Mind-body therapies are among the most widely recommended and used form of complementary and alternative medicine. Nursing has long championed these interventions, citing the healing potential of the mind on physiological systems. Professional beliefs about the inherent holism of the human being are now supported by advances in science; there is basic bench research that now suggests an observable connection between protein expression and stress, mood and hormones as well as the information transduction between the limbic, autonomic, endocrine, immune and neuropeptide systems.1-2 Recent research using functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) scanning also provide insight about how mind-body therapies work (the mechanism of action) as well as the linkages between brain activity, intervention and physiological/behavioral/emotional changes.3
The public has increasingly embraced mind-body therapies. There were significant increases in the use of meditation, yoga and deep breathing between 2002 and 2007.4 Almost 12.7% of the US population reported using deep breathing, while over 9.4% of adults engage in meditation.4 Yoga was practiced by almost 20% of the surveyed adults and recommended by providers for problems associated with chronic osteoarthitis pain and stiffness, hypertension, depression and anxiety.4 A recent survey of practitioners working with underserved populations similarly reported use of meditation, relaxation and breathing exercises in their population, citing the ease of use and low cost of these self-help strategies to mitigate anxiety, depression and chronic pain.5
What Constitues Mind-Body Therapies?
Strategies and techniques that rely on the powerful influences of thought, emotion, and mental imaging to positively impact the body are identified as mind-body therapies. These techniques include guided imagery, relaxation, hypnosis, biofeedback, meditation and breathwork? Is this just deep breathing?. Body-mind therapies ascribe to the same theoretical basis, but use body movement to modulate mental/emotional states that ultimately affect physiological function. Body-mind techniques include tai chi, yoga, dance, qigong, mindful walking and even therapeutic gardening. Full descriptions of common mind-body therapies can be found at the University of Minnesota's Center for Spirituality and Healing website at http://takingcharge.csh.umn.edu/
Mind-body approaches rely heavily on self-care, personal motivation and patient knowledge for implementation. Practitioners who recommend their use to patients are often called upon to provide basic education that describes when and how to perform many of them. Professional resources are plentiful and include available DVDs, CDs, online instructions, books and print media. Reliance online resources for practitioners include those found in Table 1.
Table 1.
Online Mind-Body Resources for Practitioners
Reliable patient resources are also available, including online guided meditations, daily guided imagery exercises, deep breathing guides and mindful movement. Self-help sites that have been used successfully by patients and recommended by providers over several years for daily meditations, breathwork, relaxation and guided imagery sessions include those in Table 2.
Table 2.
Online Resources for Patients:
Some mind-body therapies require referral to qualified providers. Hypnosis, effective in acute and chronic pain, sleep disorders, addictions and smoking cessation, should be provided by hypontherapist certified by the American Society of Clinical Hypnosis. A list of professionals in your area can be found at www.asch.net. Similarly, there are claims that biofeedback reduces blood pressure, improves success in weight loss and smoking cessation and decreases symptoms associated with irritable bowel and chronic gastrointestinal disorders. Biofeedback should be administered by therapists are certified by the BCIA (Biofeedback Certification Institute of America). Qualified practitioner can be identified at www.bcia.affiniscape.com.
Body-mind therapies present additional challenges to the referring NP. Referrals should be provided only after you are confident that the patient can physically tolerate the various movements, positions and environmental stressors required by the different techniques and practices. For example, there are many systems of yoga. Each system has different requirements; some may focus on simple stretching exercise/poses that improve flexibility and mobility, while others may involve intense heat, perspiration and physical intensity as a way to cleanse the body. Therefore, patient needs and abilities should be matched with the type of yoga that is recommended and the school or practice that the patient is referred to. For additional information about safely recommending yoga, visit http://www.csh.umn.edu/modules/index.html and review the free on-line continuing education module on yoga therapies.
Evidence Associated with Mind-body Therapies
There is increasing evidence about the effectiveness of mind-body therapies from clinical trials research and meta-analyses. Mind-body therapies have been found to be effective in preoperative anxiety, acute and chronic pain syndromes, symptoms associated with chemotherapy and radiation, depression, chronic mental illnesses, post-traumatic stress disorders and addictions.6 There is preliminary scientific evidence, as well as strong anecdotal and clinical evidence, that these therapies maybe useful to enhance immune function, modify cardivascular changes associated with coronary artery disease, reduce recovery time from surgical procedures and decrease neurological symptoms associated with Parkinson's disease.3 Yet, systematic reviews of studies about these therapies have found that most of the evidence is weak, that studies are often poorly designed and that sample sizes are small.6 Therefore, ongoing research about mind-body therapies is a focus of multiple institutes at NIH with a goal to better understand the effects of these therapies on disease outcomes, symptom management, quality of life and patient resilience.
Footnotes
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“This publication was made possible by Grant Number T32 AT001287 from the National Center for Complementary and Alternative Medicine (NCCAM). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCCAM, or the National Institutes of Health.”
References
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