Alternative health care gains steam

Nearly half of all Americans report they have used some type of alternative or complementary medicine--from mind-body interventions such as meditation or relaxation therapy to herbal remedies, massage, acupuncture or chiropractic care--either in conjunction with or in lieu of traditional medical approaches, according to some estimates.

In fact, studies have shown that people with such psychological problems as insomnia, depression and anxiety are frequent users of alternative therapies, especially massage, chiropractics and acupuncture. In 2001, researchers found that 56 percent of people with anxiety disorder and 53 percent of people with depression reported using alternative treatments in the previous year, according to a study in the American Journal of Psychiatry (Vol. 158, No. 2).

That concerns health psychologist Margaret A. Chesney, PhD, who says there's little to no scientific evidence that many of these therapies--often still hard to define (see side links)--are safe and effective.

"The public is already turning to these forms of medicine, and we need to play catch-up in studying them," says Chesney, who as the new deputy director of the National Center for Complementary and Alternative Medicine (NCCAM), is heading up efforts to do just that. NCCAM, established by Congress in 1998, is one of 27 institutes and centers that make up the National Institutes of Health (NIH).

In her position there, Chesney is encouraging psychologists to study complementary and alternative therapies with a view toward acquiring the evidence needed to determine whether these approaches should be added to standard psychological practice.

Research under way

In fact, some psychologists are already involved in studying such therapies through NCCAM or other research grants.

With support from NCCAM, for example, some have conducted clinical trials on St. John's Wort, an herbal treatment believed to help treat depression. So far, researchers have found that St. John's Wort is no more effective than a placebo for treating major depression; they are still investigating whether it has any effectiveness for treating minor cases of depression.

Taking into account a possible placebo effect is crucial when researching alternative as well as conventional therapies, Chesney notes. But, since "placebo" can be a misnomer, she adds, NCCAM is interested in research that shows the extent that patient expectations can influence treatment outcomes.

Other NCCAM-funded research on alternative mind-body interventions under way includes:

• Meditation's possible use in treating pre-hypertension. Researchers will evaluate how meditation, particularly mindfulness meditation, can reduce blood pressure in pre-hypertension. Studies have already shown that one form of meditation--transcendental meditation--can reduce blood pressure on par with medical treatment in people with mild hypertension. The study is being conducted by principal investigator and psychologist Sarah Reiff-Hekking, PhD, of the University of Massachusetts Medical School, Worcester.

• Acupuncture's effects on brain activity. This research will use functional magnetic resonance imaging to study the neurobiology of acupuncture in healthy human subjects. Researchers will investigate the brain activity involved with different acupuncture techniques and classes of acupuncture points. The principal investigator is Bruce R. Rosen, PhD, MD, of Harvard University.

• The health effects of yoga. The research project includes two pilot studies that use a yoga-based intervention for people with HIV and depression or diabetes. One study is examining 30 people with HIV and depression to gather preliminary data on the effects of yoga on depression, quality of life and the immune system. Researchers also will use yoga-based interventions to study possible changes in glucose levels in diabetics. The study is being conducted by principal investigator Frederick M. Hecht, MD, of the University of California, San Francisco (UCSF).

• Self-hypnosis as an aid in minor surgeries. Researchers--including psychologists and principal investigator Elvira V. Lang, MD, of Harvard University--are studying the efficacy of the behavioral methods of relaxation, self-hypnosis and imagery in reducing cognitive and physiologic stress during and after surgery. Previous research by the team has shown that self-hypnotic relaxation can reduce physiologic and cognitive stress during some surgeries. Researchers include psychologists Eleanor Laser, PhD; Susan Lutgendorf, PhD; and Henrietta Logan, PhD.

Elsewhere in the country, psychologist Susan Folkman, PhD, director of the Osher Center for Integrative Medicine at UCSF, has headed research studies that combine traditional medicine with alternative approaches. The center, which emphasizes mind-body medicine, studies such topics as massage for cancer-related fatigue--research funded by NCCAM--and a systematic, qualitative review of nearly 40 clinical studies on using milk thistle to treat acute and chronic liver disease. The center also puts new methods it studies into practice in its clinic.

Folkman, who was appointed director three years ago, says psychologists can contribute to such research by providing methodological expertise in study design and measure development as well as by leading clinical trials.

Psychology professor Catherine Stoney, PhD, at Ohio State University also has been studying alternative therapies. She has been researching the effectiveness of B-vitamin supplements in stress reduction and their physiological effects and influence on health.

Stoney, a health psychologist, will continue to explore such research interests when she joins the staff of NCCAM in June. In her new role as a program officer there, she plans to foster and spearhead innovative CAM research conducted by psychologists and others around the country.

In particular, Stoney wants to encourage clinical and research psychologists to investigate the effectiveness of CAM psychological strategies already being used in clinical practice and examine their relationship to traditional medicine. She hopes this research contributes to psychology's "rich history of developing interventions that are not mainstream...and of using complementary as well as alternative approaches."

Echoing those sentiments is APA CEO Norman B. Anderson, PhD--a former director of NIH's Office of Behavioral and Social Sciences Research--who says psychologists can collaborate with those in other fields to study topics like acupuncture, dietary supplements and massage.

"We have a great deal of expertise in the design of studies that have strong interpersonal components and where double-blind clinical trials are not feasible," Anderson says. "I think CAM has become a vibrant research area where psychologists are uniquely suited to make a contribution."