Health Psychology

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Health Psychology

• Chapter 14
• Alternative Medicine
• Dec 7, 2007
• Classes 43

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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
• Healing therapies that typically fall outside the
  Western biomedical model of disease, diagnosis,
  and treatment

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Examples of CAM
Acupuncture Imagery Aromatherapy Magnets B
iofeedback Massage Chiropractic Prayer Diets
Reflexology Exercise Relaxation Folk
remedies Self-help/support groups Herbal/botani
cal therapy Spiritual healing (by others)
Homeopathy Vitamins Hypnosis Yoga
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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

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Why do people use CAM?

• Desire for health and wellness (1)
• Prevention
• Cancer- recent estimate 83 (2)
• Pain
• Musculoskeletal pain
• Back and neck pain

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Who uses CAM?

• Kessler 2001
• Surveys show large increase in past 50 years in
  U.S. and other industrialized countries
• Eisenberg 1998
• Between 1990 to 1997, increase from 34 to 42 of
  US households reporting CAM use
• Barnes 2004
• In 2002, 75 of U.S. adults reported use of CAM
  in lifetime and 62 in past 12 months (when
  prayer included)

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Who uses CAM?
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Who uses CAM?

• Palinkas 2000
• 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

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Who uses CAM?

• Chiropractic and massage are most frequently used
  practitioner-based CAM therapies (1).
• 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).

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4 Reasons for Improvement

• In general, four reasons why people improve
• Effective treatment
• Illness improved on its own
• Patient was misdiagnosed
• Patient expectations
• Lets take a closer look at this one
• The story of Mr. Wright (page 435-436)

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Placebo Effect

• Talbot (2000)
• Placebos are at least half as effective for
  controlling pain as are active drugs like aspirin
  and codeine
• Blakeslee (1999)
• Placebos are just as effective as SSRIs

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Is it biological as well???

• Vincent and Furnham (1997)
• Classically conditioned
• Benson (1996)
• Remembered wellness
• Brody (2000)
• Placebos tap into the bodys natural inner
  pharmacy
• Bendetto (1996)
• Interesting experiment in which researchers claim
  a placebo enhanced the activity of endorphin
  release (see page 437)

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A closer look at the most widely used alternative
treatments

• Acupuncture
• Mind-Body Therapies
• Hypnosis
• Relaxation and Meditation
• Spirituality and Prayer
• Chiropractic
• Naturopathic Medicine

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Acupuncture

• Used for most common ailments backaches,
  headaches, arthritis, allegies, muscles aches and
  spasms, etc.
• Shen Nung (Father of Chinese Medicine)
• Qi
• Energy running through our body
• 14 main meridians
• Needles bring us back to homeostasis
• Deqi
• Sensation is felt (not painful)

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Acupuncture

• How does it work???
• ???
• Does it work?
• Chronic pain yes
• Substance abusers yes
• How much research?
• A lot but unfortunately not without many
  limitations
• Other issues
• Good news More insurance companies covering this
• Bad news Conventional methods may be abandoned

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Hypnosis

• 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

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Franz Anton Mesmer (1734-1815)

• Mesmer would pass magnets over the bodies of
  ailing people, some of who would lapse into a
  trancelike state and then awaken much improved
• At the time many thought Mesmers 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

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Can hypnosis work on anyone?

• Can you be hypnotized against your will?
• Hypnotic Susceptibility
• Degree to which a person responds to hypnotic
  suggestions
• 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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Can hypnosis alleviate pain?

• Yes this has been clearly established in
  experiments
• Hypnotized subjects report far less pain than
  others when their arms are placed in ice water

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Why?

• 2 Theories
• Selective Attention Theory
• Dissociation Theory

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Selective Attention Theory

• 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
• Aspects of the Gate Control Theory???

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Dissociation Theory A divided consciousness?

• A dissociation or split between different levels
  of consciousness dissociating the sensation of
  pain with our emotional suffering
• Hilgard (1986) the hidden observer

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Reports of Pain in Hypnosis
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Relaxation and Meditation

• Progressive Muscle Relaxation
• Active training in tensing and relaxing muscles
• Mindfulness Meditation
• awareness without thought
• Transcendental Meditation
• Focused awareness on a single object or word
  (mantra)

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Spirituality and Prayer

• Recent trend
• Medicine and spiritual healing coming together
• Does spirituality promote health?
• 80 in US say yes
• But scientific evidence is mixed

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Chiropractic

• Chiropractic and massage are most frequently used
  practitioner-based CAM therapies
• 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
• For example Chiropractors in every zip code
  region in Kentucky

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Naturopathic Medicine

• Herbal therapy
• 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)
• Food Supplements
• Strong evidence supporting benefits
• Dietary Medicine
• 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)

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Naturopathic Medicine

• Do they work?
• Again, studies show mixed results

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Why do people use CAM?

• Very few individuals rely exclusively upon
  alternative modalities
• 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.

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Who practices CAM?

• 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

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Who practices CAM?

• Chiropractors
• Around 66,000 DCs in US
• Most accepted professional therapy
• Licensed in all states
• High patient satisfaction
• Massage Therapists
• Over 46,000 AMTA members in US
• Most common CAM modality in hospital-based
  programs
• Licensed in 2/3 of states

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Who practices CAM?

• Increasing numbers of dual-trained practitioners
• RNs
• Holistic Nursing Certification
• Therapeutic Touch, Healing Touch
• MDs
• American Board of Holistic Medicine
• American Board of Medical Acupuncture

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What about communication?

• Eisenberg (2001)
• Between 40 and 70 of CAM users do not disclose
  their use to their physician.
• WHY?

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Why does this matter?

• Kaufman (2002)
• 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

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Health psychologists role

• Always ask! What else are you doing for your
  health?
• Be open and nonjudgmental.
• Consider patient preferences and values.
• Encourage self-monitoring of results.

Eisenberg 1997
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Health psychologists role

• Coordinate care as appropriate.
• Be honest about your lack of knowledge and open
  to education.
• Monitor safety and efficacy, arrange follow-up.
• 8. Document all discussions and advice.

Eisenberg 1997
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Where are we now?

• 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
• 1992 2 M
• 2004 117.7 M

www.nccam.nih.gov
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Where does this leave us?

• Many conventional treatments
• have been adopted without good quality research
• are costly
• are invasive
• are likely to have adverse effects
• AND
• often provide inadequate relief

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Where does this leave us?

• CAM interventions generally
• are low cost
• are low risk
• are free of serious side effects
• AND
• are widely used

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CAM evidence and research Cancer-related
symptoms

• Research in progress on
• Nausea related to chemotherapy
• Acupuncture
• Ginger
• Pain and end-of-life symptoms
• Massage
• Acupuncture
• Fatigue
• L-carnitine
• Massage
• www.nccam.nih.gov/clinicaltrials

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CAM evidence and research Cancer-related
symptoms

• Research in progress on
• Quality of life
• Distant healing (glioblastoma)
• Mindfulness-based art therapy
• Healing touch (advanced cervical)
• Lymphedema
• Massage, manual lymph drainage
• (breast cancer)
• www.nccam.nih.gov/clinicaltrials

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Framework for approaching CAMin clinical
situations

• 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
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Evidence-based Medicine (EBM) and CAM

• EBM aims to integrate
• best research evidence
• clinical expertise
• patient values

Sackett 2000
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Integrative Medicine

• A combination of mainstream medical therapies and
  CAM therapies for which there is high-quality
  scientific evidence of safety and effectiveness

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Credits

• http//www.mc.uky.edu/cam/cam_presentations/CAM20
  an20integrative20approach202004-11-06.ppt