Integrative Medicine Improves Mood in an Inpatient Setting
As public mental health beds become scarce, the needs of the smaller number of people residing in these facilities have become more challenging and complex. Most evidence-based practices were neither developed nor validated with clinical samples having the complex patterns of comorbidity often seen in state psychiatric facilities. For example, a hospital clinician may be called to treat an individual with treatment-resistant schizophrenia who has also experienced an acquired brain injury, struggles with chronic pain, has abused narcotics for years, has experienced repeated traumas, engages in aggressive behaviors, lacks family support, and has never been employed.
Evidence-based practices such as clozapine monotherapy, cognitive-behavioral therapy for schizophrenia, or cognitive remediation may be partially effective but insufficient to bring about symptom abatement, promote rehabilitative goals, and improve quality of life. Recently there has been an expansion of interest in alternative treatment methodologies, such as Eastern therapeutic and meditative techniques (tai chi, for example). These approaches are commonly referred to as complementary and alternative medicine (CAM). We report on our hospital’s effort to incorporate alternative therapeutic interventions to address the treatment and rehabilitative needs of the men and women in our care.
Connecticut Valley Hospital is a 600-bed facility providing tertiary care in the fields of addiction medicine, forensics, and acute and rehabilitation psychiatry to men and women ages 18 to 90. A self-selected group of 30 patients from this population attended one of two groups. Over the course of 13 sessions between January and April 2010, both groups were exposed to several types of CAM: qigong, yoga, tai chi, vibrational healing (relaxation assisted by vibrations generated by a Tibetan prayer bowl), seated meditation, guided imagery, and aromatherapy.
A description of each practice and its application is beyond the scope of this report, but we discuss our use of yoga as an example here. Each yoga session began with ten minutes of warm-up stretches, followed by more challenging stretches, poses, vinyasas (postures in a flow sequence), and balancing postures. The leaders started each group by explaining the mood and stress ratings and requesting all patients to rate their mood and stress at that time. Choices were offered concerning session content (“Do you want to do gentle stretching today or a real workout?”). Each session lasted 40 minutes and closed with a relaxation known as shavasana, a pose that allows the body a chance to regroup after exertion from the more difficult postures. During this technique, group members lay still on their mats and relaxed, noting any difference in how they felt and experienced their bodies since the session’s beginning. After the shavasana, all members chanted “Namaste” (“The light in me reflects the light”) with their hands in prayer pose; group members again rated their mood and stress level.
Most individuals who participated in the various CAM sessions rated themselves as calmer and in better moods after the sessions. For example, after a memorable session of qigong, one participant commented that he went from feeling “bland” to “I could take over the world! Ten out of ten!” Although such anecdotal reports need to be interpreted cautiously, they suggest that CAM can provide individuals who are coping with severe psychopathology with an adjunct to traditional treatment modalities.
Further research will examine whether CAM improves outcome in the care of individuals with severe psychiatric disabilities. It would be useful to ascertain which CAM treatments are most effective and whether improvements that affect discharge from the hospital are possible as a result of systematically applying a particular CAM.
