Business Owners Lifestyle + Wellness

From The Wall Street Journal: The Booming Business of American Anxiety

BY Spectrum Wealth Management | Sep 6, 2023
By Julie Wernau and Andrea Petersen
Aug. 21, 2023

A search for “anxiety relief” on Google pulls up links for supplements in the form of pills, patches, gummies and mouth sprays. There are vibrating devices that hang around your neck and “tone your vagus nerve,” weighted stuffed animals, bead-filled stress balls and coloring books that claim to bring calm. Ads for online talk therapy apps pop up on social-media sites.

Americans are anxious—and a flurry of old-line companies, upstarts and opportunistic entrepreneurs aim to fill the demand for relief

Photographs by Alex Wallbaum for The Wall Street Journal

Anxiety has come into focus across the country in part due to the stress of the pandemic, increased awareness about mental health and more screening in schools and at doctors’ offices. In a recent federal survey, 27% of respondents reported they had symptoms of an anxiety disorder. That’s up from 8% in 2019, according to the National Center for Health Statistics.

Americans looking for help have found that the supply of available and qualified therapists hasn’t kept up with demand. Some can’t afford the fees. That has left a growing industry geared toward anxiety outside the medical and traditional mental-health professions, including supplements, products and mental-health coaches.

The science behind much of the industry is unclear and in some cases questioned by scientists and researchers. The antianxiety claims of most products have no federal or regulatory oversight. The role of the Food and Drug Administration is to ensure that supplements meet safety standards, are well manufactured and accurately labeled, but the agency doesn’t need to approve supplements before they can be sold or marketed. Supplements might interact with other medications.

Wearable devices aren’t regulated if they are intended for general wellness. Some scientists say there haven’t been enough large-scale, peer-reviewed studies to determine whether such products, which can cost hundreds of dollars, work. There’s also limited research on mental-health coaching, and clinicians warn that adequate training is needed to identify people in crisis and direct them to appropriate treatment.

Some in the industry say the science will catch up, and their goal is to fill the gap in a shortage of options for treatment.

Sales of a range of supplements that say they offer anxiety support spiked after the pandemic hit, according to data from research firm NIQ. One of the more popular supplements that claim to help manage anxiety is ashwagandha, a plant that’s been used in traditional Ayurvedic medicine for thousands of years. The number of packaged ashwagandha products sold over the past year has grown fourfold since the same period ending mid-2019, according to NIQ.

Jessica Terry was first diagnosed with anxiety years ago. It grew worse when the pandemic hit, she said, and she would go to her car to cry so that her children wouldn’t see her. She was able to start seeing a therapist online for free during the pandemic through her insurance company, but soon the therapist said she needed to start charging her. Terry said she couldn’t afford it.

“I don’t think about Covid anymore, but I’m stuck in the same place,” the autism specialist in Northhampton, Mass., said.

Terry, 42, takes a low dose of the antidepressant Lexapro daily, and has found that meditation helps. She has turned to a host of other products to help tame her anxiety. She breathes in and out each morning and falls asleep to stories about the ocean on the Headspace app, which costs about $70 a year. She puts low-dose cannabis honey in her tea.

On bad days, she uses a $9 patch that smells of lavender and eucalyptus or a heavy heating pad that aims to feel like a comforting hand.

New diagnoses

Anxiety is a normal human emotion that can spur people to action. It becomes a disorder when it causes prolonged distress and interferes with a person’s work and relationships.

In the three years since the start of the pandemic in the U.S., nearly three patients in 100 who entered a healthcare facility left with a newly diagnosed anxiety disorder. That rate is higher than cancer or diabetes, according to healthcare and analytics company Truveta.

Established treatments for anxiety disorders include cognitive behavioral therapy, where people learn to approach the situations that make them anxious and to tolerate uncomfortable feelings. Antidepressant medications such as Prozac and Lexapro are commonly prescribed, too. Benzodiazepines like Xanax and Klonopin can ease anxiety symptoms immediately, but many doctors don’t recommend them because of the risk of addiction and abuse.

These treatments have limitations. After a course of CBT, only about half of people with anxiety disorders see clinically significant improvement, according to scientific studies. About 40% of people who take the most popular antidepressants for anxiety disorders receive little benefit. Some need to stop the medications because of side effects.

Psychedelic drugs are drawing attention—and investor dollars—as a potential treatment for a range of mental-health issues, but studies are still ongoing.

Research suggests some of the benefits of antidepressants may be related to the placebo effect, where people believe a treatment is working and feel better. In studies of drugs such as Zoloft and Lexapro for anxiety disorders, people taking those medications improved—as did control groups of people taking placebos, though to a lesser extent.

The placebo effect is likely a factor when people say they feel relief after taking supplements or using some of the other products marketed for anxiety, said Jill Ehrenreich-May, a psychology professor at the University of Miami and president of the Association for Behavioral and Cognitive Therapies. “If somebody believes they are going to be effective, that is such a powerful thing,” she said.

Sherry Frey, vice president of total wellness at NIQ, said surveys have found that consumers listed vitamins and supplements above things like diet and exercise in how they managed their mental health.

Sales have been helped along by social-media influencers, some of whom are therapists or doctors themselves and sell products from their profile pages.

Dr. Daniel G. Amen, a psychiatrist who has 1.9 million followers on his TikTok page @docamen, suggests his followers take theanine, magnesium, ashwagandha and a supplement called GABA for anxiety. “Before you reach for a benzo like Xanax, try those first,” he said in one recent video.

He also owns a supplement company, with anxiety-related pills and gummies that go for around $20 to $50 a bottle.

In an email, Amen said he prescribes medications when necessary, but he is opposed to them being the first and only solution. He said he developed his supplement company to provide an alternative to medications.

Ashwagandha has made its way into capsules, gummies, spreads and beverages. It contains a group of naturally occurring steroids that have shown to have some anti-inflammatory and antioxidant effects in the human body, according to the National Institutes of Health.

The NIH says studies on ashwagandha have been small. Some studies have found it to be effective for insomnia and stress, but more research is needed to determine its helpfulness for anxiety, the Institutes said. The plant may also increase testosterone levels and interact with certain medications, according to studies.

Other supplements that have been touted to help anxiety include vitamin D3, magnesium, omega-3 fatty acids, chamomile and kava. Studies have linked vitamin D deficiency with increased anxiety and depression and magnesium deficiency with heightened stress, although the impact from supplementation remains unclear.

Low levels of omega-3, found in fish and seafood, have been tied to anxiety, although it’s unclear if the issue is in part that poor mental health can lead to a poor diet. Data is limited on chamomile and kava.

People searching for anxiety remedies are bound to come across gummies, oils, teas and other products containing cannabidiol, or CBD. CBD is derived from cannabis, usually from hemp plants. Pure CBD is not intoxicating.

There’s some evidence that CBD may relieve anxiety symptoms, but the science is limited. Many of the CBD products on the market aren’t accurately labeled, and may contain much lower or higher levels of CBD than indicated. They may also contain detectable levels of THC, the substance largely responsible for marijuana’s high, according to a study published in 2017 in the journal JAMA.

An array of wearable devices and apps that claim to tame anxiety led the American Psychiatric Association to recently create a tool to help members evaluate their usefulness.

Products include the $325 Apollo Neuro, a small, wearable device that uses waves of vibrations in an attempt to mimic the body’s natural, calming response to touch. Dr. Dave Rabin, co-founder and chief medical officer of Apollo Neuroscience, said the concept behind wearable products is grounded in decades of research that shows physical touch can help people restore a sense of safety and control.

Sensate is a $299 device that people can place on their chests. The company said that the product’s humming vibrations signal the vagus nerve—which runs from the brain to the digestive system—to relax, and that its own initial studies have been promising. The $250 Muse meditation headband says it can monitor brain waves and act as a kind of meditation coach. Muse said research institutions including the Mayo Clinic and Harvard University have used its products in more than 200 published, peer-reviewed studies related to stress reduction.

Weighted blankets, which have been shown to reduce anxiety in certain situations in a few small

studies, are now being transformed and marketed as $25 weighted stuffed animals, $160 hoodies and $100 pajamas. And the range of fidget toys, used to relieve excess energy and ground people in the moment, has exploded into things that can be popped, chewed, rotated, squished and sucked.

Online help

Growing demand for telehealth has led to the rise of mental-health coaches who work with clients online, including at Headspace, which operates a popular meditation app and sells mental-health telehealth services to employers and health insurance plans under its Ginger brand.

“Not every pain in your knee requires a surgeon. Not every anxious feeling requires a therapist,” said Russell Glass, Headspace’s chief executive officer.

Headspace started its own training program accredited by the National Board for Health & Wellness Coaching, which began offering a certification exam in 2017. The organization has certified more than 9,000 health coaches, who receive at least 75 hours of schooling—compared with years of training for psychologists and social workers.

Headspace contracts with more than 4,000 companies including Adobe, Mattel and Starbucks to offer mental-health services to their workers. Users on its Ginger app can immediately connect via text-based chat with a mental-health coach. The app also encourages users to take several assessments that measure anxiety, depression and stress levels.

Users begin with a coach, but people who have high scores on the anxiety or depression assessments, including those who have suicidal thoughts or trauma, work with a therapist and/or a psychiatrist, too, the company said. Other users can see therapists and psychiatrists, who conduct sessions via video, but fewer than 30% of members overall do.

In January, UnitedHealthcare launched a coaching program for people dealing with generalized anxiety, social anxiety and depression that is available to five million of its members. Lyra Health, a telehealth company that provides mental-health services to employers like Lululemon and Salesforce, has more than 430 coaches, up from 10 in 2018.

Coaches aren’t supposed to diagnose and treat illnesses, said Nicole Pope, director of operations at the National Board for Health & Wellness Coaching. Instead, their role is to help clients adopt behaviors that support their health, such as getting enough sleep, exercising and investing in healthy relationships, she said.

Health coaches charge between $50 and $150 for an hour-long session. The going rate for experienced clinical psychologists can be as much as $300 for a 45-minute session.

The line between a mental-health coach and a therapist can be fuzzy.

At Lyra, coaches work with some clients to reframe thoughts that can fuel anxiety, using elements of what’s known as acceptance and commitment therapy—commonly used by therapists, too.

Shane O’Neil-Hart, Lyra’s clinical director for mental-health coaching, said a coach’s approach to sessions is slightly different than a therapist’s. “We’re going to focus on how we can enhance your well-being, more than how we can fix your problems,” he said.

There is limited independent scientific research on the efficacy of mental-health coaching for anxiety. Headspace and Lyra have both funded studies showing that their coaching approaches led to reductions in anxiety and depression symptoms.

There’s a more robust body of research on peer counseling, where non-therapists are trained to actively listen and provide support, but studies have yielded mixed results.

Anxiety researchers and clinicians say that non-therapists can help address the rising demand for mental-health care. Still, they warn that anyone can call themselves a mental-health coach and start seeing clients.

“You want to make sure protocols are in place if somebody is in crisis or a higher level of care is needed,” said Vaile Wright, senior director for healthcare innovation at the American Psychological Association.


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