Complementary and Alternative Medicine (CAM):

Historically, traditional Western medicine has approached healing in just the body or just the mind. It also tends to view the source of a problem as external, in a "disease" or "disorder" model. For centuries, Eastern medicine has taken a very different direction, viewing the mind and body as unified, with energy fields both inside and around the body seen as part of the total health system, and approaching healing as an internal process.

Many kinds of Eastern medicine have begun to find their way into Western culture. In addition, other non-traditional approaches have become more visible in addressing what may be viewed as both physical and mental dis-ease. Many are being integrated into traditional mental health settings as their safety, effectiveness, and scientific validity are recognized.

What is complementary and alternative medicine (CAM)?

The sections below focus on several types of mental healthcare practices previously considered outside the scope of conventional Western medicine, many of which are now commonly incorporated in treatment. In general, these approaches may be divided into two broad categories:

• Complementary or integrative approaches (working along with traditional medicine)
• Alternative approaches (working in place of traditional approaches)

Complementary and alternative approaches often see life experience and an individual's coping mechanisms as the source of difficulties – that it is not what has happened to a person that is the problem, but how the person perceives and deals with what happened. It is apparent that what one considers to be the source of a problem (genetics, disease, internal energy imbalance, or life experience) will affect what treatment options are considered to manage or rectify the problem.

Considering complementary or alternative treatments for mental and emotional problems

Most people in our society are familiar with mainstream, Western medicine. At its best, Western medicine can diagnose and treat many problems that otherwise might cause devastating effects in a person's health. However, mainstream medicine also has limitations. In recent years, there has been an increased interest in approaches from other parts of the world, or from other perspectives. Eastern medicine often relies on concepts that are outside Western understandings. For example, most Eastern approaches view disease or disorders (including mental conditions) as indication of blocked energy in the body, while Western medicine is more likely to want "scientific proof" that this energy even exists.

Some reasons people consider complementary or alternative treatments are:

• Feeling that Western medicine is too mechanical, dogmatic, or compartmentalized
• Belief that Western medicine is fine for what it is, but does not go far enough
• A perspective that the cause of a problem may lie in life experiences, rather than in genetic defects or diseases
• Concern about the safety of medications, particularly those used to treat mental or emotional problems
• Seeing CAM as less invasive than Western approaches and wanting to try it instead of, or at least prior to, seeing a medical doctor
• Objections to what they see as "instant fix-it" or "pill-popping" attitudes
• Being "turned off" to traditional treatments, because of a lack of trust in doctors, or bad experiences with the medical world
• Religious beliefs that preclude drugs or surgery
• Desire for a sense of spirit or human depth that seems missing in Western approaches
• Desire for engaging more of the "whole" person in treatment
• Interest in exploring practices that have been in use for thousands of years in other parts of the world

Most traditional psychotherapy approaches are based on memory and cognitive reasoning. But current research indicates that the source of anxiety or depression may be unrecognized trauma in a person's life, and that emotional trauma may result in only fragments of thought or sensations, rather than cognitions. For this reason, healing – whether from one traumatic event or a series of events – may not lend itself to the more traditional therapies.

In deciding about the use of complementary or alternative approaches, an individual or parent should become educated about available options in order to make the best choices for their particular needs. For example:

• Some might want to see a medical doctor or take psychiatric medication to relieve the most severe symptoms of anxiety or depression, while considering other alternatives for ongoing treatment
• Some might prefer to avoid physicians and medications entirely and pursue different means to address symptoms
• Others might want to try a variety of alternative approaches to find a good "fit" for the specific problems in their lives.

Types of complementary or alternative approaches to mental health treatment

Alternative Medical Systems

There are many other medical systems in the world, beyond the standard Western system. Cultures throughout the world have a variety of healers or shamen. These systems are well-developed, with a 5,000-year old track record for healing, and many are gaining wide acceptance as alternative or complementary approaches in the West. Each of these systems addresses human suffering in different ways, but generally they seek to re-establish a balance or harmony within the body and in the lifestyle of the person being treated. Because they tend to view mental or emotional difficulties as part of a larger matter of balance and overall health, they are included here:

• Ayurveda ("Science of Life" Traditional Medicine from India) is the oldest medical system. The focus on energy and balance rather than symptoms seeks to restore wholeness in the mind-body-spirit system. Disease is viewed as an outgrowth of mental conditions. Each person has a particular combination of physical, mental and emotional characteristics – distinct bioenergetic types known as Vata, Pitta, and Kapha – that are genetically determined and prenatally influenced. Different causes and treatments of physical and emotional disorders are based in part on this individual constitution, with the kind of patient being more important than the kind of symptoms. Physical and mental health is achieved by balancing diet, exercise, sleep, and sexual activity. Some of the tools of Ayurveda include a variety of stress management techniques, meditation, aromatherapy, yoga, and massage.
• Traditional Chinese Medicine (TCM), in use for more than 4,000 years, is based on the flow of vital energy (qi or chi, pronounced "chee") throughout the body. In a healthy state, the yin and yang (negative and positive energies) are balanced, while a disease state results from an imbalance. Thus, the use of herbs, nutrition, meditation, acupuncture, and exercise are intended to restore balance and return the body, mind, emotions and spirit to health.
• Native American healing is thousands of years old and combines religion, spirituality, herbal medicine, and rituals to treat medical and emotional problems, including trauma and addictions. Because there are hundreds of tribal nations, the practices vary, but generally include purifying ceremonies, chants, sweat lodge, and other tribal customs. Healing rituals can last for minutes, days or weeks and may involve a combination of dance, chanting, body painting, and prayer.
• Homeopathic Medicine ("like cures like") was developed n the early 20^th century. It does not treat a "disease" or disorder by name (such as depression) but rather by specific symptoms (including things that affect symptoms, such as sounds, smells, tastes, moods, energy, time of day or temperature when symptoms are worse, etc.). Small, highly diluted quantities of specific substances are used to cure symptoms which would actually be caused by larger doses of the same substance.
• Naturopathic Medicine sees physical and mental health as arising from a healing power in the body that establishes, maintains, and restores health. Many other treatment modalities (such as Chinese medicine, homeopathy, etc.) are incorporated to support this healing power, along with nutritional and lifestyle changes.

Nutritional or other "balancing" approaches

• Vitamins and supplements: Many people may suffer from both physical and mental conditions that arise from inadequate nutrition. Nutritional deficiencies often first appear in the form of mental symptoms. Some researchers believe that the imbalances in the system can be regulated by nutritional supplements. For example, depression may be caused by an amino acid imbalance or vitamin deficiency. The B-Vitamins, omerga-3 fatty acids, and folic acid are helpful for regulating stress and balancing mood. St. John's Wort and Kava Kava may help with depression and anxiety. However, without proper guidance of a nutritionist, these substances may also create serious side effects for some people.
• Allergies: There are many theories that allergies to such foods as wheat, sugar, and milk cause or exacerbate symptoms in schizophrenia, autism, anxiety, learning disabilities, ADHD, and other conditions. Some people find that avoiding these foods, or determining other possible food sensitivities may reduce symptoms. Other suspected sources for emotional problems are sensitivities to substances such as paint fumes, plastics, or even electromagnetic fields. Some of these can be avoided, if it is determined that they may be causing emotional symptoms.
• Dietetic changes: Many people find that adjustments in their diet may affect their mental and emotional health. For example, blood sugar levels have a strong impact on mood and emotional energy, and can be managed by eating small amounts every few hours, particularly of protein-rich foods, in a well-balanced overall diet.  
• Light therapy: For some people, a lack of full-spectrum sunlight may cause Seasonal Affective Disorder (SAD), and they may best be helped by daily exposure to light from a special bulb, which is now easily available from many lighting stores. This is particularly useful for those in far northern regions that do not get sunlight for long periods during the winter.
• Chelation therapy: A synthetic amino acid called EDTA is added to the blood, where it "grabs" (chelates) onto metallic substances, which are then allowed to wash out of the body. An analogous process is unclogging a drain by adding a chemical which dissolves the block, and then washing the compound down the pipes. Patients who have had chelation treatment often notice less depression, more alertness, and better memory. It is speculated that this improvement results when harmful toxins are removed from the blood stream, thus protecting the brain from effects of these toxins.
• Aromatherapy: The use of essential oils – extracts or essences from flowers, herbs, and trees – is one of the oldest therapies, dating back 6,000 years to ancient Rome, Greece and Egypt. These oils are usually massaged into the skin, wafted in a room, or dissolved in a bath. Of our five primary senses, the olfactory is the only one that transmits information directly from the nose into the limbic center of the brain, the seat of emotions and memory. Recent brain scan research has shown that different scents affect brainwave production; for example, with some increasing alpha (relaxation) waves and others affecting beta (alertness) waves. Aromatherapy is effective with many disorders, including stress, anxiety, pain, PMS, depression, certain types of male impotence, and many others.
• Bach flower remedies: This system is similar to homeopathy, in that tiny quantities of a plant-based substance are diluted, preserved in brandy, then sipped in water. There are 38 different flower essences and one combination known as Rescue Remedy. The remedies are used for a variety of emotional difficulties, including many specific fears and types of depression, as well as personality characteristics, such as selfishness, intolerance, and inflexibility.

Creative arts therapies

Creative arts therapies such as dance, music, art, and drama may help reduce symptoms by providing outlets for expression of emotions. They also offer access to "right-brain" material – non-verbal, emotionally based – which can be impossible to reach through the traditional talk therapies. Creative writing using dreams, symbols, and myth can also be a way to process emotional material.

Therapists who are registered in their specialization have received training in the use of creative expression to assist with mental health issues. Many creative arts therapists are also licensed mental health clinicians, while others may work with a licensed professional as an adjunct to treatment. The links below indicate the training programs available to art, music, dance and drama therapists, which can assist you in understanding what each type of art can do, and how to know if a provider has been certified as a therapist.

Energy Therapies

Energy therapies involve focused attention on the energy fields that are believed to surround and penetrate the body. Some of these therapies use movement, while others involve manipulation of the energy field or the body. Still others focus on the electromagnetic fields that are all around us. Some examples of energy therapies are:

• Qi gong (pronounced "chee kung") is an ancient Chinese system using movement, meditation, relaxation, mind-body integration, and breathing exercises. The purpose is to improve circulation, balance flow of chi, reduce stress and anxiety, and restore energy and health.
• Reiki (pronounced "ray-kee") is a Japanese system of transferring energy from the practitioner to heal the patient's spirit, which leads to physical health. The Reiki Master does not touch the person directly, but places hands over the body. Reiki also uses distance healing, believing that energy fields in the universe are all interconnected and thus can be affected from far away.
• Therapeutic Touch is a form of "laying on of hands", which may also involve the healer passing hands over the body without actually touching it, to detect energy imbalances and re-direct them through the energy of the therapist. According to the founders, TT is "based on the assumptions that human beings are complex fields of energy, and that the ability to enhance healing in another is a natural potential". There are a growing number of registered nurses who have also been trained in this healing art in classes around the world, who use their gentle presence and touch to assist patients with many kinds of physical and emotional distress. Skeptics challenge the existence of an energy field and claim that relief occurs because people feel comforted – to which most healers would probably say that is not the only reason, but if comfort helps, that's also a good thing.
• The power of the mind – meditation, prayer, and distance healing are all varieties of thought forms used to calm the mind and body, and to call in a sense of intervention in health from energies of the spirit. Because stress is at the root of so many physical and mental disturbances – or at the very least, stress will exacerbate existing conditions – learning to relax the mind and body will ease many symptoms in the mind and body.
  
  - There are many types of meditation that come from various cultural traditions (Buddhist, Zen, Tibetan, Transcendental, yoga, etc.). In general, they often involve calm and regular breathing, and a focus on one object (a "yantra" such as a candle or picture), one thought (such as "peace" or "relax"), or one word (a "mantra", often in Sanskrit or another language) that the mind is directed to return to over and over, and to set aside other distracting thoughts. With regular practice, one can learn to sit quietly and relax deeply, with a calming result.
  
  - Prayer has been used for thousands of years by every culture. Regardless of religious tradition, prayer in general reflects a belief that there is a power greater than the individual, and that it is possible to access that power through words or thoughts. Many people attribute the healing of their physical or mental conditions to prayer, or to whatever their personal belief in a God or Higher Source might be. There have even been some experiments that have attempted controlled studies to "document" that prayer works by having strangers at great distances pray for people in hospitals or with various conditions to see if the prayer group improved at greater rates than the control group. These studies are controversial, but those who believe in prayer as a healing power would say they do not need a study to know that it works.
  
  - Others would say that the power of the mind to change the body is evident whenever someone believes in something, a phenomenon known as a placebo effect. Some will then dismiss the value of the intervention as "just" a placebo. However, if a belief that something will help does in fact help, it is important to recognize that what we think or believe has a powerful effect on what happens in our lives. The opposite of a placebo is a nocebo (Latin for "I will harm"), the effect of a negative belief. The power of an idea to cause healing or harm is evidence of the power of the mind to lead to outcomes in the body and the overall health. This fact highlights the critical importance for doctors and others to maintain a positive outlook and not to predict a specific timeframe for the course of a disease.

Better known mind-body approaches

Some types of mind-body healing have become so commonplace, and are so often integrated into traditional treatment, that it is difficult to call them alternatives anymore. Examples include:

• Relaxation techniques or deep breathing
• Yoga or exercise
• Hypnosis
• Biofeedback and neurofeedback
• Acupuncture

Some forms of physical manipulation might also be considered mind-body treatments, if the practitioner is skilled in connecting the two. Examples include: 

• Chiropractic
• Osteopathy
• Massage
• Cranial-sacral therapy

Newer mind-body approaches

Recent developments in the treatment of emotional trauma include new, highly effective forms of psychotherapy and somatic (body) therapies. Although often intensely interpersonal, these therapies are also psychological and neurological in their focus and application. This group of therapies relies on innate instinctual resources, rather than medications, to bring about healing.

Keeping a positive attitude to help treat emotional problems

The power of thought was discussed above in energy therapies. In addition, in some situations emotional disturbances are actually the result of a lack of acceptance of differences. For example, a person whose temperament is more high strung or more laid back than others in his or her family may be labeled as anxious or depressed, simply by comparison. Another frequently reported source of depression and even suicide is in families with a child who does not match parental expectations – who is sensitive when a parent wants toughness, or is fat when a parent wants thin, or is gay when a parent wants heterosexual, or is more interested in fixing engines than going to law school. Learning to accept, allow for, and even appreciate differences in family members is sometimes all that is needed to relieve depression or anxiety.

References and resources for complementary and alternative medicine

General information on complementary and alternative medicine

National Center for Complementary and Alternative Medicine (NCCAM) is funded by the National Institutes of Health (NIH), and has for the last several years been studying various non-traditional approaches to physical and mental health. This site provides a good overview of terms, and has many links.

Alternative Health News Online provides regular updates on news about complementary and traditional treatments.

Alternative Medicine Foundation provides evidence-based research resources for health-care professionals and information for patients and consumers.

Center for Mental Health Services, Knowledge Exchange Network from the National Health Information Center, provides general information about alternative therapies for mental and emotional health.

Ayurveda

About Ayurveda This page provides a very simple definition, including the origin and basic principles of Ayurvedic Medicine.

Traditional Chinese Medicine

Treatment of Stress, Anxiety and Depression describes the use of acupuncture as treatment for a variety of mental conditions.

Native American healing

The Path of the Feather describes shamanic journeys, medicine wheels and spirit animals as traditions used for healing.

Homeopathy

National Center for Homeopathy's Website includes a searchable directory of practitioners in the United States.

Psychological Problems: Treating Mind and Body* provides a good overview of the concept of homeopathy for treatment of mental health issues. There is also a section discussing how various types of psychotherapy are similar in approach to homeopathy, for example, by introducing small amounts of an emotional toxin (such as something the person fears being presented in small increments to build up tolerance). (*This is an excerpted chapter from a book, and appears on a website that also contains commercial advertising.)

Prozac Free reviews a book that discusses the use of homeopathic medicine for depression and other mental and emotional problems.

Bach flower remedies

Bach Flower Remedies were developed by a British medical doctor in the early 20^th century and are still in use around the world. This site describes the 38 flower essences and their uses, provides links to practitioners, and answers questions about the remedies.

Flower Essence Society, established in 1979 to continue exploration into the use of flower oils, has expanded the original list of 38 flowers to well over 100. This site includes a downloadable booklet with a quiz to help sort out which flower essences may be helpful to an individual. There is also a section on research into stress and depression, with a link to sign up as a participant in the current study.

Nutrition and other "balancing" approaches

Nutritional Therapy A report on the Food and Mood project, which includes specific recommendations for improving mental health. In addition to general information on such substances as caffeine, there is a chart listing many of the common mental health problems as they are often related to food sensitivities (e.g.: wheat and depression).

Nutritional Approaches to Mental Health* is written by an orthomolecular psychiatrist and discusses the uses of many different vitamins, minerals and supplements for specific mental health issues. (*This is an excerpted chapter from a book, and appears on a website that also contains commercial advertising.)

Mental Health and Protein Nutrition discusses the treatment of addictions, eating disorders, depression and other mood disorders through nutritional "mood foods".

Light Treatment for Seasonal Affective Disorder (SAD) from the non-profit Society for Light Treatment and Biological Rhythms. Many links to articles on circadian rhythms, jet lag, sleep disorders, melatonin and light treatment for SAD.

Chelation Therapy describes the theory, methods, benefits and possible side effects of chelation therapy.

Aromatherapy discusses how aromatherapy works, describes safety issues including which essences should not be used, and lists several types of problems with their corresponding treatments.

About Aromatherapy from the National Association for Holistic Aromatherapy, describes benefits and lists of top essential oils used. Good section on methods of application.

Creative arts therapies

The American Art Therapy Association describes the practice of art therapy and types of settings in which it is used, the kinds of issues effectively addressed by art therapy, and certification requirements for art therapists.

The American Music Therapy Association discusses what music therapists do, where they work, how they can be helpful, and what their certification involves.

The American Dance Therapy Association describes what dance/movement therapists do, which ones work in team settings and which in private settings, how they can be helpful, and provides lists of schools that train dance therapists.

Proprioceptive Writing is a process developed by two psychologists in Maine. It is an adjunct to therapeutic process, a writing tool, and a form of meditation.

Depression Learning Path from Uncommon Knowledge and the European Therapy Studies Institute, the complete website provides information on the relationship between dreams and depression, and ways to treat depression without drugs, A unique feature is a free "coach by email" to guide an individual through the Depression Learning Path over an 18-day period.

Energy therapies

Qi Gong describes the history and practice of this ancient Chinese healing art, and includes lists of practitioners as well as scientific studies and papers on the subject.

Reiki discusses the history and practice of this ancient Japanese healing art, which was rediscovered in the late 1800s. This site also includes photos showing the various hand positions used in Reiki.

Therapeutic touch

Therapeutic Touch This is the homepage of the founders of this process, who describe the history and list current classes.

Meditation, prayer and the power of mind

Meditation A comprehensive overview of various types of meditation with sample texts for many of them, discussion of several conditions that can be improved by meditation, as well as some individual situations that call for avoidance of meditation.

Learning Meditation describes basic meditation and includes several short audio meditations with music, for a variety of purposes (relaxation, healing, weight management, for children, etc.).

Transcendental Meditation is one of the best-known forms of meditation, popularized in the 1970s and practiced around the world. This site includes many of the scientific studies that have been done that demonstrate the effectiveness of TM for a variety of purposes.

Prayer and Spiritual Healing A very thorough webpage with many articles on religion, spirituality, the basic elements of prayer for health or healing common to most cultural traditions, specific examples from a variety of the world's major religions, and several discussions on applications for specific mental health issues such as anxiety and depression.

The Healing Power of Placebos from the Food and Drug Administration, discusses the use of placebos in drug testing, and includes several examples of how belief affects outcome.

Better known Body-Mind Therapies

Foundation for Chiropractic Education and Research is the oldest and most respected chiropractic research-funding institution. At this site, you can find many articles and outcome studies on chiropractic research.

Managing Negative Mental Health through Yoga explains the yoga view of negative emotions and describes the use of yoga for prevention and cure.

Better Than Prozac? from Yoga Journal, compares outcome studies of antidepressant medications and yoga in relieving depression.

Understanding Clinical Hypnosis from atHealth.com, discusses myths. precautions and applications of clinical hypnosis.

Hypnosis, Hypnotherapy and Hypnotherapists from TherapistFinder.net, discusses how to find a therapist who uses hypnosis, and specific several types of conditions for which hypnosis is useful.  

Biofeedback includes examples of types of biofeedback, applications, and cautionary notes.

Biofeedback from the National Institutes of Health, a definition and a few examples of uses, with two illustrations.

Neurofeedback This site is sponsored by an affiliation of more than 200 groups under one company. Discusses clinical applications and contains considerable information on the use of EEG Biofeedback, also known as Neurofeedback, with pictures showing equipment, and many questions answered.

Additional resources

Trauma Resources A non-profit website that discusses alternative perspectives on emotional trauma and its treatment. Includes an online video and links to events and practitioners.

Interconnections* A website from the UK, sponsored by several different practitioners, that offers brief descriptions of a variety of alternative approaches to understanding and addressing a variety of personal and emotional health issues.

Jaelline Jaffe, Ph.D., created this article with contributions from Jeanne Segal, Ph.D. Last modified on: 2/05/07.