Shamanic healing Identifying Appropriate CAM Modalities

Reviews of Complementary, Alternative, and Integrative Approaches

• This section reviews evidence for specific CAM and integrative modalities used to treat common mental health problems, focusing on those validated by research findings.

Pharmacologic and Related Treatments

Dietary Modification

• Suboptimal intake of nutrients like omega-3s, magnesium, B12, and zinc impacts the microbiome and gut–brain axis, increasing depression risk.

• Reducing refined sugar and caffeine can improve mood.

• Caffeine increases epinephrine, norepinephrine, and cortisol, causing nervousness and panic attacks in predisposed individuals.

• Folate, B6, and B12 in legumes, greens, and beets enhance mood by aiding serotonin, dopamine, and norepinephrine synthesis.

• Omega-3 sources include salmon, halibut, and flaxseed oil.

• Higher omega-3 intake correlates with lower C-reactive protein and reduced risk of inflammatory disorders like depression and Alzheimer's.

• Lower depression and suicide rates are seen in countries with high fish consumption, like Japan (0.12%), compared to low consumption countries like New Zealand (6%).

• Fish consumption two to three times weekly reduces cognitive decline risk in older adults. High fish intake is inversely correlated with cognitive impairment, while high linoleic acid intake correlates with higher cognitive decline rates.

• Lifestyle factors influence dietary preferences, affecting Alzheimer's risk. Excess caloric and high-fat intake promote free radicals, increasing Alzheimer's risk. A meta-analysis showed a 0.3% increase in Alzheimer's risk per 100-calorie increase in daily intake.

• Moderate wine consumption (two to four glasses per day) is associated with a reduced risk of Alzheimer's.

• Ketogenic diets may have antidepressant and anxiolytic effects, mainly from animal studies.

• Chronic alcohol abuse leads to malnutrition, reducing thiamin, folate, B6, and trace minerals. Hypoglycemia from alcohol's liver effects can cause confusion and anxiety. Improved nutrition may aid alcoholics in maintaining sobriety; one study showed 80% abstinence at 6 months with a caffeine-free, low-sugar diet.

Probiotics

• Probiotics' health and mental health benefits are under intensive research.

• Neuropsychiatric disorders like autism, depression, anxiety, and schizophrenia involve dysregulation of the microbiota–gut–brain (MGB) axis.

• Probiotics' antidepressant effects may be mediated by immune modulation, anti-inflammatory effects, and neurotransmitter pathway modulation.

• Individual gut microbiota variations may require personalized probiotic selection.

• Probiotics may have therapeutic effects on mild to moderate depressive symptoms.

• A meta-analysis found non-significant overall mood differences in subjects taking probiotics versus placebo.

• A review found inconsistent evidence for probiotics reducing depression and anxiety.

• A study found that probiotic supplementation significantly reduces the severity of depressed mood and anxiety.

• Studies on probiotics in neuropsychiatric disorders are limited by small study sizes and methodologic problems. Outcomes vary based on probiotic formulas, study populations, and study design. Probiotics are generally well-tolerated but contraindicated in immunocompromised individuals due to potential complications.

Vitamins B-FAMILY VITAMINS

• Folate is needed for SAMe synthesis. Folate deficiency increases homocysteine and depression risk.

• L-methylfolinic acid more readily crosses the blood–brain barrier and enhances antidepressant efficacy.

• Folate augmentation (1 to 15 mg per day) enhances antidepressant efficacy. Folic acid (200 to 400 μg per day) might enhance lithium carbonate benefits in manic patients.

• Folate deficiency in schizophrenia patients may result from malnutrition and antipsychotic effects. Methylfolate may reduce psychotic symptoms.

• Low folate, niacin, and thiamin are associated with cognitive impairment.

• Folate or B12 deficiency doubles Alzheimer's risk. However, evidence for vitamin B supplementation as a treatment of cognitive impairment, including dementia, is inconclusive.

• L-methylfolinic acid can be used without checking b12 levels

• B12 is often recommended for older adults with impaired cognition but research is inconsistent. Patients cognitively impaired for less than 1-year experienced significant improvements in cognitive function, whereas patients who had been impaired for longer than 1 year became worse, suggesting that supplementation may ameliorate symptoms related to B12 deficiency only in the early stages of cognitive impairment.

• Alcoholics often deficient in thiamin, folate, B6, and B12 may benefit from supplementation.

• Thiamin is essential for acetylcholine metabolism. It improves mood and energy. It may lessen symptom severity in patients diagnosed with schizophrenia. Thiamin-dependent enzymes may be abnormal in Alzheimer disease.

• Niacin may protect the liver against the acute toxic effects of alcohol in individuals who have relapsed.

• High-dose niacin has become standard therapy for schizophrenia in orthomolecular psychiatry.

• Nonmedicated patients with schizophrenia in the early acute phase of illness may experience significant and sustained benefits from high doses of niacin.

• Inositol, a B vitamin, showed nonsignificant benefits over placebo for mood and anxiety disorders.

• Inositol and imipramine were equally effective in reducing panic attacks.

VITAMIN D-3 (CHOLECALCIFEROL)

• Vitamin D3 has anti-inflammatory, immunomodulatory, and neuroprotective effects and increases levels of the rate-limiting enzyme needed for the synthesis of serotonin, dopamine, and norepinephrine.

• Vitamin D deficiency is common and may increase depression risk. Supplementation may reduce depression severity in seasonal affective disorder when serum D3 levels are raised to 35 ng/mL or greater.

• Vitamin D supplementation is more effective against major depressive disorder than milder forms of depressed mood. It resulted in moderate improvement in depressed mood.

• High doses of vitamin D may be more effective than bright light therapy in treating seasonal depressed mood.

Minerals

• Magnesium is essential for neuronal cell membrane fluidity and neuroplasticity and plays a central role in the brain’s antioxidant protective mechanisms. Magnesium deficiency is an established risk factor for overall poor mental health, depressed mood, and cognitive impairment.

• Zinc has general neuroprotective effects, is involved in hippocampal neurogenesis, and modulates the activity of the hypothalamic-pituitary axis. Abnormal low zinc serum levels may be mediated by dysregulation of the immune system.

• Research findings on the mood-enhancing effects of magnesium and zinc are inconsistent. Zinc supplementation resulted in modest improvements in symptom severity.

• Preliminary evidence supports zinc supplementation's antidepressant efficacy as an adjuvant to prescription antidepressants.

• High copper levels may cause Alzheimer disease by damaging the molecule required to eliminate amyloid-beta plaques soon after they are formed.

• Selenium deficiency may cause degeneration of the GABA neurotransmitter system, increasing the risk of Alzheimer disease, Parkinson disease, and other neuropsychiatric disorders. Selenium supplementation may reduce symptoms of anxiety and depressed mood in some populations.

Amino Acids 5-HYDROXYTRYPTOPHAN, L-TRYPTOPHAN

• 5-hydroxytryptophan and L- tryptophan have been investigated for their putative antidepressant and anxiolytic effects.

• 5-HTP is generally preferred over L-tryptophan because it crosses the blood–brain barrier more readily, is converted into serotonin more efficiently than L- tryptophan, and has more marked antidepressant effects.

• Findings of placebo-controlled studies support that 5-HTP starts to have antidepressant effects at doses between 100 and 300 mg/day.

• 5-HTP is moderately sedating, and doses greater than 100 mg should be taken at bedtime. RCTs have reported consistent anxiolytic effects of 5-HTP for generalized anxiety and panic disorder.

• L-Tryptophan, 1 g, at bedtime reduces time to sleep onset in mild situational insomnia, and doses up to 15 g may be necessary for severe insomnia. Case reports suggest that nighttime use of 5-HTP at 300 to 600 mg may improve mild to moderate insomnia and lessen sleep disturbances related to obstructive sleep apnea and narcolepsy.

• Treatments employing the amino acid precursors of serotonin (i.e., 5-HTP) and dopamine (i.e., L-tyrosine) must be properly balanced in order to be efficacious over the long term.

• Both amino acids are contraindicated in combination with MAOIs as the combination may result in a serious serotonin syndrome. Both amino acids are also contraindicated in combination with lithium because they can elevate serum lithium levels to toxic levels.

ACETYL-L-CARNITINE

• Acetyl-L-carnitine (ALC) has been investigated as a novel antidepressant because of its beneficial effects on neuroplasticity, neuronal cell membranes, and neurotransmitter modulation.

• ALC may slow the rate of cognitive decline in normal aging, dementia, and traumatic brain injury.

• ALC may accelerate response when taken as a monotherapy or an adjunct to antidepressants. Relatively greater antidepressant effects were observed in older subjects, and side effects were significantly lower in subjects taking ALC.

• Findings of RCTs suggest that ALC 1.5 to 3 g/day improves age-related symptoms of cognitive impairment in healthy older adult nondemented individuals and depressed older adult patients.

• ALC 1,500 to 3,000 mg/day improves reaction time, memory, and cognitive performance in patients with dementia and may slow the rate of progression of cognitive impairment.

• Younger individuals experiencing presenile dementia may benefit more than older individuals, and for unclear reasons, 62 years may be the “optimal age” beyond which ALC loses much of its cognitive- enhancing effects. ALC is generally well tolerated and may be safely used in combination with antidepressants and cholinesterase inhibitors.

L-THEANINE

• L-Theanine (N-ethyl-L-glutamine), found in green tea, is used to treat anxiety and depressed mood. Animal studies confirm that L-theanine increases brain serotonin, dopamine, and γ-aminobutyric acid (GABA) levels and may have general neuroprotective effects.

• Anxiety-reducing effects of L-theanine are believed to be mediated by enhanced EEG alpha activity in the occipital and parietal regions that are dose-dependent and reportedly similar to EEG changes observed during meditation.

• Calming effects may last 8 to 10 hours and are usually experienced within 30 minutes following ingestion of L-theanine at doses between 50 and 200 mg.

• A 2020 systematic review of RCTs on L-theanine for reducing stress- response and anxiety symptoms in healthy individuals found consistent positive evidence for efficacy at doses of 200 to 400 mg/day.

• L-Theanine is generally well tolerated, and there are no published reports of serious adverse side effects or interactions with other natural products or conventional medications.

N-ACETYL-CYSTEINE

• The findings of animal and human studies suggest that NAC decreases neuronal glutamate release. Limited findings suggest that NAC 2 to 3 g/day may be a safe and effective adjunctive treatment of moderately severe OCD and trichotillomania (TTM) in adults but not severe OCD or TTM in children and adolescents.

• Individuals in the NAC group experienced significantly greater reductions in hair-pulling behavior compared to the placebo group, and no adverse effects were reported.

• Findings on NAC in bipolar disorder are inconsistent. In a 2-month open-label phase of a randomized placebo- controlled study, moderately depressed bipolar patients treated with NAC 1 g BID experienced significantly decreased indices of functioning and improved life quality compared to the placebo group.

GLYCINE

• Glycine functions as an inhibitory neurotransmitter. Glycine and glutamate are required co-agonists for the activation of NMDA receptors.

• Case reports and RCTs suggest that glycine and other naturally occurring NMDA agonists help correct NMDA receptor dysfunction underlying negative symptoms and cognitive impairments in schizophrenia.

• A small open trial found that negative psychotic symptoms improve with glycine at doses up to 60 g per day.

• Glycine is well tolerated.

LYSINE AND ARGININE

• Limited findings suggest that lysine and arginine may enhance stress-response and reduce general anxiety when used alone or in combination.

• L-Lysine and L-arginine are generally well tolerated, and serious adverse effects have not been reported.

S-ADENOSYL METHIONINE

• SAMe is essential for synthesis of serotonin, dopamine, and norepinephrine. It is a widely used treatment of depression, arthritis, and fibromyalgia.

• Folic acid and B12 are required cofactors for re-methylation of homocysteine back to SAMe and are routinely recommended to patients taking SAMe.

• Although SAMe has been widely used for many years to treat depressed mood, large placebo-controlled studies have been conducted only in the last few decades. Recent well-powered studies and systematic reviews have reported non-significant or inconsistent findings.

• Advantages of SAMe over antidepressants include relatively rapid onset of action, usually within 1 week of starting treatment, the absence of clinically significant interactions with drugs, and relatively few side effects compared with antidepressants. The standard maintenance regimen for depressed mood is between 800 and 1,600 mg in two to four divided doses.

• Omega-3 Fatty Acids

  • EPA and DHA investigated for mood disorders, ADHD, and schizophrenia.

  • Mechanisms: Increased serotonin, anti-inflammatory effects, and modulation of phosphatidyl-inositol activity.

  • Effective as adjunctive treatment for depressed mood (1-2 g/day), especially high-EPA formulas.

  • May benefit obese individuals with high inflammation.

  • May reduce anxiety related to substance abuse, test-taking, and hormonal changes.

  • Side effects: GI upset, nausea, bloating, diarrhea; small risk of increased bleeding.

  • May be used as preventive strategy for schizophrenia in high-risk individuals.

  • Not effective for established schizophrenia.

• Phosphatidyl Serine and Phosphatidyl Choline

  • Phosphatidyl serine may improve cognitive function and memory in early Alzheimer's.

  • CDP-choline may improve cognitive performance in early Alzheimer's and aid stroke recovery.

• Multinutrient Formulas

  • Evidence of efficacy for high-dose vitamin B complex and micronutrient formulas for stress, anxiety, and PTSD.

  • High-dose formulas generally more effective.

  • Significant findings include stress-reducing effects of EFAs, reduced premenstrual anxiety with Mg and B6, and reduced anxiety with high-dose vitamin C.

  • Micronutrient formulas generally well-tolerated, but high doses of vitamin A can cause toxicity.

• Botanicals

  • Ashwagandha:

    • Effective for anxiety related to chronic stress and may be an adjunctive treatment for GAD.

    • Doses: 125-1,200 mg/day.

    • Side effects: GI distress, diarrhea; avoid during pregnancy.

  • Cannabidiol (CBD):

    • Potential treatment for GAD, panic disorder, social anxiety, OCD, and PTSD.

    • Well-tolerated at doses up to 1,500 mg/day.

    • Side effects: Dry mouth, low blood pressure, lightheadedness, drowsiness.

  • Golden Bouquet (Galphimia glauca):

    • Anxiolytic effects comparable to benzodiazepines for GAD.

    • Dose: 310 mg BID.

    • Side effects: Headaches, GI distress, and sedation.

  • Ginkgo Biloba:

    • Used for dementia and neurodegenerative diseases; neuroprotective effects.

    • May improve cognitive performance, especially when combined with Panax ginseng.

    • Dose: 160 mg per day

    • Side effects: Upset stomach, dizziness, headaches; avoid with aspirin, warfarin, or heparin.

  • Ginseng (Panax Ginseng):

    • May improve visual working memory in schizophrenia patients.

    • May reduce neurologic adverse effects of antipsychotics.

  • Kava (Piper Methysticum):

    • Used for stress and moderate anxiety.

    • Dose: 70-240 mg per day of kava lactones

    • Side effects: Nausea, rash, headaches, dizziness; avoid during pregnancy and with alcohol/benzodiazepines; potential liver toxicity.

  • Lavender (Lavandula Officinalis):

    • Anxiolytic properties; Silexan (standardized oral preparation) comparable to SSRIs and benzodiazepines for GAD.

    • Dose: 80-160 mg/day.

  • Roserooot (Rhodiola Rosea):

    • Enhances stamina, reduces fatigue and stress-related anxiety.

    • Doses of 340 to 680 mg/day for mild to moderate depressed mood can be effective, or 200mg BID for stress reducing effects.

    • Side effects: Dizziness, dry mouth, and excessive salivation.

  • Saffron (Crocus Sativus):

    • Comparable efficacy to antidepressants for mild to moderately severe depressed mood.

    • Dose: 20-30 mg/day.

  • St. John's Wart (Hypericum Perforatum):

    • Treats depressed mood; interacts with many medications.

    • Dose: 300 to 900 mg twice daily.

  • Toothed clubmoss (Huperzia Serrata):

    • Treat cognitive impairment related to normal aging.

    • Dose: 0.2 and 0.8 mg/day

  • Turmeric (Curcuma Longa):

    • Has antidepressant and antianxiety effects.

    • Doses between 500 mg and 1,000 mg/day are effective

  • Valerian (Valeriana Officinalis):

    • Improves subjective sleep quality.

    • Dose: 600 to 900 mg taken at bedtime

• Hormones

  • Dehydroepiandrosterone (DHEA):

    • May improve mood and cognitive function; potential antipsychotic effects.

    • Doses: 30 to 90 mg/day for DHEA supplementation, can supplement 90 to 450 mg/day.

    • Side effects: Acne, hirsutism, mania; avoid in hormone-sensitive cancers.

  • Melatonin:

    • Treats insomnia; regulates sleep-wake cycle.

    • Doses: 0.3 to 3 mg.

    • Side effects: Headaches and itching.

• Psychedelics

  • LSD, ketamine, psilocybin, and ayahuasca are under investigation as potential treatments for depressed mood, anxiety disorders, PTSD, and other psychiatric disorders.

  • Adverse effects includes transient anxiety, nausea, headaches, and mild transient increases in heart rate and blood pressure.

Somatic Therapies: Exercise

• Infrequent physical activity is a risk factor for depressed mood.

• Exercise increases brain-derived neurotrophic factors, enhances neural plasticity and synapse formation.

• Associated with increases in the size of the frontotemporal and parietal lobes.

• Increases brain levels of endorphins, dopamine, norepinephrine, and serotonin.

• Aerobic conditioning and strengthening exercises are equally effective.

• Optimum duration and frequency are related to age and fitness level.

• Exercise can be as effective as sertraline for improvements in mood, self-esteem, and negative thoughts.

• Exercise-only group had a lower 6-month relapse rate compared to antidepressant-only group.

• Antidepressant effects of running or fast walking may be equivalent to CBT and conventional antidepressants for moderate depression.

• Brightly lit indoor environments during exercise (2,500 to 4,000 lx) reported greater improvements in mood and vitality.

• Associated with a reduced risk of all categories of dementia.

  • Walking less than 1/4 mile daily almost doubled the probability of dementia diagnosis compared to walking at least 2 miles daily.

• Regular vigorous physical activity, significantly less likely to have been diagnosed with dementia than women with more sedentary lifestyles.

• Daily exercise in individuals with moderate dementia reduced depressed mood but did not improve cognitive functioning.

• 20 to 30 minutes of regular daily exercise significantly reduces symptoms of generalized anxiety.

• Regular walking or jogging (4 miles three times a week) reduced the severity and frequency of panic attacks.

• Alcoholics who exercised regularly reported improvements in mood and general well-being.

• Abstinent alcoholics reported improved mood with regular strength training or aerobic exercise.

• Exercise probably enhanced sleep quality and improved overall quality of life.

Expressive Movement Therapies

• Dance therapy and other expressive movement therapies are treatments for depression, anxiety disorders, and schizophrenia.

• Regular practice is associated with significant reductions in the severity of anxiety and depressed mood.

Animal-Facilitated Psychotherapy

• Provides a sense of social connection and renewed purpose and has beneficial effects on mood, anxiety, and global cognitive functioning.

• Regular contact with therapy dogs and other animals may reduce anxiety, improve mood, and increase attention span.

• Improves general emotional well-being in depressed and anxious persons.

Massage

• The anxiety-reducing effects of massage are believed to be mediated by decreased cortisol and increased parasympathetic tone.

• Regular massage therapy reduces the severity of chronic moderate state anxiety related to test-taking, problem- solving, or work stress.

Snoezelen

• Multimodal treatment of dementia that employs music, light patterns, tactile surfaces, and essential oils.

• Apathy, speech skills, and psychomotor agitation improved in demented patients after four to eight sessions.

Mindfulness Training and Mind–Body Practices

• Mindfulness training includes meditation and guided imagery.

• Mind–body practices include taijijuan, qigong, yoga, and others.

• Improved capacity for focused attention and reflection.

• MBCT is beneficial adjunctive therapy for unipolar depression and MBSR and MBCT are beneficial adjunctive interventions for anxiety disorders.

• Regular practice may be as effective as CBT or antidepressants in patients with moderately depressed mood.

• Mindfulness training combined with cognitive therapy may enhance outcomes compared to cognitive therapy alone.

• Regular use of MBCT may significantly improve executive functioning, memory, and ability to complete tasks in stable patients diagnosed with bipolar disorder.

Relaxation Techniques

• Include sustained deep breathing, progressive muscle relaxation, guided imagery, and systematic desensitization.

• The mechanism of action may involve reducing muscle tension using behaviors or cognitions that diminish tension and autonomic arousal.

• The regular practice of progressive muscle relaxation or sustained deep breathing at bedtime reduces the time needed to fall asleep in chronic insomniacs.

• All interventions resulted in “reliable and durable benefits” that were superior to placebo, including improved quality of sleep and reduced sleep latency.

• Nonpharmacologic treatments of chronic insomnia are initially more expensive and require more time than conventional drug therapy but are reliable, yield sustained benefits, and are thus more cost-effective in the long run.

• Equivalent improvements in state anxiety levels by the end of the trial.

• Anxious adult outpatients randomized to 12 weekly sessions of applied relaxation versus conventional cognitive therapy experienced significant and comparable reductions in anxiety.

• Depressed patients who had previously been diagnosed with somatoform disorders experienced greater improvements in mood when guided imagery was combined with antidepressants than with antidepressants alone.

• Women reporting anxiety and postpartum depressed mood experienced significant reductions in both anxiety and depressed mood using a combined relaxation-guided imagery protocol during the first four weeks after childbirth.

• Guided imagery has beneficial effects on the immune system, physiologic stress responses, and general mental-emotional functioning.

Yoga

• Calming effects of yogic breathing related to modulation of parasympathetic–sympathetic tone.

• Regular practice of yoga postures (asanas) improves cardiorespiratory performance and increases feelings of general well-being.

• Combining a mindfulness practice with yoga may have greater mood-enhancing benefits.

• Regular SK yoga practice may reduce the need for anxiolytics in individuals diagnosed with GAD.

• Regular practice of a specific kundalini yoga left-nostril breathing technique may significantly reduce symptom severity in patients with OCD.

• Many approaches in current use reduce some PTSD symptoms, including intrusive memories, avoidance, and emotional arousal.

Meditation

• Beneficial physiologic effects include decreased oxygen consumption, respiratory rate, and blood pressure, and decreased autonomic arousal.

• Consistent practice of mindfulness meditation significantly reduces generalized anxiety.

• Anxious individuals reported decreased physical and emotional distress, improved quality of life, enhanced general well-being, greater optimism, and increased feelings of control.

• IBS patients experienced significantly fewer symptoms of IBS and anxiety when practicing two brief (15 minutes) daily sessions of mindfulness meditation.

• A review of meditation practices aimed at preventing PTSD found more evidence supporting mindfulness meditation than mantra reciting or compassionate meditation.

• Significant improvements in overall quality of life and reductions in core PTSD symptoms.

Therapies Based on Scientifically Validated Forms of Energy and Information

• Include biofeedback, sound, full-spectrum bright light exposure, dim blue light, high-density negative ions, virtual reality graded exposure therapy (VRGET), brain–computer interface (BCI) technologies, and microcurrent electrical stimulation.

Music and Sound

• Patients in the music group experienced greater reductions in overall anxiety.

• Certain binaural beats (16 to 24 Hz) may improve depressed mood, enhance attention, and improve short-term and immediate recall in healthy adults.

• Binaural beats at lower frequencies may consistently induce a calm, relaxed state.

• Findings of RCTs suggest that music alone or in combination with guided imagery improves mood in depressed patients with cancer.

• Depressed outpatients reported significant improvements in mood and beneficial changes in heart rate and blood pressure soon after listening to tranquil music.

• Regular singing, engaging in dance therapy, listening to music, and participating in musical games improve cognitive and behavioral functioning in individuals with severe dementia.

Light

• Entrainment of sleep–wake cycles by external bright light cues and the associated suppression of melatonin production by the pineal gland is the established mechanism of action underlying the therapeutic benefits of light exposure on sleep and daytime fatigue.

• Exposure to natural sunlight, especially in the early morning, has significant antidepressant effects and may reduce the length of hospital stays in severely depressed inpatients.

• A systematic review of controlled studies confirmed antidepressant effects of bright light (10,000 lx) exposure therapy in seasonal depressed mood but provided only limited evidence supporting bright light as a treatment of nonseasonal unipolar depressed mood.

• Pregnant depressed women may also benefit.

High-Density Negative Ions

• Regular daily exposure to high-density negative ions may be an effective treatment of seasonal depressed mood and may have comparable efficacy to bright light exposure for this condition.

Biofeedback Using EEG and HRV

• Electroencephalographic (EEG) biofeedback and HRV biofeedback employ information extracted from the body’s intrinsic electromagnetic rhythms as sources of feedback.

• Double-blind studies have evaluated the efficacy of EEG biofeedback (also called neurofeedback) as a treatment of anxiety, depressed mood, attention-deficit disorder, and PTSD.

• Beta-frequency training in EEG biofeedback may result in improved performance on standardized intelligence tests in nonimpaired individuals.

• EEG biofeedback training and conventional antianxiety medications may have comparable efficacy for the management of generalized anxiety.

• Recent research findings support that EEG biofeedback involving very low frequencies, between 0.02 and 0.2 Hz, results in rapid, significant reductions in the severity of PTSD symptoms and improvements in global cognitive functioning.

• Symptom severity was evaluated weekly using the PCL-5—the military version of the PTSD Checklist.

• 75% of persons with moderate to severe PTSD symptoms experienced significant clinical improvement, including reductions in psychological, cognitive, psychophysiological, and physiologic symptoms.

• EEG biofeedback was found to be more effective than progressive muscle relaxation.

Virtual Reality Graded Exposure Therapy

• VRGET is a rapidly evolving therapy with important implications for the management of PTSD and severe phobias that are difficult to treat using more conventional therapies.

• VRGET combines advanced computer graphics, three- dimensional visual displays, and body-tracking technologies to create realistic virtual environments with the goal of simulating feared situations or objects.

Cranioelectrotherapy Stimulation

• Cranioelectrotherapy stimulation (CES), also called microcurrent electrical stimulation, is based on the application of extremely weak electrical current to the head and neck to treat anxiety, insomnia, and substance use disorders.

• The mechanism of action may involve stimulation of endorphin release and induction of EEG frequency changes that reduce the severity of anxiety.

• Daily application of weak electrical current to the neck or the head may stimulate global brain activity, resulting in beneficial modulatory changes in neurotransmitters implicated in dementia.

Therapies Based on Postulated Forms of Energy or Information Not Validated by Current Science

• Treatments based on postulated subtle forms of energy or information are not verified by current science.

• CAM approaches based on hypothesized subtle forms of energy include acupuncture, homeopathic remedies, HT, qigong, Reiki, and energy psychology.

Acupuncture

• Conventional needle acupuncture, electroacupuncture, and computer-controlled electroacupuncture (CCEA) have consistent beneficial effects on depressed mood.

• High frequencies (up to 1,000 Hz) may yield responses in depressed patients superior to both conventional acupuncture and electroacupuncture.

• A narrative review of controlled studies, outcomes studies, and published case reports on acupuncture as a treatment of anxiety and depressed mood supported that sham- controlled studies are associated with consistent improvements in anxiety using both conventional acupuncture and electroacupuncture.

Uncommon transient adverse effects associated with acupuncture include bruising, fatigue, and nausea.

• Infrequent cases of infection with human immunodeficiency virus, hepatitis B, and hepatitis C have been reported when nonsterilized needles are used.

• Rare cases of pneumothorax and cardiac tamponade have been reported as a result of accidental puncturing of the lungs or the pericardium.

Homeopathy

• Preliminary findings from open studies suggest that certain homeopathic remedies may improve depressed mood.

• Case reports of symptomatic improvement following the administration of specific homeopathic remedies have been published for PTSD, social phobia, panic disorder, and OCD.

Healing Touch and Therapeutic Touch

• HT practitioners claim to be able to intuitively assess energetic imbalances manifesting as physical or psychological symptoms and “direct” healing energy to specific bodily regions to correct purported imbalances, resulting in improved functioning or enhanced well-being.

• Agitated patients with dementia exhibited significantly fewer behavioral symptoms of dementia, including reduced restlessness and fewer disruptive vocalizations, compared to patients who received mock-TT.

Qigong

• Ancient energy healing method used in Chinese medicine that has its origins before written language.

• Anxiety, depressed mood, and quality of sleep were significantly better in subjects who had practiced qigong consistently for at least 5 years than in those who had never practiced qigong.

• A systematic review and meta-analysis of studies on qigong "exercise" for stress and anxiety in adults identified seven RCTs that met the inclusion criteria.

Reiki

• Regular Reiki treatments may increase feelings of general well-being and reduce stress.

Energy Psychology

• EFT, TFT, and body psychotherapy are “energy psychology” techniques used to treat mood disorders, phobias, and other anxiety disorders.

• Findings suggest that the therapeutic benefits of EFT may be attributable to desensitization and distraction.

Somatoemotional Release and Craniosacral Therapy

• Practitioners of craniosacral therapy gently guide the spinal and cranial bones with the goal of bringing the CNS into greater “harmony."

• Vietnam veterans reported significant reductions in pain and physical distress and improvements in depressed mood, anxiety, suspiciousness, guardedness, and behavioral isolation.

Shamanic Healing

• Shaman is a person who is regarded by their tribe or sociocultural group as having the power to heal the sick, predict the future, and communicate with the supernatural world, including primitive natural forces and spirits of the dead.

• Findings suggested that shamanic healing approaches contribute to the psychiatric stability and general emotional well-being of individuals diagnosed with bipolar disorder.