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Becca Zacchari on Treatment Outcomes of Alternative Therapies
OHSU Psychiatry grand rounds 10.18.16
Her interest: Trauma and substance abuse
Conventional and alternative treatment is merging-->integrative health

CAM = complementary and alternative medicine, term falling out of use
Complementary is new hip term
Complementary health approaches split into natural products (supps, herbs) and mind/body practices

2009 stats
16.6% of adults in Using MBTs = mind body therapies
Most used in anx/dep and msk pain syndromes
most use in conjunction with conventional care
20% use MBT for conditions they though conventional medicine would not healp
high rates of perfceived helpfulness (68-90%)

Most pop approaches
products
breathing
yoga, tai chi, qi gong
chiro & osteo manipulation
meditation
massage
diets
homeopathy
progressive relaxation
guided imagery

What is Mindfulness?
The solitary sitting search for "inner peace", enlightenment
No, just a technique to use in daily life
Mindfulness means paying attention in a particular way; on purpose, in the present moment, and non-judgmentally.  --Jon Kabat-Zinn (who developed MBSR)
A way of controlling attention
Attitude of curiousity
Human ability to observe our own thoughts
Mind full, or mindful?
Racing thoughts = not mindful, instead "pay attention to one thing on purpose without judgement"
MBT = mindfulness based therapies = dedicated protocols
8-10 weeks, 1.5-2.5 hours/week; homework
MBSR = mindfulness based stress reduction
MBCT = mindfulness based cognitive therapy
MBRP = mindfulness based relapse prevention
Tools: Body scans, breathing, guided imagery
Train your mind to attend to one thing
Separate self from thoughts
MBI = mindfulness based interventions = other protocols with mindfulness as a component, yoga, zone "in", body scan, breathing exercise, guided imagery
ACT = acceptance and commitment
DBT = Dialectical Behavior therapy

GUIDED SEATED MEDITATION
Invite pt to tape guided meditation
Sit comfortably
Put down things in hands
Put both feet on the ground
Now she reads a text---sounds like a yoga class
Pay attention to the breath, belly, present moment

GROWING EVIDENCE BASE
MBTs in primary care, 6 RCT's, moderate outcomes for general and metnal health
Meta-analysis n=12,145
Small effect for improving quality of life
Better results for mental health conditions than physical
Gains maintained at followup
Bunch of studies in her presentation
Structural changes in the brain from mindfulness practice: incr gray matter, incr positive affect, less negative, improved emotional regulation, incr immune response, structural changes in amygdala, left cortex changes

ACUPX
Not for those with needle phobia
Ancient, practice in China, Japan, Korea, Taiwan, and now US
insertion of fine gauge stainless steel needles
~365 acupoints located at meridians
goal is to restore balance
energy channels
traditional, electro, laser, auricular, reflexology, acupressure, battlefield acupx
needles places and left to sit before removal
sessions 30-75 minutes
can be administered as group
NIH and WHO support its use for certain conditions
Research summarized: efficacious: back and neck pain, headache, migraine, nausea, vomiting, labor pain
Needs more: induction of labor, primary dysmen, cancer pain, RA, joint osteoarthritis
Efficicacy not confirmed: insomnia, epilepsy, VS, dep, schizo, cocaine dep, ASD, smoking cessation, bells' dysphagia in stroke, asthma, lots more

YOGA
adaptable to the individual, modification tailor to ability level
can mean many things
props for assistance
she mentions chakras and mantras
she says yoga has 4 parts: asana, pranayama, mantra, relaxation
pretzel poses are not representative
breathwork: attention, alternating pressure of in and out breath, alternating nostrils
meditation: image, word
relaxation is connected with benefits
creation of balance, strength and flexiblility thru preformance of poses or postures, each of which has specific physical benefits
types: chair, traumat sensitive, individual, group, caregiver, nidra/rest
props: chair, blocks
yoga and kidney dialysis: delivered at same time, simple vinyasa

One study
postures-->flexibility, strength, coordination, balance, resp fx, self efficacy
breathing-->emot reg, stress reg, resilience, equanimity, self-efficacy
meditation-->transcendence, unitive state, flow, transformation, sense of purpose
relaxation-->attention, mindfulness, concentration, cognition, meta-cognition
Kalsa 2016 research

Treatment outcomes:
Gene transcription
QOL improvements
Neurophysiological changes
Immunological changes

Her studies
involved cog performance, self-report measures, saliva cortisol
veterans in study, with PTSC, physically able, excluded psychotic
cog: response inhibition strong response, switching set small response, concentration mod response
all self report much improved
perceived benefits: shape, mood, togetherness, happiness, stress coping, soul nourishment, harmony, relaxation, etc

she encourages us to practice yoga ourselves
she leads CIH at the Portland VA, lots of stuff
CIH = ??

belle.zaccari at va.gov
503-220-*(*-8262 ext 58593

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