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InterventionStrength of EffectQuality of EvidenceAdditional BenefitsEase of ImplementationSafety
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%NotesStudies reviewedNotesEstimateNotesEstimateNotesEstimateNotes
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Filters/ SortingChange in effect (intervention group) - Change in effect (control group)Number of studies we reviewed that presented control and intervention effect scores.
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CBT8-week CBT programme54.26Sung et al. (2010) - 53% reduction in salivary cortisol
Sahranavand et al. (2018) - 55.53% reduction in anxiety sensitivity
Van der Klink et al. (2001) - 0.68 effect size [meta-analysis: cohen's d]
Richardson and Rothstein (2008) - 1.16 effect size [meta-analysis: cohen's d]

86Studies where results were statistically significant: 2/2 (100%)
Average sample size: 43
Two meta-analyses show medium and large effect sizes for CBT on stress		HighHoffman et al.'s (2012) review of meta-analyses found strong effects of CBT on anxiety, anger management, and bulimia as well as medium effects for several other conditions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/MediumStudies reviewed involved 2-3 months of guided training in CBT. Apps like Sanvello, Mind Ease and Bloom can plausibly provide a large proportion of the same benefit in a more accessible format.HighFew risks outside of confronting potentially uncomfortable thoughts and feelings
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Yoga (Sudarshan Kriya)Training in a set of yogic breathing exercises27.15Seppala et al. (2014) - 35.17% decrease in general distress anxiety score (MASQ)
Zuba and Vedamuthachar (2015) - 19.13% decrease in blood cortisol
2Studies where results were statistically significant: 2/2 (100%)
Average sample size: 47.5		HighSignificant effects also found for depression, anxiety, PTSD, asthma, and hypertension, amongst other conditions in this review (https://sci-hub.wf/10.1089/acm.2005.11.711)LowStudies reviewed involved 20+ hours of training in the techniques of SKY and likely requires at least a basic level of formal instruction to gain similar levels of benefit. Introductory courses may cost £150-250.HighNothing notable
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Diaphragmatic breathingSlow breathing (avrg. 4 breaths per min) from the diaphragm27.05Ma et al. (2017) - 30% decrease in salivary cortisol
Perciavalle et al. (2017) - 24.1% decrease in salivary cortisol		2Studies where results were statistically significant: 2/2 (100%)
Average sample size: 39		HighThis review study found a low quality of evidence but plausibly wide-ranging additional benefits, including for treating eating disorders, hypertension, migraine, and anxiety, and improving quality of life for patients with certain chronic conditions (https://www.mdpi.com/2305-6320/7/10/65) HighNo cost involved and very simple to practiceHighNothing notable
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MBSR8-10 week course in Mindfulness Based Stress Reduction, either in-person or via an app26.81Geary and Rosenthal (2011) - 28.7% decrease in Perceived Stress Score (PSS)
Huberty et al. (2019) - 21.6% decrease in Perceived Stress Score (PSS)
Rosenweig et al. (2003) - 30.15% decrease in percieved tension score (POMS scale)
3Studies where results were statistically significant: 3/3 (100%)
Average sample size: 96		HighGrossman et al.'s (2003) meta-analysis found significant effects for general physical and mental wellbeing, as well as for specific conditions, including depression, anxiety, and pain management: https://doi.org/10.1016/S0022-3999(03)00573-7 MediumMBSR courses can be accessed for free, either online (e.g. Palouse Mindfulness) or through an app (e.g. Calm; The Mindfulness App). However, courses studied in the literature review were all 8 to 10 weeks long, suggesting a significant time investment is necessary for reductions in stress.HighSimilar to CBT, few risks outside of confronting potentially uncomfortable thoughts and feelings
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Dark chocolate25-50g of dark chocolate daily21.33Wirtz et al. (2014) - 7.47% decrease in blood cortisol
Tsang et al. (2019) - 35.2% decrease in salivary cortisol		2Studies where results were statistically significant: 2/2 (100%)
Average sample size: 47.5		LowSome weak evidence of possible links to reduced blood pressure and heart disease risk (https://www.healthline.com/nutrition/7-health-benefits-dark-chocolate#TOC_TITLE_HDR_6)HighInexpensive and easy to findHighNothing notable
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Music10 minutes listening to music with no/ minimal distraction (ideally classical; otherwise personal preference)15.69Thoma et al. (2013) - 1.98% decrease in salivary cortisol
Chafin et al. (2010) - 29.40% additional decrease in systolic blood pressure post-stressor vs. control
Pelletier (2004) - 0.67 effect size [meta-analysis: cohen's d]
24Studies where results were statistically significant: 2/3 (100%)
Average sample size: 506
One meta-analysis reviewed showing a medium effect size		MediumListening to and playing music has been associated with improvements to general wellbeing and positive affectHighFree and easy, simply a matter of selecting appropriate music. Personal preference appears somewhat effective but the most effective music likely involves a "slower tempo, low pitches... primarily string composition, regular rhythmic patterns,
no extreme changes in dynamics, and no lyrics" (e.g. Dvorak 'New World Symphony')		HighRisk of tinnitus from long, loud exposure to excessive noise. This can be avoided by limiting exposure to particularly loud noise (or wearing earplugs in these circumstances)... and by reducing stress! https://www.tinnitus.org.uk/how-do-i-prevent-it
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(Abbreviated) Progressive Muscle Relaxation5 minutes of trained Progressive Muscle Relaxation practice14.27Pawlow and Jones (2003) - 24.98% decrease in salivary cortisol
Rausch, Gramling and Auerbach (2006) - 3.55% in STAI score
2Studies where results were statistically significant: 2/2 (100%)
Average sample size: 217		High"PMR techniques have been found to be effective in controlling anxiety (e.g. Carlson, Bacaseta, & Simanton, 1988), reducing pain (Gada, 1985), regulating physiological processes (Carlson et al., 1988), and increasing overall quality of life (Carrington et al.,1980)": https://doi.org/10.1037/1072-5245.13.3.273HighRelatively easy to learn and implement (e.g. https://www.uofmhealth.org/health-library/uz2225). A condensed version can be done in 2-5 mins, though this is likely to be less effective than the interventions studied. HighNo obvious risks
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TeaRegular tea consumption (2-4 cups a day)13.12Steptoe et al. (2007) - 24% decrease in salivary cortisol
Arent et al. (2010) - 2.23% decrease in serum cortisol		2Studies where results were statistically significant: 1/2 (100%)
Average sample size: 41.5		HighThere is uncertain and limited evidence of green tea providing value as a cancer therapy. Benefits of tea, both green and black, appear largely derived from their L-theanine content, which has also been linked to reduced anxiety and improved brain function (https://www.healthline.com/nutrition/top-10-evidence-based-health-benefits-of-green-tea#3.-Increases-fat-burning) HighBlack or green tea are easy and cheap to purchase, and a common habit for many alreadyHighHigh black tea consumption can lead to anxiousness and headaches due to the caffeine it contains
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Lavender oilInhaling 2 drops of lavender oil daily10.92(Hosseini et al., 2016) - 8.42% decrease in blood cortisol
(Bikmoradi et al., 2015) - 4.34% decrease in perceived stress (DASS-21 score)
(Kianpour et al., 2016) - 20.02% decrease in perceived stress (DASS-21 score)
3Studies where results were statistically significant: 2/3 (66.6%)
Average sample size: 97		MediumPotentially also reduces anxiety (https://www.sciencedirect.com/science/article/pii/S094471130900261X?via%3Dihub) and improves sleep quality (https://pubmed.ncbi.nlm.nih.gov/16131287/)

HighRelatively easy to source, simple to do, and inexpensive. £5-10 a bottle which should last for 6 months (400 drops in 20ml, 2 drops a day). E.g. https://www.hollandandbarrett.com/shop/natural-beauty/skincare/skin-oils/lavender-oil/HighEssential oils can cause contact dermatitis (https://www.healthline.com/health/essential-oil-allergic-reaction)
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Nature exposure20-30 minutes spent in a natural setting (e.g. walking through a park)10.78Alvarsson et al. (2019) - 3.5% decrease in skin conductiveness
Toda et al. (2013) - 15.91% decrease in subjective stress score
Largo-White et al. (2011) - 12.94% decrease in Perceived Stress Score (PSS)

3Studies where results were statistically significant: 2/3 (67%)
Average sample size: 73		HighNature exposure has a wide range of benefits for mental health (https://www.science.org/doi/10.1126/sciadv.aax0903)HighNo cost involved and very simple to practiceHighNo known risks
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Massage30 mins of massage, twice a week10.63Listing et al. (2010) - 10.63% reduction in perceived stress (tension)
"reductions in salivary cortisol may be short-lived and multiple massage treatments do not appear to have a cumulative effect" (Moraska et al., 2007) (https://www.hindawi.com/journals/ecam/2010/292069/) 		1Studies where results were statistically significant: 0/1 (0%)
Average sample size: 34
HighMoyer et al.'s (2004) meta-analysis found effects on state anxiety, blood pressure, and heart rate: https://doi.org/10.1037/0033-2909.130.1.3LowAnything from £35-50 per hour for massage sessions. No evidence on effectiveness of untrained massageHighNegative side-effects very unlikely. Rare cases of blood clots or muscle damage from deep tissue massage
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PetsOwning a pet and consistently spending time with them10.25Allen, Shykoff and Lizzo (2001) - 6.79% decrease in systolic blood pressure response to a stressful task
Polheber and Matchcock (2013) - 13.72% lower increase in salivary cortisol in response to a stressful task vs. control		2Studies where results were statistically significant: 2/2 (100%)
Average sample size: 67		MediumPet ownership has been associated with "higher self-esteem, more positive moods, more ambition, greater life satisfaction, and lower levels of loneliness" but the evidence for these effects is inconclusive (Herzog, 2011: https://doi.org/10.1177/0963721411415220)
LowPets are expensive and require significant time commitments to look after.Medium
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Saffron30mg saffron extract supplement taken daily8.98Kell et al., 2017 - 8.98% decrease in perceived stress (DASS-21 score)1Studies where results were statistically significant: 1/1 (100%)
Average sample size: 128		HighAssociated with a significant reduction in symptoms of depression, possibly on par with some antidepressant medication (https://pubmed.ncbi.nlm.nih.gov/15341662/)
Also plausible benefits to reducing anxiety and increasing sleep quality		HighRelatively easy to source, simple to do, and inexpensive. £20 for a tub of 120 capsules. E.g. https://www.amazon.co.uk/Vegavero-Premium-Lepticrosalides-Chemical-Additives/dp/B07F1FKM3M/ref=pd_lpo_1?pd_rd_i=B07F1FKM3M&psc=1Medium30mg is the maximum advisable dose for daily supplementation. A range of possible health issues with higher doses, including increased risk of hypertension and lower concentrations of immune cells (https://examine.com/supplements/saffron/)
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Meditation (in general)Single session mindfulness meditation for 10-20 mins7.35Goyal et al. (2014) - 11% reduction in stress scores [meta-analysis: various measures]
Goleman and Schwartz (1976) - 5.88% decrease in STAI score
Winzelburg and Luskin (1999) - 5.19% decrease in TSI score

11Studies where results were statistically significant: 3/3 (100%)
Average sample size: 270
One meta-analysis (Goyal et al., 2014), showing a small level of effect		HighSedlmeier et al. (2011) [meta-analysis]: "In general, results were strongest (medium to large) for changes in emotionality and relationship issues, less strong (about medium) for measures of attention, and weakest (small to medium) for more cognitive measures." (https://doi.org/10.1037/a0028168)HighEasy to learn and implement as a habit, e.g. through an app such as Calm, Headspace,or Waking Up.HighWhile meditation has been associated with some negative outcomes (e.g. increased risk of depression, anxiety and psychosis), evidence for these outcomes appears weak and unvalidated: https://greatergood.berkeley.edu/article/item/can_meditation_cause_you_harm
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Gratitude (Journaling)Daily list of positive events and/ or things in life you are grateful for3.12Jacowska et al. (2016) - no effect found vs. control on salivary cortisol
Gavian (2011) - 6.23% decrease in DASS-21 mental stress score vs. control
Davis et al. (2016) - 0.11 effect size [meta-analysis: cohen's d]		8Studies where results were statistically significant: 0/1 (100%)
Average sample size: 233		HighDemonstrated improvement to subjective well-being and positive affect (https://greatergood.berkeley.edu/pdfs/GratitudePDFs/6Emmons-BlessingsBurdens.pdf)MediumRelatively easy to do but requires a consistent time commitment HighNo known risks
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