Tuesday, December 24, 2013

Stress and Relaxation Techniques

     Stress has become one of the main points of discussion in regards to health in American culture today.  Indeed, stress takes much the blame for what ails the general population (Lehrer, Woolfolk, & Sime, 2007).  There are several forms of adaptation and techniques for management of stress responses.  Many of these techniques fall under the heading of complementary and alternative medicine in that they are designed to help the body heal, recover, and be at its best (Freeman, 2009).


The Six Families of Relaxation

    Many caregivers recognize six groups, or families, of relaxation techniques (Lehrer, et. al., 2007).  These families are autogenic training, meditation or mindfulness, yoga stretching, positive imagery or self-statements, breathing exercises, progressive muscle relaxation (Lehrer, et. al., 2007).

      Autogenic training is the practice of the subject becoming more aware of their body.  The hope is that as a person is able to focus on the ability to sense their own body that they will be able to then regulate some of the processes of the nervous system.  This training will often focus the subject’s concentration on their breathing, temperature, and heartbeat (Morgan & Jorm, 2009).

      Meditation or mindfulness is similar to autogenic training in that it is designed to help the subject become more self-aware and to seek to regulate their own thoughts (Morgan & Jorm, 2009).  The technique for meditation is simple in concept but can be difficult for some in practice.  The different forms of meditation use different tools in order to focus and relax the mind.  This could be as simple as a mental picture or rocking back and forth, or as pre-planned as requiring an external sound or visual aid (Lehrer, et. al., 2007).

      Yoga, and specifically, yoga stretching is designed to help loosen and relax muscles.  Typically, yoga and stretching involves deep breathing as well as physically pausing from other labor.  A proven technique for applying yoga and yoga stretching to a relaxation plan is to begin with simple stretches based on yoga positions.  The patient can learn and begin to practice the stretches quickly.  They can then build upon their mastery of these movements and continue to add the application of yoga to their lifestyle if they choose (Lehrer, et. al., 2007).

      Positive imagery or self-statements is a technique that seeks to address either the clients’ perception of who they are as it relates to the stressor, or helps them to imagine a mental scene that is relaxing for them.  A simple technique for applying self-statements is to first recognize the internal voice that is either limiting or encouraging (Chohan, 2010).  The client must then review the statements that they are already speaking to themselves and change the ones that are not encouraging or positive (Chohan, 2010).

      Imagery is similar in that it is internal, however, instead of words; the subject visualizes a scene that helps them to relax (Lehrer, et. al., 2007).  It does not necessarily need to be a specific place, or even somewhere that the client has visited previously.  The goal is that the focus of the mind is on this mental picture as opposed to the stressor.

      Caregivers will often use breathing exercises and progressive muscle relaxation together (Morgan & Jorm, 2009).  Breathing exercises, or mindful-breathing, is more than just controlled breathing.  The goal is to gain a sense of all of what the body is doing, but to specifically focus on the act of breathing (Feldman, Greeson, & Senville, 2010).

      Progressive muscle relaxation is a practice designed to help participants fully relax their muscles.  Often a client will not even realize how tense some muscle groups have been until they process through releasing that tension (Feldman, et. al., 2010).  One technique for this form of relaxation is to guide the client into slow, relaxed breathing and to then help them process through specific muscle groups, relaxing each group as they go.  

Conclusion

      As previously noted, stress may be a greater source of negative health issues than many recognize.  Because of the impact that stress ultimately has on so many systems within the human body, the potential is present for the impact to be widespread.

      Although there is a variety of relaxation techniques, many caregivers recognize six groups or families that encompass most of the different techniques.  If a simple relaxation technique can have a powerful influence on human health, then that may speak equally to the negative hold that unresolved stress may have.



References


Chapman, C., Tuckett, R., & Song, C. (2008).  Pain and Stress in a Systems Perspective:  Reciprocal Neural, Endocrine, and Immune Interactions. The Journal of Pain, 9(2) 122-145.  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S1526590007009534#

Chohan, S. (2010). Whispering Selves and Reflective Transformations in the Internal Dialogue of Teachers and Students. Journal Of Invitational Theory & Practice, 16, 10-28.  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=b333a5cf-0071-4ffe-86cf-dd52c83f8b8c%40sessionmgr112&vid=12&hid=3


Danese, A., & McEwen, B. S. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology & Behavior, 106(1), 29-39.  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S0031938411004045


Feldman, G., Greeson, J., & Senville, J. (2010).  Differential effects of mindful breathing, progressive muscle relaxation, and loving-kindness meditation on decentering and negative reactions to repetitive thoughts, Behaviour Research and Therapy, 48(10), 1002-1011.  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S0005796710001324


Fletcher, D., & Sarkar, M. (2012). A grounded theory of psychological resilience in Olympic champions. Psychology of Sport and Exercise, 13(5), 669-678.  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S1469029212000544#


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


Hennessy, M., Kaiser, S., & Sachser, N. (2009).  Social buffering of the stress response:  Diversity, mechanisms, and functions. Frontiers in Neuroendocrinology, 30(4), 470-482.  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S0091302209000405#


Kranner, I., Minibayeva, F., Beckett, R., & Seal, C. (2010). What is stress? Concepts, definitions and applications in seed science. The New Phytologist, 188(3), 655-673.


Lehrer, P., Woolfolk, R., & Sime, W. (Eds.). (2007).  Principles and Practice of Stress Management.  New York:  Guilford Press.


McEwen, B., Eiland, L., Hunter, R., & Miller, M. (2012).  Stress and anxiety: Structural plasticity and epigenetic regulation as a consequence of stress, Neuropharmacology, 62(1), 3-12.  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S0028390811002905#


Morgan, A. J., & Jorm, A. F. (2009). Outcomes of self-help efforts in anxiety disorders. Expert Review of Pharmacoeconomics & Outcomes Research, 9(5), 445-59.  http://search.proquest.com.proxy1.ncu.edu/docview/577530419?accountid=28180&title=Outcomes+of+self-help+efforts+in+anxiety+disorders#.UR8tY-hwyGU.email


Offidani, E., & Ruini, C. (2012).  Psychobiological correlates of allostatic overload in a healthy population. Brain, Behavior, and Immunity, 26(2), 284-291.  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S0889159111005277#


Reimann, M., Bonifacio, E., Solimena, M., Schwarz, P., Ludwig, B., Hanefeld, M., & Bornstein, S. (2009).  An update on preventive and regenerative therapies in diabetes mellitus, Pharmacology & Therapeutics, Volume 121(3), 317-331. http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S0163725808002349#

Prescription Drugs versus Complementary & Alternative Options

      All medications have potential negative side effects, in addition to their primary positive effects.  Physicians hope that the primary effects will be what their patients experience as opposed to the side effects.  Ideally, the physician and patient determine together that the potential benefit is worth the very real risk that the side effect may pose (Doweiko, 2009).  

     According to the American Psychological Association, attention-deficit/hyperactivity disorder (ADHD) effects up to 7% of the population (as cited by Bruchmüller, Margraf, & Schneider, 2012).  Although often thought of as a childhood issue, the National Institute of Mental Health (NIMH) reports that over the course of a year, physicians will diagnosis approximately 4.1% of adults with ADHD (NIMH, 2012).
     A second emotional issue, depression, affects approximately 10% of the American population over the course of their lives (Goldberg, 2010).  According to NIMH, physicians will annually diagnose approximately 6.7% of the adult population of the United States as suffering from depression (NIMH, 2012).
    Therefore, these two emotional issues have the potential to negatively influence well over 10% of the American population each year.  The key issue then becomes whether or not the treatment for ADHD and depression gives the desired relief.

The Appropriateness of the Drugs to Treat the Diagnosis
      A modern opportunity for caregivers is the growing realization that alternate treatment options may be more effective than medication in the care of patients dealing with ADHD and depression.  This becomes even more significant when caregivers consider the differences for treatment needs depending on the age of the patient (Benkert, Krause, Wasem, & Aidelsburger, 2010).
      Research has discovered that those with ADHD as a child have a tendency to continue that struggle in adulthood, which can lead to depression and other mental health issues (Hinshaw, Owens, Zalecki, Huggins, Montenegro-Nevado, Schrodek, & Swanson, 2012).  Physicians must work closely with their maturing patients in order to determine when a change in treatment plan may be necessary.
      Recently published studies bring some encouraging guidance for physicians.  In these studies, the researchers discovered that physicians could avoid the potential suicide risk related to medication for depression by recommending different therapy and complementary and alternative medicine instead (Soeteman, Miller, & Kim, 2012). 
     As previously noted here and in other posts, a wide variety of complementary and alternative medicine treatments have been demonstrated effective when dealing with depression, and can even be applied to ADHD, especially in adults (Freeman, 2009). 
     Appropriate medication may be part of the overall treatment plan for a patient, but a caregiver coming from the biopsychosocial model will try to understand when that medication is necessary, while applying the other aspects of treatment equally.  Medication may not be necessary at all, if all of the involved parties are willing to consider some of the complementary and alternative options for ADHD and depression treatment.



References

Barnes, M., & Hong, J., (2012). Exercise as a Non-Pharmaceutical Treatment Modality to
Prevent Comorbidity of Type II Diabetes and Major Depression. International Journal Of
Caring Sciences, (2), 203.
http://www.internationaljournalofcaringsciences.org/docs/16.Exercise%20as%20Non-Pharmaceutical.pdf

Benkert, D., Krause, K., Wasem, J., & Aidelsburger, P. (2010). Effectiveness of pharmaceutical
therapy of ADHD (Attention-Deficit/Hyperactivity Disorder) in adults – health
technology assessment. GMS Health Technology Assessment, Doc13.  http://xt6nc6eu9q.search.serialssolutions.com/?genre=article&atitle=Effectiveness+of+pharmaceutical+therapy+of+ADHD+(Attention-Deficit%2fHyperactivity+Disorder)+in+adults+%E2%80%93+health+technology+assessment&title=GMS+Health+Technology+Assessment&issn=18618863&isbn=&volume=6&issue=&date=20100101&aulast=Benkert%2c+Diana&spage=Doc13&pages=&rft.sid=EBSCO:Directory+of+Open+Access+Journals:08e1f5a919b12bbeeb7c226c4fd67e7b

Bruchmüller, K., Margraf, J., & Schneider, S. (2012). Is ADHD diagnosed in accord with
diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal Of
Consulting And Clinical Psychology, 80(1), 128-138.  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=1f0d75d8-c620-46fc-879f-ccc49aa54f93%40sessionmgr11&vid=4&hid=6

Doweiko, Harold E. (2009).  Concepts of Chemical Dependency.  Belmont, CA: Brooks/Cole
Cengage Learning.

Edmunds, A., & Martsch-Litt, S. (2008). ADHD Assessment and Diagnosis in Canada: An
Inconsistent but Fixable Process. Exceptionality Education Canada, 18(2), 3-23.  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=0410fe6c-a945-4cc1-9325-7f1c83c0b78e%40sessionmgr4&vid=5&hid=3

Fisher, A., & Watkins, M. W. (2008). ADHD Rating Scales' Susceptibility to Faking in a
College Student Sample. Journal Of Postsecondary Education & Disability, 20(2), 81-92.  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=9dfa9f5d-2619-4268-b8ac-42572eec3d48%40sessionmgr114&vid=4&hid=2

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

Garfield, C., Dorsey, E., Zhu, S., Huskamp, H., Conti, R., Dusetzina, S., Higashi, A., Perrin, J.,
Kornfield, R., Alexander, R., (2012). Health Care Delivery Research: Trends in Attention
Deficit Hyperactivity Disorder Ambulatory Diagnosis and Medical Treatment in the United States, 2000–2010. Academic Pediatrics, 12, 110-116.   http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=8e59f911-17a0-46a6-abd9-9eea61ba16dc%40sessionmgr112&vid=3&hid=6

Goldberg, Raymond (Ed.). (2010). Taking Sides: Clashing Views in Drugs and Society. New
York, NY:  McGraw-Hill.

Hickie, I. (2007). Is depression overdiagnosed?. BMJ: British Medical Journal (International
Edition), 335(7615), 329.  http://depressionet.org.au/wp-content/uploads/2010/12/article_ianhickie_no.pdf

Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S., Montenegro-Nevado, A. J., Schrodek, E.,
& Swanson, E. N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury. Journal Of Consulting And Clinical Psychology, 80(6), 1041-1051.  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=4b98a97a-04fd-49dd-9571-d938bd578f61%40sessionmgr115&vid=12&hid=116

Huang, Y., & Tsai, M. (2011). Long-Term Outcomes with Medications for Attention-Deficit
Hyperactivity Disorder. CNS Drugs, 25(7), 539-554.
http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=68a60b4f-011b-4ae9-8e76-b58e0844ceab%40sessionmgr112&vid=17&hid=3

McPherson, S., & Armstrong, D. (2012). General Practitioner Management of Depression: A
Systematic Review. Qualitative Health Research, 22(8), 1150.  http://qhr.sagepub.com.proxy1.ncu.edu/content/22/8/1150.full.pdf+html

National Institute of Mental Health. (2012, December 19). The Numbers Count: Mental
Disorders in America.  Retrieved from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml

Parker, G. (2007). Is depression overdiagnosed?. BMJ: British Medical Journal (International
Edition), 335(7615), 328.  http://depressionet.org.au/wp-content/uploads/2010/12/article_gparker_yes.pdf

Siddique, J., Chung, J. Y., Brown, C., & Miranda, J. (2012). Comparative effectiveness of
medication versus cognitive-behavioral therapy in a randomized controlled trial of low-income young minority women with depression. Journal Of Consulting And Clinical Psychology, 80(6), 995-1006.  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=68a60b4f-011b-4ae9-8e76-b58e0844ceab%40sessionmgr112&vid=18&hid=3

Soeteman, D., Miller, M., Kim, J. (2012).  Modeling the Risks and Benefits of Depression
Treatment for Children and Young Adults, Value in Health, (15)5, 724-729.  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S1098301512015902

Trout, A. L., Ortiz Lienemann, T., Reid, R., & Epstein, M. H. (2007). A Review of Non-
Medication Interventions to Improve the Academic Performance of Children and Youth With ADHD. Remedial & Special Education, 28(4), 207-226.  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=4b98a97a-04fd-49dd-9571-d938bd578f61%40sessionmgr115&vid=8&hid=6

Wancata, J., & Friedrich, F. (n.d). DEPRESSION: A DIAGNOSIS APTLY USED?. Psychiatria
Danubina, 23(4), 406-411.  http://hrcak.srce.hr/file/114099

Herbal Supplements

        Below is a fictional scenario designed to assess how complementary and alternative medicine can be applied to a variety of situations. In this case, herbal supplements are considered for their health benefits, especially weight loss. Lee has been referred to my office by her physician.  This is due to our work with complementary and alternative medical practices, including nutrition.  Lee’s doctor is working to assist her with her asthma and heart health concerns.  Additionally, Lee was previously diagnosed with a functional hypothyroidism.  On top of all of this, one of Lee’s greatest concerns, especially at age 50, is that she has continued to put on weight and is somewhat desperate to find some way to slim down.  Some friends have recommended a supplement to her that contains Ma Huang.  This is my evaluation of her situation, especially in light of possibly using Ma Huang.

A Letter to Lee Concerning Ma Huang
            Lee, I want to thank you for visiting our office and for your honesty related to your concerns for health.  It sounds as though your doctor is working diligently to ensure that you have all of the resources and information that you need in order to make wise decisions.
            Let me start by saying that although I appreciate that your friends want to help you with your health and weight goals, the recommendation to use “E-Z Lose” will take you in the wrong direction.  The reason that “E-Z Lose” has been a successful weight loss treatment for some is because of the ingredient, Ma Huang.  Ma Huang, by another name is known as Ephedra.  A synthesized form of Ephedra is Ephedrine or Pseudoephedrine, which is a prescription drug found mostly in decongestants (Manore, 2012).  The reason it is a prescription drug is because it is a primary ingredient in the production of Methamphetamine, which is a highly addictive illegal, synthetic drug more commonly known as “Ice.”  People who become addicted to “Ice” tend to mentally and physically waste-away.
            In fact, I am not sure how your friends have legally acquired “E-Z Lose” since Ephedra, or Ma Huang, was essentially outlawed in the US in 2004 (Manore, 2012).  Someone would have to order this product from overseas which means that the quality and purity of the product are even more in question.
            In your specific case, “E-Z Lose” is even more of a concern.  Although some people have tried to use Ephedra in the past as a type of home-remedy for asthma, that use demonstrated some very severe side effects (George, & Topaz, 2013).  Additionally, with your heart concerns, Ephedra is an even greater risk (Song, Shim, Ryu, Kim, Jung, & Yoo, 2008).  
            The risk factor for those struggling with heart conditions is extremely high (Singh, Rajeev, & Dohrmann, 2008).  Even prior to the FDA’s choice to ban the substance, the American Association of Clinical Endocrinologists (AACE) determined that any potential benefits from Ephedra use were negated by the potential risks (AACE, 2003).
            Given all of these details, I would have to say that “E-Z Lose” and any other Ephedra based products would not be a good choice for you, or anyone else for that matter.  Although it has helped others lose weight in the past, that is because its effectiveness is based in the same ingredients used to produce illegal, highly addictive drugs.

Second Meeting Dialogue
Me:  Good morning Lee, thank you for coming back in.
Lee:  Oh sure Dr. Arnold.  Thank you for looking into my situation.
Me:  No problem, that’s why I’m here.  Did you have a chance to look over my email to you about Ephedra?
Lee:  I did.  I guess I have to reluctantly agree with you about the Ephedra.  In fact, when I shared your information with some of my friends they said they were going to stop taking it too.  They mentioned that they noticed that they had been having trouble sleeping since they started on the “E-Z Lose” and since stopping they’ve noticed that their sleep is getting back to normal.
Me:  Well, I’m glad that they were honest with you about their experience and that the information helped.  I was hoping to gather some additional information though (AACE, 2003).
Lee:  Oh, OK.
Me:  Are you taking anything else other than the corticosteroids that your doctor has prescribed?  
Lee:  Not really.  I take a multi-vitamin and some stuff to help sleep, but that is about it.
Me:  Hmmmm.  OK.  You did not list a sleep aid on our first intake forms.  What is the brand name?
Lee:  Well, there isn’t really a brand name.  My family’s from Mississippi and there is an herb that folks have used for years to help with sleep and insomnia.  My grandmother used it to.  We call it Bugleweed (Yarnell, & Abascal, 2006).  I’m not sure what the fancy, scientific name is.
Me:  (Smiling) That’s OK, I don’t know the fancy name off the top of my head either, however I am familiar with bugleweed.  I know that folks have used it for insomnia; however, studies have also shown that it is effective at reducing thyroid activity (Yarnell, & Abascal, 2006).
Lee:  What!  Really?  Wow!  
Me:  Indeed.  Did you share that information with your doctor?
Lee:  No.  I guess I need to let her know.
Me:  I would definitely recommend that.  But do not stop taking any medication until she tells you to do so.  OK?
Lee:  Oh, right.
Me:  So what is your nutrition like?  What foods do you typically eat?
Lee:  Well, I try to eat healthy, so fruits and vegetables mostly.  We try to grow our own food as much as possible.  We have a small farm outside of town a bit, so we have plenty of fruit trees and a variety garden.  I bake my own bread.  I love to bake.
Me:  Well that sounds nice.  Is your family vegetarian then?
Lee:  Oh no.  We will regularly cook up some chicken, fish, and some steak now and then, and of course we have our laying hens, so we regularly have eggs, usually for breakfast.
Me:  Hmmmm.  With the asthma, have you ever been treated for allergies?
Lee:  Not really.  It has kind of always been with me.
Me:  It may be worth getting tested.  There are situations in which people are found to have an allergic reaction to different foods, which trigger asthma.  Eggs and different types of fish or shellfish are some of the trigger foods (Jacobs, Greenhawt, Hauswirth, Mitchell, & Green, 2012).
Lee:  Really?  I had never thought about that.
Me:  It is probably worth doing the testing to see if there is anything that might be triggering your asthma at all.
Lee:  Yeah, definitely.
Me:  So, for your weight loss goals, I know that you have said that you are planning on avoiding the “E-Z Lose” product, right?
Lee:  Yes.  For sure.
Me:  OK, and your goal is long-term weight loss, right?  Not just some quick drop.
Lee:  Right.  If I just wanted to try to drop weight fast I would just stop eating.  I’m not going to do that, but I guess that would get the weight down.
Me:  True, but you would definitely not be happy.  The thing with weight loss is that it is simple and complex all at the same time.  Theoretically it is calories in, calories out.  But not all calories are equal.  For example, you mentioned that you bake your own bread, and that you love to bake.  So do you eat a lot of baked goods?
Lee:  Well, I guess it depends on your definition of “a lot.”  My family enjoys their sweets, and the homemade bread doesn’t last long. (smile).
Me:  I can understand that.  I like my sweets too.  However, understanding your nutritional choices is going to make a big difference.  Supplements for weight loss are not the answer.  There are products on the market to help with nutritional shortages, but it sounds like you have a good mix of nutrition available to you.  Herbal treatment options for health have been used for years (Freeman, 2009).  So, there are a number of herbal choices that you could consider, but we would want to talk with your doctor about them before you begin making changes (Li, 2011).
Lee:  OK.  Want do I need to do first?
Me:  First, before you make any real changes, I would like for you to keep an intake journal for a week.  You can ask your doctor about the bugleweed, and stop using that if she says it is OK, but other than that, for a full 7 days, I would like for you to keep a journal in which you record everything that you put in your body.  If you do not have a food scale, go ahead and pick one up and either weigh or measure everything that you eat or drink.  Try to be as specific as possible.  Track your water, and any other beverages.  Do you drink anything other than water?
Lee:  We make our own sweet tea, and I’ll have a coke every so often.  Maybe some wine every once in a while.
Me:  OK.  Let me know how you make the sweet tea.  That is going to have a good amount of sugar in it.  We all tend to drink more calories than we realize.  Once we see what your current food choices are like for a week, we can analyze it all and see where you can begin to make some adjustments.  It is possible that you are already getting enough exercise just working around the farm, at least to get started.  If you, your doctor, and me can make some headway with the functional hypothyroidism, the asthma and your weight goals, then you can begin to add in more exercise later.  How does that sound?
Lee:  That sounds pretty good to me.
Me:  OK.  So, for all this to work, you have to take complete ownership of it.  The next step is for you to start writing down everything that enters your mouth, even a stick of gum, by the way.
Lee:  Oh.  OK.
Me:  So, what I would like to do is set up an appointment with your doctor with the three of us after you have tracked your food for a week.  That way we can talk about your nutrition, your medication, and also see what we can all agree upon for a plan for long-term weight loss for you.  Does that sound good?
Lee:  Yeah.  That sounds great.
Me:  And by the way, we haven’t even touched on other weight loss treatment options like hypnosis.  So don’t let yourself get discouraged, we are just getting started and a large part of all this is figuring out what works for you.
Lee:  OK.  Thank you.  I really appreciate it.

Summary
            Lee’s case is not terribly unique.  Many Americans are struggling with health concerns that may stem from long term health and nutrition choices.  In Lee’s case, with some collaborative effort on the part of her primary care physician and the CAM doctor, she should be able to find ways to move forward with her weight loss goals, as well as possibly in some of her other health concerns.
            Most likely her primary care doctor has already talked to her about her diet and exercise habits, but it is possible that Lee felt like they were not realistic.  Hopefully by hearing a similar message from the CAM provider Lee will take serious steps toward improving her health.
            By giving Lee some concrete, time sensitive steps to take it is very likely that she will follow through.  Also, by letting her know that her CAM provider is willing to walk this path with her, it gives her the extra support that is required for weight loss success.  I believe that she has a high likelihood for success.


References

AACE Nutrition Guidelines Task Force (2003). American Association of Clinical 
Endocrinologists medical guidelines for the clinical use of dietary supplements and nutraceuticals.
https://www.aace.com/files/nutraceuticals-2003.pdf

Alkemade, A. (2010). Central and peripheral effects of thyroid hormone signaling in the control 
of energy metabolism. Journal of Neuroendocrinology, 22(1), 56-63. doi:10.1111/j.1365-2826.2009.01932.x  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=e9147ded-1233-45e3-9a8d-2c8a5b731471%40sessionmgr111&vid=11&hid=104

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

George, M., & Topaz, M. (2013). "A Systematic Review of Complementary and Alternative 
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Jacobs, T., Greenhawt, M., Hauswirth, D., Mitchell, L., & Green, T. (2012). A survey study of 
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Manore, M. M. (2012). Dietary Supplements for Improving Body Composition and Reducing 
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Palamar, J. (2011). Review: How ephedrine escaped regulation in the United States: A historical 
review of misuse and associated policy. Health Policy, 99(1), 1-9. doi:10.1016/j.healthpol.2010.07.007  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S0168851010002010

Singh, A., Rajeev, A., & Dohrmann, M. (2008). Cardiomyopathy associated with ephedra-
containing nutritional supplements. Congestive Heart Failure (Greenwich, Conn.), 14(2), 89-90.  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=9900c8cc-77db-479e-b33b-f4fb5bd6407e%40sessionmgr4003&vid=6&hid=101

Song, H., Shim, K., Ryu, K., Kim, T., Jung, S., & Yoo, K. (2008). A case of ischemic colitis 
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Yarnell, E., & Abascal, K. (2006). Botanical Medicine for Thyroid Regulation. Alternative & 
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Reiki: An Annotated Bibliography

           Below is an annotated bibliography concerning the complementary and alternative medicine treatment of Reiki.  This therapy is explained as one person, the Reiki practitioner, channeling a form of energy that they then transfer to another person to aid with healing (Freeman, 2009). 

Assefi, N., Bogart, A., Goldberg, J., & Buchwald, D. (2008). Reiki for the treatment of fibromyalgia: a randomized controlled trial. Journal of Alternative and Complementary Medicine (New York, N.Y.), 14(9), 1115-1122. doi:10.1089/acm.2008.0068

            This article begins with the explanation that fibromyalgia is a disease that causes chronic pain and physical, muscular tenderness (Assefi, Bogart, Goldberg, & Buchwald, 2008).  The authors then give a background concerning Reiki, and then further explain that their hypothesis, based on the results of previous studies, was that Reiki would be an effective treatment for the chronic pain related to fibromyalgia (Assefi, et al, 2008).
            The researchers’ chosen method was to recruit 100 participants and then randomize them into four groups.  One group employed the touch-version of Reiki, a second group used the distance form of Reiki, the third group used sham touch Reiki, and the fourth group used sham, distance Reiki (Assefi, et al, 2008).  The treatments were conducted twice a week for 8 weeks (Assefi, et al, 2008).
            This study found that the Reiki participants, whether participating in the touch group or the distance group, did not see any significant positive influence from either treatment (Assefi, et al, 2008).  This study, according to the authors, may be the first one to accurately test Reiki for chronic pain treatment (Assefi, et al, 2008).
            This study may be an excellent example of the fact that the Reiki treatment is reliant on the skill of the practitioners (Assefi, et al, 2008).  Although those who led the treatment in this study were considered Reiki masters, there is still a level of individual skill that needs to be recognized.  In essence, part of the evaluation is of these studies is an evaluation of the actual Reiki master or masters as well (Assefi, et al, 2008). 


Bowden, D., Goddard, L., & Gruzelier. (2010). Research report: A randomised controlled single-blind trial of the effects of Reiki and positive imagery on well-being and salivary cortisol. Brain Research Bulletin, 81, 66-72. doi:10.1016/j.brainresbull.2009.10.002


            The authors of this study hypothesized that people who participated in Reiki would see a reduction in stress related indicators, and would therefore notice an improved overall wellbeing.  Additionally, the researchers tested their arrangement for a fully blind test group (Bowden, Goddard, & Gruzelier, 2010). 
            The study was conducted by recruiting 35 psychology undergraduates.  These participants were then divided into groups who received either self-hypnosis relaxation training with visualized immune function, self-hypnosis with verbal instructions concerning immune function, or verbal instructions without self-hypnosis but focusing on deep relaxation.  Within each of these groups the researchers developed two sub-groups.  One group received Reiki and one did not (Bowden, et al, 2010).  By doing so, the researchers effectively removed as many outside influences on the results concerning Reiki.
            The authors found that those who participated in the Reiki groups recorded slight improvements in their rate of illness compared to those who did not participate in the Reiki groups (Bowden, et al, 2010).  More significantly, the Reiki participants recorded noticeable improvements in stress reduction (Bowden, et al, 2010).
            The approach that the researchers took in this study was very thorough in that they ensured that the results purely reflected the effectiveness of Reiki.  The study also highlighted the possibility of Reiki being used to help with stress and overall wellness to a level seen in a physical, biological response (Bowden, et al, 2010). 

Catlin, A., & Taylor-Ford, R. (2011). Investigation of standard care versus sham Reiki placebo versus actual Reiki therapy to enhance comfort and well-being in a chemotherapy infusion center. Oncology Nursing Forum, 38(3), 212-220.

            The authors of this study originally sought to understand if Reiki therapy specifically helped chemotherapy patients with their overall comfort and wellbeing (Catlin, & Taylor-Ford, 2011).  However, what their study discover was that the treatment that provided the greatest comfort was more dependent upon regular, meaningful patient interaction with the nursing staff (Catlin, & Taylor-Ford, 2011).
            The research was accomplished using a double-blind study made up of three different groups (Catlin, & Taylor-Ford, 2011).  The researchers recruited 189 participants in order to ensure they had a large enough population for all three groups.  The participants were allotted to these three groups and received standard care treatment, sham-Reiki, or authentic Reiki treatment (Catlin, & Taylor-Ford, 2011).
            The researchers found that the results indicated that the sham-Reiki gave similar or even better results than the actual Reiki (Catlin, & Taylor-Ford, 2011).  The authors theorize that this may be due to the placebo effect, but also the personal interaction with caring nurses (Catlin, & Taylor-Ford, 2011).  They also took steps to ensure that energy transfer was not happening by accident in the sham-Reiki (Catlin, & Taylor-Ford, 2011).
            This is a very well done study in that they demonstrated the power of human influence.  Although not a strong demonstrator of Reiki, there is honest value in these results.  Further research may demonstrate that the power of Reiki is based more in relationships and personal support instead of purely methods.

Diaz-Rodríguez, L., Arroyo-Morales, M., Cantarero-Villanueva, I., Férnandez-Lao, C., Polley, M., & Fernández-de-las-Peñas, C. (2011). The application of Reiki in nurses diagnosed with Burnout Syndrome has beneficial effects on concentration of salivary IgA and blood pressure. Revista Latino-Americana de Enfermagem (RLAE), 19(5), 1132-1138.

            In this study the researchers hypothesized that Reiki would produce a positive result when treating nurses who were experiencing burnout syndrome (BS) (Diaz-Rodríguez, Arroyo-Morales, Cantarero-Villanueva, Férnandez-Lao, Polley, & Fernández-de-las-Peñas, 2011).  Part of this hypothesis included the recognition that BS can be evaluated through physical response such as higher blood pressure and salivary biological makeup, and therefore the researchers should be able to see any results through these same indicators (Diaz-Rodríguez, et al, 2011).
            The methodology of the study involved the recruiting of 18 female nurses who had all been diagnosed with BS (Diaz-Rodríguez, et al, 2011).  The researchers then divided the participants into two groups and gathered baseline readings for saliva and blood pressure.  One group then received a Reiki treatment while the other group received a placebo treatment (Diaz-Rodríguez, et al, 2011).
            The authors found that a single Reiki treatment showed a significant improvement in blood pressure as well as salivary stress indicators (Diaz-Rodríguez, 2011).  The researchers further hypothesize that if these nurses were to receive more training, and continue with the treatment that they would see even greater results (Diaz-Rodríguez, et al, 2011).
            Although this sample group was small, this study is still significant in that the researchers were able to record these results with only one treatment.  It is also significant that these positive results were substantiated through measureable physical responses.

Ferraresi, M., Clari, R., Moro, I., Banino, E., Boero, E., Crosio, A., Dayne, R., Rosset, L., Scarpa, A., Serra, E., Surace, A., Testore, A., Colombi, N., & Piccoli, B. (2013). Reiki and related therapies in the dialysis ward: an evidence-based and ethical discussion to debate if these complementary and alternative medicines are welcomed or banned. BMC Nephrology, 14129.

            This article highlights the fact that much of the established medical community is attempting to understand Reiki at the same time that their patients are asking questions about the treatment (Ferraresi, Clari, Moro, Banino, Boero, Crosio, Dayne, Rosset, Scarpa, Serra, Surace, Testore, Colombi, & Piccoli, 2013).  This review seeks to present the evidence from several studies that seem to show a possibility that Reiki would be an effective treatment for dialysis related issues and pain (Ferraresi, et al, 2013).
            The methodology of the authors was to highlight six, specific reviews and trials (Ferraresi, et al, 2013).  The authors noted that 4 of the 6 research articles recognized significant improvements for the Reiki groups.  Curiously, even with this evidence from their own research, the authors conclude that Reiki should only be applied sparingly, but that further research needs to be conducted (Ferraresi, et al, 2013).
            It would appear to this author that the writers of this article are still hesitant to recommend a treatment option that they do not fully understand.  It is significant to note that the evidence speaks for itself in that the authors found, in most studies, statistically significant results yet they choose to either dismiss these results as low-grade or irrelevant to the quality of life for the patient (Ferraresi, et al, 2013).  This may though, be yet another review that demonstrates the “complementary” side of complementary and alternative medicine.  The results would seem to show that Reiki has a place as an authentic option in dialysis care.

Kundu, A., Lin, Y., Oron, A., & Doorenbos, A. (2013). Reiki therapy for postoperative oral pain in pediatric patients: Pilot data from a double-blind, randomized clinical trial, Complementary Therapies in Clinical Practice, 1744-3881.

            The researchers in this study hypothesized, based on previous research, that Reiki would help pediatric patients deal more effectively with pain related to oral surgery (Kundu, Lin, Oron, & Doorenbos, 2013).  They tested this hypothesis with 38 children participating in a double-blind, randomized controlled study (Kundu, et al, 2013).
            A choice that this author found very curious is that the study was done with the Reiki given prior to the surgery, and that was the only Reiki treatment shared.  In other words, this was really more of a study to see if Reiki could be applied as a pre-emptive strike against postoperative pain (Kundu, et al, 2013).  The researchers’ method for this was to divide the participants into two groups, with 19 in each group, who were then treated with either authentic Reiki, or sham Reiki.
            The conclusion that the authors determined was that a single, pre-operative treatment was Reiki is not effective in lessening post-operative pain, at least for pediatric patients.  They did also recognize that it is possible to do a double-blind randomized controlled study with Reiki (Kundu, et al, 2013).
            As previously noted, this author believes that what this study really highlights is that Reiki may not be effective as a pre-emptive treatment for post-operative pain.  It is also significant to note that this study was focused on one treatment session that was accomplished right before the surgery was set to take place.  No additional Reiki treatment was offered post-operative (Kundu, et al, 2013).

Morse, M., & Beem, L. (2011). Benefits of Reiki therapy for a severely neutropenic patient with associated influences on a true random number generator. Journal of Alternative and Complementary Medicine (New York, N.Y.), 17(12), 1181-1190. doi:10.1089/acm.2010.0238


            In this study the authors initially shared up front that they feel that Reiki, on its own, is now considered a proven treatment for pain and stress (Morse, & Beem, 2011).  Therefore, the intent of this study is to see if a Random Number Generator (RNG) would recognize any changes in the patient, as the treatment was ongoing (Morse, & Beem, 2011).
            The researchers worked specifically with one patient who was suffering from Hepatitis C types 1 and 2, and a host of other diseases (Morse, & Beem, 2011).  The key point for this particular patient was that his body had not responded well to conventional treatment (Morse, & Beem, 2011).
            The patient received Reiki treatment in a community environment as well as one-on-one sessions (Morse, & Beem, 2011).  Prior to beginning the Reiki sessions the patient was only given a 5% chance of healing, following the sessions his health had improved enough to be able to participate in other treatment options.  A year after the treatment he is still free of the virus (Morse, & Beem, 2011).  The researchers concluded that in the case of this patient, it was the Reiki treatment that allowed him to be able to heal, and fully recover (Morse, & Beem, 2011).  
            Although this study only involved one patient, the authors did an excellent job of confirming the actual energy transfer that was taking place, and noting the recovery in the patient.  Of special interest is the fact that this patient was not responding to conventional treatment, and yet Reiki helped his body to take advantage of this care.  This is truly the definition of complementary medical care (Morse, & Beem, 2011). 

O'Mathúna, D. P. (2011). Reiki for Psychological Outcomes and Pain Relief. Alternative Medicine Alert, 14(9), 98-101.
 
            This article starts out with a general explanation of Reiki including some of the concepts behind the practice.  The primary focus, or hypothesis, of this article is to present a review of different studies that had been completed demonstrating the effectiveness of Reiki treatment especially in the realms of psychological and pain issues (O'Mathúna, 2011).  
            The author’s methodology was to highlight several studies conducted using Reiki.  Many of the studies cited found no significant difference between Reiki groups and those who received no treatment (O'Mathúna, 2011).  Other studies cited showed that Reiki, both locally and over distance, showed significant results.  These studies were conducted in the realms of depression, anxiety, overall emotional wellbeing, and pain relief (O'Mathúna, 2011).  Curiously, the studies reviewing pain relief noticed the greater results.  However, the nature of many of these studies was that the results were based on the perception of the patients (O'Mathúna, 2011).
            The author notes that these studies are still very limited.  However, the author pointed out that it appears as though Reiki may be more effective at treating pain and some related issues, when compared to the application of Reiki for emotional and psychological treatments (O'Mathúna, 2011).
            The author does an excellent job of compiling information from a number of studies, and providing an overview of their results.  He also gives sound recommendations at the end of the article in which he encourages doctors to inform potential Reiki patients concerning the limited amount of evidence for the effectiveness of Reiki.  Therefore, Reiki should not be the patient’s only treatment choice.
Townsend, J. (2013).

Temari Reiki: A new hands-off approach to traditional Reiki. International Journal of Nursing Practice, 1934-38. http://onlinelibrary.wiley.com/doi/10.1111/ijn.12042/full
 
            This article includes an introduction and overview of Reiki as a treatment for wellbeing and healthcare.  The author points out that traditional Reiki typically involves a physical touch on the part of the practitioner in order to share their own personal energy.  This paper highlights a more recent form of Reiki, entitled Temari, which does not include any type of touch.  The author feels that this is a superior form of Reiki (Townsend, 2013).  
            The authors’ hypothesis is based on a methodology formed through her personal experience and has demonstrated to her that Temari Reiki is a more focused form of Reiki in that she is able to direct energy specifically to the areas that the client is most concerned about, usually due to injury or illness.  Her clients have stated that they sensed the focused energy accelerated the healing process (Townsend, 2013).  
            Since this article is basically a review and survey, the author mostly describes her own personal experiences, and shares some vignettes from some of her patients.  One key point to her conclusion concerning the superiority of Temari Reiki is that this form of Reiki focuses on accessing the chakras, or energy points or centers of the body, instead of physical touch (Townsend, 2013).  This seems to be the more significant highlight from the survey.  The author feels that she has possibly uncovered the location of two new chakras that she has been able to manipulate successfully for her patients.
            This survey gives a good, general definition of Reiki, and especially Temari Reiki.  However, the level of verified data is somewhat lacking.  To be fair, it should be noted that the author recognizes this fact and states the need for more research to be accomplished.

vanderVaart, S., Berger, H., Tam, C., Goh, Y., Gijsen, V. J., de Wildt, S. N., Taddio, A., &
Koren, G. (2011). The effect of distant reiki on pain in women after elective Caesarean section: a double-blinded randomised controlled trial. BMJ Open, 1(1), 1.
 
            The authors of this study begin with an explanation of Caesarean section (C-section) deliveries, as well as the recognition that opioid pain medications are transferred to infants within breast milk (vanderVaart, Berger, Tam, Goh, Gijsen, de Wildt, Taddio, & Koren, 2011).  The researchers also highlight the fact that Reiki has been demonstrated to be effective against pain in other studies (vanderVaart, et al, 2011).
            The hypothesis for this trial was that distance Reiki would also prove to be effective against the pain of recovery from a C-section (vanderVaart, et al, 2011).  They also desired to ensure that they were using an effective double-blind trial arrangement for this study (vanderVaart, et al, 2011).
            The participants were recruited over the course of a 7-month period.  There were a total of 80 participants with 40 included in the group that received Reiki, and 40 in the control group (vanderVaart, et al, 2011).  Those receiving the distance Reiki were given their first treatment no less than 30 minutes prior to their surgery.  They also received a distance Reiki treatment in the morning of the following two days, for a total of three Reiki treatments.  Each treatment lasted for approximately 20 minutes (vanderVaart, et al, 2011).
            The researchers found that there was no noticeable difference for the participants who received distance Reiki when compared to the control group (vanderVaart, et al, 2011).  The researchers noted that their results are contrary to other Reiki studies.  Some of the limitations of this study may be significant in that the authors used only one Reiki master, and only three brief treatments, using only the distance version of Reiki (vanderVaart, et al, 2011).  In evaluation, these limitations may be the best indicator for the possible use of these results.  Each study reviewing Reiki must recognize how their limitations directly influence their results.


References

Assefi, N., Bogart, A., Goldberg, J., & Buchwald, D. (2008). Reiki for the treatment of fibromyalgia: a randomized controlled trial. Journal of Alternative and Complementary Medicine (New York, N.Y.), 14(9), 1115-1122. doi:10.1089/acm.2008.0068  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=3183ee15-0d6a-49b4-851d-aae5a0cfab82%40sessionmgr115&vid=5&hid=4108

Bowden, D., Goddard, L., & Gruzelier. (2010). Research report: A randomised controlled single-blind trial of the effects of Reiki and positive imagery on well-being and salivary cortisol. Brain Research Bulletin, 81, 66-72. doi:10.1016/j.brainresbull.2009.10.002  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S0361923009003177


Diaz-Rodríguez, L., Arroyo-Morales, M., Cantarero-Villanueva, I., Férnandez-Lao, C., Polley, M., & Fernández-de-las-Peñas, C. (2011). The application of Reiki in nurses diagnosed with Burnout Syndrome has beneficial effects on concentration of salivary IgA and blood pressure. Revista Latino-Americana de Enfermagem (RLAE)19(5), 1132-1138.  http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010411692011000500010&lng=en&nrm=iso&tlng=en

Ferraresi, M., Clari, R., Moro, I., Banino, E., Boero, E., Crosio, A., Dayne, R., Rosset, L., Scarpa, A., Serra, E., Surace, A., Testore, A., Colombi, N., & Piccoli, B. (2013). Reiki and related therapies in the dialysis ward: an evidence-based and ethical discussion to debate if these complementary and alternative medicines are welcomed or banned.  BMC Nephrology14(129). doi:10.1186/1471-2369-14-129  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=caac4f06-6a07-42ee-b780-43910a72c50a%40sessionmgr114&vid=7&hid=104
 
Freeman, L.W. (2009) Mosby's complementary & alternative medicine: A research-based approach. (3rd ed). St. Louis, MO: Mosby.  
 
Kundu, A., Lin, Y., Oron, A., & Doorenbos, A. (2013).  Reiki therapy for postoperative oral pain in pediatric patients: Pilot data from a double-blind, randomized clinical trial, Complementary Therapies in Clinical Practice, 1744-3881, http://dx.doi.org/10.1016/j.ctcp.2013.10.010.  http://www.sciencedirect.com/science/article/pii/S1744388113000881
 
Morse, M., & Beem, L. (2011). Benefits of Reiki therapy for a severely neutropenic patient with associated influences on a true random number generator. Journal of Alternative and Complementary Medicine (New York, N.Y.), 17(12), 1181-1190. doi:10.1089/acm.2010.0238  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=69b21aa6-15b7-4e9b-b0aa-b5f5881b71c1%40sessionmgr4003&vid=4&hid=104
 
O'Mathúna, D. P. (2011). Reiki for Psychological Outcomes and Pain Relief. Alternative Medicine Alert14(9), 98-101.  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=caac4f06-6a07-42ee-b780-43910a72c50a%40sessionmgr114&vid=7&hid=104
 
Townsend, J. (2013). Temari Reiki: A new hands-off approach to traditional Reiki. International Journal of Nursing Practice19, 34-38.  http://onlinelibrary.wiley.com/doi/10.1111/ijn.12042/full
 
vanderVaart, S., Berger, H., Tam, C., Goh, Y., Gijsen, V. J., de Wildt, S. N., Taddio, A., & Koren, G. (2011). The effect of distant reiki on pain in women after elective Caesarean section: a double-blinded randomised controlled trial. BMJ Open1(1), 1. doi:10.1136/bmjopen-2010-000021  http://xt6nc6eu9q.search.serialssolutions.com/?ID=DOI:10.1136%2fbmjopen-2010-000021&genre=article&atitle=The+effect+of+distant+reiki+on+pain+in+women+after+elective+Caesarean+section%3a+a+double-blinded+randomised+controlled+trial.&title=BMJ+Open&issn=20446055&isbn=&volume=1&issue=1&date=20110901&aulast=vanderVaart%2c+Sondra&spage=1&pages=1-9&rft.sid=EBSCO:Publisher+Provided+Full+Text+Searching+File:66937307