In mid-2021, a crisis with her husband prompted Lillie Marshall, 40, of Boston to look for a couples’ therapist. Although she contacted more than 40 practitioners, she could not find one to counsel them. She was in “utter misery,” she said, and tried to ease her mental anguish with daily walks, meditation, writing, drawing and reiki.
As more people seek counseling, pandemic-stressed Americans are discovering that it’s not easy to find a therapist.
“The pandemic exploded the demand for therapy,” said Seth Arkush, a New Jersey psychotherapist who runs a multi-city center that integrates alternative therapies into its mental health services. “People are on waiting lists. I have no availability for new clients because all my therapists are booked. So, I’m hiring new therapists.”
That’s not surprising given reports that 280 million people worldwide are suffering from depression.
If you are waiting to connect with a therapist, what can you do in the meantime?
“You can do what a therapist would probably tell you to do anyway: Mindfulness practices,” said Arkush, referring to a form of meditation that gets people to focus on the here and now without being judgmental. “You’re not going to gain any great understanding of what is causing your feelings — that’s what a therapist does. But you’ll increase your ability to cope.”
What does science say about mindfulness and other alternative practices? There seems to be good evidence that some can help; for others, not so much. James Lake, founding member and former chair of the American Psychiatric Association’s caucus on complementary and alternative medicine, said these techniques are most effective for people suffering “mild to moderate” mental health symptoms.
Here’s a run-through of what research so far has shown.
“In a nutshell, there is no better pill for mental health than exercise,” said Eli Puterman, associate professor of physical activity and health at the University of British Columbia. “Exercise increases endorphins, serotonin, endocannabinoids, and brain-derived neurotrophic factor [BDNF] that each provide a different neurological and mental benefit. For example, endocannabinoid increases have been linked to calmer mood states, endorphins and serotonin to elevated mood, and BDNF to better plasticity and memory formation. In combination, they likely create a better mood and cognitive state to tackle everyday stressors and major life events.”
It doesn’t have to be a lot of exercise, either, said Jennifer Heisz, author of “Move the Body, Heal the Mind: Overcome Anxiety, Depression, and Dementia and Improve Focus, Creativity, and Sleep,” and director of the NeuroFit Lab at McMaster University in Canada.
“Our research shows that three 30-minute bouts of moderate exercise is enough to prevent stress-induced depression,” Heisz says, adding that the effects last for more than an hour after the exercise ends. Whether you walk, do yoga or ride your bike, you feel better, Heisz said, because the body releases Neuropeptide Y after moderate to light exercise, and “it protects the brain from trauma.”
You don’t have to go all out, either. Another study by Heisz shows moderate exercisers fared best.
Meditation, deep breathing
These related techniques offer a simple way to address symptoms, Arkush said. It’s not a do-it-once-and-feel-better practice, however, and effectiveness will depend on what you’re experiencing — depression, anxiety or some other condition.
A meta-analysis showed that regular meditation slightly reduces depressive symptoms. Yet another study showed that a sustained practice of deep breathing could reduce the release of the stress hormone cortisol, which means that you may be able to better manage anxious situations.
How does meditation compare to other “relaxation techniques?” A 2019 meta-analysis concluded that meditation may be more effective than other relaxation methods for anxiety treatment. Over time, meditation can reduce the size of the amygdala, the area of the brain activated by fear and stress, which could lead to improved mental health.
“Deep breathing is so calming because it activates the vagus nerve, which sends a message to the brain that it is time to rest and de-stress,” Heisz said. “The science is really strong about that.”
Trauma informed yoga
Designed for people who’ve experienced trauma, trauma informed yoga (TIY) aims to restore a sense of control to those who’ve lost theirs. “Trauma is stored in the body, and trauma is all about loss of voice, choice, agency and power, coupled with terror,” Arkush said.
In traditional yoga, the teacher determines the poses, breathing, rest and pace, said Molly Boeder Harris, founder of the Breathe Network (TheBreatheNetwork.org), a group that works with survivors of sexual trauma. “In trauma informed yoga, the teacher lets students know that they are in control of their experience and will offer much more flexibility — giving you choices about what poses you want to do, how deep into them you want to go and getting consent when it comes to being touched.”
While some studies have shown improvement in depressive symptoms for those who have practiced TIY, randomized control trials haven’t proved its benefits. A recent meta analysis failed to support the method’s effectiveness, but the research is still emerging, said Matthew Vasquez, associate professor of social work at the University of Northern Iowa and one of the study’s co-authors.
“For whatever reasons, the studies looked at 12 weeks of TIY,” Vasquez said. “We need studies that look at what happens after six months or 12 months.”
Vasquez added that by itself, TIY will not resolve trauma for those who have experienced it. “That’s not really the purpose. The purpose is reacquainting yourself with your body in a safe way.” he said.
Writing about your deepest feelings can be effective for people with depression, post-traumatic stress disorder, obsessive thoughts and other conditions, said James W. Pennebaker, Regents centennial professor of liberal arts at the University of Texas at Austin and author of several books, including “Writing to Heal: A Guided Journal for Recovering From Trauma & Emotional Upheval.”
“Writing helps to organize experiences, to understand them and to get through them in a sense,” he said. “The research on this is voluminous — there have been well over 2,000 papers on expressive writing.”
If people write about an upsetting experience even a few times, Pennebaker said, “it helps reduce ruminations, allows people to sleep and to clear their mind.”
Focusing on your blessings can offer mental health benefits for some people, said Joel Wong, professor of counseling psychology at the Indiana University School of Education.
In a study by Wong, people experiencing anxiety or depression were divided into three groups: one received therapy only, a second got therapy plus three sessions writing about their thoughts and feelings about stressful experiences, and the third got therapy plus three opportunities to write letters of gratitude to people who had made a difference in their lives.
Three months later, those who had written gratitude letters experienced the greatest mental health gains.
“Gratitude displaces the negative emotions that we have,” Wong said. “When you turn your attention to those who have blessed you, it unshackles the toxic emotions we sometimes get mired in.” If you can’t write a full-blown letter of gratitude to someone who helped you, Wong said, “a shorter note or text — just two or three sentences — can be meaningful.” Even writing two or three things you’re grateful for each day in a journal can help, he says.
While Wong’s study is small, and not definitive, some other small studies have shown promising results. But counting your blessings may not work for everyone — or for very long.
“There’s evidence that gratitude intervention can have an impact on symptoms of depression and anxiety, but the effects are usually small,” said Laurie Santos, Yale University psychology professor.
As marijuana becomes more accessible across the country, many are turning to CBD products to relieve mental health symptoms. But a recent Lancet study found “scarce” evidence to back the practice. CBD, derived from the cannabis plant but without THC, the psychoactive ingredient that causes people to feel “high,” did not reduce anxiety, depression, PTSD or mental health symptoms, according to the study.
Thersilla Oberbarnscheidt, an assistant professor of psychiatry at the University Pittsburgh Western Psychiatric Hospital with a PhD in neuroscience, who did an extensive literature review on the subject, said she found “the claim that [CBD] is actually good for anxiety is based on subjective reports and public opinion and not yet based on scientific evidence.”
She said that because CBD products are in a murky regulatory place, consumers cannot be sure of what they are getting and at what dose. “I can’t say it absolutely doesn’t work, but to make the statement that it’s therapeutic, we need more research studies showing it,” Oberbarnscheidt said.
Inserting small needles in the scalp or along the ears shows “moderate evidence” for alleviating mental health symptoms, said Lake, but he doesn’t rate it as a top-tier approach to addressing depression, anxiety or other symptoms. There are few studies that endorse acupuncture for that: NIH’s National Center for Complementary and Integrative Health (NCCIH) said that acupuncture can help manage physical pain in certain cases, but that not enough evidence exists to show it can help with depression.
“There is not a lot of scientific evidence for the use of acupuncture as a sole treatment for depression,” said Sharon Jennings-Rojas, chair of the Department of Acupuncture and Herbal Medicine at the Maryland University of Integrative Health. But it might be worth trying while waiting for a therapist to fit you in; she added, however, that acupuncture “does not in any way” replace psychiatric treatment.
Reiki practitioners say they move energy through the body: Barely touching their subjects, reiki masters are said to “channel energy” to the recipient, which supposedly allows them to take what their body needs for healing, according to a description by the NCCIH.
As for science — there is not much. According to the NCCIH, most studies of reiki have not been “high quality” and have produced inconsistent results. And some researchers argue that further tests on reiki would be a waste of time because it is pseudoscience.
Still, some researchers said it might work as an alternative therapy just as a placebo that may help some who believe it will.
“The way I see it is that the placebo effect is a powerful thing,” said Emily Anhalt, clinical psychologist and co-founder of Coa, a gym for mental health in San Francisco and New York. “Perhaps there’s something to be said for another human caring for you, being present for you. If that alone is helpful to you, then great.”
These techniques are most effective for people suffering “mild to moderate” mental health symptoms, California psychiatrist James Lake said. But if you cannot function at work or school, or if your relationship is suffering, or you are thinking about killing yourself or hurting someone else, then seek help at an emergency room, Lake said.