By Joe Tatta, PT, DPT 

Physical therapists understand that the presence of anxiety can have an impact on patient outcomes. This article outlines five methods through which physical therapists can positively influence their clients’ anxiety. It includes exercise and physical activity; lifestyle-based interventions; cognitive behavioral techniques; embodiment approaches; and exposure therapy. Each method is rooted in evidence-based practices and offers a multidimensional approach to holistic mental health care.

For a comprehensive overview of the physical therapist’s role in mental health, refer to our earlier blog post, The Physical Therapist’s Role in Behavioral and Mental Health. 

Exercise and Physical Activity Eases Anxiety

Exercise and physical activity programs are recommended for the treatment of anxiety. Physical activity is a cornerstone of physical therapy and has been extensively documented to alleviate symptoms of both stress and anxiety. Regular exercise triggers the release of endorphins, known as the body’s natural painkillers and mood elevators. Aerobic exercises, such as walking, swimming, or cycling, have been shown to reduce anxiety and depression in a variety of populations. Strength training and flexibility exercises also contribute to improved mood and reduced anxiety levels by increasing muscle mass and enhancing overall physical health, which in turn impacts mental health. There is also a critical relationship between depression and anxiety and PTs have skills and tools to address depression and close the depression gap in mental health care.  

Lifestyle-Based Interventions Offer Support

Lifestyle modifications play a critical role in managing stress and anxiety. Physical therapists can guide patients in integrating two key components of lifestyle change: sleep and nutrition.

Sleep and Anxiety: Sleep is a critical recovery process for both the body and mind. PTs can educate clients on sleep hygiene practices such as maintaining a regular sleep schedule, creating a bedtime routine, and designing an optimal sleep environment. Additionally, specific relaxation and breathing exercises can be taught to help clients manage insomnia and improve sleep quality.

Nutrition and Anxiety: Nutritional counseling can be integrated into physical therapy to support mental health. Diets rich in omega-3 fatty acids, vitamins, and minerals have been linked to lower levels of stress and anxiety. Physical therapists can collaborate with dietitians to provide tailored nutritional advice that supports an anti-inflammatory diet, potentially reducing physiological stress responses and improving mood stability. Many PTs use nutrition to treat pain and as an important target of health behavior change. 

Cognitive Behavioral Techniques for Anxiety

Cognitive Behavioral Therapy (CBT) techniques can be adapted for use by physical therapists to help clients manage symptoms of anxiety. Techniques such as cognitive restructuring, which involves identifying and challenging negative thought patterns, and graded exposure to feared activities or scenarios, can be particularly effective. Mindfulness-based stress reduction and other relaxation techniques can also be taught within sessions to help patients cope with and reduce their anxiety. PTs can use low-moderate intensity psychological techniques in practice to manage health conditions. 

Embodiment Approaches Also Help

Embodiment in physical therapy involves the use of movement to enhance the connection between mind and body. Techniques such as yoga, Pilates, and Tai Chi can be incorporated into treatment plans to improve physical strength and flexibility while also enhancing mental clarity and reducing anxiety. These practices emphasize breath control, alignment, and mindful movement, which are beneficial in the regulation of the autonomic nervous system and the mitigation of anxiety symptoms. Embodiment approaches are well within the PTs scope of practice to address mental health conditions. 

Exposure Therapy for Anxiety Disorders

Exposure therapy is a psychological treatment that has been found effective for anxiety disorders and can be adapted for use in physical therapy. This approach involves safe and controlled exposure to the physical sensations of anxiety, to reduce the fear response associated with these sensations. Physical therapists can use exercise as a form of exposure therapy by gradually increasing the intensity of physical activity in a controlled manner to help patients overcome their anxiety related to specific movements or physical tasks.

Acceptance and Mindfulness-Based Approaches Are Supported for Anxiety 

Acceptance and mindfulness-based approaches are a family of methods and treatments used to manage the symptoms of many mental health conditions. These approaches demonstrate large effects on anxiety symptoms (g = -1.92, 95%CI[-3.44, -0.40]) when compared to inactive (i.e., care as usual, waitlist) or non-specified (i.e., condition not defined) controls.  Overall, the evidence supports the use of mindfulness and acceptance-based raining programs for anxiety. 

Acceptance and mindfulness-based approaches are recommended for physical therapist practice.  This includes Acceptance and Commitment Therapy (ACT) and general mindfulness-based interventions. ACT and mindfulness are transdiagnostic approaches that can be applied to a variety of symptoms and conditions. Many of these approaches have shared mechanisms such as stress reduction, cognitive control, focused awareness, acceptance, reduced rumination, and emotion regulation.

Learn more about our courses in ACT for Pain and the Mindfulness-Based Pain Relief Certification. 

Conclusion

Physical therapists have a broad toolkit that can be effectively utilized to support clients experiencing stress and anxiety. They can play a strong role in addressing mental health conditions such as anxiety. By integrating these five approaches—exercise, lifestyle modification, cognitive behavioral techniques, embodiment approaches, and exposure therapy—into their practice, PTs can provide comprehensive care that addresses both the physical and psychological aspects of these conditions. Further research and interdisciplinary collaboration will continue to enhance the scope and effectiveness of physical therapy interventions in mental health care.