Overview on Complementary and Alternative Therapies

From 1999, National Institutes of Health (NIH) created the National Center for Complementary and Alternative Medicine (NCCAM) with the mission of investigating the efficiency of complementary and alternative medicine interventions and how they can better improve health (http://www.apa.org/monitor/2013/04/ce-corner.aspx).  Since then, many studies have shown the effectiveness of the CAM modalities on various ailments and disorders.

Complementary or alternative medicine (CAM) is being used in practice more often now.  These two words are often used together;  however, they are significantly different from each other.  A complementary therapy is a form of therapy used alongside the conventional medical treatment to cope better with illness.  On the other hand, an alternative therapy is generally used instead of conventional medical treatment.  We will discuss a few CAM modalities below.
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Meditation
Meditation is commonly and widely used.  It is a process by which people learn to focus their attention as a way of gaining greater insight into themselves and their surroundings.  Research has showed that the meditation program is associated with significant reductions in blood pressure (Rainforth, Schneider, Nidich, Gaylord-King, Salerno, & Anderson, 2007).  In another study by Grossman, Niemann, Schmidt and Walach (2007), they suggested that mindfulness meditation may help individuals with either clinical (i.e. cancer, heart disease, depression) or non-clinical issues to cope with stress level.

Aromatherapy
Aromatherapy is a natural way of healing a person’s mind, body and soul using the fragrance or smell during the therapy session.  It is believed that using different scents (extracted from plants) and oils are beneficial for different therapeutic purposes, such as reducing pain, anxiety and agitation (Ali, Al-Wabel, Shams, Ahamad, Khan, & Anwar, 2015).  In the study by Domingos and Braga (2015), aromatherapy is found to show the effectiveness in relieving anxiety by decreasing the heart and respiratory rates in patients diagnosed with personality disorders during psychiatric hospitalization.  Chang and Shen (2011) have also found that with the use of Bergamot during the aromatherapy, individuals with moderate and high degrees of anxiety and stress level showed significant improvement in reducing blood pressure and heart rate, hence striking a balance in their autonomic nervous activity.  However, it is also important to note that personal preference on the scents could also lead to different results.

Yoga
Yoga is a physical practice that unites the body, mind and spirit (Hagen & Nayar, 2014).  During the yoga process, individuals will have slow and rhythmic breathing, which can release prolactin and the hormone oxytocin, lead to a sense of calmness (Toerner, Toschi, Nava, Clapp, & Neumann, 2002).  Besides, yoga can also improve children’s sense of self-awareness, self-confidence and concentration skills (Thiyagarajan Subramanian, Trakroo, Bobby, & Das, 2015).  National Health Interview Survey (2007) showed that yoga was the most favoured CAM practices among children with behavioural, emotional or mental health problems.

Religion and Spirituality
Religion and spirituality are two separate entities.  Religion is institutionized spirituality, hence, there are various religions involves spirituality which are different sets of beliefs, traditions and doctrines (Verghese, 2008).
Brody (2003) found that parents are more likely to have harmonious marital relationships and better parenting skills when they are more involved in church activities.  This leads to the improvement in children’s competence, self-regulation, psychosocial adjustment and school performance.  Tonigan’s (2003) study also demonstrated that spirituality promotes alcohol abstinence by increasing the likelihood of being honesty and responsible.
Religion and spirituality have been integrated into practices among psychologists and psychotherapists (D’Souza, 2004; Verghese, 2008).  Certification is not required to integrate religion and spirituality into practices.  However, professionals should not go beyond their clinical roles and take on the role of clergy.  Education and training should be considered to obtain in order to ensure their clinical competence (Barnett & Shale, 2012).

Dance Therapy
Dance therapy is a psychotherapeutic use of movement to promote emotional, cognitive, physical and social integration of individuals (American Dane Therapy Association, 2012).  It is believed that by focusing on the body, one should be able to affect his or her mind and therefore relieve a variety of symptoms by enjoying the pleasure of creating rhythmic motions with the body (Barnstaple, 2016).   Studies have also showed that dance therapy can help with symptoms associated with dementia (Verghese et al., 2013), depression (Koch, Morlinghaus & Fuchs, 2007) and a variety of physical disabilities, as well as to promote overall well-being (Burgess, Grogan & Burwitz, 2006).
Debates are still on-going with regards to the effectiveness of dance therapy.  For instance, Meekum, Karkou & Nelson (2015) have found no significant impact of dance therapy on individuals with depression.  On the other hand, Harris (2007) revealed a reduction in anxiety, depression, intrusive recollection, elevated arousal and aggression symptoms among a group of former boy combatants.

Music Therapy
Music therapy uses music to promote healing and enhance quality of life.  It provides distraction from anxiety, pain and depression (Mettner, 2005; Petteron, 2001) by directing the listener to soothing and comforting music (Lane, 2005).
Music therapy has been widely used as a complementary therapy along with other cancer treatments to help patients cope mentally and physically with their diagnosis.  Studies have showed the significant improvements in cancer patients’ state of well-being such as decreased level of cortisol, increased level of relaxation and more positive emotions (Burns, Harbuz, Hucklebridge & Bunt, 2001; Hirsch & Meckes, 2000).

Art therapy
Creating art is found to be helpful in the healing process as individuals can slowly walk through their painful or traumatic experiences hidden in their subconscious mind by creating a painting or drawing (Eaton, Doherty & Widrick, 2007; St. Thomas & Johnson, 2002).  Studies have demonstrated the effectiveness of art therapy in various health issues such as asthma, depression, cancer (Beebe, Gelfance & Bender, 2010; Thyme, Sundin, Stahlberg, Lindstrom, Eklof & Wiberg, 2007; Svensk, Oster, Thyme, Magnusson, Sjodin, Eisemann, Astrom & Lindh, 2009).  Results showed that art therapy can reduce anxiety, improve quality of life and self-concept, reduce depressive and stress-related symptoms and increase in coping resources with regards to the health issues.

Limitations on CAM
Research on the effectiveness and underlying mechanisms of the many CAM modalities has greatly increased in recent years.  However, psychologists should be aware of the potential limitations associated with some of this research such as the recruitment sample, ways of grouping the participants and sample size.  In fact, many CAM studies have samples that are smaller than 10 subjects (Kunstler, Greenblat, & Moreno, 2004).  These limitations, thus, lead to the generalizability issues.  Although many findings have provided helpful information for understanding the efficacy of various CAM modalities, lack of longitudinal studies remain (Tonigan, 2003).  Despite the limitations mentioned, it does not mean that CAM modalities are not useful.

Ethics Principles
Psychologists should comply the ethics principles when practising the CAM modalities.  For instance, psychologists should possess the needed knowledge and skills to be able to practice effectively and to not practice outside areas of demonstrated competence (Barnett & Shale, 2012).  Further, psychologists are required to maintain their competence through ongoing professional development activities that include keeping informed about recent developments in the field.
Another point to consider is that several CAM modalities are appropriate for psychologists to integrate into treatment with their clients when appropriately trained and credentialed to do so.  Yet administering process may constitute an inappropriate multiple relationship and a boundary violation.  Psychologists should be especially sensitive to boundary issues when a CAM modality is implemented through physical contact, such as with massage therapy, chiropractic and Reiki.
Image credit: http://www.pbdmauritius.org/journal-of-alternative-and-complementary-drugs-the.html

Conclusion
In summary, psychologists need to recognize when it is appropriate to integrate a specific modality into a client's psychological treatment as opposed to making a referral to a CAM practitioner, and knowing how to do this effectively are essential components of each psychologist's competence.  Psychologists must also be aware of when clients should or should not continue with a CAM modality that has been previously implemented.  Hence, remain educated and up-to-date on the field of CAM well as the various modalities and their diverse uses are crucial.

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