WHOLE HEALTH: CHANGE THE CONVERSATION
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1 Advancing Skills in the Delivery of Personalized, Proactive, Patient-Driven Care Complementary Approaches in the VA- A Glossary of Therapies and Whole Health Resources for Learning More Clinical Tool This document has been written for clinicians. The content was developed by the Integrative Medicine Program, Department of Family Medicine, University of Wisconsin-Madison School of Medicine and Public Health in cooperation with Pacific Institute for Research and Evaluation, under contract to the Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration. Information is organized according to the diagram above, the Components of Proactive Health and Well-Being. While conventional treatments may be covered to some degree, the focus is on other areas of Whole Health that are less likely to be covered elsewhere and may be less familiar to most readers. There is no intention to dismiss what conventional care has to offer. Rather, you are encouraged to learn more about other approaches and how they may be used to complement conventional care. The ultimate decision to use a given approach should be based on many factors, including patient preferences, clinician comfort level, efficacy data, safety, and accessibility. No one approach is right for everyone; personalizing care is of fundamental importance.
2 Complementary Approaches in the VA A Glossary of Therapies and Whole Health Resources for Learning More Clinical Tool The 2011 VA Healthcare Analysis and Information Group (HAIG) survey found that the therapies listed in the following tables were offered in one or more VA facilities. 1 These tables briefly define each therapy, along with where in the Whole Health curriculum you can find more information about it. Therapies are classed based on the five categories of complementary medicine used by the National Center for Complementary and Alternative Medicine (NCCAM). Different clinicians and organizations class these therapies in different ways. The number after each therapy s name is the number of VA facilities offering a given therapy. This list is by no means exhaustive. Therapies with an asterisk (*) beside them are not offered in VA facilities but are important for clinicians to know about. For more information about CAM, see the Introduction to Complementary Approaches educational. Page 1 of 8
3 Therapy Animal-assisted therapy (70) Aromatherapy (26) Art therapies Music therapy (64) Biofeedback (75) Guided imagery (85) Hypnosis/hypnotherapy (45) Mantram repetition (14) I. Mind-Body Medicine A type of therapy that involves an animal, other than a service animal, as a fundamental part of a person s treatment. Aromatherapy is a therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled to promote health and well-being. Art therapies can include creating various forms of art, dance therapy, and music therapy, among others. Music is used to achieve nonmusical therapeutic goals. Biofeedback uses information from physiological monitoring devices to teach clients how to consciously regulate bodily functions, such as breathing, heart rate, and blood pressure. Any of various techniques (such as series of verbal suggestions) used to guide another person or oneself in imaging sensation especially in visualizing an image in the mind to bring about a desired physical response (such as stress reduction). Hypnosis is an altered state of consciousness characterized by increased responsiveness to suggestion. The hypnotic state is attained by first relaxing the body, then shifting attention toward a narrow range of objects or ideas as suggested by the hypnotist or hypnotherapist. Hypnotherapy is the application of hypnosis as a form of medical therapy. A form of non-sitting meditation where sacred words or phrases are silently, internally repeated throughout the day as objects of concentration and redirected attention. Where to Go for More Detailed Information Animal-Assisted Therapies clinical Biofeedback clinical ; Clinical Hypnosis clinical ; Meditation clinical Page 2 of 8
4 Mindfulness (84) Nontraditional spiritual practices (33) Progressive muscle relaxation (78) Stress management/ relaxation therapy (96) Transcendental meditation (9) Yoga (45) Meditation is a conscious mental process using certain techniques such as focusing attention or maintaining a specific posture to suspend the stream of thoughts and relax the body and mind. Mindfulness is a form of meditation where the focus of attention is on a physical sensation such as breathing intentionally to increase awareness of the present. Alternative pastoral/spiritual care utilizes spiritual interventions or practices provided or facilitated by a qualified chaplains that lie outside of traditional religious/faith practices and traditional health care. (By VA policy, all pastoral/spiritual care for patients is either provided by or facilitated by VA chaplains. For example, if a Native American shaman provides direct patient spiritual care, it is under the management and supervision of a VA chaplain.) Progressive muscle relaxation is used to relieve tension and stress by systematically tensing and relaxing successive muscle groups. Relaxation therapy is a broad term used to describe a number of techniques that promote stress reduction, the elimination of tension throughout the body, and a calm and peaceful state of mind. A technique of sitting meditation derived from Hindu tradition that promotes deep relaxation through the use of a mantra (a specific word or phrase). A course of specific exercises, postures, breathing, and meditation to promote wellbeing. Mindful Awareness educational ; Meditation clinical. Spirit and Soul educational ; Collaborating with Chaplains: Frequently Asked Questions clinical Progressive Muscle Relaxation clinical ; Progressive Relaxation clinical Power of Mind educational. Meditation clinical ; Working Your Body educational ; Yoga: Looking Beyond The Mat clinical Page 3 of 8
5 Therapy Chelation therapy (1) Diet-special/diet therapy (34) Dietary/nutritional supplements (48) Herbal medicines (10) II. Biologically Based Approaches Chelation therapy is a chemical process in which a substance is used to bind molecules, such as metals or minerals, and hold them tightly so that they can be removed from the body. Major dietary changes to promote health not related to allergies or intolerance, e.g., the blood type diet or raw food diet; may include significant reductions or increases in certain daily nutrient intake requirements. Products that bear or contain a vitamin, mineral, botanical, or other substance used to supplement the diet. Plants or parts of plants used for therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. Where to Go for More Detailed Information Section on chelation therapy in the Chelation, Cleanses, Saunas, and Supplements: What Every Clinician Should Know About Popular Approaches to Detox clinical Food and Drink educational and related clinical s Dietary Supplements: An Overview educational and related clinical s Dietary Supplements: An Overview educational and related clinical s Page 4 of 8
6 Therapy Acupressure (28) Acupuncture (80) Aquatherapy (not included in HAIG Report) Massage therapy (49) (there are many forms) Movement practices (19) *Chiropractic (not considered CAM in VA CAM survey, but offered at 22 VA sites in 2011) *Osteopathic medicine (not considered CAM in VA CAM survey, but often classed as such elsewhere) WHOLE HEALTH: CHANGE THE CONVERSATION III. Manipulative and Body-Based Therapies Use of the fingers to press key points on the body s surface of the skin to stimulate the flow of energy. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles through the skin. Exercises and treatments performed in water for various therapeutic benefits. Includes methods like tai chi, aqua running, and Watsu, among others. Pressing, rubbing, and moving muscles and other soft tissues of the body, primarily by using the hands and fingers. A broad range of Eastern and Western movement-based approaches used to promote physical, mental, emotional, and spiritual well-being. Chiropractic was developed by DD Palmer in the 1890s. Chiropractors may incorporate many techniques and maneuvering of the bones of the spine through various means, including high-velocity, lowamplitude thrusts. Osteopaths, in addition to receiving similar training to medical students, practice osteopathic manipulative treatment (OMT). Several techniques are used, including muscle energy technique and craniosacral therapy. Where to go for More Detailed Information Acupuncture and Traditional Chinese Medicine clinical Acupuncture and Traditional Chinese Medicine clinical Massage Therapy clinical Working Your Body educational and related clinical s Chiropractic is not considered to be a complementary therapy in the HAIG report. It is treated as a conventional therapy. Osteopathic Medicine clinical Page 5 of 8
7 Therapy Energy healing (20) Tai chi/qi gong (33) IV. Energy Medicine (also Known as Biofield Therapies) There are many types. Examples include: Therapeutic touch: An adaptation of several religious and secular healing traditions and is commonly used in nursing practice for many different conditions. The practitioner passes his or her hands over the body of the person being treated to induce relaxation, reduce pain, and promote healing. Healing touch: A noninvasive technique utilizing the hands to energize and balance the energy within the human body to restore and promote health. Reiki: A form of treatment based on the belief that there is a universal energy that supports the body s healing abilities. The healing energy is channeled from the practitioner to the patient. Tai chi is a mind-body practice that originated in China as a martial art. A person doing tai chi moves his or her body slowly and gently, while breathing deeply and meditating. (Tai chi is sometimes called moving meditation. ) Qi gong is an ancient Chinese discipline combining the use of gentle physical movements, mental focus, and deep breathing directed toward specific parts of the body. Where to Go for More Detailed Information Energy Medicine (Biofield Therapies) clinical Page 6 of 8
8 Therapy Homeopathy (1) Native American healing practices (16) Other indigenous healing (1) Sweat lodge (15) Traditional Chinese medicine (2) Ayurveda* Naturopathy* WHOLE HEALTH: CHANGE THE CONVERSATION V. Whole Systems of Medicine A whole medical system that originated in Europe. Homeopathy seeks to stimulate the body s ability to heal itself by giving very small doses of highly diluted substances that in larger doses would produce illness or symptoms (an approach called like cures like ). A Native American healer or medicine man is a traditional healer who uses information from the spirit world to benefit the patient. Methods based on indigenous theories, beliefs, and experiences. Healers implement health practices, approaches, knowledge, and beliefs incorporating plant, animal, and mineral-based medicines; spiritual therapies; manual techniques; and exercises applied singularly or in combination to treat, diagnose, and prevent illnesses or maintain well-being. The sweat lodge (also called purification ceremony, sweat house, medicine lodge, medicine house, or simply sweat ) is a ceremonial sauna and is an important event in some North American First Nations or Native American cultures. Traditional Chinese medicine originated in ancient China and has evolved over thousands of years. Practitioners use herbs, acupuncture, and other methods to treat a wide range of conditions. A whole medical system that originated in India. It aims to integrate the body, mind, and spirit to prevent and treat disease. Therapies used include herbs, massage, and yoga. Naturopathic medicine proposes that there is a healing power in the body that establishes, maintains, and restores health. Practitioners work with the patient with a goal of supporting this power through treatments such as nutrition and lifestyle counseling, dietary supplements, medicinal plants, exercise, homeopathy, and treatments from traditional Chinese medicine. Where to Go for More Detailed Information Homeopathy clinical Acupuncture and Traditional Chinese Medicine clinical Ayurveda clinical Naturopathy clinical Page 7 of 8
9 Whole Health: Change the Conversation Website Interested in learning more about Whole Health? Browse our website for information on personal and professional care. This clinical was written by J. Adam Rindfleisch, MPhil, MD, Associate Professor and Director of the Academic Integrative Medicine Fellowship Program, Department of Family Medicine, University of Wisconsin-Madison School of Medicine and Public Health, and Assistant Director and faculty for the VHA Whole Health: Change the Conversation clinical program. References 1. Healthcare Analysis and Information Group (HAIG) Complementary and alternative medicine survey. September Department of Veterans Affairs, Veterans Health Administration. Accessed February 10, Page 8 of 8
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