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Anger Management
Stress Reduction and Management

by Tiffany Field
American Psychological Association, 2009
Review by Roy Sugarman, Ph.D. on Oct 13th 2009

Complementary and Alternative Therapies Research

So much for these therapies being 'flakey'.  Dr Field is a serious and acknowledged researcher in the field, and holds appointment and has received awards in and from prestigious universities and societies, as well as publishing hundreds of journal articles, and many books, of which this is the latest.

She thus sets about demonstrating the evidence base for therapies that can be combined with psychotherapy, and the evidence for the success or lack of it in doing so.

In this way, she takes on Massage therapy, Acupressure, Reflexology, Acupuncture, Tai Chi, Chi Gong, Yoga, Pilates, Exercise as a whole, Music Therapy, Aromatherapy, Progressive muscle relaxation, Imagery, Hypnosis, Biofeedback, Meditation, and so on, including what works in children.  Elsewhere in the book , she looks at resources for complementary medicine, training and credentialing of therapists, what works for what illnesses or conditions, and the origins of the therapies above as an alternative or complementary set of approaches.

Suffice it to say it's a thinnish book, despite being thorough.  She notes she could only find two decent studies on combining complementary therapies with psychotherapy, specifically in depression.  These two studies cover CBT and mindfulness, and interpersonal therapy combined with massage therapy.   There are a myriad of lighter weight studies and concepts examined, such as light music or incense/oil burners in a therapy room, through to movement or massage being incorporated, or being practiced at a separate venue.  Many of the subjects examined in the book, as listed above, are already part of many standard approaches to psychological intervention, such as relaxation, hypnosis and biofeedback to name a few.

She spends some time on the origins of complementary and alternative therapies, eg Ayurvedic medicine (not much research) and Chinese medicine ( a lot of evidence in many conditions) , Shamanism (weakest support of all approaches for efficacy), Homeopathy (highly individualized, with contradictory results), Native American Medicine (no standardized data, but high acceptance in 80% of patients), Naturopathy (individualized, but with seemingly good results in some conditions, studies not scientific though), Osteopathy (hard to evaluate as it is conventional medicine-friendly, but more expensive), Chiropractic (only modest evidence despite widespread acceptance in nonjoint problems) and so Field must conclude that although most of the evidence is from Zero impact journals, or in non-English speaking journals, there is good evidence to support many alternatives to the standard approaches, and many are highly effective in certain conditions.

Massage therapy in particular has been shown to enhance the activity of the Vagal system, leading to a decrease in the stress hormone cortisol, and perceived stress, changes in the EEG, higher dopamine and serotonin levels versus lower epinephrine and cortisol levels, and with applications in pre and post natal depression, borderline personality disorders, bulimia, smoking cessation, anorexia nervosa, pain syndromes with evidence of lowered substance P measures, lower adrenergic levels, and in headaches, a good response to migraine as well. MS and Parkinson's patients also declared benefits, as did those with objective measures of wellbeing in hypertension, CVD, the immune system in cancer patients, and in HIV patients. There are successful findings in sport and injury as well, as expected, and acupressure and reflexology are also examined here.

Acupuncture in particular longer duration manual acupuncture, has been demonstrated to have the most effect on different parts of the brain.  The only problem is that sham procedures often produce significant brain effects as well. As the world overall accepts, placebo is a real effect, not psychological, but accompanied by brain changes. In this way, some forms of acupuncture are effect irrespective of where the needles are placed, eg in auricular acupuncture in smoking cessation, but in others, e.g., cocaine users, only in the 'correct' locations.  Similarly, outcome expectations will also affect results. There is apparently a correlation between acupuncture and local nitrous oxide levels, and patients with fibromyalgia may benefit.  Neck pain and back pain may benefit. Evidence in more severe musculoskeletal conditions and neurological disorders is scarce and contradictory.  Some effects in ulcerative colitis may be noteworthy, but moxibustion may also help in such cases (little dirt cones piled on acupuncture sites).

Movement such as that in Tai Chi and Chi Gong is expected to work, given our sedentary lives, and it does. Blood pressure, cholesterol levels, heart rate, aerobic measures, EEG, pain, osteoporosis, immune conditions such as HIV and cancers all show changes along with the obvious physical benefits. Age is not immune, and so in one study at least, older Tai Chi practitioners (and Golfers!) were able to compare performances with young university students in reaction times and leaning flexibility. Chi Gong has less impressive characteristics, but there is some evidence.

Yoga appears to increase vagal activity and reduce cortisol, and can improve various medical conditions such as pain, migraine, insomnia, hypertension and so on.  Anxiety, depression, sleep, all show improvements.  A host of conditions respond to yoga and Pilates.

The benefits of exercise are well known, and accepted, and there is an emerging trend in books anyway from authors such as John Ratey that the benefits to both body and brain are extensive and way in excess of what has been traditionally accepted to be the case.

Music therapy has also received attention, increasing blood flow in reward and arousal areas of the brain, and with a role in anxiety, depression, and a large number of more serious mental conditions.  The list of conditions here studied is really large, more so than exercise for instance. T cells and killer cells increase, cortisol decreases and so on, as for other interventions, but in some ways, for many more conditions across the board.

Field continues in this vein for the treatments noted above, demonstrating in each case the benefits of each intervention as studied in various conditions.

Interestingly, the human responses are not just in certain conditions, but in multiple, suggesting this less targeted approach is universally better for the body and brain complex.  However, whilst medicine may target individual complaints or conditions, there appear to be benefits in some conditions and not others, but mostly, intervening for one thing may improve other things in a single person.

Many of the interventions are highly personalized, and with the entire field of personalized medicine, one size fits all randomized control studies may not be possible, as in homeopathy for instance.

Field has done extensive work with touch, and this is evidenced in the chapter on children, a small but compelling one. Evidence is presented for glucose levels and peak airflow in particular that is most impressive.  The role of exercise in children, especially in a new generation of sedentary indoor kids, is well established, and her results as presented here are accepted widely.  The most frequent intervention in children was in those with autism and attentional disorders, with nearly all being supplemented with some complementary or alternative intervention.

Field has produced a sound and comprehensive work, arguing impassively for consideration to be given to complementary and alternative approaches to most conditions, with few exceptions, but with some reservations mentioned in some treatments noted above. She has produced a very welcome and useful work, for things to do when what you do is not working entirely as you want it, and as a way of empowering patients to do more, and safely so.  For overall, there is virtually not a word given to side effects and very few to contraindications, hence, the popularity of many of these interventions.


© 2009 Roy Sugarman



Roy Sugarman PhD: Director of Applied Neuroscience, Human Performance Institute, Sydney, Australia