Exploration of Medicine

Table 6. A summary of the core mechanisms of action for each non-pharmacological intervention.

Intervention	Primary pathways involved	Key molecular/neuroendocrine effects
Aromatherapy	Olfactory-limbic axis (amygdala, hippocampus, hypothalamus)	↑ GABAergic activity (linalool) ↓ Cortisol and IL-6 ↑ Parasympathetic tone
Massage therapy	Somatosensory and neuroimmune modulation Gate control of pain (spinal inhibition)	↓ Cortisol, TNF-α ↑ Oxytocin, serotonin ↓ Sympathetic activation
Mindfulness & guided imagery	Prefrontal cortex, anterior cingulate cortex, amygdala Gene expression regulation	↓ NF-κB pathway ↑ Telomerase activity ↓ Inflammatory gene expression
Music & art therapy	Mesolimbic reward system (VTA, nucleus accumbens) Default mode network (self-referential processing)	↑ Dopamine ↓ Cortisol ↑ Endogenous opioid release
Sleep & relaxation	Autonomic nervous system balance (vagal activation) Sleep-related neurocognitive circuits (insula, thalamus, prefrontal cortex)	↓ Cortisol and α-amylase ↑ Melatonin ↑ Sleep architecture and circadian alignment

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↑: Increased activity/secretion; ↓: decreased activity/secretion. GABA: gamma-aminobutyric acid; IL-6: interleukin-6; NF-κB: nuclear factor kappa B; TNF-α: tumor necrosis factor-alpha; VTA: ventral tegmental area.

Declarations

Author contributions

SDG: Conceptualization, Investigation, Writing—original draft, Writing—review & editing, Validation, Supervision. The author has read and approved the submitted version.

Conflicts of interest

The author declares that there are no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

Not applicable.

Copyright

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