Cold therapy for anxiety disorders
Evidence review
Overview
Whole-body cryotherapy (2-3 minutes of extreme cold air in a chamber), added to medication for 3 weeks, was followed by a 50% or greater fall in Hamilton anxiety scores in 46.2% of 26 outpatients with anxiety or depressive disorders, versus none of 34 receiving medication alone. A meta-analysis of WBC across mental health problems found a medium between-group effect with high heterogeneity and risk of bias. These studies are small, largely from one research group and not anxiety-specific. No study of cold-water immersion or cold plunge in people with a diagnosed anxiety disorder was found.
Key findings
- WBC added to pharmacotherapy, 60 outpatients: HAM-A response 46.2% vs 0% after 15 sessions (Rymaszewska 2008)
- WBC meta-analysis across mental health problems, 10 studies, 294 participants: between-group g=0.76 (95% CI 0.17-1.36) (Doets 2021)
Every study we reviewed
2 found benefit
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 3 studies on anxiety and mental health, across all heat and cold therapies, including case reports and older work not graded here.
Whole-body cryotherapy as adjunct treatment of depressive and anxiety disorders.
Rymaszewska J et al. Arch Immunol Ther Exp (Warsz). 2008. PubMed 18250970 · DOI · Free full text
- Who
- outpatients aged 18-65 with depressive and anxiety disorders (ICD-10) on standard pharmacotherapy
- What
- whole-body cryotherapy chamber (WBC; cold air, not water immersion), 15 daily 2-3 minute sessions added to pharmacotherapy (n=26) vs pharmacotherapy alone (n=34)
- Protocol
- -166 to -256 °F · 2-3 min · 5/wk · 3 wk
- Measured
- Hamilton Anxiety Rating Scale and HAM-D response (>= 50% decrease)
- Result
- After 3 weeks, HAM-A response in 46.2% of the WBC group vs 0% of controls; HAM-D response 34.6% vs 2.9%.
- Limitations
- not randomized or blinded in abstract; small; anxiety and depressive diagnoses combined; single research group
A systematic review and meta-analysis of the effect of whole body cryotherapy on mental health problems.
Doets JJR et al. Complement Ther Med. 2021. PubMed 34655758 · DOI · Free full text
- Who
- 10 studies (6 randomized or controlled) of WBC as add-on for mental health problems
- What
- whole-body cryotherapy as add-on treatment
- Measured
- mental health problems (Hedges' g)
- Result
- Between-group pooled effect g=0.76 (95% CI 0.17-1.36); overall within-group g=1.63 (1.05-2.21) with I2=93%. The strongest subgroup evidence was for depressive symptoms; an anxiety-specific pooled estimate is not given in the abstract.
- Limitations
- mixed diagnoses; high heterogeneity; risk of bias including allegiance bias
Protocols used in the studies
Whole-body cryotherapy chamber at -166 to -256 F (-110 to -160 C) for 2-3 minutes, once daily on weekdays for 15 sessions (3 weeks), added to standard pharmacotherapy. No cold-water immersion protocol has been studied in diagnosed anxiety disorders.
What is still unknown
Randomized, sham-controlled trials in specific anxiety disorders; whether cold-water immersion has any effect in diagnosed anxiety disorders; durability; tolerability in people prone to panic.
Safety
Cautions for cold therapy in this condition
- The cold shock response on entering cold water (gasp, hyperventilation, tachycardia) can be distressing and can provoke panic-like symptoms; supervised, gradual exposure is used in clinical studies (Tipton 1989, PMID 2691172).
- WBC is a supervised chamber procedure and is not equivalent to home cold-water immersion.
- See general cold safety entry.
For clinicians
Suggested rationale
In a controlled trial of outpatients with anxiety and depressive disorders (Rymaszewska 2008), whole-body cryotherapy added to pharmacotherapy was followed by a higher anxiety response rate than medication alone (46.2% vs 0%); this is small, non-randomized evidence for an adjunct and does not extend to cold-water immersion.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: F41.1, F41.9. Examples only; the clinician assigns the code.
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