wang^#², Wen-Jing Zhang^#², Hui-Ru Wang^#², Li-Ping Yue^#¹, Yu-Ling Huang^#², Yin Wang^#², Yan Xu^#¹, Qiang-Qiang Fu^#⁷, Zhen Zheng^#⁴

Affiliations

¹ Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China.
² Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
³ Institute of Health and Wellbeing, Federation University, Mount Helen, VIC, Australia.
⁴ School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.
⁵ Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia.
⁶ School of Computing Technologies, RMIT University, Melbourne, VIC, Australia.
⁷ Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.

^# Contributed equally.

Abstract

Background: Clinical practice guidelines (CPGs) are used to guide decision-making, especially regarding complementary and alternative medicine (CAM) therapies that are unfamiliar to orthodox healthcare providers. This systematic review aimed to critically review and summarise CAM recommendations associated with anxiety management included in the existing CPGs.

Methods: Seven databases, websites of six international guidelines developing institutions, and the National Centre for Complementary and Integrative Health website were systematically searched. Their reporting and methodological quality were evaluated using the Reporting Items for practice Guidelines in Healthcare checklist and the Appraisal of Guidelines for Research and Evaluation (2nd version) instrument, respectively.

Results: Ten CPGs were included, with reporting rates between 51.4 and 88.6%. Seven of these were of moderate to high methodological quality. Seventeen CAM modalities were implicated, involving phytotherapeutics, mind-body practice, art therapy, and homeopathy. Applied relaxation was included in 70% CPGs, which varied in degree of support for its use in the treatment of generalised anxiety disorder. There were few recommendations for other therapies/products. Light therapy was not recommended for use in generalised anxiety disorder, and St John's wort and mindfulness were not recommended for use in social anxiety disorder in individual guidelines. Recommendations for the applicability of other therapies/products for treating a specific anxiety disorder were commonly graded as "unclear, unambiguous, or uncertain". No CAM recommendations were provided for separation anxiety disorder, specific phobia or selective mutism.

Conclusion: Available guidelines are limited in providing logically explained graded CAM recommendations for anxiety treatment and care. A lack of high-quality evidence and multidisciplinary consultation during the guideline development are two major reasons. High quality and reliable clinical evidence and the engagement of a range of interdisciplinary stakeholders are needed for future CPG development and updating.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022373694, identifier CRD42022373694.

Keywords: anxiety; clinical practice guidelines; complementary and alternative medicine; complementary and integrative health; guidelines; herbalism; mind–body practice; systematic review.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by Shanghai Key Laboratory for Pharmaceutical Metabolite Research Project [SHZYDX2023-01] and University’s scientific research project, Shanghai Sanda University [2021zz02-yj] to F-YZ; National key R&D Program of China [2021YFC2501500] to W-JZ; Future Plan for Traditional Chinese Medicine Inheritance and Development of Shanghai Municipal Hospital of Traditional Chinese Medicine [WLJH2021ZY-ZYY002] to H-RW; and Construction of Non-pharmacological TCM Treatment of Insomnia Center, Shanghai Municipal Health Commission [ZY (2021–2023)-0204–06] to Y-MW.