fresh produce and grains surrounded by stethoscope in shape of heartComplementary and alternative medicine (CAM) refers to the array of therapies that extend beyond conventional Western medical treatments. The term complementary describes treatments used in conjunction with standard care, and the term alternative relates to less conventional methods of treatment. In recent years, the term “integrative health” has been used to describe the incorporation of evidence-based CAM therapies into conventional treatments for the purpose of enhancing overall health.

People seeking treatment for a range of mental health concerns may find some complementary or alternative treatment approaches to be helpful when these treatments are undertaken with the knowledge and support of a mental or medical health professional. 

History of CAM

The branch of medical care referred to as complementary and alternative medicine has been in practice in some parts of the world, such as China and India and among the numerous tribes of the indigenous American peoples, for hundreds of years. These traditional techniques may not necessarily be considered "complementary" or "alternative."  Before the 19th century, medicine was considered a supplemental field, and many techniques now viewed as complementary or alternative were mainstream at that time. Formal hospitals were rare, and most doctors practiced medicine part-time while satisfying other roles like judge, magistrate, farmer, or shop owner. At the start of the 19th century, conventional medicine began to take form, and over the course of the next several decades, the medical field grew rapidly.

Nonetheless, conventional medicine had its critics, who often claimed it to be expensive, risky, and imprecise. Some of these critics formed the Popular Health Movement (PHM), which flourished during the 1830s and 1840s and was devoted to the preservation of herbal remedies, nutrition, exercise, self-healing, and other practice methods of midwives and lay practitioners. The lasting impact the Popular Health Movement had on the medical field is still in effect today. In 1992, the National Institute of Health established the Office of Alternative Medicine (OAM), which was renamed the National Center for Complementary and Alternative Medicine (NCCAM) in 1998 and is now known as the National Center for Complementary and Integrative Health. Even today, CAM therapies continue to grow in popularity. National surveys show nearly 69% of Americans use at least one form of CAM treatment in any given year. 

"Integrative medicine," a term recently adopted by a number of government and educational organizations, is intended to emphasize the use of multiple therapy and treatment approaches in the achievement of optimal mind-body wellness and health, rather than suggest alternative approaches be used in the place of conventional medical treatments. 

How Popular Are CAM Approaches? 

A 2007 national survey of Americans showed that approximately 38% of adults and 12% of children reportedly use CAM. This amounts to approximately $33.9 billion in annual out-of-pocket expenses. Neither the use of vitamin or mineral supplements nor the use of prayer for health reasons were included in these figures, though both numbers have been included in CAM expenditure figures in the past. Additionally, although the above statistics represent overall CAM use and expenditures, people with diagnosed medical or mental health concerns tend to use CAM at higher rates than the general population.

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Among the most widely used CAM therapies are manipulative therapies (such as chiropractic and massage therapy) for back pain, yoga and other forms of exercise, and acupuncture. Dietary supplements, such as vitamins and herbal medicines, are also fairly common. Research indicates about half of all American adults take one or more dietary supplements. 

Integrating CAM into Therapy

The field of psychology consistently evolves and expands as new research leads to the development of new ideas regarding not only care and treatment but also the concepts of general health and well-being. Many individuals take a holistic approach to healing and wellness and, as part of this approach, incorporate techniques outside the fields of medical and mental health. These techniques, which may be movement-based, biological, or energy-based, include treatments such as acupuncture, massage therapy, yoga, Reiki, biofeedback, nutritional therapies, and meditation. Some have been proven to have a positive effect on mental and/or physical health, while others are not yet supported by scientific evidence. 

Because many of these treatments are not evidence-based, some people may fear criticism from health care professionals and be reluctant to tell physicians or therapists about any complementary or alternative treatments they are utilizing. However, not all CAM therapies are a good fit for every individual. Some have little evidence of benefit and may have the potential to harm. It is thus recommended that therapists encourage those in treatment to talk about any CAM use, without offering critique or judgment, in order to obtain a clear picture of treatment progress. Doing so can both help strengthen the therapeutic relationship by allowing the person in treatment to feel a greater sense of trust and provide an opening for a conversation about the potential risks and benefits of any complementary or alternative approach. When all members of an individual's health care team know about all approaches being used, they may be able to help those in treatment avoid potentially harmful drug or therapy interactions. 

Therapists do not typically prescribe oral intake therapies, such as herbal or vitamin supplementation, but some of those in treatment may choose to use these in order to help address mood issues or other concerns. Discussing the use of these supplements is considered by medical professionals to be as important as disclosing the use of prescribed medications and other mind/body-altering substances. 

A thoughtful, collaborative discussion of CAM therapies can potentially enrich the therapy experience for those who see these approaches as additional tools for emotional and physical healing. Therapists can introduce those in treatment to complementary approaches such as meditation or relaxation. Doctors can suggest chiropractic care or massage therapy. A person who has had success with a particular CAM approach can share this information with a provider, in the interest of increasing knowledge about CAM.

Integrative Health Psychology

The label “integrative health psychology” can help clarify the emphasis on enhancing overall health (mental and physical) via psychotherapy and complementary/alternative therapies. The term “integrative” as it relates to psychotherapy can be characterized as:

  • Drawing upon more than one psychotherapy model when working with people in therapy
  • Collaborating with all members of the health care team, when appropriate (including medical professionals, CAM practitioners, and any other health care providers)
  • Including complementary/alternative approaches into the psychotherapy process, when indicated

The above descriptors of integrative health psychology are not necessarily new ways of looking at mental health care. Mind-body approaches, such as guided imagery, hypnotherapy, meditation, and relaxation training have long been used by many to help manage mood, improve feelings of physical energy, and foster a general sense of well-being. 

Techniques such as these can easily be incorporated into talk therapy. A growing number of therapists already do so with good results. Mindfulness training, for example, was introduced as a practice outside of the realm of psychotherapy and has been shown to be effective in the treatment of several mental health issues. These approaches may be viewed as stand-alone therapies or treatment techniques that can be integrated into traditional psychotherapy. 

How Can Integrative Approaches Help? 

Unconventional approaches have been shown to have benefit for some individuals in the treatment of a number of mental health concerns, especially when used in addition to standard treatment or as part of a combined treatment plan. Caution is generally advised when choosing an alternative treatment approach, as the effects of many treatments have not been extensively studied or regulated and/or may be less well-known. However, some treatments are widely utilized and are known to be helpful as part of treatment. It is recommended that any alternative or complementary approach be first discussed with primary care providers.

Meditation-based approaches, for example, have been proven to have a largely positive impact, with few to no negative side effects.Meditation-based approaches have been proven to have a largely positive impact, with few to no negative side effects. Studies have shown meditation can be helpful in the treatment of insomnia and may potentially be helpful in reducing risk for self-harm and suicidal thoughts in adolescents.

Research has shown yoga, a meditation-based practice, may serve to reduce stress for many and can also be helpful in relieving symptoms of depression, anxiety, and possibly schizophrenia. Yoga has become fairly popular in the United States in recent years. According to national survey estimates, more than 7% of adults tried yoga at least once, and almost 4% had practiced yoga within the last year. Multiple studies have shown yoga may contribute to an improved mood and improved quality of life. 

Acupuncture, a form of traditional alternative medicine, may benefit in the treatment of chronic pain, according to research.

Omega-3 fatty acids, also known as fish oil, may help address mood concerns and depression. Some also believe fish oil helps enhance the effectiveness of antidepressants. Research has shown that young adults who begin taking omega-3 fatty acids after experiencing their first psychotic episode may be less likely to develop a more serious condition. Folate, otherwise known as folic acid and vitamin B9, may also be used to supplement traditional mental health treatment for people with depression and schizophrenia. One specific form of folate, I-methylfolate, has been approved for this use by the FDA.

Other CAM treatments people report benefit from include, but are not limited to: 

Criticisms and Limitations of CAM

Although a significant amount of research supports the safe and effective use of a number CAM therapies, people choosing to use a complementary or alternative approach may wish to seek the advice of their primary care provider and/or therapist and seek out certified, trained professionals who have received their training from an accredited institution. 

Supportive evidence is lacking in the case of many CAM approaches. In addition to research challenges, some safety concerns regarding CAM do exist.

  1. The application of CAM therapies in lieu of proven treatment in the case of life-threatening illness can put people at risk.
  2. The use of herbal supplements not backed by research or approved by the FDA can be dangerous. People may experience harmful drug interactions or ingest toxic or contaminated ingredients.
  3. Manipulation of the body can increase the risk of harm when the proper skill, knowledge, or training is not guaranteed.

While more research supporting the integration of alternative and complementary approaches may provide support for these treatments, controlled studies are often difficult to facilitate, due to the unique types of treatment that CAM encompasses. It can be challenging to apply conventional expectations of research to therapies that are unconventional. Further, due to the nature of CAM, the placebo effect that often negates efficacy in traditional research studies may be viewed as a self-healing procedure and thus provide evidence that a CAM therapy is effective. 

References: 

  1. Complementary & alternative medicine for mental health. (2016, April 8). Retrieved from http://www.mentalhealthamerica.net/sites/default/files/MHA_CAM.pdf
  2. Complementary health approaches. (n.d.). Retrieved from https://www.nami.org/Learn-More/Treatment/Complementary-Health-Approaches
  3. Gritz, J. R. (2015, June 25). The evolution of alternative medicine. The Atlantic. Retrieved from http://www.theatlantic.com/health/archive/2015/06/the-evolution-of-alternative-medicine/396458
  4. Mindfulness meditation may benefit people with chronic insomnia. (2014, September 1). Retrieved from https://nccih.nih.gov/research/results/spotlight/090114 
  5. Mindfulness meditation may reduce risk of suicidal thoughts in middle schoolers. (2014, April 27). Retrieved from https://nccih.nih.gov/research/results/spotlight/071514 
  6. National center for complementary and integrative health. (2016, March 17). Retrieved from https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-center-complementary-integrative-health-nccih
  7. National survey reveals use of mind and body practices, shifts in use of natural products. (2015, February 10). Retrieved from https://nccih.nih.gov/research/results/spotlight/0021015 
  8. Novella, S. (2015). Overview of complementary and alternative medicine. Retrieved from http://www.merckmanuals.com/professional/special-subjects/complementary-and-alternative-medicine/overview-of-complementary-and-alternative-medicine 
  9. Types of complementary and alternative medicine. (n.d.). Retrieved from http://m.hopkinsmedicine.org/healthlibrary/conditions/complementary_and_alternative_medicine/types_of_complementary_and_alternative_medicine_85,P00189 
  10. What is integrative health and medicine? (n.d.). Retrieved from http://aihm.org/about/what-is-integrative-medicine
  11. Yoga for anxiety and depression. (2009). Harvard Mental Health Letter. Retrieved from http://www.health.harvard.edu/mind-and-mood/yoga-for-anxiety-and-depression