Mind-Body Therapies for Improving Mental Health

Mind Over Matter

Mind-body therapies, also known as complementary health approaches (CHAs) are a diverse group of healthcare practices and healing techniques focused on the integration of mind, body, brain, and behavior.[1] While mind-body therapies treat a variety of acute and chronic health conditions, there has been renewed interest in ancient traditions, such as yoga and meditation, to treat mental health conditions like depression and anxiety.

These therapies serve as complementary adjuncts to conventional forms of mental health treatment. “Complementary” medicine differs from “alternative” medicine in the sense that complementary medicine is utilized together with other forms of medicine whereas alternative medicine serves as a complete replacement. While both have historically drawn some skepticism as their origins lie outside of typical Western modes of treatment, complementary medicine has been shown to effectively bridge various forms of therapy in a coordinated way. Moreover, mind-body therapy provides a low intensity and accessible therapy and treatment option for a wide variety of individuals, including those in marginalized populations and disadvantaged individuals who may not otherwise receive mental health treatment.[2] 

Health Benefits 

The goal of mind body therapy is to lower levels of stress hormones to improve overall health and reduce risk of chronic illness. With heightened levels of stress, one is at greater risk for several diseases including high blood pressure, heart irregularities, anxiety, insomnia, persistent fatigue, digestive disorders, diminished fertility, and diabetes.[3] 

Mount Sinai’s Icahn School of Medicine states that mind-body techniques can encourage relaxation, improve coping skills, reduce tension and pain, and lessen the need for medication.[4] Specifically related to improvements in mental health, it has been posited that mind-body practices can foster a sense of control, increase optimism, and provide social support that improves one’s quality of life and reduce symptoms related to depression and anxiety.[5] In addition, the National Center for Complementary and Integrative Health (NCCIH) believes that multiple modes of treatment can better treat the whole person rather than administering a treatment for one single organ.[6]

Types of Mind-Body Therapies

There are several types of Mind-Body Therapy as defined by the NCCIH, however the most popular are yoga, tai-chi, and qigong, followed by meditation and massage therapy.[7,8] 

Low-Intensity & Movement-Based: 

1. Yoga: Yoga has its origins in an ancient healing practice in India known as Ayurveda, and draws upon the intersection of movement through postures, mindful breathing and meditation, and well as an emphasis on personal and spiritual growth. A typical yoga practice moves through a series of poses to help strengthen the physical body as well as establish a stronger connection to one’s own interiority (i.e., mind to muscle connection). Yoga is one of the most utilized and effective forms of mind-body therapy. It has been shown to increase feelings of relaxation, improve self-confidence and body image, and induce feelings of optimism and well-being.[9] 

2. Tai Chi: Tai chi has its roots in ancient Chinese philosophy and traditional medicine theory that focuses primarily on controlling breath and internal energy. Tai chi features specific exercises that improve balance, mobility, and stamina and is also effective in treating stress and anxiety disorders through the encouragement of bodily awareness. Tai chi has been posited to have similar effects to Cognitive Behavioral Therapy (CBT), specifically in its ability to treat insomnia. A study by Raman et al. (2013) showed that older adults with chronic conditions who practiced tai chi reported improved sleep quality and better psychological well-being.[10]

3. Qigong: Qigong is an ancient Chinese healing practice which integrates bodily movements and muscle relaxation with breathing techniques and meditation that strengthen one’s connection to their internal vital energy force. Qigong can stabilize both sympathetic and parasympathetic nervous system activity in order to reduce blood pressure and feelings of stress and anxiety. Related to improvements in cognitive function, qigong has been shown to improve both processing speed and sustained attention in older adults.[11]

Encourage Physical & Mental Relaxation:  

1. Acupuncture: Acupuncture has its roots in traditional Chinese medicine and healing systems. This practice draws from the belief that one’s qi or energy (similar to the energetic life force which generates the movements of qi-gong) flows along channels that connect different parts of the body in a synergetic way. When this energy becomes stagnant, individuals may experience pain or psychological distress related to anxiety, depression, and insomnia. Acupuncture stimulates areas of the brain known to reduce sensitivity to pain and stress as well as promote relaxation by activating the parasympathetic nervous system, which initiates the relaxation response.[12]

2. Aromatherapy: Aromatherapy utilizes the scent of plant oils and extracts to promote relaxation by engaging specific brain pathways.[13] Since olfactory smell receptors have signaling pathways connected to the brain, aromatherapy engages the parasympathetic nervous system to promote relaxation and also encourages the brain to produce more chemicals like serotonin or dopamine which are primarily responsible for controlling mood.[14] Memorial Sloan Kettering Cancer Center notes that aromatherapy using lavender or sweet marjoram may help anxiety. Additionally, they found that aromatherapy combined with massage was preferred to cognitive behavior therapy, but with similar benefits on lessening distress in cancer patients.[15]

3. Massage: Massage therapy promotes circulation, muscle relaxation, and alleviates stress through the manipulation of muscles and soft tissues in the body. It has also been posited that massage therapy can lower the production of the stress hormone cortisol in the body while releasing serotonin to boost mood and feelings of well-being. In addition to regulating breathing and improving sleep, the Mayo Clinic Health System notes that massage can help alleviate stress, anxiety, depression, nausea, pain, fatigue, and insomnia in cancer patients.[16] 

4. Meditation: Meditation is a widely used and empirically-proven effective therapy technique focused on the reestablishment of mind to body and breath. While it is relatively easy to implement a few minutes of meditation into one’s daily routine, meditation therapy is often offered as a structured 8 week program known as mindfulness-based stress reduction (MBSR). Meditation has been shown to improve mental functioning, self-awareness, mood, and well-being. The most common goals of meditation include inner calmness, physical relaxation, psychological balance, and improved vitality and coping.[17]

5. Guided Imagery: Guided imagery involves the recreation of mental imagery, sounds, and smells to ease anxiety and reduces feelings of depression, stress, fatigue, and discomfort. Practicing visualization and utilizing mental imagery can elicit a positive mood and greater feelings of calm and joy. Guided imagery is often used in conjunction with or implemented into meditation or yoga sessions with the help of a licensed instructor. For example, in a typical session, the practitioner helps the client enter a state of deep relaxation via breathing techniques, music, and/or progressive muscle relaxation in a quiet environment.[18]

The mind-body therapies listed above are all unique and vary widely in terms of their mechanism of action and origin, however, all of these therapies are considered low-intensity and sustainable practices that promote well-being, mental and physical relaxation, and a stronger connection to one’s body.[19] With guidance from licensed professionals, these therapies can effectively address the social, spiritual, and behavioral factors in one’s personal life in order to elicit better mental health. 

Contributed by: Kaylin Ong

Editor: Jennifer (Ghahari) Smith, Ph.D.

references

1 Integrative Medicine: About Mind-Body Therapies | Memorial Sloan Kettering Cancer Center. (n.d.). Www.mskcc.org. https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/mind-body 

2 Burnett-Zeigler, I., Schuette, S., Victorson, D., & Wisner, K. L. (2016). Mind–Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review. Journal of Alternative and Complementary Medicine, 22(2), 115–124. https://doi.org/10.1089/acm.2015.0038

3 Mind-Body Therapies | Taking Charge of Your Health & Wellbeing. (2016). Taking Charge of Your Health & Wellbeing. https://www.takingcharge.csh.umn.edu/explore-healing-practices/what-are-mind-body-therapies 

4 Mind-body medicine Information | Mount Sinai - New York. (n.d.). Mount Sinai Health System. https://www.mountsinai.org/health-library/treatment/mind-body-medicine#:~:text=What%20is%20mind%2Dbody%20medicine%20good%20for%3F 

5 Mind-Body Therapies | Taking Charge of Your Health & Wellbeing. (2016)

6 National Center for Complementary and Integrative Health. (n.d.). NCCIH. https://www.nccih.nih.gov/ 

7 Ibid.

8 Integrative Medicine: About Mind-Body Therapies | Memorial Sloan Kettering Cancer Center. (n.d.). Www.mskcc.org. https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/mind-body 

9 Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International Journal of Yoga, 4(2), 49–54. https://doi.org/10.4103/0973-6131.85485 

10 Vincent J Minichiello, Y. Z. (2013). Tai Chi Improves Sleep Quality in Healthy Adults and Patients with Chronic Conditions: A Systematic Review and Meta-analysis. Journal of Sleep Disorders & Therapy, 02(06). https://doi.org/10.4172/2167-0277.1000141 

11 Qi, D., Wong, N. M. L., Shao, R., Man, I. S. C., Wong, C. H. Y., Yuen, L. P., Chan, C. C. H., & Lee, T. M. C. (2021). Qigong exercise enhances cognitive functions in the elderly via an interleukin-6-hippocampus pathway: A randomized active-controlled trial. Brain, Behavior, and Immunity. https://doi.org/10.1016/j.bbi.2021.04.011 

12 Anxiety. (n.d.). British Acupuncture Council. Retrieved October 17, 2023, from https://acupuncture.org.uk/fact-sheets/anxiety-and-acupuncture-factsheet/ 

13 Aromatherapy: Do essential oils really work? (2019). John Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/aromatherapy-do-essential-oils-really-work 

14 Camille Noe Pagán. (2018, January 11). What Is Aromatherapy? WebMD; WebMD. https://www.webmd.com/balance/stress-management/aromatherapy-overview 

15 Aromatherapy. (2016). Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/integrative-medicine/therapies/aromatherapy 

16 Massage helps anxiety, depression. (n.d.). Mayo Clinic Health System. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/massage-for-depression-anxiety-and-stress 

17 Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits. Journal of Psychosomatic Research, 57(1), 35–43. https://doi.org/10.1016/s0022-3999(03)00573-7  

18 Guided Imagery | Memorial Sloan Kettering Cancer Center. (n.d.). Www.mskcc.org. https://www.mskcc.org/cancer-care/integrative-medicine/therapies/guided-imagery 

19 Mind-Body Therapies. (n.d.). Crohn’s & Colitis Foundation. Retrieved October 17, 2023, from https://www.crohnscolitisfoundation.org/complementary-medicine/mind-body-therapies#:~:text=Mind%2Dbody%20therapies%20focus%20on 

The Gut-Brain Connection: The Role of Probiotics in Maintaining Good Mental Health

You Are What You Eat

The human intestine consists of around 100 trillion bacteria that are essential for our health. The connection between the gut and brain has been proven to significantly affect people, especially those suffering from mental illness or other mental health disorders. This connection (known as bidirectional signaling) occurs as neural signals control gastrointestinal functioning; however, signaling from gut microbiota can also affect neurological functioning. Current research on the relationship between the gut and brain could impact those with mental health disorders, particularly the two most-prevalent in the U.S. (anxiety at 16.6% and depression at 28.8%).[1] 

mechanisms in the brain

The primary connection between the gut and brain involves the hypothalamic-pituitary-adrenal (HPA) axis. Through this axis, the gut microbiota can regulate levels of stress hormones such as cortisol. Vagal pathways, which are involved in the activation and regulation of the HPA axis, are the means by which the gastrointestinal tract can activate stress circuits.[2] Probiotics live microorganisms that are administered as dietary supplements or food products for health benefits have the ability to reverse the response of stress hormones being released down the HPA axis.[3] Abnormalities and hyperactivity of the HPA axis have been found to be a possible biological factor of anxiety and depression, along with other neuroanatomical abnormalities in levels of neurotransmitters (i.e., chemical substances that deliver hormonal responses in the brain).[4,5] The HPA axis is also related to depression, as depressive episodes are associated with its dysregulation and the resolution of these depressive episodes are associated with its normalization.[6] Gut microbiota are important in influencing the programming of the HPA axis in the early stages of life as well as in the reactivity of stress throughout life. 

There are several neurotransmitters affected by microbiota strains in the gut, such as norepinephrine, serotonin, and neuroendocrine. Specifically, GABA (4-aminobutanoic acid) is an inhibitory neurotransmitter in the central nervous system (CNS) that works in areas of the brain related to emotion, mood, and memory. Dysfunctions in the signaling of GABA are linked to an increase in anxiety and depression.[7] The probiotic strains of Lactobacilli and Bifidobacteria have been found to act on GABA in a similar way to antidepressants by increasing the production of GABA and reducing anxiety.[8] This demonstrates how gastrointestinal tract microflora can produce chemical changes in the brain that could regulate emotional and sensory reactions. In addition, the bacteria of the gastrointestinal tract influences CNS functioning through the neuronal activation of stress circuits. In terms of serotonin, the serotonergic system is a major component of the pathogenesis of mood disorders. There is a relationship between microbial composition and serotonin signaling, as changes in the microbiota affect the signaling systems of both serotonin and GABA in the CNS. Specifically, probiotics increased levels of tryptophan (serotonin’s precursor) thereby increasing serotonin availability in the same way as the antidepressant citalopram.[9] Wallace & Milev (2017) also showed that the administration of probiotics prevented increases in levels of norepinephrine that are induced by stress. 

the dangers of gut inflammation

The bacterial diversity of the human microbiome and inflammation of the gut have been found to be related to anxiety and depression. Stool samples of those experiencing anxiety and depression had a lower diversity in the composition of the microbial community compared to the control group (i.e., those without anxiety and depression) who had a greater diversity.[10] Microbial composition is influenced by factors such as genetic predisposition, age, nutrition, exercise, stress, and use of antibiotics.[11] In addition, the use of antibiotics has been shown to significantly decrease the microbial number and diversity in the gut.[12] Lee & Kim (2021) found that around 50% of patients with irritable bowel syndrome (IBS) have comorbid depression and/or anxiety disorder, revealing a high correlation between IBS and stress-related mental health disorders.[13] In terms of the relation of stress and probiotics to the gut microbiome, psychological stress is known to increase intestinal permeability, which allows for the entrance of harmful chemicals such as toxins and various forms of waste to enter the gut and bloodstream. The presence of pathogenic bacteria in the gut has been found to increase anxiety-like behaviors. Similarly, infection and inflammation of the gut also increase anxiety-like behaviors, via gut inflammation caused by increased intestinal permeability (i.e., “leaky gut”).[14,15]

Benefits of probiotics

Probiotics reduce intestinal permeability and inflammation by improving the integrity of the gastrointestinal lining.[16] Further, probiotics help prevent bacterial translocation that is associated with anxiety and depression.[17] Treatment of probiotics have been observed to cause a behavioral effect resembling that from the treatment of the antidepressant citalopram. This demonstrates that probiotics may have the ability to act as a form of antidepressant in a more natural way than prescription medication. Studies by Liu et al. (2019) and Chao et al. (2020) have observed lower levels of depression scores in groups that were in the probiotic condition compared to the placebo condition.[18,19] 

The implications for the psychological benefits of probiotics are significant. Given the high prevalence of anxiety and depression, probiotics offer a promising alternative to the administration of antidepressants and other psychological medications.[20] It’s important to note that if someone is currently taking prescription antidepressants, they should not lower or stop taking them unless directed to do so by their prescribing physician. In terms of implementing probiotics into one's lifestyle, significant evidence suggests that the daily consumption of a probiotic supplement can have positive psychological effects such as an increase in better mood, decrease in anxiety, and decrease in depression (particularly since anxiety is often comorbid with major depressive disorder).

beneficial probiotic foods

Alternatively, there are several fermented foods that can be implemented into one’s diet to increase probiotic intake:[21]

• Yogurt - one of the best sources of probiotics; yogurt is cultured/fermented milk that has been supplemented with active cultures that promote the growth of good bacteria in the gastrointestinal tract

• Sauerkraut - finely cut raw cabbage that has been fermented by various lactic acid bacteria

• Kefir - a tart and tangy cultured milk drink packed with various strains of beneficial probiotics and live cultures; healthiest option is the plain flavor as flavored varieties often contain added sugar; can also be added to smoothies

• Kombucha - probiotic-rich fermented drink made with tea, sugar, bacteria and yeast

• Kimchi - a spicy Korean condiment packed with lactobacilli (mentioned earlier in the article); a great addition to Asian dishes including rice, stir fries, and barbecued meats

• Miso soup - miso is fermented soy that contains healthy bacteria

• Tempeh - a good alternative to meat made with probiotic-rich fermented soybeans; this is also a healthy source of protein, fiber, and antioxidants

It is important to eat a variety of diverse probiotic foods, since each contains different types of probiotic strains, and each have different effects on the body. In addition, moderation is key in terms of probiotics, as over-consumption may lead to side effects such as bloating or digestive problems.[22] 

Before adding any supplements to one’s diet (such as probiotics), it’s always best to consult your primary care physician to inquire if probiotic supplementation will be suitable for you and confirm which dosage might be best in your case. 

Contributed by: Preeti Kota

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 Liu, R. T., Walsh, R. F. L., & Sheehan, A. E. (2019, April 17). Prebiotics and probiotics for depression and anxiety: A systematic review and meta-analysis of controlled clinical trials. Neuroscience & Biobehavioral Reviews. Retrieved October 6, 2022, from https://www.sciencedirect.com/science/article/pii/S0149763419300533?casa_token=ken0MaMJETEAAAAA%3Azjgy9sFKvv6Yf-7-7w9IIarVfXEeDGX9aYQ21R-cwPTSQnGUVf_R9-3AwXkERA4k5Ymlpgzl

2 KA;, F. J. A. M. V. N. (n.d.). Gut-Brain Axis: How the microbiome influences anxiety and depression. Trends in neurosciences. Retrieved October 6, 2022, from https://pubmed.ncbi.nlm.nih.gov/23384445/

3 Ibid.

4 YK;, L. Y. K. (n.d.). Understanding the connection between the gut-brain axis and stress/anxiety disorders. Current psychiatry reports. Retrieved October 6, 2022, from https://pubmed.ncbi.nlm.nih.gov/33712947/

5 Wallace, C. J. K., & Milev, R. (2017, February 20). The effects of probiotics on depressive symptoms in humans: A systematic review - annals of general psychiatry. BioMed Central. Retrieved October 6, 2022, from https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-017-0138-2

6 Foster & Neufeld (2013)

7 Ibid.

8 Kane, L., & Kinzel, J. (2018). The effects of probiotics on mood and emotion. JAAPA, 31(5), 1-3. 10.1097/01.JAA.0000532122.07789.f0

9 Wallace, C. J. K., & Milev, R. (2017, February 20). The effects of probiotics on depressive symptoms in humans: A systematic review - annals of general psychiatry. BioMed Central. Retrieved October 6, 2022, from https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-017-0138-2

10 Lee & Kim (2021)

11 Ibid.

12 Foster & Neufeld (2013)

13 Lee & Kim (2021)

14 Foster & Neufeld (2013)

15 Wallace & Milev (2017)

16 Ibid.

17 Lee & Kim (2021)

18 Liu et al. (2019)

19 Chao, L., Liu, C., Sutthawongwadee, S., Li, Y., Lv, W., Chen, W., Yu, L., Zhou, J., Guo, A., Li, Z., & Guo, S. (1AD, January 1). Effects of probiotics on depressive or anxiety variables in healthy participants under stress conditions or with a depressive or anxiety diagnosis: A meta-analysis of randomized controlled trials. Frontiers. Retrieved October 6, 2022, from https://www.frontiersin.org/articles/10.3389/fneur.2020.00421/full

20 Wallace & Milev (2017)

21 How to get more probiotics. Harvard Health. (2020, August 24). Retrieved October 6, 2022, from https://www.health.harvard.edu/staying-healthy/how-to-get-more-probiotics#:~:text=The%20most%20common%20fermented%20foods,sourdough%20bread%20and%20some%20cheeses

22 Yang, S. (2022, April 22). Why cooking with probiotics might change your gut health for the better. TheThirty. Retrieved October 6, 2022, from https://thethirty.whowhatwear.com/how-to-incorporate-probiotics-into-diet/slide13