ICL 10.6: Behavioral and Complimentary Interventions Flashcards
(35 cards)
what is the mission of the national center for complementary and integrative health?
the mission of NCCIH is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health andhealthcare
this used to be called the alternative medicine center!
what are the different domains of complimentary and integrative health practices?
- biologically based = herbs, diets, vitamins
- energy = use of energy fields
- manipulative = body movements by others like massage therapy
- mind-body = mind effects on body functions
- whole medical systems = complete theory and practice like acupuncture
in which conditions is complimentary and integrative heath most commonly used?
(most common)
1. chronic back pain
- head cold
- chronic neck pain
- joint pain; arhtritis
- anxiety/depression
- chronic GI problems
- acute headaches
(least common)
a lot of these are chronic so it makes sense these patients want to seek complimentary treatment! also, these things don’t have cures! plus a lot of these problems have a lot of important comorbidities. so patients will probably be reaching out to their physician when deciding which therapies to chose
how frequently do people use complimentary and integrative heath therapies?
- mind body medicine (52%)
emphasis on mindfulness, relaxation therapy, guided imagery etc.
- biologically based practices (22%)
- manipulative and body based practices (11%)
- whole medical systems (3%)
- energy medicine (.5%)
what practices are mind-body interventions?
- relaxation
- biofeedback
- meditation
what are relaxation therapies?
a group of behavioral therapeutic approaches whose primary objective is the achievement of physical and mental relaxation –> this is a type of mind-body intervention
two common components are:
1. repetitive focus on a word, sound, phrase, or body sensation (breath)
- a passive attitude toward intruding thoughts
ex. mindful breathing, progressive relaxation, passive relaxation
what is passive relaxation?
repeat relaxing words that convey mental and physical relaxation to reduce arousal and pain
- the words usually mention heaviness which is associated with muscular relaxation
- warmth of the hands and feet; use mental techniques to warm the hands/feed
- saying words like calm, peaceful, quiet
a type of relaxation therapy which is a type of mind-body intervention
what is progressive relaxation?
muscles are alternately tensed and relaxed to identify the difference between tension and relaxation and produce relaxation voluntarily
you’re trying to help people who have pain but don’t realize that their muscles are tight
a type of relaxation therapy which is a type of mind-body intervention
what is biofeedback therapy?
an active therapeutic technique, based on operant conditioning by which a person learns awareness and control of a physiological function (self regulation) and then is able to apply that to whatever their personal goal is –> this is a type of mind-body intervention
it involves some kind of instrument or measuring device! eventually after the person has been trained, they will no longer need the instrument
ex. biofeedback device that measures the temperature of the skin; the person would have this attached to their finger and the person is guided through a relaxation therapy talking about how to get your hands to warm and as your hands warm, the noise from the device will decrease – so the feedback is in the form of the sound decreasing and patients can also watch the temperature too in live time – through training the patient will help identify their internal state and they’re able to generate the relaxation response without the deivce
what are the types of biofeedback in clinical use?
- EMG = electromyograph measures skeletal muscle motor unit potentials
- thermal = measures the temperature of the skin
- heart rate variability = measures the change in heart rate during inhalation and exhalation
- EEG = electroencephalography measures brain wave activity –> doesn’t work as well because it’s hard for patients to identify when they’re at a good brain wave activity and replicate that without the machine
which disorders are treated with biofeedback alone?
pediatric ADHD
how id pediatric ADHD treated?
biofeedback therapy! specifically EEG feedback which provides information about brain wave patterns
the goal is to learn to generate brain waves associated with concentration and attention (decrease theta/beta ratio) – > multiple sessions are required (30)
controlled study showed improvement in attention and executive function
metanalysis rated EEG as “probably efficacious” so the risk is low and the benefits can be pretty high for some kids if they’re able to stick with it
how are tension-type headaches treated with complimentary and integrative heath treatments?
biofeedback + relaxation therapy
sensors on the forehead (back of neck, jaw) connect to an EMG which provides information about muscle tension –> relaxation is used to relieve tension in face, neck and shoulder muscles
protocol: approximately 10 sessions and home practice of relaxation = progressive/passive relaxation or breathing
there is a documented decrease in frequency and intensity of muscle tension headache!
how does cognitive behavioral therapy vs. relaxation help with chronic back pain treatment?
CBT: evidence is good; benefit is moderate
progressive relaxation: evidence is fair; benefit is substantial!!
since most pain over time becomes comorbid with a mood or anxiety disorder, you should recommend CBT in addition to progressive relaxation!
how are anxiety disorders treated with complimentary and integrative heath treatments?
biofeedback + relaxation + psychotherapy
- thoughts and beliefs related to anxiety responses are explored through psychotherapy, usually CBT
- biofeedback promotes mastery of stress related physiological responses (ex. heart rate variability or thermal biofeedback of fingers would be great; fingers get cold and heart rate goes up during stress)
- passive relaxation and slow breathing are practiced to generalize the relaxation response
what is meditation? what are the 2 types of meditation?
focusing your attention on a mantra (a word or words), an object or the breath, or the moment
- transcendental meditation (TM)
- mindfulness meditation
what is transcendental meditation?
uses a mantra to quiet the mind
the mantra is usually a word; so it’s a repetition of this mantra
practice 2x a day for 20 minutes
what is mindfulness meditation?
non-judgmental awareness of and acceptance of the present moment
can be practiced formally or informally
formal would be taking time specifically to meditate and be in the moment, focus on the full experience of that moment
informal meditation would be focusing on eating; eating meditation would be paying attention specifically to what you’re eating and the entire experience of that – walking meditation would be paying attention to walking, the sensation of your feet on the ground, the breeze, your heart rate; everything about that specific experience
what are the effects of transcendental meditation on metabolic syndrome? what is metabolic syndrome?
metabolic syndrome = high BP, DM2, hyperlipidemia
TM decreased BP, decreased insulin resistance and improved the lipoprotein profile as long as TM practices were continued!
for people with pain and anxiety conditions, once they learn the process of relaxation, they can cut back relaxation to 2-3 times a week but people with physical conditions like high BP have to do the meditation every day
what are the physical effects of mindfulness meditation on the body?
changes were observed in brain regions associated with attention, emotional balance and self regulation!
patients were less reactive to stress, better able to concentrate and less reactivity to anxiety, anger, etc.
this includes regions such as anterior cingulate cortex, prefrontal cortex and striatum, limbic areas, insula, medial prefrontal cortex
these results suggest neuroplasticity
what does MBSR stand for?
MBSR = mindfulness-based stress reduction
which psychiatric conditions is MBSR used to treat?
- depression: significant increase in positive emotions and ability to find pleasure in day to day activities
- bipolar disorder: significant decrease in anxiety and fewer depressive symptoms
MBSR = mindfulness-based stress reduction
how does mindfulness meditation effect sleep?
a study compared sleep hygiene with mindfulness
results showed mindfulness meditation had:
1. shorter time to get to sleep; decrease onset insomnia
- fewer awakenings
- sense of restorative sleep upon awakening
what is medical acupuncture?
acupuncture involves the insertion of thin metal needles at precise points and applying heat or electrical stimulation.
in Ohio, it’s provided by physicians who have a valid medical license and who have completed 300 hours of acupuncture training
non-physician providers must file with the state medical board and be recognized by the National Certification Commission for Acupuncture and Oriental Medicine
