Physical Treatments
This leaflet is for anyone who wants to know more about using
complementary and alternative medicines (CAMs) for mental
health problems. It covers:
Which CAMs can be used for mental health
problems?
Many treatments have been used, some more
successfully than others. Your choice should be guided by their
safety and effectiveness. If they are safe and do not interfere
with other treatments, then anything that makes you feel good can
be used.
How good are they?
Very little research has been done into these
treatments. Research is expensive and many of the studies have been
too small to give a clear answer. The most research has been
done on treatments for depression, anxiety and insomnia.
Who can I speak to about CAMs?
Finding an expert can be difficult. Your
doctor, nurse or pharmacist may give you some guidance or be able
to suggest someone who knows more. It is best to choose a CAM
therapist with a recognised qualification, who is member of a
regulated society. See finding a
practioner.
How to use CAMs safely?
- Keep an open mind about the
different options available.
- If in doubt, seek advice from your doctor,
nurse or pharmacist.
- Tell the therapist about any illness,
seizures or allergies or if you plan to become pregnant or
breast-feed.
- Discuss your concerns about conventional
treatments.
- Ask about your therapist’s qualification and
experience.
- Ask about side-effects of treatment.
- Seek medical advice if you experience unusual
symptoms.
- Make special time for your treatment
sessions.
Acupuncture
Acupuncture involves piercing the skin with
fine needles. There are two types:
- Traditional Chinese
acupuncture involves placing the needles along
assumed energy channels or ‘meridians’. This is done in order to
restore a disturbed energy balance, which is theoretically
responsible for illness.
- The Western medical
approach uses similar techniques without using the
energy concept. In the West, acupuncture is mainly used as a
treatment for pain. Its use for mental health problems is still in
its infancy.
How is the strength of acupuncture
determined?
The dose of acupuncture can be varied by the needle sites, the
depth and duration of insertion, the number of needles and the
number of sessions. The dose can also be increased by manual
stimulation of the needles, or electrical sitmulation. This is
where the dose is increased by running a small electric
current through the needles. Moxibustion is when the needles are
heated by burning mugwort.
Which mental health problems can be treated with
acupuncture?
Anxiety, depression, stress and insomnia can
all be treated. If you don’t feel an improvement after several
sessions, or your symptoms become severe, medical help should be
sought.
How well does it work?
Acupuncture seems to reduce anxiety. Most
research has studied its effect for conditions such as tooth
extraction, withdrawal from alcohol addcition, and diseases, such
as cancer. It can help to induce calmness in these situations.
We don't really know how well it works, as
only a few small studies have been done. However, it seems to have
some benefit and acupuncture could even be combined with
antidepressants in some cases. Electro-acupuncture may be the
most effective method. This seems to have a similar effect on
muscles as exercise, and exercise has been shown to improve
mood.
Anxiety, agitation and low mood may be
improved.
About 1 in 10 people feel tired after
acupuncture. Thus it comes as no surprise that acupuncture has been
used to treat insomnia and some studies suggest that it may work.
The main drawback is that the insomnia may come back once the
treatment is stopped.
What about addiction and acupuncture?
Acupuncture is used to treat withdrawal symptoms, but on its own
it does not seem to help people overcome addiction to smoking,
drinking or drugs. More research needs to be done to understand how
acupuncture could help people with addiction problems.
Side-effects of acupuncture
If you are sensitive to pain, or if you have fibromyalgia or
chronic fatigue with muscle pain, it may not help you. This is
because your pain sensitivity could make the treatment
uncomfortable or painful. However, one recent trial has shown that
it may reduce pain in fibromyalgia.
Most people get very few side-effects. Some needle points
require more caution than others, for instance those in the chest.
Common side-effects include bruising, bleeding and pain. Some
people can faint, which is why the first session should be
conducted lying down. Some people can also become very tired. If
this happens to you, then do not drive after the sessions.
Similarly, you should not drive to the first session in case this
happens to you.
Infection can occur, but since acupuncture needles are only used
once, this is unlikely. Some people get anxious or have a strong
emotional reaction to the treatment. If this happens during the
session, it might be best to stop and discuss what happened.
Sometimes it can help to simply lower the dose. Tell your
acupuncturist if you may be pregnant.
Are there serious side-effects?
Acupuncture involves needles, so it is
possible to pierce organs, nerves and blood vessels. In the worst
case, needling over the chest or back could pierce the heart or
lungs. Skilled therapists would avoid such injuries. However, if
you get breathing difficulties after needling of the chest and
upper back, you should consult a doctor immediately and explain
that you had acupuncture.
Ear acupuncture
Ear acupuncture, or auriculotherapy, involves
inserting very fine needles into the surface of the ears. The
needles are never inserted into the openings of the ear. Since ears
are prone to infections, the skin area should be cleaned and
disinfected. Ear acupuncture has been used to treat addiction and
pain. Some people use needles which stay in the ear, sometimes for
up to two weeks. These needles are more prone to infection, and
people who suffer from heart valve disease must never use them.
People who are treated with steroids, or have diabetes, also have a
higher risk of infection.
TENS
TENS is short for Transcutaneous Electrical
Nerve Stimulation. Electrodes are placed on the skin, so no needles
are used. TENS is mainly used as a treatment for pain.
Aromatherapy
This is based on the healing properties of
plant oils. These oils are diluted in a “carrier oil”. The
oils are commonly used in oil burners, in bath water, or massaged
into the skin. The aroma of the essential oil evaporates and
stimulates the sense of smell. An aromatherapy massage is based on
techniques to relieve tension and improve circulation.
Practitioners believe this allows oil molecules to be absorbed into
the blood stream during massage, and then passed through the
body to the nervous system. People use aromatherapy for relaxation,
sleep improvement, pain relief and to help in depression.
Its effects are weak, so it is best to use it
in conjunction with conventional treatments. Aromatherapy is
safe, but some oils should not be used if you are pregnant, if
you have epilepsy, or in babies and young children. Some oils can
lead to allergies or increased sensitivity to light.
Homeopathy
Homeopathy uses the principle of like to cure
like. This involves using extremely diluted substances to avoid
toxicity. The medicines may be so diluted that very few, or no,
molecules of the original substance are present in the tablets or
solutions taken. Homeopathic medicines are prepared from minerals,
plant and animal substances. The more diluted the solution, the
stronger the claimed effect. This is one of the most controversial
aspects of homeopathy.
There is a lot of scepticism about the
effectiveness of homeopathy and using it as a substitute for
conventional treatments is unwise. However, some people find it
helps to combine homeopathic and conventional medicines.
Homeopathic remedies are very safe because they are highly diluted.
Occasionally, deterioration of existing symptoms can occur, this is
called “aggravation”.
Yoga
Yoga is a technique, which is more than 5000
years old. “Yoga” means “union” in Sanskrit. It uses spiritual and
physical exercises to heal mind and body. The exercises need to be
adapted to fit individuals. Yoga can have a calming and relaxing
effect and reduce agitation. It may be useful for anxiety and
stress. Yoga has also been tested as a treatment of depression and
epilepsy, but the findings are inconclusive.
Biofeedback
Biofeedback is a technique where bodily
functions which are usually ignored, or perceived as automatic, are
monitored in order to control them. Functions monitored include,
heart or breathing rate, blood pressure, sweating and muscle
tension. Monitors are attached to measure and provide feedback of
the chosen function. It can be used for agitation, anxiety and
stress, but it is difficult to draw firm conclusions about its
effectiveness. One of the main criticisms is that it is costly and
similar effects can be achieved through meditation or
relaxation.
Relaxation
Relaxation is usually used to reduce agitation
and arousal. One technique is progressive muscle relaxation. This
involves tensing and relaxing different muscle groups. It is useful
for problems associated with muscle tension, and can help in
anxiety and asthma. Sessions take about 20 minutes. The exercises
need to be done every day to work. Autogenic training is another
technique. This involves autosuggestion to control breathing, heart
rate and muscle tone.
Meditation
Spiritual techniques can help in a variety of
mental and physical health problems. Religious activity can improve
your health. However, meditation can affect your mental
health, and even cause psychotic episodes in vulnerable people.
People suffering from psychotic disorders should use these
techniques with caution.
Hypnosis
Hypnosis involves the induction of a trance or
sleep like state. Suggestions targeting the problems can then be
introduced to facilitate healing. Hypnosis can be tried for many
different problems. However it is important to choose an
experienced and well-trained hypnotherapist. Hypnosis can be used
along side conventional medicine to treatment schizophrenia, but
people suffering from psychosis should use these techniques with
caution.
Reiki/Therapeutic touch
'Reiki' relates to spiritual life force
and energy. Reiki therapists claim to channel energy from their
hands to the client which leads to healing. Advanced reiki therapy
involves healing from a distance. Reiki therapy is controversial.
If reiki is not successful, some therapists may claim that this is
because the client was blocking the energy. This could result in
people wrongly blaming themselves for the therapy not working. The
evidence for reiki being effective is poor. Therapeutic touch is a
concept related to Reiki, but there is no distance healing.
Reflexology
This treatment works on the principle that
specific points in the feet, hands and ears represent certain body
systems or organs. Illness is seen as a sign that the person is out
of balance, and that energy flows are disturbed. By applying
pressure point massage the energy flows and balance is
restored. Reflexology can give a sense of well-being and relaxation
and it may be help in stress, anxiety and poor sleep. If symptoms
are severe, reflexology may not work. In such cases, it still can
be a useful additional treament.
Finding a practitioner
Finding a well-trained practitioner can be
difficult. You can ask your doctor or mental health professional to
sugggest a qualified practioner.
Acupuncture:
The British Medical
Acupuncture Society trains doctors and health care
professionals.
The British
Academy of Western Medical Acupuncture also trains
health care professionals. Physiotherapists and osteopaths have
their own acupuncture training.
The British Acupuncture
Council represents non-medically qualified
practitioners trained in traditional Chinese acupuncture.
Aromatherapy:
The Aromatherapy
Council has a national register of
aromatherapists who meet the agreed national standards
for training, professional skills, behaviour and
health.
Homeopathy:
In the
UK, the Faculty of Homeopathy trains medical doctors and other
health professionals.
The
Royal London Homeopathic Hospital has been
part of the NHS from its beginning in 1949. The hospital offers a
whole range of other complementary and alternative medicines.
The Society of
Homeopaths represents non-medically trained
practitioners; it is the largest organisation.
Hypnosis:
The National Council for
Hypnotherapy represents over 700
practitioners within the United Kingdom.
The British
Institute of Hypnotherapy is an association of
hypnotherapists, Psychotherapists, and neurolinguistic programming
practitioners.
The General
Hypnotherapy Register is the registering agency
for the General Hypnotherapy Registering Council.
All three organizations offer accreditation
and operate a code of practice as well as grievance and complaints
procedures.
Reiki:
All members of the UK Reiki
Federation of practitioners and teachers, have
undersigned to the Federation’s code of ethics, have Reiki
insurance and hold Reiki certificates.
Reflexology:
Reflexology
Forum is a national organisation that represents up to
80% of all the reflexologists in the UK. It has several member
organizations and currently develops a register of recognized
practitioners.
Yoga:
The British Wheel of Yoga
is recognized by the Sports Council as the national governing body
for yoga in Great Britain. It represents the UK at the
European Federation of National Yoga Organisations and offers a
training and accreditation programme for professional
qualifications. BWY also accredits other organisations’ training
programmes.
Useful websites
MedlinePlus:
This is a website run by the US National
Institute of Health. The homepage has a search option allowing you
to type in different keywords, to enable you to retrieve the
information you want. Typing the keyword “alternative medicine” or
“drug information” will direct you to the relevant sites.
Navigating with the buttons on the top of the menu will help you to
find what you are looking for.
World Health
Organisation:
This website is very complex, but easy to use.
It tells you how complementary and alternative medicines are
practised all over the world. From the homepage, choose the option
“health topics”. This will lead you to an alphabetical index
allowing you to click to the topic of your interest. Try
“acupuncture” or “traditional medicine”.
The Prince's Foundation for Integrated
Health:
A UK website providing information on the
integration between complementary and conventional healthcare. The
Foundation is currently producing national guidelines on the use of
complementary healthcare within the National Health Service to be
published in 2007. Click on “publications” in the menu to see
available reports, for instance the “Complementary health care
guide for patients”, which can be downloaded free of charge.
National Center for Complementary
Alternative Medicine / National Institutes of
Health:
This website from the US offers very
comprehensive information on complementary medicines. It is easy to
surf. Of particular interest is the clinical trial register, which
gives an overview of the evidence base collated in the US.
Obviously this needs to complemented with information from other
clinical trial databases, such as the Cochrane
collaboration www.cochrane.org. Click on “news and events” for
important safety updates.
Quackwatch
Quackwatch is “ a nonprofit corporation
whose purpose is to combat health-related frauds, myths, fads,
fallacies, and misconduct." Its primary focus is on quackery-related
information that is difficult or impossible to get elsewhere. This
website can be very helpful to consult when rather unusual
treatments are suggested, particularly if high fees are to be paid
in advance. Some people may find the website too provocative and
over-sceptical towards complementary medicines. Click onto the
“cheers and jeers” section to get a flavour of the site.
This leaflet was produced by the Royal College of
Psychiatrists' Public Education Editorial Board.
© March 2007 Royal College of Psychiatrists. This leaflet
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