Mind-Body Approaches

Also known by these names

  • Acceptance and commitment therapy
  • Art therapy
  • Biofeedback
  • Cognitive-behavioral stress management
  • Cognitive-behavioral therapy (CBT)
  • Consciousness-changing therapies
  • Guided imagery
  • Guided meditation
  • Hypnosis
  • Hypnotherapy
  • Hypnotic suggestion
  • Mindfulness-based cognitive therapy (MBCT)
  • Mindfulness-based stress reduction (MBSR)
  • Mindfulness meditation
  • Music therapy
  • Progressive muscle relaxation
  • Psychedelic therapies
  • Psycho-education
  • Psychosocial interventions
  • Qigong
  • Self hypnosis
  • Simonton method
  • Support groups
  • Tai chi
  • Transcendental Meditation
  • Walking meditation
  • Yoga

Key Points

  • Mind-body therapies include many diverse techniques, all with a goal of relaxing or clarifying the mind. Some also relax the body.
  • BCCT’s interest in these therapies lies in their success in improving wellness and quality of life for cancer patients.
  • Several of these therapies have been recommended in practice guidelines to improve wellness and improve quality of life in cancer patients.
  • Most mind-body therapies involve very little risk, although others require trained supervision.
  • Some therapies can be practiced alone, but others are best conducted under trained supervision or guidance.
  • 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.


Nancy Hepp, MS, BCCT Project Manager

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Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher

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Last updated September 16, 2021.

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.

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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

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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.

  • Fewer depressive symptoms in stroke survivors and their caregivers with psychosocial interventions in ameta-analysis of RCTs8

Specific Therapies

Art Therapy

Art therapy is an expressive therapy that uses the creative process of making art to improve physical, mental and emotional well-being.9


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.

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Regular practice several times a day can be an effective tool in managing your stress response.

Theta Brain State

Theta 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.”11


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:12

  • 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”:13

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Cognitive-Behavioral Stress Management

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.16

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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.20 See the ACT website, which includes a link to find an ACT therapist.

Cognitive-Behavioral Therapy (CBT)

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.

Recommended with good evidence as part of a multidisciplinary approach to reduce anxiety, mood disturbance, chronic pain, and improve quality of life in Society of Integrative Oncology 2009 clinical practice guidelinesDeng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. Summer 2009;7(3):85-120.

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.21

A 2017 study found that cognitive-behavioral therapy plus hypnosis reduced emotional distress in women with breast cancer undergoing radiotherapy.22

Lower likelihood of developing an anxiety or depressive disorder among newly diagnosed cancer patients at high risk of these disorders, compared with those who received usual care; no effect was found with people without high risk in a mid-sized RCT23

Better body weight, adiposity, leptin, insulin resistance, and C-reactive protein among overweight/obese women at high risk of breast cancer with an individually tailored, cognitive-behavioral therapy program that assists women in identifying strategies to improve their nutrition and physical activity habits with the goal of reduced body weight and obesity compared to controls in a small RCT24

  • Substantially less cancer-related fatigue during cancer treatment with cognitive–behavioral therapy combined with physical activity, and moderately less fatigue after treatment either with or without physical activity compared to usual care in a meta-analysis of RCTs25
  • Less cancer-related fatigue with cognitive–behavioral therapy in a meta-analysis of RCTs26
  • Weak trends toward better quality of life and lower stress levels among breast cancer survivors with CBT in a meta-analysis of six RCTs27
  • Slightly lower scores of hot flashes at the end of treatment but not during follow-up among people with breast cancer with CBT compared to controls in a meta-analysis of RCTs28

Cognitive-Behavioral Therapy for Insomnia (CBT‐I)

Cognitive-behavioral therapy for insomnia (CBT‐I) is effective in improving insomnia:

  • A 2017 review concluded CBT-I is effective.29
  • CBT-I led to improvements in attention and subjective cognitive function in cancer survivors with insomnia.30
  • 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.31  
  • 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.32

Cognitive Bias Modification (CBM)

CBM interventions are designed to directly modify attention and interpretation biases via repeated practice on cognitive tasks.33

  • Lower self-reported levels of worry, anxiety, depression, and other symptoms of generalized anxiety disorder (GAD)  with internet-delivered interpretation training (cognitive bias modification) in a mid-sized RCT34

Dignity Therapy

Dignity therapy is psychotherapy to relieve psychological and existential distress in patients at the end of life. Preliminary evidence shows

  • Benefits in anxiety, depression, and dignity-related distress among people with advanced cancer in a meta-analysis of RCTs35
  • Better dignity-related distress, but only a weak trend toward lower anxiety and depression among among people with cancer in palliative care in a meta-analysis of RCTs and other experimental studies36

Guided Imagery

“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.37 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."38

  • 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.”39 A review in 2018 found limited evidence of improvements in depression, anxiety and quality of life, but not in pain.40 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.41
  • Less cancer-related procedural pain among children with cancer compared to standard care or attention control in a meta-analysis of controlled trials42
  • Self-hypnosis combined with self-care was linked to improvements in fatigue, sleep, emotional distress and cognitive functioning among people with cancer in a small RCT.43
  • Less anxiety with surgery with self-hypnosis44 or anodyne imagery45
  • No difference in quality of life, anti-emetic use, re-hospitalization rates, treatment delays, and infection rates among women with ovarian cancer undergoing chemotherapy with an intervention combining healing touch, hypnosis, and massage compared to no intervention in a small RCT46
  • Moderately lower scores of hot flashes at the end of treatment among people with breast cancer with hypnosis compared to controls in a meta-analysis of RCTs47

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.48 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.49 A systematic review in 2020 concluded that hypnosis is effective in addressing cancer-related pain in breast cancer patients.50


Evidence not specific to people with cancer:

  • Lower anxiety in a meta-analysis of RCTs51
  • Lower anxiety scores among people with chronic obstructive pulmonary disease in a small RCT52
  • No impact on anxiety among adult burn patients with hypnosis in a meta-analysis of RCTs53
  • Use during invasive medical procedures:
    • Lower anxiety scores among men undergoing rigid cystoscopy with hypnosis in addition to routine local anesthesia in a small RCT54
    • Less use of pain medication with invasive medical procedures, but no significant change in anxiety or pain intensity55
    • Anxiety was higher before a medical procedure, but lower after the procedure, with hypnosis compared to no hypnosis in a mid-sized RCT.56

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.

Meditation and Mindfulness-based Clinical Interventions

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 follow summary draws from Tai Chi Society,57 The Qigong Institute,58 and Livestrong.com.59

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.

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Some meditation practices include movement or energy, including these:

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Expressive Arts Therapy, including Music Therapy

Music therapy may include playing instruments, vocal and instrumental improvisation, singing, composing, music-guided imagery and listening to music, led by a therapist. 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 art 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.80
  • A 2020 review and meta-analysis regarding studies of people with cancer 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."81
  • Benefits with music therapy for anxiety, plus low-quality studies showing benefits for depression, pain, fatigue, quality of life, but no effect on mood or distress; small reductions in heart rate, respiratory rate and blood pressure but not on oxygen saturation levels or physical functioning82
  • A 2020 systematic review concluded that music therapy is effective in addressing cancer-related pain in breast cancer patients.83
  • Significantly better quality of life and lower scores for anxiety, depression, pain, and fatigue among people with breast and gynecologic cancers with use of arts therapies based on music, painting, or dance in a meta-analysis of 19 RCTs84 The analysis found no benefits for sleep disturbance, anger, vigor, tension, confusion, or stress.
  • Lower scores for anxiety depression, and pain among people with cancer in a meta-analysis of RCTs,85 but no evidence of significant effect of five-element music therapy among people with cancer in a separate meta-analysis or RCTs86
  • Lower anxiety among critically ill people87 and adult burn patients with music therapy in  meta-analyses of RCTs88
  • Better quality of life among people with breast cancer with expressive writing in a meta-analysis of RCTs89
  • Less cancer-related fatigue after a session of music therapy among hospitalized adults with cancer and moderate to severe cancer-related fatigue receiving active music therapy such as singing or selecting songs compared to passive listening in a mid-sized observational study90
  • No effect on anxiety, depression, stress among people with cancer with dance/movement therapy in a meta-analysis of two small controlled trials91  
  • Large improvement in quality of life among breast cancer survivors treated within the prior five years with a 12-week dance and movement program compared to no intervention in a small RCT92
  • Less anxiety related to surgery with music therapy93

Listening to Music

  • Less anxiety with listening to music during invasive medical procedures in meta-analyses of RCTs94
  • Benefits with listening to music (medical music) on anxiety and depression, but no impact on quality of life or on mood or distress95
  • Less anxiety and pain, and improvements in sleep, level or arousal, and duration of mechanical ventilation among critically ill adults in a review of RCTs96

Music therapy is considered safe. See more on the CAM-Cancer website: Music therapy.

Progressive Muscle Relaxation and General Relaxation

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.97
  • Better sleep quality and scores on anxiety among people with COVID-19 with progressive muscle relaxation in a small RCT98

PMR is generally considered safe. See more on the CAM-Cancer website: Progressive Muscle Relaxation.

General relaxation techniques:

  • Lower anxiety scores among burn patients with relaxation techniques99
  • Less aromatase inhibitor-associated joint pain (arthralgia) among postmenopausal female breast cancer survivors (but not those with metastatic cancer) with relaxation techniques in a meta-analysis of intervention studies100

Psychedelic Therapies

Psychedelic therapies are used to “produce a nonordinary state of consciousness for religious or spiritual purposes.”101 They may also be used to reduce anxiety and promote wellness.

Also known as entheogenic therapies, psychedelic substances or psychotropic substances, these are typically of two origins:

  1. Entheogenic substances naturally produced by organisms, such as psilocybin produced by hundreds of varieties of mushrooms
  2. Synthesized substances such as MDMA (ecstasy)

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Psychoeducation, Paced Respiration, and Relaxation (PEPRR)

  • Lower depression scores with PEPRR compared to treatment as usual among caregivers for people undergoing hematopoietic stem cell transplant when the caregivers had poor sleep at baseline, but no impact of PEPRR on anxiety102

Simonton Method

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

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.103

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:104

  • 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

Recommended with good evidence as part of a multidisciplinary approach to reduce anxiety, mood disturbance, chronic pain, and improve quality of life in Society of Integrative Oncology 2009 clinical practice guidelinesDeng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. Summer 2009;7(3):85-120.

See Sharing Love & Support and Healing Circles: Share Your Experience for further information.

Other Psychosocial and Behavioral Interventions

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.105 This therapy can be administered by non sleep-specialists, making it accessible to more patients.

A 2017 review found these benefits among breast cancer survivors:106

  • 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.
    • A 2021 review found benefit among people with a psychological condition or symptoms (such as depression), but not otherwise, with internet-based ACT.107  
    • A 2021 meta-analysis of RCTs of generally poor quality found ACT was associated with better outcomes after treatment completion and at 1-3 months and at 3-6 months of follow-up for depression, anxiety, quality of life, psychological distress, and stress. Outcomes were still significant after 6 months of follow-up for depression, anxiety, quality of life, and stress. ACT was associated with psychological flexibility and was not associated with a reduction in fear at treatment completion. However, psychological flexibility (1-3 months) decreased and fear (1-6 months) decreased, and the longer-term effect was still significant.108
  • 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. Recommended with good evidence as part of a multidisciplinary approach to reduce anxiety, mood disturbance, chronic pain, and improve quality of life in Society of Integrative Oncology 2009 clinical practice guidelinesDeng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. Summer 2009;7(3):85-120.

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.109

Laughter therapy uses humor to help relieve pain and stress and improve a person’s sense of well-being. It can decrease stress hormone levels, alter dopamine and serotonin activity (related to mood and depression) and improve quality of life as shown in small randomized controlled trials not specific to cancer:

  • Lower loneliness scores with laughter therapy among older adults110
  • Improved pain and sleep quality111 and lower levels of stress hormones112 with laughter yoga
  • Lower anxiety levels in a meta-analysis of RCTs113
  • Decreased depression and anxiety, and improved sleep quality among adults in a meta-analysis of RCTs114
  • Less anxiety during medical procedures and improved psychological adjustment among children and adolescents in the presence of hospital clowns115  
  • Substantially less anxiety among children preparing for surgery, and a small-to-medium effect on reducing parents' state anxiety in two meta-analysis of RCTs116 and intervention studies117

Dyadic intervention: Interventions "offered to cancer patients and their family caregivers together as the unit of care" were linked to benefits by three months among people with cancer in these areas:

  • Total quality of life
  • Total spiritual aspect of quality of life
  • Emotional, social, and mental aspects of quality of life
  • Depression
  • Anxiety
  • Relatedness
  • Marital functioning

By six months, dyadic was linked to better patient social aspect and depression in a meta-analysis of RCTs.118

Unspecified psychological interventions (as a group):

  • Less anxiety among people with cancer, especially those with higher psychological distress at baseline, and with evidence-based interventions in a meta-analysis of clnical trials119  
  • Psychological interventions show positive, statistically significant benefits for anxiety and problem-solving skills, and, to a lesser extent, for posttraumatic stress among family members of children with cancer. No statistically significant differences were found for mood, acute stress, coping skills, social support, or quality of life in a meta-analysis of various types of experimental trials.120

Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.

Highlighted Video

Brian Bouch discusses integrative oncology, part 1

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Non-cancer Uses of Mind-Body Approaches

Mind-body techniques have been used with these conditions and situations:126

  • Arthritis
  • Balance problems (such as from Parkinson’s disease)
  • High blood pressure
  • Irritable bowel syndrome
  • Labor and delivery
  • Low bone density
  • Obesity and weight loss
  • Sleep disorders
  • Type 2 diabetes
  • Urinary incontinence

Psychological and psychosocial therapies have been used with these conditions and situations:127

  • Easing pregnancy, labor and delivery
  • Reducing high blood pressure
  • Improving digestion
  • Maintaining normal blood sugar levels
  • Increasing blood flow to major muscles
  • Reducing muscle tension and chronic pain
  • Improving concentration and mood
  • Improving sleep quality
  • Lowering fatigue
  • Addressing mental illness

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:


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