Peter Bablis
Ryan R. Day
Sophia Bablis
Henry Pollard- 1University Research Institute of Maternal and Child Health & Precision Medicine, Athens, Greece
- 2Universal Health, Double Bay, NSW, Australia
- 3Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
This narrative review explores the integration of mindfulness-based interventions (MBIs) into musculoskeletal (MSK) care, based on the premise that addressing the mind–body interface can enhance patient outcomes. First, we outline how chronic stress affects twelve physiological systems and contributes to the onset and persistence of MSK conditions. Second, we synthesise evidence showing that MBIs mitigate these stress effects through mechanisms such as improved attention regulation, interoceptive awareness, and reduced catastrophising. Third, we highlight Neuro-Emotional Technique (NET) as a practitioner-facilitated hybrid-MBI exemplar that targets unresolved emotional stress patterns and aligns with the biopsychosocial model of healthcare. We also note contraindications via red and yellow flag considerations, emphasising the importance of careful patient selection and responsible application. Taken together, this review provides a rationale for incorporating MBIs as adjuncts to conventional therapies, supporting recovery, fostering resilience, and advancing patient-centred MSK care.
Introduction
Healthcare has long grappled with the separation of mind and body, a concept deeply rooted in Western medicine’s historical and philosophical traditions. Although this separation facilitated the development of specialised treatments, it also led to a fragmented approach to patient care, overlooking the interconnected nature of mental and physical health (World Health Organization, 2024). In this narrative review, we propose that musculoskeletal (MSK) practitioners consider mindfulness-based interventions (MBIs) as part of an integrative approach to care – a perspective presented to, but not widely adopted by, this audience in recent years.
The literature on the practical application of mindfulness interventions in MSK therapies remains sparse. This review therefore draws together evidence on the interdependence between psychological and physical well-being, the effects of chronic stress on twelve major physiological systems, and how MBIs may counteract these detrimental stress effects (Robinson, 2023; Canadian Mental Health Association Ontario, 2014). In view of the influence of stress on conditions commonly managed in MSK practice, considering mind–body factors forms part of a comprehensive duty of care to provide safe and effective treatment.
Aim and scope
The aim of this narrative review is threefold. First, we outline how chronic stress contributes to MSK conditions across biological, psychological, and social domains. Second, we synthesise evidence demonstrating how MBIs mitigate stress-related mechanisms and provide a rationale for their application alongside MSK therapies. Third, we highlight Neuro-Emotional Technique (NET) as an exemplar of a practitioner-facilitated hybrid-MBI, illustrating how such approaches may be operationalised in MSK practice. Together, these aims address the impact of MBIs on health, review an example of good practice, and clarify clinical decision-making considerations for MSK practitioners.
Background: the historical context of mind–body dualism
The dichotomy between mind and body has been a subject of philosophical debate for centuries. In the 4th century BC, Plato lamented, “the great error of our day in the treatment of the human body [is] that physicians separate the mind from the body (Maté, 2024).” Despite this, the dualistic approach became entrenched in Western medicine, heavily influenced by René Descartes’ 17th-century philosophy, which posited that the mind and body are fundamentally distinct entities. This view shaped medical practice for centuries, emphasizing the treatment of physical symptoms while often neglecting psychological aspects of health (Mantri, 2008).
However, integrative healthcare approaches, such as those found in traditional Chinese medicine, Ayurveda, and other non-Western traditions, have long recognized the inseparability of mind and body in achieving optimal health (Fan, 2017). These, and other ancient traditions and philosophies, emphasize that physical symptoms often reflect underlying psychological distress and vice versa, ultimately founding what now know as “meditation” and “mindfulness.” While agreed definitions remain elusive due to contrasting cultural foundations and ideas (Chiesa, 2013; Awasthi, 2013; Baer, 2019; Grossman, 2011), Western pioneers like Hippocrates similarly advocated for treating patients holistically, considering both physical and psychological dimensions (Mantri, 2008).
Today, specialization in medical fields often leads to a narrow focus on specific conditions, neglecting the broader context of a patient’s overall health (Mantri, 2008). Although the concept of mind–body integration is becoming more widely accepted in holistic healthcare settings, its practical application remains limited in many mainstream complementary health practices. The interdisciplinary scientific field of psychoneuroimmunology (the study of the interactions between psychological states, the nervous system and the immune system) shows that poor mental or emotional health as a result of chronic or acute stress frequently overlaps with musculoskeletal pain and illness (Australian Institute of Health and Welfare, 2024; Mental Health Foundation UK, 2024b; Barbe and Barr, 2006; Aviña-Zubieta et al., 1997; Navarro-Ledesma et al., 2024; Malterud, 2010; Ahrens et al., 2012), with each influencing the other’s severity and progression (Doan et al., 2023). In this paper, the scientific evidence is discussed in detail for the purpose of aiding recognition of the many common ways stress-related illness presents to MSK practitioners, and the role of MBIs as adjunct lifestyle and treatment interventions for MSK therapies.
The need for a mind–body approach in MSK care
Musculoskeletal (MSK) practitioners, who focus on treating conditions related to the muscles, bones, and joints, often encounter patients with symptoms influenced by psychological factors. Conditions such as chronic back pain, fibromyalgia, tension headaches, and arthritis are frequently exacerbated by stress, anxiety, sleep loss, and emotional distress (Mills et al., 2019; Anxiety and Depression Association of America, 2024). This interconnection underscores the importance of adopting a holistic, integrative approach that addresses both physical and psychological health components (Dunn et al., 2024).
The holistic approach aligns with the biopsychosocial (BPS) model proposed by George Engel in 1977, which encourages healthcare providers to consider biological, psychological, and social factors in understanding health and disease (Engel, 1977). For MSK practitioners, this model offers a framework for addressing not just the physical symptoms but also the psychological and emotional contributors to a patient’s condition such as patient beliefs and expectations, and the influence of the interpersonal dynamics in clinical encounters on health outcomes. Ultimately, this approach can promote a more comprehensive understanding of their patients’ health, fostering recovery from physical ailments and enhancing overall well-being (Borrell-Carrió et al., 2004).
Understanding how chronic stress operates across these domains provides the foundation for examining its systemic physiological effects, outlined in the next section.
The effects of chronic stress on physical health
Stress is defined as a state of threatened homeostasis following exposure to adverse forces (Chrousos and Gold, 1992). Acute stress (lasting minutes or hours) may be adaptive and even beneficial (Dorn and Chrousos, 1993; Rudland et al., 2020). Chronic stress, however, persists for days, weeks, or months (Olff, 1999) and is a significant factor in the onset, progression, and exacerbation of many health conditions (American Psychological Association, 2022; Mental Health Foundation UK, 2024a; American Psychological Association, 2022). When physiological demands are exceeded (Koolhaas et al., 2011), chronic stress contributes to allostatic load (Salleh, 2008; McEwen, 1998; McEwen and Stellar, 1993; Juster et al., 2010), depletes the body’s adaptive capacity (Kazakou et al., 2023), resulting in maladaptation (Stratakis and Chrousos, 1995) and poorer health outcomes (Guidi et al., 2021; Parker et al., 2022).
These effects are mediated through the Hypothalamic–Pituitary–Adrenal (HPA) axis, the body’s central stress response system, and the Psycho-Immune-Neuroendocrine (PINE) network, which integrates neural, immune, and endocrine functions to maintain health (Kazakou et al., 2023; Hardy and Pollard, 2006; Chrousos, 2009; Mariotti, 2015; Morey et al., 2015; Charmandari et al., 2005; Chrousos and Kino, 2007; González-Díaz et al., 2017). Dysregulation of these psychophysiological systems contributes to widespread health impacts including chronic illness, musculoskeletal disorders, acute and chronic pain, and organ system dysfunction that can result due to unique genetic, epigenetic and environmental factors, and the influences of the past stressful experiences of the individual (Chapman et al., 2008).
This is particularly relevant for MSK practitioners as chronic stress contributes to the onset and persistence of many common musculoskeletal presentations (Salvagioni et al., 2017; NIB, 2021; Schneiderman et al., 2005), including tension-type headache (Bendtsen and Fernández-de-la-Peñas, 2011), neck, shoulder, and upper-limb pain (Cagnie et al., 2007; van den Heuvel et al., 2005; Bongers et al., 2006), temporomandibular joint pain (Fillingim et al., 2013; Manfredini et al., 2003; Manfredini et al., 2004), fibromyalgia (Paschali et al., 2021; McBeth and Silman, 2001), back pain (Linton, 2000), and myofascial trigger points (Bosque et al., 2023). Chronic stress can diminish function and contribute to illness across all major body systems (Figure 1).
Figure 1. The 12 body systems that chronic stress can affect.
These systemic mechanisms provide the biological and clinical context for understanding how stress is embedded within a biopsychosocial (BPS) model of MSK care.
The BPS model of stress in MSK care
Within the BPS model of MSK care, chronic stress functions at three levels: biologically through HPA and PINE dysregulation, psychologically through appraisal, attention, and avoidance patterns, and socially through contextual pressures such as workload or relationships. Mindfulness practices directly target these mechanisms (Maloney et al., 2024). By enhancing interoceptive awareness and attention regulation, and cultivating non-reactivity and acceptance, they can reduce muscle tension, pain sensitivity, catastrophizing, and fear-avoidance while improving adherence to active care (Todd and Aspell, 2022; Aboushaar and Serrano, 2024). This integration clarifies why stress-responsive MSK pain often improves when cognitive, affective, and behavioral dimensions are addressed alongside physical treatment (Dunn et al., 2024).
Because chronic stress operates across biological, psychological, and social domains, interventions that target multiple dimensions simultaneously are especially relevant. Mindfulness-based interventions (MBIs) represent one such approach. The following section therefore defines mindfulness and its principal categories before considering how different forms of MBIs apply to MSK practice.
Mindfulness and mindfulness based interventions (MBIs)
American professor Jon Kabat-Zinn, creator of Mindfulness-Based Stress Reduction (MBSR) program (Kabat-Zinn, 1990) and credited by many as the founder of the contemporary mindfulness movement, defines mindfulness as, “awareness that arises through paying attention, on purpose, in the present moment, non-judgementally,… in the service of self-understanding and wisdom (Mindful Staff, 2017).” The 9 attitudinal principles of mindfulness, according to Kabat-Zinn, are: nonjudging, patience, a beginner’s mind, trust, non-striving, acceptance, letting go, gratitude and generosity (Kabat-Zinn, 2024). These attitudes and principles can be applied across a broad spectrum of practices (Maloney et al., 2024) in two broad categories: Formal (high intensity) and Informal (low intensity).
• Formal (high intensity) practices can be Dynamic (movement-based), Static (attention-based) or Hybrid practices that combine elements of both (Lutz et al., 2008; Dunn et al., 1999; Rao, 2011; Kabat-Zinn, 2003; Prakhinkit et al., 2014). They are usually facilitated by a practitioner or facilitator and often follow a given structure/process.
• Informal (low intensity) practices tend to be less structured, less time-consuming [showing benefits in as little as a few minutes (Hanley et al., 2015; Palmer et al., 2023; Strohmaier et al., 2021; Pratt, 2024)] and more easily accessible (Vilhauer, 2024), helping increase stress resilience when performed daily (Manigault et al., 2021). Informal practices have been shown to be effective in reducing stress (Sparacio et al., 2024), and can be categorised broadly as either Daily Life Awareness practices or Brief Self-Directed practices.
Figure 2 provides a visual representation of the various categories and of MBIs, followed by some examples of each classification.
Figure 2. Categorisation of mindfulness based interventions (MBIs) including common examples.
Benefits of mindfulness-based interventions (MBIs)
Considering the pervasive health effects of chronic stress that anecdotally present in the practices of MSK practitioners, it is important to identify robust and reliable methods for counter-acting and relieving chronic stress alongside physical therapies. MBIs are practices that cultivate awareness, focus(attention), emotional regulation and acceptance of self and the present moment, with the goal of reducing chronic stress and enhancing well-being (Garland et al., 2017; Hölzel et al., 2011).
While the research assessing the effectiveness of mindfulness is continuing to evolve, and a greater number of high quality studies with larger sample sizes are needed (Zhang et al., 2021), a growing body of evidence supports the efficacy and safety of MBIs in addressing the physical and psychological effects of chronic stress (Carlson, 2012; Cardle et al., 2023; Pérez Fernández et al., 2022; Brown and Jones, 2013).
At the same time, the broader MBI literature is not without limitations. Systematic reviews consistently highlight heterogeneity in study designs, variability in intervention protocols, and modest effect sizes across conditions (Zhang et al., 2021; Ong et al., 2024). Publication bias and limited long-term follow-up data further constrain the strength of conclusions (Goldberg et al., 2022). In addition, while Table 1 summarises counter-stress effects across physiological systems, the current evidence does not permit firm conclusions about which types of MBIs (e.g., formal vs. informal, static vs. dynamic) are most efficient in producing these results (Preissner et al., 2025; Kakoschke et al., 2021). Comparative trials that directly examine format and delivery characteristics remain limited, and this represents an important area for future research.
Table 1. Chronic stress effects on body systems and the counter-stress effects of MBI.
Table 1 outlines the effects of chronic stress on different body systems and highlights current and emerging research of the counter-stress effects of MBIs.
When to use caution with MBIs
While MBIs have numerous benefits for countering the effects of chronic stress, they may not be universally suitable for everyone (Britton et al., 2021). For some individuals, particularly those with certain severe mental health conditions, MBIs can potentially trigger adverse effects. Identifying patients who exhibit “red” and “yellow” flags (Lustyk et al., 2009) is essential for making appropriate recommendations, as represented in our MSK decision flowchart (Figure 3).
Figure 3. Decision flowchart for MSK practitioners when considering MBIs.
Red flags are serious health indicators that require referral to a mental health specialist or emergency services, such as imminent harm to self or others, suicidal ideation, or self-harm. The MBSR standards of practice recognise this by excluding any participant with a psychological condition or suicidality (Santorelli, 2014; Dobkin et al., 2012). Research indicates that mindfulness practices may not be appropriate for people with severe psychological or psychiatric disorders, including but not limited to post-traumatic stress disorder (PTSD), acute anxiety, psychosis or severe depression (Van Dam et al., 2018; Creswell, 2017). (In contrast to older literature, more recent studies suggest that MBIs may indeed be beneficial for many sufferers of psychosis (Ellett, 2024), a reminder that this is still an evolving area of scientific enquiry).
Yellow flags include symptoms such as persistent low mood, emotional dysregulation and difficulty coping with stress. These indicators may be detected through clinical history taking or observation and, although less severe that red flags and adverse events (Binda et al., 2020), still require cautious monitoring by practitioners (Lindahl et al., 2017). Co-management with an appropriately qualified mental health professional should also be considered. Although some temporary emotional discomfort may be expected on the pathway to achieving the true benefits of mindfulness meditation (Binda et al., 2020; Lindahl et al., 2020) and should not be considered as harmful side effects (Baer and Kuyken, 2016), in a small number of cases self-reflective activities could exacerbate mental health symptoms, potentially leading to emotional numbness or distress, withdrawal, dissociation, increased anxiety, or even a resurgence of traumatic memories (Davidson and Kaszniak, 2015; Kuyken et al., 2022; Britton et al., 2021).
Therefore, before recommending MBIs it is important for MSK practitioners to implement clinical judgment and exercise appropriate caution in accordance with their scope of practice and duty of care (Farias and Wikholm, 2016). Careful patient selection and monitoring of patient responses for adverse reactions is essential to ensure that any emerging psychological complications are promptly identified and managed (Kuyken et al., 2008). To provide safe and effective care, MSK practitioners may consider establishing a referral network with qualified mental health professionals and seek to maintain open communication with these specialists when managing patients with complex psychological needs. Additionally, validated clinical tools known as Patient Reported Outcome Measures (PROMS) can assist with monitoring emotional wellbeing including the Depression, Anxiety and Stress Scale (DASS-21); (Antony et al., 1998; Lovibond and Lovibond, 1995), the Perceived Stress Scale (PSS) (Cohen et al., 1983), the Five Facet Mindfulness Questionnaire (FFMQ) (Baer et al., 2006), the Fear Avoidance Beliefs Questionnaire (FABQ) (Waddell et al., 1993), the Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001) and the Distress and Risk Assessment Method (DRAM) (Main and Waddell, 1991; Main et al., 1992). Taking a proactive approach ensures that patients receive appropriate and timely support, safeguarding both their physical and mental well-being.
Decision-making in MSK practice
In addition to recognising red and yellow flags, MSK practitioners must also exercise decision-making that balances clinical judgment, patient preference, and scope of practice. Indicators such as stress-related symptom exacerbation, high levels of catastrophising, maladaptive coping behaviours, or a history of stress-linked pain episodes may suggest suitability for adjunctive MBIs, whereas severe psychiatric illness, active trauma symptoms, or clear patient resistance may signal the need for referral instead. Practitioner training, access to referral networks, and resource availability further shape these decisions. By applying structured screening together with these broader clinical considerations, MBIs can be integrated safely and effectively into MSK practice as adjuncts to physical therapies.
For patients with no red or yellow flags, MSK practitioners can offer guidance to patients by suggesting MBIs that might be most appropriate according to the patient’s circumstances, personality and lifestyle by considering the individual needs, conditions, and histories and applying clinical judgement (Britton, 2019). This could involve providing recommendations for mindfulness resources or practices to try, referrals to suitably qualified mental health or mindfulness practitioners, or offering adjunct mindfulness-oriented techniques alongside, or in addition to, MSK therapies.
Neuro-emotional technique (NET) as an MBI for MSK therapies
Building on these findings, it is valuable to consider a practitioner-facilitated hybrid-MBI that exemplifies how such counter-stress effects can be integrated into musculoskeletal practice. Among the many MBIs, Neuro-Emotional Technique (NET) is highlighted here because it uniquely operationalises these principles within MSK practice through a practitioner-facilitated, structured method. Like the MBIs presented earlier in Table 1, NET has been associated with counter-stress effects across multiple systems, including neuroendocrine, immune, and musculoskeletal pathways, as highlighted below. It is therefore highlighted in this review as a representative model of how a practitioner-facilitated hybrid-MBI may operate within MSK care.
NET is a precision body–mind intervention (PBMI) (Bablis et al., 2024) that was developed by chiropractor Dr. Scott Walker in the 1980s using a 15-step methodology (Walker, 1996). Taught exclusively to registered health professionals, it is designed to identify and resolve emotional stress patterns known as Neuro-Emotional Complexes (NECs) (Walker, 1996), which are theorised to drive adverse physiological responses contributing to chronic pain and illness. NET combines elements from Traditional Chinese Medicine (TCM), Cognitive–Behavioural Therapy (CBT), and manual therapy (Foa and Jaycox, 1999), and employs the validated manual muscle test (Pollard et al., 2005; Cuthbert and Goodheart, 2007; Monti et al., 1999) as a biofeedback tool to detect stress-related responses. Recent publications suggest that NET reduces allostatic load (Bablis et al., 2024; Bablis et al., 2024) by addressing dysregulated stress response systems (HPA and PINE) (Stapelberg et al., 2015; Nold and Allers, 2020) already outlined earlier in this review. By resolving the emotional components of stress underlying chronic musculoskeletal pain and illness (Sharif et al., 2018), NET complements conventional physical therapies within a biopsychosocial model of care.
Mindfulness mechanisms and therapeutic process of NET
While the full 15-step NET procedure has been described in Walker’s manual (Walker, 1996) and reproduced in clinical trial protocols (Karpouzis et al., 2009), a condensed overview illustrates the therapeutic flow. NET typically involves: (1) identifying a stress-related physiological response via manual muscle testing, (2) linking this response to an unresolved emotional experience (the Neuro-Emotional Complex), (3) facilitating mindful awareness and cognitive reframing of the stressor, (4) applying a brief somatic intervention (such as spinal or acupoint stimulation) during recall, and (5) re-testing to confirm resolution (Walker, 1996; Karpouzis et al., 2009). This flow illustrates how NET engages somatic awareness, mindful attention, and cognitive reappraisal – mechanisms that underpin established mindfulness interventions.
Importantly, NET’s therapeutic elements can also be understood as cultivating Kabat-Zinn’s attitudinal foundations of mindfulness (Kabat-Zinn, 2024). Meridian-based somatic cueing (derived from TCM) directs non-judgmental awareness to bodily sensations and supports letting go. Cognitive–behavioural strategies such as reappraisal and exposure foster acceptance, patience, and non-striving. Manual therapy anchoring and practitioner touch cultivate trust, beginner’s mind, and embodied presence. Together, these components operationalise mindfulness attitudes in ways that are directly relevant to MSK practice (Table 2).
Table 2. Integration of NET components with mindfulness attitudes and MSK clinical relevance.
During the NET process some patients appear to experience what could be described as a brief sympathetic activation or “storm,” often characterised by heightened arousal responses such as sweating, increased heart rate, or a sudden sense of insight into the origin of their stress. We hypothesise that this state reflects a momentary convergence of multiple neural systems. Specifically, the procedure may engage the subconscious or autonomic components of the nervous system (through manual muscle testing), limbic circuits involved in emotional awareness and processing, and neocortical networks implicated in contextual appraisal and meaning-making. When these elements align, the patient may experience what we have termed the Somato-Limbic Integration Point (SLIP) - a transient integrative state where bodily sensation, affective awareness, and cognitive reframing co-occur.
Although the SLIP is currently a theoretical construct, it provides a framework for describing the rapid shifts in awareness sometimes observed in clinical practice. Preliminary neuroimaging research on NET supports the plausibility of such integrative mechanisms, with Monti et al. (2017, 2018) reporting changes in activation within limbic and cortical regions following treatment. Future studies will be needed to empirically test the SLIP hypothesis and clarify its neurobiological underpinnings.
Evidence and limitations of NET research
Research on NET has demonstrated positive outcomes across diverse conditions, including chronic low back pain (Bablis et al., 2022, 2023; Bablis and Pollard, 2016), pregnancy-related low back pain (Peterson et al., 2012), neck pain (Bablis et al., 2008), hypothyroidism (Bablis et al., 2024; Bablis and Pollard, 2004; Bablis and Pollard, 2009a), Polycystic Ovarian Syndrome (PCOS) (Bablis et al., 2006a), infertility (Bablis et al., 2006b), type 2 diabetes (Bablis et al., 2024), anxiety and depression (Jensen, 2010; Bablis and Pollard, 2009b), high cholesterol (Peterson, 1995), separation anxiety (Karpouzis et al., 2008), phobia resolution (Jensen and Ramasamy, 2009; Peterson, 1997) and ADHD (Karpouzis et al., 2009). Functional neuroimaging studies further suggest that NET influences brain physiology by reducing activation in regions associated with traumatic memories and distress (e.g., anterior cingulate gyrus, parahippocampus, insula, and brainstem) (Monti et al., 2017; Monti et al., 2018). In a randomized controlled trial of chronic low back pain, patients receiving NET in addition to standard care reported greater reductions in pain and disability (Oswestry Disability Index), lower pro-inflammatory cytokine levels (TNF-α, CRP, IL-1, IL-6), and improved quality of life (SF-36 domains) compared to standard care alone (Bablis et al., 2022).
To date, no published trials have reported unequivocally null or negative effects of NET on MSK outcomes. While the available evidence is encouraging, it remains preliminary, with modest sample sizes, study heterogeneity, and limited independent replication. These limitations highlight the importance of cautious interpretation and the need for further high-quality trials, including active-comparator and long-term follow-up studies, to establish NET’s role more definitively.
Clinical relevance of NET to MSK practice
Even so, NET is particularly relevant to MSK practitioners because it addresses the psychosocial stressors that can underlie or perpetuate pain. By offering a structured method for identifying and resolving emotional stress responses in the clinical setting, NET provides a practical way to support holistic care.
Addressing the mind–body interface may help clinicians avoid missing important contributors to persistent pain and dysfunction, while integrating interventions such as NET enables MSK practitioners to address both the physical manifestations and the stress-related mechanisms that sustain them. Taken together, these findings position NET as a practitioner-facilitated, hybrid-MBI that operationalises mindfulness principles and may be feasibly integrated into MSK care.
Conclusion
The profound interconnection between physical and mental health supports the need for a holistic approach in musculoskeletal (MSK) care. This review addressed three aims: (1) to show how chronic stress contributes to MSK conditions across biological, psychological, and social domains; (2) to synthesise evidence that mindfulness-based interventions (MBIs) can mitigate stress-related mechanisms and provide a scientific rationale for their use alongside MSK therapies; and (3) to present Neuro-Emotional Technique (NET) as an exemplar of a practitioner-facilitated hybrid-MBI, illustrating how such approaches may be applied in practice. Collectively, the evidence suggests that stress and unresolved emotional factors are not peripheral to MSK presentations but may substantially influence pain and dysfunction. Incorporating MBIs offers one pathway to address these influences, provided practitioners apply clinical judgement, implement red and yellow flag screening, and collaborate with mental health professionals where needed. While further high-quality research is required to strengthen the evidence base, integrating MBIs thoughtfully into MSK care has the potential to improve recovery, foster resilience, and support long-term health within a biopsychosocial model of care.
Author contributions
PB: Conceptualization, Supervision, Writing – original draft, Writing – review & editing. RD: Conceptualization, Data curation, Project administration, Writing – original draft, Writing – review & editing. SB: Conceptualization, Writing – review & editing. HP: Supervision, Writing – review & editing.
Funding
The author(s) declare that no financial support was received for the research and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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References
Abera, M., Hanlon, C., Daniel, B., Tesfaye, M., Workicho, A., Girma, T., et al. (2024). Effects of relaxation interventions during pregnancy on maternal mental health, and pregnancy and newborn outcomes: a systematic review and meta-analysis. PLoS One 19:e0278432. doi: 10.1371/journal.pone.0278432
Aboushaar, N., and Serrano, N. (2024). The mutually reinforcing dynamics between pain and stress: mechanisms, impacts and management strategies. Front. Pain Res. 5:1445280. doi: 10.3389/fpain.2024.1445280
Agorastos, A., Nicolaides, N., Bozikas, V., Chrousos, G., and Pervanidou, P. (2020). Multilevel interactions of stress and circadian system: implications for traumatic stress. Front. Psych. 10:1003. doi: 10.3389/fpsyt.2019.01003
Ahmed, S., Mahmood, Z., and Zahid, S. (2015). Linking insulin with Alzheimer's disease: emergence as type III diabetes. Neurol. Sci. 36, 1763–1769. doi: 10.1007/s10072-015-2352-5
Ahrens, C., Schiltenwolf, M., and Wang, H. (2012). Zytokine im psychoneuroendokrin-immunologischen Kontext unspezifischer muskuloskeletaler Schmerzen [cytokines in psychoneuroendocrine immunological context of nonspecific musculoskeletal pain]. Schmerz 26, 383–388. doi: 10.1007/s00482-012-1153-5
Alam, F., Islam, M., Sasongko, T., and Gan, S. (2016). Type 2 diabetes mellitus and Alzheimer's disease: bridging the pathophysiology and management. Curr. Pharm. Des. 22, 4430–4442. doi: 10.2174/1381612822666160527160236
American Psychological Association, “Stress in America2022,” (2022). Available online at: https://www.apa.org/news/press/releases/stress/2022/concerned-future-inflation (Accessed 16 May 2024).
American Psychological Association, “How stress affects your health,” (2022). Available online at: https://www.apa.org/topics/stress/health (Accessed 9 July 2024).
Antony, M., Bieling, P., Cox, B., Enns, M., and Swinson, R. (1998). Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychol. Assess. 10, 176–181. doi: 10.1037/1040-3590.10.2.176
Anxiety and Depression Association of America, “Chronic pain,” (2024). Available online at: https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/chronic-pain (Accessed 11 September 2024).
Arzate-Mejia, R., Carullo, N., and Mansuy, I. (2024). The epigenome under pressure: on regulatory adaptation to chronic stress in the brain. Curr. Opin. Neurobiol. 84:102832. doi: 10.1016/j.conb.2023.102832
Australian Institute of Health and Welfare, “Physical health of people with mental illness,” Australian government, (2024). Available online at: https://www.aihw.gov.au/reports/mental-health/physical-health-of-people-with-mental-illness (Accessed 9 July 2024].
Aviña-Zubieta, J., Páez, F., and Galindo-Rodriguez, G. (1997). Rheumatic manifestations of neurologic and psychiatric diseases. Curr. Opin. Rheumatol. 9, 51–55. doi: 10.1097/00002281-199701000-00010
Awasthi, B. (2013). Issues and perspectives in meditation research: in search for a definition. Front. Psychol. 3:613. doi: 10.3389/fpsyg.2012.00613
Bablis, P., Day, R., Bablis, S., and Pollard, H. (2024). Treatment of hypothyroidism and stress using neuro-emotional technique (NET): A case study. Cureus 16:e58231. doi: 10.7759/cureus.58231
Bablis, P., Day, R., and Pollard, H. (2024). Treatment of type 2 diabetes and stress using neuro-emotional technique: case report. Front. Endocrinol. 15:1382757. doi: 10.3389/fendo.2024.1382757
Bablis, P., and Pollard, H. (2004). Hypothyroidism: a new model for conservative management in two cases. Chir J Aus 34, 11–18.
Bablis, P., and Pollard, H. (2009a). A mind–body treatment for hypothyroid dysfunction: A report of two cases. Complement. Ther. Clin. Pract. 15, 67–71. doi: 10.1016/j.ctcp.2009.01.004
Bablis, P., and Pollard, H. (2009b). Anxiety and depression profile of 188 consecutive new patients presenting to a neuro-emotional technique practitioner. J. Altern. Complement. Med. 15, 121–127. doi: 10.1089/acm.2007.0805
Bablis, P., and Pollard, H. (2016). Feasibility study of the short term effects of neuro emotional technique for chronic low back pain. Chir. J. Aus. 44, 267–282.
Bablis, P., Pollard, H., and Bonello, R. (2008). Neuro emotional technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: a controlled clinical trial. Chiropr. Osteopat. 16:4. doi: 10.1186/1746-1340-16-4
Bablis, P., Pollard, H., and McHardy, A. (2006a). Two reports of resolution of polycystic ovary syndrome induced anovulation in females receiving neuro emotional technique. Chir J Aus 36, 2–8.
Bablis, P., Pollard, H., and Monti, D. (2006b). Resolution of anovulation infertility using neuro emotional technique: a report of 3 cases. J. Chiropr. Med. 5, 13–21. doi: 10.1016/S0899-3467(07)60128-1
Bablis, P., Pollard, H., and Rosner, A. (2022). Stress reduction via neuro-emotional technique to achieve the simultaneous resolution of chronic low back pain with multiple inflammatory and biobehavioural indicators: A randomized, double-blinded, placebo-controlled trial. J. Integr. Med. 20, 135–144. doi: 10.1016/j.joim.2021.12.001
Bablis, P., Pollard, H., and Rosner, A. (2023). The endurance of neuro-emotional-technique effects on chronic low-Back pain - randomized, controlled trial with implications for cost savings. Nat Med J. Available at: https://www.researchgate.net/publication/375895335_The_Endurance_of_Neuro-Emotional-Technique_Effects_on_Chronic_Low-Back_Pain_Randomized_controlled_trial_with_implications_for_cost_savings
Baer, R. (2019). 2019 assessment of mindfulness by self-report. Curr. Opin. Psychol. 28, 42–48. doi: 10.1016/j.copsyc.2018.10.015
Baer, R., and Kuyken, W., “Is Mindfulness Safe?” Mindful.org - Healthy Mind, Healthy Life. (2016). Available online at: https://www.mindful.org/is-mindfulness-safe/ (Accessed 24 September 2025).
Baer, R., Smith, G., Hopkins, J., Krietemeyer, J., and Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment 13, 27–45. doi: 10.1177/1073191105283504
Balban, M., Neri, E., Kogon, M., Weed, L., Nouriani, B., Jo, B., et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep. Med. 4:100895. doi: 10.1016/j.xcrm.2022.100895
Barbe, M., and Barr, A. (2006). Inflammation and the pathophysiology of work-related musculoskeletal disorders. Brain Behav. Immun. 20, 423–429. doi: 10.1016/j.bbi.2006.03.001
Barrett, B., Hayney, M., Muller, D., Rakel, D., Ward, A., Obasi, C., et al. (2012). Meditation or exercise for preventing acute respiratory infection: a randomized controlled trial. Ann. Fam. Med. 10, 337–346. doi: 10.1370/afm.1376
Bartholomew, E., Chung, M., Yeroushalmi, S., Hakimi, M., Bhutani, T., and Liao, W. (2022). Mindfulness and meditation for psoriasis: A systematic review. Dermatol Ther 12, 2273–2283. doi: 10.1007/s13555-022-00802-1
Bendtsen, L., and Fernández-de-la-Peñas, C. (2011). The role of muscles in tension-type headache. Curr. Pain Headache Rep. 15, 451–458. doi: 10.1007/s11916-011-0216-0
Binda, D., Greco, C., and Morone, N. (2020). What are adverse events in mindfulness meditation? Glob. Adv. Health Med. 11:6640. doi: 10.1177/2164957X221096640
Black, P. (2002). Stress and the inflammatory response: a review of neurogenic inflammation. Brain Behav. Immun. 16, 622–653. doi: 10.1016/s0889-1591(02)00021-1
Black, D., Cole, S., Irwin, M., Breen, E., St Cyr, N., Nazarian, N., et al. (2013). Yogic meditation reverses NF-κB and IRF-related transcriptome dynamics in leukocytes of family dementia caregivers in a randomized controlled trial. Psychoneuroendocrinology 38, 348–355. doi: 10.1016/j.psyneuen.2012.06.011
Black, D., O'Reilly, G., Olmstead, R., Breen, E., and Irwin, M. (2015). Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA Intern. Med. 175, 494–501. doi: 10.1001/jamainternmed.2014.8081
Black, D., and Slavich, G. (2016). Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann. N. Y. Acad. Sci. 1373, 13–24. doi: 10.1111/nyas.12998
Bongers, P., Ijmker, S., van den Heuvel, S., and Blatter, B. (2006). Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (part I) and effective interventions from a bio behavioural perspective (part II). J. Occup. Rehabil. 16, 279–302. doi: 10.1007/s10926-006-9044-1
Borrell-Carrió, F., Suchman, A., and Epstein, R. (2004). The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann. Fam. Med. 2, 576–582. doi: 10.1370/afm.245
Bosque, M., Margalef, R., Llaveria, A., and Santafe, M. (2023). Stress increases the spontaneous release of ACh and may be involved in the generation and maintenance of myofascial trigger points in mouse. Behav. Brain Res. 452:114572. doi: 10.1016/j.bbr.2023.114572
Britton, W. (2019). Can mindfulness be too much of a good thing? The value of a middle way. Curr. Opin. Psychol. 28, 159–165. doi: 10.1016/j.copsyc.2018.12.011
Britton, W., Lindahl, J., Cooper, D., Canby, N., and Palitsky, R. (2021). Defining and measuring meditation-related adverse effects in mindfulness-based programs. Clin. Psychol. Sci. 9, 1185–1204. doi: 10.1177/2167702621996340
Brown, C., and Jones, A. (2013). Psychobiological correlates of improved mental health in patients with musculoskeletal pain after a mindfulness-based pain management program. Clin. J. Pain 29, 233–244. doi: 10.1097/AJP.0b013e31824c5d9f
Buscemi, V., Chang, W., Liston, M., McAuley, J., and Schabrun, S. (2019). The role of perceived stress and life stressors in the development of chronic musculoskeletal pain disorders: A systematic review. J. Pain 20, 1127–1139. doi: 10.1016/j.jpain.2019.02.008
Cacioppo, J., Berntson, G., Malarkey, W., Kiecolt-Glaser, J., Sheridan, J., Poehlmann, K., et al. (1998). Autonomic, neuroendocrine, and immune responses to psychological stress: the reactivity hypothesis. Ann. N. Y. Acad. Sci. 840, 664–673. doi: 10.1111/j.1749-6632.1998.tb09605.x
Cagnie, B., Danneels, L., Van Tiggelen, D., De Loose, V., and Cambier, D. (2007). Individual and work related risk factors for neck pain among office workers: a cross sectional study. Eur. Spine J. 16, 679–686. doi: 10.1007/s00586-006-0269-7
Canadian Mental Health Association Ontario, “Connection between mental and physical health,” (2014). Available online at: https://ontario.cmha.ca/documents/connection-between-mental-and-physical-health/ (Accessed 9 July 2014).
Cardle, P., Kumar, S., Leach, M., McEvoy, M., and Veziari, Y. (2023). Mindfulness and chronic musculoskeletal pain: an umbrella review. J. Multidiscip. Healthc. 16, 515–533. doi: 10.2147/JMDH.S392375
Carlson, L. (2012). Mindfulness-based interventions for physical conditions: a narrative review evaluating levels of evidence. ISRN Psychiatry 2012:651583. doi: 10.5402/2012/651583
Carson, J., Carson, K., Gil, K., and Baucom, D. (2004). Mindfulness-based relationship enhancement. Behav. Ther. 35, 471–494. doi: 10.1016/S0005-7894(04)80028-5
Cerniauskas, I., Winterer, J., de Jong, J., Lukacsovich, D., Yang, H., Khan, F., et al. (2019). Chronic stress induces activity, synaptic, and transcriptional remodeling of the lateral Habenula associated with deficits in motivated behaviors. Neuron 104:e8, 899–915. doi: 10.1016/j.neuron.2019.09.005
Chaix, R., Alvarez-López, M., Fagny, M., Lemee, L., Regnault, B., Davidson, R., et al. (2017). Epigenetic clock analysis in long-term meditators. Psychoneuroendocrinology 85, 210–214. doi: 10.1016/j.psyneuen.2017.08.016
Chaix, R., Fagny, M., Cosin-Tomás, M., Alvarez-López, M., Lemee, L., Regnault, B., et al. (2020). Differential DNA methylation in experienced meditators after an intensive day of mindfulness-based practice: implications for immune-related pathways. Brain Behav. Immun. 84, 36–44. doi: 10.1016/j.bbi.2019.11.003
Chang, H., Perkins, M., Novaes, L., Qian, F., Zhang, T., Neckel, P., et al. (2024). Stress-sensitive neural circuits change the gut microbiome via duodenal glands. Cell 187, 1–20. doi: 10.1016/j.cell.2024.07.019
Chapman, C., Tuckett, R., and Song, C. (2008). Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. J. Pain 9, 122–145. doi: 10.1016/j.jpain.2007.09.006
Charmandari, E., Tsigos, C., and Chrousos, G. (2005). Endocrinology of the stress response. Annu. Rev. Physiol. 67, 259–284. doi: 10.1146/annurev.physiol.67.040403.120816
Chen, Y., and Lyga, J. (2014). Brain-skin connection: stress, inflammation and skin aging. Inflamm. Allergy Drug Targets 13, 177–190. doi: 10.2174/1871528113666140522104422
Chiesa, A. (2013). The difficulty of defining mindfulness: current thought and critical issues. Mindfulness 4, 255–268. doi: 10.1007/s12671-012-0123-4
Chrousos, G. (2000). The role of stress and the hypothalamic-pituitary-adrenal axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and target tissue-related causes. Int. J. Obes. Relat. Metab. Disord. 24, S50–S55. doi: 10.1038/sj.ijo.0801278
Chrousos, G. (2009). Stress and disorders of the stress system. Nat. Rev. Endocrinol. 5, 374–381. doi: 10.1038/nrendo.2009.106
Chrousos, G., and Gold, P. (1992). The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA 267, 1244–1252.
Chrousos, G., and Kino, T. (2007). Glucocorticoid action networks and complex psychiatric and/or somatic disorders. Stress 10, 213–219. doi: 10.1080/10253890701292119
Cohen, S., Kamarck, T., and Mermelstein, R. (1983). A global measure of perceived stress. J. Health Soc. Behav. 24, 385–396. doi: 10.2307/2136404
Collins, S. (2001). Stress and the gastrointestinal tract IV. Modulation of intestinal inflammation by stress: basic mechanisms and clinical relevance. Am. J. Physiol. Gastrointest. Liver Physiol. 280, G315–G318. doi: 10.1152/ajpgi.2001.280.3.G315
Cottrell, E., and Seckl, J. (2009). Prenatal stress, glucocorticoids and the programming of adult disease. Front. Behav. Neurosci. 3:19. doi: 10.3389/neuro.08.019.2009
Creswell, J. (2017). Mindfulness interventions. Annu. Rev. Psychol. 68, 491–516. doi: 10.1146/annurev-psych-042716-051139
Creswell, J., Irwin, M., Burklund, L., Lieberman, M., Arevalo, J., Ma, J., et al. (2012). Mindfulness-based stress reduction training reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized controlled trial. Brain Behav. Immun. 26, 1095–1101. doi: 10.1016/j.bbi.2012.07.006
Cuthbert, S., and Goodheart, G. J. (2007). On the reliability and validity of manual muscle testing: a literature review. Chiropr. Osteopat. 15:4. doi: 10.1186/1746-1340-15-4
Dallman, M., Strack, A., Akana, S., Bradbury, M., Hanson, E., Scribner, K., et al. (1993). Feast and famine: critical role of glucocorticoids with insulin in daily energy flow. Front. Neuroendocrinol. 14, 303–347. doi: 10.1006/frne.1993.1010
Davidson, R., and Kaszniak, A. (2015). Conceptual and methodological issues in research on mindfulness and meditation. Am. Psychol. 70, 581–592. doi: 10.1037/a0039512
Davis, M., Zautra, A., Wolf, L., Tennen, H., and Yeung, E. (2015). Mindfulness and cognitive-behavioral interventions for chronic pain: differential effects on daily pain reactivity and stress reactivity. J. Consult. Clin. Psychol. 83, 24–35. doi: 10.1037/a0038200
Dhillon, A., Sparkes, E., and Duarte, R. (2017). Mindfulness-based interventions during pregnancy: a systematic review and meta-analysis. Mindfulness 8, 1421–1437. doi: 10.1007/s12671-017-0726-x
Doan, T., Ha, V., Strazdins, L., and Chateau, D. (2023). Healthy minds live in healthy bodies – effect of physical health on mental health: evidence from Australian longitudinal data. Curr. Psychol. 42, 18702–18713. doi: 10.1007/s12144-022-03053-7
Dobkin, P., Irving, J., and Amar, S. (2012). For whom may participation in a mindfulness-based stress reduction program be contraindicated? Mindfulness 3, 44–50. doi: 10.1007/s12671-011-0079-9
Dorn, L., and Chrousos, G. (1993). The endocrinology of stress and stress system disorders in adolescence. Endocrinol. Metab. Clin. N. Am. 22, 685–700. doi: 10.1016/S0889-8529(18)30158-0
Drummond, P., and Hewson-Bower, B. (1997). Increased psychosocial stress and decreased mucosal immunity in children with recurrent upper respiratory tract infections. J. Psychosom. Res. 43, 271–278. doi: 10.1016/s0022-3999(97)00002-0
Dunn, B., Hartigan, J., and Mikulas, W. (1999). Concentration and mindfulness meditations: unique forms of consciousness? Appl. Psychophysiol. Biofeedback 24, 147–165. doi: 10.1023/a:1023498629385
Dunn, M., Rushton, A., Mistry, J., Soundy, A., and Heneghan, N. (2024). The biopsychosocial factors associated with development of chronic musculoskeletal pain. An umbrella review and meta-analysis of observational systematic reviews. PLoS One 19:e0294830. doi: 10.1371/journal.pone.0294830
Edwards, K., Edes, A., and Brown, J. (2019). Stress, well-being and reproductive success. Adv. Exp. Med. Biol. 1200, 91–162. doi: 10.1007/978-3-030-23633-5_5
Ellett, L. (2024). Mindfulness for psychosis: current evidence, unanswered questions and future directions. Psychol. Psychother. 97, 34–40. doi: 10.1111/papt.12480
Engel, G. (1977). The need for a new medical model: a challenge for biomedicine. Science 196, 129–136.
Fan, D. (2017). Holistic integrative medicine: toward a new era of medical advancement. Front. Med. 11, 152–159. doi: 10.1007/s11684-017-0499-6
Farias, M., and Wikholm, C. (2016). Has the science of mindfulness lost its mind? BJPsych Bull 40, 329–332. doi: 10.1192/pb.bp.116.053686
Fillingim, R., Ohrbach, R., Greenspan, J., Knott, C., Diatchenko, L., Dubner, R., et al. (2013). Psychological factors associated with development of TMD: the OPPERA prospective cohort study. J. Pain 14, T75–T90. doi: 10.1016/j.jpain.2013.06.009
Finestone, H., Alfeeli, A., and Fisher, W. (2008). Stress-induced physiologic changes as a basis for the biopsychosocial model of chronic musculoskeletal pain: a new theory? Clin. J. Pain 24, 767–775. doi: 10.1097/AJP.0b013e3181790342
Foa, E., and Jaycox, L. (1999). “Cognitive-behavioral theory and treatment of posttraumatic stress disorder” in Efficacy and cost-effectiveness of psychotherapy. ed. D. Spiegel (Arlington, VA, United States: American Psychiatric Publishing, Inc.).
Fox, K., Nijeboer, S., Dixon, M., Floman, J., Ellamil, M., Rumak, S., et al. (2014). Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neurosci. Biobehav. Rev. 43, 48–73. doi: 10.1016/j.neubiorev.2014.03.016
Franklin, T., Saab, B., and Mansuy, I. (2012). Neural mechanisms of stress resilience and vulnerability. Neuron 75, 747–761. doi: 10.1016/j.neuron.2012.08.016
Gapp, K., Bohacek, J., Grossmann, J., Brunner, A., Manuella, F., Nanni, P., et al. (2016). Potential of environmental enrichment to prevent transgenerational effects of paternal trauma. Neuropsychopharmacology 41, 2749–2758. doi: 10.1038/npp.2016.87
García-Campayo, J., Puebla-Guedea, M., Labarga, A., et al. (2018). Epigenetic response to mindfulness in peripheral blood leukocytes involves genes linked to common human diseases. Mindfulness 9, 1146–1159. doi: 10.1007/s12671-017-0851-6
Garland, E., Hanley, A., Baker, A., and Howard, M. (2017). Biobehavioral mechanisms of mindfulness as a treatment for chronic stress: an RDoC perspective. Chronic Stress 1, 1–14. doi: 10.1177/2470547017711912
Gathright, E., Salmoirago-Blotcher, E., DeCosta, J., Balletto, B., Donahue, M., Feulner, M., et al. (2019). The impact of transcendental meditation on depressive symptoms and blood pressure in adults with cardiovascular disease: a systematic review and meta-analysis. Complement. Ther. Med. 46, 172–179. doi: 10.1016/j.ctim.2019.08.009
Gee, D., Gabard-Durnam, L., Flannery, J., Goff, B., Humphreys, K., Telzer, E., et al. (2013). Early developmental emergence of human amygdala-prefrontal connectivity after maternal deprivation. Proc. Natl. Acad. Sci. USA 110, 15638–15643. doi: 10.1073/pnas.1307893110
Goldberg, S., Riordan, K., Sun, S., and Davidson, R. (2022). The empirical status of mindfulness-based interventions: a systematic review of 44 meta-analyses of randomized controlled trials. Perspect. Psychol. Sci. 17, 108–130. doi: 10.1177/1745691620968771
González-Díaz, S., Arias-Cruz, A., and Elizondo-Villarreal, B. (2017). Psychoneuroimmunoendocrinology: clinical implications. World Allergy Organ. J. 10:19. doi: 10.1186/s40413-017-0151-6
González-Moret, R., Cebolla, A., Cortés, X., Baños, R., Navarrete, J., de la Rubia, J., et al. (2020). The effect of a mindfulness-based therapy on different biomarkers among patients with inflammatory bowel disease: a randomised controlled trial. Sci. Rep. 10:6071. doi: 10.1038/s41598-020-63168-4
Gouin, J., and Kiecolt-Glaser, J. (2012). The impact of psychological stress on wound healing: methods and mechanisms. Crit. Care Nurs. Clin. North Am. 24, 201–213. doi: 10.1016/j.ccell.2012.03.006
Graham, N., Douglas, R., and Ryan, P. (1986). Stress and acute respiratory infection. Am. J. Epidemiol. 124, 389–401. doi: 10.1093/oxfordjournals.aje.a114409
Graubard, R., Perez-Sanchez, A., and Katta, R. (2021). Stress and skin: an overview of mind body therapies as a treatment strategy in dermatology. Dermatol. Pract. Concept. 11:e2021091. doi: 10.5826/dpc.1104a91
Gray, T., Carney, M., and Magnuson, D. (1989). Direct projections from the central amygdaloid nucleus to the hypothalamic paraventricular nucleus: possible role in stress-induced adrenocorticotropin release. Neuroendocrinology 50, 433–446. doi: 10.1159/000125260
Grossman, P. (2011). Defining mindfulness by how poorly i think i pay attention during everyday awareness and other intractable problems for psychology's (re)invention of mindfulness: comment on Brown et al. (2011). Psychol. Assess. 23, 1034–1040. doi: 10.1037/a0022713
Gu, J., Strauss, C., Bond, R., and Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of meditation studies. Clin. Psychol. Rev. 37, 1–12. doi: 10.1016/j.cpr.2015.01.006
Gu, H., Tang, C., and Yang, Y. (2012). Psychological stress, immune response, and atherosclerosis. Atherosclerosis 223, 69–77. doi: 10.1016/j.atherosclerosis.2012.01.021
Guidi, J., Lucente, M., Sonino, N., and Fava, G. (2021). Allostatic load and its impact on health: a systematic review. Psychother. Psychosom. 90, 11–27. doi: 10.1159/000510696
Hanley, A., Warner, A., Dehili, V., Canto, A., and Garland, E. (2015). Washing dishes to wash the dishes: brief instruction in an informal mindfulness practice. Mindfulness 6, 1095–1103. doi: 10.1007/s12671-014-0360-9
Hannum, G., Fan, J.-B., Guinney, J., Zhao, L., Zhang, L., Hughes, G., et al. (2013). Genome-wide methylation profiles reveal quantitative views of human aging rates. Mol. Cell 49, 359–367. doi: 10.1016/j.molcel.2012.10.016
Hardy, K., and Pollard, H. (2006). The organisation of the stress response, and its relevance to chiropractors: a commentary. Chiropr. Osteopat. 14:25. doi: 10.1186/1746-1340-14-25
Harfenstellar, J. (2022). An open trial on the feasibility and efficacy of a mindfulness-based intervention with psychoeducational elements on atopic eczema and chronic itch. Psych 4, 160–172. doi: 10.3390/psych4020014
Hemingway, H., and Marmot, M. (1999). Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart disease. Systematic review of prospective cohort studies. BMJ 318, 1460–1467. doi: 10.1136/bmj.318.7196.1460
Herman, J., McKlveen, J., Ghosal, S., Kopp, B., Wulsin, A., Makinson, R., et al. (2016). Regulation of the hypothalamic-pituitary-adrenocortical stress response. Compr Physiol 6, 603–621. doi: 10.1002/cphy.c150015
Higgins, E., Davidson, R., Busse, W., Klaus, D., Bednarek, G., Goldman, R., et al. (2022). Clinically relevant effects of mindfulness-based stress reduction in individuals with asthma. Brain Behav. Immun. Health 25:100509. doi: 10.1016/j.bbih.2022.100509
Hofmann, S., Sawyer, A., Witt, A., and Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J. Consult. Clin. Psychol. 78, 169–183. doi: 10.1037/a0018555
Hölzel, B., Lazar, S., Gard, T., Schuman-Olivier, Z., Vago, D., and Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect. Psychol. Sci. 6, 537–559. doi: 10.1177/1745691611419671
Horvath, S. (2013). DNA methylation age of human tissues and cell types. Genome Biol. 14:R115. doi: 10.1186/gb-2013-14-10-r115
Jensen, A. (2010). A mind-body approach for precompetitive anxiety in power-lifters: 2 case studies. J. Chiropr. Med. 9, 184–192. doi: 10.1016/j.jcm.2010.08.003
Jensen, A., and Ramasamy, A. (2009). Treating spider phobia using neuro emotional technique: findings from a pilot study. J. Altern. Complement. Med. 15, 1363–1374. doi: 10.1089/acm.2008.0595
Juster, R., McEwen, B., and Lupien, S. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci. Biobehav. Rev. 35, 2–16. doi: 10.1016/j.neubiorev.2009.10.002
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Delacorte Press.
Kabat-Zinn, J. (2024). “9 attitudes of mindfulness by Jon Kabat-Zinn,” MBSR training, Available online at: https://mbsrtraining.com/attitudes-of-mindfulness-by-jon-kabat-zinn/ (Accessed 13 September 2024).
Kabat-Zinn, J., Massion, A., Kristeller, J., Peterson, L., Fletcher, K., Pbert, L., et al. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am. J. Psychiatry 149, 936–943. doi: 10.1176/ajp.149.7.936
Kakoschke, N., Hassed, C., Chambers, R., and Lee, K. (2021). The importance of formal versus informal mindfulness practice for enhancing psychological wellbeing and study engagement in a medical student cohort with a 5-week mindfulness-based lifestyle program. PLoS One 16:e0258999. doi: 10.1371/journal.pone.0258999
Kaliman, P., Alvarez-López, M., Cosín-Tomás, M., Rosenkranz, M., Lutz, A., and Davidson, R. (2014). Rapid changes in histone deacetylases and inflammatory gene expression in expert meditators. Psychoneuroendocrinology 40, 96–107. doi: 10.1016/j.psyneuen.2013.11.004
Karpouzis, F., Pollard, H., and Bonello, R. (2008). Separation anxiety disorder in a 13-year-old boy managed by the neuro emotional technique as a biopsychosocial intervention. J. Chiropr. Med. 7, 101–106. doi: 10.1016/j.jcm.2008.05.003
Karpouzis, F., Pollard, H., and Bonello, R. (2009). A randomised controlled trial of the neuro emotional technique (NET) for childhood attention deficit hyperactivity disorder (ADHD): a protocol. Trials 10:6. doi: 10.1186/1745-6215-10-6
Kazakou, P., Nicolaides, N., and Chrousos, G. (2023). Basic concepts and hormonal regulators of the stress system. Horm. Res. Paediatr. 96, 8–16. doi: 10.1159/000523975
Kiecolt-Glaser, J., Marucha, P., Malarkey, W., Mercado, A., and Glaser, R. (1995). Slowing of wound healing by psychological stress. Lancet 346, 1194–1196. doi: 10.1016/s0140-6736(95)92899-5
Kiecolt-Glaser, J., Robles, T., Heffner, K., Loving, T., and Glaser, R. (2002). Psycho-oncology and cancer: psychoneuroimmunology and cancer. Ann. Oncol. 13, 165–169. doi: 10.1093/annonc/mdf655
Kim, I., Lee, J., and Park, S. (2022). The relationship between stress, inflammation, and depression. Biomedicine 10:1929. doi: 10.3390/biomedicines10081929
Koolhaas, J., Bartolomucci, A., Buwalda, B., de Boer, S., Flügge, G., Korte, S., et al. (2011). Stress revisited: a critical evaluation of the stress concept. Neurosci. Biobehav. Rev. 35, 1291–1301. doi: 10.1016/j.neubiorev.2011.02.003
Kroenke, K., Spitzer, R., and Williams, J. (2001). The PHQ-9: validity of a brief depression severity measure. J. Gen. Intern. Med. 16, 606–613. doi: 10.1046/j.1525-1497.2001.016009606.x
Kuyken, W., Ball, S., Crane, C., Ganguli, P., Jones, B., Montero-Marin, J., et al. (2022). Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Evid. Based Ment. Health 25, 99–109. doi: 10.1136/ebmental-2021-300396
Kuyken, W., Byford, S., Taylor, R., Watkins, E., Holden, E., White, K., et al. (2008). Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. J. Consult. Clin. Psychol. 76, 966–978. doi: 10.1037/a0013786
Kyrou, I., and Tsigos, C. (2008). Chronic stress, visceral obesity and gonadal dysfunction. Hormones (Athens) 7, 287–293. doi: 10.14310/horm.2002.1209
Labanski, A., Langhorst, J., Engler, H., and Elsenbruch, S. (2020). Stress and the brain-gut axis in functional and chronic-inflammatory gastrointestinal diseases: A transdisciplinary challenge. Psychoneuroendocrinology 111:104501. doi: 10.1016/j.psyneuen.2019.104501
Landeo-Gutierrez, J., and Celedón, J. (2020). Chronic stress and asthma in adolescents. Ann. Allergy Asthma Immunol. 125, 393–398. doi: 10.1016/j.anai.2020.07.001
Leonard, B. (2010). The concept of depression as a dysfunction of the immune system. Curr. Immunol. Rev. 6, 205–212. doi: 10.2174/157339510791823835
Li, J., Long, L., Liu, Y., He, W., and Li, M. (2016). Effects of a mindfulness-based intervention on fertility quality of life and pregnancy rates among women subjected to first in vitro fertilization treatment. Behav. Res. Ther. 77, 96–104. doi: 10.1016/j.brat.2015.12.010
Lindahl, J., Cooper, D., Fisher, N., Kirmayer, L., and Britton, W. (2020). Progress or pathology? Differential diagnosis and intervention criteria for meditation-related challenges: perspectives from Buddhist meditation teachers and practitioners. Front. Psychol. 11:1905. doi: 10.3389/fpsyg.2020.01905
Lindahl, J., Fisher, N., Cooper, D., Rosen, R., and Britton, W. (2017). The varieties of contemplative experience: a mixed-methods study of meditation-related challenges in Western Buddhists. PLoS One 12:e0176239. doi: 10.1371/journal.pone.0176239
Linton, S. (2000). A review of psychological risk factors in back and neck pain. Spine (Phila Pa 1976) 25, 1148–1156. doi: 10.1097/00007632-200005010-00017
Liu, H., Cai, K., Wang, J., and Zhang, H. (2023). The effects of mindfulness-based interventions on anxiety, depression, stress, and mindfulness in menopausal women: A systematic review and meta-analysis. Front. Public Health 10:1045642. doi: 10.3389/fpubh.2022.1045642
Lovibond, S., and Lovibond, P. (1995). Manual for the depression anxiety and stress scales (DASS21) second edition. Sydney, NSW: Psychology Foundation of Australia, 1–3.
Lucassen, P., Pruessner, J., Sousa, N., Almeida, O., Van Dam, A., Rajkowska, G., et al. (2014). Neuropathology of stress. Acta Neuropathol. 127, 109–135. doi: 10.1007/s00401-013-1223-5
Lucini, D., Di Fede, G., Parati, G., and Pagani, M. (2005). Impact of chronic psychosocial stress on autonomic cardiovascular regulation in otherwise healthy subjects. Hypertension 46, 1201–1206. doi: 10.1161/01.HYP.0000185147.32385.4b
Lustyk, M., Chawla, N., Nolan, R., and Marlatt, G. (2009). Mindfulness meditation research: issues of participant screening, safety procedures, and researcher training. Adv. Mind Body Med. 24, 20–30.
Lutz, P., Chay, M., Pacis, A., Chen, G., Aouabed, Z., Maffioletti, E., et al. (2021). Non-CG methylation and multiple histone profiles associate child abuse with immune and small GTPase dysregulation. Nat. Commun. 12:1132. doi: 10.1038/s41467-021-21365-3
Lutz, A., Slagter, H., Dunne, J., and Davidson, R. (2008). Attention regulation and monitoring in meditation. Trends Cogn. Sci. 12, 163–169. doi: 10.1016/j.tics.2008.01.005
Main, C., and Waddell, G. (1991). A comparison of cognitive measures in low back pain: statistical structure and clinical validity at initial assessment. Pain 46, 287–298. doi: 10.1016/0304-3959(91)90112-B
Main, C., Wood, P., Hollis, S., Spanswick, C., and Waddell, G. (1992). The distress and risk assessment method. A simple patient classification to identify distress and evaluate the risk of poor outcome. Spine (Phila Pa 1976) 17, 42–52. doi: 10.1097/00007632-199201000-00007
Maloney, S., Kock, M., Slaghekke, Y., Radley, L., Lopez-Montoyo, A., Montero-Marin, J., et al. (2024). Target mechanisms of mindfulness-based programmes and practices: a scoping review. BMJ Ment Health 27:e300955. doi: 10.1136/bmjment-2023-300955
Malterud, K. (2010). Kroniske muskelsmerter kan forklares på mange måter [Chronic muscular pain is not unexplainable]. Tidsskr. Nor. Laegeforen. 130, 2356–2359. doi: 10.4045/tidsskr.09.0828
Manfredini, D., Bandettini di Poggio, A., Cantini, E., Dell'Osso, L., and Bosco, M. (2004). Mood and anxiety psychopathology and temporomandibular disorder: a spectrum approach. J. Oral Rehabil. 31, 933–940. doi: 10.1111/j.1365-2842.2004.01335.x
Manfredini, D., Landi, N., Bandettini Di Poggio, A., Dell'Osso, L., and Bosco, M. (2003). A critical review on the importance of psychological factors in temporomandibular disorders. Minerva Stomatol. 52, 321–326.
Manigault, A., Slutsky, J., Raye, J., and Creswell, J. D. (2021). Examining practice effects in a randomized controlled trial: daily life mindfulness practice predicts stress buffering effects of mindfulness meditation training. Mindfulness 12, 2487–2497. doi: 10.1007/s12671-021-01718-1
Mantri, S. (2008). Holistic medicine and the Western medical tradition. Virtual Mentor 10, 177–180. doi: 10.1001/virtualmentor.2008.10.3.mhst1-0803
Mariotti, A. (2015). The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future Sci. OA 1:FSO23. doi: 10.4155/fso.15.21
Masere, C., Nakade, Y., Zheng, J., Babygirija, R., Ludwig, K., and Takahashi, T. (2009). Chronic restraint stress has no more stimulatory effects on colonic motility in rats. Neurosci. Lett. 453, 147–150. doi: 10.1016/j.neulet.2009.02.042
Maté, G., “Goodreads Gabor Maté quotes,” Goodreads, (2024). Available online at: https://www.goodreads.com/quotes/8699371-while-all-of-us-dread-being-blamed-we-all-would (Accessed 16 May 2024).
McBeth, J., and Silman, A. (2001). The role of psychiatric disorders in fibromyalgia. Curr. Rheumatol. Rep. 3, 157–164. doi: 10.1007/s11926-001-0011-8
McCreary, J., Erickson, Z., Hao, Y., Ilnytskyy, Y., Kovalchuk, I., and Metz, G. (2016). Environmental intervention as a therapy for adverse programming by ancestral stress. Sci. Rep. 6:37814. doi: 10.1038/srep37814
McEwen, B. (1998). Protective and damaging effects of stress mediators. N. Engl. J. Med. 338, 171–179. doi: 10.1056/NEJM199801153380307
McEwen, B. (2007). Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol. Rev. 87, 873–904. doi: 10.1152/physrev.00041.2006
McEwen, B., and Gianaros, P. (2011). Stress- and allostasis-induced brain plasticity. Annu. Rev. Med. 62, 431–445. doi: 10.1146/annurev-med-052209-100430
McEwen, B., and Stellar, E. (1993). Stress and the individual. mechanisms leading to disease. Arch. Intern. Med. 153, 2093–2101.
McFarlane, A. (2007). Stress-related musculoskeletal pain. Best Pract. Res. Clin. Rheumatol. 21, 549–565. doi: 10.1016/j.berh.2007.03.008
McGreevey, S. “Eight weeks to a better brain,” MGH communications, the Harvard gazette, (2011). Available online at: https://news.harvard.edu/gazette/story/2011/01/eight-weeks-to-a-better-brain/ (Accessed 23 May 2024).
Mental Health Foundation UK, “Stress: Statistics - results of our 2018 study.” (2024a). Available online at: https://www.mentalhealth.org.uk/explore-mental-health/statistics/stress-statistics (Accessed 9 July 2024).
Mental Health Foundation UK, “Physical health and mental health.” (2024b). Available online at: https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/physical-health-and-mental-health (Accessed 9 July 2024).
Mills, S., Nicolson, K., and Smith, B. (2019). Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br. J. Anaesth. 123, e273–e283. doi: 10.1016/j.bja.2019.03.023
Mindful Staff, “Jon Kabat-Zinn: Defining Mindfulness,” Mindful.org, (2017). Available online at: https://www.mindful.org/jon-kabat-zinn-defining-mindfulness/ (Accessed 22 May 2024].
Monti, D., Sinnott, J., Marchese, M., Kunkel, E., and Greeson, J. (1999). Muscle test comparisons of congruent and incongruent self-referential statements. Percept. Mot. Skills 88, 1019–1028. doi: 10.2466/pms.1999.88.3.1019
Monti, D., Tobia, A., Stoner, M., Wintering, N., Matthews, M., Conklin, C. J., et al. (2018). Changes in cerebellar functional connectivity and autonomic regulation in cancer patients treated with the neuro emotional technique for traumatic stress symptoms. J. Cancer Surviv. 12, 145–153. doi: 10.1007/s11764-017-0653-9
Monti, D., Tobia, A., Stoner, M., Wintering, N., Matthews, M., He, X., et al. (2017). Neuro emotional technique effects on brain physiology in cancer patients with traumatic stress symptoms: preliminary findings. J. Cancer Surviv. 11, 438–446. doi: 10.1007/s11764-017-0601-8
Morey, J., Boggero, I., Scott, A., and Segerstrom, S. (2015). Current directions in stress and human immune function. Curr. Opin. Psychol. 5, 13–17. doi: 10.1016/j.copsyc.2015.03.007
Muka, T., Koromani, F., Portilla, E., O'Connor, A., Bramer, W., Troup, J., et al. (2016). The role of epigenetic modifications in cardiovascular disease: A systematic review. Int. J. Cardiol. 212, 174–183. doi: 10.1016/j.ijcard.2016.03.062
Musaelyan, K., Yildizoglu, S., Bozeman, J., Du Preez, A., Egeland, M., Zunszain, P., et al. (2020). Chronic stress induces significant gene expression changes in the prefrontal cortex alongside alterations in adult hippocampal neurogenesis. Brain Commun. 2:fcaa153. doi: 10.1093/braincomms/fcaa153
Navarro-Ledesma, S., Hamed-Hamed, D., Gonzalez-Muñoz, A., and Pruimboom, L. (2024). Impact of physical therapy techniques and common interventions on sleep quality in patients with chronic pain: A systematic review. Sleep Med. Rev. 76:101937. doi: 10.1016/j.smrv.2024.101937
Ng, Q., Venkatanarayanan, N., Loke, W., Yeo, W., Lim, D., Chan, H., et al. (2019). A meta-analysis of the effectiveness of yoga-based interventions for maternal depression during pregnancy. Complement. Ther. Clin. Pract. 34, 8–12. doi: 10.1016/j.ctcp.2018.10.016
NIB, “The impact of stress in Australia,” (2021). Available online at: https://www.nib.com.au/the-checkup/impact-of-stress-in-australia (Accessed 16 May 2024].
Nold, V., and Allers, K., “Consequences of chronic stress on the PINE network,” (2020). Available online at: https://www.intechopen.com/chapters/76550 (Accessed 11 October 2023).
O'Donovan, A., Tomiyama, A., Lin, J., Puterman, E., Adler, N., Kemeny, M., et al. (2012). Stress appraisals and cellular aging: a key role for anticipatory threat in the relationship between psychological stress and telomere length. Brain Behav. Immun. 26, 573–579. doi: 10.1016/j.bbi.2012.01.007
Olff, M. (1999). Stress, depression and immunity: the role of defense and coping styles. Psychiatry Res. 85, 7–15. doi: 10.1016/s0165-1781(98)00139-5
Ong, N., Teo, F., Ee, J., Yau, C., Thumboo, J., Tan, H., et al. (2024). Effectiveness of mindfulness-based interventions on the well-being of healthcare workers: a systematic review and meta-analysis. Gen. Psychiatr. 37:e101115. doi: 10.1136/gpsych-2023-101115
Palmer, R., Roos, C., Vafaie, N., and Kober, H. (2023). The effect of ten versus twenty minutes of mindfulness meditation on state mindfulness and affect. Sci. Rep. 13:20646. doi: 10.1038/s41598-023-46578-y
Parker, H., Abreu, A., Sullivan, M., and Vadiveloo, M. (2022). Allostatic load and mortality: a systematic review and meta-analysis. Am. J. Prev. Med. 63, 131–140. doi: 10.1016/j.amepre.2022.02.003
Paschali, M., Lazaridou, A., Paschalis, T., Napadow, V., and Edwards, R. (2021). Modifiable psychological factors affecting functioning in fibromyalgia. J. Clin. Med. 10:803. doi: 10.3390/jcm10040803
Pascoe, M., Thompson, D., and Ski, C. (2017). Yoga, mindfulness-based stress reduction and stress-related physiological measures: a meta-analysis. Psychoneuroendocrinology 86, 152–168. doi: 10.1016/j.psyneuen.2017.08.008
Pérez Fernández, J., Salaberria, K., and de Ocenda, Á. R. (2022). Mindfulness-based pain management (MBPM) for chronic pain: a randomized clinical trial. Mindfulness 13, 3153–3165. doi: 10.1007/s12671-022-02023-1
Peterson, K. (1995). Two cases of spinal manipulation performed while the patient contemplated an associated stress event: the effect of the manipulation/contemplation on serum cholesterol levels in hypercholesterolemic subjects. Chir Technique 7, 55–59.
Peterson, K. (1997). The effects of spinal manipulation on the intensity of emotional arousal in phobic subjects exposed to a threat stimulus: a randomized, controlled, double-blind clinical trial. J. Manip. Physiol. Ther. 20, 602–606.
Peterson, C., Haas, M., and Gregory, W. (2012). A pilot randomized controlled trial comparing the efficacy of exercise, spinal manipulation, and neuro emotional technique for the treatment of pregnancy-related low back pain. Chiropr. Man. Therap. 20:18. doi: 10.1186/2045-709X-20-18
Pollard, H., Lakay, B., Tucker, F., Watson, B., and Bablis, P. (2005). Interexaminer reliability of the deltoid and psoas muscle test. J. Manip. Physiol. Ther. 28, 52–56. doi: 10.1016/j.jmpt.2004.12.008
Prakhinkit, S., Suppapitiporn, S., Tanaka, H., and Suksom, D. (2014). Effects of Buddhism walking meditation on depression, functional fitness, and endothelium-dependent vasodilation in depressed elderly. J. Altern. Complement. Med. 20, 411–416. doi: 10.1089/acm.2013.0205
Pratt, M., “5 minutes of mindfulness brings real benefits, according to science,” (2024). Available online at: https://www.mindful.org/5-minutes-of-mindfulness-brings-real-benefits-according-to-science/ (Accessed 16 September 2024).
Preissner, C., Vilier, L., Bertelsmann, N., Beckers, K., de Ruijter, D., de Vries, H., et al. (2025). A systematic review on the effectiveness of unstandardized mindfulness interventions in improving dietary and physical activity outcomes in healthy adults. BMC Public Health 25:1705. doi: 10.1186/s12889-025-22850-w
Rao, K. (2011). Applied yoga psychology: studies of neurophysiology of meditation. J. Conscious. Stud. 18, 161–198.
Ren, H., Collins, V., Clarke, S., Han, J., Lam, P., Clay, F., et al. (2012). Epigenetic changes in response to tai chi practice: a pilot investigation of DNA methylation marks. Evid. Based Complement. Alternat. Med. 2012:841810. doi: 10.1155/2012/841810
Riegner, G., Dean, J., Wager, T., and Zeidan, F. (2024). Mindfulness meditation and placebo modulate distinct multivariate neural signatures to reduce pain. Biol. Psychiatry, 97, 81–88. doi: 10.1016/j.biopsych.2024.08.023
Robinson, J., “How does mental health affect physical health? ”. New York, NY, USA. (2023). Available online at: https://www.webmd.com/mental-health/how-does-mental-health-affect-physical-health (Accessed 9 July 2024).
Rod, N., Grønbaek, M., Schnohr, P., Prescott, E., and Kristensen, T. (2009). Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile: a longitudinal study. J. Intern. Med. 266, 467–475. doi: 10.1111/j.1365-2796.2009.02124.x
Roth, R., Tam, S., Ida, Y., Yang, J., and Deutch, A. (1988). Stress and the mesocorticolimbic dopamine systems. Ann. N. Y. Acad. Sci. 537, 138–147. doi: 10.1111/j.1749-6632.1988.tb42102.x
Rudland, J., Golding, C., and Wilkinson, T. (2020). The stress paradox: how stress can be good for learning. Med. Educ. 54, 40–45. doi: 10.1111/medu.13830
Salvagioni, D., Melanda, F., Mesas, A., González, A., Gabani, F., and Andrade, S. (2017). Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies. PLoS One 12:e0185781. doi: 10.1371/journal.pone.0185781
Sandberg, S., Paton, J., Ahola, S., McCann, D., McGuinness, D., Hillary, C., et al. (2000). The role of acute and chronic stress in asthma attacks in children. Lancet 356, 982–987. doi: 10.1016/S0140-6736(00)02715-X
Sandman, C., Davis, E., Buss, C., and Glynn, L. (2011). Prenatal programming of human neurological function. Int. J. Pept. 2011:837596. doi: 10.1155/2011/837596
Santorelli, S. (2014). Mindfulness-based stress reduction (MBSR): Standards of practice,” University of Massachusetts Medical School Center for mindfulness in medicine, health care, and society” Worcester, MA, USA
Schneiderman, N., Ironson, G., and Siegel, S. (2005). Stress and health: psychological, behavioral, and biological determinants. Annu. Rev. Clin. Psychol. 1, 607–628. doi: 10.1146/annurev.clinpsy.1.102803.144141
Sharif, K., Watad, A., Coplan, L., Lichtbroun, B., Krosser, A., Lichtbroun, M., et al. (2018). The role of stress in the mosaic of autoimmunity: an overlooked association. Autoimmun. Rev. 17, 967–983. doi: 10.1016/j.autrev.2018
Sparacio, A., IJzerman, H., Ropovik, I., Giorgini, F., Spiessens, C., and Uchino, B. (2024). Self-administered mindfulness interventions reduce stress in a large, randomized controlled multi-site study. Nat. Hum. Behav. 8, 1716–1725. doi: 10.1038/s41562-024-01907-7
Spinelli, C., Wisener, M., and Khoury, B. (2019). Mindfulness training for healthcare professionals and trainees: A meta-analysis of randomized controlled trials. J. Psychosom. Res. 120, 29–38. doi: 10.1016/j.jpsychores.2019.03.003
Stapelberg, N., Neumann, D., Shum, D., McConnell, H., and Hamilton-Craig, I. (2015). From physiome to pathome: a systems biology model of major depressive disorder and the psycho-immune-neuroendocrine network. Curr. Psychiatr. Rev. 11, 32–62. doi: 10.2174/157340051066614061
Stojanovich, L. (2010). Stress and autoimmunity. Autoimmun. Rev. 9, A271–A276. doi: 10.1016/j.autrev.2009.11.014
Stratakis, C., and Chrousos, G. (1995). Neuroendocrinology and pathophysiology of the stress system. Ann. N. Y. Acad. Sci. 771, 1–18. doi: 10.1111/j.1749-6632.1995.tb44666.x
Streeten, D. (1993). Is hypothalamic-pituitary-adrenal hyperactivity important in the pathogenesis of excessive abdominal fat distribution? J. Clin. Endocrinol. Metab. 77, 339–340. doi: 10.1210/jcem.77.2.8345038
Strohmaier, S., Jones, F., and Cane, J. (2021). Effects of length of mindfulness practice on mindfulness, depression, anxiety, and stress: a randomized controlled experiment. Mindfulness 12, 198–214. doi: 10.1007/s12671-020-01512-5
Suess, W., Alexander, A., Smith, D., Sweeney, H., and Marion, R. (1980). The effects of psychological stress on respiration: a preliminary study of anxiety and hyperventilation. Psychophysiology 17, 535–540. doi: 10.1111/j.1469-8986.1980.tb02293.x
Taché, Y., Martinez, V., Million, M., and Wang, L. (2001). Stress and the gastrointestinal tract III. Stress-related alterations of gut motor function: role of brain corticotropin-releasing factor receptors. Am. J. Physiol. Gastrointest. Liver Physiol. 280, G173–G177. doi: 10.1152/ajpgi.2001.280.2.G173
Tang, Y., Hölzel, B., and Posner, M. (2015). The neuroscience of mindfulness meditation. Nat. Rev. Neurosci. 16, 213–225. doi: 10.1038/nrn3916
Teixeira, R., Díaz, M., Santos, T., Bernardes, J., Peixoto, L., Bocanegra, O., et al. (2015). Chronic stress induces a hyporeactivity of the autonomic nervous system in response to acute mental stressor and impairs cognitive performance in business executives. PLoS One 10:e0119025. doi: 10.1371/journal.pone.0119025
Thind, H., Lantini, R., Balletto, B., Donahue, M., Salmoirago-Blotcher, E., Bock, B., et al. (2017). The effects of yoga among adults with type 2 diabetes: a systematic review and meta-analysis. Prev. Med. 105, 116–126. doi: 10.1016/j.ypmed.2017.08.017
Todd, J., and Aspell, J. (2022). Mindfulness, interoception, and the body. Brain Sci. 12:696. doi: 10.3390/brainsci12060696
Tsigos, C., Kyrou, I., Kassi, E., and Chrousos, G. (2000). “Stress: endocrine physiology and pathophysiology” in Endotext [internet], editors: Feingold, KR; Anawalt, B; Blackman, MR (South Dartmouth, MA: MDText.com, Inc).
Tsigos, C., Papanicolaou, D., Kyrou, I., Raptis, S., and Chrousos, G. (1999). Dose-dependent effects of recombinant human interleukin-6 on the pituitary-testicular axis. J. Interf. Cytokine Res. 19, 1271–1276. doi: 10.1089/107999099312948
Van Dam, N., van Vugt, M., Vago, D., Schmalzl, L., Saron, C., Olendzki, A., et al. (2018). Mind the hype: a critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspect. Psychol. Sci. 13, 36–61. doi: 10.1177/1745691617709589
van den Heuvel, S., van der Beek, A., Blatter, B., Hoogendoorn, W., and Bongers, P. (2005). Psychosocial work characteristics in relation to neck and upper limb symptoms. Pain 114, 47–53. doi: 10.1016/j.pain.2004.12.008
Vilhauer, M. “Meditation: How to meditate without a formal routine,” Psychology today, (2024). Available online at: https://www.psychologytoday.com/sg/blog/healthy-minds/202406/how-to-meditate-without-a-formal-routine (Accessed 10 Jul 2024).
Waddell, G., Newton, M., Henderson, I., Somerville, D., and Main, C. (1993). A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52, 157–168. doi: 10.1016/0304-3959(93)90127-B
Wang, Z., Liu, S., Xu, X., Xiao, Y., Yang, M., Zhao, X., et al. (2022). Gut microbiota associated with effectiveness and responsiveness to mindfulness-based cognitive therapy in improving trait anxiety. Front. Cell. Infect. Microbiol. 12:719829. doi: 10.3389/fcimb.2022.719829
Won, E., and Kim, Y. (2016). Stress, the autonomic nervous system, and the immune-kynurenine pathway in the etiology of depression. Curr. Neuropharmacol. 14, 665–673. doi: 10.2174/1570159x14666151208113006
World Health Organization, “Constitution,” (2024). Available online at: https://www.who.int/about/governance/constitution (Accessed 9 July 2024).
Wu, Y., Johnson, B., Acabchuk, R., Chen, S., Lewis, H., Livingston, J., et al. (2019). Yoga as antihypertensive lifestyle therapy: a systematic review and meta-analysis. Mayo Clin. Proc. 94, 432–446. doi: 10.1016/j.mayocp.2018.09.023
Yang, H., Koh, E., Sung, M., and Kang, H. (2021). Changes induced by mind-body intervention including epigenetic marks and its effects on diabetes. Int. J. Mol. Sci. 22:1317. doi: 10.3390/ijms22031317
Yegorov, Y., Poznyak, A., Nikiforov, N., Sobenin, I., and Orekhov, A. (2020). The link between chronic stress and accelerated aging. Biomedicine 8:198. doi: 10.3390/biomedicines8070198
Zeng, Y., Xie, X., and Cheng, A. (2019). Qigong or tai chi in cancer care: an updated systematic review and meta-analysis. Curr. Oncol. Rep. 21:48. doi: 10.1007/s11912-019-0786-2
Zgierska, A., Obasi, C., Brown, R., Ewers, T., Muller, D., Gassman, M., et al. (2013). Randomized controlled trial of mindfulness meditation and exercise for the prevention of acute respiratory infection: possible mechanisms of action. Evid. Based Complement. Alternat. Med. 2013:952716. doi: 10.1155/2013/952716
Zhang, D., Lee, E., Mak, E., Ho, C., and Wong, S. (2021). Mindfulness-based interventions: an overall review. Br. Med. Bull. 138, 41–57. doi: 10.1093/bmb/ldab005
Zhang, B., Ma, S., Rachmin, I., He, M., Baral, P., Choi, S., et al. (2020). Hyperactivation of sympathetic nerves drives depletion of melanocyte stem cells. Nature 577, 676–681. doi: 10.1038/s41586-020-1935-3
Zhang, H., Wang, M., Zhao, X., Wang, Y., Chen, X., and Su, J. (2024). Role of stress in skin diseases: A neuroendocrine-immune interaction view. Brain Behav. Immun. 116, 286–302. doi: 10.1016/j.bbi.2023.12.005
Glossary
ACE - Adverse Childhood Experiences
BPS - Biopsychosocial Model of Healthcare
CBT - Cognitive Behavioural Therapy
CRP - C-Reactive Protein
DASS-21 - Depression, Anxiety and Stress Scale
DRAM - Distress and Risk Assessment Method
ELS - Early Life Stress
FABQ - Fear Avoidance Beliefs Questionnaire
FFMQ - Five Facet Mindfulness Questionnaire
IL-1 - Interleukin-1
IL-6 - Interleukin-6
HPA - Hypothalamic–Pituitary–Adrenal
LBP - Low Back Pain
MAPs - Mindful Awareness Programs
MBI - Mindfulness-Based Intervention
MBSR - Mindfulness-Based Stress Reduction
MSK - Musculoskeletal
NEC - Neuro-Emotional Complex
NET - Neuro-Emotional Technique
ODI - Oswestry Disability Index
PBMI - Precision Body–Mind Intervention
PHQ-9 - Patient Health Questionnaire
PINE network - Psycho-Immune-Neuroendocrine network
PROMs - Patient Reported Outcome Measures
PSS - Perceived Stress Scale
PTSD - Post-Traumatic Stress Disorder
RCT - Randomised Controlled Trial
SF-36 - Short Form Health Survey
SLIP - Somato-Limbic Integration Point
TCM - Traditional Chinese Medicine
TNF-α - Tumour Necrosis Factor-α
Keywords: mindfulness-based interventions, musculoskeletal therapy, chronic stress management, biopsychosocial model of healthcare, neuro-emotional technique, psychoneuroimmunology, mind–body interventions, stress physiology
Citation: Bablis P, Day RR, Bablis S and Pollard H (2025) Why mindfulness matters in musculoskeletal therapies: a narrative review. Front. Psychol. 16:1518141. doi: 10.3389/fpsyg.2025.1518141
Edited by:
Adelinda Araujo Candeias, University of Evora, PortugalReviewed by:
Áthila Campos Girão, Federal University of São Paulo, BrazilSuzana Pustivšek, Academic and Research Network of Slovenia, Slovenia
Copyright © 2025 Bablis, Day, Bablis and Pollard. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Ryan R. Day, cmRheUB1bml2ZXJzYWxoZWFsdGguY29tLmF1
†ORCID: Peter Bablis, orcid.org/0000-0002-1574-7153
Ryan R. Day, orcid.org/0009-0008-4070-3460
Sophia Bablis, orcid.org/0009-0001-6165-5356
Henry Pollard, orcid.org/0000-0003-0269-5697