Patients often seek help for mild, nonspecific anxiety, yet not all anxiety warrants medication. Many patients are not able to commit to regular psychotherapy but can still benefit from techniques that can be practiced at home. In this article, I'll show you how to use accessible, simple interventions like mindfulness, muscle relaxation, and self-directed apps to relieve anxiety when medications are not the best choice.

Mild anxiety vs anxiety disorder
Anxiety is synonymous with "distress." Complaints of anxiety communicate negative feelings, but do not point to a specific anxiety disorder. Most anxiety disorders are characterized by phobic tendencies to avoid anxiety, rather than anxiety itself. For example, 23% of people have had panic attacks, but only 4% have panic disorder. The difference? Panic disorder requires efforts to avoid panic attacks, typically extreme enough to cause dysfunction.

Exercise
Regular physical activity significantly lowers anxiety. While high-intensity workouts may be slightly more effective than low-intensity ones, both types reduce anxiety compared to doing nothing (Aylett E et al, BMC Health Serv Res 2018;18(1):559). The sweet spot appears to be 30–45 minutes of aerobic exercise, 3 times a week. Start small—just 10 minutes a day of brisk walking or any activity that gets the heart rate up—and build from there.

Contact with nature
Walking in nature lowers anxiety, even a stroll as short as 20 minutes. Outdoor gardening also reduces anxiety. For those that can't get outside, indoor plants and nature images help (Gerdes ME et al, Int J Environ Res Public Health 2022;19(9):5121; Grassini S, J Clin Med 2022;11(6):1731; Browning MHEM et al, Sci Rep 2023;13:1239).

Sleep
Sleep is like free therapy. The sleeping brain sifts through recent events, holding onto those that are worth remembering and discarding memories that can be let go of. Sleep deprivation raises anxiety, and strategies that improve sleep bring relief. Recommend sleep hygiene, such as waking at regular times, avoiding daytime naps, sleeping in a dark and cold room, ensuring wind-down time, and limiting screens and blue/white light in the hour or two before bed.

CBT-insomnia (CBT-i) takes sleep hygiene to another level, adding more potent behavioral strategies like restricting time in bed. It is available through FDA-cleared apps (Sleepio Rx, Somryst) or a free app (CBT-i Coach).

Caffeine reduction
In a meta-analysis, the association between caffeine and anxiety registered a large effect size (SMD = 0.94), so counseling patients to reduce intake makes sense (Liu C et al, Front Psychol 2024;15:1270246). Talk with patients about gradually reducing caffeinated beverages, avoiding soda and energy drinks altogether, and swapping out coffee for tea. Besides containing a smaller dose of caffeine, tea has ingredients that reduce anxiety and tachycardia, like L-theanine. Abstinence, however, may not be necessary. While four cups of coffee are a known cause of panic attacks, 150 mg/day of caffeine (ie, a mug of drip coffee or two shots of espresso) did not worsen panic disorder in a new randomized trial (Hoppe JM et al, J Psychopharmacol 2025;39(8):836–846).

Dietary changes
Increasing intake of omega-3 fatty acids from fatty fish, flaxseed, and walnuts lowers anxiety. In a meta-analysis of 19 studies that looked at both anxiety symptoms and anxiety disorders, omega-3 fatty acid supplements improved anxiety at an average dose of 1606 mg/day (Su KP et al, JAMA Netw Open 2018;1(5):e182327).

Probiotics reduce anxiety, whether from capsules or fermented foods like yogurt, kefir, sauerkraut, and kimchi (Aucoin M et al, Nutrients 2021;13(12):4418). Low levels of zinc and selenium are linked to elevated anxiety symptoms, while adequate intake appears beneficial in reducing anxiety. The role of supplementation is less clear. Encouraging intake of foods rich in zinc (eg, shellfish, oysters, pumpkin seeds, leafy and root vegetables) and selenium (eg, Brazil nuts, seafood, beans, lentils) is a good idea. The Mediterranean diet, which emphasizes fruits, vegetables, whole grains, nuts, and olive oil, is associated with reduced anxiety (Aucoin M et al, Nutr Neurosci 2025;28(6):635–648).

Magnesium
Low levels of magnesium are associated with anxiety and dysphoria. Magnesium blunts the release of excitatory glutamate and helps lower cortisol levels, both of which worsen anxiety. Magnesium supplementation may reduce anxiety and improve sleep with minimal side effects (Rawji A et al, Cureus 2024;16(4):e59317). Magnesium oxide is not well absorbed, so stick with magnesium glycinate or threonate that contains 300 mg of elemental magnesium.

Lavender
Lavender oil prepared in 80 mg capsules (Silexan) is effective for subsyndromal anxiety as well as generalized anxiety disorder (GAD). In fact, it held up favorably to lorazepam and paroxetine in reducing anxiety, with less side effects (Dold M et al, Eur Arch Psychiatry Clin Neurosci 2023;273(7):1615–1628). The dose range is 80–160 mg, with increased response at the higher dose. For patients who don't want to take a pill, lavender inhalation (aromatherapy) shows promise, with positive trials reducing anxiety among cancer patients.

Intentional worry
Anxious people can spend a lot of time worrying, but worry is only useful when it serves as a reminder to do something. Otherwise, it's just a stuck loop. Anxiety is sometimes frustrating because it can make a person feel like they have no control over how much they worry.

The paradoxical technique of "worrying on purpose" at a regular time every day (ideally not before bedtime) can help. Advise patients to worry on purpose and to write the worries down. Over time, they'll feel more in control of their worries and build a habit of worrying once a day instead of all day long (see the table "Intentional Worry Instructions").

Progressive muscle relaxation
Progressive muscle relaxation (PMR) lowers anxiety, promotes sleep, and decreases headaches and physical pain. It can be done lying down or sitting in about 10 minutes.

PMR is a two-step relaxation practice involving creating tension in specific muscle groups and noticing what that tension feels like, then releasing it and focusing on what a relaxed muscle feels like. Patients move through muscle groups in order, alternately tensing and relaxing them. See the tables "PMR Instructions" and "Additional PMR Resources."

Deep breathing
This calming technique helps with stress, anxiety, and panic. It takes just a few minutes and can be done anywhere, whether sitting in a chair or lying in bed. Instruct patients that if they are lying down, they should place their arms a little bit away from their sides, palms up. If they are sitting, they can place their arms on the chair with feet on the ground.

Mindfulness
Practicing mindfulness directs attention away from worry and negative thoughts. It brings patients into the moment and helps them experience thoughts and emotions with greater equanimity and acceptance. Exercises can be easily taught in session or with the assistance of apps (see the table "Mindfulness Apps"). Using mindfulness apps has stood up in RCTs, showing benefits for reducing anxiety and stress (Gál É et al, J Affect Disord 2021;279:131–142). Key features of mindfulness include:

• Focus on the experience. Pay attention, focusing on the experience using the senses of sound, sight, smell, touch, and taste.
• Be in the moment. Slow down and intentionally focus on the here and now. Patients should try to intentionally bring an open, accepting, and discerning attention to everything they do. Find joy in simple pleasures.
• Acceptance. Be open and accept experiences, others, and oneself.
• Breathing. Focus on the breath as it moves in and out of the body.
• Body scan meditation. Patients should lie on their back with legs extended and arms at the sides, palms facing up. Focus attention slowly and deliberately on each part of the body, in order, from toe to head or head to toe. Be aware of any sensations, emotions, or thoughts associated with each part of the body.
• Walking meditation. Find a quiet place and begin to walk slowly. Focus on the experience of walking, being aware of the feeling of being upright and the movements and sensations of the body.
• The 3-3-3 rule. Counsel patients to bring focus back to the here and now and away from anxiety by doing three things:
  • Look around: Name three things they can see in their environment.
  • Listen carefully: Identify three distinct sounds they can hear.
  • Move mindfully: Consciously move three different parts of the body.

App for generalized anxiety
The Daylight app uses CBT and other techniques mentioned above to reduce worry and anxiety (www.bighealth.com/daylight). There is also a prescription version, which is FDA cleared as a treatment for GAD (www.bighealth.com/daylight-rx). Exercises covered include cognitive reframing, intentional worry, PMR, and mindfulness.

Putting it together
Mild anxiety can be addressed with simple lifestyle changes and regular, brief exercises. Digital apps can coach patients through brief cognitive and behavioral exercises and track patients' progress. See the table "Strategies for Mild Anxiety" for a summation of this article's topics.

Carlat Verdict: There is no need to reach for the prescription pad for mild anxiety, unless you're prescribing exercise, diet changes, digital treatment, or perhaps lavender. Incorporate some of these handy approaches to help patients manage anxiety.