Mind-body medicine is an approach to healing that harnesses the power of thoughts, beliefs, and emotions to affect health positively (Cassileth 1998). The field includes a range of approaches and techniques including but not limited to social support, cognitive and behavioral therapy, meditation, guided imagery, spiritual and energetic healing, music therapy, and hypnosis (Luskin et al. 2000).

The majority of ancient healing practices, such as Traditional Chinese Medicine and Ayurveda, emphasize the important links between the mind and the body (Cassileth 1998). Philosophical thought, though, from Plato to Descartes has shaped the Western medical view that the mind and the body are separate and distinct aspects of human beings (Evengård et al. 1999). The Age of Enlightenment, which began in the 17^th century, launched a cultural shift toward valuing scientific evidence as the basis for medical theory; any connection between mind and body were viewed as superstitious remnants of folk medicine. Louis Pasteur's Germ Theory of Illness further solidified this attitude and became the basis for Western scientific medicine. Germ theory purports that microorganisms cause most forms of disease; illness resulting from the mind was split off into the field of psychiatry (Castleman 1996). Advances in the fields of microbiology, pathology, and molecular biology further uncovered bacterial and genetic causes of disease, which left many old mind-body hypotheses unsubstantiated by scientific evidence (Cassileth 1998).

In 1964, psychiatrist George Solomon observed that depression seemed to exacerbate rheumatoid arthritis; this led him to investigate the impact of emotions on immune function in general. He developed the new scientific field of psychoneuroimmunology (PNI) to study the interactions of psychology, neurology, and immunity. In the late 1960s and early 1970s, cardiologist Herbert Benson began studying the effects of transcendental meditation on blood pressure and coined the term "the relaxation response." However, Benson never established the exact mechanism of action that constituted the apparent mind-body link (Castleman 1996). Beginning in 1975, psychologist Robert Ader published studies demonstrating that cognitive and emotional cues could affect immune response (Ader and Cohen 1993). His research established PNI as a legitimate medical specialty (Castleman 1996). In the past few decades, research has uncovered important connections between the mind and the body, renewing interest in the applications of some age-old traditions, such as yoga and meditation. Today, the field of PNI has helped establish behavioral medicine programs at prestigious medical centers in the United States and around the world (Cassileth 1998).

Stress is believed to activate the hypothalamus-pituitary-adrenocortical axis (Evengård et al. 1999), leading to the release of stress hormones, which affect nearly every organ and system in the body. For instance, stress related to hostility can induce an imbalance between sympathetic and parasympathetic nervous system activity, and adversely affect cardiovascular, endocrine, and neuroendocrine function (Niaura et al. 2000). In addition, anxiety may affect immune function as reflected in changes in levels of immune markers including IFN-gamma and IL-4 in the blood, and decreases in natural killer (NK) cell activity (Hashiro and Okumura 1998). Conversely, negative emotions, such as anger and cynical hostility, have also been shown to increase NK activity (Miller et al. 1999); either direction of change may cause a potential disruption in normal immune function. Stress is often associated with immune downregulation, thereby decreasing the production of interleukin-1 beta messenger RNA (Marucha et al. 1998) and reducing the number of T helper cells (Brosschot et al. 1998). Distress and depression may be linked to defective repair of damaged DNA (Kiecolt-Glaser and Glaser 1999). Furthermore, neuropeptides are thought to be the biochemical mediators of emotion; since neuropeptides and their receptors are found throughout the immune system as well as in the CNS, the network of neuropeptides and their receptors is believed to constitute a neurohormonal communication system that helps regulate immune function (Pert et al. 1998). Research suggests that emotional expression that encourages disclosure and active coping creates balance in the neuropeptide-receptor network, and thus stabilizes the immune system (Pert et al. 1998). These factors demonstrate that the brain, immune system, and endocrine system are an integrated information circuit; a change in one necessarily affects the others (Evengård et al. 1999).

Mind-body medical practices are intended, through a variety of methods, to activate the relaxation response and stabilize the stress response. A relaxed state improves physiological function by reducing the release of stress hormones from the neuroendocrine system and by enhancing immune function (Castleman 1996). The connection between stress hormones and immune function is further supported by in vitro research, which indicates that norepinephrine and epinephrine accelerate the growth of the gram-negative bacteria Pseudomonas aeruginosa and Klebsiella pneumoniae. Although the relevance of this research to human health remains to be established, the study at least suggests a new perspective on the role of stress in the development of infections (Belay 2000). Similarly, distress and depression in cancer patients are associated with defective repair of damaged DNA and alterations in programmed cell death (apoptosis); the evidence suggests that psychological interventions, such as support groups, may ultimately benefit cellular function in such patients. Increased social connection may thus be a key psychological mediator of the positive health benefits of PNI (Kiecolt-Glaser and Glaser 1999). As a consequence of stress reduction and the inducement of relaxation, mind-body medicine may positively influence a patient's quality of life as well as the course of many different disease processes, including hypertension, asthma, coronary heart disease, obesity, cancer, and myocardial ischemia. See the section entitled Clinical Applications for further discussion.

Mind-body medicine includes a wide variety of conventional and alternative modalities; the clinical evaluation, therefore, is dependant on the particular treatment sought. For more information on clinical evaluation of alternative approaches related to mind-body medicine, please see the monographs on specific therapies such as Relaxation, Spirituality, Hypnotherapy, and Biofeedback.

A review of complementary therapies for acute pain indicates that mind-body techniques, such as cognitive and behavioral therapy, relaxation and breathing methods, TENS, and biofeedback, may be beneficial adjuncts to pharmacological treatments for acute pain. It is suggested that such methods provide distraction, enhance relaxation, increase coping skills, reduce tension and pain, and decrease the need for medication (Rusy and Weisman 2000). A meta-analysis of mind-body techniques, including cognitive-behavioral treatment, relaxation, hypnosis, and biofeedback, suggests that they may be effective in moderating loudness, annoyance, negative affect, and sleep disturbances related to tinnitus. Cognitive-behavioral treatment seems to be specifically effective in inducing the longest lasting effects on tinnitus annoyance (Andersson and Lyttkens 1999). Furthermore, research suggests that better coping skills and the perceived control over symptoms can improve the course of gastrointestinal diseases, including dyspepsia, constipation, diarrhea, irritable bowel syndrome, acid reflux disease, ulcerative colitis, and Crohn's disease (Drossman et al. 2000).

Researchers postulate that cognitive-behavioral therapy may be effective in moderating symptoms of chronic fatigue syndrome (CFS). This condition seems to deregulate immune function, as CFS has been correlated with a decreased ratio of CD4+/CD8+ T cells and a depressed function of natural killer cells. In addition, MRI studies indicate areas of potential inflammation and/or demyelination in the subcortical regions of the brain in patients with CFS, suggesting pathology of the central nervous system. Because of the relationship between CFS and altered immune and nervous system function, some researchers believe that the complex origin of the disease is best understood and treated within the framework of mind-body medicine (Evengård et al. 1999).

Research suggests that a stressed state and negative emotions have an adverse impact on health. On the basis of available scientific evidence, one may conclude that mind-body interventions may be beneficial in conditions including, but not limited to, hypertension (HTN), cancer, asthma, and coronary artery disease (CAD). Many mind-body techniques are also used to treat symptoms of anxiety and depression. One report indicates that unconscious defensive or repressive coping mechanisms are associated with serious medical consequences such as HTN (Mann 2000). Another study identifies a significant relationship between hopelessness and HTN (Everson et al. 2000). Still another demonstrates that helplessness and hopelessness may be linked to a significantly reduced survival rate in patients with breast cancer (Watson et al. 1999). Emotional factors also play a role in asthma patients' perception of their illness; in one study, anxiety was correlated with a greater subjective assessment of bronchoconstriction compared to objective measurements (Affleck et al. 2000).

Hostility in particular is correlated with a range of negative health effects. Clinical trials show that hostile attitudes may reduce cardiac output and increase diastolic blood pressure and total peripheral vascular resistance during episodes of social stress, thereby creating a greater risk for coronary heart disease (Davis et al. 2000). Hostility is also associated with obesity, central adiposity, insulin resistance, body mass index, elevated serum triglycerides, and decreased HDL cholesterol (Niaura et al. 2000). In addition, hostility, anger, and stress-induced exhaustion are correlated with increased blood clotting, hemodynamic reactivity, and inflammation, and may lead to increased risks of myocardial ischemia and coronary artery disease (Kop 1999).

Mind-body medicine may unintentionally create the notion that patients are responsible for their illnesses because they lack the proper mental attitude; aside from being scientifically inaccurate, such blame can induce feelings of distress and guilt (Castleman 1996). Some experts believe that mind-body medicine may be most effective when combined with other therapies. In addition, there may be risks, side effects, and adverse events associated with each individual modality within the field of mind-body medicine. Please see the monographs on specific therapies such as Relaxation, Spirituality, Hypnotherapy, and Biofeedback for further information. 

Similarly, contraindications depend on the type of modality being used. Please see the monographs on specific therapies related to mind-body medicine such as Relaxation, Spirituality, Hypnotherapy, and Biofeedback for further information.

Psychosocial interventions show particular promise for HIV patients (Robinson et al. 2000), cancer patients (Kiecolt-Glaser and Glaser 1999), and women at risk for pre-term delivery (Ruiz and Pearson 1999). Assessing psychosocial risk factors in the etiology of disease (i.e., CAD) may provide a useful guide for the development of such intervention strategies (Kop 1999). In addition, the correlation between helplessness/hopelessness and survival rate in breast cancer patients reinforces the need to provide adequate psychological care for oncology patients (Watson et al. 1999).

Future studies should examine the role of psychological intervention, such as cognitive-behavioral treatment, in improving coping skills and perceived self-control and their effect on the clinical outcome of many disorders, including but not limited to gastrointestinal disorders (Drossman et al. 2000). Furthermore, the potential cost-effectiveness and lack of side effects associated with mind-body therapies make continued research an important priority (Luskin et al. 2000).

Recently, the National Institutes for Health (NIH. 2000) received $10 million to conduct research in the behavioral sciences and establish pilot mind-body medical centers (NIH. 2000). In particular, more research is needed to identify the precise neuroendocrine and central nervous system mechanisms that underlie the mind-body connection (Everson et al. 2000). Future research should also identify the specific modalities that are most likely to improve health status, as well as target interventions for depressed and hopeless patients (Tucker 1999).

Mind-body techniques comprise a wide variety of modalities and each one has its own training, certification, and licensing procedures.

For more information on mind-body medicine, please see the monographs on specific therapies that may be related to mind-body medicine, such as Relaxation, Spirituality, Hypnotherapy, and Biofeedback. In addition, the Mind/Body Health Newsletter is a scientifically referenced quarterly newsletter published by the Center for Health Sciences at the Institute for the Study of Human Knowledge. Subscriptions can be ordered from ISHK Book Service, P.O. Box 381062, Cambridge, MA 02238-1062, at 800-222-4745.

Ader R, Cohen N. Psychoneuroimmunology: conditioning and stress. Annu Rev Psychol. 1993;44:53-85.

Affleck G, Apter A, Tennen H, et al. Mood states associated with transitory changes in asthma symptoms and peak expiratory flow. Psychosom Med. 2000;62(1):61-68.

Andersson G, Lyttkens L. A meta-analytic review of psychological treatments for tinnitus. Br J Audiol. 1999;33(4):201-210.

Belay T. Stress may encourage growth of disease-causing bacteria. Paper presented at: General Meeting of the American Society for Microbiology; May 24, 2000; Los Angeles, Calif.

Brosschot JF, Godaert GL, Benschop RJ, Olff M, Ballieux RE, Heijnen CJ. Experimental stress and immunological reactivity: a closer look at perceived uncontrollability. Psychosom Med. 1998;60(3):359-361.

Cassileth BR. The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary Therapies. New York: W.W. Norton & Company; 1998.

Castleman M. Nature's Cures. Emmaus, Pa: Rodale Press, Inc.; 1996.

Davis MC, Matthews KA, McGrath CE. Hostile attitudes predict elevated vascular resistance during interpersonal stress in men and women. Psychosom Med. 2000;62(1):17-25.

Drossman DA, Leserman J, Li Z, Keefe F, Hu YJ, Toomey TC. Effects of coping on health outcome among women with gastrointestinal disorders. Psychosom Med. 2000;62(3):309-317.

Evengård B, Schacterle RS, Komaroff AL. Chronic fatigue syndrome: new insights and old ignorance. J Intern Med. 1999;246(5):455-469.

Everson SA, Kaplan GA, Goldberg DE, Salonen JT. Hypertension incidence is predicted by high levels of hopelessness in Finnish men. Hypertension. 2000;35(2):561-567.

Hashiro M, Okumura M. The relationship between the psychological and immunological state in patients with atopic dermatitis. J Dermatol Sci. 1998;16(3):231-235.

Kiecolt-Glaser JK, Glaser R. Psychoneuroimmunology and cancer: fact or fiction? Eur J Cancer. 1999;35(11):1603-1607.

Kop WJ. Chronic and acute psychological risk factors for clinical manifestations of coronary artery disease. Psychosom Med. 1999;61(4):476-487.

Luskin FM, Newell KA, Griffith M, et al. A review of mind/body therapies in the treatment of musculoskeletal disorders with implications for the elderly. Altern Ther Health Med. 2000;6(2):46-56.

Mann SJ. The mind/body link in essential hypertension: time for a new paradigm. Altern Ther Health Med. 2000;6(2):39-45.

Marucha PT, Kiecolt-Glaser JK, Favagehi M. Mucosal wound healing is impaired by examination stress. Psychosom Med. 1998;60(3):362-365.

Miller GE, Dopp JM, Myers HF, Stevens SY, Fahey JL. Psychological predictors of natural killer cell mobilization during marital conflict. Health Psychol. 1999;18(3):262-271.

Niaura R, Banks SM, Ward KD, et al. Hostility and metabolic syndrome in older males: the normative aging study. Psychosom Med. 2000;62:7-16.

NIH. NIH establishes five mind-body research centers [press release]. Accessed August 2, 2000 at www.nih.gov/news/pr/sept99/od-30.htm .

Pert CB, Dreher HE, Ruff MR. The psychosomatic network: foundations of mind/body-medicine. Altern Ther Health Med. 1998;4(4):30-41.

Robinson FP, Mathews HL, Witek-Janusek L. Stress reduction and HIV disease: a review of intervention studies using a psychoneuroimmunology framework. J Assoc Nurses AIDS Care. 2000;11(2):87-96.

Ruiz RJ, Pearson AJ. Psychoneuroimmunology and preterm birth. A holistic model for obstetrical nursing practice and research. MCN Am J Matern Child Nurs. 1999;24(5):230-235.

Rusy LM, Weisman SJ. Complementary therapies for acute pediatric pain management. Pediatr Clin North Am. 2000;47(3):589-599.

Tucker JB. Modification of attitudes to influence survival from breast cancer. Lancet. 1999;354(9187):1320.

Watson M, Haviland JS, Greer S, Davidson J, Bliss JM. Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet. 1999;354(9187):1331-1336.