Transcript Document

Health Psychology
Chapter 14:
Alternative Medicine
Dec 7, 2007
Classes #43
Complementary and Alternative
Medicine (CAM)

A group of diverse medical and health care
systems, practices, and products that are
not presently considered to be part of
conventional medicine
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Healing therapies that typically fall outside
the Western biomedical model of disease,
diagnosis, and treatment
Examples of CAM
Acupuncture
Imagery
Aromatherapy
Magnets
Biofeedback
Massage
Chiropractic
Prayer
Diets
Reflexology
Exercise
Relaxation
Folk remedies
Self-help/support groups
Herbal/botanical therapySpiritual healing (by others)
Homeopathy
Vitamins
Hypnosis
Yoga
Complementary and Alternative
Medicine (CAM)

The list of what is considered to be CAM
changes continually as those therapies that
are proven to be safe and effective become
adopted into conventional health care and as
new approaches to health care emerge
Why do people use CAM?
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Desire for health and wellness (1)
Prevention
Cancer- recent estimate 83% (2)
Pain
 Musculoskeletal pain
 Back and neck pain
Who uses CAM?
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Kessler 2001
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Eisenberg 1998
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Surveys show large increase in past 50 years in
U.S. and other industrialized countries
Between 1990 to 1997, increase from 34% to
42% of US households reporting CAM use
Barnes 2004
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In 2002, 75% of U.S. adults reported use of
CAM in lifetime and 62% in past 12 months
(when prayer included)
Who uses CAM?
Who uses CAM?
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Palinkas 2000
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Surveys of primary care clinic populations
show 28-47% utilization of CAM
21% of patients in primary care practices
reported using CAM for the same health
problem for which they sought conventional
care on that visit
Who uses CAM?
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Chiropractic and massage are most
frequently used practitioner-based CAM
therapies (1).
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An estimated 8-17% of US population visits a
chiropractor each year, 33% over lifetime.
About 1/3 of US population reports having ever
had a therapeutic massage.
Individuals in rural and underserved
communities are particularly likely to use
chiropractic care (2).
4 Reasons for Improvement
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In general, four reasons why people improve:
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Effective treatment
Illness improved on its own
Patient was misdiagnosed
Patient expectations
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Lets take a closer look at this one…
The story of “Mr. Wright” (page 435-436)
Placebo Effect
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Talbot (2000)
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Placebos are at least half as effective for
controlling pain as are active drugs like aspirin
and codeine
Blakeslee (1999)
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Placebos are just as effective as SSRI’s
Is it biological as well???
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Vincent and Furnham (1997)
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Benson (1996)
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“Remembered wellness”
Brody (2000)
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Classically conditioned
Placebos tap into the body’s natural “inner pharmacy”
Bendetto (1996)
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Interesting experiment in which researchers claim a
placebo enhanced the activity of endorphin release
(see page 437)
A closer look at the most widely
used alternative treatments…
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Acupuncture
Mind-Body Therapies
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Hypnosis
Relaxation and Meditation
Spirituality and Prayer
Chiropractic
Naturopathic Medicine
Acupuncture
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Used for most common ailments – backaches, headaches,
arthritis, allegies, muscles aches and spasms, etc.
 Shen Nung (Father of Chinese Medicine)
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Qi
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14 main meridians
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Energy running through our body
Needles bring us back to homeostasis
Deqi
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Sensation is felt (not painful)
Acupuncture
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How does it work???
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Does it work?
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Chronic pain – yes
Substance abusers – yes
How much research?
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???
A lot but unfortunately not without many limitations
Other issues…
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Good news: More insurance companies covering this
Bad news: Conventional methods may be abandoned
Hypnosis
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An altered state of consciousness brought on
by special techniques and that produces
responsiveness to suggestions for changes in
experience and behavior
Probably around since antiquity, the
rediscovery of hypnosis is commonly credited
to Franz Anton Mesmer
Franz Anton Mesmer
(1734-1815)
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Mesmer would pass magnets over the bodies of
ailing people, some of who would lapse into a
trancelike state and then awaken much improved
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At the time many thought Mesmer’s work was linked to
quackery…
Today skepticism remains as books on hypnosis is often
grouped with those on parapsychology, ghosts, and
witchcraft
Nevertheless, most psychologists believe it to be a
respectable topic for scientific study
Can hypnosis work on anyone?
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Can you be hypnotized against your will?
 Hypnotic Susceptibility
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Willingness to be hypnotized is most important factor
 A key quality of hypnotically susceptible people is if
they can become deeply absorbed in imaginative
activities (Fantasy-prone personalities)
Stanford Hypnotic Suggestibility Scale
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Degree to which a person responds to hypnotic
suggestions
Can hypnosis alleviate pain?
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Yes – this has been clearly established in
experiments…
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Hypnotized subjects report far less pain than
others when their arms are placed in ice water
Why?
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2 Theories
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Selective Attention Theory
Dissociation Theory
Selective Attention Theory
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We feel little or no pain because our thoughts
are away from it – like the injured athlete who
still completes the play or the person who
refuses to look at that needle
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Aspects of the Gate Control Theory???
Dissociation Theory:
A divided consciousness?
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A dissociation or split between different levels
of consciousness – dissociating the sensation
of pain with our emotional suffering
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Hilgard (1986): “the hidden observer”
Reports of Pain in Hypnosis
Relaxation and Meditation
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Progressive Muscle Relaxation
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Mindfulness Meditation
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Active training in tensing and relaxing muscles
“awareness without thought”
Transcendental Meditation
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Focused awareness on a single object or word
(mantra)
Spirituality and Prayer
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Recent trend:
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Medicine and spiritual healing coming together
Does spirituality promote health?
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80% in US say yes
But scientific evidence is mixed
Chiropractic
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Chiropractic and massage are most frequently used
practitioner-based CAM therapies
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An estimated 8-17% of US population visits a chiropractor
each year, 33% over lifetime.
About 1/3 of US population reports having ever had a
therapeutic massage.
Individuals in rural and underserved communities are
particularly likely to use chiropractic care
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For example: Chiropractors in every zip code region in
Kentucky
Naturopathic Medicine
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Herbal therapy
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Food Supplements
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Used by 12-14% of the US population, up from 2.5%
in 1990 (Kaufman, 2002)
16-18% of patients taking prescription medications
also take herbal remedies (Kaufman, 2002)
Strong evidence supporting benefits
Dietary Medicine
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Another strong link to better health as correct diet
appears to cut down risk for most of major chronic
illnesses (heart disease, strokes, some cancers)
Naturopathic Medicine
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Do they work?
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Again, studies show mixed results
Why do people use CAM?
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Very few individuals rely exclusively upon
alternative modalities
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Most individuals who use CAM do so because
of preference and the perception that the
combination of CAM and conventional
treatments is superior to either alone
When conventional care is not relieving their
symptoms.
Who practices CAM?
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Wide variation in background and approach
Diversity in training programs
 Some weekend and/or distance learning
certificate programs
 Non-MD acupuncture programs require
2,000-3,000 hours (4 year masters degree)
 Chiropractic training involves 4 years beyond 2
or 4 years of college
No standardization of approach to accreditation
and licensure
 Most require 300-500 hours and CEUs
Variations by type of practitioner and by state
Who practices CAM?
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Chiropractors
 Around 66,000 DCs in US
 Most accepted professional therapy
 Licensed in all states
 High patient satisfaction
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Massage Therapists
 Over 46,000 AMTA members in US
 Most common CAM modality in hospitalbased programs
 Licensed in 2/3 of states
Who practices CAM?
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Increasing numbers of dual-trained
practitioners…
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RNs
 Holistic Nursing Certification
 Therapeutic Touch, Healing Touch
MDs
 American Board of Holistic Medicine
 American Board of Medical Acupuncture
What about communication?
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Eisenberg (2001)
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Between 40 and 70% of CAM users do not
disclose their use to their physician.
WHY?
Why does this matter?
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Kaufman (2002)
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The substantial overlap between use of
prescription medications and herbal
supplements raises concerns about
unintended interactions
Patient use of CAM is often a clue to values
and preferences that need to be
acknowledged
Health psychologists role…
1.
Always ask! “What else are you doing for
your health?”
2.
Be open and nonjudgmental.
3.
Consider patient preferences and values.
4.
Encourage self-monitoring of results.
Eisenberg 1997
Health psychologists role…
5.
Coordinate care as appropriate.
6.
Be honest about your lack of knowledge
and open to education.
7.
Monitor safety and efficacy, arrange
follow-up.
8. Document all discussions and advice.
Eisenberg 1997
Where are we now?
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There is an urgent need for more and better
trials of CAM therapies and the increased
research suggests we are going in that
direction
Research funding
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1992
2004
$2 M
$117.7 M
www.nccam.nih.gov
Where does this leave us?
Many conventional treatments
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have been adopted without good quality
research
are costly
are invasive
are likely to have adverse effects
AND
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often provide inadequate relief
Where does this leave us?
CAM interventions generally
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are low cost
are low risk
are free of serious side effects
AND
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are widely used
CAM: evidence and research
Cancer-related symptoms
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Research in progress on
Nausea related to chemotherapy
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Pain and end-of-life symptoms
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Acupuncture
Ginger
Massage
Acupuncture
Fatigue
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L-carnitine
Massage
www.nccam.nih.gov/clinicaltrials
CAM: evidence and research
Cancer-related symptoms
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Research in progress on
Quality of life
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Distant healing (glioblastoma)
Mindfulness-based art therapy
Healing touch (advanced cervical)
Lymphedema
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Massage, manual lymph drainage
(breast cancer)
www.nccam.nih.gov/clinicaltrials
Framework for approaching CAM
in clinical situations
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Protect against dangerous practices
Permit practices that are harmless and that
may help
Promote and use practices that are safe
and effective
Partner with patients and encourage
communication about CAM
Jonas 2000
Evidence-based Medicine (EBM)
and CAM
EBM aims to integrate
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best research evidence
clinical expertise
patient values
Sackett 2000
Integrative Medicine
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A combination of mainstream medical therapies
and CAM therapies for which there is highquality scientific evidence of safety and
effectiveness
Credits
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http://www.mc.uky.edu/cam/cam_presentations/CAM%20an%20integrative
%20approach%202004-11-06.ppt