Health effects of alternative and complementary therapies.
Many individuals who suffer from depression and anxiety do not seek traditional treatments in the form of therapy and medications. This is sometimes due to cost, sometimes due to accessibility, and sometimes due to the stigma associated with mental health treatments or beliefs about the efficacy of psychological treatments. Of those who do seek traditional treatment, some individuals do not respond well to traditional psychotherapy and pharmacological interventions. Many individuals who are either resistant to or unresponsive to traditional treatments are looking for alternative and complementary therapies. Labyrinths, as one of these therapies, foster opportunities for reflection and calming mindfulness both within and beyond traditional health care settings. As one therapist has stated, “I encourage my psychotherapy clients to walk the labyrinth in my garden before our sessions to facilitate turning inward and leaving everyday pressures behind, and afterward to let the issues raised in the therapy sessions settle into their psyches before returning to homes or jobs.” What then can be said about labyrinth walking as a form of alternative or complementary care?
Do labyrinths genuinely have behavioral health benefits?
Walking in every form can be mindful (as in being centered on the present), can be meditative (as in being quieted internally), or can be mindfully meditative (as in being reflectively focused). These three states of mind differ. Each has its own value. Being centered on the present moment provides a natural if only temporary distraction from worries about the future and regrets about the past. Becoming calm produces an inner distraction. There are relatively simple techniques for self-calming which require consistent practice yet only modest training. Resolving disturbing levels of confusion is more complex. Confusion creates an active and agitated state of mind that resists distractive relief. Resolving confusions requires a reexamination of situations with calmly focused reflection and creative thinking. Without guidance to revise thinking, self-reflection itself can lead to rumination and an intensification of disturbing thoughts. Relief from highly disturbing levels of pain from confusion, anxiety, or grief all can benefit from professional behavioral therapy.
Pharmacological treatment is generically prescriptive based on consistent physiological effects. Behavioral therapy is individually crafted based on personally complex situations. Medication is one of the adjunctive tools that can be used in behavioral therapy.
Patients vary, healthcare providers vary, and therapeutic environments vary.
With intentions to cultivate best practice, when behavioral health providers do find therapeutic approaches that they feel have the potential to broadly provide breakthrough benefits, they share case studies.
The evolution of the psychological practice of “Reality Therapy ” offers a case in point. In this practice, a labyrinth (of the proper sort) is viewed as an adjunctive feature of Reality Therapy (Hong and Jacinto, 2012). Benefits are predicted for patients who are experiencing life transitions such as bereavement, substance-use recovery, depression or anxiety, and, with specific caveats, individuals recovering from traumatic experiences (i.e., domestic violence).
Reality Therapy is an approach to psychotherapy and counseling developed within a Veterans Administration hospital in the 1960s and evolved into “Control Therapy” in the 1970s and into ‘Choice Therapy” in the 1990s. At its core is a guided exploration of the realistic choices that can be made to regain a sense of control of one’s life. In essence, the practice presumes that problems arise from socially universal human conditions rather than individual mental illnesses. The therapy does not concern itself with a person’s past nor with unconscious mental processes but rather focuses on an immediate situation. To do this, caregivers focus a patient’s attention on a sequence of series of four questions. The process of labyrinth walking sustains a patient’s focus on therapeutic questions as situational discoveries lead to a clinical resolution. In this fashion, labyrinth walking serves not only as a platform for direct therapy but also as a means of building skill for forward-going self-care.
The critical considerations for using labyrinth walking clinically is the therapist’s presence during the walk. Patients need to be guided to sustain focus on each of four questions during each of the four stages of the walk; the approach to the center, the time spent in the center, the approach to the exit, and anchoring reflection on the process. Factors which influence the quality of the therapeutic guidance, and shape the multi-sensory experience of the labyrinth, influence the clinical outcome. Not all Reality Therapy practices make use of labyrinths, and not all labyrinths provide adjunctive benefit.
Even with scant evidence from controlled clinical trials, a belief has emerged that Labyrinth walking is beneficial psychologically, physically, and spiritually. Under appropriate conditions, a labyrinth walk combines meditative mindfulness, rhythmic walking, natural sensations, and somatic feelings to create a sensation of being present in the world within one’s own body. The experience can create feelings of playful calmness, self-renewal, and spiritual connection with a larger presence. However, none of these benefits are guaranteed if a labyrinth walk is not mindful.
Labyrinth walking advocates from spiritual traditions frequently assert that there is no “wrong way” to walk a labyrinth. This is a highly invitational claim and yet the invitation is always followed with various recommended hints. The impression that is given is that labyrinth walking is like preparing a meal: there are many possible ingredients and varied possible ways of combining them. Labyrinth walkers as cooks are invited to experiment. However, naïve work in the kitchen can produce initially unsavory tastes that linger, preempting hopes for repeat performances.
What type of labyrinth is most likely to provide behavioral health benefits?
First and foremost, a labyrinth is not a maze, and there should be no effort at all made to conceal the unobstructed path to and from the center. The certainty that by following the path footstep by footstep will lead to the center will reduce the distraction of the uncertainty of possibly getting lost. All true labyrinths share this feature.
The most familiar labyrinths replicate a design that is found churches and cathedrals in Europe. The design is based on the labyrinth in Chartres Cathedral. This labyrinth consists of an artistically woven stonework path that meanders through eleven concentric rings. However, this design provides 900 feet (yes, 3 football fields of rocky road) with some two dozen switchbacks. Step by step, this is more than three quarters of a mile. For the practice of Reality Therapy, therapists are advised to complete the labyrinth (and the post-labyrinth debrief) within thirty to fifty minutes. The Chartres labyrinth is too complex to routinely support Reality Therapy. Fortunately, there are many alternative designs which trace their origins deeply into antiquity (some estimates reach back to 18,000 BCE). These classic designs consist of three to seven circuits drawn through comfortable paths in earth or sand or painted on lawns or pavement. Some recent forms include only three to five circuits and may be equipped with partial railings too. An added virtue of a short labyrinth walk is that a walker can extend the experience by repeating the walk to fit their own schedule.
If a therapist walks along with a patient, or whenever two people walk together, the path width is a consideration. An eighteen inch path is considered comfortable for one walker, but a three foot path provides comfort for two walkers and for accommodating wheelchairs. The wider path design also makes it easier for walkers who are returning from the center to comfortably pass walkers who are headed toward the center.
The center of a labyrinth itself should be wide enough for multiple walkers to pause and reflect. The center should also define that space as a destination for reflection. This might be achieved by including artistic embellishments that heighten the sense of being special.
Labyrinth paths that are framed with stones or brick make it easy to see the path but may also represent a trip hazard. Setting stonework into the soil reduces that risk. And using color to highlight the pathway can both enhance the experience of walking as well as aid in detecting boundaries in dim light.
The center of the labyrinth is symbolic of reflective offerings: reflection on a prior journey while contemplating a future journey. This symbolism can be enhanced if some central receptacle can be installed to accept tokens. Walkers who pause to reflect might also leave an object at the center to represent releasing something of the past. In anticipation of such symbolism, labyrinths might have a supply of tokens (such as pebbles, seashells, pinecones, etc.) at the entrance for walkers to carry along with their specific intentions. Walkers remain in the center for as long as they want … sitting or standing as features within the center might accommodate.
The design of the labyrinth and the quality of its path are central considerations; however, the setting of the labyrinth contribute to the overall experience of labyrinth walking. Labyrinths can benefit by facing an expansive natural view, such as an ocean, lake, river, forest, or mountain range. Fragrant surroundings and gentle breezes engage additional senses during walking. Distance from distracting sounds, like highways or housing, favor reflective walking. And the approach to the labyrinth entrance itself is part of the overall experience. From a distance, a labyrinth benefits from a certain level of observability but, at the same time, also benefits for a certain level of respectful privacy. The environment can add dimensions of natural connection, safety, and intimacy. Landscape architects speak of such sites as healthcare gardens. Toward this end, benches around the periphery of labyrinths offer a vicarious labyrinth walking experience (in a fashion like the used of hand-held “finger labyrinths; see https://youtu.be/XQYNfqgtBbA).
Signage is a critical feature that is generally absent from contemporary labyrinths. Labyrinths used for specific therapeutic benefits genuinely need and do have guides, trainers, or coaches to model an effective use for a specific intended outcome. Labyrinths designed with general health care in mind often offer no guidance. Some information for novice walkers can be provided by signs or informant cards placed nearby. This information can provide “hints” for walking for physical, mental, or spiritual benefits, making modest statements of intention such as: “Stand at the entrance and take a moment to reflect on where you are in your life and then quiet the mind,” or “Focus on a question from the heart and soul of your being – the one you have been asking yourself. Carry your question as you enter the labyrinth. You may find a response to your question as you reach the center. On your journey out, you may discover ways to improve your response to the question.” Alternatively, information might focus on physical aspects of labyrinth walking, such as “Slow rhythmic walking helps relieve anxiety. As does meditation. Walking with a labyrinth can provide a safe, focused area to combine both. To get the most out of your walk, focus on each step as your foot touches the ground. Grounding anchors to the here and now. Walk to the center slowly, pause, take a few deep calming breaths, and then return.” The hints can’t be too explicit (or they will take to long to fully read and put to practice) and they cannot be too implicit (or they will not be recognized by those who might need hints the most). Fortunately, here in the early years of the 21st century, signs could link to websites with audiovisual materials through QR codes and URL addresses. And websites could link to a carefully curated YouTube video (such as https://youtu.be/NsESX_R6nC4) . The challenge will always remain to design instructions with sufficient simplicity and clarity to allow untrained walkers to walk effectively.
It is not fully surprising that some new age spirituality is drawing renewed attention to labyrinths as sacred spots on the earth for managing the heartfelt anxieties of the 21st century. This is a turn from the penitent walk of the medieval mournful pilgrim who, unable to make the trip to the Holy Lands, was consigned to trek through a Labyrinth. In the richness of new age spiritualty, the labyrinth is not only sacred but is also a space for fun. Although children and teens are unlikely to spontaneously walk labyrinths mindfully and slowly they are drawn to labyrinths as a challenge for youthful energy. They race through labyrinths, often for some imagined or real prize. Ceremonial or ritual games might link intergenerational use of a labyrinth, building familiarity with a labyrinth as positive experience. Arguably this is as it should be, for if a labyrinth does not serve the happiness of humanity of all ages, what practical use can it then serve? If a labyrinth does not enrich lives, who would choose to build, maintain, and use a labyrinth? However, with this socially bonding use of a labyrinth, there can arise a need to accommodate large groups as well as playful spirits. The single entry and return course of a labyrinth has been modified to provide a pathway for processions. One continuous path leads to the center and a second continuous path provides an exit. Walkers (or racers) need not collide with those coming toward the center as they leave the center. To accommodate broad community use, one or more public labyrinths might consider the practical utility of a processional design for celebratory marches and playful races.
All of the clinically helpful and socially desirable labyrinth features are rarely found in any one of the many contemporary labyrinths that have popped up in backyards, universities, grade schools, community centers, libraries, forests, prisons, refugee camps, and even critical care settings. Most generally, they provide a reprieve from a hectic environment. With recent pointed discussions among architects, more attention for the intended use of a labyrinth is likely to influence the design of future labyrinths.
How might a labyrinth walker gain the most health benefit from a walk?
When there is no therapist on hand, a labyrinth walker must choose for themselves how they will walk. Some labyrinth advocates assert that there is no right or wrong way to walk a labyrinth … however, they then typically proceed to enumerate lists of tested practices. Principally, guidance is given to recognizing one’s intention for walking a labyrinth. Spiritual intentions can range from humble thankfulness to devote hopefulness. Guidance is given for setting an intention, and toward this end, certain key words are suggested as part of a prayerful mantra to carry into the walk. Some suggested terms include healing, new direction, gratitude, kindness, release, celebration, confidence, courage, compassion, forgiveness, serenity, peace, metamorphosis, forgiveness, and the like. Intentions can be set before one gets to a labyrinth, before one steps into the labyrinth, or, as some suggest, during a three fold walk around the outside of the labyrinth. Setting an intention is a matter of quieting oneself and feeling a need that calls for resolution or a desire that calls for fulfillment. Without an intention, the experience of walking a labyrinth is not unlike the experience of walking anywhere else. If a labyrinth feels sufficiently special, then an intention to explore the walk to feel what the walking will feel like is OK. Opening oneself to something new is a core purpose of the labyrinth.
With an intention in mind, a meditative focus is summoned. This mindful meditation is linked to the experience of the presence. Mindful meditation does not seek to empty the mind but rather to connect the mind with the present moment. To maintain a focus on the present moment, a walker might repeat a question over and over to discover what the question stirs into awareness while body focuses on present feelings. For example, with an intent for forgiveness, a walker moving toward a labyrinth center might be coached to ask ‘‘What do I want?’’ At the center, the walker may ponder “What am I doing to get what I want?’’ And on the return walk, the walker might ask ‘‘How will I know if what I am doing is working?’’ And during reflection after walking, a walker might ask ‘‘What will I do once I get what I want?’’ Following a labyrinth walk, a reality therapist gives a walker a creative task to “anchor” the experience of the walk in their memory (such as a drawing, a poem, or a journal entry). The walker’s “anchor” provides a point for recurrent reflection.
There is not a hard line between physically healthy practice and spiritual practice. Like physical practice, spiritual practice also recommends initially calming oneself and setting an intention. The focus in a spiritual practice is directed toward sensing connection. The gaze is softly focused on the path. The feet connect with the earth, and as they do they both set a gentle rhythm and also report on the sensation of the earth beneath the feet. All sensations are used to connect the body with the moment. Smiling gently is also part of a somatic experience, because as one feels one’s smile they also feel a purpose within themselves. Each step becomes an intentional step, enriching the entire experience.
Often labyrinths are walked in silence, but sometimes a walker will listen to music, hum, chant, or sing. The experience of hearing one’s own voice as one speaks causes a feeling of recognizing one’s presence in the moment. Mantra, such as “May this walk ease my anxiety,” have been suggested. Walking with beads provides a tactile feeling and adds a dimension of touch to the sensed present. From the fabric that one wears to the rhythm of one’s breathing, every somatic sense that can be drawn into the experience is drawn into the experience.
While some labyrinth advocates assert that there is no right or wrong way to walk a labyrinth, the evidence argues that there are in fact a variety of right ways and wrong ways to walk a labyrinth … for therapeutic benefit. Moreover, walking one labyrinth may be profoundly different from walking another, and for many of us mindfully walking through a forest, a meadow, or a large garden may be a fair substitute for any labyrinth walk at all. And yet, some of us might find labyrinth walking to be profoundly helpful and adopt it to a routine part of our lives. Others might find the experience momentarily satisfying and while remaining curious to test other labyrinths may never choose to adopt any one labyrinth.
We might agree that physical activity in general is good for us. Walking, running, and swimming for a sufficient duration at an appropriate pace brings individuals into a peacefully meditative “zone,” a sensation of timeless flow. And if we can agree that meditation is helpful while recognizing that many of us cannot sit still for ten or twenty minutes of meditation, we might be hopeful for blending walking with meditation. As with all meditations, the mind does wander, but each bend or turn in the labyrinth path can call the mind back to the present. As a bottom line, then, if a labyrinth as a behavioral health adjuvant does no harm and has low installation and maintenance costs, why wouldn’t a community choose to make a behavioral health statement by endorsing the use of walking meditative labyrinths?
How does labyrinth walking promote changes within the mind?
Some may remain skeptical of therapeutic benefits of labyrinth walking in the absence of scientific agreement on a clearly beneficial physiological mechanism of action. Mechanistic theory is an area of speculation for the same challenges that hinder clear demonstration of therapeutic efficacy. Physiological researchers have variously monitored pulse, systolic and diastolic blood pressures, cortisol levels, respiratory sinus arrhythmia, salivary alpha amylase as well as subjective reports of mental ease.
Short term benefits which are subjectively reported as improved clarity, peace, and serenity, might be mediated by feedback loops in endocrine or paracrine systems. Rapidly active pharmacological agents which mimic these effects support this view. Long-term benefits have been associated with improved management of hypertension, depression, anxiety, and grief. While pharmacological agents can temporarily relieve these symptoms, recovery suggests a restoration of natural regulatory circuits. Long-term benefits are not derived from a single labyrinth walking session. Enduring effects have been reported with twenty to forty minutes of walking three times a week for at least six weeks (6 hours to 12 hours total walking time). This time cycle suggests that some form of learning or relearning is associated with recovery, and this turns attention toward physiological, psychological and neuronal systems.
One physiological idea proposes that neural stimulation from walking a labyrinth facilitates meditation by helping free walkers from their own stray thoughts. Walking for a sufficient time might induce the mental state of “flow.” Flow is the melting together of action and consciousness named by the psychologist Mihály Csíkszentmihályi in 1970. It reflects complete immersion in an activity that is often associated with a sense of joy and fulfillment. Common examples of behaviors that induce “flow” include extended periods of walking, running, or swimming. A somewhat related proposal (with scant experimental support) is that when walking the circular path of the labyrinth, our brain switches from one cerebral hemisphere to the other with each alternating footstep as you walk back and forth. The rocking back and forth motion may help to activate parts of the brain bilaterally, and this might balance activity in both creative and analytical sides of the cerebral cortex.
A second idea is a psychological proposal that rhythmic predictability acts like a metronome to keep us on task. Proprioceptive and vestibular information is processed by the brain as we step along paths, quieting input from the vagus nerve. This idea relates generically to labyrinth walking, meandering, and “Forest Bathing” (the Japanese practice of shinrin-yoku). With scant experimental support, this idea asserts that we switch our use of one cerebral hemisphere with the other as we walk. Each alternating footstep triggers a switch in response to rocking back and forth. The regularity of this reciprocal dynamic activates parts of the brain bilaterally balancing activity in both creative and analytical sides of the cerebral cortex. Balanced cortical activity may have an effect of centering us.
A third idea is neurological mechanism, and it draws upon recent findings in cognitive science. Given that labyrinth walking enhances the recovery of a meditative focus as our attention naturally drifts, recovery seems reasonably related to motor activity. Movement and cognitive activity are reciprocally linked from the basal ganglia system to the cortex. More specifically, activity of the subthalamic nucleus, a small lens-shaped cluster of densely packed neurons in the midbrain, that links motor activity with cognitive activity. Changes in movement correlate with cognitive changes. Surprising movement (as a distraction) correlates with a cognitively disrupted thread of thought. Because our attention naturally drifts into threads of thought, small surprise bring us back to the moment. By inference then, when we encounter a “turn” in the labyrinth path, we disrupt the train of thought from our drifted attention. This disruption eases recovery of a meditative state of mind. Learning, such as may occur during extended labyrinth walking, would ease the capacity to release some distracting thoughts and return to a preferred focus. One researcher summarizes this research saying, “For now, we’ve shown that unexpected, or surprising, events recruit the same brain system we use to actively stop our actions, which, in turn, appears to influence the degree to which such surprising events affect our ongoing trains of thought.” There is growing evidence that significantly links physical fluidity to cognitive flexibility
REFERENCES
Anh-Huong, N and Hanh, TN (2006) Walking Meditation
Behman, PJ, Rash, JA, Bagshawe, M and Giesbrecht, G F (2018). Short-term autonomic nervous system and experiential responses during a labyrinth walk. Cogent Psychology, 5(1), Article 1495036. https://doi.org/10.1080/23311908.2018.1495036
Butcher, HK (2023). A unitary caring theory perspective of labyrinth walking research. Nurs. Sci. Q. 35:2. doi: 10.1177/089431842211502
Chambers, SN and Jacobs, WJ (2018) The Professional – Taylor & Francis
Clark, YZ (2015) The Sacred Art of Labyrinth Design: Optimization of a Liminal Aesthetic – digitalcommons.library.umaine.edu
Curry, H (2000) The Way of the Labyrinth: A Powerful Meditation for Everyday Life. New York, NY: Penguin Compass.
Deblinger, L (2001). Nondrug approaches to hypertension. Patient Care, 35(11), 20-22, 25-26, 35-38, 41 [online]. Available at http://www.skyaid.org/Skyaid%2520Org/Medical/NonDrug_Hypertension.htm
Dunphy, M, Borsdorf, L and Chambliss, C (2000) Educational Applications of Wellness Techniques: An Experimental Investigation of the Effects of Labyrinth Walking. Annals American Journal of Health Promotion, 9 (5)
Engineer, A, Gualano, RJ, Crocker, RL and Smith, JL (2021) An integrative health framework for wellbeing in the built environment. Building and …
Fisher, M (2003) The therapeutic use of labyrinths. Spirituality and Health International.
Freeman, VL (2005) One path with many turns. Altern Med. 80:43-49.
Hanson, V (2015) An Arts-Based Inquiry: The Space of Labyrinth in Art Therapy – spectrum.library.concordia.ca
Hills, SJ (2018) The Effects of Walking a Labyrinth on Symptoms of Depression and Anxiety and Level of Self-Compassion. Doctoral Dissertation in the Graduate College of the Oklahoma State University.
Hong, YJ and Jacinto, GA (2012) Reality Therapy and the Labyrinth: A Strategy for Practice. Journal of Human Behavior in the Social Environment, 22:619–634.
Hwang, MH (2018) Health practitioners’ understanding and use of relaxation techniques (rts), mindfulness meditation (mm) and relaxation music (rm) in the UK and South Korea. uwe-repository.worktribe.com
Lizier, DS, Silva-Filho, R, Umada, J, Melo, R and Neves, AC (2018) Effects of Reflective Labyrinth Walking Assessed Using a Questionnaire. Medicines (Basel). 2018 Dec; 5(4): 111.
McGee JS, Katzenmeyer C, Boddie SC, Meraz R and Wood S (2023) A sense of connectedness, transcendent experiences, and insights for compassionate action emerge through an international collective labyrinth walk with a shared intention during the COVID-19 pandemic. Front. Psychol. 14:1232784. doi: 10.3389/fpsyg.2023.1232784.
McTaggart, L (2007) The Intention Experiment: Using Your Thoughts to Change Your Life and the World. New York, NY: Atria
Cooper Marcus, C and Sachs, N (2014) Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces.
Sachs, N and Cooper Marcus, C (2015) Labyrinths for healthcare: approach with caution . The Dirt; Uniting the built and natural environments.
Sandor, MK and Froman, RD (2006) Exploring the Effects of Walking the Labyrinth. Journal of Holistic Nursing. 24(2):103-110. doi:10.1177/0898010105282588 T
Sandor, MK (2002) Moving into meaning: Processing loss on the labyrinth. Presentation and facilitated labyrinth walk, Houston Labyrinth Network, Galveston, TX.
Sandor, MK (2004) Walking the labyrinth: The healing effects of sacred landscapes. Presentation at American Holistic Nurses Association, 24th Annual Meeting, Scottsdale, AZ.
Sewell, R (2017) Complementary therapies: progressing from knowledge to wisdom. Innovations in Cancer and Palliative Care Education.
Ubbes, VA (2025) The Use of Labyrinths in the University Preparation of Health Professionals. Medical Research Archives,
Weaver, MS, Powell, A, Bace, S, and Wratchford, D (2019) Centering Care: The Role of Labyrinths for Fostering Reflection in Pediatric Palliative and Critical Care Settings. Journal of Pain and Symptom Management, Volume 58, Issue 1, 167 – 170
Whitem, L (2022) Palliative care nursing as mindfulness: Embodying a relational ethic through strong emotion, uncertainty and death.
Zucker, DM and Sharma, A (2012) Labyrinth walking in correction. Journal of Addictions Nursing.
Zucker, DM, Choi, J, and Cook, MN (2016) The effects of labyrinth walking in an academic library. Journal of Library
Bergland, C (2016) The Neuroscience of Losing Your Train of Thought. Psychology Today.
Wessel, JR, Jenkinson, N, Brittain, JS, Voets, SHEM., Aziz, TZ, and Aron, A. R. (2016). Surprise disrupts cognition via a fronto-basal ganglia suppressive mechanism. Nature Communications, 7. https://doi.org/10.1038/ncomms11195