Nancy Hepp, MS, BCCT Project Manager
Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher
Last updated December 7, 2020.
Also known by these names
Mind-body approaches include several techniques. Some have a goal of relaxing both mind and body. Some focus on clarifying the mind, improving focus, enhancing decision-making capacity, managing stress or resolving conflict. Many of these techniques are associated with reduced levels of pain, fatigue, stress, anxiety, nausea and vomiting, depression, sleep disruption or other symptoms common in cancer and cancer treatments.
Clinical Practice Guidelines
2009 evidence-based clinical practice guidelines for integrative oncology included “incorporation as part of a multidisciplinary approach for reducing anxiety, mood disturbance, and chronic pain and for improving quality of life in cancer patients. Evidence shows the benefit of support groups, supportive/expressive therapy, cognitive-behavioral therapy, and cognitive-behavioral stress management.”1
Managing Side Effects and Promoting Wellness
Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being
Because many of these therapies generally involve very little risk and may improve quality of life, many practitioners are comfortable recommending them for patients.
Studying the effectiveness of these therapies is difficult because of the challenges in creating controls and placebo conditions. However, mounting evidence shows benefits for cancer patients from several of these therapies, as described below. These therapies are most likely beneficial across a wide range of cancers, even though research to date may focus on only a few cancer types. Because many of these therapies generally involve very little risk and may improve quality of life, many practitioners are comfortable recommending them for patients.
Art therapy is an expressive therapy that uses the creative process of making art to improve physical, mental and emotional well-being.8
Patients using biofeedback are connected to electrical sensors or other instruments that report information about body status back to the patient. Information may include heart rate, blood pressure, breathing, muscle contraction, brain waves, sweat glands or skin temperature. The goal is for the patient to learn responses and actions that move these markers in the desired direction. While in the past, patients had to visit clinics, hospitals or physical therapists to access instruments, wearable devices are now available.
Regular practice several times a day can be an effective tool in managing your stress response.
Theta Brain StateTheta brain state “is a state where tasks become so automatic that you can mentally disengage from them. The ideation (formation of ideas or concepts) that can take place during the theta state is often free flow and occurs without censorship or guilt. It is typically a very positive mental state.”10
Breathing is one of the simplest, most basic and yet powerful tools to manage a state of stress. Adjusting your breathing can be done anywhere and at any time. Deep diaphragmatic breathing is belly or abdominal breathing in which the belly, rather than the chest, expands when inhaling. This type of breathing resets the autonomic nervous system and has the following effects:11
- Decrease oxygen consumption, heart and breath rate
- Increase theta wave state and parasympathetic activity
- Generally feeling alert and invigorated
The Relaxing Breath
Shanti Norris, a yoga teacher who works with people with cancer simply explains: “One cannot feel anxious as long as one is breathing slowly and deeply.” Here are her instructions for managing stress with “The Relaxing Breath”:12
This psychotherapy approach combines meditation with a variety of cognitive-behavioral strategies, such as problem solving and interpersonal communication. The goal is to recognize and alter responses to negative thoughts.14
Managing Fear of Cancer Recurrence
A pilot study found that acceptance and commitment therapy (ACT) reduced fear of recurrence among breast cancer survivors better than survivorship education or a 30‐minute group coaching session with survivorship readings.17 See the ACT website, which includes a link to find an ACT therapist.
CBT, a type of psychotherapy, aims to help patients change behavior by changing thoughts and feelings. Used to treat mental, emotional, personality and behavioral disorders such as insomnia and depression, CBT has also been used to treat anticipatory nausea and vomiting.
A study investigated a single half-day group intervention for ovarian cancer survivors. The intervention included sexual health education and rehabilitation training, relaxation and cognitive-behavioral therapy skills to address sexual symptoms, followed by a single tailored booster telephone call four weeks after the group. The intervention led to significantly improved overall sexual functioning and psychological distress that were maintained at a six-month follow-up.18
Cognitive-behavioral therapy for insomnia (CBT‐I) is effective in improving insomnia:
- A 2017 review concluded CBT-I is effective.21
- CBT-I led to improvements in attention and subjective cognitive function in cancer survivors with insomnia.22
- CBT-I for eight weeks was effective in treating moderate to severe insomnia and more effective than acupuncture for those with mild symptoms of insomnia. Both therapies also improved quality of life. Although both treatments produced meaningful and durable improvements, CBT-I was more effective and should be the first line of therapy.23
- CBT-I has also shown success with adolescent and young adult (AYA) cancer survivors. Participants in small study reported a significant lessening in insomnia severity, daytime sleepiness and fatigue, and an overall improvement in quality of life eight and 16 weeks after beginning the online program.24
“Guided imagery involves using the imagination to create a specific sensory experience to achieve a clinical goal, such as promoting overall well-being or treating specific symptoms. The National Comprehensive Cancer Network recommends both imagery and hypnosis as effective treatments for anticipatory nausea and vomiting. A review of more than 100 imagery studies found that compared with no treatment, imagery was more helpful for treating depression, anxiety, discomfort, and quality of life, with effects similar to other mind-body interventions such as hypnosis and relaxation alone.25 See Guided Imagery.
Also referred to as hypnosis or hypnotic suggestion, this therapy is usually done with the help of a therapist using verbal repetition and mental images to create a trance-like state. Hypnosis has been promoted to reduce pain, nausea and vomiting, hot flashes, fatigue and anxiety. A 2019 article in the Washington Post reported that "some US hospitals are offering hypnosis to patients to lessen preoperative anxiety, to manage postoperative pain and even to substitute for general anesthesia for partial mastectomies in breast cancer."26
A 2017 review of all studies of hypnosis for cancer patients concluded that "hypnosis is a viable means of reducing pain and anxiety without side effects, while allowing patients to play an active role in their comfort and well-being.”27 A review in 2018 found limited evidence of improvements in depression, anxiety and quality of life, but not in pain.28 However, study design to date may be inadequate to fully assess the impacts. A rigorous review in 2017 found "no studies met the inclusion criteria" for rigorous testing of hypnosis with cancer patients at the end of life.29
Studies specific to breast cancer have found benefit. A 2017 study found that cognitive-behavioral therapy plus hypnosis reduced emotional distress in women with breast cancer undergoing radiotherapy.30 A 2018 non-randomized study of women undergoing breast surgery found shorter hospital stays; less anxiety; less weakness (asthenia) during follow-up chemotherapy; less radiodermatitis; and reduced incidence of hot flashes, joint and muscle pain and asthenia while on endocrine therapy in the group receiving hypnosis sedation compared to those receiving general anesthesia.31 A systematic review in 2020 concluded that hypnosis is effective in addressing cancer-related pain in breast cancer patients.32
Hypnotherapy is generally considered safe when administered by a trained professional, but some mental health conditions preclude its use. Patients can learn this skill and therefore, after instruction, perform a type of hypnosis on themselves. See more on the CAM-Cancer website: Hypnotherapy.
All forms of meditation have the aim of reducing stress, mood disturbances and fatigue, as well as improving quality of life.
All forms of meditation have the aim of reducing stress, mood disturbances and fatigue, as well as improving quality of life. Meditation generally strives to focus attention, regulate breathing, and raise awareness of thoughts and feelings to achieve inner calm, physical relaxation, psychological balance and improved vitality and coping. Participants practice approaching thoughts and feelings without judgment.
Tai Chi or Qigong: What’s the Difference?
The qi (also spelled chi) is “the life energy that flows through the body’s energy pathways.” Tai chi and qigong both cultivate the qi by combining movement, breathing and meditation.
Some meditation practices include movement or energy, including these:
Music therapy may include playing instruments, vocal and instrumental improvisation, singing, composing, music-guided imagery and listening to music. The goal is usually to address physical, emotional, cognitive and social needs. Music interventions may affect anxiety, depression, fatigue, pain and quality of life in cancer patients, with small impacts on heart rate, breathing rate and blood pressure.
Evidence of music therapy's effects:
- A 2018 review found that music therapy was associated with a decline in pain in patients with terminal illness and possibly with reduced anxiety in cancer patients.43
- A 2020 review and meta-analysis concluded: "During curative treatment, results were most promising with regard to anxiety, depression, and pain medication intake, while in palliative settings, improvements with regard to quality of life, spiritual well-being, pain, and stress were reported."44
- A 2020 systematic review concluded that music therapy is effective in addressing cancer-related pain in breast cancer patients.45
Music therapy is considered safe. See more on the CAM-Cancer website: Music therapy.
This therapy involves successively tensing and relaxing major skeletal muscle groups to reduce feelings of tension, to lower perceived stress, and to induce relaxation. Some evidence indicates that patients participating in PMR training have experienced reduced anxiety, pain and symptoms of depression, as well as improvements in sleep parameters and overall quality of life. A review in 2017 categorized relaxation techniques ”as having preliminary positive evidence” for pain management.46 PMR is generally considered safe. See more on the CAM-Cancer website: Progressive Muscle Relaxation.
Also known as entheogenic therapies, psychedelic substances or psychotropic substances, these are typically of two origins:
- Entheogenic substances naturally produced by organisms, such as psilocybin produced by hundreds of varieties of mushrooms
- Synthesized substances such as MDMA (ecstasy)
The Simonton method of counseling for cancer patients combines cognitive-behavioral elements, relaxation exercises, guided imagery and meditation. This method aims to prolong survival time and improve quality of life. See more on the CAM-Cancer website: Simonton Method and the Simonton Cancer Center website.
Support groups provide a safe place for patients to share feelings and challenges, helping many people cope with the emotional aspects of cancer.
Support groups provide a safe place for patients to share feelings and challenges, helping many people cope with the emotional aspects of cancer. Groups also allow people to learn from others facing similar situations.48
In his book Life Over Cancer, Keith Block suggests that support groups are most helpful during or after treatment rather than right after diagnosis. Benefits of a structured support group may include these:49
- Confidential expression of concerns, fears and anger
- Development of new or strengthened coping skills
- Enhanced communication and a closer connection to those who matter most in your life
- Warding off isolation and disconnection
- Opportunities for relaxation, cognitive reframing and self-hypnosis training
- Meditation guidance
- Opportunities to laugh with people who can readily appreciate the difficulties of finding special moments of joy
Sleep Training Education Program: Both STEP‐1 (a single sleep education session) and STEP‐2 (a three‐session, group cognitive behavioral treatment) improved Insomnia Severity Index (ISI) scores, with substantial remission of insomnia among cancer survivors in a small study.50 This therapy can be administered by non sleep-specialists, making it accessible to more patients.
- Acceptance and Commitment Therapy (ACT), using acceptance and mindfulness strategies and promoting commitment to behavior change, increasing psychological flexibility and adaptability. Studies show preliminary evidence for reduced anxiety and symptoms of depression.
- Behavioral lifestyle interventions, focusing on increasing health behaviors, primarily physical activity. Benefits include improvements in fatigue, symptoms of depression, body image and health-related quality of life.
- Couples-focused interventions, psychological interventions for breast cancer survivors and their partners. These interventions may impact quality of life, distress, relationship functioning and physical symptoms.
- Meaning-Centered Psychotherapy (MCP), targeting psychological, existential and spiritual distress of advanced survivors. Benefits include improvements in quality of life, symptoms of depression and hopelessness.
- Supportive-Expressive Therapy (SET), promoting peer social support and expression of emotions and existential concerns and focuses on facing and grieving losses. Benefits include improvements in symptoms of depression, hopelessness and helplessness, trauma symptoms, and social functioning.
A study found benefit of a single exercise counseling session during which symptoms were reviewed and current functional status, as well as current and previous exercise habits and capabilities were assessed. Individualized exercise recommendations were developed, including short- and long-term exercise goals and plans for follow-up sessions. At the close of the session, global distress scores had improved. At a follow-up session, improvements were noted in fatigue and in global health, mental health, and physical health scores.52
Integrative Programs, Protocols and Medical Systems
|For more information about programs and protocols, see our Integrative Programs and Protocols page.|
Brian Bouch discusses integrative oncology, part 1
- Programs and protocols
- Traditional systems
Non-cancer Uses of Mind-Body Approaches
Mind-body techniques have been used with these conditions and situations:58
Psychological and psychosocial therapies have been used with these conditions and situations:59
BCCT has not reviewed the effectiveness of these therapies for non-cancer uses.
BCCT has not conducted an independent review of mind-body therapies research. This summary draws from several sources:
- CAM-Cancer Summaries
- Mayo Clinic
- Memorial Sloan Kettering Cancer Center’s About Mind-Body Therapies
- National Cancer Institute Topics in Integrative, Alternative, and Complementary Therapies (PDQ®)–Health Professional Version
- Greater Good in Action
- Other sources as noted
Courses, Guides & Apps
- Insight Timer: Guided Meditations free app for meditations
- Greater Good in Action: Walking Meditation
- Smith Center for Healing and the Arts: Progressive muscle relaxation instructions by Shanti Norris
- Linda E. Carlson and Michael Speca. Mindfulness‐Based Cancer Recovery: A Step‐By‐Step MBSR Approach to Help You Cope With Treatment and Reclaim Your Life
- UMass Memorial Medical Center's Center for Mindfulness: MBSR 8-week Online Live (summer 2020)
Books and Websites
- Mayo Clinic:
- Memorial Sloan Kettering Cancer Center: About Mind-Body Therapies
- National Cancer Institute Topics in Integrative, Alternative, and Complementary Therapies (PDQ®)–Health Professional Version
- Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010.
- Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer. Berkeley, California: Ten Speed Press. 2013.
- Lemole G, Mehta P, McKee D. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
- Ornish Lifestyle Medicine Program for Prostate Cancer
- Rossman M, Shrock D. Chapter 13: Mind-body Medicine in Integrative Cancer Care. In Abrams DI, Weil AT. Integrative Oncology. 2nd Edition. New York, NY: Oxford University Press. 2014.
More from Our Resources Database
- Ralph Moss: Moss Report Podcast
- Dr. Cynthia Li: Brave New Medicine
- Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology
- Integrative Oncology Talk
- University of Arizona Andrew Weil Center for Integrative Medicine: Integrative Pain Management Series
- University of Arizona Andrew Weil Center for Integrative Medicine: Introduction to Integrative Oncology (2019-2021)
- Dawn Lemanne and Victoria Maizes: Advising Women Undergoing Treatment for Breast Cancer
- Translational Behavioral Medicine: Frontiers in Mindfulness and other Complementary & Integrative Approaches in Behavioral Medicine
- Dr. Ralph Moss: Dealing with the Trauma of Cancer: Dr. Moss interviews Dr. James S. Gordon
- Lee Majewski: Coping with Cancer: A Journey to a New Life
- Andrew Weil Center for Integrative Medicine: CanHEAL
- Block KI, Block PB, Gyllenhaal C: Integrative Treatment for Colorectal Cancer
- Integrative Cancer Review
- Martin L. Rossman, MD: Fighting Cancer from Within
- Julie Lusk: 30 Scripts for Relaxation, Imagery and Inner Healing–Volume 1
- Julie Lusk: 30 Scripts for Relaxation, Imagery and Inner Healing–Volume 2
- Mala Cunningham, PhD: Before and After Surgery
- Martin L. Rossman: Preparing for Surgery
- National Cancer Institute: Cancer Pain Control: Support for People with Cancer
- September 2018 Issue of the Journal of Alternative and Complementary Medicine
- Wayne Jonas, MD: Your Healing Journey: A Patient’s Guide to Integrative Breast Cancer Care
- The New School at Commonweal: Dwight McKee, MD: 40 Years Practicing Integrative Cancer Medicine, Part 2
- Foundation for a Mindful Society: Mindful
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- Ted Schettler, MD, MPH: The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing
- Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition
- Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
- Memorial Sloan Kettering Cancer Center: Integrative Medicine Education & Training Programs
- Lorenzo Cohen and Alison Jefferies: Anticancer Living: Transform Your Life and Health with the Mix of Six
- Ting Bao, MD: The Role of Integrative Therapy in Cancer Care
- CAM-Cancer Collaboration: CAM-Cancer
- Memorial Sloan Kettering Cancer Center: About Herbs, Botanicals and Other Products
- National Cancer Institute: Office of Cancer Complementary and Alternative Medicine
- Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer
- American Academy of Anti-Aging Medicine and Metabolic Medical Institute: Integrative Cancer Therapy Fellowship Modules
- Jeremy R. Geffen, MD, FACP: Jeremy Geffen, MD—The Seven Levels of Healing
- Fang Fu, Huaijuan Zhao, Feng Tong, and Iris Chi: A Systematic Review of Psychosocial Interventions to Cancer Caregivers
- National Comprehensive Cancer Network Patient and Caregiver Resources
- Carole O'Toole and Carolyn B. Hendricks: Healing outside the Margins: The Survivor's Guide to Integrative Cancer Care
- healthjourneys: Meditations
- Belleruth Naparstek: Belleruth Naparstek
- Martin L. Rossman, MD: The Healing Mind
- Julie Lusk, MEd: Wholesome Resources
- Jeanne Achterberg: Imagery in Healing: Shamanism and Modern Medicine
- Jeanne Achterberg and Barbara Dossey: Rituals of Healing
- Jeanne Achterberg: Jeanne Achterberg (1942-2012): Imagery in Healing -- Part One Complete: Thinking Allowed
- David Zuniga, PhD: Guided Meditation for Cancer Patients and Caregivers HD
- O. Carl Simonton, MD, James Creighton, PhD, and Stephanie Matthews Simonton: Getting Well Again
- O. Carl Simonton, MD, and Reid Henson with Brenda Hampton: The Healing Journey
- Martin L. Rossman, MD: Fighting Cancer
- Belleruth Naparstek: A Guided Meditation to Help with Concentration, Focus & Learning
- Cancer Research UK
- Sexuality during and after Cancer