Exercise the key to mental health treatment success?

Exercise and Mental Health Treatment
 
There is no doubt that exercise is good for you.  There is no doubt that exercise is considered a CAM.  There is little doubt that most physicians would recommend some form of exercise to supplement other forms of treatment for various physical concerns.  But what about for mental health issues?
 

 

The effects of cardio vascular exercise on mental health conditions has been studied for many years and in many ways.  Consider the following mental health conditions and studies that have been conducted:

 

• Depression - (Blumenthal, Babyak et al., 2007; Brenes et al., 2007; Legrand & Heuze, 2007; Perraton et al., 2010; Rethorst et al., 2010) - exercise has been shown to decrease depressive symptoms short term symptoms, severity of symptoms and all ages.
• Anxiety - (Herring, Jacob, Suveg, Dishman, & O’Connor, 2011; Herring, O’Connor, & Dishman, 2010) - exercise ahs also been shown to decrease anxiety symptoms.  There are fewer studies on exercise and anxiety as compared to depression but most are strong studies.
• PTSD - (Diaz & Motta, 2008; Motta et al., 2010; Newman & Motta, 2007) - exercise has been shown to decrease PTSD symptoms.  These studies were smaller due to the use of adolescents and children. 

 

Why exercise works

 

There are numerous theories as to why exercise is helpful in reducing mental health symptoms.  One is the thought that positive moods and self-esteem result thus leading to improved mental health (Raglin, 1990).  Another theory is that the brain and body go through a series of changes during exercise that helps the growth of neurons, new blood vessels, and a release of certain neurochemicals (i.e. serotonin, dopamine, acetylcholine and norepinephrine) in the brain--all that help with decrease in mental health symptoms (Voss et al., 2011).  Overall, the brain is a central piece in both exercise and mental health and this is thought to be the connection.  

 

In my experiences, I have seen exercise have a positive benefit in my life.  It has served as a coping skill for stress.  It has served as a physical balancing--having been my healthiest in the last 6 years since I started running (other than the running related injuries but that is due to excessive running - another subject for another post).  It has served as a change in lifestyle.  I work a sedentary job and without exercise, my body would struggle to function normally.

 

Is exercise for you? Absolutely! The great thing about exercise is that there are so many types you can get involved with.  Not everyone enjoys running or biking or swimming.  Visit your local gym and talk to trainers about what types of classes are offered. The point is to find something that you enjoy. Whether you have a diagnosed mental illness or not, exercise can help balance the stress of life. 

 

References

 

Blumenthal, J. A., Babyak, M. A., Doraiswamy, P. M., Watkins, L., Hoffman, B. M., Barbour, K. A., . . . Sherwood, A. (2007).  Exercise and pharmacotherapy in the treatment of major depressive disorder.  Psychosomatic Medicine, 69, 587-596. doi:10.1097/PSY.0b013e318148c19a

 

Brenes, G. A., Williamson, J. D., Messier, S. P., Rejeski, W. J., Pahor, M., Ip, E., & Penninx, B. W. J. H., (2007). Treatment of minor depression in older adults: A pilot study comparing sertraline and exercise. Aging & Mental Health, 11(1), 61-68. doi:10.1080/13607860600736372

 

Da Costa, D., Lowensteyn, I., Abrahamowicz, M., Ionescu-Ittu, R., Dritsa, M., Rippen, N., . . . Khalife, Samir. (2009). A randomized clinical trial of exercise to alleviate postpartum depressed mood. Journal of Psychosomatic Obstetrics and Gynecology, 30(3), 191-200. doi:10.1080/01674820903212136

 

Diaz, A. B., & Motta, R. (2008). The effects of an aerobic exercise program on posttraumatic stress disorder symptom severity in adolescents. International Journal of Emergency Mental Health, 10(1), 49-60. Retrieved from http://www.chevronpublishing.com/product.cfm?dispprodid=480

 

Herring, M. P., Jacob, M. L., Suveg, C., Dishman, R. K., & O’Connor, P. J. (2011). Feasibility of exercise training for the short-term treatment of generalized anxiety disorder: a randomized control trial. Psychotherapy and Psychomatics, 81, 21-28. doi:10.1159/000327898

 

Herring, M. P., O’Connor, P. J., & Dishman, R. K. (2010). The effects of exercise training on anxiety symptoms among patients. Archives of Internal Medicine, 170(4), 321-331. Retrieved from http://archinte.ama-assn.org/cgi/content/full/170/4/321

 

Legrand, F., & Heuze, J. P. (2007). Antidepressant effects associated with different exercise conditions in participants with depression: A pilot study. Journal of Sport & Exercise Psychology, 29(3), 348-364. Retrieved from http://www.univ-reims.fr/rubrique-cachee/laboratoires-labelises/ea-4298-laboratoire-de-psychologie-appliquee-lpa/gallery_files/site/1/1697/3184/12879/13024/13027.pdf

Motta, R. W., Kuligowski, J. M., & Marino, D. M. (2010). The role of exercise in reducing childhood and adolescent PTSD, anxiety, and depression. Communique, 38(6), 24-26. Retrieved from http://readperiodicals.com/201003/2030175731.html

 

Newman, C. L., & Motta, R. W. (2007). The effect of aerobic exercise on childhood PTSD, anxiety, and depression. International Journal of Emergency Mental Health, 9(2), 133-158.

 

Perraton, L. G., Kumar, S., & Machotka, Z. (2010). Exercise parameters in the treatment of clinical depression: A systematic review of randomized controlled trials. Journal of Evaluation in Clinical Practice, 16(3), 597-604. doi:10.1111/j.1365-2753.2009.01188.x

 

Raglin, J. S. (1990). Exercise and mental health: Beneficial and detrimental effects. Sports Medicine, 9(6), 323-329.

 

Rethorst, C. D., Landers, D. M., Nagoshi, C. T., & Ross, J. T. D. (2010). Efficacy of exercise in reducing depressive symptoms across 5-HTTLPR genotypes. Medicine and Science in Sports and Exercise, 42(11), 2141-2147. doi:10.1249/MSS.0b013e3181de7d51

 

 

Voss, M., Nagamatsu, L. M., Liu-Ambrose, T., & Kramer, A. F. (2011). Exercise, Brain, and Cognition Across the Lifespan. Journal of Applied Physiology, 111(5), 1505-1513. doi: 10.1152/japplphysiol.00210.2011

 

 





CAM Culture

The importance of cultural awareness in CAM

Cultural awareness is simply the ability of a person to be aware of the differences in culture around them and to understand the importance that culture has to each person (Berg, 2003). 

The importance of cultural awareness in CAM becomes especially important based upon the vast array of CAM types.  The myriad of cultures that many CAM types come from also legitimize the importance for any CAM practitioner to be well versed in cultural issues. 

The following are some examples of CAM interventions and their cultural roots (Freeman, 2009):

• Biofeedback - United States
• Hypnosis - traces back to Egypt and Greece but was also seen in many part of the world
• Chiropractic - originated in multiple areas but largely seen in Indian cultures.  Later seen more prominently in Greek culture.
•  Acupuncture - from Chinese medicine
• Massage - can be traced to ancient cultures in the middle east, Greece as well as Chinese medicine
• Aroma therapy - all over the globe--many middle east nations used as well as European and South America
• Herbal medicine - all cultures but currently European nations such as Germany have a succinct system to test the safety of herbs used as medicine
• Reiki and Therapeutic Touch - has roots in Japanese medicine
• QiJong - Chinese medicine
• Yoga - India

Certainly it is important to understand some history of CAM interventions but it is also important to know the individual patient's cultural desires.  For example, if a patient desires a more natural approach which has been a part of their culture and heritage, this needs to be assessed in the beginning.  This type of patient will not want the more traditional American medicine techniques such as medications.  Instead they may be desiring help in finding the right herbal supplements to help.  They may also be open to natural ways of dealing with stress (e.g. exercise, yoga). 

Prior to working with patients or clients and trying to assess their cultural desires, it is imperative that you as a practitioner assess your own feelings regarding different cultures.  Are you open to other people's views? Are you open to learning about various cultures? If you cannot say yes to either question, you may struggle to be a culturally competent practitioner. 

For more information on cultural competence and assessing yourself see the following website to help guide you http://nccc.georgetown.edu/index.html 

References

Berg, D. (2003). Culture, Faith Traditions, and Health. Center for Spirituality and Healing. Retrieved from http://www.csh.umn.edu/Integrativehealingpractices/culture/comp/cp01.html

National Center for Cultural Competence. (2011). Retrieved from http://nccc.georgetown.edu/index.html

 

All Cracked Up!

Chiropractic

What do you think of when you think of a chiropractor? You might think of someone who cracks your back or neck.  Chiropractic is more than this.  It is considered a form of CAM and can greatly help in some circumstances.

 

 

Chiropractic focuses on the musculoskeletal system and nervous system. The "back cracking" may be part of adjustments that are made to the musculoskeletal system but there are multiple interventions that chiropractors use. The following are some included interventions that chiropractors might incorporate:

• manipulation of joints and spine
• muscle tension assessment
• massage
• physical therapy
• heat and ice
• electrical stimulation
• exercise
• relaxation techniques
• posture advice
• nutritional and self-care

Typical chiropractic practice includes a combination of the above interventions.  There is however, a small subset of chiropractors who adhere to a strictly vertebral subluxation approach.  This is an assessment and adjustment of the spinal cord where this group believes that many disorders originate from (Freeman, 2009).

 

The research on how effective chiropractic is said to be poor by some.  See http://www.sciencebasedmedicine.org/top-10-chiropractic-studies-of-2013/ for information on one person's assessment on the top 10 studies on chiropractic in 2013.  Based upon the factors of a solid study design, these do not look promising. 

 

So the question remains-- is chiropractic a valid intervention? The research and the opinions are vast. From personal experience, I have had both positive and negative experiences from chiropractic intervention specific for back pain.  Doing some research and talking with multiple physicians regarding your condition is the best path to follow.  It may lead to hearing and reading various views but an informed decision is better than taking a chance. 

 

 

References

 

Freeman, L.W. (2009) Mosby's complementary & alternative medicine: A research-based approach. (3rd ed). Mosby.

To herb or not to herb...

Herbal Supplements

Herbal supplements are a huge industry.  It may be considered a type of CAM but it could be separated into a different category.  Consider this--in 2009 it was estimated that the sales of herbal supplements topped 5 billion dollars and was rising steadily (Nutraceuticals World, 2010).  It is also estimated that tens of millions of Americans are using some form of herbal supplement (Marinac et al., 2007).

Herbal supplements are sold and advertised to treat just about anything from legitimate health issues (e.g. diabetes, high blood pressure) to more self-fulfilling reasons (e.g. body part growth, appearance) and everything in between.  One of the most widely used subtypes of supplement is a dietary supplement.  The Center for Disease Control (2011) estimated that nearly 50% of Americans used a dietary supplement between the years 2003 and 2006.  But there are reasons to be mindful of dietary herbal supplements.

According to the National Institutes of Health (2013) there are five areas to be aware of:

• Dietary supplements contain  a number of different ingredients -- not all have been confirmed as having health benefits.
• Always read the labels and follow instructions of supplements.  They are not always safe.  Supplements may be supplemented with other substances.
• There may be some negative interactions between some supplements and some medications.  Many supplements have not been tested for pregnant women, nursing mothers, or children.
• The U.S. Food and Drug Administration (FDA) is responsible for regulating foods and drugs and this includes dietary supplements, however  the regulations for dietary supplements are much less strict than prescription and over the counter medications. 
• Be sure to coordinate with your primary care physician on any type of CAM which includes using any sort of herbal supplements. 

The bottom line is this--read, consult, and be patient when considering herbal supplements.  It may take more time to consult with your physician but the ramifications of interactions with your medications or a supplement that has harmful additives is not worth the added stress on your life. 

References

 

Center for Disease Control and Protection. (2011). Dietary supplement use among U.S. adults has increased since NHANES III (1988–1994). Retrieved from http://www.cdc.gov/nchs/data/databriefs/db61.htm

 

National Institutes of Health. (2013). Using dietary supplements wisely. Retrieved from http://nccam.nih.gov/health/supplements/wiseuse.htm

 

Nutraceuticals World. (2010). U.S. Herbal Supplement Sales Reach $5 Billion. Retrieved from http://www.nutraceuticalsworld.com/issues/2010-06/view_industry-news/u-s-herbal-supplement-sales-reach-5-billion/      

 

Marinac, J.S., Buchinger, C.L., Godfrey, L.A.,  Wooten, J. M., Sun, C., & Willsie, S.K. (2007).

Herbal products and dietary supplements: A survey of use, attitudes, and

knowledge among older adults. View shared postThe Journal of the American Osteopathic Association, 107, 13-23. Retrieved from http://www.jaoa.org/content/107/1/13.full.pdf

 

 

 

 

 

 

 

 

 



Touch Me?

The Value of Therapeutic Touch (TT)

There are many types of touches:

• A greeting (i.e. handshake, high-five, fist bump)
• A consoling light touch to let someone know you are with them
•     An affectionate hug or kiss
•     A strike of violence rooted in anger
•     A therapeutic manipulation or assessment from a healthcare professional
•     A massage to help one feel better

But consider the value of therapeutic touch.  Some may not understand the term.  TT can be differentiated from massage, consoling touches, assessment and manipulations.  TT is defined as a healing technique that does involve hands but where touching is not involved.  The direct human energy from one's hands are used in a process to help the patient heal (Therapeutic Touch, 2011).

TT basically involves four phases: 1.) Centering - the therapist clears their mind to focus on the energy levels of the patient. 2.) Assessment - the therapist runs their hands palm down a few inches from the patients body up and down searching for irregularities in the energy levels. 3.) Extinguishing - the therapist runs their hands over the patient's body several times and gets rid of the negative energy by flicking them off when at the end of the body.  4.) Transferring - the therapist then transfers their own healthy energies to the patient using a similar motion of the hands over the body (Therapeutic Touch, 2011).

 

While Therapeutic Touch is a safe procedure, many people still question if it is a real and effective method treatment.  Numerous studies have assessed it but many of these studies have been criticized for small sample sizes, lack of random sampling and poor overall design (Freeman, 2009).  One must be careful with such a treatment not to delay other forms of evidence based treatment for the condition.  This is where the problems may lie. 

I have my doubts about the effectiveness of TT at least at the level that most in the field claim.  There may be some value in the proximity of the practitioner to the patient--an intimacy factor.  But the root of TT is the manipulation of the energy field--a completely different area than intimacy.  Don't let my opinion sway you.  Do you own research. 

References

 

American Cancer Society. (2011). Therapeutic Touch. Retrieved from  
          http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/manualhealingandphysicaltouch/therapeutic  touch



Freeman, L.W. (2009) Mosby's complementary & alternative medicine: A research-based approach. (3rd ed). Mosby.

Is Spiritual/Religious therapy really a CAM?

Christian counseling.  Spiritual advising. Pastoral counseling. Religious institutions.  Prayer with your physician. Pastoral visits while in the hospital. Biblically based addictions treatment. Church based support/recovery groups.
 

The above are all examples of religious or spiritual types of treatment for physical, mental,
emotional, relational and spiritual issues.  But should they be considered Complementary or
Alternative modes of treatment? Or are they a primary source of treatment for many people?

 
Spirituality is on some lists of CAMs (see http://nccam.nih.gov/health/atoz.htm).  To really make
any statements about whether this type of treatment is a CAM or should be considered a primary treatment, we should first define spiritual or religious therapy.  Religion is often seen as a moral set of standards one adheres to that might include participating in a group like setting (i.e. church) to help exercise these standards (Dictionary.com, 2014).  Spirituality has been more difficult to define.  Spirituality in general can be seen as more experiential whether this pertains to religious activities or non-religious activities (Culliford, 2014).  

Furthermore, for the sake of this discussion we need to differentiate between including spirituality or religion into healthcare and therapy that is considered spiritual (or religious).  A patient attends a physicians appointment looking to get treatment for a specific issue (e.g. seeing an oncologist due to cancer).  The physician can include spiritual or religious aspects to treatment and even refer out to someone who has more expertise.  But some people seek spiritual or religious therapy specifically to receive that approach to help with a specific issue (i.e. addiction, depression, relationship issues, etc.). 

Now let's go back to the original question.  Should spiritual or religious therapy be considered a CAM or a primary treatment for some? This is really a matter of opinion.  Some might be offended to say that seeking out a spiritual advisor or a Christian counselor is alternative to anything.  For some, it is the only choice dependent upon the issue to be addressed.  Based on lists of CAMs, it seems to fit.  But it does not make it any less important than traditional forms of therapy. 
 
 

References

Culliford, L. (2014). PsychologyToday.com. What is Spirituality? Retrieved from   

     http://www.psychologytoday.com/blog/spiritual-wisdom-secular-times/201103/what-is-spirituality

Dictionary.com (2014). Religion. Retrieved from http://dictionary.reference.com/browse/religion