Mind-Body Practices for Enhanced Well-Being When Living with Rheumatoid Arthritis

Summary of a presentation to the Early RA Support and Education Workshop at Hospital for Special Surgery

Robert Schmehr, LCSW
Manager, Mind-Body Therapy Program
Integrative Medicine Service
Memorial Sloan-Kettering Cancer Center

Mind-body practices like meditation can help those with rheumatoid arthritis (RA) deal with pain, fatigue, sleep difficulties and stress, among other concerns. By remembering that the body and mind work together, one can learn to channel this bi-directional (mind influences body, body influences mind) experience toward achieving stress reduction and improving a sense of well-being.

Increasingly, researchers are studying the human brain to observe how different thoughts and physical experiences react to inflammatory or calming hormones. These hormones play a role in helping people either become more responsive and take-charge, or more avoidant and reactive about self-care and actively partnering with their medical team.

Meditation to Achieve Mind-Body Awareness

Meditation simply means the focus of the energy of the mind – or focused awareness. The idea is that you focus, aim, and sustain attention. There are many ways to meditate, but the foundation of all meditation is mindfulness.

What is mindfulness? Simply put, mindfulness is “Paying attention, on purpose, in the present moment, without judgment, as if your life depends on it."[1]

Goals of Meditation Practice

  • Relaxation: Physical and emotional (reduce pain)
  • Psychological Insight: Supports healthy behavior change
  • Spiritual Insight: For patients who are interested

With RA, people commonly experience joint pain beginning in the hands and feet. . When one meditates in an adjusted posture that is right for their own body, the neurologic and endocrine systems are able to communicate better. The meditation practitioner will begin to feel how such adjustments affect their overall sense of well-being and quality of life. Once an appropriate meditation posture has been established, the meditation practitioner can then bring their awareness to the breath. With regular meditation practice, people become more in touch with how thoughts and emotions, as well as physical sensations, influence the depth and speed of the breath and heart rate.

Over time, one learns that when one is comfortable and calm, the breath moves more slowly and more deeply. Slowed, rhythmic breath corresponds with the “relaxation response” and fewer inflammatory hormones. Fewer inflammatory hormones may translate into less joint pain. And with regular practice, the capacity for self-regulation – or the ability to calm oneself – improves.

Common Features of All Forms of Meditation

  • Posture: Sitting, lying, moving
  • Awareness of breath
  • Focused attention (concentration – varies according to type of  meditation practice
  • Cultivating the attitudes of non-judgment, acceptance, and letting go

Types of Meditation

These are some of the most popular forms of meditation:

Mindfulness Based Stress Reduction (MBSR): The most well-known and widely-researched form of mindfulness meditation is MBSR. MBSR was developed in 1979 by psychologist Jon Kabat-Zinn, PhD, at the University of Massachusetts Medical Center. MBSR is a standardized 8-week program that takes a western approach to ancient Buddhist practices. With regular practice, MBSR helps people become more responsive and less reactive. It also improves communication, sleep and mood.

Mantra Meditation: In Sanskrit, Man means “mind”; tra means “instrument” or “tool.” This practice uses the repetition of a phrase or a sound that helps move the mind from a place of worry and stress to a place of calm. Data suggests that when people find a mantra that works for them, and they repeat it for 10 to 20 minutes, it is a powerful tool.[2] They experience a relaxation response, improved immune response, lowered pain scores and improved quality of life.

Guided Imagery & Visualization: These similar types of mind-body therapies are also components of hypnotherapy. Concentrating on images that activate the brain to send health-promoting signals through the entire body may lead to improvements in a number of areas. These include: relaxation, mood, reduction in  physical pain and greater motivation to change behavior. Guided imagery may be learned from audio recordings or individual sessions with licensed professionals. A review of current research suggests that guided imagery may provide some relief of RA pain.[3]

Breath work: Breath work or rhythmic breathing is a powerful form of mind-body therapy. Clinicians teach patients different forms of rhythmic breathing. The aim is to achieve the capacity for concentric breathing, which means moving the breath -- even in, even out. The goal is to get the breath cycle down to about four breaths per minute. This stimulates the vagus nerve, which harmonizes the parasympathetic nervous system -- thereby promoting a relaxation response.

The Benefits of MBSR and Other Practices

Mindfulness meditation helps practitioners gain a deeper understanding of the bi-directional (two-way) relationship between mind and body. With regular mindfulness practice, individuals gain insight into how thoughts and feelings match various physical experiences.  At the same time, they become aware of how physical experiences relate to various thoughts and feelings. With more awareness and insight into this phenomenon, practitioners may learn to become less reactive to their medical and personal challenges. They may also develop ways to creatively respond to and manage physical and emotional pain.

Research Findings

The findings of a study on the Effect of Mindfulness-Based Stress Reduction in Rheumatoid Arthritis Patients saw a positive “change in depressive symptoms, with secondary outcomes of change in psychological distress, well-being, mindfulness, and RA disease activity” for patients who had a regular MBSR practice for six months.[4]

Patients who engage in meditation and other complementary practices such as yoga, tai chi and guided imagery, regularly report positive outcomes. This includes lower levels of stress, and less fatigue, joint pain, depression and anxiety. A recent study found that MBSR participants had decreased joint tenderness, improved mood and improved Global Assessment Functioning (GAF).6  The GAF Scale is a measure used by physicians and mental health professionals to rate how well someone is managing the physical, psychological and social challenges of daily life. Though there was no measurable change in the level of swelling in the joints of the participants, there was a change in their experience of RA.

The impact of an individual’s experience may help to explain the improvements.  A 2013 study that focused on MBSR and stress reduction also found that there were specific ways that mindfulness was beneficial to certain people. A regular MBSR practice may help break the cycle of psychological stress that contributes to the cycle of flares in some people with RA.[5]

The findings of these studies (which tend to be small in scale) of patients who have participated in MBSR programs mirror the on-the-ground experiences reported by clinicians who work with patients with RA. Patients who use mindfulness techniques and who also focus on managing their emotions have reported improved physical functioning, less pain and fatigue and diminished depression and anxiety.

A Final Word

Mindfulness meditation is also known as insight meditation. When we practice mindfulness meditation on a regular basis, it helps us gain insight into how our own attitudes influence the ability to manage emotional and physical pain.

Cultivating mindful awareness involves more than just a daily meditation practice.  It is a way of life that Jon Kabat-Zinn describes as “awareness of awareness.” In chapter 2 of Full Catastrophe Living, Kabat-Zinn provides clear explanations of the attitudes of mindfulness. A monthly review of this chapter would be beneficial to all, regardless of their particular medical status.

For more information about MBSR, the benefits of other mind-body therapies, and the traditions from which they all arose:

  • Academy for Guided Imagery: www.academyforguidedimagery.com
  • Center for Mindfulness in Medicine, Health Care, and Society: http://www.umassmed.edu/cfm
  • Hanh, T.N. 1991, Peace is Every Step: The Path of Mindfulness in Everyday Life (Bantam Books)
  • Insight Meditation Society: http://www.dharma.org
  • Kabat-Zinn, J. 2005 Wherever You Go There You Are: Mindfulness Meditation in Everyday Life. (Hachette Books)
  • Memorial Sloan-Kettering Cancer Center Integrative Medicine
  • http://www.mskcc.org/integrativemedicine
  • New York Insight Meditation Center
  • http://www.nyimc.org
  • NCCAM. Mind-Body Medicine: An Overview, 2007
  • Rossman, M. 2000, Guided Imagery for SelfHealing (H.J. Kramer/New World Library)
  • Salzberg, S. 2002, Lovingkindness: The Revolutionary Art of Happiness (Shambhala Publications, Inc.)
  • Seigel, D. 2007, The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being (W. W. Norton & Co.)
  • Suzuki, S. 2010, Zen Mind, Beginner’s Mind: Informal talks on Zen meditation and practice (Shambhala Publications)
  • Tibet House US http://www.tibethouse.us
  • UCLA Mindful Awareness Research Center http://www.marc.ucla.edu


  1. Kabat-Zinn, J. 1990, Full Catastrophe Living: Using the Wisdom of our Body and Mind to Face Stress, Pain and Illness. (Bantam Books)
  2. Benson, H., and Klipper M.Z. The Relaxation Response. HarperCollins: 2000
  3. Astin,J.A., et al. Psychological interventions for rheumatoid arthritis: A meta-analysis of randomized controlled trials. Arthritis & Rheumatism, 47:291-302
  4. Pradhan E.K., et al. Effect of Mindfulness-Based stress reduction in rheumatoid arthritis patients. Arthritis & Rheumatism. 2007 Oct 15;57(7):1134-42.
  5. Rosenkranz, et al. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain, Behavior, and Immunity 27 (2013) 174-184

Summary by Joan Westreich, LCSW
Social Work Coordinator, Early RA Support and Education Program


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