Acupuncture, massage therapy, yoga. These are just a few types of treatment you may have heard about for stress, anxiety and increasingly, anxiety disorders, that are considered "complementary and alternative medicine." 56 percent of people with an anxiety disorder and 53 percent of people with depression reported using alternative treatments in 2000, according to a study in the American Journal of Psychiatry.

What is complementary and alternative medicine? Are these treatments safe? Can they help people with anxiety disorders? Read on to learn more about these techniques as well as issues to think about if you or a loved one are considering including complementary and alternative medicine as part of an overall treatment plan.

(*Important: If you are currently taking any medication, be sure to inform your prescribing doctor(s) about any vitamins, supplements or other ingested substances you might also be taking or are considering taking, to avoid any potentially negative interactions.)

What is complementary and alternative medicine?

Complementary and alternative medicine (CAM) is a term used to describe the various approaches to health care that exist outside the realm of conventional medicine as practiced in the U.S. The list of what is considered to be CAM frequently changes as therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge.

Are complementary medicine and alternative medicine the same thing?

No. Although they are commonly grouped together, complementary medicine is used together with conventional medicine, while alternative medicine is used in place of conventional medicine.

How can CAM help people with anxiety disorders? Are CAM approaches scientifically proven?

Certain types of CAM can help to lessen the symptoms of anxiety disorders and may even treat them. However, scientific evidence remains limited at this time. The potential benefits of various CAM approaches for people with anxiety and other mental health disorders are described in more detail below. It is best to check with your mental health provider or primary care doctor before beginning any type of CAM treatment.

What types of CAM practices exist?

The National Center for Complementary and Alternative Medicine (NCCAM), a division of the National Institutes of Health (NIH) and the government's lead agency for scientific research on CAM, divides the practices into 5 categories:

1. Alternative Medical Systems. Alternative medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the U.S. Examples of alternative medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda.

2. Mind-Body Interventions. Mind-body medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some techniques that were considered CAM in the past have become mainstream (for example, patient support groups and cognitive-behavioral therapy). Other mind-body techniques are still considered CAM, including meditation, prayer, and therapies that use creative outlets such as art, music or dance.

3. Biologically Based Therapies. Biologically based therapies in CAM use substances found in nature, such as herbs, foods and vitamins. Some examples include dietary supplements, herbal products and the use of other so-called natural but as yet scientifically unproven therapies (for example, using shark cartilage to treat cancer).

4. Manipulative and Body-Based Methods. Manipulative and body-based methods in CAM are based on manipulation and/or movement of one or more parts of the body. Some examples include chiropractic or osteopathic manipulation, and massage.

5. Energy Therapies. Energy therapies involve the use of energy fields. There are of two types:

• Biofield therapies are intended to affect energy fields that supposedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, Reiki, and Therapeutic Touch.
  
• Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.

For more information, click here.

What specific CAM approaches are used to help people with anxiety and other mental health disorders?

According to the National Mental Health Information Center, a division of the Substance Abuse and Mental Health Services Administration, the following CAM approaches emphasize the interrelationship between mind, body, and spirit, and have been used to reduce the symptoms of anxiety and other mental health disorders. Although some of these approaches have a long history, many remain controversial. Therefore, it is crucial to consult with your health care provider(s) before undertaking any of these approaches.

• Self-help groups. Many people with anxiety disorders and other mental/health problems find that self-help groups are an invaluable resource for recovery and empowerment. Self-help generally refers to groups or meetings that:

  o	Involve people who have similar needs
  o	Are facilitated by a consumer, survivor or other layperson
  o	Assist people to deal with a "life-disrupting" event, such as a death, abuse, serious accident, addiction, or diagnosis of a physical, emotional, or mental disability, for oneself or a relative
  o	Are operated on an informal, free-of-charge and nonprofit basis
  o	Provide support and education
  o	Are voluntary, anonymous, and confidential.

  To find a self-help group for anxiety disorders in your area, click here.
• Diet and Nutrition. Adjusting both diet and nutrition may help some people with mental health problems manage their symptoms and promote recovery. For example, cutting back or eliminating caffeine has been shown to reduce panic attacks in people who are prone to them. Another example is the use of herbal treatments, B-complex vitamins, riboflavin, magnesium, and thiamine by some holistic/natural physicians to treat anxiety, autism, depression, drug-induced psychoses and hyperactivity in their patients.
• Pastoral Counseling. Some people prefer to seek help for mental health problems from their pastor, rabbi, priest, other religious leader or pastoral counselor. Counselors working within traditional faith communities increasingly are recognizing the need to incorporate psychotherapy and/or medication, along with prayer and spirituality, to effectively help some people with Health Problems.
• Relaxation and Stress Reduction Techniques. Examples include:
  

  o	Biofeedback: This technique involves using monitoring devices to provide information regarding an autonomic bodily function, in an attempt to gain some control over that function. Learning to control muscle tension and "involuntary" body functioning, such as heart rate and skin temperature, can be a path to conquering a person's anxiety and fears. It is sometimes used in combination with, or as an alternative to, medication to treat anxiety disorders, including panic disorder and phobias. For example, a person can learn to "retrain" his or her breathing habits in stressful situations to induce relaxation and decrease hyperventilation.
  o	Guided Imagery or Visualization: This process involves going into a state of deep relaxation and creating a mental image of recovery and wellness. Physicians, nurses, and mental health providers sometimes use this approach as part of a treatment plan for panic disorder, phobias, stress, depression, and alcohol and drug addictions.
  o	Massage therapy: The underlying principle of this approach is that rubbing, kneading, brushing and tapping a person's muscles can help release tension and pent up emotions. It has been used to ease the symptoms of trauma-related stress and depression. A highly unregulated industry, certification for massage therapy varies widely from state to state. Some states have strict guidelines, while others have none. Check with your state department of professional regulation or health department to see if they have guidelines.

• Animal Assisted Therapies. Working with an animal(s) under the guidance of a health care professional may benefit some people with mental health problems by facilitating positive changes, such as enhanced socialization skills. Animals can be used as part of group therapy programs to encourage communication and increase the ability to focus. Developing self-esteem and reducing anxiety and loneliness are just some potential benefits of individual-animal therapy.
  
• Expressive Therapies. Examples include:

  o	Art Therapy: Drawing, painting, and sculpting help some people to reconcile inner conflicts, foster self-awareness and facilitate personal growth. Some mental health providers use art therapy as both a tool for diagnosis and as a method to help treat various disorders.
  o	Dance/Movement Therapy: The underlying premise to dance/movement therapy is that it can help a person integrate the emotional, physical, and cognitive facets of "self" by giving him or her a sense of release and inner peace.
  o	Music/Sound Therapy: Research suggests that music stimulates the body's natural "feel good" chemicals (opiates and endorphins). This stimulation results in improved blood flow, blood pressure, pulse rate, breathing and posture changes. Music or sound therapy has been used to both treat mental health disorders and to diagnose them.

• Culturally Based Healing Arts. Traditional Oriental medicine (such as acupuncture and Reiki), Indian systems of health care (such as Ayurveda and yoga), and Native American healing practices (such as the Sweat Lodge and Talking Circles) all incorporate the beliefs that a) wellness is a state of balance between the spiritual, physical, and mental/emotional "selves"; b) an imbalance of forces within the body is the cause of illness; and c) herbal/natural remedies, combined with sound nutrition, exercise, and meditation/prayer, will correct this imbalance. Specific examples of these arts include:

  o	Acupuncture: The Chinese practice of inserting needles into the body at specific points manipulates the body's flow of energy to balance the endocrine system. This manipulation regulates functions such as heart rate, body temperature, and respiration, as well as sleep patterns and emotional changes. Acupuncture has been used in clinics to assist people with substance abuse disorders through detoxification; to relieve stress and anxiety; to reduce symptoms of depression; to treat attention deficit and hyperactivity disorder in children; and to help people with physical ailments.
  o	Ayurveda: Ayurvedic medicine is described as "knowledge of how to live." It incorporates an individualized regimen - such as diet, meditation, herbal preparations, or other techniques - to treat a variety of conditions, to facilitate lifestyle changes, and to teach people how to release stress, anxiety and tension through yoga or transcendental meditation.
  o	Yoga/meditation: Practitioners of this ancient Indian system of health care use breathing exercises, posture, stretches and meditation to balance the body's energy centers. Yoga is sometimes used as an adjunct to other treatment for anxiety disorders, depression and stress-related disorders.
  o	Native American traditional practices: Ceremonial dances, chants, and cleansing rituals are part of Indian Health Service programs to heal stress, trauma, depression and substance abuse.
  o	Cuentos: Based on folktales, this form of therapy originated in Puerto Rico. The stories used contain healing themes and models of behavior such as self-transformation and endurance through adversity. Cuentos is used primarily to help Hispanic children recover from mental health problems related to leaving one's homeland and living in a foreign culture.

More information on these approaches can be found by clicking here.

Is there scientific evidence to back up use of CAM? Are CAM treatments as effective as other, more conventional treatments?

As with anything else, results can vary based on the individual. At this time, evidence for the treatments discussed above is mainly anecdotal. Progress is being made in thoroughly evaluating the claims made about CAM, with several research-based organizations attempting to compile scientific reviews of different alternative and complementary treatments. For example, the National Center for Complementary and Alternative Medicine (NCCAM) aims to provide a standard for measuring the effectiveness of CAM through rigorous science, educate CAM researchers, and present trustworthy information to consumers and healthcare professionals. However, at this time, evidence is limited but evolving.

Can CAM be used with other treatments?

In many cases, yes. Because no single CAM treatment has been proven effective in treating anxiety disorders, clinicians often recommend that when these treatments are used, they are used in conjunction with evidence-based treatments such as medication and/or cognitive behavioral therapy. Of course, there is always a possibility that certain CAM treatments may interfere with primary treatment (a supplement may interfere with medication, for instance). For this reason, it is imperative that you discuss any additional treatments you might undertake with your doctor.

For more information on standard approaches to treating anxiety disorders, click here.

Are CAM therapies safe?

Any treatment for an anxiety or other disorder needs to be considered and evaluated on an individual basis. When considering a CAM approach, remember that "natural" does not necessarily mean "safe." You should always talk to your doctor or therapist before trying a CAM approach, as well as educate yourself by utilizing some of the resources listed at the end of this feature. Below are some issues to think about when considering CAM treatment:

• Account for Individuality. People respond differently to treatments. How a person might respond to a CAM treatment depends on many things, including the person's state of health, how the treatment is used or the person's belief in the treatment.
  
• Consider a Practitioner's Training. For CAM therapies that are administered by a practitioner, the training, skill and experience of the practitioner affects safety. However, in spite of careful and skilled practice, all treatments - whether CAM or conventional - can have risks.
  
• Research Product Safety. For a CAM product that is sold over the counter (without a prescription), such as a dietary supplement, safety can depend on a number of things, including the components or ingredients that make up a product; where the components or ingredients come from; and the quality of the manufacturing process (for example, how well the manufacturer is able to avoid contamination). To research specific dietary supplements, visit NIH's Office of Dietary Supplements here. You can find more information about safety from the Food & Drug Administration by clicking here.

Does insurance cover CAM?

As more CAM treatments gain acceptance in the conventional medical community, more insurance companies are beginning to cover or partially cover such treatments. Certain treatments, such as acupuncture, are considered to be more mainstream now and are more likely to be covered by insurance. However, due to the lack of conclusive scientific evidence supporting many treatments, many insurance companies are hesitant to provide coverage. For more information on financial concerns and CAM, consult NCCAM's fact sheet, "Consumer Financial Issues in Complementary and Alternative Medicine," available here.

How do I find a CAM practitioner?

Before seeking a CAM practitioner, you should consult with your mental health professional and/or primary care physician. He or she may be able to provide a recommendation as to the type of CAM treatment that would be helpful for your specific problem. Also, you may want to be aware of the licensing requirements of your state before choosing a practitioner. Many treatments do not have to meet federal licensing requirements, but some states do require accreditation for certain techniques, such as acupuncture. If your state requires licensing, you want to be sure the person you choose is licensed. Additionally, there are often professional organizations for each treatment that require their members to meet certain standards. These organizations include the Nurse Healers-Professional Associates International for therapeutic touch practitioners and the American Art Therapy Association for art therapists. NIH offers the Directory of Health Organizations, which provides information about professional organizations for different treatments. The directory is available at http://dirline.nlm.nih.gov/.

For more information on selecting a CAM practitioner, click here.

How do I learn more about CAM?

Much of the information-sharing about CAM is done through word of mouth. You can educate yourself by talking to family, friends and other acquaintances, reading articles and searching for information on the Internet, and even by contacting your insurance company (some but not all share information on CAM). The following websites are good places to start:

National Center for Complementary and Alternative Medicine (NCCAM), a division of the National Institutes of Health: http://nccam.nih.gov/

MedlinePlus, a database provided by the U.S. National Library of Science and the National Institutes of Health: http://medlineplus.gov/

Aetna Intelihealth: http://www.intelihealth.com

The Cochrane Collaboration: http://www.cochrane.org/

References and Resources:

Aetna InteliHealth
InteliHealth, a consumer health website of the insurance company Aetna, provides information from many sources (including Harvard Medical School and NIH). InteliHealth maintains a database on alternative and complementary treatments.

Directory of Health Organizations
A service of the NIH, the directory provides information on professional organizations related to CAM treatments and is searchable by treatment.

MedlinePlus
A database provided by the U.S. National Library of Science and NIH, MedLinePlus includes information from the National Library of Medicine, NIH, and other government agencies and health-related organizations.

National Mental Health Information Center
Part of the Substance Abuse and Mental Health Services Administration, the National Mental Health Information Center offers information on CAM approaches to mental health care.

NCCAM & the NCCAM Clearinghouse
NCCAM and its Clearinghouse offer consumers and professionals a wealth of information on complementary and alternative medicine.
Contact information:
Toll-free in the U.S.: 1-888-644-6226, International: 301-519-3153, TTY (for deaf or hard-of-hearing callers): 1-866-464-3615
E-mail: info@nccam.nih.gov

(*Important: If you are currently taking any medication, be sure to inform your prescribing doctor(s) about any vitamins, supplements or other ingested substances you might also be taking or are considering taking, to avoid any potentially negative interactions.)

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