|
 
 |
| NARRATIVE REVIEW |
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| Year : 2023 | Volume
: 11
| Issue : 2 | Page : 121-127 |
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Effectiveness of mind body medicine
Ranjan Solanki1, Arvind Singh Kushwaha1, Sitikantha Banerjee2, Mubashhera Firdaus Khan1
1 Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
2 HIV Sentinel Surveillance, Regional Institute, ICMR-NICED, Kolkata, West Bengal, India
| Date of Submission | 02-Sep-2022 |
| Date of Decision | 09-Nov-2022 |
| Date of Acceptance | 11-Nov-2022 |
| Date of Web Publication | 18-Apr-2023 |
Correspondence Address:
Arvind Singh Kushwaha
Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/mjhs.mjhs_94_22
A descriptive literature review of articles where mind–body interventions were used for various conditions including pediatric, obstetric, chronic illnesses, chronic pain, neurology, and oncology conditions was conducted. The aim of this study was to evaluate the evidence for the efficacy of mind–body interventions used in pediatric, obstetric, chronic illnesses, chronic pain, neurology, and oncology conditions. A literature search was done using electronic databases such as MEDLINE, PubMed, Google, and Google Scholar. The search terms included relevant MeSH terms, and Entry Literature sources published internationally up to June 2021 were included in the study. Terms in PubMed and keywords were identified by brainstorming. The keywords “Mind Body therapies in Antenatal and postnatal care, Paediatrics, Neurology, Autism, and Mental illnesses” were searched. There was no restriction on the period of publication of the studies. All the studies fulfilling the search criteria were included in the study. The mind–body therapies that were considered for inclusion were yoga, meditation, relaxation, breathing exercises, biofeedback acupressure, acupuncture, and hypnosis. These therapies show efficacy in providing symptomatic relief in conditions such as anxiety, depression, autism, menopause, dysmenorrhea, and chronic pain. While used as an adjunct in the treatment of cancers, mind–body therapies were found to have great evidence of efficacy. However, many studies lack large sample sizes and matched control groups. Mind–body therapies are efficacious in many ailments of public health significance. They are easy to administer, cost-effective, and not known to have many side effects. Mind–body therapies could be integrated as an adjunct to mainstream medicine. Their effective use could reduce the cost and burden on the health-care system.
Keywords: Evidence, mind–body medicine, systematic review
How to cite this article:
Solanki R, Kushwaha AS, Banerjee S, Khan MF. Effectiveness of mind body medicine. MRIMS J Health Sci 2023;11:121-7 |
| Introduction | |  |
There are certain limitations of modern medical therapies in treating a spectrum of diseases which leads to a stage of frustration for both doctors and patients. Mind–body therapies have been practiced since antiquity under different names and in different parts of the world. These therapies could bridge the gap between the demand of beneficiaries from the health-care system and the supply of the services effectively if used appropriately. However, there is a lack of enough well-designed studies to prove their efficacy. The lack of evidence creates hurdles in mainstreaming these therapies.
Mind–body therapies are based on the tenet that mental and physical processes are deeply intertwined.[2] The physical process of the body could be greatly influenced by working closely with mental processes. The group of mind–body therapies usually practiced across the world includes relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, qigong, cognitive-behavioral therapies, group support, autogenic training, and spirituality.
Historical background
The use of mind–body medicine could be traced back to antiquity. The indigenous medicine of different countries such as India, China, and Egypt is deeply steeped in the practice of mind–body therapy. Maimonides (1135–1204) indicated that the physical well-being of a person is dependent on his or her mental well-being, and vice versa. Maimonides proposed that fear and anxiety have to be assessed before invasive medical procedures.
The Ayushman Bharat Yojana has been launched in India in 2018. 70,000 health and wellness centers (AB-HWCs) have been operationalized till March 2020 under this program. The AB-HWCs are the platform to deliver preventive, promotive, and comprehensive primary health care. Mind–body techniques (MBTs) such as yoga and meditation are an integral part of the service delivery package of the health and wellness center.
How does it work? The hypothalamus is considered the seat of emotion in the brain. The hypothalamus regulates the pituitary gland which is considered a master endocrine gland. Routine mind–body therapies stimulate hypothalamus through various mechanisms. Mind–body therapies also have been found to stimulate the vagus nerve which is a parasympathetic nerve and bring a sense of relaxation. Thus, the balance between sympathetic and parasympathetic is restored by the practice of mind–body therapies. Many the techniques such as mindfulness and pranayama have already been used as an adjunct to conventional medicine. These techniques are gaining popularity worldwide. 14% of the U. S. adult population have reported having been using these techniques.[1],[2] This review of reviews and articles has been conducted to pool the evidence of the efficacy of the use of different MBTs in pediatrics, obstetric, chronic illnesses, mental illnesses, and neurological conditions.
| Materials and Methods | | |
Literature search
A literature search was done using electronic databases such as MEDLINE, PubMed, Google, and Google Scholar. The search terms included relevant MeSH terms, and Entry Literature sources published internationally up to June 2021 were included in the study. Terms in PubMed and keywords were identified by brainstorming. For identifying the intervention, MeSH terms such as Mind Body therapy*, spiritual therapies, behavioural therapy, and their entry terms were included. For individual health conditions, i.e., ANC, PNC, Paediatrics, Neurology, Autism, and Mental illnesses, suitable MeSH/entry terms were used, and a final search builder was developed combining search terms using Boolean operators such as Mind Body therapies including yoga, Meditation, relaxation, breathing exercises, biofeedback, acupressure, acupuncture, and hypnosis. However, we limited our search to studies including Meditation, Yoga, Breathing technique, and relaxation only.
Study eligibility
As the number of publications in each domain was huge, only systematic reviews and meta-analyses of randomized controlled trials (RCTs)/nonrandomized trials were chosen for carrying out this narrative review. The studies where the effectiveness of different mind–body medicine techniques were in the selected domains mentioned above was identified and reviewed. A review of reviews on this context was also included in this study. Eighty-three review articles and RCTs were reviewed and 39 were finally selected for the review purpose. All resulting abstracts were reviewed independently by two authors (RS and AKS) to determine if the articles met the inclusion criteria. The full texts of the studies meeting eligibility requirements were retrieved. Considering the volume of systematic reviews available in the literature, selected articles were included for this study based on the judgment of two independent researchers who were experts in this field. Exclusion criteria included studies in non-English publications and those not available freely in the abovementioned libraries. The data were extracted from each article, full text/abstracts were reviewed by two researchers, and the findings were summarized.
Mind–body interventions in pregnancy and related conditions of women
Antenatal care
Eight trials were evaluated for evidence of mind–body therapies as a part of the Cochrane Database of Systematic Reviews in 2011, wherein mind–body therapies were evaluated for reducing pregnancy-related anxiety and stress-related infertility. The MBTs that were considered were hypnotherapy (one trial), imagery (five trials), autogenic training (one trial), and yoga (one trial). They found that the use of imagery reduces anxiety at the early and middle stages of labor. The imagery also was found to affect anxiety and depression during the postpartum period.[3] Beddoe et al. evaluated the role of progressive muscle relaxation, yoga, and meditation during pregnancy. The results were very promising. The use of mind–body therapies was associated with higher birth weight, shorter length of labor, fewer instrument-assisted births, and reduced perceived stress and anxiety during pregnancy.[2] A systematic review and meta-analysis of RCTs of mind–body medicine intervention during pregnancy to reduce anxiety were conducted in 2020. The review indicated that mind–body interventions significantly reduce antenatal stress (standard mean deviation [SMD] = −0.94; 95% confidence interval [CI] [−1.25, −0.63]; P < 0.00001). The subgroup analysis indicated that mind–body interventions such as mindfulness, cognitive behavioral therapy, relaxation techniques, and yoga significantly reduce antenatal stress.[4]
Another systematic review (2020) of 175 articles including RCT was performed to pool the evidence related to the role of yoga in reducing stress during pregnancy. The study suggests that antenatal yoga may be safe and may effectively reduce the symptoms of stress, anxiety, and depression during pregnancy. The practice of mind–body therapies not only reduces the pain sensation during labor but also enhances maternal immunity and emotional well-being.[5]
Studies have also been conducted to see the effect of mind–body medicine intervention in reducing hypertensive disorders of pregnancy. In a systematic review, few studies have found that relaxation technique effectively reduces the systolic (MD = 11.3, 95% CI = 13.23 to − 9.39) and diastolic blood pressure (MD = 6.59, 95% CI = 9.43 to − 3.75) and reduced stress (MD = 11.4, 95% CI = 16.5 to − 6.3). It was also observed that the practice of yoga reduces the risk of developing hypertensive disorders in pregnancy (risk ratio = 0.28, 95% CI = 0.09–0.91).[6]
Postpartum stress
Twenty percent of women do experience perinatal major depressive disorder and 10% of women suffer from perinatal anxiety. The drugs treating perinatal anxiety and depression though are effective women feel apprehensive regarding their effect on the fetus. A systematic literature review to assess the efficacy of perinatal yoga on anxiety and depression was conducted in 2015. It has been observed that yoga significantly reduces the risk of anxiety and depression.[7],[8]
Ease in labor pain
A systematic review of RCT has been conducted to study the efficacy of mind–body therapies to relieve pain during labor. It has been indicated that relaxation, yoga, and music play a role in reducing labor pain. However, it has to be further explored with a rigorous study design.[9]
Infertility
The systematic review and meta-analysis of RCTs were conducted to study the efficacy of the MBTs in relieving infertility-related anxiety and depression rate. The mind–body therapies have been found to reduce the symptoms of anxiety (SMD = −3.44; 95% CI = −5.94, −0.95; P = 0.007; I2 = 69%) and depression (SMD = −5.79; 95% CI = −10.36, −1.22; P = 0.010; I2 = 86%) associated with infertility. The therapy also improves the quality of life (QOL) of the practitioners (SMD = 7.40; 95% CI = 2.92, 11.88; P = 0.001; I2 = 53%) and positively influences the pregnancy rate (SMD = 2.06; 95% CI = 1.08, 3.95; P =0.030; I2 = 73%).[10]
Dysmenorrhea
Dysmenorrhea is a major gynecological complaint among females. Studies show the effect of yoga,[11] MBT,[12] progressive relaxation exercise, and imagery[13],[14] in improving dysmenorrhea with different study designs.
Menopause
A systematic review and meta-analysis of 5 RCTs indicated that the psychological symptoms during menopause could be successfully managed using mind–body therapies. In contrast, an RCT comparing yoga with exercise or usual activity did not show improvements in VMS frequency or bother from baseline to endpoint in the intervention groups. Mindfulness-based stress reduction (MBSR) has been found to reduce the frequency of hot flushes and anxiety during menopause. The menopause-related QOL and sleep quality also showed a clinically meaningful improvement. The state of perceived stress and anxiety also improved in the MBSR group.
In a systematic review conducted in 2017 by Aliss et al., the effectiveness of hypnosis in the reduction of frequency and severity of hot flashes was studied in 2 RCTs. The hypnosis was compared against active structured attention control. It was observed that hypnosis significantly reduces subjective hot flush frequency (74%) and physiologically monitored hot flashes (57%). In addition, hypnosis was also found to improve self-reported sleep quality and sexual function. It has been mentioned in this review that the North American Menopause Society recommends hypnosis in the management guideline of menopause.[15]
Mind–body medicine intervention in children
A systematic review of 11 RCTs and 5 cohort studies (n = 860 children) was conducted in 2009. The findings from the review supported the hypothesis that meditation interventions bring about a positive change in the psychological, behavioral, and cardiovascular outcomes of the trial participants. However, the review also emphasizes the need for more rigorous conduct of the studies. The trials included in this review were conducted in children aged 6–18 years. were enrolled for most of the studies. The interventions used were transcendental meditation, mindfulness, and MBSR. These meditation interventions were of 4–16 weeks in duration. They included individual sessions ranging from 10 min to 2 h in duration (daily short-duration sessions or weekly long-duration sessions). The adherence to meditation practice was reported in only seven RCTs and ranged between 68% and 90%. Any adverse effects were not reported in any of the studies.[15]
Autism
A systematic review of 16 studies to evaluate the efficacy of mind–body therapies in autism spectrum disorder (ASD) was conducted in 2017. The interventions incorporated MBTs such as mindfulness, meditation, yoga, Nei Yang Gong. The outcomes that were studied included behavior, psychological symptoms, and QOL for children and adults with ASD and their parents. The evidence of mind–body therapies for people with ASD and their primary caregiver was found to be restricted in this review. It was proposed to have RCTs with a larger sample size.[16]
Attention deficit hyperactivity disorder
The role of mind–body medicine in attention deficit hyperactivity disorder (ADHD) has been explored in many studies, but there is a lack of large-scale studies to provide any concrete evidence. A systematic review of 12 studies among children in the age group of 4–18 years having attention deficit hyperactive disorder was conducted in 2019. The review concluded that yoga or meditation be useful therapies in mitigating ADHD symptoms. However, it was acknowledged that the quality and rigor of most of the studies need to be improved.[17],[18],[19],[20],[22]
Anxiety in children
Anxiety disorders are the most prevalent psychological disorders among children and youths. A systematic review of 6 RCTs, 9 nonrandomized trials, and 1 case study was conducted in 2017. The objective of the review was to pool evidence of the role of yoga in reducing the symptoms of anxiety among children and adolescents. Nearly, all studies indicated the reduction of symptoms of anxiety after an intervention with yoga therapy.[21]
Preoperative anxiety and postoperative pain
A systematic review of a total of 59 trials was conducted in 2020. It was indicated that hypnosis and breathing interventions were reducing children's preoperative anxiety and stress. A meta-analysis also found that the guided imagery introduced preoperatively can effectively reduce preoperative anxiety and postoperative pain in a more cost-effective way than conventional preoperative nursing care (d = −3.71).[23],[24]
Chronic pain
A structured review was conducted for eight mind–body interventions for older adults with chronic nonmalignant pain in 2007. The progressive muscle relaxation in adjunct with guided imagery is efficacious for osteoarthritis pain. An uncontrolled trial to implore the efficacy of biofeedback in both older and younger adults stratified by age indicated reductions in pain following the intervention of biofeedback. Tai chi, yoga, hypnosis, and progressive muscle relaxation were significantly associated with pain reduction in these studies.[25]
Meditation and tai chi were found to have limited use for the alleviation of lower back pain or pain of osteoarthritis in an elderly population. A systematic review of 20 trials was conducted in 2007 by Morone et al. The objective of the review was to evaluate the feasibility and safety of mind–body interventions such as yoga, meditation, tai chi, biofeedback, hypnosis, imagery, and progressive muscle relaxation for nonmalignant pain reduction in an elderly population.[25] The mind–body interventions were found to be safe and feasible in an older population. However, the intervention did not lead to significant pain reduction.
Rheumatologic disease
A review was conducted by Field in 2016 of empirical studies and meta-analyses on the effects of yoga and tai chi on knee osteoarthritis-associated pain in the elderly.[26] A clinically significant reduction in pain was achieved by the practice of yoga, meditation, breathing technique, and tai chi.[26]
Adverse effects of chemotherapy
The intervention of mind–body therapies has also proven its efficacy in managing side effects of chemotherapy such as nausea, vomiting, pain, fatigue, anxiety, and depressive symptoms. Some mind–body interventions also have been found to influence the biomarkers indicating immune function and stress hormones.[27]
HIV
A descriptive review was conducted by Maria et al. in 2019 of 84 studies to explore the frequency and efficacy of mind–body interventions to reduce the physical and psychological symptoms of HIV. The most widely practiced MBM techniques by people living with HIV were relaxation techniques (n = 20), meditation (n = 17), progressive muscle relaxation (n = 10), 7 yoga (n = 9), and hypnosis (n = 8). Mindfulness, and yoga, and meditation has shown promising outcomes in the reduction of physical and psychological symptoms and enhancing the QOL in people living with HIV.[28]
Inflammatory biology
The data were pooled from 26 RCTs to answer the quest “Could mind–body techniques play a role in regulating cellular and genomic markers of inflammation?” The MBTs have been shown to have mixed effects on circulating inflammatory markers including C-reactive protein and interleukin-6. The trials have consistently shown decreased expression of inflammation-related genes and pro-inflammatory transcription factor nuclear factor kappa. This phenomenon could be explained through neuroendocrine, neural, and psychological pathways.[29]
Chromosomal processes in mind–body medicine
MBTs influence the interaction between the mind, body, behavior, and the environment to bring about a state of homeostasis between the sympathetic and parasympathetic systems of the body.[30] The MBTs gear the system away from fight and flight mechanism and restore a state of relaxation. The relaxation response thus elicited. The MBTs can also influence the chromosomal and telomere processes, thereby influencing molecular aging, and the modulation of inflammatory states on cellular levels.
Neurology
Globally, various MBTs have been used for the management of a large number of neurological disorders. A review of systematic reviews has been carried out and the following evidence has been pooled from the study.
Gunjawate and Ravi identified that three out of five studies done to explore the efficacy of yoga, pranayama, and relaxation therapy on the management of tinnitus found the reduction in severity, stress, anxiety, and irritability associated with tinnitus and thus improving the QOL in patients of tinnitus.[31] Cheong et al. carried out a meta-analysis on the clinical effect of inhalational aromatherapy for the treatment of insomnia. The findings of 34 identified studies revealed that the use of aromatherapy was highly effective in improving sleep problems such as insomnia, including quantitative and qualitative sleep effects (95% CI, effect sizes = 0.6491). The intervention of aromatherapy also alleviates stress, depression, anxiety, and fatigue. Single aroma inhalation was found to be more effective than the mixed aroma inhalation method.[32] A systematic review of 20 RCTs from five countries on tai chi's effect on patients with sleep complaints was carried out by Li et al.[33] It was acknowledged that tai chi could improve the sleep quality in a significant way assessed by the Pittsburgh Sleep Quality Index when compared with nontreatment and active treatment groups.
Gil-Bermejo-Bernardez-Zerpa et al. carried out a systematic review of five studies to implore the effectiveness of MBM techniques on motor recovery and QOL in patients with multiple sclerosis. The results revealed that the use of imagery and mindfulness in patients with multiple sclerosis using motor imagery could significantly improve walking speed and distance, fatigue, and QOL among patients of multiple sclerosis. Dynamic balance and perceived walking ability were also found to be improved among the patients of multiple sclerosis.[34] A review on the effect of yoga on the QOL and fatigue in patients with multiple sclerosis was carried out by Shohani et al. As per the pooled evidence of this meta-analysis, the yoga intervention significantly reduced the fatigue in patients with multiple sclerosis in conventional MS care group.[35]
A meta-analysis to assess the effect of MBTs on QOL in neurofibromatosis patients of 10 randomized-controlled trials was conducted by Wei et al. It was revealed that the physical, psychological, social, and environmental QOL of patients get improved among patients of neurofibromatosis by practice of various Mind Body techniques. This improvement of QOL assessed on the WHO QOL scale was observed among diverse NF populations, including NF2 and young patients experiencing deafness.[36] A systematic review aiming at assessing the treatment effects of motor imagery for enhancing the ability to walk among people following stroke revealed very low-certainty evidence that motor imagery was more beneficial for improving gait (walking speed) compared to other therapies at the end of the treatment (pooled standardized mean difference = 0.44; 95% CI = 0.06–0.81; P = 0.02)[7] Lyu et al. conducted a meta-analysis to pool the evidence of the effect of tai chi on poststroke patients and patients with nonmotor disorders. The review included a total of 11 RCTs. The significant improvement in scores of depression among the tai chi training recipient as compared to the recipient of conventional rehabilitation therapy was acknowledged. However, no improvements were found in poststroke global mental disorders or sleep disorders between tai chi and control groups.[37],[38] Battel et al. carried out a systematic review to assess the impact of biofeedback on the improvement of swallowing reflexes in patients with Parkinson's disease (PD). The findings of all four studies suggest that interventions those involved visual biofeedback were found to have promising effects on swallowing-related QOL among PD patients.[39] Chen et al. carried out a review on the effect of qigong-based therapy on patients with PD. The review included seven studies. It was revealed that qigong significantly improves motor symptoms, walking ability, and balance in patients with PD.[40]
| Conclusion | | |
Mind–body therapies are useful in reducing symptoms, alleviating pain, anxiety, and depression, and improving QOL in many chronic medical conditions in all age groups and genders. They are easy to administer, cost-effective, and not known to have many adverse effects usually seen with drugs used for long duration in managing pain. Mind–body therapies could be integrated as an adjunct in mainstream medicine to improve patient satisfaction and improve their QOL. We need to mainstream them in medical education and research. Future studies conducted in the domain should have robust study designs and sample sizes. Although mind–body therapies are not directed toward a definitive cure for the underlying condition, they hold the promise to relieve symptoms and play an important role in self-care. Their effective use could reduce the cost and burden on the health-care system.
Ethical approval
Ethical approval was not required for this article.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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