Alternative Health Care Systems

in the practice of Psychiatry

Moderator: Dr. Sandhya Gupta

Presenter: Mr.Ganesh.K
 Introduction
• A diverse range of autonomous health-care
practices used both for health support and
prevention and for care in illness.
• There is well documented evidence for the
increasing widespread use of complementary and
alternative medicine in the treatment of physical
and psychiatric symptoms and disorders within
Western populations.
• The World Health Organization refers to the
increase in the use of nonconventional medicine,
meaning traditional, complementary and
alternative medicine, in countries all over the world
in its Traditional Medicine Strategy 2002-
• 2005.
Introduction
 Definitions
Allopathic Medicine:
• A system of medicine that embraces all
methods of proven value in the treatment
of disease.
• Conventional medicine, Western
Medicine
Complementary and Alternative
Medicine
• A group of diverse medical and health
care systems, practices, and products that
are not presently considered to be part of
conventional medicine.
• (NCCAM, 2006)
Definitions
Alternative medicine::
• Used in place of conventional medicine
• using special diet to treat cancer instead of
chemotherapy, surgery, etc...
Complementary medicine:
• Used together with conventional
medicine
• using aroma therapy to relieve discomfort
following surgery
• Integrative medicine:
• combines mainstream and CAM therapies for which there is
some high-quality scientific evidence of safety and
effectiveness.
 Are complementary medicine and
alternative medicine different from
each other?
• Complementary medicine is used together with
conventional medicine.
An example of a complementary therapy is
using to help lessen a patient's discomfort
following surgery.
• Alternative medicine is used in place of
conventional medicine.
An example of an alternative therapy is using
a special diet to treat cancer instead of undergoing
surgery, radiation, or chemotherapy that has been
recommended by a conventional doctor.
Roots of Nontraditional Therapies

• Ancient Greece: massage, art therapy,

herbal therapy.
• The Far East: energetic-touch
therapies.
• China: acupuncture, herbalism.
• India: Ayurvedic medicine.
• Shamanistic practices–folk healing
that involves entering altered states of
consciousness
Principles of CAM
• Human Body is Self Regulating and has a
ability to heal itself.
• Parts of Human Body are inter dependent.
• Focuses on Structures and Systems of Body –
Bones, Joint, Soft Tissue, Circulatory,
Lymphatic.
• Cellular Memories stored in tissues and
muscles.
• Working on body can bring deeper changes in
muscular, nervous, endocrine and immune
system of body.
 CAM Modalities Now
in Mainstream Medicine
• Codeine • Behavioral therapy
for pain for headache
• Digitalis for • Hypnosis for
heart failure smoking cessation
• Ipecac for • Low fat, low
poisoning cholesterol diets
• Quinine for • Exercise
malaria for diabetes
• Aspirin for • Support groups
fever for breast cancer
The Use of CAM in the US.
2004 Report by NCCAM & NCHS
Who uses CAM the most?

• Women more than men

• people with higher education
• people who have been hospitalized in past year
• former smokers (more than current or never smoked)
Why?
• Positive motives
– Perceived effectiveness or safety
– Spiritual
– Holism
– All things natural
– Active role
– Control over treatment
– Pleasant therapeutic experience
– Good patient/therapist relationship
• Fewer time restraints
• On equal terms
• Empathy
– Non-invasive
– Accessibility
– Affluence
Why?
• Negative motives
– Dissatisfaction with conventional
health care
• Ineffective
• Adverse effects
– Doctor-patient relationship
• insufficient time
• waiting lists
– Reject science and technology
– Reject “the establishment”
– Desperation
CAM domains
 Types of CAM
• Biologically based practices
– Use substances found in nature such as herbs, foods & vit.
• Manipulative and body-based therapies
– Based on movement of one or more parts of the body
• Mind-body interventions
- uses a variety of techniques designed to enhance the
mind's capacity to affect bodily function and symptoms.
• Energy therapies
– are meant to restore disturbances in the body's natural
energy
 Types of CAM (Common)
• Bowen
Acupuncture
• Alexander Technique
Biofeedback
• Allergy testing
Chiropractic
• Aromatherapy
Chinese Herbal Medicine
• Art Therapy
Counselling
• Autogenic Training
Craniosacral Therapy
• Auricular
Crystal Therapy
Acupuncture
• AyurvedaFlower Therapy
Dowsing
• Bodywork
Healing Herbalism
• Homeopathy
 Types of CAM (Common)
• Physiotherapy
Hydrotherapy
• Hypnotherapy
Radionics
• Indian Head Massage
Reflexology
• Iridology
Reiki
• Kinesiology
Shiatsu
• Music
Tai ChiTherapy
• Naturopathy
TENS therapy
• Nutrition Chinese Medicine
Traditional
• Osteopathy
Thought Field Therapy
• Yoga Therapy
 Types (Rarer)
• Light Touch
Auricular Acupuncture
Therapy
• Australian Flower Essences Therapy
Magnotherapy
• Bach Flower
Marma Therapy
remedies
• Bee Venom Therapy
Meta-Aromatherapy
• Chelation Therapy
Microwave Resonanace Therapy
• Colonic Hydrotherapy
Naturotherapy
• Colour Therapy
Oxygen Therapy
• Dream Therapy
Panchakama Therapy
• Eye scans
PIP Movement Desensitization and Reprogramming
• Exercise
Raw Vegetable
HealingJuice Therapy
• Health Clubs
Rolfing
• Health Screening
Spiritual Counselling
• Juice Therapy
Stress Management
• Light Therapy
Swimming Therapy
• Transdecendal Meditation
• Tragerwork
• Vegetable Juice Therapy
Research input
• Kessler et al reported data on the use of
complementary therapies to treat anxiety
and depression in the USA, which indicate
that complementary and alternative
therapies are used more than conventional
therapies by people with anxiety and
severe depression.
• This large-scale study found depression,
anxiety and insomnia to be among the
most common reasons for people to use
complementary therapies.
Research input
• In the UK, estimates of the proportion of the
general population using CAM range from 14% to
30% and positive public attitudes toward the use
of complementary therapies, with acupuncture
being identified as one of the most popular forms
of complementary treatment.
• The findings of a large postal survey conducted in
Australia showed that people who were
experiencing mild to moderate depression chose
self-help strategies and complementary therapies
such as aromatherapy, St John's wort, meditation
and nutritional supplements rather than seeking
professional help.
Mind-body therapies
 MIND/BODY INTERVENTIONS
• Methods by which an individual can
consciously control some sympathetic
nervous system functions.
• Self-regulatory techniques include
meditation, relaxation, imagery,
biofeedback, and hypnosis and spiritual
therapies.
 MEDITATION

• State of consciousness in which individual

eliminates environmental stimuli from
awareness, producing a state of relaxation
and stress relief.
• Health benefits include decreased respiration,
heart rate, and oxygen consumption,
improved mood, spiritual calm and
heightened awareness.
 Meditation types
• All the meditation techniques can be grouped
into two basic approaches:
– Concentrative meditation and
– Mindfulness meditation.
Some indications:
Recurrent Depression
Chronic anxiety
Chronic insomnia
Overall emotional well-being
 Uses of meditation
• Anxiety or tension
• Chronic bereavement
• Chronic fatigue syndrome
• Irritability
• Hypertension
• Mild depression
• Low self esteem or self blame
• Sleep disorders
• Psychological disorders
 Limitations

• Over meditation may

precipitate
psychoses episode.

• Augments the effect

of certain
medications
 Research input
• Lee et al. investigated the effectiveness of a
meditation-based stress management programme in
patients with anxiety disorder.
• Forty-six patients diagnosed with anxiety disorders
were randomly assigned to either the meditation
programme (MBSR, which included some education
on coping with anxiety, exercise, muscle build up,
relaxation and hypnotic suggestion) or the education
programme.
• There were significant decreases in all anxiety scale
scores for themeditation programme group compared
with patients on the education programme.
 Research input
• Pilkington et al concluded that two recent
trials suggest that mindfulness-based cognitive
therapy, which integrates aspects of CBT with
components of MBSR programmes, may be
useful in preventing relapse in people who
have recovered from depression.
 RELAXATION
• Relaxation is the state of generalized
decreased cognitive, physiological or
behavioral arousal.
• The process of relaxation elongates the
muscles, reduces the neural impulses sent
to brain and thus decreases the activity of
brain as well as other body systems.
• Acquisition of cognitive skills to replace
negative thoughts with positive thoughts.
 Relaxation therapy
• Types:
– Progressive relaxation
– Passive relaxation
• Clinical applications
– lowering HR,RR and muscle tension
– Improving well being
– E.g. deep breathing
• Limitation
– “Predormescent start”
 IMAGERY
• It is a process of incorporating the "power of
the mind" to assist the body to heal, maintain
health or relax by way of an inner
communication involving all senses, (i.e.
visual, touch, smell, sight, sound).
• Two types
– Self directed
– Guided
 Guided imagery
• Nurses can use guided imagery with clients
capable of hearing and understanding the
nurse’s suggestions.
• Decreases physical tension, anxiety, adverse
effects of chemotherapy.
 BIOFEEDBACK
• Measures physiological responses like muscle
tension, skin temperature, and heart rate to
improve health by using signals from client’s own
body.
• Effective for a number of conditions, including
headaches, urinary incontinence, hypertension,
chronic pain.
 HYPNOSIS
• Induces an altered state of consciousness
or awareness resembling sleep and during
which the person is more receptive to
suggestion.
 Research input
• Alladin and Alibhai compared the
effectiveness of the combination of hypnosis
and CBT, which they termed cognitive
hypnotherapy, with that of standard CBT in 84
patients with major depression.
• Patients were randomly assigned to the two
treatment groups, which were run over 16
weeks. The investigators found that treatment
outcomes were significantly enhanced when
CBT was combined with hypnotherapy.
 SPIRITUAL THERAPIES
• Faith healing–usually accomplished through
prayer. The healer is a channel for divine
power.
• Healing prayer–when praying, people believe
they are communicating directly with God or
a Higher Power. Prayer can affect well-being.
 MANIPULATIVE AND
BODY-BASED METHODS
• Use techniques of manipulating or
moving various body parts to achieve
therapeutic outcomes.
• Includes movement/exercise, yoga, tai
chi, and chiropractic treatment.
 MOVEMENT/EXERCISE
• Associated with athletic exercise, dance,
celebration, and healing rituals.
• The primary goal of exercise is fitness.
• Other positive outcomes include sleeping
better and having more energy.
 EXERCISE
• Aerobic exercise most studies
• Adherence rates in exercise
studies comparable to those
in medication trials
• Randomized controlled trials
• Antidepressant effects
comparable to CBT
• Feasible in older subjects
• Total caloric expenditure/wk
more critical than
frequency/wk
 Alexander therapy
• Alexander technique is actually a method to
relieve the pain and stress caused by the way
we have misused our body during daily
activities.
 Alexander therapy (contd)
• The Alexander Technique (awareness, movement,
and touch) teaches people to change dysfunctional
movement patterns by educating clients in how to
change their daily habits of movement and posture
to
– restore the correct relationship of head, neck, and
back
– promote proper balance, posture, and movement
in the body
 YOGA/YOGA THERAPY
• Means “union” in Sanskrit.
• Integrates mental, physical, and spiritual
energies to promote health and wellness.
• Breathing, posture, and movement.
• Promotes relaxation, develops
proprioception, awareness of movement,
weight distribution, and position.
 Yoga
Main branches of Yoga:
Hatha Yoga- Yoga of purifying physical and mind
Karma Yoga- Yoga of action
Jhana Yoga- Yoga of knowledge
Bhakti Yoga- Yoga of devotion
Raja Yoga- Yoga of controlling mind
 Yoga
Most common yoga practice includes asanas
(body postures) & pranayama (breathing
exercises)

Randomized controlled trials

– Pranayama + asana reduces symptoms
in depressed college students
– Pranayama comparable to tricyclic in
treating depressed psych inpatients
– Asanas superior to wait-list in reducing
depressive symptoms
– Short-term antidepressant effects of
pranayama + asana comparable to
PMR and superior to control
 TAI CHI
• Looking for harmony with nature and the
universe through complementary (yin and
yang) balance.
• A series of slow, continuously flowing
movements.
• Improves flexibility, range of motion,
muscle strength, and balance.
 CHIROPRACTIC THERAPY
• Combines the Greek words cheir (hand) and praxis
(action) to describe a treatment done by hand.
• Hands-on therapy–especially adjustment of the
spine–is central to chiropractic care. Misalignments
of the spine can interfere with the flow of energy
needed to support health.
• Focuses on the relationship between the body's
structure–mainly the spine–and its functioning.
 Rolfing (Structural integration)
Technique of deep massage intended to
realign the body by altering the length and
tone of muscle, fascia and connective tissues.
Basis of practice is the belief that
misalignment of myofascial (soft) tissue may
have detrimental effect on person’s energy
level, self image, muscular efficiency and
general health.
 Rolfing
Pressure or deep painful massage is applied
with the fingers and elbows.
The Rolfing practitioner manipulate and
stretch the body's fascial tissues to reestablish
proper physical alignment of the head, torso,
pelvis, legs, and feet and
To promote mental balance.
To promote emotional balance and emotional
relaxation.
 ENERGY THERAPIES
• Use of the hands to direct or redirect the flow
of the body’s energy fields and enhance
balance within those fields.
• Includes touch, therapeutic massage,
therapeutic touch, healing touch,
acupressure, and reflexology.
 TOUCH
• The means of perceiving or experiencing
through tactile sensation.
• The meaning of touch and the body areas
acceptable to touch vary from culture to
culture.
 THERAPEUTIC TOUCH
• Based on the ancient practice of the laying
on of hands and using the hands to direct
energy to achieve a balanced state.
Research input
• In Meta Analysis of 11 Controlled
Therapeutic Touch Studies, 7 Controlled
studies had positive outcome.
• Therapeutic healing enhances body’s ability
to heal itself and beneficial for allergies,
heart condition & chronic pain.
-Winsted – Fry P, Kijek J. An
intergrative renew and meta analysis of
therapeutic touch & research. Alternative
therapies in Health & Medicine.
 HEALING TOUCH
• An energy therapy using hands to clear,
energize, and balance the energy field.
• The practitioner re-aligns the energy flow,
which reactivates the mind/body/spirit
connection to eliminate blockages to self-
healing.
 TOUCH IN NURSING PRACTICE
• An integral part of assessment.
• Promotes bonding.
• An important means of communication.
• Assists in soothing, calming, and comforting.
• Helps keep the client oriented.
Uses
 Wound healing
 Pain management
 Stress management
 Prevention of illness
 Enhance spiritual development and
 Provide support and assistance in dying process.
Cultural Considerations of Touch

• Ask permission before touching a

client.
• Tell the client what is going to
happen.
• The meaning of touch and the body
areas acceptable to touch vary from
culture to culture.
 THERAPEUTIC MASSAGE
• The application of hand pressure and motion
to improve the recipient’s well-being.
• A back rub or massage results in relaxation,
increased circulation of the blood and lymph,
and relief from musculoskeletal stiffness,
spasm, pain.
• Used in
– Pain relief (e.g. back pain, headache)
– Reducing anxiety
– Depression and
– Temporarily reduction in BP, HR and state anxiety
etc.
 ACUPRESSURE
• Based on Chinese theory stating that the
body is divided into meridian channels
through which qi, or energy, flows.
• Acupressure releases blocked energy when
specific points (Tsubas) are pressed with the
fingers, thumbs, and hands.
 Acupressure ( Contd…)
Caution: should not be applied near areas of fractures,
broken bones or near blood clots, wounds, sore and
bruises.
Psychiatry Conditions Treated:
Pain management
Insomnia
Anxiety
Depression
Substance abuse including smoking cessation.
Medical problems- Cancer, asthma, diabetes, backaches,
Spondylitis, Slipped Disks, Fractures, and Dislocations, Arthritis
and Rheumatism, Intestinal Problems – Colitis, Gouts/Stones
in Kidney & Bladder, Paralysis
 SHIATSU
• Shiatsu utilizes the forearm, elbow, knee, and
foot to activate the points.
• Relaxation, Back pain, Headache,
Premenstrual syndrome, Anxiety, Insomnia,
Neck and shoulder pain, Tiredness, Recovery
from injuries, Stress,
• Contraindications include venous stasis,
phlebitis, and traumatic and deep tissue
injuries.
 REFLEXOLOGY
• Art and science of enervating over 7,000
nerves in the feet believed to correspond to
every muscle system and organ in the body.
• Promotes health by relieving pressures and
accumulation of toxins in the corresponding
body part.
 Reflexology
• Pain relief in acute and chronic states
• Control of anxiety
• Reduction of blood pressure
• Relaxation
• Improved sleep

Pebble massage
sandals
Acupuncture
The modern name is derived from the
Latin words Acus (needle) and Punctura
(penetration).
Component of traditional Chinese
medicine that originated in China over
5,000 years ago.
Concept: disease results from disruption
in the flow of Qi (vital energy) and
imbalance in the forces of yin and yang
(opposite energy fields, must be in
balance).
 Acupuncture (contd)
Technique of acupuncture
Involves penetrating the skin with thin, solid,
metallic needles that are manipulated by the hands
or by electrical stimulation.
Charts more than 2000 points in the body -
located along invisible energy called `meridians‘.
 How Acupuncture Works
 Stimulates the release of pain-relieving endorphins
 Influences the release of neurotransmitters,
substances that transmit nerve impulses to the
brain
 Influences the autonomic nervous system
 Stimulates circulation
 Influences the electrical currents of the body
 Risk and complications
Small bruises on the insertion site
Pneumothorax
Infections and
Punctured organs
Soreness and pain
ACUPUNCTURE

Electro-acupuncture
Manual acupuncture
Laser acupuncture

Randomized controlled trials

– Luo et al: EA equivalent to tricyclic in depression
(unipolar + bipolar subjects)
– Allen et al : EA group only marginally better than
wait-list control
– Roschke et al: EA no better than sham EA
as adjuvant to antidepressant
– Quah-Smith et al: Laser acupuncture superior to
sham in treating depressive symptoms
Research input
• Recently reported RCT evaluated the efficacy and
acceptability of acupuncture for treatment of
posttraumatic stress disorder (PTSD)
• In all, 84 patients diagnosed with PTSD were randomly
assigned to one of three groups, with one group receiving
acupuncture, another group receiving cognitive-
behavioural therapy (CBT) and the third acting as a wait
list control.
• A total of 61 participants completed the trial and the
results suggest that acupuncture might be useful in
reducing symptoms of PTSD, depression, anxiety and
impairment in people diagnosed with PTSD.
• Treatment effects in the acupuncture group were similar
to those with the group CBT intervention, and both
interventions were superior to the wait listed control on
all measures.
Research input
• Psychiatric Patients' Experiences in Complementary and
Alternative Medicine (CAM), and in Religious Support – A
Pilot Study
O. Kozumplik and V. Juki} Department of Integral Psychiatry,
Psychiatric Hospital »Vrap~e«, Zagreb, Croatia
• In the Psychiatric Hospital »Vrap~e« an investigation on a 200
patient sample was carried out in the year 2000. The purpose of
the investigation was to analyze the examinees’ experiences of
complementary and alternative medicine (CAM) and religious
support. 35.5% of the examinees had had previous experiences of
CAM and religious support. The examinees born in towns used
CAM methods and religious support significantly more often.
• The schizophrenic patients used CAM methods and religious
support significantly more frequently than the patients with
affective and anxiety disorders. Non-significantly more often CAM
methods and religious support were utilized by women, examinees
between 21 and 30 years of age, persons who graduated from
junior college, those who live in cohabitation and patients of
Islamic religion.
Research input
• Patients consulted priests most often. Significantly more
often patients did not pay for the CAM treatments and
religious support and non-significantly more often
patients considered CAM therapy and religious support to
be successful. Non-significantly more often patients
consulted CAM practitioners and religious practitioners
without being previously advised by their relatives or
friends.
• Relatives of the patients advised them to consult CAM
practitioners and religious practitioners significantly
more often than the friends of the patients did.
Considering the possible missed benefits and harm effects
of CAM treatment as well as of the interaction between
utilization of CAM methods/religious support and
conventional treatment, this problem should be given full
attention.
BIOLOGICALLY
BASED THERAPIES
• Phytochemicals
• Antioxidants
• Herbs
PHYTOCHEMICALS
• Nonnutritive, physiologically active
compounds present in plants in
very small amounts.
• Protect against cancer and prevent
heart disease, stroke, and cataracts.
• Consumption of a wide variety of
fruits and vegetables provides best
supply.
Nutritional supplements
• Mischoulon reported that the results of
recent studies of omega-3 fatty acid
supplementation, including the use of
eicosapentaenoic acid (EPA), are promising
in treatment of depression.
• In addition, the omega-3 fatty acids have
been shown to be safe and might be useful
in specific populations, such as the elderly,
pregnant or lactating women and people
with medical co-morbid conditions.
Nutritional supplements
• A number of controlled trials and a few
open studies have suggested that
supplementation with doses of EPA and
docosahexaenoic acid (DHA) that are
about five times higher than the standard
dietary intake in the USA may have
antidepressant or mood-stabilizing effects.
 DIETARY SUPPLEMENTS
Omega-3 Fatty Acids

– Worldwide, lower serum omega-3 fatty acids significantly correlate

with depression
– Double-blind, placebo-controlled studies show efficacy of omega 3
(from fish oil) in unipolar and bipolar depression
– Typical EPA dose 2.5 gm/day
– Flaxseed oil also source for omega-3 fatty acids,
but no controlled studies to date
re: use in psych conditions
– Food increases omega-3 absorption
– Do not heat fish oil
– Vitamin E may help in vivo potency
– Caution with anti-coagulants and hi-dose NSAIDS
 DIETARY SUPPLEMENTS

Folic Acid

– Folate deficiency appears significantly correlated with

higher rates of depression
– Data suggest low serum folate may hinder antidepressant
response
– Folate (0.5 mg/day) may be important adjuvant in treating
women (but not men) with resistant depression
– Folate may help prevent relapse during & after depression
tx
DIETARY SUPPLEMENTS
S-Adenosyl-Methionine (SAMe)

– Several placebo-controlled
trials
for use in depression
– Meta-analysis shows SAMe
(400mg-1600 mg by mouth)
may be equivalent
to tricyclics
– No data on comparison to
SSRI’s
– Risk of mania, serotonin
syndrome
ANTIOXIDANTS
• Substances that prevent or inhibit
oxidation.
• Prevent tissue damage from free
radicals, which are unstable
molecules that can damage cells and
trigger cancer growth.
• May prevent heart disease, cancer,
cataracts.
 Herbs
• Used for centuries in care of the sick.
• Some herbs, when used with prescribed
medications, can cause potentially harmful
herb-drug interactions.
• During assessment, ask specifically about use
of herbal and vitamin supplements.
 HERBAL REMEDIES

St. John’s Wort

– Equivalent to low-dose
tricyclic in mild-mod
depression
– Typical dose 900-1800
mg/day (in three divided
doses)
– Watch for photo-toxicity and
herb-drug interactions

Hypericum perforatum
 HERBAL REMEDIES
Valerian Root
– Used for hundreds of years for
anxiety / insomnia
– Seven placebo-controlled trials
(400-900 mg/day)
– 6 of 7 studies found statistically
significant, dose-related sedative
effects
– Not benzodiazapine, so little
abuse potential
– Avoid if liver dysfunction
– Avoid concurrent use with Valeriana officinalis
benzodiazapines
 HERBAL REMEDIES
Rhodiola
– Enhances cognitive
performance under stress
– Reduces mental fatigue
– Improves sexual function
– Improves overall well-being
– 300-900 mg/day for
depression
– Caution with bipolar and
post-MI patients

Rhodiola Rosea
Research input
• A Cochrane review reported by Pittler and Ernst,
which included 11 RCTs involving 645 patients,
showed that kava is the only herbal remedy that has
been proven to be effective in reducing anxiety.
• The valerian review[16**] identified one
randomized controlled trial involving 36 patients
with generalized anxiety disorder that was eligible
for inclusion.
• This study found that patients taking diazepam
experienced significantly greater improvement in
self-reported anxiety symptoms than those in the
valerian and placebo groups, with no significant
differences in reported side effects between the
three groups.
Herbs
• A recent review reported by Ernst indicated
that St John's wort (Hypericum perforatum)
is the only herbal remedy found to be
effective as a treatment for mild to
moderate depression.
• Ernst cautioned against using St John's
wort with other medications because it can
increase the plasma levels of a range of
drugs and there is a possibility that it can
occasionally trigger psychosis in patients
who are using selective serotonin reuptake
inhibitors.
OTHER METHODOLOGIES
• Aromatherapy
• Humor
• Animal-assisted therapy
• Music therapy
• Play therapy
 Aroma therapy
• Aromatherapy is concerned with the
psychological, physiological and
pharmacological effects of essential oils
introduced by means of inhalation, olfaction
and dermal application.
• These oils should be used intelligently and
with caution.
Aroma therapy (contd)
– Used since Egyptian times
– Distilled plant extracts
• 400 Oils
• Varying quality (RCT)
– Improve well-being
• Peppermint – digestive effects
• Tea Tree Oil – antibacterial
– Massage, Baths, Inhalation
Research input
• Perry and Perry found only one small
open-label study of aromatherapy in
the treatment of psychiatric patients
diagnosed with anxiety and
depressive disorders.
• The study's author reported that six of
the eight participants experienced
reduced anxiety and improved mood
over an 8-month period of use.
Humor
• Determine the client’s perception
of what is humorous.
• Can relieve anxiety, improve
respiratory function, promote
relaxation, enhance immunological
function, and decrease pain by
stimulating endorphin production.
ANIMAL-ASSISTED THERAPY
• Has many applications including
overcoming physical limitations,
improving mood, lowering blood
pressure, and improving
socialization skills and self-esteem.
 MUSIC THERAPY
• Use of musical or rhythmic interventions
specifically selected by a music therapist to
accomplish the restoration, maintenance, or
improvement of social or emotional
functioning, mental processing, or physical
health of an individual.
 Music therapy ( contd..)
Music therapy:
• Promote wellness
• Manage stress
• Alleviate Pain
• Express Feelings
• Enhance Memory
• Improve
Communication
• Promote physical
Rehabilitation
 Art therapy
• A form of expressive therapy that uses art
materials, such as paints, chalk and markers as
primary mode of communication.
• Based on the belief that the creative process
of art is both healing and life-enhancing.
• Helps the client to:
– Increase insight and judgment,
– Cope better with stress,
– Increase cognitive abilities,
– Have better relationships with family and friends.
 Art therapy
• Goal : to improve or maintain mental health
and emotional well-being.
• Drawing, painting, sculpture and photography
are used.
• Therapist interpret the symbols and
metaphors form the creative work.
“It’s not about being an artist, it’s about using visual
symbols to explore feeling and emotions.....it’s
about seeing feelings, making them visible to
yourself".
 Hydropathy /Aquatherapy
• Treatment of disease by the use of water.
• Method of treatment that attempts to cure all
diseases by the external (bath) or internal
(colonic irrigation) use of water.
• Water can be in the form of ice, vapor, or
liquid.
 Hydrotherapy
• Can be hot or cold water which is used.
• Types
– Packing
– Hot air baths (Saunas)
– General baths
– Local baths
– Compress
 Hydrotherapy
• Used in:
– Stress reduction
– Sexual arousal
– Cognitive enhancement
– Others- Musculoskeletal disorders (arthritis,
ankylosing spondylitis), Spinal cord injuries,
spasticity, stroke or paralysis
• Mech. of action:
– Heat is soothing, easing muscle tension and
relieving pain. Heat also improves circulation.
– Cold can either be stimulating or soothing.
 PLAY THERAPY
• Especially useful with children.
• Constitutes a method for children
to communicate their needs and
feelings to care providers.
 LIGHT THERAPY
• Light therapy is another physical intervention
that is used to treat depression and depressive
disorders.
• It exposes patients to a bank of bright lights for
a variable number of hours per day, usually
between 1 and 3 h. Patients can read or engage
in other activities during the period of exposure.
• In a recent paper that reviewed CAM therapies in
the treatment of depression in children and
adolescents, Jorm et al. found good evidence for
the efficacy of light therapy in winter depression.
Bee venom therapy
– Contain sulphur
– Stimulates cortisol release
– Applied to surface
– Chronic inflammatory conditions
– RA, Myositis
– Applied for 5days with 2-3day
interval
– Normally haemorrhagic
 Magnetic therapy
• Magnets help to balance the acid-
alkaline imbalances and increase
calcium ions, increase blood and
oxygen circulation and carry away
toxins, neutralise histamine
• Unipolar
• either north or south, North relieve pain, reduce swelling,
promotes tissue alkalisation, promotes restful sleep, increases
oxygenation to tissues and calms nerves, South Opposite

• Bipolar
 Ayurveda
Ayur = Life; Veda = Knowledge
Ayurveda : “the science of life”
A system of medicine that originated in India
several thousand years ago.
Two ancient books on palm leaves are first
books written for Ayurveda (i.e. Charak
Samhita, Charak susruta)
 Ayurveda (contd)
Aim is to integrate and balance the body,
mind, and spirit
Philosophy is that people, their health, and
the universe are all related and health
problems can result when these relationships
are out of balance.
 Ayurveda (contd)
Interconnectedness (among people,
their health, and the universe ):
All the things are joined together
Each human being has element that can be found
in the universe.
All are born in a state of balance within
themselves and in relation to the universe.
Health will be good if one's interaction with the
immediate environment is effective
 Ayurveda’s Beliefs
Constitution (Prakriti) and health:
Three doshas control the constitution (i.e. vata,
pitta, and kapha )
Each dosha is made up of one or two of the five
basic elements: space, air, fire, water, and earth.
Each dosha has a particular relationship to body
functions
 Vata Doshas
Vata dosha: combination of the elements
space and air.
most powerful dosha because it controls very
basic body processes such as cell division, the
heart, breathing, and the mind
People with vata dosha are more susceptible
to skin, neurological and mental diseases.
 Pitta doshaP
Elements fire and water.
Control hormones and the digestive system.
Pitta is upset by, for example, eating spicy or
sour food; being angry, tired, or fearful; or
spending too much time in the sun.
People with Pitta are more susceptible to
heart diseases and arthritis.
 Kapha dosha
Elements water and earth
Help to keep up strength and immunity and to
control growth
Aggravated by, for example, sleeping during
the daytime, eating too many sweet foods
People with kapha dosha are more
susceptible to gallbladder problems, stomach
ulcers, and respiratory illnesses such as
asthma.
 Ayurveda (contd)
Treatment goals:
Eliminate impurities (Panchkarma): focuses on
respiratory and digestive tract. (enema, fasting,
inhalers)
Reduce symptoms: yoga, meditation, breathing
exercises etc., herbs with honey to improve
digestion and reduce fever.
Reduce worry and increase harmony in the
patient’s life: yoga, meditation
Eliminate both physical and psychological
problems
 Ayurveda (contd)
Some examples of use of plants
Spice turmeric is used in Rheumatoid arthritis,
Alzeihmer’s disease and wound healing.

A mixture (Arogyawardhini) of sulfur, iron,

powdered dried fruits, tree root, and other
substances has been used to treat problems of the
liver.
 Unani medicine
It is influenced by Islam.
It has a base of honey which is considered to
have healing properties and used in medicine
and food practiced in Islamic world.
Based on theory of the presence of the
elements (in Unani, they are considered to be
fire, water, earth and air) in the human body.
Pearls and metal are also used in making
medicines.
 Siddha
Oldest medicine system in India.
Medicine professed and practiced by siddhas
who wrote their recipes on Palm leaves.
Mainly developed by the Dravidians.
Still practiced in south India.
Medicine is made of the parts of the plants
and trees such as leaves, bark, stem, root etc
Metals like gold, silver and iron powder are
used.
 Siddha (contd)
Mode of action:
Revitalizes and rejuvenates the organs, the
dysfunction of which is causing the disease.
Maintains the ratio of Vata, Pitta and Kapha.
It works when Allopathy fails, e.g. in DM, corrects
the function of pancreas, stimulating it to produce
insulin in the natural way, which in turn maintains
the blood sugar level.
 Homeopathy
Greek words homeo, meaning similar, and
pathos, meaning suffering or disease.
Based on law of similars", (all effective drugs
produce symptoms in healthy individuals
similar to those of the diseases that they can
treat).
Problems encountered with use of
CAM
• Safety risk
– Especially during pregnancy
– Ayurvedic treatments
• Heavy metals (Lead, Mercury, Arsenic)
– Unknown purities
– Reactions are not routinely monitored
– Dietary supplements can interact with
prescribed medications
• Difficulty establishing
reliability/efficacy
Problems encountered with use of
CAM
• Significant lack of evidence/research
– Speculative
– Small trials
– Often biased
• Financial motivations
• Lack of regulation
– Some with registered Osteopaths (GOsC)
and Chiropractors (GCC)
– Remaining registration is voluntary
 Role of nurse
Practitioner
Training
Referral
Research
Consistency of standards
Dosing
Controlling organization
Drug interaction
Adulteration
Side effects and toxicity
Patient motivation
Check safety in pregnancy and lactation
Appropriate documentation of care
 Nursing theory providing context
Alternative/complementary modalities performed
from within a context of a nursing theory/model take
on meaning from within the theory.
E.g. Roy adaptation model, deals with the concept of
focal, contextual and residual stimuli.
Nurse working within the context of this, assesses
the stimuli and takes action to promote the client’s
adaptation in physiologic needs, self-concept, role
function, and relations of interdependence nursing
health and illness.
 Nursing theory providing context
• With regard to contextual stimuli, she uses
Music therapy to change the environment and
promote the client’s adaptation to stressful
situation.
Using Alternative & Complementary
Therapies
• Have a non-judgmental attitude.
• Ask clients if they use nontraditional therapies.
• Get instruction in these therapies before trying
to administer them.
• Try one or two basic therapies (e.g. massage or
guided imagery).
• Discuss a therapy with the client before using it.
Nursing taxonomy providing the context
Nursing Nursing Rationale
Diagnosis/concern Intervention(s)
Impaired Comfort Acupressure, to decrease perceived
TT pain
Disturbed Sleep Massage to promote relaxation, rest
Pattern
Impaired Art therapy to facilitate expression
Communication
Impaired Coping Humor to facilitate appreciation of
that which is funny, to
relieve tensions
Spiritual Distress Spiritual to facilitate a sense of
support inner peace
Current trends
• Mind/body medicine and research
• Holism and nursing practice
Holism and Nursing Practice
As a healing facilitator, the nurse
enters into a relationship with the
client and can be a:
– guide.
– change agent.
– instrument of healing.
Nurse as Instrument of
Healing
• To serve in this capacity, a nurse
should develop the following
attributes:
• Knowledge base.
• Intentionality (having conscious
direction of goals).
• Respect for differences.
• Ability to model wellness.
 What patients should be advised
• Discuss with doctor - some CAMs interfere
with conventional therapy
• Ask
• what benefits can be expected
• What are the risks
• Do the benefits outweigh the risks
• What side effects
• Will it interfere with conventional therapy
• Is it part of a clinical trial if so who’s the sponsor
 Summary
• Definition of CAM
• Types
• Role of nurse
 Conclusion
• Interest in complementary and alternative
medicine (CAM) continues to grow as an
increasing number of people, including health
care professionals, look at ways to improve
their own lives and those of others by using a
variety of alternatives to conventional
medicine.
 References
www.google.com
www.nccam.com
www.pubmed.com
Kaplan and Sadock’s. synopsis of psychiatry; Complementary
and alternative medicine in psychiatry, 10th edi, pg 839-56
Barbara, Psychiatric mental health nursing, Alternative
therapies. 313-327
Black and Hawks, Medical Surgical Nursing, Clinical
Management for positive Outcome, Elsevier, 7th edition, page
no. 109-118.
Lippincot’s “Perspective for Nursing Practice” 5 th edition,
page no. 12-30.