Complimentary and Alternative MedicineMichelle NissenAngela RobinsonTeresa Siefke

Complementary and Alternative Medicine (CAM)

Objectives

• Define Complimentary and Alternative therapies

• Discuss the prevalence of CAM in society today

• Identify common therapies used in CAM

• Identify the risks of using CAM• Provide credible resources for the use

of CAM

Definition • Complimentary Medicine–medicines used that are not

mainstream but are used together with conventional medicine

• Alternative Medicine– non-mainstream medicines

used in place of conventional therapies

(US Department of Health and Human Services, 2013)

Categories of CAM

(Frass et al., 2012, p. 47)

Prevalence

Approximately 32.2% of the population uses some form of CAM - not including prayer

1997- 12.2 billion out of pocket2007 – 34 billion out of pocket

(Frass et al., 2012)

Prevalence Most used therapies

• Homeopathic• Acupuncture• Chiropractic Manipulation• Phytotherapy/Herbal Medicine• Massage

Five medical conditions that use CAM • Back pain• Depression• Insomnia• Severe headaches • Stomach ailments

(Frass et all., 2012)

Iridology

http://www.iridologyphg.com/

Analyze color, pigment distribution, and lacunae are believed to allow diagnosis of abnormalities and believe that these changes are “seen” before clinical manifestations are detected(Munstedt, et al., 2005)

Iridology• Analyze the iris to detect

certain diseases• 110 subjects to identify

cancer– Only three cases were

correctly identified– Yielded sensitivity of only

0.04

• Despite its popularity, iridology has shown no real benefit(Munstedt, et al., 2005)

Diet• Low fat (LF) vs low carbohydrate

(LC)– One year randomized clinical trial

• woman 25-50 years old• BMI 27-40 kg/m² • non-diabetic • generally healthy

• Total plasma insulin to determine the IR and IS individuals– IR >10.6 μIU/ml – IS <6.9 μIU/ml– Intermediate levels were excluded

(McClain, Otten, & Gardner, 2013)

Insulin Resistant

• LF diet– less likely to adhere and lose

weight when compared to IS

• LC diet–more success with weight loss

• Improved insulin levels compared to other groups – Degree of weight loss

correlated with improved insulin

(McClain, Otten, & Gardner, 2013)

Twelve-month change in diet by insulin

resistance status in diet groups

(McClain, Otten, & Gardner, 2013, p. 89)

Mediterranean• MedDiet consists mainly of– Fruits, vegetables, cereals, whole

grain breads, beans, nuts, seeds– Locally grown fresh and seasonal

foods– Sugars and honey only a few

times per week– Fat mainly from olive oil, low

amount of cheese, yogurt– Low red meat, high fish– Moderate red wine

(Hartley, Clarke, Hooper, Thorogood, & Stranges, 2013)

MedDiet & CVD• Survey of 11 RCTs– None could positively link

MedDiet to outcomes–Most showed reduction in

individual CVD risk factors• Small reductions in cholesterol,

LDL-C, triglycerides, and lowered blood pressure• No significant increase in HDL

or reduction in diabetes risk

(Hartley, Clarke, Hooper, Thorogood, & Stranges, 2013)

Metabolic Syndrome

(MetS)• Increased risk of CVD• Pro-inflammatory state

with elevated levels of inflammatory markers– C-reactive protein (CRP)– Interleukin-6 (IL-6)– Interleukin-8 (IL-8)– Tumor necrosis factor-α (TNF-

α)

(Richard, Couture, Desroches, & Lamarche, 2013)

MedDiet & MetS

• Four phase study– 5-week: control-feeding diet

(isocaloric/weight maintain)-to minimize inter-individual variations attributed to individual diet

– 5-week: controlled feeding MedDiet (isocaloric, no weight loss)-evaluate impact on inflammation before weight loss

– 20-week: free-living feeding for weight loss (-500kcal/day) with dietician assistance to reach a minimum of 5% body weight reduction

– 5-week: MedDiet after weight loss (isocaloric feeding/weight maintain)

(Richard, Couture, Desroches, & Lamarche, 2013)

Four Phase Study Design

(Richard, Couture, Desroches, & Lamarche, 2013, p. 53)

Results

• Even without clinically significant weight loss, a significant decrease in plasma CRP was found.

• Without clinically significant weight loss, little impact on IL-6, IL-18, and TNF-α were seen• these are adipose tissue-derived

cytokines(Richard, Couture, Desroches, & Lamarche, 2013, p. 54)

Issues• Traditional Remedies account for

35% of Acute Kidney Injury• The mortality rate is from 24% to

75% • Factors contributing to

nephrotoxicity– Incorrect use– Incorrect route of administration– Co-existing Illness– Interactions with other medications– Poor Storage

(Luycks, 2012)

Issues• alfalfa, and black cohash – transplant rejection• CKLS -a liver and spleen purifier –acute interstitial

nephritis• Cone flower (part of echinacia) used for fever or

prevention of colds- renal tubular acidosis and hypokalemai

• Creatinine- used for body building- acute interstitial nephritis

• Hydralazine sulfate- for cancer- hepatorenal syndrome• Ma- huang (contains euphedra) nephrolithiasis• Licorice- weight loss- ATN due to rhabdomyolysis • Pennyroyal- to induce abortion- ATN hepatorenal

syndrome• Spanish fly blister beetle- sexual stimulant, wart

removal- ATN, glomerular injury protein urea• St johns wort- depression- transplant rejection• Vitamin C- infection, cancer, fatigue, viral infections-

tubular calcium oxalate crystal deposition• Wormwood oil- stimulates digestion- rhabdomyolysis

(Luycks, 2012)

Chelation• Chelators bind to metal ions and are

then excreted via urine or feces– Have been used for treatment of heavy

metal accumulation and toxic poisoning, e.g. lead (Pb)

• Established for the treatment of mylodysplastic syndromes (MDS) and transfusional iron overload

• MDS is characterized by ineffective hemopoiesis, may progress to acute myeloid leukemia and approximately 90% are anemic

(Gattermann, 2008)

Guidelines• WHO classification of MDS 2002

– Refractory anemia– Refractory anemia with ringed

sideroblasts– Refractory anemia with excess blasts– Cytopenia with multilineage dysplasia– Refractory cytopenia with

multilineage dysplasia– Ringed sideroblasts– Unclassified meylodysplastic

syndrome– 5q-syndrome (separate subtype)

(Gattermann, 2008)

Supportive Therapy

• RBC transfusion, no agreed upon Hb threshold– Asian-Pacific 6-9 g/dL– Latin America 7-10 g/dL– Italian Society of Hematology

>8 g/dL– Hb >10g/dL is rare

• Case-by-case basis, symptoms, and co-morbid processes such as cardiac function, oxygenation, and quality of life

(Gattermann, 2008)

Iron Overload• Chronic transfusions result in

iron overload from catabolism of erythrocytes– iron levels exceeding binding

capacity of transferrin

• Monitor iron overload by serum ferritin is useful– not as accurate as

superconducting quantum interference device (SQUID) or hepatic MRI

(Gattermann, 2008)

Chelation Therapy

• Recommended to treat iron overload

• Initiation of therapy –When serum ferritin is ≥1000

μg/L – Patient has received two

units of RBC per month for one year

(Gattermann, 2008; NCCN task force report, 2009)

Medications

(NCCN task force report, 2009, p. S6)

Alzheimer’s Disease

• Metal ions accumulate in the brain in neurodegenerative diseases like Alzheimer’s Disease (AD)– copper (Cu)– iron (Fe)– zinc (Zn) – aluminum (Al)

(Hegde, et al., 2009)

Alzheimer’s cont.

• AD can have high levels compared to a normal brain– Cu 400 μM-vs-70 μM– Zn 1 mM-vs-350 μM

• Clioquinol (CQ)-specific Cu-Zn chelator • CQ has been banned in the US since

1971• PBT2, another hydroxyquinoline

ligand is in Phase IIa double blind trials in mouse model for AD

(Hegde, et al., 2009)

Natural Chelators

• Polyphenols– have antioxidant, anti-

inflammatory, and metal chelating properties

• Flavanoids are the largest group– include anthocyanins and

anthoxanthins– anthoxanthins further divided

• flavones, isoflavones, flavanols, and flavans

(Hegde, et al., 2009)

Curcumin• Curcumin also has

anti-inflammatory properties that are believed to reduce the swelling within neuronal cells

• Curcumin can bind with several metals, reducing their toxicity– include binding with

redox-active metals such as Cu and Fe

http://www.google.com/imgres?imgurl=http://www.curcuminresearch.org/Images/inhibits.jpg&imgrefurl=http://www.curcuminresearch.org/cancer.html&h=175&w=288&tbnid=Nmy4m16OGm3LFM:&zoom=1&tbnh=91&tbnw=151&usg=__UUko_UwOs-UQqeX7FObhgIK4BAQ=&docid=ZPZDFzVCDWUexM&itg=1&sa=X&ei=Nl6bU_eNHM6XyASsmoG4DQ&ved=0CO4BEPwdMAo(Hegde, et al., 2009)

EGCG• Polyphenols

– Epigallocatechin-3-gallate (EGCG), a polyphenolic, is the major component of green tea

– Green tea polyphenols are potent metal chelators, including Fe and Cu, which are associated with the pathogenesis in AD

http://www.google.com/imgres?imgurl=http://www.bjjee.com/wp-content/uploads/2013/01/keep-calm-and-drink-green-tea-39.png&imgrefurl=http://www.bjjee.com/nutrition/the-benefits-of-green-tea-lemon-for-bjj-players/&h=240&w=210&tbnid=yVwi9XLVMcKpvM:&zoom=1&tbnh=104&tbnw=91&usg=__wwTgHDzZAANB8dRtzhz5ux6r1Tk=&docid=PhqQxgie_v5ZvM&itg=1&sa=X&ei=oV6bU43zHta0yAT8zIDICQ&ved=0CMQBEPwdMAo

(Hegde, et al., 2009)

Anthroposophy Medicine

• Anthroposophical medicine was developed/inspired by Rudolf Steiner; Austrian philosopher and scientist (1861-1925)

• Anthropos = human; Sophia = wisdom

• Focused on the entire human being

• Extension to conventional medicine

• Anthroposophical doctors are fully licensed, board certified

http://www.rudolfsteineraudio.com/

Anthroposophic Medicine and Therapies in America, 2014)

Anthroposophical Medicine

• Rudolph Steiner joined a Dutch physician, Dr. Ita Wegmen to open first Anthroposophical medical clinic in Arleshim, Switzerland

• Dr. Wegmen developed a cancer treatment using extract from mistletoe, called Iscar, later developed into Iscador

• Iscador approved in Germany and a number of countries, clinical trials in U.S.A.

Anthroposophic Medicine and Therapies in America, 2014

https://www.google.com/

Countries practicing AM

http://www.ivaa.info/anthroposophic-medicine/facts-and-figures-am-worldwide/therapists-in-anthroposophic-medicine/

Mind-Body Therapies

Mind-body medicine concentrates on:• The interactions among the

mind, brain, body, and behavior• The ways in which emotional,

mental, social, spiritual, experimental, and behavior influences can affect one’s health

National Institute of Health, 2010

Tai Chi• Originated in ancient China, began as a

martial arts meaning “self-defense”• Consists of slow, relaxed, graceful movements

concentrating on body and mind• Referred to as “Meditation in motion” • Tai Chi safely promotes improvement with

balance, flexibility, and cardiovascular in aging adults with chronic conditions

• RCT compare the effectiveness of stroke survivor patients with Tai Chi, silver sneakers, and usual care on physical function, fall rate, and quality of life during a 12 week intervention

• Tai Chi led to improved aerobic endurance and reduced fall rates

Taylor-Piliae et al., 2014

Qigong • Similar to Tai Chi, most researcher

combine the two• Focus on physical movement, mental

focus, and deep breathing• Most effective with strengthening

bones, cardiovascular fitness, balance, and quality of life

• Researchers of Institute of Integral Qigong and Tai Chi analyzed 77 articles and 66 RCT’s, n=6410, strong evidence with positive health benefits of Tai Chi and Qigong

Qigong & Tai Chi

Alexander Technique

• Improves mobility posture performance and alertness

• Relieves chronic stiffness, tension and stress• In Asthma

– Improved• Forced expiratory flow 9%• Maximal inspiratory pressure 12%• Maximum Voluntary Ventilation 6%

(Cates, 2012)

• In Low back pain– Improved

• Number of day in pain from 27 of 28 to 3 of 28 (Woodman and Moore, 2012)

https://www.youtube.com/watch?v=-u8Py3GCYf4

(American Society for the Alexander Technique, 2014)

Feldenkrais Method

Two Techniques• Functional Integration

• Uses skilled manipulation and passive movements

• Awareness Through Movement• Uses guided attention and

purposeful movement

(The Feldenkrais Institute, 2013)

Feldinkrais Method

• Improves balance, mobility and balance confidence

• Shown to decrease a patients fear of falling (Ullmann, Willians, Hussey, Durstine, McClenaghan , 2010)

• Found significant improvement in physical and emotional well being and pain

• Increased ability to focus on positive aspects of recovery and decrease in dwelling on pain (Conners, Pile, Nichols, 2011)

Massage• Massage therapy uses the hands to

press, rub, and manipulate soft tissue

• One of the fastest growing aspects of CAM

– 31% of Americans received a massage in the last 5 years

– 15% of Americans discussed massage with their physicians in the past year

– 59% of patients would like to see massage covered by insurance

(American Massage Therapy Association, 2012; National Center for Complimentary and Alternative Medicine, 2014)

Massage

(Adams, White and Beckett, 2010, p. 8 )

MassageCHF

• Improved blood pressure, heart rate, respiratory rate and oxygen saturation

• Reported a reduction in anxiety(Chen et al., 2013)

Oncology• Included in the Evidence Based

Practice Guidelines for Integrative Oncology– Found that massage significantly

reduced pain and improved mood (Deng et al., 2009)

Reflexology• Certain pressure points on the

hands, feet and ears correspond with different body organs

• Applying pressure to different areas will improve function in the organ associated with this area.

• Found to be beneficial in pain associated with cancer and diabetic neuropathy

(Dalal, Maran, Pandey, & Tripathi, 2014, p. 6)

Rolfing• Based on the concept that

our connective tissue connects all parts of the body including muscles, bones, nerves and organs

• Very similar to massage but described as almost painful- works to balance the length and tone of all of the soft tissues in the body

(The Rolf Institute of Structural Integration, 2014)

ChiropracticManipulation

• The process of applying controlled force to the spine or joint to restore mobility, relieve pain and muscle tightness

• Based on the theory that tissues undergo chemical and physical changes that cause inflammation and pain

• Manipulation of these tissues restores mobility and alleviates pain

(The American Chiropractic Association, 2014)

Chiropractic Manipulation

• Spinal Manipulation is included in the Guidelines for control of low back pain by the American College of Physicians and the American Pain Society

• The Agency for Research and Quality also recommends the use of spinal manipulation for low back pain

• Use of the guidelines as part of the hospital based standardized care pathway resulted in a 95% satisfactory rating and a 68% reduction in pain

(National Center for Complimentary and Alternative Medicine, 2014)

Chiropractic Manipulation

Patients evaluated for low back pain received standardized or chiropractic treatment

Top graph does not show a significant reduction in pain the participants reported, however many fewer pain days with chiropractic therapy and no narcotic use

(Bishop, Quon, Fisher, & Dvorak, 2010, p. 1061)

Osteopathic Manipulation

• Very similar to Chiropractic Manipulation however is performed by a doctor osteopathic medicine

• This therapy has also been shown to reduce the need for analgesics when used for relief of back pain

(Seffinger et al., 2010)

Magnetic Therapy

• Ionizing electromagnetic fields energy decreases calcium transport alterations in human lymphocytes, supports natural killer cells to fight cancer and viruses, modulates traumatic brain injury, and reduces post-op infections

(Ross & Harrison, 2013)

Music Therapy• Classical Music– anxiety, depression, cardiovascular

disturbances, pain, stress, and sleep disorders

• Popular Music– eye opener

• Meditation Music– sedative effects

• Music from the Patients Youth– help with motivation, concentration

and improved mood

(Trappe, 2012)

Music TherapyCardiac Disease

• Reduces pain and respiratory rate• Reduces anxiety• Reduces systolic blood pressure and

heart rate• Improves sleep following cardiac

procedures or surgery• Reduces level of cortisol • Increases levels of oxytocin and PA02• Led to lower levels of anxiety

compared to subjects given midalozam

(Dileo, 2013; Trappe, 2010)

Light Therapy• Light therapy involves

exposure to blue light for a certain amount of time each day

• This exposure results in: – Increased sleep time of 18%– Increases in total sleep time – Decreases in awakenings – Improvement in daytime

fatigue(Tamrat, Huyn-Le, & Goyal ,2013, Chong, Tan, Tay, Wong, & Ancoli-Isreal, 2013, DPsych, Ponsford, Taffe, Lockley, &Rajaratnam ,2014)

Acupuncture• One of the oldest healing

practices in the world• Developed in ancient China• Stimulates parts of the

body to regulate flow of Qi along pathways called Meridians

• Done with very thin needles or cups or mugwart (National Center for Complimentary and Alternative

Medicine, 2014)

AcupunctureChinese Acupuncture Treatment based on extensive questioning and

observation

Japanese Acupuncture Uses the least amount of stimulation possible to affect the greatest amount of change

Korean Hand Acupuncture Hands are seen as microcosms of the body and needles are inserted into specific parts of the hand

Auricular Acupuncture The ears are the microcosms of the body and needles, seeds, and tacks are placed in and around the ear. Used for substance abuse

Scalp Acupuncture The scalp is seen as the microcosm. Used a lot for motor impairment and spinal conditions

Non-Insertion Acupuncture Uses blunt needles made of silver or platinum to touch the skin at specific points

Cupping Influences the flow of Qi and blood. The suction stimulates blood flow to the area

Moxibustion Burning mugwart to warm specific acupuncture sights and promote Qi

(Solleivo, 2012)

Acupuncture

(Acar, Cuvas, Ceyham, & Dikman, 2013, p. 421)

Anxiety and Surgery

Acupuncture

• Cerebral Aneurysm Rupture– Reduced angiographic

vasospasm– Reduced delayed ischemic

neurologic deficit

(Ko et al., 2013)

AromatherapyLaparoscopic intra-abdominal

surgery (LABG) chosen for:– Similar postoperative

requirements due to uniformity of surgery technique

– Visceral pain does not typically respond well to opioids

– Reducing opioid adverse effects in morbidly obese patients

(Kim, et al., 2001)

Post-operative pain

Use of Lavender oil decreased amount of morphine use

• Lavender (n=26) 2.38 mg • Placebo (n=27) 4.26 mg

(P<.04)

There was no statistical significance in the need for antiemetics or antihypertensives

(Kim, et al., 2001)

Work StressSeven categories:

• Environment, structure, changes

• Non-optimal work arrangements

• Patient care demands• Collaboration with others• Workload• Role conflict and

ambiguity• Personality factors; Type A

behavior patterns and locus of control

(Davis, Cooke, Holzhauser, Jones, & Finucane, 2005)

http://jeffreysterlingmd.files.wordpress.com/2014/01/stress-management-checklist-to-survive-and-thrive.jpg

Study• 15 minute seated massage– 16 per week for 12 weeks– Participants chosen at random

with subsequent consent to participate

– Massages per participant averaged 2.7 per person

• Music via earphones• Aromatherapy spray mist– One of four scents, chosen by

participant

(Davis, Cooke, Holzhauser, Jones, & Finucane, 2005)

ED Nurses• Data collection of

Perceived Occupational Stress Scale (POSS) and consisted of 46 questions

• Pretest and posttest response of 48% was achieved

• 86% improvement in anxiety after massage

(Davis, Cooke, Holzhauser, Jones, & Finucane, 2005)

Relaxation Techniques

• Autogenic training• Biofeedback• Deep-breathing exercises• Guided Imagery• Meditation• Self Hypnosis• Prayer

Autogenic Training • Autogenic training was developed

by, German neurologist Johannes Schultz, about a 100 years ago

• Autogenic = self-generating; you are in control

• AT is composed of six mental exercises aimed at reducing anger, tension, and stress

• AT main goal is to achieve a relaxed state of main and decrease stress

(National Center for Complementary and Alternative Medicine, 2014)

Autogenic Training

• Concentrates on reducing anxiety, depression, stress, and GI disturbances

• 59 patients, randomized chose to participant in a study with standardized care or autogenic training

• The results; baseline standard deviation at two and five months, BP & HR baseline and at five months

AnxietyState

BaselineSD

2 Month

5 Month

BP 5 Month

HR 5 Month

Experimental group

10.3 9.8 8.8 17.9 7.3 14.3 9.3

Control group 11.3 14.5 15.5 15 22.3 12.2 11.6

(Kanji, N., White, A., & Ernest, E.,2004)

Autogenic Training & Tension Headaches

• Seven clinical control trials included• Different methods of CAM methods

were chosen to evaluate headaches • Hypnosis, biofeedback, autogenetic

training, and control groups• The results: inconclusive, the

presence of evidence is insufficient• Self-Hypnosis did show a small

improvement• Biofeedback is more effective than

AT & the preferred treatment

(Kanji, N., White, A. R., & Ernest, E., 2006)

Biofeedback• Developed in the 1960’s to train experimental

research subjects to alter brain activity, BP, HR, and other functions not controlled voluntarily

• Use electronic devices to teach a person how to consciously produce relaxation state

• Physical therapist use biofeedback in stroke patients to help regain movement in paralyzed muscles

• Psychologists use it in anxious or tense patients to produce a calming affect

• Specialists incorporate with patients experiencing pain

• Can assist in reducing migraines or tension headaches, digestive disorders, hypertension, cardiac arrhythmias, Raynaud's disease, epilepsy, and some movement disorders(Andrasik, 2010)

Biofeedback & Headaches• Techniques: biofeedback-assisted relaxation

response or more specialized approaches• Biofeedback-assisted relaxation response for

headaches has bend evaluated for decades via comprehensive reviews by expert panels and meta-analytic statistical analysis

• Relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive-behavioral therapy may be considered as treatment options for prevention of migraine (Grade A evidence)

• Behavioral therapy(biofeedback, relaxation) may be combined with preventive drug therapy to achieve additional clinical improvement for migraine relief (Grade B evidence)

• Evidenced-based recommendations are not yet possible on the use of hypnosis, acupuncture, TENS, cervical manipulation, or hyperbaric oxygen as preventative or acute therapy for migraine (Grade C evidence)

(Andrasik, 2010)

Biofeedback Statistics of

Migraine Patients

(Andrasik, 2010, p. 75)

Guided Imagery/

Self-Hypnosis

Self-Hypnosis

Meditation• Meditation refers to a group of techniques:

mantra meditation, relaxation response, and mindfulness meditation

• Developed in the Eastern religious or spiritual traditions

• Meditation is practiced globally for health and well-being, outside of the traditional development

• Meditation teaches a person how to focus, concentrating on mindful thoughts, feelings, and sensations while observing in nonjudgmental way

• Most used for anxiety, pain, depression, stress, insomnia, and overall wellness

MeditationMood, BP, & Heart rate reduction

•Mindfulness meditation is used to reduce negativity, depression, tension, fatigue, anxiety and lower heart rate•A study conducted identified a significant drop in negative mood, 88%

Lower Acute Respiratory Infections•Comparison of a control, exercise, and mindfulness meditation group underwent monitoring of ARI’s and the outcomes monitoring incidence, duration, and global severity.•The results conducted a significant reduction of ARI’s with meditation (incidence, duration, and global severity) when compared to the control group• Incidence 33%, duration 43%, and global severity 60% lower if a person practiced mindfulness meditation when compared to the control group

(Zeidan, Johnson, Gordon, & Goolkasian, 2010; Barrett et al., 2010)

Yoga- Historical origins in ancient

Indian philosophy- Incorporates mind and body- Combines physical posture,

breathing techniques, meditation, and distinct philosophy

- Different types of Yoga - Yoga is sixth common used

CAM National Institute of Health, 2014

Benefits of Yoga

• Decrease low back pain• Reduce anxiety and stress• Enhance quality of life• Improve overall fitness and

well-being• Improve mood/ depression

Yoga and Chronic Back

Pain• A RCT n= 228 adults; enrolled in yoga, stretching exercises, or issued a self-care book to examine the best reduction in back pain

• After 12 weeks of therapy yoga group were superior to the self-care group for function, -2.5[95% CI, -3.7 TO -1.3]; P<.001 & mean difference symptoms, -1.1 [95% CI, -1.7 TO -0.4]; P<.001.

• 26 Weeks mean difference yoga superior, -1.8 [95% CI, -3.1 TO -0.5]; P<.001

• Yoga was not superior to stretching

Yoga and Smoking Cessation

• A study of 55 women, randomized to examine yoga and smoking cessation compared to general health and wellness group

• At end of eight weeks yoga demonstrated 24hour smoking cessation vs wellness condition, (46.9% vs 17.4%; odds ratio 4.19; 95% CI, 1.2-15.1; P=0.029

• Yoga more likely to have attained 7-day point prevalence abstinence (7PPA) vs wellness condition; (40.6% vs 13% odd ratio; 4.56; 95%CI, 1.1-18.6; P=0.034

Yoga & Anxiety

Bock et al., p.245 2012

Issues• Yoga low-impact• Low side effects• Recommend guidance of

well-trained instructor• Stroke and nerve pain, rare

possibilities• Pregnant women with certain

medical history should avoid some types of yoga

National Center of Complementary Alternative Medicine, 2014

Hypnosis• Also known as hypnotherapy• Evolved in the 1700’s accidentally by

somnambulism (sleepwalking).• Focused relaxation state of awareness to

alter desired medical conditions • Facilitate communication between bilateral

sides of the brain • Person is always in control, but fully relaxed• Three aspects to hypnosis: absorption,

dissociation, and suggestibility • Commonly used to treat anxiety, chronic

pain, depression, GI disturbances, HTN, insomnia, and hot flashes cancer or postmenopausal women

National Center for Complementary Alternative Medicine, 2014

Hypnosis Studies

• Multiple meta-analyses support hypnosis for management of symptoms associated with chemotherapy, surgical & invasive procedures

• Results identified a reduction in symptomology; N/V, pain, anxiety, and distress

• Emotional distress improved 82% undergoing invasive procedures

• Post-operative anxiety reduced with hypnosis

Lew, Kravits, Garberoglio, & Williams, 2011

Guided Imagery

• Focuses on pleasant images or visualizations to replace negative or stressful occurrences

• Promotes relaxation• Most commonly used to promote

sleep, calm emotions, reduce anxiety, depression, and decrease pain

Group Therapy & Cognitive Behavior

Therapy• Similar in nature, focus on cognitive

(thoughts) and behavior (actions) to change an underlying concern

• A RCT comparing multidimensional family therapy and cognitive behavior or a drug addiction

• Data gathered at baseline, termination, six, and twelve months, n=224

• Results determined both interventions are promising treatments

Liddle, Dakof, Turner, Henderson, & Greenbaum, 2008

Homeopathic

Pet Therapy• Animal-assisted therapy is a complementary

intervention, primarily dogs• Evidence supporting therapeutic animal

visits for medical and surgical patients with pervasive developmental disorders; cerebral palsy, speech disorders, cardiovascular disease, Alzheimer's disease, schizophrenia, cancer, spinal cord injuries, and extended rehabilitation facilities

• A literature review provided Class IIa-IIb evidence, recommending animal-assisted therapy to optimize healing environments

Pet Therapy Studies

Prayer