Table 1.

Description of Mind-Body Therapies (MBTs).

ModalityDescriptionUse by the Public17 (%)
Relaxation techniquesRelaxation techniques, broadly defined, include those practices whose primary stated goal is elicitation of a psychophysiological state of relaxation or hypoarousal. In certain practices, the goal might be to reduce muscular tension (as in progressive muscle relaxation in which muscles are alternatively tensed and relaxed). In other cases, the primary goal is to achieve a hypometabolic state of reduced sympathetic arousal. The most prominent example of the latter is Benson’s relaxation response18,1916.3
MeditationMeditation has been defined as the “intentional self-regulation of attention,” a systematic mental focus on particular aspects of inner or outer experience.20–23 Unlike many approaches in behavioral medicine (eg, biofeedback, relaxation strategies), most meditation practices were developed within a religious or spiritual context and held as their ultimate goal some type of spiritual growth, personal transformation, or transcendental experience. It has been argued that as a health care intervention, meditation can be taught and used effectively regardless of a patient’s cultural or religious background.24 The two most extensively researched forms are transcendental meditation,25 in which practitioners repeat a silent word or phrase (a mantra) with the goal of quieting (and ultimately transcending) the ordinary stream of internal mental dialogue, and mindfulness meditation,26 in which practitioners simply observe or attend to (without judgment) thoughts, emotions, sensations, perceptions, etc, as they arise moment by moment in the field of awareness10.0
Guided imageryGuided imagery involves the generation (either by oneself or guided by a practitioner) of different mental images. Using the capacities of visualization and imagination, individuals evoke images, usually either sensory or affective. These images are typically visualized with the goal of evoking a psychophysiological state of relaxation or with some specific outcome in mind (eg, visualizing one’s immune system attacking cancer cells, imagining oneself feeling healthy and well, exploring subconscious themes, etc)4.5
HypnosisHypnosis has been defined as “a natural state of aroused, attentive focal concentration coupled with a relative suspension of peripheral awareness.”27 Primary components of the hypnotic trance experience include (1) absorption, or the intense involvement of a central object of concentration; (2) dissociation, in which experiences that would ordinarily be experienced consciously occur outside of normal conscious awareness, in part owing to the intense absorption; and, (3) suggestibility, in which persons are more likely to accept outside input (ie, instructions, guidance) without cognitive censor or criticism271.2
BiofeedbackDeveloped in the 1960s, biofeedback involves the use of devices that amplify physiological processes (eg, blood pressure, muscle activity) that are ordinarily difficult to perceive without some type of amplification. Participants are typically guided through relaxation and imagery exercises and instructed to alter their physiological processes using as a guide the provided biofeedback (typically visual or auditory). Examples of prominent forms of this therapy are electromyographic biofeedback, in which patients with a condition, such as tension headaches, are provided with feedback regarding the degree of tension in the frontalis muscle, or temperature biofeedback, in which patients with migraine headache disorder are instructed to warm their hands using as their feedback cue sounds or tones indicating temperature changes in this region of the body1.0
Cognitive behavioral therapyAmong more traditional psychological interventions, one of the more prominent MBTs is cognitive-behavioral therapy. It emphasizes the role of cognitive processes in shaping affective experience and argues that problematic emotions, such as anger, depression, and anxiety, result from irrational or faulty thinking.28,29 Behavior therapy (as distinguished from cognitive behavior approaches) tends to emphasize the use of environmental reinforcements (eg, not rewarding certain behaviors) to change or elicit certain behavioral changes.N/A
Psychoeducational approachesThese approaches typically combine certain psychological strategies (eg, cognitive behavioral coping skills training, relaxation, meditation, and imagery for stress reduction) with patient education (ie, teaching patients about their disease, appropriate treatments, self-care behaviors, and communicating with health care providers). A prototype is the Arthritis Self-Management Program developed by Lorig and colleagues30N/A
  • N/A = not available.

    Note: In describing MBTs, researchers have used a number of broad, interrelated terms, including “behavioral,” “psychosocial,” “psychoeducational,” and so on. Such variations in terminology can reflect differing approaches and emphases. Often, however, the terms simply reflect the particular theoretical orientations of the investigators (eg, those working in the complementary and alternative medicine field might refer to meditation as a mind-body therapy, whereas researchers within behavioral medicine might refer to it as a behavioral intervention). For simplicity of presentation, we have tried to use the broader term mind-body therapies throughout the article to refer collectively to these different approaches.