Mind-Body Medicine: An Overview
About This Series
“Mind-Body Medicine: An Overview” is one of five background papers on the major
areas of complementary and alternative medicine (
as part of the
(NCCAM’s) strategic planning efforts for the years 2005 to 2009. These brief reports
should not be viewed as comprehensive or definitive reviews. Rather, they are
intended to provide a sense of the overarching research challenges and
opportunities in particular
resources mentioned in this fact sheet, see “For More Information.”
“I would rather know the person who has the disease than know the disease the person has.”
- Hippocrates
Introduction
Mind-body medicine focuses on the interactions among the brain, mind, body,
and behavior, and on the powerful ways in which emotional, mental, social,
spiritual, and behavioral factors can directly affect health. It regards as
fundamental an approach that respects and enhances each person’s capacity
for self-knowledge and self-care, and it emphasizes techniques that are
grounded in this approach.
Definition of Scope of Field
Mind-body medicine typically focuses on intervention strategies that are
thought to promote health, such as relaxation, hypnosis, visual imagery,
meditation, yoga, biofeedback, tai chi, qi gong, cognitive-behavioral therapies,
group support, autogenic training, and spirituality.∗ The field views illness as an
opportunity for personal growth and transformation and health care providers
as catalysts and guides in this process.
∗ Certain mind-body intervention strategies listed here, such as group support for cancer survivors,
are well integrated into conventional care and, while still considered mind-body interventions, are
not considered to be complementary and alternative medicine.
Mind-body interventions constitute a major portion of the overall use of
2002, mind-body techniques, including relaxation techniques, meditation, guided imagery,
biofeedback, and hypnosis, were used by about 17 percent of the adult
was used by 45 percent of the population for health reasons.1
Background
The concept that the mind is important in the treatment of illness is integral to the healing
approaches of traditional Chinese and Ayurvedic medicine, dating back more than 2,000 years. It
was also noted by Hippocrates, who recognized the moral and spiritual aspects of healing, and
believed that treatment could occur only with consideration of attitude, environmental influences,
and natural remedies (ca. 400 B.C.). While this integrated approach was maintained in traditional
healing systems in the East, developments in the Western world by the 16th and 17th centuries led
to a separation of human spiritual or emotional dimensions from the physical body. This separation
began with the redirection of science, during the Renaissance and Enlightenment eras, to the purpose
of enhancing humankind’s control over nature. Technological advances (e.g., microscopy, the stethoscope,
the blood pressure cuff, and refined surgical techniques) demonstrated a cellular world that seemed far
apart from the world of belief and emotion. The discovery of bacteria and, later, antibiotics further dispelled
the notion of belief influencing health. Fixing or curing an illness became a matter of science (i.e., technology)
and took precedence over, not a place beside, healing of the soul. As medicine separated the mind and the body,
scientists of the mind (neurologists) formulated concepts, such as the unconscious, emotional impulses, and
cognitive delusions, that solidified the perception that diseases of the mind were not “real,” that is, not based
in physiology and biochemistry.
In the 1920s, Walter Cannon’s work revealed the direct relationship between stress and
neuroendocrine responses in animals.2 Coining the phrase “fight or flight,” Cannon described
the primitive reflexes of sympathetic and adrenal activation in response to perceived danger
and other environmental pressures (e.g., cold, heat). Hans Selye further defined the deleterious
effects of stress and distress on health.3 At the same time, technological advances in medicine
that could identify specific pathological changes, and new discoveries in pharmaceuticals,
were occurring at a very rapid pace. The disease-based model, the search for a specific
pathology, and the identification of external cures were paramount, even in psychiatry.
During World War II, the importance of belief reentered the web of health care. On the beaches
of
discovered that much of the pain could be controlled by saline injections. He coined the term
“placebo effect,” and his subsequent research showed that up to 35 percent of a therapeutic
response to any medical treatment could be the result of belief.4 Investigation into the placebo
effect and debate about it are ongoing.
Since the 1960s, mind-body interactions have become an extensively researched field. The
evidence for benefits for certain indications from biofeedback, cognitive-behavioral
interventions, and hypnosis is quite good, while there is emerging evidence regarding their
physiological effects. Less research supports the use of
yoga. The following is a summary of relevant studies.
Mind-Body Interventions and Disease Outcomes
Over the past 20 years, mind-body medicine has provided considerable evidence that
psychological factors can play a substantive role in the development and progression of
coronary artery disease. There is evidence that mind-body interventions can be effective in the
treatment of coronary artery disease, enhancing the effect of standard cardiac rehabilitation in
reducing all-cause mortality and cardiac event recurrences for up to 2 years.5
Mind-body interventions have also been applied to various types of pain. Clinical trials
indicate that these interventions may be a particularly effective adjunct in the management of
arthritis, with reductions in pain maintained for up to 4 years and reductions in the number of
physician visits.6 When applied to more general acute and chronic pain management,
headache, and low-back pain, mind-body interventions show some evidence of effects,
although results vary based on the patient population and type of intervention studied.7
Evidence from multiple studies with various types of cancer patients suggests that mind-body
interventions can improve mood, quality of life, and coping, as well as ameliorate disease and
treatment-related symptoms, such as chemotherapy-induced nausea, vomiting, and pain.8
Some studies have suggested that mind-body interventions can alter various immune
parameters, but it is unclear whether these alterations are of sufficient magnitude to have an
impact on disease progression or prognosis.9,10
Mind-Body Influences on Immunity
There is considerable evidence that emotional traits, both negative and positive, influence
people’s susceptibility to infection. Following systematic exposure to a respiratory virus in the
laboratory, individuals who report higher levels of stress or negative moods have been shown
to develop more severe illness than those who report less stress or more positive moods.11
Recent studies suggest that the tendency to report positive, as opposed to negative, emotions
may be associated with greater resistance to objectively verified colds. These laboratory
studies are supported by longitudinal studies pointing to associations between psychological
or emotional traits and the incidence of respiratory infections.12
Meditation and Imaging
Meditation, one of the most common mind-body interventions, is a conscious mental process that
induces a set of integrated physiological changes termed the relaxation response. Functional
magnetic resonance imaging (fMRI) has been used to identify and characterize the brain regions
that are active during meditation. This research suggests that various parts of the brain known to
be involved in attention and in the control of the autonomic nervous system are activated,
providing a neurochemical and anatomical basis for the effects of meditation on various
physiological activities.13 Recent studies involving imaging are advancing the understanding of
mind-body mechanisms. For example, meditation has been shown in one study to produce
significant increases in left-sided anterior brain activity, which is associated with positive
emotional states. Moreover, in this same study, meditation was associated with increases in
antibody titers to influenza vaccine, suggesting potential linkages among meditation, positive
emotional states, localized brain responses, and improved immune function.14
Physiology of Expectancy (Placebo Response)
Placebo effects are believed to be mediated by both cognitive and conditioning mechanisms.
Until recently, little was known about the role of these mechanisms in different
circumstances. Now, research has shown that placebo responses are mediated by conditioning
when unconscious physiological functions such as hormonal secretion are involved, whereas
they are mediated by expectation when conscious physiological processes such as pain and
motor performance come into play, even though a conditioning procedure is carried out.
Positron emission tomography (PET) scanning of the brain is providing evidence of the release of
the endogenous neurotransmitter dopamine in the brain of Parkinson’s disease patients in
response to placebo.15 Evidence indicates that the placebo effect in these patients is powerful and
is mediated through activation of the nigrostriatal dopamine system, the system that is damaged
in Parkinson’s disease. This result suggests that the placebo response involves the secretion of
dopamine, which is known to be important in a number of other reinforcing and rewarding
conditions, and that there may be mind-body strategies that could be used in patients with
Parkinson’s disease in lieu of or in addition to treatment with dopamine-releasing drugs.
Stress and Wound Healing
Individual differences in wound healing have long been recognized. Clinical observation has
suggested that negative mood or stress is associated with slow wound healing. Basic mindbody
research is now confirming this observation. Matrix metalloproteinases (MMPs) and the
tissue inhibitors of metalloproteinases (TIMPs), whose expression can be controlled by
cytokines, play a role in wound healing.16 Using a blister chamber wound model on human
forearm skin exposed to ultraviolet light, researchers have demonstrated that stress or a
change in mood is sufficient to modulate MMP and TIMP expression and, presumably, wound
healing.17 Activation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal
medullary (SAM) systems can modulate levels of MMPs, providing a physiological link among
mood, stress, hormones, and wound healing. This line of basic research suggests that
activation of the HPA and SAM axes, even in individuals within the normal range of depressive
symptoms, could alter MMP levels and change the course of wound healing in blister wounds.
Surgical Preparation
Mind-body interventions are being tested to determine whether they can help prepare patients
for the stress associated with surgery. Initial randomized controlled trials—in which some
patients received audiotapes with mind-body techniques (guided imagery, music, and
instructions for improved outcomes) and some patients received control tapes—found that
subjects receiving the mind-body intervention recovered more quickly and spent fewer days in
the hospital.18
Behavioral interventions have been shown to be an efficient means of reducing discomfort and
adverse effects during percutaneous vascular and renal procedures. Pain increased linearly
with procedure time in a control group and in a group practicing structured attention, but
remained flat in a group practicing a self-hypnosis technique. The self-administration of
analgesic drugs was significantly higher in the control group than in the attention and
hypnosis groups. Hypnosis also improved hemodynamic stability.19
Conclusion
Evidence from randomized controlled trials and, in many cases, systematic reviews of the
literature, suggests that:
• Mechanisms may exist by which the brain and central nervous system influence immune,
endocrine, and autonomic functioning, which is known to have an impact on health.
• Multicomponent mind-body interventions that include some combination of stress
management, coping skills training, cognitive-behavioral interventions, and relaxation
therapy may be appropriate adjunctive treatments for coronary artery disease and certain
pain-related disorders, such as arthritis.
• Multimodal mind-body approaches, such as cognitive-behavioral therapy, particularly
when combined with an educational/informational component, can be effective adjuncts
in the management of a variety of chronic conditions.
• An array of mind-body therapies (e.g., imagery, hypnosis, relaxation), when employed
presurgically, may improve recovery time and reduce pain following surgical procedures.
• Neurochemical and anatomical bases may exist for some of the effects of
mind-body approaches.
Mind-body approaches have potential benefits and advantages. In particular, the physical and
emotional risks of using these interventions are minimal. Moreover, once tested and
standardized, most mind-body interventions can be taught easily. Finally, future research
focusing on basic mind-body mechanisms and individual differences in responses is likely to
yield new insights that may enhance the effectiveness and individual tailoring of mind-body
interventions. In the meantime, there is considerable evidence that mind-body interventions,
even as they are being studied today, have positive effects on psychological functioning and
quality of life, and may be particularly helpful for patients coping with chronic illness and in
need of palliative care.
References
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