MIND-BODY MEDICINE

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A SCIENTIFIC LOOK AT ALTERNATIVE MEDICINE

Mind-Body Medicine and Other Approaches Related to Mental Health and Brain Function

Thomas J. Wheeler, PhD

Associate Professor (retired), Department of Biochemistry and Molecular Biology,

University of Louisville School of Medicine, Louisville KY

thomas.wheeler@louisville.edu

Revised 2026

Copyright 2026. Permission to copy for non-profit uses is granted as long as proper citation of the source is given.

DISCLAIMER: The material presented here is not medical advice. It represents the author's summary of scientific evidence concerning various topics. For medical advice, see your physician.

Edzard Ernst ratings: some of the approaches described in this article have been evaluated by Edzard Ernst in his book “Alternative Medicine: A Critical Assessment of 202 Modalities” (Second Edition. Springer, 2022). For each approach, Ernst evaluated five criteria (plausibility, efficacy, safety, cost, and risk/benefit balance) with three possible grades (positive, debatable, or negative).

Abbreviations: NCCAM, National Center for Complementary and Alternative Medicine; NCCIH, National Center for Complementary and Integrative Health; RCT, randomized controlled trial

CONTENTS

Mind-body medicine - general

Mind-body medicine - techniques (including meditation, mindfulness, music therapy, relaxation, and others)

Placebo effects

Hypnosis

Biofeedback 

Causes and treatment of autism

Treatment of other conditions (including Alzheimer’s, other forms of dementia, and mental function; anxiety; ADHD; depression; and others)

Other unconventional practices related to mental health (including brain stimulation, brain training, Emotional Freedom Technique, EMDR, Facilitated Communication and variants, SPECT, and many others)

References

                                    MIND-BODY MEDICINE - GENERAL

"Mind-body medicine focuses on the interactions among the brain, mind, body, and behavior, and on the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health. It regards as fundamental an approach that respects and enhances each person's capacity for self-knowledge and self-care, and it emphasizes techniques that are grounded in this approach" (NCCAM 2007. Mind-body medicine: An overview).

“The National Center for Complementary and Integrative Health (NCCIH) now classifies complementary approaches by their primary therapeutic input (how the therapy is taken in or delivered). What were previously referred to as mind and body practices are now categorized as psychological, physical, or combined psychological-physical approaches. Here are some examples:

    Psychological approaches: meditation, mindfulness, music therapies

    Physical approaches: acupuncture, massage, spinal manipulation

    Psychological-physical combination approaches: yoga, tai chi, dance therapies”

(NCCIH 2025. Mind and body practices.)

Ernst (2022. Alternative Medicine: A Critical Assessment of 202 Modalities) wrote: “Some proponents of mind-body therapies seem to assume that, conventional clinicians are unaware that the mind can influence them and claim that they adhere to the long obsolete division between the mind and body. The mind, emotions, and attention play important roles in the experience of many symptoms, for instance, pain. Conventional medicine does not only account for this fact but also exploits it in numerous ways. Most mind-body therapies are supposed to induce a degree of relaxation which, in turn, can lead to a reduction of many symptoms...Mind-body therapies are usually not curative but symptomatic treatments. Thus, they are rarely used as sole therapies but employed in conjunction with further treatments which often makes it difficult to know their relative contributions to the clinical outcome. Most mind-body therapies can be delivered to groups of patients which, for a range of reasons, can be preferable to individual therapy.”

Proposed mechanisms

Beyond dealing with pain, emotional and mental states are also thought to influence the body's ability to fight disease through the immune system.

Stress may cause or contribute to various diseases:

1.   Stress causes release of glucocorticoids via the hypothalamic-pituitary-adrenal axis. Acutely this can activate the immune system, but chronic glucocorticoid release will down-regulate the immune system and lead to increased disease susceptibility.

2.   Other physiological responses that are useful in stress (increased pulse and blood pressure, increased blood glucose, decreased gastrointestinal tract activity) can be harmful if continued chronically.

Thus, relief of stress may lessen an underlying cause or contributing factor for various conditions.

McEwen (1998. New Engl J Med. 338(3):171-9) discussed “the long-term effect of the physiologic response to stress, which I refer to as allostatic load...One speculation is that allostatic load over a lifetime may cause the allostatic systems to wear out or become exhausted. A vulnerable link in the regulation of the HPA axis and cognition is the hippocampal region. According to the ‘glucocorticoid-cascade hypothesis,’ wear and tear on this region of the brain leads to dysregulation of the HPA axis and cognitive impairment...inadequate responses by some allostatic systems trigger compensatory increases in others. When one system does not respond adequately to a stressful stimulus, the activity of other systems increases, because the underactive system is not providing the usual counterregulation. For example, if cortisol secretion does not increase in response to stress, secretion of inflammatory cytokines (which are counterregulated by cortisol) increases.”

Arguments in favor

Evidence for connections between the brain and the immune system has led to an area of research called psychoneuroimmunology.

Communication between the brain and the immune system:

1.     The brain can release peptide hormones (neuropeptides) that can affect the immune system.

2.     There are also nerves connecting the brain directly to some cells of the immune system.

3.     The immune system can release hormones (e.g., the cytokine interleukin-1) that affect the brain and other organs.

Animal studies showed that disruptions in these communications (by mutation, pharmacological intervention, or surgery) increases the susceptibility to inflammatory disease, as the brain does not properly down-regulate the immune system.

"There is considerable evidence that emotional traits, both negative and positive, influence people's susceptibility to infection" (NCCAM 2007. Mind-body medicine: An overview).

Studies on animals and people indicate that stress can affect the immune system (though the effects are complex, and do not always suppress the immune system). A stressful lifestyle is associated with increased infection and poorer health in general. Hostility is associated with more heart attacks.

Mind-body therapies may improve the quality of life for patients even if their diseases are not overcome.

"...The physical and emotional risks of using these interventions are minimal. Moreover, once tested and standardized, most mind-body interventions can be taught easily" (NCCAM 2007. Mind-body medicine: An overview).

Reviews (2000-later)

Astin et al. 2003. J Am Board Fam Pract. 16(2):131-47: “there is considerable evidence of efficacy for several mind-body therapies in the treatment of coronary artery disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. We found moderate evidence of efficacy for mind-body therapies in the areas of hypertension and arthritis.”

NCCAM 2007. Mind-body medicine: An overview: "Evidence from multiple studies with various types of cancer patients suggests that mind-body interventions can improve mood, quality of life, and coping, as well as ameliorate disease and treatment-related symptoms, such as chemotherapy-induced nausea, vomiting, and pain...Multicomponent mind-body interventions that include some combination of stress management, coping skills training, cognitive-behavioral interventions, and relaxation therapy may be appropriate adjunctive treatments for coronary artery disease and certain pain-related disorders, such as arthritis."

Wahbeh et al. 2008. Neurology. 70(24):2321-8: “There are several conditions where the evidence for mind-body therapies is quite strong such as migraine headache. Mind-body therapies for other neurology applications have limited evidence due mostly to small clinical trials and inadequate control groups.”

Bertisch et al. 2009. J Psychosom Res. 66(6):511-9: Evidence suggests that mind-body techniques, "such as progressive muscle relaxation and yoga, may effectively treat insomnia and low back pain."

Critiques

Mind-body therapies may raise false hopes of recovery. Patients may blame themselves for causing the disease or for failing to get well.

In some studies, techniques were combined with other factors (diet, exercise) so it is difficult to evaluate the effect of mental aspects. For subjective outcomes (e.g., perception of pain), placebo effects are possible. Correlation of recovery or survival with attitude or social support may be misleading - patients with better attitude and support may comply better with medication, recommended exercise, etc.

Several authors, reviews, and clinical trials have concluded that there is no good evidence that mind-body therapies can affect the incidence or progression of cancer. "Some studies have suggested that mind-body interventions can alter various immune parameters, but it is unclear whether these alterations are of sufficient magnitude to have an impact on disease progression or prognosis" (NCCAM 2007. Mind-body medicine: An overview). A study by Spiegel indicating benefits from psychosocial support on breast cancer survival (Spiegel et al. 1989. Lancet. 2(8668):888-91) has been criticized, for example, by Sampson (2002. Semin Oncol. 29(6):595-600) and Coyne et al. (2007. Psychol Bull. 133(3):367-94). Spiegel’s own replication study was unsuccessful (Spiegel et al. 2007. Cancer.110(5):1130-8).

A meta-analysis of effects of psychological intervention on the immune system (Miller and Cohen 2001. Health Psychol. 20(1):47-63) concluded that there was “only modest evidence that interventions can reliably alter immune parameters.”

Concerning claims that mind-body practices could “reprogram your DNA,” Gorski (2017 Jun 26. Science-Based Medicine) wrote “None of this means that I don’t find it fairly plausible that various exercise regimens could decrease the level of pro-inflammatory gene expression. I even find it plausible that relaxation and meditation might result in similar effects. It is, however a long stretch to claim that such activities ‘reprogram your DNA’ in that changing gene expression doesn’t require doing anything to the DNA itself, just changing levels of the proteins that regulate expression of the genes whose levels change.”

Ernst (2022. Alternative Medicine: A Critical Assessment of 202 Therapies) wrote, “For several mind-body therapies, the evidence is encouraging but rarely compelling. This is usually due to several issues: a paucity of studies, the methodological problems encountered when conducting such clinical trials, the low quality of the existing trials, and the lack of research funds in this area.”

Other points

Nerurkar et al. (2011. Arch Intern Med. 171(9):862-4) analyzed National Health Interview Survey data from 2007. They found that increasing use of mind-body medicine was a large factor in the increase in complementary and alternative medicine. Usage of physician-referred mind-body therapies (P-MBT) was 2.9% of Americans, vs. 15.5% for self-referred usage (S-MBT). "Deep breathing exercises were the most common P-MBT used (84.4%), followed by meditation (49.3%), yoga (22.6%), progressive muscle relaxation (19.9%), and guided imagery (13.9%); similar trends were seen in the S-MBT group." A story on the study quoted Dr. Nerurkar: "What we learned suggests that providers are referring their patients for mind-body therapies as a last resort once conventional therapeutic options have failed. It makes us wonder whether referring patients for these therapies earlier in the process could lead to less use of the health care system, and possibly, better outcomes for these patients" (Newswise 2011 May 9).

Bertisch et al. (J Psychosom Res. 66(6):511-9), analyzing 2002 data, found that mind-body therapies were most frequently used for anxiety/depression, back pain, and various other types of pain.

Summary

A growing body of evidence indicates that mental attitudes can affect the incidence and progress of disease, though many results need to be confirmed with more research. Applying the various techniques described above may help patients, as long as they do not have unrealistic expectations.

Edzard Ernst rating for mind-body medicine as a whole: Plausibility: positive. Efficacy: debatable-positive. Safety: positive. Cost: positive. Risk/benefit balance: debatable-positive.

MIND-BODY MEDICINE: TECHNIQUES

Deep breathing

“Studies have shown that slow, deep breathing (also called diaphragmatic breathing) exercises may modestly lower blood pressure and reduce levels of cortisol...There is evidence that deep breathing reduces glycemia (the concentration of glucose or sugar in the blood) in people with type 2 diabetes, which may make it a useful addition to standard care for this condition” (NCCIH 2022. Stress).

Reviews:

• Chaddha et al. 2019. Complement Ther Med. 45:179-84: “Slow breathing showed a modest reduction in blood pressure. It may be a reasonable first treatment for low-risk hypertensive and prehypertensive patients who are reluctant to start medication.”

• Hopper et al. 2019. JBI Database System Rev Implement Rep. 17(9):1855-76: “The evidence suggests that diaphragmatic breathing may decrease stress as measured by physiologic biomarkers, as well psychological self-report tools. “

Guided imagery

“Imagery (also called guided imagery or visualization) is an alternative therapy where the patient is taught by a trained practitioner to evoke certain mental images, sounds, tastes, smells, or other sensations associated with certain therapeutic aims...often recommended as a symptomatic therapy for a range of conditions and is normally used in addition to other treatments...It is easy to use and can be learned quickly and economically, for instance, in groups or via a video...Imagery is said to alleviate symptoms such as pain, stress, anxiety and low mood...Proponents of guided imagery also claim that this technique can improve general health, creativity, and mental health as well as physical performance...Imagery is normally a safe therapy. Yet in some people, guided imagery can exacerbate or aggravate mental and physical conditions; for example, it can worsen the symptoms of post-traumatic stress disorder, phobias, and other mental problems” (Ernst 2022. Alternative Medicine: A Critical Assessment of 202 Modalities).

Ernst (2023 Apr 4. Edzard Ernst blog) wrote, “I happen to think that guided imagery is a promising albeit under-researched therapy. Therefore, I am particularly frustrated to see that the few trials that do emerge of this option are woefully inadequate to determine its value.”

Reviews:

• Meeus et al. 2015. Clin Rehabil. 29(3):221-33 [chronic fatigue syndrome and fibromyalgia]: “There is moderate evidence for the acute effect of guided imagery on pain, although the content of the visualization is a matter of debate.”

• Giacobbi et al. 2015. Pain Manag Nurs. 16(5):792-803: “Guided imagery appears to be beneficial for adults with AORD [arthritis and other rheumatic diseases].”

Edzard Ernst rating: Plausibility: positive. Efficacy: positive. Safety: positive. Cost: positive. Risk/benefit balance: positive.

Laughter therapy

“Laughter or humour therapy is the use of laughter for therapeutic purposes. Laughter therapy is mostly practised in groups. In some hospitals, clowns are also employed for laughter therapy of children. The contagious nature of laughter is used to make participants laugh. Consequently, they relax which can have positive effects on health” (Ernst 2024 Sep 14. Edzard Ernst blog).

“Laughter is said to decrease blood levels of cortisol, epinephrine, growth hormone, and 3,4-dihydrophenylacetic acid (a major dopamine catabolite), indicating a reversal of the stress response. Laughter therapy is claimed to provide physical benefits, such as helping to:

• Relax muscles throughout the body

• Trigger the release of endorphins (the body’s natural painkillers)

• Relieve pain

• Improve mental functions (i.e., alertness, memory, creativity)

• Improve overall attitude and well-being

• Reduce stress/tension

• Improve sleep

• Strengthen social bonds and relationships.

“Many of these outcomes are, however, not as well-documented as claimed by proponents...

So, there is a surprising amount of encouraging evidence. But there is also a void of answers to important questions, e.g.:

• How do the effects compare to conventional treatments?

• How long do the effects last?

• How expensive is the treatment?

• How easy is it to implement in a hospital setting?” (Ernst 2025 Jun 25. Edzard Ernst blog).

Reviews:

• Mora-Ripoll 2010. Altern Ther Health Med. 16(6):56-64: “Although there is not enough data to demonstrate that laughter is an all-around healing agent, this review concludes that there exists sufficient evidence to suggest that laughter has some positive, quantifiable effects on certain aspects of health.”

• Sridharan and Sivaramakrishnan. 2016. Eur J Pediatr. 175(10):1353-60: “We found that hospital clowns play a significant role in reducing stress and anxiety levels in children admitted to hospitals as well as their parents.”

• Zhang et al. 2017. J Paediatr Child Health. 53(3):237-45: “While significant variability existed between studies, the meta-analysis confirmed the effectiveness of pre-operative clown therapy on reducing psychological distress in children and parents.”

• Stiwi et al. 2022. Complement Ther Clin Pract. 47:101552: “Laughter-inducing interventions can have beneficial effects on a variety of health-related outcomes including mental health, physical health, and physiological parameters.”

Edzard Ernst rating: Plausibility: positive. Efficacy: positive. Safety: positive. Cost: positive. Risk/benefit balance: positive.

Meditation (see also mindfulness and Transcendental Meditation)

"There are many types of meditation, most of which originated in ancient religious and spiritual traditions. Generally, a person who is meditating uses certain techniques, such as focusing attention (for example, on a word, an object, or the breath); a specific posture; and an open mind toward distracting thoughts and emotions. Meditation can be practiced for various reasons - for example, with an intent to increase physical relaxation, mental calmness, and psychological balance; to cope with one or more diseases and conditions; and for overall wellness" (NCCAM 2006. Meditation for health purposes). “Meditation and mindfulness may help reduce symptoms of anxiety, depression, and post-traumatic stress disorder. Meditation may also benefit people with insomnia and those with substance use disorder” (NCCIH 2025. Mind and body practices). “Clinical practice guidelines issued in 2014 by the Society for Integrative Oncology recommend meditation as supportive care to reduce stress, anxiety, depression, and fatigue in patients treated for breast cancer” (NCCIH 2022. Stress).

“According to the National Health Interview Survey...the percentage of U.S. adults who practiced meditation more than doubled between 2002 and 2022, from 7.5 to 17.3 percent. Of seven complementary health approaches for which data were collected in the 2022 survey, meditation was the most popular...For children aged 4 to 17 years, data are available for 2017; in that year, 5.4 percent of U.S. children used meditation” (NCCIH 2022. Meditation and mindfulness: Effectiveness and safety).

“Meditation science is now entering a third wave, exploring what we call advanced meditation - deeper and more intense states and stages of practice that often require extended training and can be experienced through increasing mastery. University research programs are being established to study these altered mental states...” (Sacchet and Brewer 2024. Scientific American. 331(1):70-5).

Mechanisms: "Functional magnetic resonance imaging (fMRI) has been used to identify and characterize the brain regions that are active during meditation. This research suggests that various parts of the brain known to be involved in attention and in the control of the autonomic nervous system are activated, providing a neurochemical and anatomical basis for the effects of meditation on various physiological activities...meditation has been shown in one study to produce significant increases in left-sided anterior brain activity, which is associated with positive emotional states. Moreover, in this same study, meditation was associated with increases in antibody titers to influenza vaccine, suggesting potential linkages among meditation, positive emotional states, localized brain responses, and improved immune function" (NCCAM 2007. Mind-body medicine: An overview).

Effects of meditation “are seen primarily in three brain regions: the posterior cingulate cortex, the hippocampus, and the amygdala. The posterior cingulate cortex...is involved in mind wandering and in one’s sense of self. In meditators, this region is quieter than it is in non-meditators...The hippocampus, on the other hand, is responsible for learning, memory, and tasks like planning and problem-solving...In fact, both gray matter and white matter increase in the hippocampus when people meditate regularly...The simultaneous increase in these two tissues therefore mean that the hippocampus becomes better at processing information and faster at conveying that information to other parts of the body. While the long-term meditator’s hippocampus is ‘bulking up’...their amygdala is trimming down. And that’s a positive thing, too, as the amygdala is all about fear and emotional reactivity. In stressful situations, this brain region activates, but thanks to meditation, ‘we see that it becomes less active during threatening conditions,’ [Sarah] Lazar says” (Hurt 2025 Nov/Dec. Discover. 24-5).

Reviews:

Multiple conditions:

• Goyal et al. 2014. JAMA Intern Med. 174(3):357-68: “Mindfulness meditation programs had moderate evidence of improved anxiety..., depression..., and pain... and low evidence of improved stress/distress and mental health-related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies).”

Blood pressure:

• Pascoe et al. 2017. J Psychiatr Res. 95:156-178: “All meditation subtypes reduced systolic blood pressure. Focused attention meditations also reduced cortisol and open monitoring meditations also reduced heart rate. When all meditation forms were analysed together, meditation reduced cortisol, C-reactive protein, blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha. Overall, meditation practice leads to decreased physiological markers of stress in a range of populations.”

• Wankhar et al. 2024. Cureus. 16(4):e58434 [meditation, mindfulness, and other mind-body medicine practices]: “The findings of the meta-analysis suggest that MBM interventions may improve systolic blood pressure alone in patients with cardiac diseases. With high heterogeneity and low quality of the included studies, more robust evidence is required before suggesting MBM as an effective treatment modality for reducing blood pressure in cardiovascular diseases.”

Cardiovascular disease:

• Rees et al. 2024.Cochrane Database Syst Rev. CD013358 [primary and secondary prevention of cardiovascular disease]: “Overall, we found very little information on the effects of meditation on CVD clinical endpoints, and limited information on blood pressure and psychological outcomes, for people at risk of or with established CVD.” One of the authors of this review commented, “As our review demonstrates, meditation and similar treatments are not nearly as well supported by evidence as their proponents try to make us believe. In other words, the often-voiced claims that such therapies are effective for the primary and secondary prevention of cardiovascular disease are largely unfounded” (Ernst 2024 Feb 20. Edzard Ernst blog).

Epilepsy:

• Singh et al. 2026. Complement Ther Med. 98:103351: “Meditation appears to be a promising adjunctive therapy for improving psychological well-being and potentially modulating cortical excitability in epilepsy.”

Pain:

• Garland et al. 2020. JAMA Intern Med. 180(1):91-105 [opioid-treated pain]: “Moderate to large effect size improvements in pain outcomes were found for meditation...”

Critiques:

Ospina et al. (2007. Evid Rep Technol Assess. (155):1-263) wrote "Scientific research on meditation practices does not appear to have a common theoretical perspective and is characterized by poor methodological quality. Firm conclusions on the effects of meditation practices in healthcare cannot be drawn based on the available evidence...TM® [Transcendental Meditation] had no advantage over health education to improve measures of systolic blood pressure and diastolic blood pressure, body weight, heart rate, stress, anger, self-efficacy, cholesterol, dietary intake, and level of physical activity in hypertensive patients; RR [relaxation response] was not superior to biofeedback in reducing blood pressure in hypertensive patients; Yoga did not produce clinical or statistically significant effects in blood pressure when compared to nontreatment; Zen Buddhist meditation was no better than blood pressure checks to reduce systolic blood pressure in hypertensive patients. Yoga was no better than physical exercise to reduce body weight in patients with cardiovascular disorders."

Coyne (2019 Apr 1. Science-Based Medicine blog) wrote, “The first thing that strikes me when looking at the evidence on meditation is that it is highly confusing. There seem to be:

• a lack of clear definitions,

• hundreds of studies, most of which are of poor or even very poor quality,

• lots of people with ’emotional baggage’,

• plenty of strange links to cults and religions,

• dozens of different meditation methods and regimen,

• unbelievable claims by enthusiasts,

• lots of weirdly enthusiastic followers.

“...once we look at the reliable medical evidence, we are bound to find that the health claims of various meditation techniques are hugely exaggerated. There is almost no strong evidence to suggest that meditation does affect any condition. The small effects that do emerge from some meta-analyses could easily be due to residual bias and confounding; it is not possible to rigorously control for placebo effects in clinical trials of meditation...For me, however, the biggest danger with (certain forms of) meditation is not the risk of psychosis. It is the risk of getting sucked into a cult that then takes over the victim and more or less destroys his or her personality. I have seen this several times, and it is a truly frightening phenomenon

“You would never know the scientific status of meditation from the way it is portrayed in media. Although some cracks are developing in the façade, the media is almost uniformly positive in extolling the benefits of meditation for our mental and physical health, our close relationships, and our work performance. There is a strong message that we are not doing all that we can do to be all we can be unless we are meditating. Yet, the evidence for practicing meditation, rather than doing something else to get the same benefits, is weak...The typical randomized trial of meditation remains a small, unblinded study without an adequate, active treatment comparison/control group. Almost all studies depend on subjective self-report to assess outcomes...The choice of comparison group stacks the deck almost to guarantee positive results, if there is a large enough sample. There is also confirmation bias, as analyses and papers that obtain positive results are more likely to get published.”

“However, much of the research on these topics has been preliminary or not scientifically rigorous. Because the studies examined many different types of meditation and mindfulness practices, and the effects of those practices are hard to measure, results from the studies have been difficult to analyze and may have been interpreted too optimistically” (NCCIH 2022. Meditation and mindfulness: Effectiveness and safety).

A review by Farias et al. (2020.  Acta Psychiatr Scand. 142(5):374-93) found that “the occurrence of AEs [adverse effects] during or after meditation practices is not uncommon, and may occur in individuals with no previous history of mental health problems.”

Edzard Ernst rating: Plausibility: positive. Efficacy: debatable. Safety: positive. Cost: positive. Risk/benefit balance: debatable.

Mindfulness (see also meditation)

Mindfulness "originated in Buddhism. It is based on the concept of being mindful, or having an increased awareness and total acceptance of the present. While meditating, the meditator is taught to bring all her attention to the sensation of the flow of the breath in and out of the body. The intent might be described as focusing attention on what is being experienced, without reacting to or judging that experience. This is seen as helping the meditator learn to experience thoughts and emotions in normal daily life with greater balance and acceptance" (NCCAM 2006. Meditation for Health Purposes). The concept of mindfulness-based stress reduction was developed in the 1970s by Jon Kabat-Zinn at the University of Massachusetts Medical Center.

“Many experts do not consider mindfulness to be an alternative therapy but see it as a set of psychological methods that have long become well-accepted, conventional treatments...Mindfulness programmes are currently popular and have been widely adopted in schools, hospitals, and other settings. They are also being applied to initiatives such as for healthy aging, weight management, athletic performance enhancement, for children with special needs, and as a help during the perinatal period” (Ernst 2022. Alternative Medicine: A Critical Assessment of 202 Modalities).

“Although commonly associated with meditation, mindfulness and meditation are not interchangeable terms. Mindfulness meditation encompasses a wide range of practices with varying objectives, whereas mindfulness itself can be conceptualized as a cognitive state, a cultivated disposition, or an intentional practice”(Lizama-Lefno et al. 2026. Healthcare (Basel). 14(2):196).

“Mindfulness-Based Therapies (MBTs) are a set of interventions that integrate meditative practices within psychotherapy, emphasizing acceptance, metacognition, and cognitive flexibility. Among the most established MBTs are Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT). Additionally, some third-wave cognitive–behavioral therapies, such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT), incorporate mindfulness techniques within broader clinical frameworks” (Ibid.).

“...Mindfulness-based interventions can be conceptually understood as operating through three complementary mechanisms: (a) attentional regulation cultivated by meditation, which enhances present-moment awareness; (b) cognitive restructuring facilitated by psychoeducation, which supports reappraisal and emotional understanding; and (c) behavioral integration achieved through informal practice, which consolidates learned skills into daily life”  (Ibid.).

There has been an explosion in research related to mindfulness in recent years, with thousands of papers per year referencing the term.

"There are nearly 1,000 certified MBSR [mindfulness-based stress reduction] instructors teaching mindfulness techniques (including meditation), and they are in nearly every state and more than 30 countries" (Pickert 2014 Feb 3. Time). "But mindfulness has reached far more people than those who have attended an MBSR class. Whereas tens of thousands of individuals have enrolled in an MBSR program, several millions have read or listened to mindfulness self-help books or recordings" (Barker 2014. Soc Sci Med. 106:168-76).

“In a 2012 U.S. survey, 1.9 percent of 34,525 adults reported that they had practiced mindfulness meditation in the past 12 months. Among those responders who practiced mindfulness meditation exclusively, 73 percent reported that they meditated for their general wellness and to prevent diseases, and most of them (approximately 92 percent) reported that they meditated to relax or reduce stress. In more than half of the responses, a desire for better sleep was a reason for practicing mindfulness meditation” (NCCIH 2022. Meditation and mindfulness: Effectiveness and safety).

Reviews:

Multiple conditions:

• Coronado-Montoya et al. 2016. PLoS One. 11(4):e0153220): “In summary, MBT [mindfulness-based therapy] appears to be a low-cost and easily implemented treatment that may be useful for providing effective mental health care to the large number of patients who are currently under-served. However, the proportion of positive trials that are reported, despite small sample sizes and low statistical power are concerning.”

• Goldberg et al. 2018. Clin Psychol Rev. 59:52-60 [psychiatric disorders]: Mindfulness approaches had similar effectiveness to evidence-based treatments and were superior to no treatment.

Anxiety:

• Haller et al. 2021. Sci Rep. 11(1):20385: “In comparison to Cognitive Behavioral Therapy (CBT), ACT [Acceptance and Commitment Therapy] MBCT [Mindfulness-Based Cognitive Therapy] showed comparable effects on both anxiety outcomes, while MBSR [Mindfulness-Based Stress Reduction] showed significantly lower effects...The evidence suggests short-term anxiolytic effects of acceptance- and mindfulness-based interventions. Specific treatment effects exceeding those of placebo mechanisms remain unclear.”

Blood pressure:

• Intarakamhang et al. 2020. Heliyon. 6(4):e03834: “MBIs [mindfulness-based interventions] can provide effective alternative therapies to assist in blood pressure reduction for patients with NCDs [non-communicable diseases].”

• NCCIH 2022. Meditation and mindfulness: effectiveness and safety: “Few high-quality studies have examined the effects of meditation and mindfulness on blood pressure. According to a 2017 statement from the American Heart Association, the practice of meditation may have a possible benefit, but its specific effects on blood pressure have not been determined.”

Cancer:

• Zhang et al. 2016. Complement Ther Med. 2016 Jun;26:1-10 [breast cancer]: “Significant positive effects were seen for anxiety, depression, fear of recurrence, and fatigue. Although the effects on stress, spirituality, pain and sleep were in the expected direction, they were not statistically significant (P>0.05). Moreover, there is limited evidence from a narrative synthesis that MBT [mindfulness-based therapy] can improve QOL [quality of life] of breast cancer patients.”

• Cillessen et al. 2019. Psychooncology. 28(12):2257-69: “MBIs appear efficacious in reducing psychological distress and other symptoms in cancer patients and survivors. However, many of the effects were of small magnitude, suggesting a need for intervention optimization research.”

Pain:

• Hilton et al. 2017. Ann Behav Med. 51(2):199-213 [chronic pain]: “We found low-quality evidence that mindfulness meditation is associated with a small decrease in pain compared with all types of controls...”

• Khoo et al. 2019. Evid Based Ment Health. 22(1):26-35 [chronic pain]: “Findings...revealed clinically important advantages relative to control for MBSR [mindfulness-based stress reduction] and CBT [cognitive-behavioral therapy], but no evidence of an important difference between MBSR and CBT was found.”

• Anheyer et al. 2019. Cephalalgia. 39(4):544-55 [chronic headache]: “Due to the low number, small scale and often high or unclear risk of bias of included randomized controlled trials, the results are imprecise; this may be consistent with either an important or negligible effect.”

• NCCIH 2022. Meditation and mindfulness: effectiveness and safety: “A 2020 report by the Agency for Healthcare Research and Quality concluded that mindfulness-based stress reduction was associated with short-term (less than 6 months) improvement in low-back pain but not fibromyalgia pain.”

• Cardle et al. 2023. J Multidiscip Healthc. 16:515-33: “This umbrella review found mixed results on the effectiveness of MBI for the management of CMSP [chronic musculoskeletal pain] across a range of outcomes (pain, sleep quality, depression, quality of life, physical functioning, mindfulness).”

Sleep:

• Rusch et al. 2019. Ann N Y Acad Sci. 1445(1):5-16: “These preliminary findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance.”

Substance use disorder:

• de Souza et al. 2015. J Altern Complement Med. 21(3):129-40: “Mindfulness appears to induce positive effects on mental health, which might contribute to the maintenance of tobacco abstinence.”

• Grant et al. 2017. J Addict Med. 11(5):386-96: “We have limited confidence in estimates suggesting MBRP [mindfulness-based relapsed prevention] yields small effects on withdrawal/craving and negative consequences versus comparator interventions. We did not detect differences for any other outcome.”

• Cavicchioli et al. 2018. Eur Addict Res. 24(3):137-62: “MBIs [mindfulness-based interventions] seemed to show clinically significant advantages compared to other clinical approaches in relation to specific primary and secondary outcomes.”

Weight loss:

• Rogers et al. 2017. Obes Rev. 18(1):51-67: “Mindfulness-based interventions may be both physically and psychologically beneficial for adults who are overweight or obese, but further high-quality research examining the mechanisms of action are encouraged.”

• Carrière et al. 2018. Obes Rev. 19(2):164-77: “Results suggest that MBIs are effective in reducing weight and improving obesity-related eating behaviours among individuals with overweight and obesity. Further research is needed to examine their efficacy for weight loss maintenance.”

Critiques:

Novella (2017 Oct 18. Science-Based Medicine blog), citing Van Dam et al. (2018. Perspect Psychol Sci. 13(1):36-61), wrote: “As the authors point out, there are significant problems with the mindfulness research and the overhyped claims that are being made for this intervention. Problems begin with the very first criterion of science-based practice – lack of an operational definition...Mindfulness research, as the authors point out, is plagued by a lack of a consistent definition, or one that can be operationalized for research. What is/are the critical component(s) of mindfulness? Is it relaxation, introspection, being in the moment, directing one’s attention, avoiding mind-wandering, or something else?...

“Having followed the mindfulness research for years and discussed it with many proponents, the response is largely the same. The details of specific variables are either poorly understood or debated, and don’t seem to really matter. As long as there is a perceived subjective benefit, that is sufficient justification...Mindfulness, in various studies, can refer to alleged specific mental phenomena such as: ‘psychological distancing/reperceiving, decentering and inhibitory control, nonconceptual discriminatory awareness, acceptance and reintegration, or focused attention, decentering, and meta-awareness.’ That is a pretty big umbrella. Proponents have also argued that mindfulness is partly relaxation, partly cognitive therapy, and partly developing vaguely defined mental skills related to the above. This creates a further problem – how do you control for nonspecific results. This gets to the second major issue that the reviewers and others have, most studies of mindfulness are poorly controlled or methodologically weak. Some lack a control group at all. The best studies have active controls, attempting, for example, to control for simple relaxation. But these best studies tend to have the most modest results (a meta-pattern important to note)...

“Likewise I would say that relaxation has health benefits and cognitive therapy potentially has psychological benefits. Mindfulness, taken broadly, seems to be a reasonable practice for relaxation and may have some effects similar to cognitive behavioral therapy. But I am not convinced by the existing research that there is any other phenomenon at work here, that there is something specific to mindfulness, or that it has benefits beyond other similar behaviors.”

Ernst (2022 Feb 12. Edzard Ernst blog) wrote “If you are an advocate of mindfulness, you probably conclude that your pet therapy is supported by reasonably sound evidence. If, however, you think a little more critically, you would probably see that the evidence is far from strong. The effect size is usually small and of doubtful clinical relevance. This is, I think, important because clinical trials of mindfulness cannot easily control for placebo effects...Therefore, the small effects that do emerge in systematic reviews/meta-analyses are most likely the result of a placebo response and not due to mindfulness per se.

“My conclusion is therefore not nearly as positive as that of fans of mindfulness: the collective evidence suggests to me that the success of mindfulness relies mostly or even entirely on the placebo effect. And this means that even dozens of further systematic reviews are not going to advance our knowledge significantly. What is needed, I think, is a few truly rigorous studies aimed at determining whether the effects of mindfulness are specific or non-specific in nature. My prediction is that, once we have this evidence, the current hype around mindfulness will calm down.”

Jarry (2024 Jan 19. McGill Office for Science and Society) commented: “The kicker is that mindfulness is rarely shown to be better than an active control. Many authors of systematic reviews of the evidence will excitedly report that mindfulness showed a small but significant benefit over people in the control group, before quietly adding that there was no difference when mindfulness was strictly compared to active control groups. The conclusion here is that doing something - anything, it would seem - is better than doing nothing...Even when researchers put mindfulness’ best foot forward, the effect it seems to have is small. Despite an accumulation of ho-hum results, I read many discussion sections of papers and quite a few editorials spinning essentially negative results into enthusiasm for future research. This is a good example of the white hat bias, which is when information is distorted because the goal is seen as righteous. It would be great if mindfulness meditation could credibly treat anxiety, insomnia, and pain perception! Thus, many scientists in the field seem intent on proving that mindfulness is good...Sometimes, researchers will report that mindfulness improved a composite score in participants, meaning an aggregate of different measures like anxiety, depression, and stress...but the benefits disappeared when looking only at anxiety or depression...

“Beyond these problems, there is the crucial difference between efficacy and effectiveness...The efficacy of mindfulness is when the intervention is done under ideal conditions; its effectiveness is how it fares in the real world. Those world-famous apps to help you meditate? Maybe they work a little bit, but they certainly don’t work if you don’t use them. When deployed in the context of a study, a quarter of participants abandon them during the study itself...Outside of research projects in which people are told to use a meditation app, the numbers are even worse...For those who stuck with it, the average duration of meditating was less than four minutes a day.”

Lizama-Lefno et al. (2026. Op. cit.) Noted that “Research has consistently indicated that the impact of mindfulness-based interventions is often overstated, particularly when compared with well-established treatments such as cognitive-behavioral therapy. Additionally, when assessing mindfulness-based interventions, it remains unclear which specific components drive therapeutic outcomes and how these interact with other psychological processes.”

Edzard Ernst rating: Plausibility: positive. Efficacy: positive. Safety: positive. Cost: positive. Risk/benefit balance: positive.

Techniques

•    Meditation or visualization of soothing scenes to reduce stress, induce relaxation.

"There are many types of meditation, most of which originated in ancient religious and spiritual traditions.  Generally, a person who is meditating uses certain techniques, such as focusing attention (for example, on a word, an object, or the breath); a specific posture; and an open mind toward distracting thoughts and emotions.  Meditation can be practiced for various reasons - for example, with an intent to increase physical relaxation, mental calmness, and psychological balance; to cope with one or more diseases and conditions; and for overall wellness." (NCCAM, "Meditation for Health Purposes" (2006))

"Functional magnetic resonance imaging (fMRI) has been used to identify and characterize the brain regions that are active during meditation. This research suggests that various parts of the brain known to be involved in attention and in the control of the autonomic nervous system are activated, providing a neurochemical and anatomical basis for the effects of meditation on various physiological activities. Recent studies involving imaging are advancing the understanding of mind-body mechanisms. For example, meditation has been shown in one study to produce significant increases in left-sided anterior brain activity, which is associated with positive emotional states. Moreover, in this same study, meditation was associated with increases in antibody titers to influenza vaccine, suggesting potential linkages among meditation, positive emotional states, localized brain responses, and improved immune function." (NCCAM, "Mind-Body Medicine: An Overview" (2007))

•    In Transcendental Meditation, “practitioners repeat a silent word or phrase (a mantra) with the goal of quieting (and ultimately transcending) the ordinary stream of internal mental dialogue” (Astin et al., J. Am. Board Fam. Pract. 16, 131-147 (2003)).  From the Vedic tradition of India.

•    Silent repetition of a neutral word or phrase (as in transcendental meditation), or of a meaningful word or phrase (possibly associated with one's religious belief).  Slow, rhythmic breathing.  Herbert Benson - relaxation response.

•    Repetition of positive affirmations

•    Guided imagery (may be guided by therapist or tape).  Said to help deal with chronic pain, tumors, infections.  Patients may visualize harmful cells being killed by antibodies or white cells.

•    Relaxation.  In progressive muscle relaxation, muscles are sequentially tensed and relaxed.

•    Mindfulness - "originated in Buddhism.  It is based on the concept of being mindful, or having an increased awareness and total acceptance of the present.  While meditating, the meditator is taught to bring all her attention to the sensation of the flow of the breath in and out of the body.  The intent might be described as focusing attention on what is being experienced, without reacting to or judging that experience.  This is seen as helping the meditator learn to experience thoughts and emotions in normal daily life with greater balance and acceptance." (NCCAM, "Meditation for Health Purposes" (2006)) Promoted by Jon Kabat-Zinn, Univ. Massachusetts Medical Center Stress Reduction Clinic.

•    Prayer, spirituality, religious observation

•    Support groups

•    Psychotherapy

•    Music therapy - certain types of music appear capable of lowering heart rate and blood pressure, reducing need for anesthesia, etc.  Can also be used to assist in physical or neurological therapy.

•    Toning - chanting of vowel sounds

•    Laughter therapy - humor may improve blood flow, enhance levels and activities of immune cells and endorphins, and decrease stress hormones.  (It is speculated that laughter is linked to the emotions of social connections.)

•    Yoga (discussed in handout on Eastern approaches)

•    Pet therapy

Some promoters (through books, lectures, workshops, etc.)

•    Deepak Chopra - endocrinologist, promoter of ayurvedic medicine.  Author, Creating Health; Perfect Health; Quantum Healing; Ageless Body, Timeless Mind.

•    Bernie Siegel - surgeon; author, Love, Medicine and Miracles and  Peace, Love and Healing.

•    Jon Kabat-Zinn - stress reduction (see above).  Author of Full Catastrophe Living.

•    Herbert Benson - cardiologist, Harvard Medical School.  Founded Mind/Body Medical Institute.  Relaxation response (see above).  Author of The Relaxation Response; co-author of Timeless Healing.

•    Larry Dossey - promoter of effects of prayer and spirituality.  Author, Healing Words.

•    Candace Pert (died 2013) - researcher in psychoneuroimmunology.  Author, Molecules of Emotion.

•    James Gordon - Director, Center for Mind-Body Medicine.

•    Templeton Foundation - funds work related to religion and spirituality.

Prayer, spirituality

Spirituality is defined by NCCAM as “an individual’s sense of purpose and meaning to life, beyond material values.  Spirituality may be practiced in many ways, including through religion.” (CAM at the NIH 12(1), 1-4 (2005))

Various studies show beneficial effects of religious faith, prayer, and church attendance in health and recovery from illness, especially in elderly.  This need not involve a supernatural explanation, but could be due to effects of positive attitude and social support, as discussed above.

Sloan et al. (Lancet 353, 664-667 (1999)) charged that these studies were seriously flawed; their points were rebutted by Koenig et al. (Int. J. Psychiatry Med. 29, 123-131 (1999)).  A later review (Sloan and Bagiella, Ann. Behav. Med. 24, 14-21 (2002)) concluded that “there is little empirical basis for assertions that religious involvement or activity is associated with beneficial health outcomes.”  Again, there was a rebuttal: Weaver et al., Altern. Ther. Health Med. 9, 42-46 (2003).  King et al. (Social Science & Medicine 48, 1291-1299 (1999)), found that stronger religious belief was associated with poorer outcome in hospitalized patients.

Blumenthal et al. (Psychosom. Med. 69, 501-508 (2007)): "We found little evidence that self-reported spirituality, frequency of church attendance, or frequency of prayer is associated with cardiac morbidity or all-cause mortality post AMI [acute myocardial infarction] in patients with depression and/or low perceived support."

Intercessory prayer is discussed in another handout, along with faith healing.

Placebo effects

Many studies show positive results in 30 to 70% of patients receiving placebos.  However, in a reexamination of the literature, Kienle and Kiene (1997) J. Clin. Epidemiol. 50, 1311-1318, stated: “Having analyzed a total of 800 articles on placebo, we have not found any reliable demonstration of the existence of placebo effects...There can be no doubt that the extent and frequency of placebo effects as published in most of the literature are gross exaggerations.”

A widely-publicized meta-analysis (Hróbjartsson and Gøtzsche (2001) New Engl. J. Med. 344, 1594-1602) found little evidence for the placebo effect, except possibly in pain and other subjective responses.  However, numerous criticisms of their analysis have been raised (e.g., letters in New Engl. J. Med. 345, 1276-1279 (2001)).  For example, the analysis pooled results from many different types of studies, which likely differ in the importance of placebo effects.

"Just as responses following drug treatment do not necessarily indicate true drug effects, so responses to placebo do not necessarily constitute placebo effects.  Patients receiving placebos either in clinical practice or in clinical trials may have improved, or appeared to have improved, for a variety of reasons other than any causal connection (via some psychological neurobiological mechanism) between the placebo and the outcome.  These may include spontaneous remission, the natural course of waxing and waning of symptoms, regression to the mean in repeated measurements, and biased patient reports that do not reflect real improvement." (Miller and Kaptchuk, J. Roy. Soc. Med. 101, 222-225 (2008))

"The placebo response depends on the subject's beliefs which determine their expectations and response.  Their beliefs will depend on the placebo message delivered by the therapist who will usually be enthusiastic and convey an optimistic message by word and body language reinforced by mechanical, electrical stimuli and the 'laying on of hands' as in massage and, in Western and Chinese medicine, simply taking the pulse.  The response will also be conditioned by previous beliefs and by peers who offer advice embellished by phrases such as 'I swear by it'." (Wigley, Clin. Med. 7, 450-452 (2007))

Waber et al. (JAMA 299, 1016-1017 (2008)) found that greater placebo effects on pain were seen if subjects thought that the pills were more expensive.

Kaptchuk et al. (PLoS ONE 5, e15591 (2010)) reported a beneficial effect of placebos in irritable bowel syndrome even when patients were told that the pills were placebos ("placebos without deception").  The study was criticized by "Orac" ("Respectful Insolence" blog, Dec. 23, 2010), who felt that deception was still involved.

A Cochrane Database Systematic Review (CD003974 (2010)) concluded that "We did not find that placebo interventions have important clinical effects in general.  However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting.  The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important."

Changes in activity in certain regions of the brain in response to placebos have been identified.

“Now, research has shown that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved, whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play, even though a conditioning procedure is carried out." (NCCAM, "Mind-Body Medicine: An Overview" (2007))

Both opioid and non-opioid (such as dopamine) mechanisms are involved in placebo effects.  "Neurophysiology and neurochemistry suggest that there are multiple placebo effects, with different neurobiological mechanisms, depending on the organ system and the target illness." (Brody and Miller, JAMA 306, 2612-2613 (2011))

We can divide placebo effects into two types:

1.    Patients may perceive subjective improvement (e.g., in pain) in the absence of objective improvement in the condition.

2.    Mind-body interactions as discussed above could produce objective improvement.

These effects may be involved in successes of some alternative practitioners.  "Some commentators have suggested that alternative therapies with elaborate procedures and distinct environmental cues might have pronounced and clinically significant placebo effects.  Recent RCTs of acupuncture, although not designed to study placebo effects, have provided results that lend support to this hypothesis." (Finniss et al., Lancet 375, 686-695 (2010))

Ethical questions: should doctors give placebos on purpose?  Should we condone alternative methods that "work" only via placebo effects, since they may be helping patients?

A 2007 survey of U.S. physicians found that about half "reported prescribing placebo treatments on a regular basis" and 62% "believed the practice to be ethically permissible" (Tilburt et al., BMJ 337, a1938 (2008)).

Other points

The National Institutes of Health established ten centers for mind-body medicine research.

Nerurkar et al. (Arch. Intern. Med. 171, 862-853 (2011)) analyzed National Health Interview Survey data from 2007.  They found that increasing use of mind-body medicine was a large factor in the increase in complementary and alternative medicine.  Usage of physician-referred mind-body therapies (P-MBT) was 2.9% of Americans, vs. 15.5% for self-referred usage (S-MBT).  "Deep breathing exercises were the most common P-MBT used (84.4%), followed by meditation (49.3%), yoga (22.6%), progressive muscle relaxation (19.9%), and guided imagery (13.9%); similar trends were seen in the S-MBT group."  A story on the study quoted Dr. Nerurkar: "What we learned suggests that providers are referring thier patients for mind-body therapies as a last resort once conventional therapeutic options have failed.  It makes us wonder whether referring patients for these therapies earlier in the process could lead to less use of the health care system, and possibly, better outcomes for these patients." (Newswise, May 9, 2011)

Bertisch et al. (J. Psychosom. Res. 66, 511-519 (2009)), analyzing 2002 data, found that mind-body therapies were most frequently used for anxiety/depression, back pain, and various other types of pain.

"There are nearly 1,000 certified MBSR [mindfulness-based stress reduction] instructors teaching mindfulness techniques (including meditation), and they are in nearly every state and more than 30 countries." (Pickert, Time, Feb. 3, 2014, 40-46)

"But mindfulness has reached far more people than those who have attended an MBSR class.  Whereas tens of thousands of individuals have enrolled in an MBSR program, several millions have read or listened to mindfulness self-help books or recordings." (Barker, Soc. Sci. Med. 106, 168-176 (2014))

SUMMARY:  A growing body of evidence indicates that mental attitudes can affect the incidence and progress of disease, though many results need to be confirmed with more research.  Applying the various techniques described above may help patients, as long as they do not have unrealistic expectations.

HYPNOSIS

Background

Can be broadly defined as an altered state of mind associated with greatly increased suggestibility; exact definition is controversial.  Research is attempting to identify changes in the brain associated with the hypnotic state.  “Brain scans show that the control mechanisms for deciding what to do in the face of conflict become uncoupled when people are hypnotized.  Top-down processes override sensory, or bottom-up information” (Blakeslee, New York Times, Nov. 22, 2005).

"The typical pain signal follows a well-worn path from the brain stem through the midbrain and into the cortex, where conscious feelings of pain arise.  In [Sebastian] Schulz-Stübner's study, the hypnotized group showed subcortical brain activity similar to that of nonhypnotized volunteers, but the primary sensory cortex stayed quiet." (Song, Time, Mar. 26, 2006, 47)

"Some 60% of patients are hypnotizable to some degree, [David] Spiegel says; an additional 15%, highly so.  The rest seem to be unresponsive." (Song, ibid)

Hypnotherapy is practiced by more than 10,000 health professionals.  However, it is also taught to, and practiced by, nonprofessionals (one can get a "Ph.D." in hypnotherapy in a 2-week course!).

Practice and scope

Hypnotic state induced by having subject focus on mental image, object, or soothing voice.  Therapist then gives suggestions relating to the desired change in behavior.

Advocated for smoking cessation, weight control, stress management, motivation, pain control, etc.

Has been tested as an alternative to anesthesia for patients who are allergic to anesthetics, or to be used in conjunction with lower anesthesia levels in order to reduce side effects.  "Hypnosis for analgesia is often superior to other non-pharmacologic treatments for producing changes in pain reports.  Also, patients undergoing surgery with hypnosis need significantly less chemical analgesia."  (Wahbeh et al., Neurology 70, 2321-2328 (2008))

“The pain-relieving effect of hypnosis is often substantial, and in a few cases the degree of relief matches or exceeds that provided by morphine.” (Nash (2001) Scientific American, July, 47-55)

"...hypnosis has potential as a clinically valuable intervention for procedure-related pain and distress in pediatric cancer patients." (Richardson et al., J. Pain Symptom Manage. 31, 70-84 (2006))

"...while both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost and thus appears attractive for outpatient pain management." (Lang et al., Pain 126, 155-164 (2006))

It also appears to be effective for nausea and vomiting in pediatric chemotherapy (Richardson et al., Eur. J. Cancer Care 16, 402-412 (2015))

Hypnosis "provided long-term adequate symptom relief in 54% of patients with irritable bowel syndrome refractory to conventional therapy." (Schaefert et al., Psychosom. Med. 76, 389-398 (2014))

“Hypnosis can boost the effectiveness of psychotherapy for some conditions...patients who received cognitive behavioral therapy plus hypnosis for disorders such as obesity, insomnia, anxiety and hypertension showed greater improvement than 70 percent of the patients who received psychotherapy alone.” (Nash (2001) Scientific American, July, 47-55)

“...a task force of the American Psychological Association validated hypnosis as an adjunct procedure for the treatment of obesity.  But the jury is still out on other disorders with a behavioral component.  Drug addiction and alcoholism do not respond well to hypnosis, and the evidence for hypnosis as an aid in quitting smoking is equivocal...there is strong, but not yet definitive evidence that hypnosis can be an effective component in the broader treatment of other conditions...these include a subgroup of asthmas; some dermatological disorders, including warts; irritable bowel syndrome; hemophilia; and nausea associated with chemotherapy...claims that hypnosis increases immune function in any clinically important way are at this time unsubstantiated.” (Nash, ibid)

Hypnosis is also used as a tool to help recall repressed or "lost" memories.  This is sometimes used in psychotherapy.  However, hypnosis is not a magic route to the truth; subjects can (and do) recall things incorrectly and construct fantasies.  (see also “Recovered memories” below)

Two pseudoscientific applications of hypnosis

1. Past-life therapy - under hypnosis, patient is "regressed" through childhood and then back to alleged previous lives.  (Some practitioners even claim to be able to "progress" the subject through future lives!)  Events in these lives are held to underlie psychological problems in the present life.  As in psychoanalysis, the reliving of these traumatic events is held to be therapeutic.

Arguments against:

•    The concept of reincarnation is unsupported by scientific evidence, and, if true, would present important philosophical problems.

•    Hypnosis  is a state of relaxation and compliance, leading to increased suggestibility and desire to please the hypnotist.  Under such conditions fantasization can occur.  Using fragments of old memories, elements of books and stories, learned historical and geographical information, etc., the subject may create a convincing story.  The subject may be unaware of the source of these "hidden memories" (cryptomnesia).

•    Careful examination of cases of alleged past lives has revealed either historical inaccuracies or inconsistencies, or information which the subject could have obtained readily earlier in life.

•    As with hypnosis in general, the techniques can be applied by people who have no training in psychotherapy, and may therefore be subject to abuse.

2. UFO abductee regression - it has been claimed that thousands of Americans have been abducted by aliens; often they allegedly have been subjected to sexual and reproductive experimentation.  These instances are usually "remembered" only after the victims are hypnotically regressed, often many years later.  This allegedly can lead to resolution of psychological problems.  Promoted by author Budd Hopkins (died 2011) and Harvard psychiatrist John Mack (died 2004).

Arguments against:

•    Problems with the general idea of alien visits include lack of corroborating physical evidence and the vast distances to other stars.

•    If aliens did visit, why would they contact and abduct obscure individuals rather than government leaders or scientists?

•    Idea that aliens could interbreed with humans is scientifically preposterous (and if they are so advanced, why would they want to?).

•    Hypnosis does not necessarily lead to truthful reports; it can be a medium in which fantasy-prone individuals are encouraged to generate stories which will please the hypnotist.

•    Hypnogogic (when falling asleep) and hypnopompic (when waking up) hallucinations may provide the bases for some reports.

•    Some individuals may generate the reports to gain the fame (e.g., talk-show appearances) and possible financial rewards which go to "victims."  Others may simply find it rewarding to have their normally secretive fantasy lives validated by the investigator.

•    With the huge numbers of people allegedly abducted, there should have been many witnesses, unless the aliens have mastered such supernatural powers as making people invisible and allowing them to pass through walls.

BIOFEEDBACK

Definition

"Biofeedback employs electronic sensors to inform people of variations in physiological processes whose activities are not normally accessible to consciousness (e.g., brain or muscle electrical activity, blood pressure, etc.)." (Beyerstein, Skeptical Inquirer 10, 42-59 (1985))  Subjects then use mental state to manipulate the process in the desired direction.

Two major types:

1) One type includes measurement of muscle tension and skin temperature (higher temperature associated with relaxation).  These techniques are not controversial (at least for some applications) and have been incorporated into many treatment programs.  Used for treatment of chronic pain and migraine headaches, to help regain movement of limbs, and incontinence.

Allen (Ped. Annals 33, 241-245 (2004)) wrote, “Research demonstrated that biofeedback can be an effective treatment for a variety of stress-related disorders, including chronic headaches, hypertension, Raynaud’s disease, irritable bowel syndrome, and fibromyalgia.”  (The article advocates the use of biofeedback for children with recurrent headaches.)

A meta-analysis by Nakao et al. (Hypertens. Res. 26, 37-46 (2003)) concluded that biofeedback “was more effective in reducing blood pressure in patients with essential hypertension than no intervention.  However, the treatment was only found to be superior to sham or non-specific behavioral intervention when combined with other relaxation techniques.”

2) Brain wave biofeedback (or neurofeedback).  Sensors on scalp and earlobes detect brain waves.  Subject is given feedback through earphones or video display.  Generally, subject tries to maximize alpha and theta waves, associated with resting, meditation, and creativity, in contrast to beta waves, associated with excitation, stress, or narrowly focused states.  (Thus, other techniques such as meditation, guided imagery, or psychotherapy may achieve the same results.)

Uses include inspiration of creativity in corporate settings; reduction of stress; improved attention span (and reduced hyperactivity) in children with attention-deficit disorder (here the goal would be to reduce alpha); reduction of depression; recall of repressed memories (memories associated with intense emotional states are held to be linked to theta waves); overcoming addictions; and dealing with insomnia and phobias; dealing with head injuries, cerebral palsy, autism, epilepsy.

Many of these applications are controversial, and benefits are not well documented.

"EEG neurofeedback has been widely used as a nonpharmacologic treatment in children and adults with ADHD but still has a limited amount of strong empirical evidence." (Wahbeh et al., Neurology 70, 2321-2328 (2008))

"The procedure is controversial, expensive and time-consuming.  An average course of treatment, with at least 30 sessions, can cost $3,000 or more, and few health insurers will pay for it." (Ellison, New York Times, Oct. 4, 2010)

Various electronic devices are also used to induce relaxation and produce desired brain states.  These may be used in practitioners' offices, in stress-reduction salons, or in the home.  The FDA has taken action against some of these.  They can produce seizures in some individuals, even with no prior history of epilepsy or seizures.

A critical evaluation was provided by B. Beyerstein (1985), "The Myth of Alpha Consciousness," Skeptical Inquirer 10, 42-59.  Some of his points:

•    Just because alpha is associated with a certain state doesn't mean that it causes it.

•    An increase in alpha during a session may simply be due to decrease in the novelty of the initial situation, in addition to the relaxation that occurs with time in the quiet, monotonous setting.

•    About 10-15% of normal subjects did not produce any alpha, yet seemed no more stressed than others.  Conversely, some very anxious individuals had high alpha.

•    In one study, subjects could be induced to increase alpha under stressful conditions (threat of electric shock)

•    Lack of controls for placebo effect in some studies.  Patients may simply believe the treatment will help them.

•    Possibly distractive effect in pain control.

•    Subjects reported transcendent experiences when given feedback to suppress alpha.

TREATMENT OF AUTISM

The dramatic increase in diagnosed cases of autism spectrum disorders (ASD) in recent decades led to a corresponding increase in the use of unconventional methods for treatment.  Some of these may once have had plausible rationales, though they were lacking in support from clinical trials.  Now that it appears that autism is caused by a combination of genetic and environmental factors in early development, there is even less reason to attempt to cure autism through methods such as chelation or special diets.

Some surveys have found that 30% to 75% of autistic children are treated with alternative methods; one by Owen-Smith et al. (Res. Autism Spectr. Disord 17, 40-51 (2015)) found that "Approximately 88% of the sample had either used CAM in the past or had recently used some type of CAM."  These authors noted that "many children with ASD may be concurrently taking both vitamins/supplements and prescription psychotropic medications and thus may be at risk for possible interactions."

"The most commonly used CAM treatments for ASD...are: With natural products: 13% to 54%. Special diet: 17% to 33%. Mind and body practices: 25% to 30%...It is most notable that families reported that they rarely asked physicians for information about CAM.  The proliferation of Internet-based lay communities and Web sites that are promoting untested treatments have increased the exposure of families to large volumes of information about treatments with potential harm." (Levy and Hyman, Child Adolesc. Psychiatric Clin. N. Am. 24, 117-143 (2015)) "Children with ASD use more CAM when they have co-existing gastrointestinal symptoms, seizure disorders, and behavior problems." (Perrin et al., Pediatrics 130, S77-S82 (2012))

"The four most frequently used CAMs (>25% of respondents indicated having tried in the past or currently using) were the gluten-free/casein-free (GF/CF) diet, probiotics, omega-3 fatty acids, and melatonin." (Hall and Riccio, Complement. Ther. Clin. Pract. 18, 159-163 (2012))

"Case series...have suggested that children with autism may have an increased prevalence of gastrointestinal symptoms...As a result, restrictive diets and other nutritional or gastrointestinal therapies, such as the gluten-free, casein-free diet, intravenous secretin, prescription of antifungal medications to treat purported fungal overgrowth in the gut, and dietary supplementation with vitamins, minerals, or omega-3 fatty acids have become widely popular interventions for children with autism, despite a lack of evidence regarding their safety or efficacy." (Ibrahim et al., Pediatrics 124, 680-686 (2009))

A review by Brondino et al. (Evid. Based Complement. Alternat. Med. 2015, 258589 (2015)) found that "There is no conclusive evidence supporting the efficacy of CAM therapies in ASD.  Promising results are reported for music therapy, sensory integration therapy, acupuncture, and massage."

Antioxidants - in 2010 the FDA stopped the marketing of OSR#1, an unapproved drug marketed to fight "oxidative stress."  More recently, N-acetylcysteine (NAC) has been popular.

Auditory Integration Training (AIT) - controlled trials found not useful (Sinha et al., Arch. DIs. Child. 91, 1018-1022 (2006)).

Chelation therapy - the rationale has been to remove mercury.  Vaccinations with thimerosal, a mercury-containing preservative, have been alleged to cause autism, but this claim has been disproven (see "Antivaccination Efforts" in the handout "Overview of Complementary and Alternative Medicine").  In 2005 a 5-year-old died after chelation.   A planned NIH trial of chelation was cancelled in 2008 over safety concerns.  A 2013 review concluded that "evidence to support the use of chelation as a treatment for children with ASD is extremely weak."  Moreover, "Because empirical evidence does not support the hypothesis that the core ASD symptoms are associated with specific levels of metals in the body, the use of chelation to remove metals from the body in order to ameliorate ASD symptoms could be seen as unfounded and illogical." (Davis et al., Res. Autism Spectrum Disorders 7, 49-55 (2013))

DAN! (Defeat Autism New!) Protocol - DAN! was a project (closed in 2011) of the Autism Research Institute.  The protocol began "with a choice of four general directions.  The subsequent choices include chelation therapy and more than 50 dietary supplements, medications, dietary strategies, and other modalities." (Barrett, "A Critical Look at Defeat Autism Now! and the 'DAN! Protocol'," Quackwatch web site (2015))

Dietary supplements - Stewart et al. (J. Acad. Nutr. Diet. 115, 1237-1248 (2015)) found that dietary supplements frequently given to children with autism did not correct common micronutrient deficiencies; rather, they provided excessive levels of certain nutrients.

Digestive enzymes - a trial found no benefit (Munasinghe et al., J. Autism Dev. Disord. 40, 1131-1138 (2010)).

Dimethylglycine (DMG) - controlled studies found not useful

Gluten- and casein-free diets - "Diet modification as a treatment for ASD is based on the as-yet-scientifically unproven hypothesis that opioid peptides, formed from the incomplete breakdown of foods containing gluten...and casein...may enter the bloodstream due to increased intestinal permeability, cross the blood-brain barrier and impede central nervous system development and function...Currently there is a lack of evidence to support the use of GFCF diets as an effective intervention for children with ASD." (Whitehouse, J. Paediatr. Child Health 49, E438-E442 (2013))

Hyperbaric oxygen therapy - a study by Rossignol et al. (BMC Pediatrics 9, 21 (2009)) gave positive results.  However, criticisms were raised: the authors were practitioners of hyperbaric oxygen therapy, and blinding may not have been successful.  Replication by an independent group found no evidence of benefit.

Intravenous immunoglobulin - based on the premise that autism is related to neuroinflammation.  Professional organizations have concluded that it is ineffective.  It has significant risks.

Lupron - a drug used for chemical castration.  Based on the scientifically invalid idea that autistic children have high testosterone levels and precocious puberty.

Massage therapy - no good evidence of effectiveness (Lee et al., J. Clin. Psychiatry 72, 406-411 (2011))

Melatonin - used to deal with sleep problems.

Omega-3 fatty acids (such as EPA and DHA) - involved in brain function and development.  Evidence in support is weak.

Probiotics - little supporting evidence to date.

Secretin - "...the administration of secretin for ASD is based on the unproven hypothesis that secretin may aid digestion, thus restricting the flow of harmful opioid peptides crossing the blood-brain barrier." (Whitehouse,  J. Paediatr. Child Health 49, E438-E442 (2013))  A 2012 Cochrane review (CD003495) found no good evidence of effectiveness.

Sensory Integration Therapy - "...based on the premise that adequate processing and integration of sensory information by the central nervous system plays a significant role in an individual's ability to participate in daily activities." (Polenick and Flora, Skeptic 17(2), 28-35 (2012)) Includes various devices and types of clothing to produce a range of sensory experiences.  Professional organizations have concluded that there is no good evidence of effectiveness.

Stem cells - "done overseas because not approved in the U.S." (Shute, Scientific American, Oct. 2010, 80-85)

Taurine - in 2002 the FDA took action against a marketer of taurine for autism.

Vancomycin - a preliminary study found temporary benefits, but symptoms soon reappeared.

Vitamin B6 - no evidence of benefit

TREATMENT OF OTHER CONDITIONS

Alzheimer's - supplementation with docosahexaenoic acid (DHA), an omega-3 fatty acid, provided no benefit (Quinn et al., JAMA 304, 1903-1911 (2010))

Attention deficit hyperactivity disorder - dietary supplements are being marketed to treat this condition.  In 2000 and 2002 the FTC took action against marketers of essential fatty acids, pycnogenol, and other products for unsupported claims.  A review by Sarris et al. (Complement. Ther. Med. 19, 219-227 (2011)) concluded that Ginkgo biloba and St. John's wort were ineffective.  A Cochrane review of polyunsaturated fatty acids (CD007986 (2012)) found that "The majority of data showed no benefit of PUFA supplementation, though there were some limited data that did show an improvement with combined omega-3 and omega-6 supplementation."  Bloch et al. (Child Adolesc. Psychiatric Clin. N. Am. 23, 883-897 (2014)) concluded that "Melatonin is effective in improving chronic insomnia in children with ADHD but has little evidence for efficacy in improving core ADHD symptoms."

A 2007 study (McCann et al., Lancet 370, 1560-1567) found that artificial colors or the preservative sodium benzoate increased hyperactivity in children.  However, the effects were quite small compared to the differences between normal and ADHD children.

Neurofeedback for ADHD is discussed in the "Biofeedback" section.

Down syndrome - nutritional therapy (with vitamins, minerals, amino acids, antioxidants, and other components) has been advocated as a treatment.  Supplementation with antioxidant vitamins and folinic acid provided no benefit (Ellis et al., BMJ 336, 594-597 (2008)).

OTHER UNCONVENTIONAL PRACTICES RELATED TO MENTAL HEALTH

(Unless otherwise noted, quotes are from S. Barrett, "Mental Help: Procedures to Avoid."

http://www.quackwatch.org/01QuackeryRelatedTopics/mentserv.html (2003))

Attachment therapy - assumes that "most, if not all, childhood mental health disturbances are caused by failure of normal development of emotional attachment to caregivers...AT practitioners also share the belief that re-enactment of typical episodes of early infancy can recapitulate and repair failed attachment development.  AT practitioners and parents carry out these re-enactments by physically holding or restraining children, by feeding older children by spoon or by baby bottle and preventing them from obtaining food by themselves, and by requiring children to gaze into the eyes of parents or therapists, in the mistaken belief that eye contact causes attachment rather than following it.  Most of the attention paid to AT methods has focused on Holding Therapy (HT), a method that uses physical restraint and intrusive physical contact as well as verbal provocation."  (Mercer, Institute for Science in Medicine White Paper, "Attachment Therapies and Associated Parenting Techniques" (2013))  These claims and methods have been rejected by professional organizations of psychologists and psychiatrists.  Injuries and at least one death have resulted from holding therapy.

"Brain Games" - "computer-based cognitive training software" is promoted for preventing declines in mental function with aging.  However, according to "A Consensus on the Brain Training Industry from the Scientific Community" (http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/), "claims promoting brain games are frequently exaggerated and at times misleading...there is little evidence that playing brain games improves underlying broad cognitive abilities, or that it enables one to better navigate a complex realm of everyday life."

Brain Gym - "nonprofit organisation promoting a series of exercises claimed to improve academic performance. The 26 Brain Gym activities are claimed to improve eye teaming (binocular vision), spatial and listening skills, hand–eye coordination, and whole-body flexibility, and by doing this manipulate the brain, improving learning and recall of information." (Wikipedia)  "The program's theoretical basis has been researched and fully discredited; there is simply no evidence that the Brain Gym works - or even that it could work." (Radford, Skeptical Inquirer, Sept.-Oct. 2009, p. 31)

Eye Movement Desensitization and Reprocessing (EMDR) - "promoted for the treatment of post-traumatic stress, phobias, learning disorders, and many other mental and emotional problems.  The method involves asking the client to recall the traumatic event as vividly as possible and rate certain feelings before and after visually tracking the therapist's finger as it is moved back and forth in front of the client's eyes...Recent reviews have concluded that the data claimed to support EMDR derive mostly uncontrolled case reports and poorly designed controlled experiments and that the theory of EMDR clashes with scientific knowledge of the role of eye movements."  According to promoters, 60,000 therapists have been trained worldwide, and they have treated 1 million patients.

Facilitated communication - used to help an autistic or otherwise disabled person communicate.  A "facilitator" helps the subject spell out messages.  However, controlled studies show that the messages are actually produced unintentionally by the facilitator. 

Lilienfeld et al. (Evid. Based Communication Assess. Intervention 8, 62-101 (2014)) wrote: "...in the early 1990s, FC became immensely popular in educational and clinical circles as a means of establishing expressive communication among non-speaking individuals with autism and other disorders...by the mid- to late-1990s, FC had been convincingly refuted by controlled research and overwhelmingly rejected by the scientific community...Professionals in the fields of communication disorders and mental health may therefore be surprised to learn that FC remains alive and well in much of the mainstream autism and developmental disabilities community, and that it seems to be staging a broader comeback..."  Leading FC promoter Douglas Biklen has been promoted to Dean of the School of Education at Syracuse University.

Feingold diet - based on idea that hyperactivity and many other conditions arise from salicylates, artificial colors, and artificial flavors in the diet.  However, blinded tests show that food additives have little effect on behavior.

Neural Organization Technique - developed by a chiropractor; purports to realign skull bones to heal mental disorders.

Neuro Emotional Technique (NET) - based on releasing emotional blocks which produce adverse health effects.  Involves applied kinesiology, chiropractic adjustments, and other invalid methods in diagnosing and dealing with these blockages.

Neurolinguistic programming - "a variable system of procedures purported to enable people to communicate more effectively and influence others.  Proponents claim that NLP has cured phobias, allergies, and other problems in one or a few brief sessions.  Its core postulates are: (a) people are most influenced by messages that reflect how they internally represent whatever they are doing; and (b) this representation is reflected by eye-gaze patterns, posture, tone of voice, and language patterns... A National Research Council committee has found no significant evidence that NLP's theories are sound or that its practices are effective."

Optometric Visual Training - "based on the idea that learning can be improved by exercises that improve coordination of the eye muscles or improve hand-eye coordination.  Its proponents assume that the basic problem that leads to reading disability is some deficit in the visual system.  The American Academy of Pediatrics and the American Academy of Ophthalmology have criticized this approach and cautioned that no eye-muscle defects can produce the learning disabilities associated with dyslexia."

Patterning (psychomotor patterning; Doman-Delacato Treatment) - for treatment of mental retardation, learning disabilities, etc.  Based on scientifically discredited idea that putting patient through series of passive motions (e.g., crawling) can stimulate brain development to more advanced stages.  Trials in the 1960's and 1970's showed little or no value.

Recovered memories - during therapy (possibly involving hypnosis), subject "remembers" early events (e.g., childhood sexual abuse).  There have been many cases of alienation within families or even criminal prosecution as a result of such "memories."  However, many of them are false, created in response to the promptings of the therapist.  (see also "past-life regression" and "UFO abductee regression" in the Hypnosis section above)

Single-photon emission computed tomography (SPECT) (brain mapping) - used in imaging the brain.  Promoted by Daniel Amen for diagnosis of ADHD and other conditions.  "However, Amen's use of SPECT scans to aid in psychiatric and neurological clinical diagnosis is based on unproven claims and has been widely criticized." (Wikipedia)

Thought Field Therapy (TFT) - psychological problems are alleged to involve disturbances in “energy fields” (or “thought fields”) in the body.  These are supposedly corrected through sequences of tapping on various acupressure points, plus other sensory activities.  No controlled studies in support.

Vagus nerve stimulation - a pacemaker-like device is implanted in order to stimulate the vagus nerve with the aim of treating depression.  The FDA approved one such device against the recommendation of its own review committee.  However, Medicare decided not to provide reimbursement: "'Vagus nerve stimulation is not reasonable and necessary for treatment of resistant depression,' and research 'provides little evidence that a patient will experience a health benefit as a direct result of VNS therapy.'" (Barglow, Skeptical Inquirer 32(5), 35-40 (2008))

READING

Mind-body medicine - overview

National Center for Complementary and Alternative Medicine (2007) "Mind-Body Medicine: An Overview"

National Center for Complementary and Integrative Health (2015) “Mind and Body Practices”

Astin, J.A., Shapiro, S.L., Eisenberg, D.M., and Forys, K.L. (2003) “Mind-Body Medicine: State of the Science, Implications for Practice” J. Am. Board Fam. Pract. 16, 131-147

Bertisch, S.M., Wee, C.C., Phillips, R.S., and McCarthy, E.P. (2009) "Alternative Mind-Body Therapies Used by Adults With Medical Conditions" J. Psychosom. Res. 66, 511-519

Nerurkar, A., Yeh, G., Davis, R.B., Birdee, G., and Phillips, R.S. (2011) "When Conventional Medical Providers Recommend Unconventional Medicine: Results of a National Survey" Arch. Intern. Med. 171, 862-864

Pennisi, E. (1997) "Tracing Molecules That Make the Brain-Body Connection" Science 275, 930-1 [abstract]

McEwen, B.S. (1998) “Protective and Damaging Effects of Stress Mediators.” New Engl. J. Med. 338, 171-179

Miller, G.E. and Cohen, S. (2001) “Psychological Interventions and the Immune System: A Meta-Analytic Review and Critique” Health Psychol. 2-, 47-63 [abstract]

Garssen, B. and Goodkin, K. (1999) “On the Role of Immunological Factors as Mediators Between Psychosocial Factors and Cancer Progression” Psychiatry Res. 85, 51-61 [abstract]

Petticrew, M., Bell, R., and Hunter, D. et al. (2002) “Influence of Psychological Coping on Survival and Recurrence in People With Cancer: Systematic Review” BMJ 325, 1066-1075

Reiche, E.M., Nunes, S.O., and Morimoto, H.K. (2004) “Stress, Depression, the Immune System, and Cancer” Lancet Oncol. 5, 617-625 [abstract]

O’Malley, P.G., Jones, D.L., Feuerstein, I.M., and Taylor, A.J. (2000) “Lack of Correlation Between Psychological Factors and Subclinical Coronary Artery Disease” New Engl. J. Med. 343, 1298-1304

Wassertheil-Smoller, S., Shumaker, S., Ockene, J. et al. (2004) “Depression and Cardiovascular Sequelae in Postmenopausal Women” Arch. Intern. Med. 164, 289-298

Shen, B.-J., Avivi, Y.E., Todaro, J.F. et al. (2008) "Anxiety Characteristics Independently and Prospectively Predict Myocardial Infarction in Men" J. Am. Coll. Cardiol. 51, 113-119

Christakis, N.A. and Allison, P.D. (2006) "Mortality after the Hospitalization of a Spouse" N. Engl. J. Med. 354, 719-730

Wahbeh, H., Elsas, S.-M., and Oken, B.S. (2008) "Mind-Body Interventions: Applications in Neurology" Neurology 70, 2321-2328 [abstract]

Cole, S.W., Hawkley, L.C., Arevalo, J.M. et al. (2007) "Social Regulation of Gene Expression in Human Leukocytes" Genome Biology 8, R189

Mind-body medicine - techniques

National Center for Complementary and Alternative Medicine (2006) "Meditation for Health Purposes" [pdf file]

Ospina, M.B., Bond, K., Karkhaneh, M. et al. (2007) "Meditation Practices for Health: State of the Research"  Evid. Rep. Technol. Assess. 155, 1-263

Ricard, M., Lutz, A., and Davidson, R.J.  (2014) "Neuroscience Reveals the Secrets of Meditation's Benefits" Scientific American, Nov., 39-45 [preview]

Barker, K.K. (2014) "Mindfulness Meditation: Do-it-Yourself Medicalization of Every Moment" Soc. Sci. Med. 106, 168-176 [abstract]

Ong, J.C., Manber, R., Segal, Z. et al. (2014) "A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia" Sleep 37, 1553-1563                       

Aucoin, M., Lalonde-Parsi, M.-J., and Cooley, K. (2014) "Mindfulness-Based Therapies in the Treatment of Functional Gastrointestinal Disorders: A Meta-Analysis" Ev. Based Complement. Alternat. Med. 2014, 140724

Castillo-Richmond, A., Schneider, R., Alexander, C.N. et al. (2000) “Effects of Stress Reduction on Carotid Atherosclerosis in Hypertensive African Americans” Stroke 31, 568-573 [Transcendental Meditation]

Sutoo, D. and Akiyama, K. (2004) “Music Improves Dopaminergic Neurotransmission: Demonstration Based on the Effect of Music on Blood Pressure Regulation” Brain Res. 1016, 255-262 [abstract]

Rousch, W. (1997) "Herbert Benson: Mind-Body Maverick Pushes the Envelope" Science 276, 357-359 [abstract]; letter in response by I. Tessman and J. Tessman, Science 278, 561; reply by Benson, Science 278, 1694-1695

Mind-body medicine - critiques

Sampson, W. (2002) “Controversies in Cancer and the Mind: Effects of Psychosocial Support” Semin. Oncol. 29, 595-600 [abstract]

Coyne, J.C., Stefanek, M. and Palmer, S.C. (2007) "Psychotherapy and Survival in Cancer: The Conflict Between Hope and Evidence" Psychol. Bull. 133, 367-394 [abstract]

Coyne, J.C., Pajak, T.F., Harris, J., et al. (2007) "Emotional Well-Being Does Not Predict Survival in Head and Neck Cancer Patients" Cancer 110, 2568-2575

Spirituality

Mitka, M. (1998) “Getting Religion Seen as Help in Being Well” JAMA 280, 1896-1897 [excerpt]

Sloan, R.P., Bagiella, E., VandeCreek, L. and Poulos, P. (2000) “Should Physicians Prescribe Religious Activities?” New Engl. J. Med. 342, 1913-1916 [excerpt]

Groopman, J. (2004) “God at the Bedside” New Engl. J. Med. 350, 1176-1178 [excerpt]

Critiques of the link between spirituality and health:

•          Sloan, R.P., Bagiella, E., and Powell, T. (1999) "Religion, Spirituality, and Medicine" Lancet 353, 664-667 [excerpt] (for rebuttal, see Koenig, H.G., Idler, E., Kasl, S. et al. (1999) "Religion, Spirituality, and Medicine: a Rebuttal to Skeptics"  Int. J. Psychiatry Med. 29, 123-131 [pdf file])

•          Sloan, R.P. and Bagiella, E. (2002) "Claims About Religious Involvement and Health Outcomes"  Ann. Behav. Med. 24, 14-21 [abstract].

Blumenthal, J.A., Babyak, M.A., Ironson, G. et al. (2007) "Spirituality, Religion, and Clinical Outcomes in Patients Recovering From an Acute Myocardial Infarction"  Psychosom. Med. 69, 501-508 [abstract]

Placebo effects

Dodes, J. (1997) "The Mysterious Placebo" Skeptical Inquirer, Jan./Feb.

Nordenberg, T. (2000) “The Healing Power of Placebos”  FDA Consumer, Jan.-Feb., 14-17

Holden, C. (2002) “Drugs and Placebos Look Alike in the Brain” Science 295, 947, 949

Wigley, R. (2007) "When is a Placebo Effect Not an Effect?" Clin. Med. 7, 450-452 [pdf file]

Tilburt, J.C., Emanuel, E.J., Kaptchuk, T.J., Curlin, F.A., and Miller, F.G. (2008) "Prescribing 'Placebo Treatments': Results of a National Survey of US Internists and Rheumatologists" BMJ 337, a1938

Miller, R.G. and Kaptchuk, T.J. (2008) "The Power of Context: Reconceptualizing the Placebo Effect" J. R. Soc. Med. 101, 222-225

Kaptchuk, T.J., Friedlander, E., Kelley, J.M. et al. (2010) "Placebos Without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome" PLoS ONE 5, e15591

Gorski, D. ["Orac"] (2010) "More Dubious Statements About Placebo Effects"  Respectful Insolence blog, Dec. 23  [critique of preceding paper]

Finniss, D.G., Kaptchuk, T.J., Miller, F. and Benedetti, F. (2010) "Biological, Clinical, and Ethical Advances of Placebo Effects"  Lancet 375, 686-695 [abstract]

Brody, H. and Miller, F.G. (2011) "Lessons From Recent Research About the Placebo Effect - From Art to Science"JAMA 306, 2612-2613 [extract]

Feinberg, C. (2013) "The Placebo Phenomenon" Harvard Magazine, Jan.-Feb., 36-39 [profile of Ted Kaptchuk]

Tavel, M.E. (2014) "The Placebo Effect: the Good, the Bad, and the Ugly" Am. J. Med. 127, 484-488 [abstract]

Wager, T.D., Rilling, J.K, Smith, E.E. et al. (2004) “Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain” Science 303, 1162-1167 [abstract]

Zubieta, J.-K., Bueller, J.A., Jackson, L.R. et al. (2005) “Placebo Effects Mediated by Endogenous Opioid Activity on μ Opioid Receptors” J. Neurosci. 25, 7754-7762                                                                                                

Kienle, G.S. and Kiene, H. (1997) “The Powerful Placebo Effect: Fact or Fiction?” J. Clin. Epidemiol. 50, 1311-1318 [abstract]

Hróbjartsson, A. and Gøtzsche, P.C. (2001) “Is the Placebo Powerless? An Analysis of Clinical Trials Comparing Placebo With No Treatment” New Engl. J. Med. 344, 1594-1602; letters in response, 345, 1276-1279

Hrobjartsson, A. and Gotzsche, P.C. (2010) "Placebo Interventions for All Clinical Conditions"  Cochrane Database Syst Rev. CD003974 [abstract]

Chvetzoff, G. and Tannock, I.F. (2003) “Placebo Effects in Oncology” J. Natl. Cancer Inst. 95, 19-29

Hypnosis

Carroll, R.T. "Hypnosis" The Skeptic's Dictionary

Stalpers, L.J.A., da Costa, H.C., Merbis, M.A. et al. (2005) “Hypnotherapy in Radiotherapy Patients: a Randomized Trial” Int. J. Radiation Oncology Biol. Phys. 61, 499-506 [abstract]

Richardson, J., Smith, J.E., McCall, G., et al. (2007) "Hypnosis for Nausea and Vomiting in Cancer Chemotherapy: a Systematic Review of the Research Evidence" Eur. J. Cancer Care 16, 402-412 [abstract]

Schaefert, R., Klose, P., Moser, G. and Häuser, W. (2014) "Efficacy, Tolerability, and Safety of Hypnosis in Adult Irritable Bowel Syndrome: Systematic Review and Meta-Analysis" Psychosom. Med. 76, 389-398 [abstract]

Biofeedback

Nakao, M., Yano, E., Nomura, S., and Kuboki, T. (2003) “Blood Pressure-Lowering Effects of Biofeedback Treatment in Hypertension: a Meta-Analysis of Randomized Controlled Trials” Hypertens. Res. 26, 37-46 [abstract]

Allen, K.D. (2004) “Using Biofeedback to Make Childhood Headaches Less of a Pain” Pediatr. Ann. 33, 241-245 [abstract]

Autism

Barrett, S. (ed.) “Autism Watch”

FDA Consumer Health Information (2014) "Beware of False or Misleading Claims for Treating Autism"

Hall, S.E. and Riccio, C.A. (2012) "Complementary and Alternative Treatment Use for Autism Spectrum Disorders" Complement. Ther. Clin. Pract. 18, 159-163 [abstract]

Perrin, J.M., Coury, D.L., Hyman, S.L. et al. (2012) "Complementary and Alternative Medicine Use in a Large Pediatric Autism Sample" Pediatrics 130, S77-S82

Hendron, R.L. (2013) "Autism: Biomedical Complementary Treatment Approaches" Child Adolesc. Psychiatric Clin. N. Am. 22, 443-456 [abstract]

Whitehouse, A.J.O. (2013) "Complementary and Alternative Medicine for Autism Spectrum Disorders: Rationale, Safety and Efficacy" J. Paediatr. Child Health 49, E438-E442

Brondino, N., Fusar-Poli, L., Rocchetti, M. et al. (2015) "Complementary and Alternative Therapies for Autism Spectrum Disorder" Ev. Based Complement. Altern. Med. 2015, 258589

Levy, S.E. and Hyman, S.L. (2015) "Complementary and Alternative Medicine Treatments for Children with Autism Spectrum Disorders"  Child Adolesc. Psychiatr. Clin. N. Am. 24, 117-143 [abstract]

Owen-Smith, A.A., Bent, S., Lynch, F.L. et al. (2015) "Prevalence and Predictors of Complementary and Alternative Medicine Use in a Large Insured Sample of Children with Autism Spectrum Disorders" Res. Autism Spectr. Disord. 17, 40-51 [abstract]

Sinha, Y., Silove, N., Wheeler, D., and Williams, K. (2006) "Auditory Integration Training and Other Sound Therapies for Autism Spectrum Disorders: a Systematic Review" Arch. Dis. Child. 91, 1018-1022 [abstract]

Barrett, S. (2010) "Boyd Haley Ordered to Stop Illegal Marketing of OSR#1" Autism Watch

Davis, T.N., O'Reilly, M., Kang, S. et al. (2013) "Chelation Treatment for Autism Spectrum Disorders: a Systematic Review" Res. Autism Spectr. Disord. 7, 49-55 [abstract]

Barrett, S. (2015) "A Critical Look at Defeat Autism Now! and the 'DAN! Protocol'" Quackwatch

Stewart, P.A., Hyman, S.L., Schmidt, B.L. et al. (2015) "Dietary Supplementation in Children with Autism Spectrum Disorders: Common, Insufficient, and Excessive" J. Acad. Nutr. Diet. 115, 1237-1248 [abstract]

Sturmey, P. (2005) “Secretin is an Ineffective Treatment for Pervasive Developmental Disabilities: a Review of 15 Double-Blind Randomized Controlled Trials” Res. Dev. Disabil. 26, 87-97 [abstract]

Barrett, S. (2015) “Secretin Found Ineffective for Treating Autism” Quackwatch

Polenick, C.A. and Flora, S.R. (2012) "Sensory Integration and Autism: Science or Pseudoscience?" Skeptic Magazine 17(2), 28-35

Treatment of Other Conditions

van der Watt, G., Laugharne, J. and Janca, A. (2008) "Complementary and Alternative Medicine in the Treatment of Anxiety and Depression" Curr. Opin. Psychiatry 21, 37-42 [abstract]

Chan, E. et al. (2003) “Complementary and Alternative Therapies in Childhood Attention and Hyperactivity Problems” J. Dev. Behav. Pediatr. 24, 4-8 [abstract]

Sarris, J., Kean, J., Schweitzer, I. and Lake, J.(2011) "Complementary Medicines (Herbal and Nutritional Products) in the Treatment of Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review of the Evidence" Complement. Ther. Med. 19, 216-227

Gillies, D., Sinn, J.K., Lad, S.S., Leach, M.J., and Ross, M.J. (2012) "Polyunsaturated Fatty Acids (PUFA) for Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents" Cochrane Database Syst. Rev., CD007986 [abstract]

Bloch, M.H. and Mulqueen, J. (2014) "Nutritional Supplements for the Treatment of ADHD" Child Adolesc. Psychiatr. Clin. N. Am. 23, 883-897 [abstract]

Nahas, R. and Sheikh, S. (2011) "Complementary and Alternative Medicine for the Treatment of Major Depressive Disorders" Can. Fam. Physician 57, 659-663

Peck, K.R., Smitherman, T.A., and Baskin, S.M. (2015) "Traditional and Alternative Treatments for Depression: Implication for Migraine Management" Headache 55, 351-355 [abstract]

Mental health - unconventional practices

Barrett, S. (2003) “Mental Help: Procedures to Avoid” Quackwatch

Laures, J.S. and Shisler, R.J. (2004) “Complementary and Alternative Medical Approaches to Treating Adult Neurogenic Communication Disorders: a Review” Disabil. Rehabil. 26, 315-325 [abstract]

Koocher, G.P., McMann, M.R., Stout, A.O., and Norcross, J.C. (2015) "Discredited Assessment and Treatment Methods Used with Children and Adolescents: A Delphi Poll" J. Clin. Child Adolesc. Psychol. 44, 722-729 [abstract]

Murray, L.L. and Kim, H.-Y. (2004) “A Review of Select Alternative Treatment Approaches for Acquired Neurogenic Disorders: Relaxation Therapy and Acupuncture” Semin. Speech Lang. 25, 133-149 [abstract]

Mercer, J. (2013) "Attachment Therapies and Associated Parenting Techniques" Institute for Science in Medicine White Paper [pdf file]

Federal Trade Commission (2000) “Marketers of Various Dietary Supplements Settle FTC Charges That They Made Unsubstantiated Claims That Their Products Could Cure ADHD”   Press release, May 11

Barrett, S. (2009) "A Skeptical Look at Linda Schaumleffel's 'Power Brain Fitness' Program" Quackwatch

Max Planck Institute for Human Development and Stanford Center on Longevity (2014) "A Consensus on the Brain Training Industry from The Scientific Community".  For a response, see: "Cognitive Training Data"

Leshin, L. (1998) "Nutritional Supplements for Down Syndrome: A Highly Questionable Approach" Quackwatch            

Lilienfeld, S.C., Marshall, J., Todd, J.T. and Shane, H.C. (2014) "The Persistence of Fad Interventions in the Face of Negative Scientific Evidence: Facilitated Communication for Autism as a Case Example" Ev.-Based Commun. Assess. Intervention 8, 62-101

Novella, S. (1996, revised 2008) “Psychomotor Patterning” Connecticut Skeptic 1(4)

Hall, H. (2008) "SPECT Scans at the Amen Clinic - A New Phrenology?" Science-Based Medicine, April 8

Hall, H. (2013) "Dr. Amen's Love Affair with SPECT Scans" Science-Based Medicine, Mar. 19

Gaudiano, B.A. and Herbert, J.D. (2000) “Can We Really Tap Our Problems Away?  A Critical Analysis of Thought Field Therapy” Skeptical Inquirer 24(4)

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