~Complementary and Alternative Medicine and Aging: Mindfulness for Stress Reduction

***Integrative Medicine

• "Bridging together conventional (usual or mainstream care or “Western” medicine) with complementary traditional/ancient medical treatments in a coordinated way.” (NCCIH)

***Allopathic Medicine

• The core of Western Medicine

• Describes the field of medicine that most people traditionally use and refer to when seeking medical care

• Also referred to as ”conventional” or “traditional medicine”

• Includes:

  • Diagnostic methods (i.e., laboratory testing, heart monitoring, imaging, and strength tests)

  • Treatment methods include prescription pharmaceuticals (including the medication and intravenous infusion), surgery, radiation, lifestyle recommendations (sometimes), and referral to specialists or therapy practitioners, such as physical, occupational, and speech therapists

• best used when people need immediate treatment

***Alternative Medicine

• Term used to describe any medical treatment outside of allopathic medical treatment

• Very broad term that can refer to thousands of treatment methods

• Some of these treatments are evidence-based, and some are in the experimental stages

• Practitioners of alternative medicine vary widely based on the training and type of alternative medicine

• The benefits and purpose will vary based on the specific modality, model of care, and symptom(s) being addressed

***Complementary Medicine

• Describes medical practices used in conjunction with standard medical care

  • e.g., taking anxiety medication + doing breathing exercises

• Similar to alternative medicine, as both are broad terms that can refer to nearly any method of care

  • The context in which they are used sets them apart

  • The difference between the two terms is whether or not conventional medical treatment is also being sought

***Mind-body Interventions

• Focus on treating the whole person

• Evoke the relaxation response (reduce sympathetic nervous system activity)

• Share a focus on attention to breath

• Share principles of…

  • movement/posture;

  • controlled breathing; and

  • focused attention/meditation

***Behavioral and ***Psychological Stress Response (allostasis)

Allostasis: “active process by which the body responds to daily events and maintains homeostasis (allostasis literally means “achieving stability through change”)

• Chronically increased allostasis can lead to pathophysiology (when your body fluctuates up and down due to constant stressors)

• Allostatic load or overload refers to the wear and tear that results from too much stress or inefficient management of allostasis, e.g., not turning off the response when it’s no longer needed; central role of the brain

Benefits and Costs of Stress

• Conceptualization of the inverted-U in the context of the benefits and costs of stress

• A broad array of neurobiological endpoints show the same property, which is that stress in the mild-to-moderate range has beneficial, salutary effects; subjectively, when exposure is transient, we typically experience this range as being stimulatory

• In contrast, both the complete absence of stress, or stress that is more severe and/or prolonged than that in the stimulatory range, have deleterious effects

***Mindfulness

• ***Mind-body Interventions

• Definition: “Paying attention to the breath on purpose, in the present moment, nonjudgmentally.“

• Being fully present with whatever is happening

• Being present for the unfolding rather than being driven by it; not running from the present or numbing oneself out

• Noticing emotions, thoughts, images, and bodily sensations that arise, and simply returning to awareness of the breath

• Nonjudgementally means with openness, acceptance, and curiosity

***Mindful Awareness equals __ + __ + __

== thoughts + emotions + sensations

Benefits of ***Mindfulness

• Stress Management

  • Reduced fight (anger/rage)-flight (running away)-freeze (paralyzed/frozen) stress response from autonomic nervous system

  • Buffer stress; build flexibility and balance

  • Stress is not the problem; it is how we relate to it

    • Change response/reaction to symptoms of stress

• Deeper awareness (playing with being less mechanical)

• Transformation

• Less judging

• Embodiment (greater awareness of being in your body)

  • More in touch with the warning signs and signals of the body

• More ownership of one’s life

• Mind cleaning

• Unification of mind and body

• Symptom Management

• Regulation of emotions

  • Disengagement from maladaptive, automatic reactions and negative thoughts; less self-preoccupied ruminative thought and vigilance

• Neuroplasticity- creates and strengthens new brain circuits

• Increased wakefulness and QOL/richness

***Mindfulness Approaches

• ***Mind-body Interventions

• Mindful Breath & Body Awareness

• Body Scan

• Mindfulness of Thoughts & Feelings

• Mindful Movement - tuning into repetitive motion of the body (movement as meditation):

  • Movement (swinging) of the arms with walking

  • Kicking of the feet with swimming

  • Footfall in running

  • Sense of the body moving in space

• Alternative objects of concentration (to the breath):

  • Tuning into:

    • Sensory Awareness: Body‘s touch points, sounds, gaze on an external object (e.g., sky or sunset)

    • Counting

    • Repeat short word or phrase (e.g., “calm“; “let it go”; “nothing to do, nowhere to go”)

***Walking Meditation Example

• ***Mind-body Interventions

• “When walking, just walk“

• No rushing, anticipation, wanting; without effort or striving

• Awareness of the swinging of the arms, foot falling, or striking

• Focus on different sensations –pressure, heaviness, stiffness, lightness, tingling; e.g., touch sensation of soles of feet hitting the ground beneath

• Mindfulness of body posture in space

***Mindful Breathing Example

• ***Mind-body Interventions

• Short guided, mindfulness exercises: 5–10 mins

  • Few minutes– 20 mins/day; as few as 3x breaths; the breath is always there to connect with

• Noticing the physical sensations of the breath rather than thinking about the breath

• Being with the breath rather than controlling it

• Not judging breaths as “too deep, too shallow, too irregular”

***Progressive Muscle Relaxation Example

• ***Mind-body Interventions

• A symptom of stress is muscle tension

• Edmund Jacobson began his work on reducing muscle tension through progressive muscle relaxation in 1908

• In order to relax, you must be able to differentiate between muscle tension and relaxation

• Start from your head or your feet, and

  • —> continue up or down your body

• For each part of your body, hold your breath and the tension for 3-4 seconds,

  • —> and then relax; when relaxing, exhale slowly and steadily

• After exhalation, spend a few seconds paying attention to the way you feel,

  • —> and then move on to the next part of your body

***Occupational Therapy and Complementary Therapy

• OTs can use any modalities, based on conventional medicine or CHA, in order to elicit occupational engagement

• This is within OT’s scope of practice if the therapist is knowledgeable in the appropriate modality

• In light of an increase in CHA use, the American Occupational Therapy Association stated that these approaches “may be used within the scope of occupational therapy practice when they are used in preparatory methods or purposeful activities to facilitate the ability of (patients) to engage in their daily life occupations”

***OT Process with Complementary Therapy

• As with any treatment modality, occupational therapists must complete an evaluation and treatment plan to determine if the patient’s deficits and needs warrant the use of CHA

• To maintain ethical and client-centered care in accordance with the values of the profession, an OT must assess the patient’s cultural traditions to determine if the use of CHA is appropriate

When is it ***outside of OT practice?

• Some occupational therapy practitioners may use CHA in a manner that is technically outside of occupational therapy’s scope of practice

  • This is acceptable only if the occupational therapist possesses the mandatory certifications and licenses to practice CHA with a primary concentration

***Types of Complimentary Health Approaches

• Acupuncture

• Animal-assisted therapy

• Aquatic therapy

• Aromatherapy

• Art therapy

• Biofeedback

• Cupping therapy

• Guided imagery

• Meditation

• Massage therapy

• Reiki

• Yoga

• Tai chi

• Etc.