Yoga & Other mind body treatments

A variety of mind-body approaches are used by people with RA for relief of symptoms and maintenance of general health. Examples include yoga, music therapy, hypnosis, Qigong, meditation, and guided imagery.



Yoga is a spiritual, physical, and mental discipline developed in India thousands of years ago. It involves exercise, relaxation, and healing, with origins in Indian philosophy. The practice of yoga may have originated as many as 5,000 years ago, but the first known work describing the practice was the Yoga Sutras, written over 2,000 years ago.1

There have been only a limited number of randomized, controlled trials to evaluate the effectiveness of yoga in RA and these studies have generally included small numbers of patients and have had limitations in terms of study design. Therefore, on the basis of existing evidence, it is difficult to make any definitive conclusions concerning the effectiveness of yoga in relieving symptoms of RA. In terms of general health benefits, there is a growing body of evidence that yoga provides benefits, including reduction of stress and improvement of mood, increased breath volume, reduction of heart rate, and increased muscular strength, a benefit which may provide protection to joints.2

Among existing studies conducted in patients with RA, one older randomized, controlled study that included 20 patients with RA found that yoga (practiced daily for 3 weeks, then weekly for 3 months) resulted in significant improvements in grip strength. Improvements in quality of life (as measured by the Health Assessment Questionnaire [HAQ]) among those patients who practiced yoga versus those who did not failed to reach statistical significance, perhaps due to the small number of patients in the study.3

Other more recent studies have reported improvements in disease activity, quality of life, reduced disability, increased strength, improved pain control, and improved mood (decreases in depression) in persons living with RA. However, most of these studies were not randomized and involved small numbers of patients.2

While yoga is generally safe, it should be modified for people with conditions such as RA because it may involve difficult postures and vigorous exercise that may pose a risk for individuals with joint and other musculoskeletal problems. Talk to your doctor before you try yoga. He or she may know of a yoga class in your area designed specifically for people with arthritis.1


Guided imagery

Guided imagery is a technique involving the use of mental images that promote relaxation. Guided imagery is often used in combination with other relaxation techniques. Results from studies of guided imagery in a range of health conditions have shown possible benefits, including reductions in anxiety, depression, sleep problems, and pain. Talk to your doctor if you are interested in try guided imagery. Your doctor may know of a practitioner experienced in the use of this technique in individuals with conditions such as RA.4,5



Many different cultures have traditions involving the use of hypnosis (induced trances or altered states of consciousness) for religious purposes, dating back to ancient Egypt, Africa, India, China, and the Americas. One of the seminal figures of Traditional Chinese Medicine, Wong Tai, referred to the use of hypnosis as early as 2,600 BC. The term hypnosis comes from the Greek word hypnos for sleep, and the use of hypnosis as a medical intervention in modern times dates back to the 18th century with the Austrian doctor Franz Anton Mesmer (the origin of the word mesmerize). Although its precise therapeutic mechanism is not understood, hypnosis appears to affect a number of parameters in the body, including body temperature, heart rate, blood pressure, brain wave pattern, and immune response. Hypnosis has been endorsed as a medical intervention by medical associations in the US and Europe, with the US National Institutes of Health citing solid evidence in favor of the use of hypnosis to treat chronic pain (particularly related to cancer). There have been several studies of hypnosis in individuals with RA, with results indicating that hypnosis may be effective in providing pain relief. In these studies, participants’ use of medications to treat pain decreased after hypnosis.6


Music therapy

Music therapy has a long history as a healing art that stretches back to ancient times in Western (ancient Greek) and non-Western (Native American, Chinese, Indian) cultures. In India, for instance, traditional musical modes called ragas have long been used to bring about certain states of mind conducive to healing. The modern practice of music therapy may have originated in the 18th century in France with Louis Roger’s theoretical work A Treatise on the Effects of Music on the Human Body. Music therapy is a standard intervention used in rehabilitation clinics, psychiatric hospitals, as well as in nursing homes, hospice care facilities, and in facilities for developmentally disabled individuals. Evidence for the effectiveness of music therapy is strongest in terms of its benefits for mood improvement, relaxation, and stress reduction. Music therapy may also have therapeutic benefits in people with sleep problems, pain, and depression. There is a strong body of evidence that music therapy is effective in pain relief and studies conducted in patients with osteoarthritis have demonstrated benefit in relief of joint pain. There have been no studies in the use of music therapy for symptomatic relief in patients with RA.7



Meditation has been practiced in various forms for thousands of years, with many techniques developed within the world’s religions, including Hindu, Buddhist, and Judeo-Christian traditions. Meditation has become very popular and is often practiced independently from any religious tradition and is used widely in healthcare settings. Meditation is an integral part of numerous other mind-body and alternative medicine systems, including yoga and Traditional Chinese Medicine. Although different approaches to meditation exist, many forms appear to involve a suspension of conscious thought via a focusing of attention, with the goal of attaining a state described as “thoughtless awareness.”8

Meditation is among the most commonly used CAM approaches and has been shown to result in changes in several parameters in the body, including brain function (changes in brain waves and blood flow to the brain), breathing (oxygen consumption), as well as production of certain hormones. The strongest evidence for the therapeutic benefits of meditation in certain health conditions (particularly cancers) is in stress reduction, decreased blood pressure, and improved quality of life. One study evaluated the effect of meditation and cognitive behavioral therapy on quality of life in 144 patients with RA. Patients who practiced a program of regular meditation experienced improvements in ability to cope with stress, pain, and depression. Those patients with a history of depression benefited the most from meditation compared with cognitive behavior therapy or a simple educational intervention, in term of relief of joint pain and improvement of mood.8



Qigong (which means breath work/technique in Mandarin Chinese: qi [or chi] translates as vital energy) is another modality that is part of Traditional Chinese Medicine. It involves energy-based healing practices derived from Taoism (a school of Chinese philosophy) and Chinese medical theories. The approach is based on the idea that vital energy moves through a network of energy pathways in the body, and that breath or breathing can be managed to optimize this vital energy and maintain good health and stamina. Evidence for use of Qigong as a treatment is strongest for hypertension, but the modality is also being studied for its benefits in other health conditions that may be of relevance to people with RA, including pain, fatigue, and stress. There has been limited study of the benefits of Qigong in patients with RA. One existing study evaluated the effects of Qigong (a 1 hour session practiced twice weekly) on mood and physical and social functioning in elderly patients with a range of chronic conditions, including RA. Patients who practiced Qigong reported significant benefits, including improvements in physical functioning, psychological health, social relationships, and general health. However, objective assessment methods (those not involving patient reports) failed to detect significant improvements in these same areas, perhaps due to the small number of patients in the study.9


Tai Chi

Tai Chi is a Chinese martial art that has been practiced for centuries for both self-defense and health benefits. It involves a system of movements and postures designed to approach the mind and body in a holistic manner as an interconnected system. Tai Chi is believed to provide health benefits for the body, including increased strength, flexibility, coordination, and improved posture, and the mind, including reduction in stress, improvement in memory and concentration, and decrease in anxiety.10

Tai Chi as a form of exercise appears to provide important general health benefits, including increased muscular strength, reduce stress, and improved cardiovascular and bone health. However, there is a limited body of evidence from randomized, controlled trials on which to judge the benefits of Tai Chi in terms of improving RA symptoms. Results from existing studies do, however, indicate the Tai Chi can be a safe form of exercise for patients with RA.2

A Cochrane review of clinical trials of Tai Chi was conducted in 2004 (Cochrane reviews are considered the gold standard of reviews of clinical evidence). The review considered results from four studies in which benefits of Tai Chi were evaluated in a total of 206 participants with RA. There were significant limitations in the studies considered in the review, including wide variation in the intensity with which Tai Chi was practiced and inadequate control of other forms of exercise that participants engaged in during the studies. The review concluded that Tai Chi did appear to result in improved joint motion in the lower extremities. However, there was no evidence that Tai Chi improved grip strength or joint tenderness. Importantly, the review also found that Tai Chi did not have any negative effects on disease activity.11


Another review of existing studies, including three studies conducted after the previous Cochrane review, found little evidence that Tai Chi was effective as a treatment for RA.4 However, findings from more recent studies indicate that Tai Chi may provide real benefits to patients with RA, including improved ACR20 responses, improved physical functioning, and improved muscle function in the lower limbs, resulting in increased walking ability and increased strength and endurance. Even though there is no definitive evidence of the benefits of Tai Chi in patients with RA, promising results from recent studies do suggest that Tai Chi may indeed be a useful and safe as an adjunctive therapy (this means as a secondary treatment that can be used in addition to a primary treatment) for RA.2

Written by: Jonathan Simmons | Last reviewed: September 2013.
View References