Complementary & Alternative Medicine in the Therapy Room

As aspiring mental health professionals and clinicians, we are constantly looking for new ways to improve our practice to better serve our clients. As a field, psychology is known for integrating new innovations into existing practices.

It is this receptivity and openness to new methods and practices that have been essential components to maintaining clinical competence within our field.

What is “CAM”?

In the last few years, we have seen a rapid increase in the use of complementary and alternative medicine (CAM) to promote health and wellness.

CAM is defined as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine” [1].

CAM is by no means a “new” invention, and has actually been around for thousands of years. The majority of CAM practices existed centuries ago in traditional non-Western cultures and have been documented in Ayurvedic Medicine and in Traditional Chinese Medicine.

In contrast to Western culture’s emphasis on physical functioning, non-Western cultures stress the importance of addressing connections between the physical, the psychological and the spiritual aspects of an individual, in order to promote overall health and wellness.

With the increase in diversity in the United States, the country has been exposed to different cultures, practices and beliefs with respect to health, wellness and disease management. For instance, many immigrant communities have brought with them various health practices that have greatly influenced medicine and clinical work within the U.S. The recent popularity of mindfulness, meditation, yoga, and many Buddhist principles demonstrate this clear shift in the way health professionals conceptualize and treat diseases.

Combining CAM With Therapy

In recent years, CAM has found its way into the therapy room, and many of us may be using CAM with our clients without even recognizing it.

In your clinical training, have you ever experimented with (or been interested in) hypnosis, biofeedback, meditation and progressive muscle relaxation? If so, then you are already integrating CAM into your work with clients…welcome to the wonderful world of integrative health care!

Although many mental health professionals integrate CAM techniques into their practices, it is important to recognize that for some CAM modalities (e.g., massage therapy, dance/movement therapy), extensive training culminating in licensure and certification is required. For other modalities (e.g., progressive muscle relaxation), additional training in the form of continuing education courses will be needed.

Even if you do not wish to become licensed or certified in each specific CAM modality, clinicians and researchers have noted the importance of having a working knowledge and basic level of familiarity with CAM and the relevant literature about its uses, benefits, and limitations [2].

Listed below are some of the most frequently used CAM modalities, which were reported in a large national survey conducted for the National Institutes of Health [3]:

Dietary Supplements

Dietary supplements are “intended to supplement the diet” [4] and can often be used to promote health and wellness as well as to treat pain, depression, and anxiety [5].

Commonly used dietary supplements include gingko biloba, St. John’s wort, vitamin supplements, and Echinacea. While psychologists may educate clients on the supplements, they should make referrals to primary care physicians when indicated.

Meditation

Meditation is a process in which clients focus their attention in order to gain insight into themselves and their environments. Typically, clients focus attention on “breathing, or on repeating a word, phrase or sound in order to suspend the stream of thoughts that normally occupies the conscious mind” [6].

Meditation is used to treat a variety of symptoms such as elevated blood pressure, anxiety, stress, pain, and insomnia, as well as to promote overall health and wellbeing [7]. Although no qualifications are necessary for practitioners of general meditation, many organizations offer certification in specific forms of meditation such as mindfulness-based meditation and transcendental meditation.

Aromatherapy

Aromatherapy is “the art and science of utilizing naturally extracted aromatic essences from plants to balance, harmonize and promote the health of body, mind and spirit” [8] and has been used for thousands of years.

Today, aromatherapy has shown positive results when used to treat pain, anxiety, and agitation specific to dementia [9; 10; 11]. Although certification is not required, it is recommended due to risks related to toxicity, skin irritation, and dosing regulations.

Progressive Muscle Relaxation

Progressive muscle relaxation (PMR) is a technique used frequently with clients who are experiencing anxiety, tension, or stress-related symptoms. During PMR, clients learn to tense and relax various muscle groups, in order to promote greater relaxation.

PMR is a CAM modality that many clinicians can integrate into their practice with minimal training.

Spirituality, Religion & Prayer

Despite controversy surrounding the involvement of spirituality, religion and prayer in the therapy room, studies have shown their benefits in the treatment of addiction, depression, and the symptoms of trauma [12; 13; 14].

Although spirituality, religion and prayer are three separate entities, they are all therapeutic resources that many clients rely on. While these modalities can be integrated into a clinician’s practice without formal certification, fundamental understanding of the faith-based practice and an understanding of ethical limitations are essential to ensuring clinical competence.

As you can see, there are many forms of CAM that clinicians can integrate into their practice with relative ease. Other forms of CAM that require more specific training and licensure include chiropractic, yoga, reiki, acupuncture, massage therapy, music therapy, and hypnosis.

As with all areas of psychology and clinical practice, it is important to consider potential ethical issues pertaining to the use of CAM, in order to ensure the highest standard of care for clients.

The following three things are significantly important for clinicians to address who wish to use CAM in their practices:

• First, it is essential for clinicians to be knowledgeable about the uses, limitations, interactions with other treatments, and potential benefits of CAM.
• In addition, it is important that the clinician possess the required knowledge and skills to be able to practice effectively and to not practice outside areas of demonstrated competence.
• Finally, clinicians must be sensitive to boundary issues and multiple relationships that may occur. For instance, it would be inappropriate for a psychologist to integrate CAM modalities requiring physical contact (e.g., Massage Therapy, Chiropractic, and Reiki) during sessions with a psychotherapy client.

Looking to add CAM modalities into your practice? Here’s a great place to start.

References

[1] National Center for Complementary and Alternative Medicine (NCCAM). (2011e). What is CAM? Retrieved from http://nccam.nih.gov/health/whatiscam/[2] Barnett, J. E., & Shale, A. J. (2012). The integration of Complementary and Alternative Medicine (CAM) into the practice of psychology: A vision for the future. Professional Psychology: Research and Practice, 43(6), 576.[3] Barnes, P. M., Bloom, B., & Nahin, R. L. (2008). Complementary and alternative medicine use among adults and children: United States, 2007. Retrieved from http://nccam.nih.gov/news/2008/nhsr12.pdf[4] Office of Dietary Supplements (ODS). (2011). Dietary supplements: Background information. Retrieved from http://ods.od.nih.gov/factsheets/dietarysupplements/[5] Geier, F. P., & Konstantinowicz, T. (2004). Kava treatment in patients with anxiety. Psychotherapy Research, 18, 297–300. doi:10.1002/ptr.1422[6] Mayo Clinic. (2010b). Book of alternative medicine (2nd ed.). New York, NY: Time, Inc.[7] Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A metaanalysis. Journal of Psychosomatic Research, 57, 35– 43. doi:10.1111/j.2042- 7166.2003.tb04008.x[8] National Association for Holistic Aromatherapy (NAHA). (2010). What is aromatherapy? Retrieved from http://www.naha.org/what_is_aromatherapy.htm[9] Han, S., Hur, M., Buckle, J., Choi, J., & Lee, M. S. (2006). Effect of aromatherapy on symptoms of dysmenorrhea in college students: A randomized placebo-controlled clinical trial. The Journal of Alternative and Complementary Medicine, 12, 535–541. doi:10.1089/ acm.2006.12.535[10] Lehrner, J., Marwinski, G., Lehr, S., Johren, P., & Deecke, L. (2005). Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office. Physiology & Behavior, 86, 92–95. doi:10.1016/ j.physbeh.2005.06.031[11] Lin, P. W., Chan, W., Ng, B. F., & Lam, L. C. (2007). Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: A cross-over randomized trial. International Journal of Geriatric Psychiatry, 22, 405– 410. doi:10.1002/gps.1688[12] Cook, C. (2004). Addiction and spirituality. Addiction, 99, 53
9 –551. doi:10.1111/j.1360-0443.2004.00715.x[13] Nasser, E., & Overholser, J. (2005). Recovery from major depression: The role of support from family, friends, and spiritual beliefs. Acta Psychiatrica Scandinavica, 111, 125–132. doi:10.1111/j.1600-0447.2004.00423.x[14] Vis, J., & Boynton, H. (2008). Spirituality and transcendent meaning making: Possibilities for enhancing posttraumatic growth. Journal of Religion & Spirituality in Social Work, 27, 69 – 86. doi:10.1080/ 15426430802113814