Complementary and alternative therapy

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Complementary therapies are a diverse range of health-related treatments which are not part of mainstream medical care. Generally speaking they are thought to increase well-being, aid relaxation and promote good mental health in all. There is a lot less evidence that complementary therapies are as effective as medically recommended treatments. However, Rethink believes that complementary therapies can be beneficial to people experiencing mental health problems when used in addition to medical treatment. Some approaches rely on anecdotal evidence whereas others are beginning to gather clinical evidence that they can be effective for certain mental health problems. Acupuncture has been found to be beneficial for people with schizophrenia when used in addition to medication. There is evidence that some herbal medicines can be effective in treating depression. Recently NICE has recommended the use of mindfulness based CBT (meditation) for recurring depression. This factsheet looks at a small selection of complementary therapies which are popular for the treatment of mental health problems but there are many more available.

Complementary therapy is a title used for a diverse group of health-related therapies which are not considered to be a part of mainstream medical care. They are also known as alternative 'natural 'non-conventional' and 'holistic' and can also be known as medicine e.g complementary medicine. Some therapies are considered as whole systems of healing and are seen by practitioners as a replacement to conventional medicine. However, Rethink believes that complementary and alternative therapies can be beneficial for mental illness if used alongside conventional treatments but not replacing them1. Why use complementary therapy for mental illness? It is widely thought that complementary therapies can provide a sense of relaxation and increased well being which can contribute positively to a persons mental health .. Furthermore, many complementary therapies involve a more holistic approach to treating people which means to treat the whole person and consider physical, psychological and spiritual needs rather than focussing on the symptoms of the illness. Many people with mental illness find this beneficial and Rethink supports a holistic approach to treating patients2. -1Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. 2009, all rights reserved. No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to Friday 10am 1pm

This factsheet will look at some of the most popular and established complementary therapies, in alphabetical order, and consider their usefulness for some mental illness. However, it may be useful to note that this is not an exhaustive list and there may be other therapies available which work for you. Acupuncture Acupuncture is a popular aspect of Traditional Chinese Medicine (TCM). TCM includes the use of herbal medicine, nutritional remedies, massage and exercise which are claimed to rebalance physical and emotional energy3. According to this system of medicine there is a non-physical energy called chi, meaning life force, which flows through our body. When we are in balance and not experiencing pain and illness this life force flows freely but when there is a blockage in the flowing of this energy problems occur which are experienced as symptoms of illness, including mental illness. Acupuncture needles are placed along points which are believed to help release the flow of chi and restore health and balance in the body. There are lots of small scale studies and anecdotal evidence from people who claim that regular acupuncture sessions have provided relief to symptoms of mild to moderate mental illness such as depression and anxiety4. Furthermore studies show that during acupuncture the body releases endorphins which are natural chemicals known to relieve pain, relax muscles and increase feelings of well being5. However, research into the long term effects of acupuncture on mental illness produce inconclusive results. Some research has shown that acupuncture can have a positive effect for people diagnosed with schizophrenia when combined with anti-psychotics6. However, reviews of studies into the long term effect of acupuncture on depression were unable to gain any conclusive evidence for its effectiveness 7. Research has not been able to establish why acupuncture can be effective. Chi or energy is not a medical term and cannot be measured or tested.

Aromatherapy Aromatherapy is the use of aromatic (pleasant-smelling), essential oils which are extracted from plants such as flowers , leaves, roots or bark. It is thought that each oil has a different therapeutic property which can affect the nervous system and brain chemistry and is absorbed through massages, baths, inhalation or creams and lotions8. Certain oils are linked to symptom relief for a wide variety of mental and emotional symptoms such as depression, grief, stress and insomnia. However, there have been few clinical trials of the long terms effects of aromatherapy on mental illness, particularly severe mental illness, and much more is needed9. Small scale research suggests that aromatherapy can be particularly beneficial for depression10 and anxiety11. Individual case studies of the use of aromatherapy on mental health patients report increased well being, reduced tension and alleviation from medication side effects12. Bach Flower Remedies -2Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. 2009, all rights reserved. No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to Friday 10am 1pm

Bach Flower Remedies were created by Dr Edward Bach a medical doctor. Whilst treating people at his practice be became interested in how the personality states of the individual impacted on their health. This philosophy eventually led him to the study of plants which he believed held the properties to treat certain emotional states such as hopelessness and despair; terror and fright; lack of confidence 13. There are 38 classic remedies which are made from floating specific flowers in water which people consume orally. Although there are some anecdotal evidence for their effectiveness there is very little clinical evidence in support of this form of therapy14.

Spiritual/Energy Healing People who practice energy healing believe that in addition to a physical body we also have an energy body. This is made up of individual chakras which are responsible for different aspects of our emotional and physical well being. When there is emotional or physical disharmony in a person these chakras become blocked or unbalanced. it is believed the practitioner acts as a channel and harnesses universal healing energy to unblock and balance the chakras. They do this by placing their hands above the body at certain positions throughout a treatment. One of the most well known forms of energy healing in England is Reiki. Anecdotally many people report a strong sense of relaxation during the treatment and a feeling of well being afterwards. Furthermore, there is some clinical evidence that this type of healing can have a positive effect for people with mild to moderate mental health problems, such as depression and anxiety15. However, more evidence is needed of the effects on severe mental illness. Although reiki is not associated with a particular religion it often has a spiritual dimension and care might be needed for people who experience religious delusions.

Western Herbal medicine This the use of plant extracts to treat medical problems including mental illness. The most well known herbal medicine for treating mental health problems is St. John's Wort (hypericum). There is strong clinical evidence that St John's Wort is just as effective as anti-depressants in mild to moderately severe depression and has fewer side effects16. Other herbal medicines, such as valerian and kava extract, are considered to be useful for anxiety but test results are not as strong 17 18 However, the active ingredient in St. Johns Wort can be harmful for some people if combined with the substance tyramine which is found in some foods such as; extracts of meat and yeast (Oxo, Marmite), broad bean pods, smoked or pickled fish, hung poultry or game, some cheeses, some red wines and some beers. Furthermore, St Johns Wort can interact with other prescribed medicines such as the effectiveness of oral contraceptive pill19. It is therefore a very good idea to seek the advice of a doctor or herbal medical practitioner before taking it. Therefore, if you are interested in trying any of them, first check that the therapist is properly qualified, then talk to your psychiatrist. -3Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. 2009, all rights reserved. No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to Friday 10am 1pm

Homeopathy Is based on the theory that an illness can be treated by using tiny amounts of a substance which causes similar symptoms to it. Homeopathy is also based on the principles of treating the whole person and a consultation would involve a thorough assessment of a person's lifestyle, personality and physical health. A treatment is then selected based on all the information gathered so two people with the same symptoms may not receive the same treatment20. There are some case studies which report homeopaths working closely with people with severe mental illness and getting successful results but there is not clinical evidence to support this21. A systematic review of clinical trials by Kleijnen concluded that there was a small amount of clinical evidence for the positive effects of homoepathy on health, including mental health22. A recent NHS review of evidence concluded there was still not enough evidence to recommend the use in depression23. Massage Massage is a form of structured and pressurised touch, or kneading, of the body which is generally used to relax and to relieve muscle pain. There are many different types of massage ranging from "Swedish massage" which involves light strokes aiming to relax the muscles which relieve tension to "Shiatsu" which, like acupuncture, believes that putting pressure on certain points will help to balance a person's energy. Often massage is combined with aromatherapy which is thought to enhance the well being effects of the session. Massage is widely available and very popular as it often has an immediate effect of reducing tension. There are small scale case studies which suggest that massage can have a short term effect on the symptoms of depression, anxiety and manic depression24. There are also some clinical trials showing massage can have a long term effect on reducing mild mental health problems. However, not enough research has been done on the effect of severe mental illness25.

Meditation and Mindfulness based CBT (MCBT). There are different types of meditation however most share the practice of sitting quietly and focusing your mind on either your breathing, a mantra (a repeated phrase) or an object. When thoughts arise the person is encouraged to gently note them without judgement and let them drift away whilst the attention is then returned to the breath or object. It is claimed that over time with practice people can learn to quieten a busy and stressful mind and gain a stronger connection to the present moment without unwanted thoughts intruding. This practice is widely known as "mindfulness" or "mindfulness meditation" and can be practiced at home on your own or in a group.

-4Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. 2009, all rights reserved. No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to Friday 10am 1pm

There are many studies which show that mindfulness meditation techniques can reduce stress and increase well being 26. Furthermore, research has shown that those who have a larger right pre-frontal cortex have a higher risk of depression and anxiety than those who have a larger left pre-frontal cortex. Although it is still unknown whether differences in brain structure are the cause or result of mental health problems, some studies have shown that regular mindfulness medication can in fact re-dress this in-balance and lead to a positive change in mental functioning27. More recently the practice has been combined with some techniques of cognitive behavioural therapy to treat depression and this has come to be known as mindfulness based CBT (MCBT). Based on the principle that recurring depression is associated with the return of negative thinking, feeling and behaving, participants learn to recognise these automatic pilot modes, step out of them and respond in healthier ways. Recent research has provided strong evidence that MCBT can be effective for treating chronic depression (three or more recurring episodes)28 and it is now recommended by the National Institute of Clinical Excellence (NICE) as a treatment option29. MBCT should be an 8-week group programme with each session lasting 2 hours, and four follow-up sessions in the year after the end of therapy. Although there is a wealth of evidence that meditation can be used for depression and anxiety there are much less studies for severe mental illness. Yoga Yoga is form of meditative and physical exercise which has its routes in India as a spiritual practice. Movements and postures are performed slowly and coordinated with an emphasis on controlling the breath. There are different types of yoga vary based on how much emphasis is placed on a different aspects such as the physical exercises or the breathing. It is claimed that yoga can enhance all aspects of a person's well being included mental health by reducing stress and improving mood. Although there have been some clinical trials to suggest that yoga can be beneficial for people with depression there have not been enough research to be sure of its effectiveness for other long term mental health problems. 30 How can I try complementary therapy? Most complementary therapies are delivered by practitioners operating privately. Before you make an appointment with a private therapist it is recommended you read the chapter on choosing a therapist below. However, private therapists can often be expensive so many people would be looking for free or low cost options. Sometimes the NHS provides complementary therapies in certain areas, particularly if they are recommended by NICE (National Institute of Clinical Excellence), so it is worth checking with your GP first or contacting PALS.

-5Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. 2009, all rights reserved. No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to Friday 10am 1pm

Some local mental health charities or well-being centres provide free or low cost complementary therapies. Search www.mind.org.uk or explore what is available in your local area. Choosing a private complementary therapist Unlike mainstream medical practitioners, complementary therapists do not have register with a statutory body to practice. However, in 2008 The Complementary and Natural Healthcare Council (CNHC) was established, with support from the Department of Health, as the main regulatory body for a selection of complementary therapies which include massage, aromatherapy, shiatsu and yoga as well as others not mentioned in this factsheet. There are plans to include Reiki in 2011. The CNHC works with professional bodies to regulate the sector by setting nationally recognised qualification standards to practice, having a voluntary register of practitioners that have those standards as well as having an independent disciplinary procedure to deal with complaints. To register with the CNHC practitioners must also undergo criminal and disciplinary record checks and provide a character reference. Once a person is registered they are able to use the CNHC kite mark on all their publicity material However, as the CMHC is relatively new and membership is voluntary not all qualified practitioners will be registered at the moment. Ideally find a therapist who is a member of the CNHC but if this is not possible then at least make sure they are members of their professional body. Many individual therapies also have "professional bodies" which represent the interests of the practitioners in their field and also make recommendations for qualification standards needed to practice. They also hold registers for practitioners who have recognised qualifications. See below for contact details of these. In Britain, acupuncture has its own self-regulatory body with a register of members who have been trained to meet industry agreed standards. Other points to consider: Check the cost of treatment beforehand to make sure you are being fairly charged. You may have to shop around a bit. Ask about the qualifications, membership of professional bodies and how long they have been practising Always make sure the practitioner has appropriate insurance. Criteria for CHNC and other professional bodies normally include. Talk it over with your doctor or nurse and ask for their advice, especially if you are going to have a therapy which involves taking pills or medicines. Choose the complementary therapy that suits your individual needs. Other people may be able to give you an idea of what worked for them. Don't be misled by promises of cures. No reputable therapist would claim to be able to cure severe mental illness. -6Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. 2009, all rights reserved. No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to Friday 10am 1pm

Further information: The Rethink Advice and Information Service produces a number of fact sheets on a range of different issues that affect people with mental illness. They are also able to give confidential, impartial, practical advice on all aspects of mental illness. They can be contacted at: RAIS 15th Floor 89 Albert Embankment London SE1 7TP Tel: 0845 456 0455 or 020 7840 3188 (Monday-Friday 10am 1pm) Email: advice@rethink.org www.rethink.org Complementary and Natural Healthcare Council The independent regulatory body for some complementary therapies. 83 Victoria Street LONDON SW1H 0HW 020 3178 2199 http://www.cnhc.org.uk

The Complementary Therapies Association A professional body that promotes the interests of professionals working in the field. They hold a comprehensive list of qualified practitioners and also have a forum for members of the public to ask questions. 2nd floor, Chiswick Gate 598-608 Chiswick High Road London W4 5RT http://www.ctha.com/

The Aromatherapy Council http://www.aromatherapycouncil.co.uk info@aromatherapycouncil.co.uk The British Acupuncture Council 63 Jeddo Road London W12 9HQ 0208 735 04000 Email: info@acupuncture.org.uk Web: www.acupuncture.org.uk -7Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. 2009, all rights reserved. No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to Friday 10am 1pm

Association of Reflexologists (AoR) 5, Fore Street, Taunton, Somerset, England, TA1 1HX Tel: 0870 567 3320 Email: info@aor.org.uk Web: www.aor.org.uk The Shiatsu Society UK Eastlands Court, St. Peters Road, Rugby, Warwickshire, CV21 3QP Tel: 0845 130 4560 Email: admin@shiatsusociety.org Web: www.shiatsu.org

Association of Natural medicine 19a Collingwood Road, Witham, Essex, CM8 2DY Email: info@naturalmedicine.fsnet.co.uk Web: www.associationnaturalmedicine.co.uk

British Complementary Medicine Association Kensington House, 33 Imperial Square, Cheltenham, GL50 1QZ Tel: 0845 345 5977 Email: info@bcma.co.uk Web: www.bcma.co.uk

Complementary Medicine Association Tel: 0845 129 8434 Email: admin@the-cma.org.uk Web: www.the-cma.org.uk

Federation of Holistic Therapists, 18 Shakespeare Business Centre, Hathaway Close, Eastleigh, Hampshire SO50 4SR Tel: 0870 420 2022 (membership office) Email: info@fht.org.uk Web: www.fht.org.uk

The Rethink Advice and Information Service welcomes your feedback on whether this information was helpful to you. You can provide feedback in the following ways: By email: Please email your feedback to us at feedback@rethink.org. By post: You can write to us at the following address:

-8Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. 2009, all rights reserved. No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to Friday 10am 1pm

RAIS Rethink 15th Floor 89 Albert Embankment London SE1 7TP. By telephone: You can call us on 0845 456 0455 or 020 7840 3188

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Rethink Policy Statement 60 Last updated 01/11 Rethink Policy Statement 60 3 The Mental Health Foundation, Healing Minds 1998 4 The Mental Health Foundation, Healing Minds 1998 5 Acupuncture and endorphins by Han JS. Neuroscience Research Institute,Peking University and Key Laboratory of Neuroscience (Peking University), Ministry of Education, 38 Xue-Yuan Road, Beijing 100083, PR China. 6 Rathbone J, Xia J. Acupuncture for schizophrenia. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD005475. DOI: 10.1002/14651858.CD005475. 7 Smith CA, Hay PPJ, MacPherson H. Acupuncture for depression. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD004046. DOI: 10.1002/14651858.CD004046.pub3.. 8 The Mental Health Foundation, Healing Minds 1998 99 The Mental Health Foundation, Healing Minds 1998
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Komori et al 1995 Buckle 1993 12 The Mental Health Foundation, Healing Minds 1998 13 Complementary Therapies, Teach Yourself, Denise Wichello Brown, 2009. 14 The Mental Health Foundation, Healing Minds 1998 15 Goldman A. Long-term effects of energetic healing on symptoms of psychological depression and selfperceived stress. Alternative Therapies in Health and Medicine 2004;10(3):42-8 16 Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3. 17 Miyasaka LS, Atallah N, Soares B. Valerian for anxiety disorders. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004515. DOI: 10.1002/14651858.CD004515.pub2.
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Pittler MH, Ernst E. Kava extract versus placebo for treating anxiety. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003383. DOI: 10.1002/14651858.CD003383. 19 http://www.mhra.gov.uk/home/groups/pl-p/documents/websiteresources/con019565.pdf 20 Healing Minds pg 21 As above 22 As above 23 Non-pharmaceutical management of depression in adults, NHS Scotland, January 2010 24 Healing Minds pg 25 As Above 26 Mindfulness Manifesto 27 r J Davidson et al. (2003) "Alterations in brain and immune functioning produced by mindfulness medication" Psychosomatic Medicine. 28 Coelho HF, Canter PH, Ernst E. Mindfulness-based cognitive therapy: Evaluating current evidence and informing future research. J Consult Clin Psychol 2007;75(6):1000-5. 29 NICE Guidance 2010: Depression: the treatment and management of depression in adults 30 Non-pharmaceutical management of depression in adults, NHS Scotland, January 2010

-9Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149, e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. 2009, all rights reserved. No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to Friday 10am 1pm