Make sure to harvest fresh plants with gloves to protect your hands and arms from the stinging hairs. Cooking or blending the leaves will deactivate the sting, as will drying the leaves for tea. Overall, nettles work to fortify and strengthen the body, making it a powerful herb for anxiety and stress.

Skullcap harvest Scutellaria lateriflora. Parts used: Leaves and flowers Preparations: Tea, tincture, and massage oil. Think of skullcap when anxiety is accompanied by overwhelm. This is an excellent plant friend to have around if you hold tension in the body, grind your teeth, and experience body pains related to anxiety and stress.

This is a great herb to work with if you do any body-based stress relief practice, including yoga or somatic experiencing. Parts used: Bracts and flowers Preparations: Tea, bath. The sweet scent of linden flowers is divine and gently soothes the nervous system. Linden is a traditional herb for stress and anxiety, plus it supports those who experience depression, insomnia, and digestive issues related to stress.

As an antispasmodic, it helps relieve body tension and relax muscles. Use fresh flowers if you can get around all the bees who love their nectar!

or dry them for teas and tinctures. Parts used: Flowers Preparations: Tea, tincture, bath. Chamomile is a well-known aromatic herb with a powerful ability to calm the spirit and the stomach!

It likewise calms the nervous system, 7 relieves headaches, soothes menstrual cramps, and aids sleep. Caution to those allergic to plants in the aster family. Parts used: Flowers and bark Preparations: Tea, tincture, cordial, syrup, honey, glycerite.

Mimosa is a wonderful remedy for those addressing anxiety, depression, grief, PTSD, insomnia, and other emotional disturbances. The flower essence is also an incredible dose of happiness. Not to be used in pregnancy. Parts used: Leaves and flowering tops Preparations: Tea, tincture, vinegar, essential oil.

Sometimes these are things we need to invite in when heaviness stays too long, the overwhelm feels too big, and the darkness seems to envelop. Lemon balm reminds me of children laughing. Not for tonic use in those experiencing hypothyroid or hypotension. Parts used: Flowers and flower buds Preparations: Tea, tincture, oil, honey, syrup, elixir, vinegar, flower essence, hydrosol.

A heart-softening, opening, and supporting herb, the magic and beauty of rose can soothe the heart back to balance. Rose helps to release grief and transmute negative vibrations into love and compassion. Its ability to free the heart makes it one of our most cherished herbs for stress and anxiety, especially when the stressors are linked to relationships and emotional matters.

Rose petals contain high amounts of antioxidants, help regulate the moon menstrual cycle, and move blood and stimulate the circulatory system. Parts used: Flowers Preparations: Tea, tincture, infused oil, essential oil, sachet.

Lavender is particularly uplifting and beneficial for anxiety and depression. Wonderful to eat, drink, smell, and behold! Whether you choose a single herb from the lists above or create a tincture or tea formula from the ones that call to you most, these tonic herbs will be of great benefit in helping you slow down, relax, and recover from external and internal overwhelm.

While herbs for stress and anxiety are incredible allies, they are ideally just the cherry on top of a well-rounded lifestyle cake, so to speak.

Making healthy changes to our daily lifestyles should be at the heart of any holistic stress therapy. A slew of factors impact our ability to manage and process stress, including diet, sleep, exercise, and friendship.

A note: Our mental and emotional health is foundational to our physical wellbeing, and the world needs YOU, so whatever healthy methods you have for helping your mental health, thank you for taking care of yourself.

A note here: therapies to treat mental illness are highly individualized, each person and situation are unique. People typically need therapeutic treatment beyond herbalism: this might include acupuncture, talk therapy, nutrition, supplements, or pharmaceuticals.

Please do not judge yourself or anyone else for needing and seeking help, natural or otherwise! You are not alone! This helpline is one option: TALK. She feels energized and resourced by her relationship with plants and flowers. Her practice, Cazimi Healing is based in North Carolina where she offers virtual and in-person consults, workshops, and an online apothecary.

She also brings her training as a Transformational Presence Coach and Energy Healer to client sessions. Ricky is committed to offering accessible healthcare for all, especially queer, trans, and gender non-conforming people, people of color, and low-income folks. She's a professional plant-human matchmaker and bonafide plant geek, with a degree in botany and over 30 years of experience teaching and writing about herbalism, medicine making, and organic herb cultivation.

These days, she channels her botanical obsession through her writing and photography in her online programs, on her personal blog Castanea , and in her new book, The Healing Garden: Cultivating and Handcrafting Herbal Remedies.

Juliet and her family reside in a home overrun with houseplants and books in Asheville, North Carolina. com , Excerpts and links may be used, provided that full and clear credit is given to Chestnut School of Herbal Medicine and chestnutherbs.

com with appropriate and specific direction to the original content. Our 1,hour Herbal Immersion Program is the most comprehensive handcrafted online herbal course available, covering botany, foraging, herb cultivation, medicine making, and therapeutics. Everything you write is always interesting and so beautifull.

Studies show that physical exercise can help reduce anxiety symptoms. Limited research also suggests that high intensity exercise may be more effective than low intensity regimens.

Exercise may also help with anxiety caused by stressful circumstances. Results of a study , for example, suggest that exercise can benefit people with anxiety related to quitting smoking.

Learn more about the mental health benefits of exercise here. Meditation can help to slow racing thoughts, making it easier to manage stress and anxiety. A wide range of meditation styles, including mindfulness and meditation during yoga , may help. Learn more about meditation here. Some people unconsciously tense their muscles in response to anxiety.

Progressive relaxation exercises can help to alleviate this tension and reduce stress. Learn more about breath management exercises here. Some research suggests that journaling and other forms of writing can help people to cope better with anxiety.

For example, a study found that emotion-based journaling may reduce mental distress and improve overall well-being. Learn more about journaling for anxiety here. Some people feel anxious if they have too many commitments at once.

These may involve family, work, and health-related activities. Having a plan for the next necessary action can help keep this anxiety at bay. Effective time management strategies can help people reduce anxiety.

Some people also find that breaking major projects down into manageable steps can help them to accomplish those tasks with less stress. Smelling soothing plant essential oils can help to ease stress and anxiety.

Certain scents work better for some people than others, so consider experimenting with various options. Limited research suggests that lavender may be especially helpful in treating anxiety disorders.

Learn more about aromatherapy here. Cannabidiol CBD oil is a derivative of the cannabis plant. CBD oil is readily available without a prescription in many alternative healthcare shops. In areas where medical cannabis is legal, doctors may also be able to prescribe the oil.

Visit our dedicated CBD hub here. Many herbal teas promise to help with anxiety and ease sleep. Some people find making and drinking tea soothing, but some teas may have a more direct effect on the brain that results in reduced anxiety.

Results of a small trial suggest that chamomile can alter cortisol levels, a stress hormone. Discover the other benefits of chamomile tea here. Like herbal teas, many herbal supplements claim to reduce anxiety.

However, little scientific evidence supports these claims. You may also choose my favorite route: making a delicious cup of chamomile and lemon balm herbal tea, and adding the extracts of St. Motherwort is safe while breastfeeding only. It increases a sense of calm and decreases anxiety.

One caveat is that some studies show lemon balm may reduce processing speed and alertness due to very mild sedation, so, for that reason it might be something you want to use in the evenings or on days off rather than say, before an exam or major presentation!

The full dose is milligrams up to four times a day. Maybe leave that for weekends. The tea above — under lavender — is a lovely evening wind-down beverage to soothe the nerves.

Feeling stressed, anxious, or on edge? Check out these 7 safe and effective herbs for treating anxiety herbalmedicine anxietyremedy stressrelief. While it is overwhelmingly safe for occasional use a few times a month, for example and even daily use at very low doses, for higher doses, taken regularly, I recommend working with a licensed practitioner, because there is a remote risk of it affecting the liver do not use if you have liver disease!

Kava kava can be taken alone in capsules or herbal tincture. Herbal tinctures, liquid extracts of the herb, are a super easy way to take herbs.

These potent liquid extracts allow you to take a tiny concentrated dose dissolved in water or your favorite green juice. However, most herbal tinctures are made by alcohol extraction — so not an option for everyone. To prepare it, purchase one of each of the following extracts from a reputable company.

If your special brand of anxiety happens to be the kind that rears its head just before your period, as part of PMS or as a stand alone symptom, Vitex also called Chasteberry or Chaste tree might be just the ticket to help you breeze through your cycles anxiety-free. Vitex has been shown in studies to attenuate symptoms of depression and anxiety that occur during PMS and to reduce PMS symptoms in general.

Another herb for anxiety I love to combine with Vitex, which also helps with PMS, is motherwort. The dose of Vitex in capsules is mg twice daily, or in tincture, mL daily. These extracts, and other herbs mentioned in this article, can be purchased from Mountain Rose Herbs , Herb Pharm , Gaia Herbs , Herbs Etc , and many other wonderful herbalist-owned companies, including those you can find in the Replenish Online Formulary.

Or look for a product at any of the above companies that contains similar ingredients. You can also find many of these herbs in capsule and pill form in a variety of combinations.

Basically, whenever some stress rescue is needed! Have you tried integrating any of the above herbs for anxiety into your life? Comment below and let me know…. I can't either. Join my mailing list and get your free download, Detox Your Medicine Cabinet!

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Also, not all anxiety disorders are the same. They can range from social anxiety or generalized anxiety disorder GAD to panic disorder and post-traumatic stress disorder PTSD.

Traditional treatments for anxiety include talk therapy, medication, or a combination of the treatments. However, experts have been looking at alternative treatments for anxiety. Researchers have been investigating the role that natural remedies can play in treating anxiety symptoms like tension, worry, and rapid heartbeat.

Also, talk with a healthcare provider about any remedies that involve alternative treatments, like dietary supplements, before trying them. The FDA only minimally regulates dietary supplements, and the effects of supplements vary individually.

Exercise is beneficial for overall health, including mental health. A reduction in anxiety can be a benefit of regular exercise. With continued regular exercise, long-term anxiety symptoms may decrease as well. In addition, mindful movement practices, like yoga, are believed to have anti-anxiety effects.

Research suggests that regular use of chamomile may help reduce symptoms of moderate-to-severe GAD. People with GAD may worry about everyday things to the degree that the worry interferes with their daily lives.

However, participants of one study had an improvement in their GAD after taking three mg capsules of chamomile extract a day for several months. The long-term use of high-dose chamomile oral extract used in the study didn't seem to create safety concerns. While more research may be needed to know the exact quantity that is considered safe, it is generally believed that any amount used in tea, as well as any short-term oral supplementation, is safe.

Negative side effects like nausea and dizziness are not common, and chamomile may interact with blood-thinning medications warfarin or drugs used to prevent organ transplant rejection cyclosporine. Chamomile could also prompt an allergic reaction in people who are sensitive to pollens like ragweed.

Acupuncture is the practice of stimulating specific points on the body, usually by inserting thin needles into the skin. Researchers are looking into what other conditions the practice can benefit, including anxiety. A review of 20 studies showed that acupuncture can reduce anxiety symptoms among people with GAD.

This is especially true in the first six weeks of treatment. During that time, acupuncture can work faster than other treatments, such as anti-anxiety drugs.

Since all the studies in the review only included people with GAD, more research is needed to determine whether acupuncture would be helpful for other anxiety disorders. Research has deemed acupuncture safe. The key to safety is going to an experienced, trained practitioner who uses clean needles.

If acupuncture is not performed correctly or dirty needles are used, there can be serious side effects. Research has pointed to an improvement in anxiety symptoms after consuming or smelling lavender—especially before surgery and before and after chemotherapy.

However, lavender may not always be the best option for you. Consuming lavender in tea or extract form could cause side effects like headache and constipation. It might also increase drowsiness when used with other sedative medications. Using essential oils as part of aromatherapy may be a natural way to get anxiety relief.

Aromatherapy entails filling a space with the smell of a particular oil, which is typically plant-based, and inhaling it. One review found that essential oils overall helped reduce anxiety. However, citrus essential oil was significantly helpful for anxiety-reducing effects. Found in seafood, shellfish, and fish oil supplements, omega-3 fatty acids are needed to build brain cells and help with other basic functions.

The fatty acids might also have a positive impact on anxiety. Although studies have had mixed findings, some research reveals that omega-3 supplementation may help significantly reduce and prevent anxiety symptoms.

This is especially true for people who've been diagnosed with a specific disorder. For decades, it's been understood that there's an association between vitamin B12 levels and anxiety symptoms. Research has suggested it's not uncommon for people with anxiety to have low levels of vitamin B The belief is supplementation of vitamin B12 may help reduce or prevent anxiety symptoms.

Vitamin B6 might ease anxiety as well. High-dose supplementation of the vitamin has been shown to reduce self-reported anxiety. More robust research is needed to say for certain, but some studies have also shown that daily intake of vitamin B6 helps reduce a range of premenstrual syndrome PMS symptoms , particularly PMS-related anxiety.

B vitamins are generally safe to use but have the potential to interfere with some medications. Check with a healthcare professional to be certain before use. Meditation is one of many relaxation techniques focused on intentional breathing and the mind-body connection.

It's often recommended as an add-on to clinical anxiety treatment plans. By producing a deep state of relaxation, studies have suggested that meditation may help reduce anxiety symptoms in people with diagnosed anxiety disorders.

There's practically zero risk involved in trying out a meditation session, as long as you're in a safe environment to close your eyes and zone out.

One study found that one month of "positive affect journaling"—writing down positive feelings or emotions—resulted in less anxiety in people who had various medical conditions and experienced heightened anxiety symptoms. Additional research on how different types of journaling could help anxiety is likely needed before experts broadly recommend it.

Melatonin, which occurs naturally in the body to help with sleep, is also available as a supplement with possible benefits for anxiety. Research has shown melatonin to support anxiety symptom reduction for individuals undergoing surgical procedures.

However, more research is needed to determine its effectiveness for anxiety unrelated to surgical procedures. L-theanine is an amino acid found in green tea but that is also available in supplement form. One review of already-published research concluded that taking mg of L-theanine supplements a day reduced anxiety levels in people going through stressful situations.

However, it is unclear how the effectiveness of L-theanine would change when it is consumed as part of tea. Magnesium —a mineral found in foods like whole grains, leafy greens, and milk—plays a role in brain function, resulting in a potential effect on anxiety.

One research review found initial evidence suggesting that magnesium supplementation could potentially reduce mild anxiety symptoms, generalized anxiety, and anxiety-related PMS symptoms. The following steps are those that might help in managing your anxiety: 6. If you know what your triggers are, then hopefully you can then minimise or remove them from your routine.

Focus your time on the things you can change and ignore the things you have no control over. Resist using alcohol, drugs or cigarettes as coping mechanisms because they can contribute to poor mental health in the long run. Most people experience stress, anxiety and fear throughout their lives.

Over time, the anxiety and stress can take its toll on their health, making them more susceptible to issues, such as heart disease, high blood pressure, diabetes, depression and panic disorders.

Anxiety and stress can also become harmful when people develop thoughts about harming themselves or others. In these instances, they should seek medical help as soon as possible. The same applies to if their thoughts are getting in the way of being able to go about their day-to-day life.

Anxiety and stress can be treated and there are many resources, strategies and treatments available to enable people to understand and manage their anxiety and stress levels.

They include:. Breathing is such a natural process that most of the time, we do it without being aware. However, when in times of stress, breathing can become rapid and shallow, adding to feelings of anxiousness.

Taking time to learn about different types of breath and practising simple breathing exercises for anxiety can help you overcome these feelings. If you feel stressed or anxious, your body will typically instigate its fight-or-flight response. But, when facing modern-day concerns, the brain will still produce this response.

You may begin to feel lightheaded, as this unbalance reduces the blood supply to the brain, and your fingers may start to tingle.

Severe hyperventilation can even result in a loss of consciousness. This reaction can increase levels of anxiety, exacerbating the situation. However, learning to control your breathing through simple breathing exercises can reduce stress and allow your oxygen and carbon dioxide levels to return to normal.

There are two ways of breathing. These are thoracic breathing from the chest and diaphragmatic breathing from the abdominals. The rapid, shallow breathing experienced when feeling anxious comes from the chest.

This way of breathing can add to feelings of anxiety, as the intakes of breath do not feel satisfying, and can make you feel as though you are suffocating. The diaphragm is a muscle located at the base of the lungs. When you breathe diaphragmatically, this muscle contracts and moves downwards, providing more space for your lungs to expand.

This downwards movement pushes on the stomach muscles and forces the abdominal wall out. Diaphragmatic breathing encourages the optimal exchange of oxygen and carbon dioxide. It slows the heart rate and can lower blood pressure. The knock-on effect is that we feel more relaxed, and anxiety levels drop.

Practice this simple breathing exercise to help lower levels of anxiety. However, focus on relaxing your body and ensure there is no tension through your shoulders.

If focusing on your breathing in this way is making you feel more anxious, stop. It can take practice to feel the benefits of this technique, so try to do a little at a time and build up slowly.

Some natural supplements can also be helpful alongside these breathing techniques to relax, reduce feelings of anxiety, and improve your sleeping patterns. Getting enough shut-eye every night is vital for both our physical and mental health. When we sleep, our bodies perform a variety of functions, from repairing damaged cells to strengthening our immune systems.

Experts say that between seven and nine hours of sleep a night is a good figure to aim for. Nevertheless, this needs to be good quality sleep to properly nourish our minds and bodies.

That means uninterrupted periods of dozing when our bodies are able to complete three to four REM sleep cycles. If you find yourself regularly lying awake at night with a thousand thoughts running through your head, you might be after some tips on how to relax.

Try to go to bed at the same time every night, too, to help maintain a good sleep routine. Before you go to bed, turn the heating off or down, close all the curtains properly and make sure your bed is as comfortable as possible. There are a handful of vitamins, herbal remedies and essential oils out there which may promote sleep.

In addition to using natural remedies for anxiety, such as the examples we listed above, there are herbal remedies for anxiety available too. They include: Some clinical trials have been carried out that suggest passionflower can potentially help with anxiety.

It works by increasing the level of gamma-aminobutyric acid GABA in your brain, which may help people to relax and sleep better.

One study of 36 people with GAD found that 50mg of valerian root extract given three times a day for four weeks, significantly reduced one measure of anxiety compared to placebo. Chamomile is a well-known herbal remedy for anxiety and has been shown to be effective in aiding relaxation, and also helping with anxiety, depression and insomnia.

It works by balancing your stress response system. If you experience anxiety, there are several essential oils that could help you, whether you experience it on a daily basis or just occasionally.

They not only smell incredible, but these aromas can have a hugely positive effect too when you add a few drops to your bath water, spray some on your pillow or apply them topically onto your skin. Essential oils have been used for thousands of years by those who experience feelings of anxiety.

They are extremely concentrated fragrant extracts. For instance, it takes Ibs of lavender flowers to make just 1Ib of lavender essential oil. When it comes to using them to help achieve some of these benefits, there are a number of ways they can be used.

This typically involves applying a few drops to a cloth and gently breathing the fragrance in or putting some in a diffuser , so the scent can be circulated in the air. Essential oils sometimes are applied directly to the skin to treat pain in a specific area, for instance, to ease tired muscles.

Certain oils are also applied directly to the body because of their soothing qualities, e. putting tea tree oil on acne or clove oil on fungal infections.

Note — certain essential oils can aggravate skin and should be diluted before being applied. They include but are not limited to: bay, clove, cinnamon, lemongrass, citronella, oregano and thyme.

Some essential oils can be used in cooking or even swallowed in small doses as medication, but this should be done with great caution. While many are safe in small doses, others are poisonous and should never be ingested.

For instance, just the thought of a dreamy hot soak in a lavender bath is relaxing, and has even more of a calming effect in reality too. For example, oils that are okay to put on your arms and legs, may not be safe to put inside your mouth, nose, eyes or private parts.

You should never apply essential oils to injured or inflamed skin, as it may make your skin react and worse overall.

Generally speaking, diluted essential oils can be safely applied to the crown of your head, behind the ears, to your neck and to your temples.

There are a few different aroma options to choose from, but the scents that are most commonly used to help with anxiety are: Lavender is renowned for its soothing properties and is often associated with helping people relax and rewind. It can be used at any time of day to help create a calming effect.

It can be especially beneficial to use before bed to promote restful sleep. It is believed to help stabilise fearful thinking, lower anxious feelings, and promote deep relaxation. Top tip: Add 2 -5 drops of bergamot essential oil to products ensuring it is correctly diluted , such as body wash, shampoo and facial scrubs.

This wonder scent can help ease anxiety and stress, so much so that researchers at the Royal Berkshire Hospital NHS Trust, Reading, used it on patients in the intensive care unit. Top tip: You can apply it to your skin with or without a carrier oil to form a lotion.

It can alleviate feelings of emotional stress, anxiety and depression. Frankincense has a rich, warm aroma. With a sweet scent similar to roses, geranium oil can help you replace negative thoughts with positive ones.

Top tip: Geranium oil also has also been known to display antimicrobial properties. Studies have shown that jasmine can help to stimulate your brain and improve your mood and energy levels.

Results like this question the effectiveness of St. John's Wort as an OCD treatment. Milk thistle Silybum marianum is an herbal remedy that has long been used in Iran. In , a double-blind, placebo-controlled study compared the effects of milk thistle to the antidepressant Prozac fluoxetine in treating OCD milligrams of milk thistle vs 30 milligrams of Prozac daily.

It was found that there was no significant difference between milk thistle and Prozac for OCD symptoms. N-Acetylcysteine is an amino acid that moderates glutamine in the brain.

N-acetylcysteine helps produce glutathione, an important antioxidant. A single study of a single person found that N-acetylcysteine improved the actions of the SSRI Luvox fluvoxamine , resulting in a significant decrease in OCD symptoms.

Since the dysregulation of serotonergic and glutamatergic pathways in the brain appears to occur with OCD, other herbs that work in this pathway have also been considered for their possible benefits. A double-blind, randomized controlled trial with a placebo control found that 5-HTP could be effective as an augmentative treatment for moderate-to-severe OCD.

Kava is an herbal medication found in clinical trials to reduce anxiety, nervous tension, restlessness, and mild depression. It has been used for hundreds of years in Polynesia, the Micronesia Islands, and Hawaii.

The key constituent in Kava is kavalactone, which stimulates production of both serotonin and gamma amino butyric acid GABA in the body which produce a calming effect to the body. It's best to take Kava from a water-based extract at less than mgs per day.

Kava is not recommended during lactation or pregnancy. Kava has been banned or restricted in some countries after suggestions that it may cause liver problems in some individuals.

There are special considerations to take into account when looking at scientific studies that investigate the effectiveness of herbal remedies for OCD, anxiety disorders, or any other mental health condition.

Sometimes, study results sound impressive because basic research standards were compromised. First, studies using herbs that are not in a standardized form may have varying activity levels of chemical components.

Studies must consider the plant's accurate identity and whether the active constituents come from the plant's leaf, root, seed, or stem. Studies evaluating the effectiveness of medications should also include a placebo treatment group that receives a "sugar pill" that is inactive and could not possibly account for any reduction in symptoms.

By using a placebo treatment, it is possible to tell if the actual drug had an effect or not. Lastly, it is important that neither the researchers nor the study participants know who is receiving what treatment until the study is over to avoid bias.

A medical study in which neither the patient nor the physicians know who is using the medication or supplement and who is receiving a placebo is called a double-blind study.

Although many consumers believe that herbals are safer and have fewer adverse effects than prescription medications, treatments like St. Herbal treatments can also interfere with prescription medications that you may already be taking. For example, if you are currently taking an SSRI to treat OCD, it is essential that you consult your treating physician before taking St.

This could lead to a problem known as serotonin syndrome. Because kava may harm the liver, taking this herbal remedy with alcohol may increase this risk. Don't forget that there are other alternatives for treating the symtoms of OCD. Beyond supplements, lifestyle interventions such as mindfulness meditation , acupuncture , and yoga may be effective as well.

Unfortunately, there have been few clinical trials looking at these interventions for people with OCD and those that have been done are of fairly poor quality. Yet, unlike prescription drugs and herbal medications, lifestyle interventions rarely have significant side effects and may also help reduce stress.

Complementary treatments are often most effective when they are used to augment other evidence-based interventions. Treatments for OCD typically include medication and therapy. Medicines that may be prescribed include selective serotonin reuptake inhibitors SSRIs or tricyclic antidepressants TCAs.

Therapies that may be helpful include cognitive-behavioral therapy CBT or acceptance and commitment therapy ACT. If you do decide to try a natural treatment for OCD in addition to your regular treatment, always talk to your doctor first. You will need to tell them about any medications, supplements, or substances you are also taking to prevent potential drug interactions.

Cui YH, Zheng Y. A meta-analysis on the efficacy and safety of St John's wort extract in depression therapy in comparison with selective serotonin reuptake inhibitors in adults. Neuropsychiatr Dis Treat. Sarris J, Camfield D, Berk M. Complementary medicine, self-help, and lifestyle interventions for obsessive compulsive disorder OCD and the OCD spectrum: A systematic review.

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