Between Tradition and Evidence: Where Integrative Therapies and Philosophies Stand in Modern Healthcare

The scientific approach looks for measurable facts, such as biology, test results and clinical outcomes. It asks: ‘Does it work? How? How safely?’. The philosophical approach values the patient's experience and overall well-being. It asks: ‘How does the person feel? What meaning do they give to what they are living through?’.

The two perspectives do not exclude each other. A patient may have good test results and still suffer. They may also feel better without any change in their tests.

Mindfulness is the training of attention on the present moment, without judgement. A meta-analysis of clinical trials concluded that mindfulness-based interventions help with conditions such as depression, anxiety and chronic pain. They were more effective than doing nothing, but not superior to other well-established treatments (Goldberg et al., 2018).

The idea that meditation ‘shrinks the amygdala’ (the brain region linked to fear) and promotes neuroplasticity is popular. However, two recent randomised trials found no structural brain changes after an eight-week programme when compared with a control activity (Kral et al., 2022). The benefits for well-being exist, but the exact brain mechanism is still unclear.

Hypnotherapy involves a state of focused attention and deep relaxation, guided by a professional. A meta-analysis covering two decades of studies indicated benefits of hypnosis across several mental and physical conditions, particularly in pain modulation (Rosendahl et al., 2024). In simple terms, hypnosis changes how the brain pays attention to pain and discomfort, without ‘controlling the mind’ of the person.

Yoga and Tai Chi combine slow movement, breathing and attention. A meta-analysis associated yoga and similar programmes with reductions in some physiological markers of stress, including cortisol and blood pressure (Pascoe et al., 2017). Slow breathing activates the parasympathetic nervous system, the body's ‘brake’ on stress, which lowers heart rate and promotes relaxation (Gerritsen & Band, 2018). For Tai Chi, the available studies are more heterogeneous, so it is prudent to speak of probable rather than confirmed benefits.

An individual patient data meta-analysis involving thousands of patients concluded that acupuncture reduces chronic pain more than no treatment and, to a lesser extent, more than ‘sham’ acupuncture (Vickers et al., 2018). The effects are real but modest. Among the proposed mechanisms is the release of endorphins, the body's own substances that ease pain.

In the case of Reiki and Bach flower remedies, strict science finds no proof that an ‘energy’ is being transmitted or ‘balanced’. The benefits observed are attributed to deep relaxation, to the attention and care received, and to the placebo effect. The placebo effect does not mean ‘nothing’: it means the improvement comes from context and expectation, not from a specific substance or force.

A meta-analysis suggested that Reiki may reduce pain, but the studies are small and of variable quality (Demir Doğan, 2018). As for Bach flower remedies, the available systematic reviews have not found efficacy beyond placebo.

These are low-risk practices, used as complementary therapies and never as substitutes for medical treatment. In oncology, international clinical guidelines mainly value mind–body interventions for relieving anxiety and depression (Carlson et al., 2023; Greenlee et al., 2017).

In Portugal, these practices no longer operate in a legal vacuum. Law No. 45/2003 set out the framework for Non-Conventional Therapies (TNC, from the Portuguese Terapêuticas Não Convencionais), and Law No. 71/2013 regulated their professional practice. The law recognises seven TNC: acupuncture, phytotherapy, homeopathy, traditional Chinese medicine, naturopathy, osteopathy and chiropractic.

To practise, a professional needs a professional licence (cédula profissional), issued by the Central Administration of the Health System (ACSS). The aim is to protect the user by ensuring adequate training, registration, professional insurance and licensed premises.

Not all the practices in this article appear on that list. Mindfulness, yoga, Reiki, Bach flower remedies and hypnotherapy are not among the seven regulated TNC. For this reason, it is always worth asking about the practitioner's training and, for the regulated TNC, about their professional licence.

The future does not lie in choosing between conventional medicine and integrative therapies, but in cooperation. Conventional medicine diagnoses and treats disease. Integrative therapies help to improve quality of life, reduce stress and make care more humane.

In practice, readers should keep up their medical follow-up, tell their doctor about any therapies they use, be wary of promises of a cure, and choose practitioners with proper training and, where applicable, a professional licence.

The evidence keeps growing and conclusions will change. In the meantime, the useful question is not ‘is this science or tradition?’, but ‘is this safe, and does it help this person?’. And for you, which question would help you decide? Share your reflection in the comments.