Anxiety: what self-help approaches are supported by evidence

What this page covers

This page summarises what systematic reviews and meta-analyses show about self-help approaches for anxiety in adults: guided self-help programmes, physical activity, breathing exercises and smartphone-delivered interventions. It describes what studies found; it is not a treatment plan, and it does not recommend starting or stopping any therapy.

Guided self-help programmes

A systematic review of 13 meta-analyses of self-help and internet-guided interventions reported medium to large effect sizes for these approaches in depression and anxiety disorders [C1]. The included meta-analyses differed in samples, types of self-help, control conditions and study design, so the size of the benefit varies. In trials that directly compared guided internet-based CBT with face-to-face CBT across psychiatric disorders, including several anxiety disorders, the two formats produced equivalent overall effects [C2], although few trials exist for each individual condition.

Physical activity

An umbrella review of systematic reviews found that physical activity had medium effects on anxiety symptoms across adult populations compared with usual care [C3]. Most of the included reviews were rated as critically low methodological quality, so the exact size of the effect is uncertain.

Breathing exercises

A meta-analysis of randomised controlled trials found that breathwork interventions showed significant effect sizes for self-reported anxiety [C4]. The included studies varied and many were at risk of bias, so the evidence is promising but not yet consistent enough for strong conclusions.

Smartphone-delivered programmes

A meta-analysis of randomised controlled trials found that smartphone-delivered psychological interventions produced significantly greater reductions in total anxiety scores than control conditions [C5]. Effect sizes were greater against waitlist or inactive controls than against active controls [C5]. Smartphone programmes have not been shown to match the efficacy of established treatments for anxiety.

When anxiety is a clinical disorder

For adults meeting diagnostic criteria for generalised anxiety disorder, psychotherapy — mostly cognitive behavioural therapy — showed a large effect compared with control conditions in a meta-analysis [C6]. This is the strongest evidence base among the options above, and it is delivered by trained professionals. Persistent, severe or impairing anxiety is a reason to seek assessment from a qualified clinician rather than relying on self-help alone.

Limits of this evidence

Much of the self-help, breathing and app evidence comes from trials with waitlist or usual-care controls, self-report measures and short follow-up [C1][C3][C5]. Publication bias was flagged in the clinical-anxiety meta-analysis [C6].

Self-help information does not replace a clinician; people with severe or persistent symptoms, or thoughts of self-harm, should contact a professional or local emergency services.