Traditional Medicine

Course Technical Information

Course Code : PCR300
Course Title : Complementary and Alternative Medicine
Credit units : 1.00
Course Description : This course is designed to enable the students to
understand their role in the practice of complementary and alternative
medicine/integrative medicine domains that are commonly used by Filipinos in medical
healthcare; those which are cost-effective, recognized by the government, a local and
global trend, and a basis for scientific research in improving the quality of life of the
individuals and the community as a whole
Course Outcomes
CO1. Identify the role of the pharmacist in the practice of complementary and alternative
medicine following regulatory standards – Role of the Pharmacist and Regulatory
CO2. Examine how complementary and alternative medicine can be applied to acute
and chronic disease therapies – Therapeutics
Course Outline
Section 1: Introduction to Integrative Medicine
1. The Philosophy of Integrative Medicine
2. Complementary and Alternative Medicine in Pharmacy practice
3. PHITAC Guidelines
4. RA 8432 – TAMA Act of 1997
5. Definition of Terms
Section 2: Alternative Medical Systems
1. Homeopathic and Naturopathic Medicine
2. Oriental Medicine/Traditional Medicine
3. Ayurvedic Medicine
Section 3: Mind-Body Interventions
1. Meditation
2. Cognitive Behavioral Therapy
Section 4: Biologically-based Therapy
1. Dietary Supplements
2. 10 Halamang Gamot
Section 5: Manipulative and Body-based Methods
1. Hilot
2. Chiropractic massage
Section 6: Energy Therapy
1. Therapeutic Touch
2. Magnetic Therapy
 UNIT 1
Introduction to Integrative Medicine
Introduction to this Topic
The approach of medicine in which the totality of a person (physical, mental, and
spiritual) is taken into account is called as integrative medicine. This branch of discipline
emphasizes therapeutic relationships and makes use of all appropriate therapies
whether it be conventional or alternative. Approximately 33% of US adults and 12% of
children use methods of CAM/Integrative Medicine. Despite the discipline having some
obstacles to health care providers especially in lifestyle and integrative health
conversations, it still has a significant potential to patient well-being.
A. The Defining Principles of Integrative Medicine
Integrative medicine emphasizes the totality of the well-being of a person. Below are
some of the principles of integrative medicine that illustrate its discipline:
1. Patient and practitioner are partners in the healing process.
2. All factors that influence health, wellness, and disease are taken into
consideration, including mind, spirit, and community, as well as the body.
3. Appropriate use of both conventional and alternative methods facilitates the
body's innate healing response.
4. Effective interventions that are natural and less invasive should be used
whenever possible.
5. Integrative medicine neither rejects conventional medicine nor accepts
alternative therapies uncritically.
6. Good medicine is based in good science. It is inquiry-driven and open to new
paradigms.
7. Alongside the concept of treatment, the broader concepts of health promotion
and the prevention of illness are paramount.
8. Practitioners of integrative medicine should exemplify its principles and commit
themselves to self-exploration and self-development.
B. Complementary and Alternative Medicine in the Pharmacy Practice
Evidence indicates that the pharmacist's role should expand to include CAM. Literature
published in the last 15 years to determine exactly where pharmacists need to intervene
is extensive. Here's what researchers have concluded:

Pharmacists have a professional responsibility to acknowledge and seek out

information about patients' CAM use.

Pharmacists need to increase their knowledge base about CAM so they have a
basic understanding of what various products do and what their risks are.

Pharmacists can and must help patients use CAM appropriately and safely.

Pharmacists should have knowledge of when patients who use CAM experience
adverse drug events, and report them appropriately.

Pharmacists need to educate patients about CAM and its potential benefits and
risks.

Pharmacists approach to CAM needs to be collaborative in nature, and they

need to work with health care professionals so that they are aware that the
patient is taking CAM and it's documented in the medical record.

These findings indicate that pharmacists’ professional responsibilities for CAM are
not terribly different than those for traditional medicines. Pharmacists who accept these
responsibilities will need to look for resources that can help them augment their
traditional training with information focused directly on CAM.

Pharmacists can start by understanding the scope of the problem and defining CAM.
It's especially important to know what patients tend to use in specific geographic areas.
In addition, pharmacists need to ask patients about CAM use. If patients are using
CAM, it's critical for pharmacists to ask them why, how it's working, and if they're having
any difficulties.
 Pharmacists also need to acknowledge the many stakeholders in the CAM
discussion. Pharmacists and patients are obviously involved, but policymakers,
regulators, professional organizations, academia, traditional physicians, alternative
practitioners, and the pharmaceutical/CAM industry are all involved as well. We must
work together to ensure the CAM is used responsibly and appropriately.

C. PITAHC Guidelines

Most of the information regarding the organization is found in their website. Click this link
to get to the main directory of downloadable files including guidelines.

Below are some examples of PITAHC guidelines:

PITAHC Guidelines on the National Certification of Hilot Practitioners and

Accreditation of Hilot Training Centers and Hilot Healing Centers
PITAHC Guidelines on the National Accreditation of Traditional and Alternative
Health Care Organizations
PITAHC Guidelines on the National Certification of
Homeopaths/Homotoxicologists and Accreditation of
Homeopathy/Homotoxicology Training Programs, Centers, and Clinics\

D. RA 8423

Please be noted that the Act has been revised to implement a body of organization that
will accelerate the development of traditional and alternative healthcare in the
Philippines. You can read the revision using this link.
 UNIT 2

Alternative Medical Systems

Introduction to this Topic

This chapter discusses Alternative Medical Systems. Alternative medical systems are
entire systems of health theory and practice (including traditional Chinese medicine,
Ayurvedic medicine, naturopathy, and homeopathy) that developed separately from
conventional medicine. These systems typically use a variety of methods that fall under
the CAM umbrella (herbal remedies, manipulative practices).

A. Homeopathic & Naturopathic Medicine

Homeopathy is the use of minute doses of natural substance (homeopathic
remedies), and naturopathic medicine often uses natural methods of treatment. The
truth is that they are entirely separate forms of medicine, with unique definitions,
philosophies, and applications. In naturopathic medical school training, homeopathy is
one of the philosophies/modalities studied. Just as NDs are also taught herbal medicine,
nutrition, etc, we are educated in the use of homeopathy as a tool in treating patients.
Depending on which ND you choose to see, some may utilize more or less homeopathy
than others based on their training or experience.Alongside the concept of treatment,
the broader concepts of health promotion and the prevention of illness are paramount.

Naturopathic Principles of Healing

“Naturopathic medicine is a distinct primary health care profession, emphasizing

prevention, treatment, and optimal health through the use of therapeutic methods and
substances that encourage individuals’ inherent self-healing process. The practice of
naturopathic medicine includes modern and traditional, scientific, and empirical
methods.” (as defined by the AANP, our national organization)

The practice of naturopathic medicine emerges from six principles of healing. These
principles are based on the objective observation of the nature of health and disease
and are examined continually in light of scientific analysis. These principles stand as the
distinguishing marks of the profession.

1. The healing power of nature — vis medicatrix naturae.

The body has the inherent ability to establish, maintain, and restore health. The
healing process is ordered and intelligent; nature heals through the response of the life
force. The physician’s role is to facilitate and augment this process, to identify and
remove obstacles to health and recovery, and to support the creation of a healthy
internal and external environment.

2. Identify and treat the cause — tolle causam

Illness does not occur without cause. Underlying causes of disease must be
discovered and removed or treated before a person can recover completely from illness.
Symptoms are expressions of the body’s attempt to heal, but are not the cause of
disease; therefore, naturopathic medicine addresses itself primarily to the underlying
causes of disease, rather than to the symptoms. Causes may occur on many levels,
including physical, mental-emotional, and spiritual. The physician must evaluate
fundamental underlying causes on all levels, directing treatment at root causes as well
as seeking relief of symptoms.

3. First do no harm — primum no nocere

The process of healing includes the generation of symptoms, which are, in fact,
expressions of the life force attempting to heal itself. Therapeutic actions should be
complementary to and synergistic with this healing process. The physician’s actions can
support or antagonize the actions of vis medicatrix naturae; therefore, methods
designed to suppress symptoms without removing underlying causes are considered
harmful and are avoided or minimized.
4. Treat the whole person — in perturbato animo sicut in corpore sanitas esse non
potest

Health and disease are conditions of the whole organism, involving a complex
interaction of physical, spiritual, mental, emotional, genetic, environmental, and social
factors. The physician must treat the whole person by taking all of these factors into
account. The harmonious functioning of all aspects of the individual is essential to
recovery from and prevention of disease, and requires a personalized and
comprehensive approach to diagnosis and treatment.

5. The physician as teacher — docere

Beyond an accurate diagnosis and appropriate prescription, the physician must

work to create a healthy, sensitive interpersonal relationship with the patient. A
cooperative doctor–patient relationship has inherent therapeutic value. The physician’s
major role is to educate and encourage the patient to take responsibility for his or her
own health. The physician is a catalyst for healthful change, empowering and motivating
the patient to assume responsibility. It is the patient, not the doctor, who ultimately
creates or accomplishes healing. The physician must strive to inspire hope as well as
understanding. The physician must also make a commitment to her/his personal and
spiritual development.

6. Prevention — principiis obsta: sero medicina curator

The ultimate goal of naturopathic medicine is prevention. This is accomplished

through education and promotion of lifestyle habits that foster good health. The
physician assesses risk factors and hereditary susceptibility to disease and makes
appropriate interventions to avoid further harm and risk to the patient. The emphasis is
on building health rather than on fighting disease. Because it is difficult to be healthy in
an unhealthy world, it is the responsibility of both physician and patient to create a
healthier environment in which to live.

Homeopathic Principles of Healing

“Homeopathy, or homeopathic medicine, is a medical philosophy and practice based

on the idea that the body has the ability to heal itself. Homeopathy was founded in the
late 1700s in Germany and has been widely practiced throughout Europe. Homeopathic
medicine views symptoms of illness as normal responses of the body as it attempts to
regain health. A homeopathic health practitioner (homeopath) uses pills or liquid
mixtures (solutions) containing only a little of an active ingredient (usually a plant or
mineral) for treatment of disease.” (via WebMD)

Homeopathy, also known as homeopathic medicine, is a medical system that was

developed in Germany more than 200 years ago. It’s based on two unconventional
theories:
 “Like cures like”—the notion that a disease can be cured by a substance that
produces similar symptoms in healthy people
 “Law of minimum dose”—the notion that the lower the dose of the medication,
the greater its effectiveness. Many homeopathic products are so diluted that no
molecules of the original substance remain.

Homeopathic products come from plants (such as red onion, arnica [mountain herb],
poison ivy, belladonna [deadly nightshade], and stinging nettle), minerals (such as white
arsenic), or animals (such as crushed whole bees). Homeopathic products are often
made as sugar pellets to be placed under the tongue; they may also be in other forms,
such as ointments, gels, drops, creams, and tablets. Treatments are “individualized” or
tailored to each person—it’s common for different people with the same condition to
receive different treatments.

According to the 2012 National Health Interview Survey (NHIS), which included a
comprehensive survey on the use of complementary health approaches by Americans,
an estimated 5 million adults and 1 million children used homeopathy in the previous
year. The 2012 survey also reported that although about 1.8 percent of children used
homeopathy, only 0.2 percent of children went to a homeopathic practitioner. A 2016
analysis of data from this survey suggests that most adults who use homeopathic
products self-prescribe them for colds and musculoskeletal pain.

In 2016, the U.S. Federal Trade Commission (FTC) announced it will hold efficacy
and safety claims for over-the-counter homeopathic drugs to the same standard as
those for other products making similar claims. It further stated that companies must
have the competent and reliable scientific evidence the FTC requires for health-related
claims, including claims that a product can treat specific conditions.

In December 2017, the U.S. Food and Drug Administration (FDA) proposed a new
risk- based enforcement approach to homeopathic products. The proposed approach
would call for more careful scrutiny of products with the greatest potential for risk,
including:
 Those with reported safety concerns
 Those that are not taken by mouth or rubbed on skin
 Those for vulnerable populations
 Those that do not meet legal standards for quality, strength, or purity

Those intended to be used for preventing or treating serious and/or life-threatening

diseases and conditions.

A 2015 comprehensive assessment of evidence by the Australian government’s

National Health and Medical Research Council concluded that there is no reliable
evidence that homeopathy is effective for any health condition.

Homeopathy is a controversial topic. A number of its key concepts don’t agree with
fundamental scientific concepts. For example, it’s not possible to explain in scientific
terms how a product containing little or no active ingredient can have any effect. This, in
turn, creates major challenges to rigorous clinical investigation of such products. For
example, researchers cannot confirm that an extremely dilute mixture contains what is
listed on the label; nor have they been able to develop objective measures that show
effects of extremely dilute products in the human body.

Another research challenge is that homeopathic treatments are highly individualized,

and there is no uniform prescribing standard for homeopathic practitioners. There are
hundreds of different homeopathic remedies, which can be prescribed in a variety of
different dilutions for thousands of symptoms.

Certain homeopathic products (called “nosodes” or “homeopathic immunizations”)

have been promoted by some as substitutes for conventional immunizations, but the
U.S. Centers for Disease Control and Prevention says there’s no credible scientific
evidence to support such claims. The National Center for Complementary and
Integrative Health (NCCIH) supports the Centers for Disease Control and Prevention’s
recommendations for immunizations/vaccinations. To learn more about vaccines visit
www.vaccines.gov.

While many homeopathic products are highly diluted, some products sold or labeled
as homeopathic may not be; they can contain substantial amounts of active ingredients,
which may cause side effects or drug interactions. Negative health effects from
homeopathic products of this type have been reported.

A 2012 systematic review of case reports and case series concluded that using
certain homeopathic products (such as those containing heavy metals like mercury or
iron that are not highly diluted) or replacing an effective conventional treatment with an
ineffective homeopathic one can cause adverse effects, some of which may be serious.

Liquid homeopathic products may contain alcohol. The FDA allows higher levels of
alcohol in these than in conventional drugs.

Homeopathic practitioners expect some of their patients to experience “homeopathic

aggravation” (a temporary worsening of existing symptoms after taking a homeopathic
prescription). Researchers have not found much evidence of this reaction in clinical
studies; however, research on homeopathic aggravations is scarce. Always discuss
changes in your symptoms with your health care provider.
The FDA has warned consumers about different products labeled as homeopathic.
For example, in 2017 it alerted consumers that some homeopathic teething tablets
had
excessive amounts of the toxic substance belladonna; in 2015, it warned consumers not
to rely on over-the-counter asthma products labelled as homeopathic, because they are
not evaluated by the FDA for safety and effectiveness.

More to Consider
 Don’t use homeopathy to replace proven conventional care or postpone seeing a
health care provider about a medical problem.
 If you are considering using a homeopathic product, bring it with you when you
visit your health care provider. The provider may be able to help you determine
whether the product might pose a risk of side effects or drug interactions.
 Follow the recommended conventional immunization schedules for children and
adults. Don’t use homeopathic products as a substitute for conventional
immunizations.
 Women who are pregnant or nursing, or people who are thinking of using
homeopathy to treat a child, should consult their (or the child’s) health care providers.

Take charge of your health—talk with your health care providers about any
complementary health approaches you use. Together, you can make shared, well-
informed decisions.

B. Oriental Medicine
According to TCM, illness arises as a result of specific yin-yang imbalances of the
Functional Entities.

The functional entities are:

1. The Five Fundamental Substances: Qi, Xue (Blood), Jinye (Body Fluids),
Jing (Essence), and Shen (Spirit).
2. Zang-fu: A Wu Xing cycle of 5 zang organs, 6 fu organs, and their
functions
3. Jing-luo: The channels or meridians through which qi flows
The functional entities are responsible for performing the five cardinal functions
that maintain health within the body. They are: Actuation, Warming, Defense,
Containment, and Transportation. If there is an imbalance within the any of the
functional entities, they will not be able to perform their cardinal functions, and as result,
illness may arise.

As mentioned previously, Oriental Medicine does not evaluate an illness purely

based on the symptoms a person is showing, but rather, on complex patterns of
disharmony in the body.
At the most basic level, these patterns are determined by Eight Principles, which
measure either an excess (vacuity) or deficiency (stagnation) of qi in one the entities.

In this article, we will discuss the eight principles of diagnosis in Traditional Chinese
Medicine.

The process of determining the actual pattern of diagnosis begins with an evaluation
of bing according to the notion of the Eight Principles. The Eight Principles describe the
basic qualities of a disease. This notion refers to four pairs of mutual opposites.

The Eight Principles (辩证)

1. Yin: Yin, along with yang is the most general classification for pattern diagnosis and it
describes the relationship between the other three pairs of the Principles. Generally
speaking, yin is Cold.

2. Yang: Yang, along with yin is used to describe the relationship between the other
three pairs of the Principles. For example, Heat is Yang.

3. Interior: Interior describes diseases that manifest themselves in the Zang-fu organs
or deep inside the body, such as qi, blood, and bone marrow. More broadly, it used to
describe diseases that cannot be classified as Exterior.
 4. Exterior: Exterior describes diseases that manifest themselves on surface of the
body, such hair, skin, nails, and meridians. Its clinical features include body chills,
fever, aversion to cold temperatures and winds, a weak pulse, and headaches.

5. Heat: Heat describes the absence of an aversion to Cold. If paired with an Exterior
pattern, its symptoms can include a rapid pulse, fever, body chills, dehydration, and a
sore throat. If paired with an Interior patter, its symptoms can include a preference for
cold drinks, clear urine, and a slow pulse.

6. Cold: Cold describes an aversion to cold. If paired with an Exterior pattern, its
symptoms can include body aches, a tense pulse, fever, body chills, and headaches.
If paired with an Interior patter, its symptoms can include nausea, stomach pain,
vomiting, and diarrhea.

7. Deficiency: Deficiency is used to describe a vacuity in qi, blood (Xue), or body

fluids (Jinye). Depending on how it relates to Interior/Exterior and Cold/Heat, it can
manifest as constipation, having a small appetite, dizziness, and slow pulse.

8. Excess: Excess is generally classified as any disease that can't be identified as a

Deficiency pattern. Usually, it means that one of the Six Excesses is present.
Depending on how it relates to Interior/Exterior and Cold/Heat, it can manifest as
quick pulse, sweaty palms, and sharp stomach pains.

After a basic diagnosis of the diseases is given via the Eight Principles, the
diagnostic continues and focuses on more specific conditions. After evaluating the
present symptoms, a person’s condition is further evaluated as to how the specific
entities (qi, meridians, Zang-fu, etc.) are affected.

Cause of Disease

Traditional Chinese Medicine does not strongly differentiate between the cause and
effect of a disease. However, there are three major categories that are considered to
give rise to disease. The three major categories of disease causes are:

1. External: Disease caused by the Six Excesses and bad qi.

2. Internal: Disease caused the by Seven Emotions or Seven Affects: Anger,

Fear, Anxiety, Fright, Grief, Pensiveness, and Joy. These are said to effect the zang-
fu organs.

3. Other Irregularities-Disease caused something that is neither external nor

internal, such as having unbalanced diet or damage done by parasites.

Four Pillars of Diagnosis

There are four methods of diagnostics in Traditional Chinese Medicine, which are often
referred to as the Four Pillars of Diagnosis. They are:

1. Inspection: Inspection or “looking” focuses on visual analysis of the face, skin

features, and particularly, the tongue. In TCM, the surface of the tongue corresponds
to particular zang-fu organs and can reveal a lot about a particular disease.
Therefore, the tongue diagnosis is considered a cornerstone practice in the
diagnostic process.
2. Auscultation: Auscultation refers to the analysis of particular sounds. In TCM,
there are five major types of sounds: shouting, laughing, singing, weeping, and
groaning. Auscultation analysis extends to olfaction, which analyzes the smell of
body odor, even though sound and smell are consider to be separate senses in the
West.

3. Palpation: Palpation refers to analysis by feeling, particularly the wrist pulse,

abdomen, and meridians points. The techniques for doing are complex and can
years to learn.

4. Inquiry: Inquiry refers to analysis by asking questions about the person’s past
health and habits. Traditionally, this included 10 questions, which ranged from diet to
sleep pattern.
 After recognizing a particular pattern of disharmony, a doctor will prescribe treatment
based on the diagnosis that was given. The treatment can include the more common
practices of Traditional Chinese Medicine, such as herbal medicine, acupuncture, and
tui na massage, but also less common practices, such as cupping.

C. Ayurvedic Medicine
The ancient Indian medical system, also known as Ayurveda, is based on ancient
writings that rely on a “natural” and holistic approach to physical and mental health.
Ayurvedic medicine is one of the world’s oldest medical systems and remains one of
India’s traditional health care systems. Ayurvedic treatment combines products (mainly
derived from plants, but may also include animal, metal, and mineral), diet, exercise,
and lifestyle.

Although Ayurvedic medicine and its components have been described in many
scholarly articles, only a small number of clinical trials using these approaches have
been published in Western medical journals. About 240,000 American adults use
Ayurvedic medicine. A few studies suggest that Ayurvedic preparations may reduce
pain and increase function in people with osteoarthritis and help manage symptoms in
people with type 2 diabetes, but most of these trials are small or not well-designed.
There is little scientific evidence on Ayurveda’s value for other health issues.

Results from a 2013 clinical trial compared two Ayurvedic formulations of plant
extracts against the natural product glucosamine sulfate and the drug celecoxib in 440
people with knee osteoarthritis. All four products provided similar reductions in pain and
improvements in function. A preliminary and small NCCIH-funded 2011 pilot study with
43 people found that conventional and Ayurvedic treatments for rheumatoid arthritis
were similarly effective. The conventional drug tested was methotrexate and the
Ayurvedic treatment included 40 herbal compounds. Outcomes from a small short-term
clinical trial with 89 men and women suggested that a formulation of five Ayurvedic
herbs may help people with type 2 diabetes. However, other researchers said
inadequate study designs haven’t allowed researchers to develop firm conclusions
about Ayurveda for diabetes. Turmeric, an herb often used in Ayurvedic preparations,
may help with ulcerative colitis, but the two studies reporting this were small – one,
published in 2005 included 10 people while the other, published in 2006, had 89.

Some Ayurvedic preparations include metals, minerals, or gems. The U.S. Food
and Drug Administration warns that the presence of metals in some Ayurvedic products
makes them potentially harmful. Although rare, Ayurvedic products may cause arsenic
poisoning. A 2015 published survey of people who use Ayurvedic preparations showed
that 40 percent had elevated blood levels of lead and some had elevated blood levels of
mercury. About one in four of the supplements tested had high levels of lead and almost
half of them had high levels of mercury. A 2015 case report published in the Center for
Disease Control’s Morbidity and Mortality Weekly Report linked elevated blood lead
levels in a 64-year-old woman with Ayurvedic preparations purchased on the Internet.

More to Consider
 Don’t use Ayurvedic medicine to postpone seeing a conventional health care
provider about a medical problem.
 If you have a health condition, talk with your conventional health care provider
before using Ayurvedic products.
 There is no significant regulation of Ayurvedic practice or education in the United
States, and no state requires a practitioner to have a license. For more information
on credentialing complementary health practitioners, see the NCCIH fact
sheet Credentialing, Licensing, and Education.
 If you’re pregnant or nursing, be sure to consult your (or your child’s) health care
provider as some Ayurvedic products may contain products that could be harmful.
 Tell all your health care providers about any complementary or integrative health
approaches you use. Give them a full picture of what you do to manage your health.
This will help ensure coordinated and safe care.
UNIT 3
Mind-Body Interventions
Introduction to this Topic
Mind-body interventions utilize the mind’s capacity to affect the body and its
physiological responses. They thereby influence health. The response to stress (the
“fight or flight” reaction) may be automatic, but recovery toward relaxed parameters (“the
relaxation response”) can be learned through self-regulation and the regular use of
mind- body interventions. Many of these interventions originate from Eastern healing
practices. Western science has found some of them to be helpful as adjunct modalities
in the treatment of disease, and their use is increasing.
A. Meditation
While there are various meditation styles, all types of meditation practices
incorporate self-observation of mental activity, attentional focus training, and cultivating
an attitude that highlights process rather than content. A recent meta-analysis of
meditation practices characterizes pure meditation practices such as mindfulness
meditation and Transcendental Meditation as well as other mind-body practices that
have a meditation component (yoga, tai chi, and qigong).
The central element of mindfulness is to acquire attentional control by focusing
on events generated internally (bodily sensations, breath, thoughts, emotions) and
externally (sights, sounds) at the current moment with nonjudgmental acceptance.
Mindfulness meditation has been formalized for clinical interventions with Mindfulness-
Based Stress Reduction and Mindfulness-Based Cognitive Therapy.
Concentration meditation entails directing attention to some intentional process
like the repetition of a word or phrase (mantra), or the breath. Transcendental
Meditation is a concentration technique that is a registered trademark and the teachers
of the technique must be formally certified. Some clinical studies of Transcendental
Meditation demonstrate benefits but the certification process has limited widespread
clinical use. Brain changes during meditation have been observed in numerous EEG
and neuroimaging studies and there is some evidence for meditation effects on
endocrine, neurotransmitter, and immune system measures.
B. Relaxation and Breathing Techniques
Relaxation and breathing techniques utilize awareness of breathing rate, rhythm,
and volume. Most often breathing techniques are used to minimize physiologic
responses to stress, possibly by increasing parasympathetic response. Also, they are
often used in conjunction with relaxation techniques such as Jacobson's progressive
muscular relaxation and autogenic training. A relatively simple respiration monitor that
facilitates slowing one's breathing rate has been approved by the Food and Drug
Administration for the reduction of blood pressure.
C. Yoga
Yoga is an ancient Indian, non-religious mind–body approach that has
components centering on meditation, mindfulness, breathing, and activity or postures.
Varieties of Hatha yoga that center on postures are the most commonly practiced in the
United States. While yoga may be beneficial for some diseases, certain forms are likely
contraindicated in neurologic disorders. For example, Bikram yoga, which is practiced in
very hot temperatures, is likely risky for patients with multiple sclerosis. Some practices
such as Iyengar yoga incorporate props and supports, and may lend themselves more
readily to people with neurologic and musculoskeletal disorders. Physiologically, yoga
practice is noted to produce changes in heart rate, blood pressure, galvanic skin
response, respiratory rate, fasting blood glucose (Type II diabetes mellitus and healthy),
breath holding time, auditory and visual reaction times, and intraocular pressure.
D. Tai Chi & QiGong
Tai chi and qigong are two traditional Chinese medicine techniques that
incorporate body movement, breath, and attentional training to improve disease
symptoms and maintain health. These practices have many similarities to yoga but, in
contrast, contain body movement as a critical component. The practice of tai chi
includes slow body positions that flow from one to the next continuously and that
promote posture, flexibility, relaxation, well-being, and mental concentration. The main
difference between qigong and tai chi is that tai chi is a martial art. Tai chi movements
practiced quickly can provide self-defense and are externally focused. Qigong cannot
and is internally focused. A similar technique from a Western context is “therapeutic
eurythmy.”
E. Hypnosis
Hypnosis involves attention and focused concentration with a relative suspension
of peripheral awareness. There are three aspects of hypnosis: absorption, dissociation,
and suggestibility. Absorption is the tendency to become fully involved in a perceptual,
imaginative, or ideational experience. Dissociation is the mental separation of
experiential components that would ordinarily be processed together. Suggestibility is
the heightened responsiveness to social cues leading to an enhanced compliance with
hypnotic instructions. The brain changes associated with hypnosis have been
documented by fMRI and EEG studies.
F. Biofeedback
Biofeedback is a medical treatment in which physiologic markers like heart rate,
breathing rate, EMG, EEG, or electrodermal activity are measured and displayed back
to the patient. The patient can then attempt to modulate physiology to achieve a certain
feedback goal, such as slowing heart or breathe rate, or relaxing certain muscles. The
desired feedback goal is based on the specific condition being treated. Numerous
psychophysiologic studies have been conducted that examine the effect of biofeedback
on physiology as well as various clinical conditions resulting in an extensive literature of
varying quality.
G. Cognitive Behavioural Therapy
Cognitive behavioral therapy (CBT) is one of the most common and best studied forms
of psychotherapy. It is a combination of two therapeutic approaches, known as cognitive
therapy and behavioral therapy.

Which methods of treatment are applied depends on the illness or problem to be

treated. The basic principle behind therapy is however always the same: What we think,
how we feel and how we behave are all closely connected – and all of these factors
have a decisive influence on our well-being.

What is cognitive therapy?

The term cognitive comes from the Latin "cognoscere", meaning "to recognize."
The point of cognitive therapy is to form a clear idea of your own thoughts, attitudes and
expectations. The goal is to reveal and change false and distressing beliefs, because it
is often not only the things and situations themselves that cause problems, but the
importance that we attach to them too.

For example, a dangerous thought pattern might be when somebody immediately

draws negative conclusions from an occurrence, generalizes them and applies them to
similar situations. In psychology, this generalized way of thinking is called “over-
generalizing.” Another distressing error in reasoning is “catastrophizing”: If something
disturbing happens, people immediately draw exaggerated conclusions about the scope
of the supposed disaster ahead.

Such thought patterns can sometimes develop into self-fulfilling prophecies and
make life difficult for the people affected. Cognitive therapy helps people learn to
replace these thought patterns with more realistic and less harmful thoughts. It also
helps people to think more clearly and to control their own thoughts better.
How does behavioral therapy work?

Behavioral therapy has its origins in American “behaviorism.” This theory

assumes that human behavior is learned and can therefore be unlearned or learned
anew. Behavioral therapy aims to find out whether certain behavioral patterns make
your life difficult or intensify your problems. In the second step you work on changing
these behavioral habits.

For example, people who have developed depressive thoughts often tend to
withdraw and give up their hobbies. As a result, they feel even more unhappy and
isolated. Cognitive therapy helps to identify this mechanism and find ways to become
more active again.

In anxiety disorders, behavioral therapy often includes learning methods to help

you calm down. For example, you can learn to reduce anxiety by consciously breathing
in and out deeply so that your body and breathing can relax. When doing this you
concentrate on your breathing instead of what is bringing on your anxiety. These kinds
of techniques can help you to calm down instead of getting all worked up with anxiety.

By the way, in Germany, most psychotherapists who are trained in cognitive

behavioral therapy call themselves behavioral therapists.

Which thought and behavioral patterns are harmful, which are not?

Harmful thoughts or behavioral habits can make people feel bad about
themselves. For example: You see somebody you know on the street and say hello, but
they do not say hello back. Your own reaction to that very much depends on how you
assess the situation.

How is cognitive behavioral therapy different from other psychotherapies?

Cognitive behavioral therapy is a problem-oriented strategy. It focuses on current

problems and finding solutions for them. Unlike psychoanalysis, for example, it does not
deal primarily with the past. Cognitive behavioral therapy is much more concerned with
dealing with current problems. The most important thing is helping people to help
themselves: They should be able to cope with their lives again without therapy as soon
as possible. This does not mean that cognitive behavioral therapy completely ignores
the influence of past events. But it mainly deals with identifying and changing current
distressing thought and behavioral patterns.

Analytic psychotherapy, which has its origin in classic Freudian psychoanalysis,

uses different methods. Here the therapist tries to help the patient discover and
understand problems and their deeper causes.

When is cognitive behavioral therapy an option?

Cognitive behavioral therapy is used to treat conditions such as depression,

anxiety and obsessive-compulsive disorders, and addictions. But it is also an option for
treating physical conditions such as chronic pain, tinnitus and rheumatism. It can help to
relieve the symptoms.

Cognitive behavioral therapy requires the patient's commitment and own

initiative. Therapy can only be successful if the patient actively takes part in the
treatment and also works on their problems between sessions. This can be a
considerable challenge, especially with severe conditions such as depression or anxiety
disorders. That is why medication is sometimes used at first to quickly relieve the worst
symptoms so that psychotherapy can be started.

Choosing a certain kind of psychotherapy also depends on the goals. If you feel
the need for deep insight into the causes of your problems, cognitive behavioral therapy
is probably not the right choice. It is particularly useful if you are mainly interested in
tackling specific problems and are only secondarily concerned with the “why.”
How does cognitive behavioral therapy work and how long does it take?
It is important that you and your psychotherapist have a close and trusting
working relationship. It can sometimes take a while to find the right therapist.

In the first session, you will briefly explain your current problems and outline your
expectations. That forms the basis for discussing the goals of therapy and the therapy
plan. The plan can be adjusted if your personal goals change over the course of
therapy.

Therapy often includes recording your own thoughts in a journal over a certain
period of time. The therapist will then check the following things with you: Do I perceive
things appropriately and realistically? What happens if I behave differently than I
normally do in a certain situation? You will regularly discuss any problems you may
have and progress that you have made.

Cognitive behavioral therapy also uses relaxation exercises, stress and pain
relief methods, and certain problem-solving strategies.

Compared to analytical psychotherapy approaches, cognitive behavioral therapy

is a short-term treatment. But there is also no standard length of cognitive behavioral
therapy. Some people already feel much better after a few sessions, while others need
treatment for several months. This depends on the kind and severity of the problems,
among other things. An individual session lasts about an hour. Sessions usually take
place once a week. Cognitive behavioral therapy is offered in psychotherapy practices,
hospitals and rehabilitation clinics. It is sometimes also offered as group therapy.

Can cognitive behavioral therapy also have side effects?

Side effects resulting from psychotherapy cannot be ruled out. Being directly
confronted with your problems or anxieties may be very stressful at first, and
relationships might also suffer as a result. It is crucial to speak openly with your
psychotherapist if any difficulties come up during therapy.

Hardly any research has been done on possible side effects of psychotherapy.