Complementary Health Practice Review current issue

Mechanisms of Action in the Inverse Relationship Between Mindfulness and Psychological Distress

Coffey, K. A., Hartman, M. — 2008-04-29

Both dispositional mindfulness and mindfulness-based interventions have been found to be associated with less psychological distress. The current study investigated three mechanisms by which mindfulness might exert its beneficial effects: emotion regulation, nonattachment, and reduced rumination. Correlational self-report data were collected from two independent, nonclinical samples of undergraduates. Structural equation modeling was then used to test the role of these three mechanisms in mediating the relationship between mindfulness and a psychological distress factor, consisting of measures for depressive and anxious symptomatology. The model was respecified based on the first sample and retested in the second sample. Results confirmed an inverse relationship between mindfulness and psychological distress. Furthermore, emotion regulation, nonattachment, and rumination significantly mediated this relationship.

Safe Effective Nondrug Treatment of Chronic Depression: A Review of Research on Low-Voltage Cranial Electrical Stimulation and Other Adjunctive Therapies

Shealy, C. N., Thomlinson, P. — 2008-04-29

Although clinical practice guidelines tend to emphasize pharmacological treatments for chronic depression, safe and effective nondrug treatments are available. This article reviews three decades of research at the Shealy Institute on nonpharmacological treatments for chronic depression in chronic pain patients via low-voltage electrical stimulation and other adjunctive therapies. More than 30,000 chronically depressed patients have been treated with cranial electrical stimulation at 1 to 2 mA at 15,000 Hz, modulated at 500 and 15 Hz. Approximately half of patients treated with this approach experienced marked clinical improvement. When combined with photostimulation at 1 to 7 Hz, 85% of patients improved adequately without use of antidepressant drugs and without complications. Magnesium replacement and nutrition education are useful adjuncts. This program is cost effective and can be carried out by a nurse practitioner and an assistant. Further controlled clinical research and research on mechanisms of action would strengthen the validity of these findings and increase the application of these therapeutic approaches.

Uninformed Complementary and Alternative Supplement Use: A Risky Behavior for Cardiovascular Patients

Bristol, M. N., Sonnad, S. S., Guerra, C. — 2008-04-29

Growing use of complementary and alternative supplements (CAS) is of concern because of the potential for herb—drug interaction among cardiovascular patients. Literary searches were conducted on PubMed to identify reports of extent and purpose of CAS use, disclosure of use by patients, physician knowledge, and possible drug—CAS interactions for cardiovascular patients. Additional published studies were located through the Web sites of various organizations. Further searches of case reports, case series, controlled trials, and laboratory evidence were performed for each of the top 10 CAS and their possible cardiovascular drug interactions. More research is needed to understand supplement—drug interactions, particularly in terms of how this potentially affects patients taking cardiovascular drugs. With this lack of research and clarity on supplement—dug interactions and the underreporting of CAS use by many patients, physician education is also in need of improvement.

A Dialogue-Building Pilot Intervention Involving Traditional and Biomedical Health Providers Focusing on STIs and HIV/AIDS Care in Zambia

2008-04-29

Collaboration between traditional and biomedically trained health workers is regarded as key in HIV/AIDS control. However, few studies have focused on exploring ways of enhancing this collaboration. Using a pre- and postintervention questionnaire, the authors assessed changes in attitudes to and practices of collaboration among 19 biomedical and 28 traditional health care providers following a 12-month dialogue-building intervention in Ndola, Zambia. The intervention consisted of peer group discussions, interactive group discussions, training sessions, and peer-influenced networking. The results show that although both groups of providers had fairly positive attitudes toward each other before the intervention, further improvements in attitudes were observed after the intervention. Referrals between the two sectors and cross visits increased. However, some attitudes to collaboration became more negative and cautious after the intervention. Dialogue-building interventions involving traditional and biomedical providers are not only feasible but also complex. Intersectoral collaboration needs time and coordination between all relevant actors in the community.

CAM Curriculum Activities to Enhance Professionalism Training in Medical Schools

Elder, W.G., Hustedde, C., Rakel, D., Joyce, J. — 2008-04-29

Enhancing the professionalism of graduates is a major objective of most health care education institutions today. Educating conventional health care providers about complementary and alternative medicine (CAM) may directly and indirectly improve trainee professionalism by expanding trainees' knowledge and appreciation of diverse health care beliefs and practices, improving physician—patient communication, enhancing self-care, and increasing sense of competence and job satisfaction. A survey based on professional competencies proposed by the Consortium of Academic Health Centers for Integrative Medicine was administered to the grantees of the National Institutes of Health, National Center for Complementary and Alternative Medicine R-25 CAM education project initiative. The survey's aim was to identify project activities that taught professionalism skills. All projects reported curricular features that enhanced trainee professionalism, with substantial percentages of project effort directed toward professionalism-related activities.