Acupuncture, massage therapy, and 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." Fifty-six percent of people with an anxiety disorder and 53 percent with depression reported using alternative treatments in 2000, according to a study reported 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.

What is complementary and alternative medicine?

Complementary and alternative medicine, also referred to as CAM, describes approaches to health care that exist outside the realm of conventional medicine as practiced in the United States. The list of what is considered CAM frequently changes as therapies proven safe and effective are adopted into conventional health care and as new approaches to health care emerge.

Ccomplementary medicine vs. alternative medicine

Although they are commonly grouped together, complementary medicine is used with conventional medicine, while alternative medicine is used in place of conventional medicine.

CAM and anxiety disorders

Some types of CAM can help lessen the symptoms of anxiety disorders and may even treat them. But scientific evidence remains limited. The potential benefits of CAM approaches for people with anxiety and other mental health disorders are described in more detail below. Check with your mental health provider or primary care physician before beginning any new type of treatment.

Types of CAM practices

The National Center for Complementary and Alternative Medicine (NCCAM), a division of the National Institutes of Health (NIH), groups the practices into five categories:

Alternative medical systems are built on 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 developed in Western cultures include homeopathic medicine and naturopathic medicine.Systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda.

Mind-body interventions use techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some techniques considered CAM in the past have become mainstream, such as patient support groups and cognitive-behavioral therapy. Other mind-body techniques still considered CAM include meditation, prayer, and therapies using art, music, dance, or other creative outlets.

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

Manipulative and body-based methods are based on manipulation or movement of parts of the body. Examples include chiropractic or osteopathic manipulation and massage.

Energy therapies involve the use of energy fields, of which two types exist:

• Biofield therapies are intended to affect energy fields that surround and penetrate the human body, although no scientific proof of them exists. Some forms of energy therapy manipulate biofields by applying pressure or manipulating the body by placing the hands in or through these fields. Examples are 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.

CAM treatment approaches

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

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

  o	Involve people who have similar needs
  o	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	Operated free of charge on an informal, nonprofit basis
  o	Provide support and education
  o	Voluntary, anonymous, and confidential

  Search for a self-help group for anxiety disorders.
• Diet and nutrition. Adjusting diet and nutrition may help some people manage their mental health symptoms and promote recovery. For example, reducing or eliminating caffeine has been shown to reduce panic attacks in people who are prone to them. Similarly, some holistic or natural physicians use herbal treatments, B-complex vitamins, riboflavin, magnesium, and thiamine to treat anxiety, autism, depression, drug-induced psychoses, and hyperactivity.
• Pastoral counseling. Some people prefer to seek help for mental health symptoms from their spiritual or religious leader or pastoral counselor. Increasingly, counselors working within traditional faith communities recognize the need to incorporate psychotherapy and medication, along with prayer and spirituality, to effectively help some people with health problems.
• Relaxation and stress-reduction techniques
  

  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, may be one way to conquer anxiety and fears. It is sometimes used with, or as an alternative to, medication to panic disorder and phobias. Learning to retrain breathing habits in stressful situations can help induce relaxation and decrease hyperventilation.
  o	Guided imagery. Also called 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 useit 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. massage therapy is a highly unregulated industry, and certification varies widely from state to state. Some have strict guidelines and thers have none.

• Animal-assisted therapies. Working with animals under the guidance of a health care professional may enhance socialization skills, develop self-esteem, and reduce anxiety and loneliness for some people with mental health symptoms. Animals can be used in group therapy programs to encourage communication and increase the ability to focus.
  
• Expressive therapies

  o	Art therapy. Drawing, painting, and sculpture help some people reconcile inner conflicts, foster self-awareness, and facilitate personal growth. Some mental health providers use art therapy as a tool for diagnosis as well as treatment.
  o	Dance and movement. The underlying premise of dance and movement therapy is that it can help integrate the emotional, physical, and cognitive facets of "self" by providing a sense of release and inner peace.
  o	Music and sound. Research suggests that music stimulates opiates and endorphins, the body's natural "feel good" chemicals. This stimulation improves blood flow, blood pressure, pulse rate, breathing, and posture changes. Music and sound therapy has been used to diagnose and treat mental health disorders.

• Culturally based healing arts. Traditional Asian medicine (acupuncture and Reiki), Indian systems (Ayurveda and yoga), and Native American healing practices (sweat lodge and talking circles) incorporate the beliefs that wellness is a state of balance between the spiritual, physical, and mental and emotional selves; an imbalance of forces within the body causes illness; and herbal and natural remedies, combined with sound nutrition, exercise, and meditation and prayer, will correct this imbalance. Below are examples of these arts:

  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 heart rate, body temperature, and respiration, as well as sleep patterns and emotional changes. Acupuncture has been used to assist people with substance abuse disorders through detoxification; to relieve stress and anxiety; to reduce symptoms of depression; to treat ADHD in children; and to treat 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. Practitioners of this ancient Indian system 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 in Puerto Rican folklore, this form of therapy involves telling folktales with 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 issues related to leaving their homeland and living in a foreign culture.

Find out more information.

Does scientific evidence back up CAM?

As with other therapies and treatments, results vary among individuals. At this time, evidence for the treatments discussed above is mainly anecdotal. Progress is being made in thoroughly evaluating the claims made about CAM; several research-based organizations are compiling scientific reviews of different alternative and complementary treatments. 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 health care professionals. Thus far, evidence is limited but evolving.

Using CAM with other treatments

In many cases it's safe to use CAM with other treatments. Because no single CAM treatment has been proved effective in treating anxiety disorders, clinicians often recommend using CAM in conjunction with evidence-based treatments such as medication or cognitive-behavioral therapy. The possibility exists that some CAM treatments can interfere with primary treatment (a supplement interfering with medication, for instance). It is imperative that you discuss any additional treatments with your health care provider..

Safety of CAM treatments

Important: If you are currently taking any medication, be sure to inform your prescribing doctors about any vitamins, supplement, or other ingested substances you might also be taking or are considering taking to avoid any potential negative interactions.

When considering a CAM approach, remember that natural does not necessarily mean safe. Always talk to your doctor or therapist before trying a CAM approach, and try to learn as much as possible yourself. Below are some issues to consider:

• Individual results. People respond differently to treatments. How one might respond to a CAM treatment depends on the state of health, how the treatment is used, or personal belief in the treatment.
  
• A practitioner's training. The training, skill, and experience of a practitioner affects safety. Even with careful and skilled practice, all treatments, including conventional and CAM, present risks.
  
• Product safety. A CAM product sold without a prescription, such as a dietary supplement, safety depends on its ingredients and their origins and the quality of the manufacturing process. To research specific dietary supplements, visit the NIH Office of Dietary Supplements or the U.S. Food and Drug Administration.

Insurance and CAM

As additional CAM treatments gain acceptance in the conventional medical community, more insurance companies cover or partially cover them. However, due to a lack of conclusive scientific evidence supporting many treatments, many insurance companies are hesitant to provide coverage. For more information about paying for CAM treatments, visit the Consumer Financial Issues in Complementary and Alternative Medicine.

Finding a CAM practitioner

First, consult your mental health professional or primary care physician, who may be able to recommend an appropriate CAM treatment for you. Find out the licensing requirements in your state before choosing a practitioner. Many treatments are not required to meet federal licensing requirements, but some states require accreditation for acupuncture and other techniques. The Nurse Healers-Professional Associates International, the American Art Therapy Association, and other professional organizations require their members to meet specific standards. Search the NIH Directory of Health Organizations, which provides information about professional organizations for different treatments.

Find out more information about selecting a CAM practitioner.

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 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 Center for Complementary and Alternative Medicine (NCCAM)
NCCAM offer consumers and professionals information on complementary and alternative medicine.
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

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

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