Complementary & Alternative Therapies 1

Increasing Use of Complementary & Alternative Therapies

• Aging population

• Increasing number of chronic illnesses

• Increasing interest in unconventional interest
  — Less invasive, less "toxic," more natural
  — Lack of satisfaction with biomedical treatments
  — Patients desire to be more active in their treatment
  — Belief that combination of treatments produce better results
  — More research supporting alternative treatments
  — Increase in beliefs and values that incorporate the mind, body, and spirit or

- "holistic" approach

Complementary Therapies

• Integrative therapies

• Definition: Therapies used in addition to conventional treatment.

• Examples:

- Therapeutic Touch

- Guided imagery

- Breathwork

- Relaxation/Meditatio

- Exercise

- Massage

- Reflexology

- Prayer

- Biofeedback

- Hypnotherapy

- Creative therapies: Art, music, dance

- Chiropractic therapy

- Herbals

- Supplements

Alternative Therapies

• Definition: Therapies that replaces allopathic medical care.

• Examples: Any complementary therapy

• Examples of therapies only considered alternative (not complementary)
  — Traditional Chinese Medicine
  — Ayurveda
  — Naturopathy

Integrative Healthcare System & Nursing

• Integrative healthcare system: Patients are treated with both biomedical and
  complementary therapies.

• Integrative nursing: "A way of being-knowing-doing that advances the health and
  well-being of people, families, and communities through caring-healing
  relationships" (p. 710).
  — Advances health and well-being through caring-healing relationships
  — Uses evidence to inform traditional and emerging interventions that
  support whole-person/whole-systems healing
  — Weigh risks and benefits of each intervention when recommending
  complementary therapies

Relaxation Therapy

Helps individuals develop cognitive skills to reduce the negative ways in
which they respond to situations in their environment. Cognitive skills
include:

• Focusing- ability to identify, differentiate, maintain attention on, and return attention to simple stimuli for an extended period

• Passivity- ability to stop unnecessary goal-directed analytic activity

• Receptivity- ability to tolerate and accept experiences that are uncertain, unfamiliar, or paradoxica

Progressive Relaxation

• Teaches how to reduce tension in the body. Localize muscle tension one muscle group at a time. Should go through a logical order

• EX: starts with muscles in the face→ arms→hands→abdomen→ legs→ feet

Passive Relaxation

• Still the mind and body intentionally without the need to tighten and relax any particular body part

• EX: Slow abdominal breathing exercise while imaging warmth flowing through the hands

Clinical Application for Relaxation Therapy

• Lower BP and HR

• Decrease muscle tension

• Improve well-being

• Reduce symptom distress in persons experiencing a variety of situations

• Some research suggests reduction in anxiety, pain, depression, and
  breathlessness

Limitations of Relaxation Therapy

• Client may be resistant

• Some clients become hypertensive during meditation

• May increase the effects of certain drugs

  
  

Meditation

• Any activity that limits stimulus input by direction attention to
  a single unchanging or repetitive stimulus so that the person is able to
  become more aware of self.

• General term for a wide range of practice

• Four components:
  1. Quiet space
  2. Comfortable position
  3. Receptive attitude
  4. Focus of attention

Clinical Application of Meditation

• Reduces BP and overall HTN ris

• The peaceful, positive mental state is pleasurable and self-reinforcing

• Reduces relapses in alcohol treatment programs

• Positive results with PTSD and chronic pai

• May reduce depression, anxiety, distress, irritability

• May improve mood and sense of identity

Limitations of Meditation

• Client may be resistant

• Some clients become hypertensive during meditation

• May increase the effects of certain drugs

Imagery

• Mind-body therapy that uses conscious mind to create mental
  images to stimulate physical changes in the body, improve perceived well-
  being, and or/enhance self-awareness.

• Involves slow, abdominal breathing

• Direct the patient to visualize an image (describe using the five senses)

• Usually involves a powerful psychophysiologic response

• May reduce pain, improve sleep, and aid in the treatment of chronic illness

Clinical Application of Imagery

• Used for a wide range of illnesses

• Very few adverse effects

• May relieve pain, reduce nightmares, improve sleep

Limitations of Imagery

• Patients with PTSD or social anxiety disorders may experience
  increased anxiety and fear.

• Some patients with COPD or asthma experience increased airway
  constriction

Biofeedback

• Effective addition to relaxation programs

• Uses instruments to teach self-regulation and voluntary self- control over
  specific physiological responses.

• Instruments measure, process, and provide information to patients about
  1. Muscle tension
  2. Cardiac activity
  3. Respiratory rate
  4. Brain-wave patterns
  5. Autonomic nervous system activity

• Patients can perform relaxation techniques to manipulate these physiologic
  responses based on feedback from the measurement instrument

• Patients get immediate feedback on what relaxation techniques work for
  them

Clinical Applications for Biofeedback

• Stroke recovery

• Smoking cessation

• ADHD

• Epilepsy

• Headache disorders

• GI disorders

• Urinary tract disorders

Limitations for Biofeedback

• Resurfacing of suppressed emotions or feelings

• Long-term effects on BP, HR, and other physiologic parameters
  require close monitoring of medications

Acupuncture

• Realigns vital energy (qi) by inserting needles into the skin along channels
  called acupoints

• Evidence: Acupuncture modifies the body's response to pain

Clinical Applications of Acupuncture

• Low back pain

• Myofascial pain

• Hot flashes

• Chronic shoulder pain

• Headaches

• Osteoarthritis

• Plantar heel pain

Limitations of Acupuncture

• Infection

• Fainting

• Bleeding

• Contraindications: Bleeding disorders Skin irritation

Therapeutic Touch

• Affects the energy fields around the body with the conscious intent to heal

• Five phase:

• Centering, Assessing, Unruffling, Treating, Evaluating

• Clinical Application
  1. Pain
  2. Dementia
  3. Trauma
  4. Acute Anxiety

• Contraindications
  1. Conditions causing sensitivity to human interaction and touch
  (abuse, psychiatric disorders)

Traditional Chinese Medicine

• Large system of medicine with multiple concepts and treatment therapies

• Includes health promotion strategies:
  1. Healthy diet
  2. Regular exercise
  3. Regular meditation/introspection
  4. Healthy family/social relationships
  5. Avoidance of environmental toxins (cigarette smoke)

General Concepts

• Yin and yang – opposing yet complementary phenomena.
  Examples are hot/cold, night/day, etc.

• Yin represents shade, cold, and inhibition and the inner part of the
  body.

• Yang represents fire, light, and excitement and the outer part of the
  body.

• Disease occurs when there is a balance in these two paired
  opposites

Therapeutic Modalities

• Acupuncture

• Chinese herbs

• Tui na massage

• Moxibustion (burning herbs with healing properties near the skin)

• Cupping

• Tai chi

• Qi gong
  

Clinical Application
— Several!! May help with fibromyalgia and menopause

Natural Products and Herbal Therapies

• Table 32.2, “Safe or Effective Herbs Determined by Non-United States Regulatory Authorities,” page 719

• “Natural” does not always mean “safe”

• Medication interactions

• Instruct to inform providers about use of all herbal, botanical, vitamins, etc.

• Not regulated by the FDA