Mind-Body Practices: An Overview

Mind and body practices are a large and diverse group of techniques that are administered or taught to others by a trained practitioner or teacher. Examples include acupuncture, massage therapy, meditation, relaxation techniques, spinal manipulation, and yoga.

Acupuncture

What’s the Bottom Line?

• How much do we know about acupuncture?
  There have been extensive studies conducted on acupuncture, especially for back and neck pain, osteoarthritis/knee pain, and headache. However, researchers are only beginning to understand whether acupuncture can be helpful for various health conditions.
• What do we know about the effectiveness of acupuncture?
  Research suggests that acupuncture can help manage certain pain conditions, but evidence about its value for other health issues is uncertain.
• What do we know about the safety of acupuncture?
  Acupuncture is generally considered safe when performed by an experienced, well-trained practitioner using sterile needles. Improperly performed acupuncture can cause serious side effects.

What Is Acupuncture?

Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. It is one of the practices used in traditional Chinese medicine.

What the Science Says About the Effectiveness of Acupuncture

Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider. However, clinical practice guidelines are inconsistent in recommendations about acupuncture.

The effects of acupuncture on the brain and body and how best to measure them are only beginning to be understood. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain.

What the Science Says About Safety and Side Effects of Acupuncture

• Relatively few complications from using acupuncture have been reported. Still, complications have resulted from use of nonsterile needles and improper delivery of treatments.
• When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, collapsed lungs, and injury to the central nervous system.
• The U.S. Food and Drug Administration (FDA) regulates acupuncture needles as medical devices for use by licensed practitioners and requires that needles be manufactured and labeled according to certain standards. For example, the FDA requires that needles be sterile, nontoxic, and labeled for single use by qualified practitioners only.

More to Consider

• Don’t use acupuncture to postpone seeing a health care provider about a health problem.

• If you decide to visit an acupuncturist, check his or her credentials. Most states require a license, certification, or registration to practice acupuncture; however, education and training standards and requirements for obtaining these vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets certain standards regarding the knowledge and use of acupuncture. Most states require a diploma from the National Certification Commission for Acupuncture and Oriental Medicine for licensing.

• Some conventional medical practitioners—including physicians and dentists—practice acupuncture. In addition, national acupuncture organizations (which can be found through libraries or by searching the Internet) may provide referrals to acupuncturists. When considering practitioners, ask about their training and experience.

• Ask the practitioner about the estimated number of treatments needed and how much each treatment will cost. Some insurance companies may cover the costs of acupuncture, while others may not. For more information, see NCCIH’s fact sheet Paying for Complementary Health Approaches.
• Help your health care providers give you better coordinated and safe care by telling them about all the health approaches you use. Give them a full picture of what you do to manage your health.

Meditation

What’s the Bottom Line?

• How much do we know about meditation?
  Many studies have been conducted to look at how meditation may be helpful for a variety of conditions, such as high blood pressure, certain psychological disorders, and pain. A number of studies also have helped researchers learn how meditation might work and how it affects the brain.
• What do we know about the effectiveness of meditation?
  Some research suggests that practicing meditation may reduce blood pressure, symptoms of irritable bowel syndrome, anxiety and depression, and insomnia. Evidence about its effectiveness for pain and as a smoking-cessation treatment is uncertain.
• What do we know about the safety of meditation?
  Meditation is generally considered to be safe for healthy people. However, people with physical limitations may not be able to participate in certain meditative practices involving movement.

What Is Meditation?

Meditation is a mind and body practice that has a long history of use for increasing calmness and physical relaxation, improving psychological balance, coping with illness, and enhancing overall health and well-being. Mind and body practices focus on the interactions among the brain, mind, body, and behavior.

There are many types of meditation, but most have four elements in common: a quiet location with as few distractions as possible; a specific, comfortable posture (sitting, lying down, walking, or in other positions); a focus of attention (a specially chosen word or set of words, an object, or the sensations of the breath); and an open attitude (letting distractions come and go naturally without judging them).

What the Science Says About the Effectiveness of Meditation

Many studies have investigated meditation for different conditions, and there’s evidence that it may reduce blood pressure as well as symptoms of irritable bowel syndrome and flare-ups in people who have had ulcerative colitis. It may ease symptoms of anxiety and depression, and may help people with insomnia.

Meditation and the Brain

Some research suggests that meditation may physically change the brain and body and could potentially help to improve many health problems and promote healthy behaviors.

• In a 2012 study, researchers compared brain images from 50 adults who meditate and 50 adults who don’t meditate. Results suggested that people who practiced meditation for many years have more folds in the outer layer of the brain. This process (called gyrification) may increase the brain’s ability to process information.
• A 2013 review of three studies suggests that meditation may slow, stall, or even reverse changes that take place in the brain due to normal aging.
• Results from a 2012 NCCIH-funded study suggest that meditation can affect activity in the amygdala (a part of the brain involved in processing emotions), and that different types of meditation can affect the amygdala differently even when the person is not meditating.
• Research about meditation’s ability to reduce pain has produced mixed results. However, in some studies scientists suggest that meditation activates certain areas of the brain in response to pain.

What the Science Says About Safety and Side Effects of Meditation

• Meditation is generally considered to be safe for healthy people.
• People with physical limitations may not be able to participate in certain meditative practices involving movement. People with physical health conditions should speak with their health care providers before starting a meditative practice, and make their meditation instructor aware of their condition.
• There have been rare reports that meditation could cause or worsen symptoms in people with certain psychiatric problems like anxiety and depression. People with existing mental health conditions should speak with their health care providers before starting a meditative practice, and make their meditation instructor aware of their condition.

More to Consider

• Don’t use meditation to replace conventional care or as a reason to postpone seeing a health care provider about a medical problem.
• Ask about the training and experience of the meditation instructor you are considering.
• Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Yoga

Yoga is a mind and body practice with historical origins in ancient Indian philosophy. Like other meditative movement practices used for health purposes, various styles of yoga typically combine physical postures, breathing techniques, and meditation or relaxation. This fact sheet provides basic information about yoga, summarizes scientific research on effectiveness and safety, and suggests sources for additional information.

Yoga in its full form combines physical postures, breathing exercises, meditation, and a distinct philosophy. There are numerous styles of yoga. Hatha yoga, commonly practiced in the United States and Europe, emphasizes postures, breathing exercises, and meditation. Hatha yoga styles include Ananda, Anusara, Ashtanga, Bikram, Iyengar, Kripalu, Kundalini, Viniyoga, and others.

Side Effects and Risks

• Yoga is generally low-impact and safe for healthy people when practiced appropriately under the guidance of a well-trained instructor.
• Overall, those who practice yoga have a low rate of side effects, and the risk of serious injury from yoga is quite low. However, certain types of stroke as well as pain from nerve damage are among the rare possible side effects of practicing yoga.
• Women who are pregnant and people with certain medical conditions, such as high blood pressure, glaucoma (a condition in which fluid pressure within the eye slowly increases and may damage the eye’s optic nerve), and sciatica (pain, weakness, numbing, or tingling that may extend from the lower back to the calf, foot, or even the toes), should modify or avoid some yoga poses.

What the Science Says About Yoga

Current research suggests that a carefully adapted set of yoga poses may reduce low-back pain and improve function. Other studies also suggest that practicing yoga (as well as other forms of regular exercise) might improve quality of life; reduce stress; lower heart rate and blood pressure; help relieve anxiety, depression, and insomnia; and improve overall physical fitness, strength, and flexibility. But some research suggests yoga may not improve asthma, and studies looking at yoga and arthritis have had mixed results.

• One NCCIH-funded study of 90 people with chronic low-back pain found that participants who practiced Iyengar yoga had significantly less disability, pain, and depression after 6 months.
• In a 2011 study, also funded by NCCIH, researchers compared yoga with conventional stretching exercises or a self-care book in 228 adults with chronic low-back pain. The results showed that both yoga and stretching were more effective than a self-care book for improving function and reducing symptoms due to chronic low-back pain.
• Conclusions from another 2011 study of 313 adults with chronic or recurring low-back pain suggested that 12 weekly yoga classes resulted in better function than usual medical care.

However, studies show that certain health conditions may not benefit from yoga.

• A 2011 systematic review of clinical studies suggests that there is no sound evidence that yoga improves asthma.
• A 2011 review of the literature reports that few published studies have looked at yoga and arthritis, and of those that have, results are inconclusive. The two main types of arthritis—osteoarthritis and rheumatoid arthritis—are different conditions, and the effects of yoga may not be the same for each. In addition, the reviewers suggested that even if a study showed that yoga helped osteoarthritic finger joints, it may not help osteoarthritic knee joints.

If You Are Considering Practicing Yoga

• Do not use yoga to replace conventional medical care or to postpone seeing a health care provider about pain or any other medical condition.
• If you have a medical condition, talk to your health care provider before starting yoga.
• Ask a trusted source (such as your health care provider or a nearby hospital) to recommend a yoga practitioner. Find out about the training and experience of any practitioner you are considering. To learn more, see Selecting a Complementary Medicine Practitioner.
• Everyone’s body is different, and yoga postures should be modified based on individual abilities. Carefully selecting an instructor who is experienced with and attentive to your needs is an important step toward helping you practice yoga safely. Ask about the physical demands of the type of yoga in which you are interested and inform your yoga instructor about any medical issues you have.
• Carefully think about the type of yoga you are interested in. For example, hot yoga (such as Bikram yoga) may involve standing and moving in humid environments with temperatures as high as 105°F. Because such settings may be physically stressful, people who practice hot yoga should take certain precautions. These include drinking water before, during, and after a hot yoga practice and wearing suitable clothing. People with conditions that may be affected by excessive heat, such as heart disease, lung disease, and a prior history of heatstroke may want to avoid this form of yoga. Women who are pregnant may want to check with their health care providers before starting hot yoga.
• Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Chiropractic, Spinal Manipulation, and Osteopathic Manipulation

Chiropractic is a health care profession that focuses on the relationship between the body's structure—mainly the spine—and its functioning. Although practitioners may use a variety of treatment approaches, they primarily perform adjustments (manipulations) to the spine or other parts of the body with the goal of correcting alignment problems, alleviating pain, improving function, and supporting the body's natural ability to heal itself.

Spinal Manipulation is the application of controlled force to a joint, moving it beyond the normal range of motion in an effort to aid in restoring health. Manipulation may be performed as a part of other therapies or whole medical systems, including chiropractic medicine, massage, and naturopathy.

Osteopathic manipulation is a type of manipulation practiced by osteopathic physicians. It is combined with physical therapy and instruction in proper posture.

Learn more on the National Center for Complementary and Integrative Health website.

Massage Therapy

Massage therapy encompasses many different techniques. In general, therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body. They most often use their hands and fingers, but may use their forearms, elbows, or feet.

Learn more on the National Center for Complementary and Integrative Health website.

Key References

Accupuncture:

• Berman BM, Langevin HM, Witt CM, et al. Acupuncture for chronic low back pain. New England Journal of Medicine. 2010;363(5):454–461.
• Cherkin DC, Sherman KJ, Avins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Archives of Internal Medicine. 2009;169(9):858–866.
• Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007;147(7):478–491.
• Cummings M. Modellvorhaben Akupunktur—a summary of the ART, ARC and GERAC trials. Acupuncture in Medicine. 2009;27(1):26–30.
• Furlan A, Yazdi F, Tsertsvadze A, et al. Complementary and Alternative Therapies for Back Pain II. Evidence Report/Technology Assessment No. 194. Rockville, MD: Agency for Healthcare Research and Quality. 2010. AHRQ Publication No. 10(11)–E007.
• Hinman RS, McCrory P, Pirotta M, et al. Acupuncture for chronic knee pain. A randomized clinical trial. JAMA. 2014;312(13):1313–1322.
• Linde K, Allais G, Brinkhaus B, et al. Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews. 2009;(1):CD001218. Accessed at www.thecochranelibrary.com on July 2, 2014.
• Linde K, Allais G, Brinkhaus B, et al. Acupuncture for tension-type headache. Cochrane Database of Systematic Reviews. 2009;(1):CD007587. Accessed at www.thecochranelibrary.com on July 2, 2014.
• Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database of Systematic Reviews. 2010;(1):CD001977. Accessed at www.thecochranelibrary.com on July 2, 2014.
• Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of Internal Medicine. 2012;172(19):1444–1453.
• Vickers AJ, Linde K. Acupuncture for chronic pain. JAMA. 2014;311(9):955–956.
• Witt CM, Jena S, Brinkhaus B, et al. Acupuncture for patients with chronic neck pain. Pain. 2006;125(1–2):98–106.
• Yuan J, Purepong N, Kerr DP, et al. Effectiveness of acupuncture for low back pain: a systematic review. Spine. 2008;33(23):E887–E900.

Meditation:

• Barrett B, Hayney MS, Muller D, et al. Meditation or exercise for preventing acute respiratory infection: a randomized controlled trial. Annals of Family Medicine. 2012;10:337–346.
• Brewer JA, Mallik S, Babuscio TA, et al. Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug and Alcohol Dependence. 2011;119(1–2):72–80.
• Brook RD, Appel RJ, Rubenfire M, et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association. Hypertension. 2013;61(6):1360–1383.
• Carim-Todd L, Mitchell SH, Oken BS. Mind-body practices: an alternative, drug-free treatment for smoking cessation? A systematic review of the literature. Drug and Alcohol Dependence. 2013;132(3):399–410.
• Chen KW, Berger CC, Manheimer E, et al. Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials. Depression and Anxiety. 2012;29(7):545–562.
• Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: a randomized clinical trial. JAMA. 2016;315(12):1240–1249.
• Cramer H, Haller H, Lauche R, et al. Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complementary and Alternative Medicine. 2012;12(162):1–8.
• Dakwar E and Levin FR. The emerging role of meditation in addressing psychiatric illness, with a focus on substance use disorders. Harvard Review of Psychiatry. 2009;17(4):254–267.
• Desbordes G, Negi LT, Pace TW, et al. Effects of mindful-attention and compassion meditation training on amygdala response to emotional stimuli in an ordinary, non-meditative state. Frontiers in Human Neuroscience. 2012;6:1–15
• Fang CY, Reibel DK, Longacre ML, et al. Enhanced psychosocial well-being following participation in a mindfulness-based stress reduction program is associated with increased natural killer cell activity. Journal of Complementary and Alternative Medicine. 2010;16(5):531–538.
• Gaylord SA, Palsson OS, Garland EL, et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. American Journal of Gastroenterology. 2011;106(9):1678–1688.
• Goldstein CM, Josephson R, Xie S, et al. Current perspectives on the use of meditation to reduce blood pressure. International Journal of Hypertension. 2012;2012:578397.
• Goyal M, Singh S, Sibinga EM, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine. 2014;174(3):357–368.
• Greeson JM, Webber DM, Smoski MJ, et al. Changes in spirituality partly explain health-related quality of life outcomes after Mindfulness-Based Stress Reduction. Journal of Behavioral Medicine. 2011;34(6):508–518.
• Jedel S, Hoffman A, Merriman P, et al. A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis. Digestion. 2014;89:142–155.
• Lakhan SE, Schofield KL. Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PLoS One. 2013;26;8(8):e71834.
• Luders E. Exploring age-related brain degeneration in meditation practitioners. Annals of the New York Academy of Sciences. 2013;1307:82–88.
• Luders E, Kurth F, Mayer EA, et al. The unique brain anatomy of meditation practitioners: alterations in cortical gyrification. Frontiers in Human Neuroscience. 2012;6:1–9.
• Nidich SI, Rainforth MV, Haaga DAF, et al. A randomized controlled trial on effects of the transcendental meditation program on blood pressure, psychological distress, and coping in young adults. American Journal of Hypertension. 2009;22(12):1326–1331.
• Morgan N, Irwin MR, Chung M, et al. The effects of mind-body therapies on the immune system: meta-analysis. PLOS One. 2014;9(7):1–14.
• Ong JC, Manber R, Segal Z, et al. A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep. 2014;37(9):1553–1563.
• Reiner K, Tibi L, Lipsitz JD. Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Medicine. 2013;14:230–242.
• Rosenkranz M, Davidson RJ, MacCoon D, et al. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain, Behavior, and Immunity. 2013;27(1):174–184.
• Rubia K. The neurobiology of meditation and its clinical effectiveness in psychiatric disorders. Biological Psychology. 2009;82(1):1–11.
• Tang Y-Y, Tang R, Posner MI. Brief meditation training induces smoking reduction. Proceedings of the National Academy of Sciences. 2013;110(34):13971–13975.
• Westbrook C, Creswell JD, Tabibnia G, et al. Mindful attention reduces neural and self-reported cue-induced craving in smokers. Social Cognitive and Affective Neuroscience. 2013;8(1):73–84.
• Zeidan F, Adler-Neal AL, Wells RE, et al. Mindfulness-meditation-based pain relief is not mediated by endogenous opioids. Journal of Neuroscience. 2016;36(11):3391–3397.

Yoga:

• Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. CDC National Health Statistics Report #12. 2008.
• Birdee GS, Legedza AT, Saper RB, et al. Characteristics of yoga users: results of a national survey. Journal of General Internal Medicine. 2008; 23(10):1653–1658.
• Bower JE, Woolery A, Sternlieb B, et al. Yoga for cancer patients and survivors. Cancer Control. 2005;12(3):165–171.
• Bureau of Labor Statistics. U.S. Department of Labor. Occupational Outlook Handbook, 2010–11 Edition: Fitness Workers. Bureau of Labor Statistics Web site. Accessed at http://www.bls.gov/ooh/personal-care-and-service/fitness-trainers-and-instructors.htm on January 24, 2012.
• Kiecolt-Glaser JK, Christian L, Preston H, et al. Stress, inflammation, and yoga practice. Psychosomatic Medicine. 2010;72(2):113–121.
• Lipton L. Using yoga to treat disease: an evidence-based review. JAAPA. 2008;21(2):34–36, 38, 41.
• Oken BS, Zajdel D, Kishiyama S, et al. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Alternative Therapies in Health and Medicine. 2006;12(1):40–47.
• Raub, JA. Psychophysiologic effects of hatha yoga on musculoskeletal and cardiopulmonary function: a literature review. The Journal of Alternative and Complementary Medicine. 2002;8(6):797–812.
• Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. Journal of Alternative and Complementary Medicine. 2010;16(1):3–12.
• Sherman KJ, Cherkin DC, Wellman RD, et al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Archives of Internal Medicine. 2011;171(22):2019–2026.
• Tilbrook HE, Cox H, Hewitt CE, et al. Yoga for chronic low back pain: a randomized trial. Annals of Internal Medicine. 2011;155(9):569–578.
• Uebelacker LA, Epstein-Lubow G, Gaudiano BA, et al. Hatha yoga for depression: a critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. Journal of Psychiatric Practice. 2010; 16(1):22–33.
• Williams K, Abildso C, Steinberg L, et al. Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine. 2009;34(19):2066–2076.
• Wren AA, Wright MA, Carson JW, et al. Yoga for persistent pain: new findings and directions for an ancient practice. Pain. 2011;152(3):477–480.

Acknowledgments

Accupuncture: NCCIH thanks the following people for their technical expertise and review of this publication: Lixing Lao, Ph.D., University of Maryland School of Medicine; Karen Sherman, Ph.D., M.P.H., Group Health Research Institute, Seattle; Maria E. Suarez-Almazor, M.D., Ph.D., The University of Texas M.D. Anderson Cancer Center; and Kristin Huntley, Ph.D., Partap Khalsa, D.C., Ph.D., and John (Jack) Killen, Jr., M.D., NCCIH.

Meditation: NCCIH thanks the following individuals for their technical expertise and review of the 2014 edition of this publication: Richard J. Davidson, Ph.D., Vilas Professor, Psychology and Psychiatry, University of Wisconsin-Madison; Jeffrey M. Greeson, Ph.D., M.S., Assistant Professor, Psychiatry and Behavioral Sciences, Duke University Medical Center; Helané Wahbe, N.D., Assistant Professor, Neurology, Oregon Health & Science University; and John Glowa, Ph.D., and John (Jack) Killen, Jr., M.D., NCCIH. Thank you to David Shurtleff, Ph.D., NCCIH, for his review of the current edition of this publication.

Yoga: NCCIH thanks the following people for their technical expertise and review of this publication: Janice K. Kiecolt-Glaser, Ph.D., Department of Psychiatry and Institute for Behavioral Medicine Research, Ohio State University College of Medicine; Barry S. Oken, M.D., Departments of Neurology, Behavioral Neuroscience, and Physiology & Pharmacology, Oregon Health & Science University; Karen J. Sherman, Ph.D., M.P.H., Group Health Research Institute; John R. Glowa, Ph.D., and John (Jack) Killen, Jr., M.D., NCCIH.