chapter 15

Health Psychology - Chapter 15: Complementary & Alternative Medicine

What Is Complementary and Alternative Medicine?

  • Conventional Medicine
      – Biomedically based medicine practiced by medical doctors (MDs).

  • Evidence-Based Medicine
      – Promotes the collection, interpretation, and integration of research-based evidence in making decisions about the care of individual patients.

Definitions in Complementary and Alternative Medicine (CAM)

  • Osteopathic Medicine
      – Emphasizes the interrelationship between the structure and function of the human body.

  • Holistic Medicine
      – Considers not only physical health but also the emotional, spiritual, social, and psychological well-being.

  • Whole Person Health
      – Biopsychosocial approach to medicine that helps people improve and restore their health in multiple domains—biological, behavioral, social, environmental.

  • Complementary & Alternative Medicine (CAM)
      – The use of “alternative medicines” in conjunction with—rather than instead of—regular medicine.

Three Ideals of Complementary and Alternative Medicine

  1. Natural Medicine
       - Whole medical systems.
       - Mind and body meditation.
       - Natural products.
       - Manipulative and body-based practices.
       - Other CAM practices.

  2. Whole Person (Holistic) Medicine

  3. Promoting Wellness
       - Integrative medicine.
       - Vitalism.
       - Traditional Chinese medicine.
       - Ayurvedic treatments.

Medicine or Quackery?

  • Emerging Trends Leading to Increased Interest in CAM
      – Costly, impersonal nature of biomedicine.
      – Adverse effects of treatment.
      – Profit-driven nature of healthcare that ignores unprofitable treatment options.
      – Vaccine hesitancy.

  • Constitutes of Evidence
      - Differences in perspective and focus:
        - Biomedical researchers demand evidence from controlled clinical trials.
        - CAM practitioners often claim that treatment variables cannot be studied independently and endorse interventions even when the evidence supporting their claims is weak.

  • Participant Selection and Outcome Measures
      - CAM evidence is often based on:
        - Informal case-study basis.
        - Anecdotal evidence.
        - Self-report and single-outcome measures.
        - Use of incomplete, biased, or invalidated treatment outcome measures.

Participant Expectancy and Placebo Effect

  • Possible Causes of Improvement in a Condition
      – Treatment is effective, misdiagnosis, spontaneous remission, cyclical conditions (e.g., arthritis).

  • Placebo Effect
      - Placebo and nocebo effects highlighted.

  • Why Do Placebos Work?
      - Several explanations:
        - Decreased anxiety.
        - Conditioned response.
        - Natural “inner pharmacy” of self-healing substances.
        - Any medical procedure can produce a placebo effect.

  • Criticism of CAM
      - Critics argue CAM is entirely placebo-based.

  • Theoretical Explanations
      - Expectancy theory.
      - Meaning response theory.

  • Placebo Analgesia
      - Evidence shows that visible injections of placebos are significantly more effective in pain reduction, indicating that knowledge of the placebo, not just the placebo itself, may induce analgesic effects.

Effectiveness of Complementary and Alternative Medicine

Acupuncture

  • General Overview
      - Originated in China and has gained popularity in Western industrialized nations.
      - Most successful in pain management, while practitioners also claim rejuvenation effects.

  • Mechanism of Action
      - Each part of the body correlates to the entire body.
      - Meridians: 14 lines of energy where acupuncture needles are inserted to produce effects elsewhere.
      - Treatment explanations include:
        - Invisible energy path (qi).
        - Pain relief through endorphin release and modulation of pain pathways.

  • Evaluating Effectiveness
      - Thousands of studies conducted, mostly uncontrolled or lacking proper sample sizes and double-blind controls.
      - Lack of standardization of acupuncture sites may skew results.
      - Sham acupuncture is known to work (counterirritation, placebo effect).

  • Studies on Acupuncture and Pain
      - More than 100 randomized controlled trials and several meta-analyses indicate mixed results; some patients report relief for:
        - Osteoarthritis.
        - Neck and lower back pain.
        - Migraine headaches.
        - Tennis elbow.
        - Postoperative dental pain.

Acupuncture and Substance Abuse

  • Usage
      - Acupuncture is a popular CAM method for treating substance abuse.

  • Goals of Treatment
      - Reducing withdrawal symptoms, maintaining participation in rehabilitation programs, and promoting abstinence from drug use.

  • Evidence of Effectiveness
      - Mixed evidence on overall effectiveness; some success in treating pain, addiction, and depression.

Mind-Body Therapies

  • Basic Premise
      - Cognitive, emotional, and spiritual factors influence health significantly.

  • Examples
      - Hypnosis:
        - Prehypnotic Stage: Induction through suggestions and imagery for relaxation.
        - Treatment Stage: Suggestions to alleviate pain.
        - Posthypnotic Stage: Additional instructions for ongoing practices after hypnosis.
      - Effectiveness
        - More powerful than placebo for pain management in highly hypnotizable individuals.
        - Linked to specific brain changes in the “pain matrix.”

  • Relaxation and Meditation Techniques
      - Various methods for managing attention:
        - Mindfulness Meditation: Focus on nonjudgmental in-the-moment perceptions.
        - Transcendental Meditation: Concentration using a mantra.

  • Impact on Health
      - Effective in managing a range of disorders:
        - Mindfulness-based stress reduction (MBSR).
        - Minimizes pain sensitivity.
        - Aids in emotion regulation.
        - Prevents depression.
        - Helps chronic pain conditions.

Tai Chi and Yoga

  • Tai Chi
      - Described as “moving meditation,” integrating exercise, dance, and concentration, beneficial for those with chronic diseases like cancer and heart disease.

  • Yoga
      - A movement-based relaxation and meditation form that combines diet, physical postures, and breathing exercises promoting both physical and spiritual well-being.

Health Promotion via Relaxation and Meditation

  • Mechanisms of Promotion
      - Alters emotional reactions to pain and symptoms, teaching individuals to reinterpret their experiences.
      - May enhance immune system function.
      - Notably reduces levels of pro-inflammatory cytokines and other inflammatory markers (as shown in MBSR).

  • Neuroimaging Insights
      - Mindfulness practices increase activity in emotional regulation regions while reducing activity in stress response areas.
      - The sympatho-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axes remain stable under stressors.

Biofeedback

  • Definition and Use
      - Provides feedback on involuntary physiological states, showing some benefits for stress-related health issues.

  • Limitations
      - No confirmation that patients gain control over internal, involuntary responses from biofeedback usage.

Spirituality and Prayer in Healing

  • Shifting Perspectives
      - Growing convergence between medicine and spiritual healing, marked by increased conferences and courses.

  • Health Outcomes
      - Studies indicate religious activity correlates with better health and longevity, potentially due to improved lifestyle, social support, and positive emotional states.

Therapeutic Manipulation

Chiropractic Care

  • Overview
      - Focuses on diagnosing, treating, and preventing neuromusculoskeletal disorders.
      - Approximately 8% of adults and 3% of children utilize chiropractic services.

  • Evaluation
      - Popular for treating back pain, although critics argue it lacks efficacy and misalignment issues often resolve naturally.
      - Research supports effectiveness in managing low back pain.

Massage Therapy

  • Definition
      - Involves soft tissue manipulation, contrasting with chiropractic's focus on joints and spine.

  • Effectiveness
      - Recognized alternative treatment for reducing stress, anxiety, pain post-surgery, and managing fibromyalgia.

Naturopathic Medicine

  • Description
      - A holistic system drawing from various traditional healing practices, including herbal remedies and homeopathy.

  • Basic Principles
      - Help nature to heal.
      - Do no harm.
      - Identify underlying causes.
      - Treat the whole person.
      - Encourage preventive measures.
      - Assume the role of a teacher.

Herbal and Other Natural Products

  • Folk Medicine Roots
      - All cultures have historically employed herbs in folk medicine, creating a pharmacopoeia.

  • Categories in Western Herbal Medicine
      - Based on potency, effects on the body, and targeted body systems.

Food and Dietary Supplement Therapy

  • Nutritional Medicine
      - Intended to correct dietary deficiencies (e.g., calcium supplements, multivitamins).

  • Megadose Therapy
      - Aimed at eliciting specific therapeutic effects, exemplified by Linus Pauling's recommendations for vitamin C intake (
     10 to 15 times the recommended daily allowance).

Dietary Medicine

  • Naturopathic Goals
      - Provision of holistic care returning to a “natural state.”
      - Combination of various CAM traditions, particularly dietary modifications and herbal remedies.
      - Discussions on food allergies versus sensitivities and dietary theories.

  • Safety Issues
      - Unregulated dietary supplements may pose health hazards.

Effectiveness of Naturopathy

  • Reported Effectiveness
      - Most effective for lifestyle and environmentally influenced diseases (e.g., allergies, fatigue, arthritis).
      - Numerous claims lack rigorous testing equivalent to pharmaceutical standards.

Future of Complementary and Alternative Medicine

  • Paradigm Shift
      - Transition in North America from passive-dependent patients to active health consumers and a complementary relationship with CAM alongside conventional medicine.

  • Conclusion
      - No single healthcare approach holds all answers; finding optimal solutions often necessitates exploring multiple remedies or treatment systems.

Questions and Engagement

  • Encourage sharing of questions and thoughts in the OWL discussion forums!