The document discusses integrative mental health approaches and their potential to address shortcomings of traditional mental health treatments. It notes that mental illness prevalence is high both in the US and worldwide, while current treatments provide limited benefits. Integrative approaches aim to fill this void through mind-body practices, exercise, diet, herbal remedies, and complex, multi-modal treatments tailored to individual patients. The field is growing but faces challenges in conducting rigorous research on complex interventions and bridging mental healthcare gaps globally.
The document discusses integrative mental health approaches and their potential to address shortcomings of traditional mental health treatments. It notes that mental illness prevalence is high both in the US and worldwide, while current treatments provide limited benefits. Integrative approaches aim to fill this void through mind-body practices, exercise, diet, herbal remedies, and complex, multi-modal treatments tailored to individual patients. The field is growing but faces challenges in conducting rigorous research on complex interventions and bridging mental healthcare gaps globally.
The document discusses integrative mental health approaches and their potential to address shortcomings of traditional mental health treatments. It notes that mental illness prevalence is high both in the US and worldwide, while current treatments provide limited benefits. Integrative approaches aim to fill this void through mind-body practices, exercise, diet, herbal remedies, and complex, multi-modal treatments tailored to individual patients. The field is growing but faces challenges in conducting rigorous research on complex interventions and bridging mental healthcare gaps globally.
The document discusses integrative mental health approaches and their potential to address shortcomings of traditional mental health treatments. It notes that mental illness prevalence is high both in the US and worldwide, while current treatments provide limited benefits. Integrative approaches aim to fill this void through mind-body practices, exercise, diet, herbal remedies, and complex, multi-modal treatments tailored to individual patients. The field is growing but faces challenges in conducting rigorous research on complex interventions and bridging mental healthcare gaps globally.
Keywords: Integrative mental health Mindfulness EMDR
In the US, The National Institute of Mental Health lists the
prevalence of mental illness among adults as 18.6% and for serious mental Illness (SMI) at 4.1% [1]. Unfortunately, as with the prevalence for heart disease, diabetes, and cancer, other countries are catching up with the States, with the WHO identifying similar or at times higher prevalence of mental health conditions worldwide [2]. These disorders, particularly SMI, are at a high personal and societal cost. Current treatments are lacking with limited benet over placebo or control interventions [3,4]. We know that theres a serious problem and traditional approaches have signicant limitations. Will efforts in integrative mental health ll this void? A full discussion on this topic, from leaders of the International Network of Integrative Mental Health (INIMH), is published in the Advances in Integrative Medicine as a White Paper [5]. Why do patients seek out complementary and integrative therapies? Some individuals have a holistic health orientation and are motivated to seek out self-management strategies consistent with their beliefs. Many more, it seems, seek treatment because they are experiencing a disabling condition for which they have not been able to nd appropriate relief through traditional approaches. What do we bring to the mix that can help our patients? Even before we put on our integrative hats, we have an advantage. People who go into this eld are likely to practice selfcare, hopefully serving as a model for our patients. I have fond memories of a heartfelt speech that my father, the scoutmaster, gave to my Cub Scout troop about the evils of smoking. It might have carried more weight had he not had a lit cigarette in his hand at the time. Additionally, we have qualities that allow us to connect with patients, convey optimism, and motivate change, even if its only a change of perspective. In a reductionist model, these nonspecic factors are considered a pesky placebo effect, as opposed to an essential part of the relationship that facilitates healing. We can think of a holistic approach as involving a 3-legged stool, with the legs being mind-body practice, exercise, and diet. Mindfulness has received wide exposure in the media and has come into our common parlance. Consequently, discussions with http://dx.doi.org/10.1016/j.aimed.2015.02.002 2212-9588/ 2015 Elsevier Ltd. All rights reserved.
patients about meditation and mind-body approaches are less
likely to elicit blank stares or the accusation of being woo woo. As with our colleagues in primary care medicine, we devote effort to help patients step up their aerobic activity level and clean up their diets. Using the Stages of Change model offers us a greater chance of successfully engaging our patients [68]. This model works especially well for what may be a 4th leg of our stool, helping individuals affected by substance use disorders. Each practitioner has his own toolkit. Hopefully, were not the person with only a hammer. By the nature of our training, some will be oriented to psychotherapeutic modalities. Increasingly, approaches that incorporate a mind-body perspective are being used in clinical practice and tested in a research setting. Among these are: mindfulness-based cognitive therapy, dialectical behavioral therapy, and cardiac coherence training utilizing heart rate variability biofeedback. A novel intervention was developed by a group from the University of Calgary, showing dramatic reductions in depressive symptoms with a program oriented to spirituality [9]. Modules focus on areas such as connectedness, self-acceptance, compassion, and gratitude. While this program was provided remotely through a web-based program, many holistic practitioners incorporate these principles into their work with clients. For those in naturopathic medicine as well as traditionally trained physicians and psychiatrists, there are things on the biomedical horizons. Because of our openness to new ideas, integrative practitioners may be the bellwethers for ideas that nd their way into more traditional practice. Before Integrative Medicine existed as a eld, there were isolated reports of antibiotics being used to treat peptic ulcer disease. This was dismissed as heretical, as before the discovery of H. Pylori, we knew that nothing can survive in the acidic milieu of the stomach. Abnormalities of folate metabolism and methylation in general are a subject of study, with much interest in Methyltetrahydrofolate Reductase (MTHFR) polymorhisms [10]. CatehcholO-methyl Transferase (COMT) is another enzymatic pathway tied in with mental health and general health problems. Single
Editorial / Advances in Integrative Medicine 2 (2015) 12
nucleotide polymorphisms (SNPs) may partially explain the
overlap seen between chronic pain and mental health conditions [11,12]. Our traditionally oriented colleagues are watching the literature on SNPs, but we may be 10 years away from EvidenceBased Medicine (EBM) pointing to specic treatments. We can use our knowledge of cell metabolism and biochemical pathways to point to nutritional treatments that may impact on the manifestations of these SNPs [13,14]. The Institute for Functional Medicine provides a nice model, which extends readily to individuals experiencing mental health difculties https://www. functionalmedicine.org/. Our colleagues in Traditional Chinese Medicine, Ayurveda, and Naturopathic Medicine have comfort and experience with the use of dietary approaches, supplements, and herbal agents for the treatment of mental health disorders. This body of knowledge is slowly making its way into our journals with better designed studies. Limitations include paucity of funding support, inherent challenges with natural product research, and issues around the complexity of studying multi-modal treatments. EBM favors randomized placebo-controlled clinical trials (RCTs), typically of the format: agent A vs. placebo for condition B. This bears little resemblance to clinical practice, in which our patients are diverse with comorbidities and our treatments often include a complex mix of diet and lifestyle changes, mind-body interventions, supplements, and possibly pharmacologics. One of the challenges we face as an academic eld is coming up with the models for testing complex interventions in a pragmatic fashion that will highlight the salient benets of these treatments singly and in combination [15,16]. An issue facing the mental health community is how to bridge the gap between services available in Westernized countries vs. areas with greater poverty, limitations to health care, and issues such as wars, terrorism, natural disasters, and refugees. This presents an opportunity for integrative approaches. Many developing countries have culturally based systems of healing, which can be enhanced to make services more widely available. Under the leadership of James Lake, MD, INIMH conducted its 1st international educational mission trip to Cuba, providing collaborative education for both Cuban and the international team of professionals. The easing of tensions between the US and Cuba may allow for a follow-up conference to take place. We hope to lead a future program in Nepal, to help widen knowledge of the Traditional Tibetan Medicine system as it applies to mental health issues. Eye Movement Desensitization and Reprocessing is a psychotherapy modality found to be quite effective in the treatment of post-traumatic stress disorders [17]. In the States, EMDR Humanitarian Assistance Program has been providing low cost training for psychotherapists from the non-prot and public sectors [18]. They have responded to international crises and are exploring expanding their mission to venues overseas. Medecins Sans Frontie`res http://www.msf.org/has led the way for providing assistance to individuals suffering from the effects or wars and natural disasters has been. They literally put themselves in the line of re. Understandably, Integrative Medicine and Health has generated skepticism and at times antagonism from our allopathic colleagues. More recently, there has been greater acceptance. There are 61 academic health centers in North America that comprise the Consortium of Academic Health Centers for Integrative Medicine, suggesting that we are no longer on the fringes http://www.imconsortium.org/. The International Network of Integrative Mental Health is a growing organization, which
provides collegial support, education, and mentorship through
web-based and other programming http://www.inimh.org. Under the leadership of Rogier Hoenders, MD, PhD, the Netherlands hosts a biannual Conference on Integrative Psychiatry, the last attended by 600 psychiatrists. This years conference took place in March 2015 http://www.congresintegralepsychiatrie.nl/english/. Educational programs, such as at Saybrook University http://www. saybrook.edu, are being developed to provide formal education in an integrative model of care. Speaking collectively for practitioners of integrative mental health, were not yet mainstream, but there is an increasing chorus of young energetic people interested in incorporating these approaches. References [1] Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-47, HHS Publication No. (SMA) 13-4805. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. [2] Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc 2009;18:2333. [3] Khan A, Faucett J, Lichtenberg P, Kirsch I, Brown WA. A systematic review of comparative efcacy of treatments and controls for depression. PLoS ONE 2012;7:e41778. [4] Kirsch I. Antidepressants and the placebo response. Epidemiol Psichiatr Soc 2009;18:31822. [5] Sarris J, Glick R, Hoenders R, Duffy J, Lake J. Integrative mental healthcare White Paper: establishing a new paradigm through research, education, and clinical guidelines. Adv Integr Med 2014;1:916. [6] Kong W, Langlois MF, Kamga-Ngande C, Gagnon C, Brown C, Baillargeon JP. Predictors of success to weight-loss intervention program in individuals at high risk for type 2 diabetes. Diabetes Res Clin Pract 2010;90:14753. [7] Paschal AM, Lewis-Moss RK, Sly J, White BJ. Addressing health disparities among African Americans: using the stages of change model to document attitudes and decisions about nutrition and physical activity. J Community Health 2010;35:107. [8] Werch CE, Ames S, Moore MJ, Thombs D, Hart A. Health behavior insights: the transtheoretical/stages of change model: Carlo C. DiClemente, PhD. Health Promot Pract 2009;10:418. [9] Rickhi B, Moritz S, Reesal R, Xu TJ, Paccagnan P, Urbanska B, et al. A spirituality teaching program for depression: a randomized controlled trial. Int J Psychiatry Med 2011;42:31529. [10] Nazki FH, Sameer AS, Ganaie BA. Folate: metabolism, genes, polymorphisms and the associated diseases. Gene 2014;533:1120. [11] Tammimaki A, Mannisto PT. Catechol-O-methyltransferase gene polymorphism and chronic human pain: a systematic review and meta-analysis. Pharmacogenet Genomics 2012;22:67391. [12] Witte AV, Floel A. Effects of COMT polymorphisms on brain function and behavior in health and disease. Brain Res Bull 2012;88:41828. [13] Morledge TJ. Introduction to Integrative Medicine. Cleveland Clinic Center for Continuing Education; 2015. [14] Lynch B. MTHFR.Net; 2015. [15] Bland J. Does complementary and alternative medicine represent only placebo therapies? Altern Ther Health Med 2008;14:168. [16] Braun MM. Temporary practice pause then resumption (TPPR) study design: an extension of the withdrawal study design to complementary and alternative medicine mind and body interventions (CAM-MABI). J Altern Complement Med 2013;19:8337. [17] Shapiro F. The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. Perm J 2014;18:717. [18] EMDR Humanitarian Assistance Program. EMDR HAP; 2015.
Ronald M. Glick MD*
Departments of Psychiatry, Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, United States *Tel.: +1 4126233023; fax: +1 4126236414 E-mail address: glickrm@upmc.edu (R.M. Glick).