Dr Robert London

CAM: A Valuable Adjunct

Clinical Psychiatry News - Volume 37, Issue 4, Page 23 (April 2009)

The use of nontraditional, or complementary and alternative therapies to address health problems in this country is more common now more than ever.

A survey by The National Center for Health Statistics (“Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007) found that 4 out of 10 adults had used some type of CAM in the past 12 months.

People also are turning to CAM therapies more often to deal with stress, anxiety, and even chronic pain. More and more people I talk with explain that when they feel nervous or “uptight,” they take a yoga class, use deep breathing exercises, or practice meditation. These people are turning to nontraditional methods to dissipate stress or pressure from work or social situations—in much the same way as do those who jog or work out in the gym.

Others turn to these therapies when their chronic medical and psychiatric problems appear to go unsolved by mainstream medical treatment or when the costs of treatment exceed the amount allowed by an insurer.

In light of this enthusiasm for CAM therapies, why don't we embrace some of the mind-body techniques as adjuncts to enhance psychotherapy, thereby helping patients get and feel better?

The Centers for Disease Control and Prevention classifies CAM therapies as alternative medical systems, the most commonly used being acupuncture; biologically based therapies, which include vitamin and dietary supplements; manipulative and body-based therapies such as chiropractic and massage; and mind-body therapies, which include relaxation, yoga, and the energy healing therapy (Reiki). Of course, the CAM therapy most often used is prayer.

I began using hypnosis, relaxation, and deep breathing exercises in my practice more than 30 years ago as part of my interest in treating anxiety disorders and certain types of chronic pain such as headache and musculoskeletal problems.

I linked these techniques with behavior modification and to some extent cognitive therapy using my learning, philosophizing, and action technique. In lectures and seminars, I argue that hypnosis and relaxation alone were not a complete therapies, but adjuncts to a clinician's primary therapy, that is, a dentist using a mind-body technique for relaxation and pain control.

When I would use a hypnotic technique in a clinical setting, it would be adjunctive and coupled to some type of behavior modification such as systematic desensitization, reciprocal inhibition, or guided imagery. When using a cognitive approach, I could offer challenges to counterproductive thought patterns, while using the hypnotic or relaxation adjuncts. I still to this day use that same concept of linking a relaxation technique to a therapeutic model.

Some proponents of nontraditional therapies believe the mind-body components of CAM are treatments in themselves. It is easy to understand why these therapies alone without a primary therapy are so sought after. These therapies do allow participants to take the initiative in addressing their problem. Mind-body CAM therapies are action-oriented and involve breathing, stretching, meditating, and mentally moving away from anxieties or stressors—all of which initiate “shifting gears” into a different mental state.

This immediacy stands in contrast to much of mental health “talk” therapy, which is often a slow process toward improvement. Traditional mental health therapy centers around feelings, symbols, and abstractions, and the processing and integration of this new information takes time.

I remember my father, an eye surgeon, telling me years ago that when a person is in some form of physical or mental distress, they want help, and even if there is no direct treatment or cure, you must offer them something. If you don't, they will seek help elsewhere. I've heard this echoed by many physicians of almost all specialties. A good thing to come out of contemporary medical education and medical practice has been that doctors are no longer as tied to their own discipline as they once were. When a patient has a problem for which they have no direct treatment, many doctors will suggest alternatives such as yoga or tai chi for relief.

For many years I have had referrals from orthopedists and neurosurgeons to help their patients with chronic pain patterns, and from primary care colleagues to help patients develop strategies in headache control. Most of the orthopedic and neurosurgical referrals center on musculoskeletal chronic pain patterns, resulting from structural problems. The headaches were usually the migraine/tension type. In treating these patients, I had good success with guided imagery techniques centering on the imagined warmth or cold being applied to the affected painful areas to help reduce or control the chronic pain patterns. Other clinicians use acupuncture and biofeedback for similar problems. These techniques seem to offer different ceremonies to solve the same problems appealing to the aesthetics of different people and often giving relief.

Even though psychiatry is an essential part of health care, psychotherapy is not the only successful treatment for stress and anxiety-related disorders and for certain chronic pain patterns. Mind-body CAM therapies are valuable additions to care and can be important adjuncts to behavior modification strategies, medical hypnosis/behavioral approaches, or the cognitive therapies.

Let me know your thoughts on CAM therapies and how the mental health professions might use some of these techniques, and I'll try to share them with my readers.

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More and more Americans are turning to complementary and alternative therapies such as yoga, deep breathing exercises, and meditation to dissipate stress or pressure from work—in much the same way as do those who jog or work out in the gym. ©Brand X Pictures

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