Advances in medical research, the consumer empowerment, and rising cost of health care have demonstrated the need to treatment models that are holistic and client driven. Complementary and alternative medicine (CAM) offers consumers choices. It includes traditional healing practices, medical systems that are thousands of years old and new or innovative treatments that may be consider unconventional. Well known examples of CAM include herbal remedies, mindfulness, meditation, manipulative/movement therapies, and Chinese Medicine. Knowledge of CAM offers social workers in all settings the opportunity to provide education and advocacy in seeking client centered and culturally competent treatment options.

Wednesday, March 23, 2011

CAM and Psychoneuroimmunology

Throughout history and across different cultures man has held different notions about what causes disease and how to cure it.  In ancient Greece the father of medicine, Hippocrates, proposed a holistic model of health (Selin & Shapiro, 2003).  This view has been challenged over thousands of years and has lead to a reductionist model of health which has perpetuated the mind/body dichotomy and served as the basis for the medical model which has become dominant in Western Medicine (Engel, 1980).    Medical research in mid 20th century has provided great insight into our understanding of disease.   New technologies, the importance of environmental factors that affect health have challenged the reductionist medical model (CarriĆ³, Suchman, & Epstein, 2004).   This has lead to the development of the biopsychosocial model where illness and health are impacted by biological, psychological and social factors (Engel).  These challenges along with the consumer health movement have opened up opportunities in the use of complementary and alternative medicine (CAM). Life events, stress and the individual’s ability to mitigate these can have profound immunological consequences.  This has lead to the formation of a new discipline, psychoneuroimmunology (PNI), which has been defined as study of the connection between the mind, the body and the immune system (Daruna, 2004).  Researchers in PNI have been able to determine that stress has been identified as having a direct impact on the endocrine, immune system and nervous system.  Stress affects the immune, endocrine and nervous systems by impacting the ability of immune cells to combat disease, affecting the levels of electrolytes, hormone neurotransmitters, neurohormones, glucose, and lipids (Daruna).  Changes in neurohormones can lead to increased cortisol levels can lead to a decrease or disruption in digestion, an increase in insulin production, and other physiological changes including changes in mood, affect, activity level, concentration and pleasure as the body responds to stress.   The consequences of immediate and chronic stressors can have profound effects mental and physical health.  Studies in the last year reveal that individuals with PTDS (Udin, et al 2010), children in center-based care (Groeneveld, Van I Jzendoorn & Linting, 2010), and positive behavioral interactions in married couples (Gouin, et al 2010) can have significant impact on the immune system.  It is important for social workers to be aware of ways in which stress affects the individual health and to facilitate the development of coping strategies that will decrease stress and lead to improved health outcomes.  (CAM) interventions provide an additional avenue for consumers to access stress alleviating interventions.
Daruna, J. H.  (2004). Introduction to Psychoneuroimmunology. Boston:  Elsevier Academic Press.
Borrell-CarriĆ³, F., Suchman, A. L., & Epstein, R. M. (2004). The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Annals of Family Medicine, 2(6), 576-582. doi:10.1370/afm.245
Engel, G. (1980). The Clinical Application of the biopsychosocial model. American Journal of Psychiatry, 137, 535-544.
Gouin, J., Carter, C. S., Pournajafi-Nazarloo, H., Glaser, R., Malarkey, W. B., Loving, T. J., . . . Kiecolt-Glaser, J. K. (2010). Marital behavior, oxytocin, vasopressin, and wound healing. Psychoneuroendocrinology, 35(7), 1082-1090. doi:DOI: 10.1016/j.psyneuen.2010.01.009
Groeneveld, M. G., Vermeer, H. J., van IJzendoorn, M. H., & Linting, M. (2010). Children's wellbeing and cortisol levels in home-based and center-based childcare. Early Childhood Research Quarterly, 25(4), 502-514. doi:DOI: 10.1016/j.ecresq.2009.12.004
Selin, H, & Shapiro, H. (Eds) (2003).  Medicine across Cultures. History and Practice of Medicine in Non-Western Cultures.  Kluwer Academic Publishers.
Uddin, M., Aiello, A. E., Wildman, D. E., Koenen, K. C., Pawelec, G., de los Santos, R., & Galea, S. (2010). Epigenetic and immune function profiles associated with posttraumatic stress disorder. Proceedings of the National Academy of Sciences of the United States of America, 107(20), 9470-9475. doi:10.1073/pnas.0910794107