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538 Women’s Health Psychology Centers for Disease Control and Prevention (1998) Diagnosis and reporting of HIV and AIDS in the States with the integrated HIV and AIDS surveillance Morbidity and Morality Weekly Report, 47(15), 309…314 Centers for Disease Control and Prevention (1999) Health, United States with health and aging chartbook Hyattsville, MD: Public Health Services Available from www.cdc.gov/nchswww /products/pubs/pubd/hus/hus.htm Champion, V L (1992) Compliance with guidelines for mammography screening Cancer Detection and Prevention, 16, 253…258 Chapman, K R., Tashkin, D P., & Pye, D J (2001) Gender bias in the diagnosis of COPD Chest, 119(6), 1691…1695 Clancy, M C (2000) Gender issues in women•s health care In M B Goldman & M C Hatch (Eds.), Women and health (pp 50…54) San Diego, CA: Academic Press Cleary, P D., & Mechanic, D (1983) Sex differences in psychological distress among married people Journal of Health and Social Behavior, 24, 111…121 Cohen, L S., Sichel, D S., Faraone, S V., Robertson, L M., Dimmock, J A., & Rosenbaum, J F (1996) Course of panic disorder during pregnancy and the puerperium: A preliminary study Biological Psychiatry, 39, 950…954 Cohen, M., Deamant, C., Barkan, S., Richardson, J., Young, M., Holman, S., et al (2000) Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV American Journal of Public Health, 90, 560…565 Collins, P Y., Geller, P A., Miller, S., Toro, P., & Susser, E (2001) Ourselves, our bodies, our realities: An HIV prevention intervention for women with severe mental illness Journal of Urban Health, 78(1), 162…175 Commonwealth Fund Commission on Women•s Health (1994) Health care reform: What is at stake for women? Policy report of the Commonwealth Fund Commission on Women’s Health New York: Author Cooper, P J (1995) Eating disorders and their relationship to mood and anxiety disorders In K D Brownell & C G Fairburn (Eds.), Eating disorders and obesity: A comprehensive handbook (pp 159…164) New York: Guilford Press Cooper-Hilbert, B (1998) Infertility and involuntary childlessness: Helping couples cope New York: Norton Crandall, C., Zitzelberger, T., Rosenberg, M., Winner, C., & Holaday, L (2001) Information technology and the National Centers of Excellence in Women•s Health Journal of Women’s Health and Gender-Based Medicine, 10(1), 49…55 Davis, R M., & Novotny, T E (1989) The epidemiology of cigarette smoking and its impact on chronic obstructive pulmonary disease American Review of Respiratory Disease, 140, S82…S84 Del Puente, A., Knowler, W C., & Bennett, P H (1989) High incidence and prevalence of rheumatoid arthritis in Pima Indians American Journal of Epidemiology, 129, 1170…178 Demakis, J G., & Rahimtoola, S H (1971) Peripartum cardiomyopathy Circulation, 44, 964…968 D•Hoore, W., Sicotte, C., & Tilquin, C (1994) Sex bias in the management of coronary artery disease in Quebec American Journal of Public Health, 84(6), 1013…1015 Downey, J., & McKinney, M (1992) The psychiatric status of women presenting for infertility evaluation American Journal of Orthopsychiatry, 62, 196…205 Dugowson, C E (2000) Rheumatoid arthritis In M B Goldman & M C Hatch (Eds.), Women and health (pp 674…685) San Diego, CA: Academic Press Dunkel-Schetter, C., Feinstein, L G., Taylor, S E., & Falke, R L (1992) Patterns of coping with cancer Health Psychology, 11(2), 79…87 Dutton, D B., & Levine, S (1989) Overview, methodological critique, and reformulation In J P Bunker, D S Gomby, & B H Kehrer (Eds.), Pathways to health (pp 29…69) Menlo Park, CA: Henry J Kaiser Family Foundation Dutton, M A., Haywood, Y., & El-Bayoumi, G (1997) Impact of violence on women•s health In S J Gallant, G P Keita, & R Royak-Schaler (Eds.), Health care for women: Psychological, social, and behavioral influences (pp 41…56) Washington, DC: American Psychological Association El-Bayoumi, G., Borum, M L., & Haywood, Y (1998) Domestic violence in women Medical Clinics of North America, 82(2), 391… 401 El-Guebaly, N (1995) Alcohol and polysubstance abuse among women Canadian Journal of Psychiatry, 40(2), 73…79 Elman, M R., & Gilbert, L A (1984) Coping strategies for role con”ict in married professional women with children Family Relations, 33, 317…337 Engelhard, I M., van den Hout, M A., & Arntz, A (2001) Posttraumatic stress disorder after pregnancy loss General Hospital Psychiatry, 23, 62…66 Fitzpatrick, K M., & Wright, M P (1995) Gender differences in medical school attrition rates Journal of the American Medical Women’s Association, 50(6), 204…206 Franks, P., & Clancy C M (1993) Physician gender bias in clinical decision making: Screening for cancer in primary care Medical Care, 31, 213…218 Friedman, S H., Nezu, A M., Nezu, C M., Trunzo, J., & Graf, M C (1999, November) Sex roles, problem solving, and psychological distress in persons with cancer Poster presented at the 33rd convention of the Association for Advancement of Behavior Therapy, Toronto, Ontario, Canada Gay, J., & Underwood, U (1991) Women in danger: A call for action The world’s women 1970–1990 Trends and statistics United Nations: National Council for International Health Geller, P A., & Hobfoll, S E (1993) Gender differences in preference to offer social support to assertive men and women Sex Roles, 28, 419…432 Geller, P A., & Hobfoll, S E (1994) Gender differences in job stress, tedium, and social support in the workplace Journal of Personal and Social Relationships, 11, 555…572 References 539 Geller, P A., Klier, C M., & Neugebauer, R (2001) Anxiety disorders following miscarriage Journal of Clinical Psychiatry, 62(6), 432…438 Gunter, N C., & Gunter, B G (1990) Domestic division of labor among working couples: Does androgyny make a differences? Psychology of Women Quarterly, 14, 355…370 Geller, P A., Striepe, M I., Lewis, J., III, & Petrucci, R J (1996, September) Women on heart transplant units: The importance of psychosocial factors among women with cardiovascular disease Paper presented at the American Psychological Association Psychosocial and Behavioral Factors in Women•s Health: Research, Prevention, Treatment and Service Delivery in Clinical and Community Settings conference, Washington, DC Guralnik, J M (2000) Aging In M B Goldman & M C Hatch (Eds.), Women and health (pp 1143…145) San Diego, CA: Academic Press Geller, P A., Striepe, M I., & Petrucci, R J (1994, October) Psychosocial factors in peripartum cardiomyopathy Poster presented at the third biennial conference on Psychiatric, Psychosocial, and Ethical Issues in Organ Transplantation, Richmond, VA Glied, S (1997) The treatment of women with mental health disorders under HMO and fee-for-service insurance Women and Health, 26(2), 1…16 Goldberg, R J., O•Donnell, C., Yarzebski, J., Bigelow, C., Savageau, J., & Gore, J M (1998) Sex differences in symptom presentation associated with acute myocardial infarction: A population-based perspective American Heart Journal, 136(2), 189…195 Gutek, B (2001) Women and paid work Psychology of Women Quarterly, 25, 379…393 Gwinner, V M., Strauss, J F., Milliken, N., & Donoghue, G D (2000) Implementing a new model of integrated women•s health in academic health centers: Lessons learned the National Centers of Excellence in Women•s Health Journal of Women’s Health and Gender-Based Medicine, 9(9), 979…985 Hall, J A., Irish, J T., Roter, D L., Ehrlich, C M., & Miller, L H (1994) Gender in medical encounters: An analysis of physician and patient communication in a primary care setting Health Psychology, 13(5), 384…392 Hawley, D J., & Wolfe, F (2000) Fibromyalgia In M B Goldman & M C Hatch (Eds.), Women and health (pp 1068…1083) San Diego, CA: Academic Press Haynes, S G., & Hatch, M C (2000) State of the art methods for women•s health research In M B Goldman & M C Hatch (Eds.), Women and Health (pp 37…49) San Diego, CA: Academic Press Goldbloom, D S., & Kennedy, S H (1995) Medical complications of anorexia nervosa In K D Brownell & C G Fairburn (Eds.), Eating disorders and obesity: A comprehensive handbook (pp 266…270) New York: Guilford Press Heffernan, K (1998) Bulimia nervosa In E A Blechman & K D Brownell (Eds.), Behavioral medicine and women: A comprehensive handbook (pp 358…363) NewYork: Guilford Press Golding, J M (1999) Intimate partner violence as a risk factor for mental disorders: A meta-analysis Journal of Family Violence, 14(2), 99…132 Henry, J G A (2000) Depression and anxiety In M A Smith & L A Shimp (Eds.), 20 common problems in women’s health care (pp 263…301) New York: McGraw-Hill Goldman, M B., Missmer, S A., & Barbier, R L (2000) Infertility In M B Goldman & M C Hatch (Eds.), Women and health (pp 196…214) San Diego, CA: Academic Press Hibbard, J H., & Pope, C R (1985) Employment status, employment characteristics and women•s health Women and Health, 10, 59…77 Goode, W (1960) A theory of strain American Sociological Review, 25, 483…496 Hirschfeld, R M A., & Cross, C K (1982) Epidemiology of affective disorders: Psychosocial risk factors Archives of General Psychiatry, 39, 35…46 Grant, B F., & Hartford, T C (1995) Comorbidity between DSM-IV alcohol use disorders and major depression: Results of a national survey Drug and Alcohol Dependence, 39, 197…206 Grant, B F., Hartford, T C., Dawson, D A., Chou, S P., & Pickering, R P (1994) Prevalence of DSM-IV alcohol abuse and dependence: United States, 1992 Alcohol Health and Research World, 18, 243…248 Grant, J (1987) Women as managers: What they can offer to organizations Organization Dynamics, 16(3), 56…63 Green“eld, S F (1996) Women and substance use disorders In M F Jensvold, J A Hamilton, & U Halbreich (Eds.), Psychopharmacology and women: Sex, gender, and hormones (pp 299…321) ashington, DC: American Psychiatric Press W Greil, A L (1997) Infertility and psychological distress: A critical review of the literature Social Science and Medicine, 45, 1679…1704 Hochberg, M C (1990) Changes in the incidence and prevalence of rheumatoid arthritis in England and Wales, 1970…1982 Seminar Arthritis Rheumatoid, 19, 294…302 Holm, K., & Scherubel, J (1997) Coronary heart disease In K M Allen & J M Phillips (Eds.), Women’s health across the lifespan (pp 125…143) Philadelphia: Lippincott Holzer, C E., Shea, B M., Swanson, J W., Leaf, P J., Myers, J K., George, L., et al (1986) The increased risk for speci“c psychiatric disorders among persons of low socioeconomic status: Evidence from the Epidemiologic Catchment Area surveys American Journal of Social Psychiatry, 6, 259…271 House, J S (1981) Work stress and social support Reading, MA: Addison-Wesley Hughes, P., Turton, P., Hopper, E., McGauley, G A., & Fonagy, P (2001) Disorganised attachment behaviour among infants born 540 Women’s Health Psychology subsequent to stillbirth Journal of Child Psychology and Psychiatry and Allied Disciplines, 42(6), 791…801 Results from the National Comorbidity Survey Archives of General Psychiatry, 51, 8…19 Hurrell, J J., Jr., & Murphy, L R (1992) Psychological job stress In W N Rom (Ed.), Environmental and occupational medicine (2nd ed., pp 675…684) Boston: Little, Brown Kessler, R C., & McLeod, J D (1984) Sex differences in vulnerability to undesirable life events American Social Review, 49, 620…631 Husten, C G., & Malarcher, A M (2000) Cigarette smoking: Trends, determinants, and health effects In M B Goldman & M C Hatch (Eds.), Women and health (pp 563…577) San Diego, CA: Academic Press Kessler, R C., Sonnega, A., & Bromet, E (1995) Post-traumatic stress disorder in the National Comorbidity Survey Archives of General Psychiatry, 52, 1048…1060 Illsley, R., & Baker, D (1991) Contextual variation in the meaning of health inequality Social Science and Medicine, 32, 359…365 Janssen, H J., Cuisinier, M C., Hoogduin, K A., & de Graauw, K P (1996) Controlled prospective study on the mental health of women following pregnancy loss American Journal of Psychiatry, 153(2), 226…230 Kamb, M L., & Wortley, P M (2000) Human immunode“ciency virus and AIDS in women In M B Goldman & M C Hatch (Eds.), Women and health (pp 336…351) San Diego, CA: Academic Press Killien, M., Bigby, J A., Champion, V., Fernandez-Repollet, E., Jackson, R D., Kagawa-Singer, M., et al (2000) Involving minority and underrepresented women in clinical trials: The National Centers of Excellence in Women•s Health Journal of Women’s Health and Gender-Based Medicine, 9(10), 1061…1070 Kite, M E., Russo, N F., Brehm, S S., Fouad, N A., Hall, C C I., Hyde, J S., et al (2001) Women psychologists in academe: Mixed progress, unwarranted complacency American Psychologist, 56(12), 1080…1098 Klier, C M., Geller, P A., & Neugebauer, R (2000) Minor depressive disorder in the context of miscarriage Journal of Affective Disorders, 59(1), 13…21 Kaplan-Machlis, B., & Bors, K P (2000) In M A Smith & L A Shimp (Eds.), 20 common problems in women’s health care (pp 631…664) New York: McGraw-Hill Klier, C M., Geller, P A., & Ritsher, J (2002) Affective disorders in the aftermath of miscarriage: A critical review Manuscript submitted for publication Kathol, R G., Broadhead, W E., & Kroenke, K (1997) Depression In L S Goldman, T N Wise, & D S Brody (Eds.), Psychiatry for primary care physicians (pp 73…96) Chicago:American Medical Association Kline, J., Levin, B., Kinney, A., Stein, Z., Susser, M., & Warburton, D (1995) Cigarette smoking and spontaneous abortion of known karyotype: Precise data but uncertain inferences American Journal of Epidemiology, 141, 417…427 Katon, W (1995) Collaborative care: Patient satisfaction, outcomes, and medical cost-offset Family Systems Medicine, 13(3/4), 351…365 Kohn, R., Dohrenwend, B P., & Mirotznik, J (1998) Epidemiological “ndings on selected psychiatric disorders in the general population In B P Dohrenwend (Ed.), Adversity, stress, and psychopathology (pp 235…284) New York: Oxford University Press Kaye, W H., Weltzin, T E., & Hsu, L K G (1993) Relationship between anorexia nervosa and obsessive and compulsive behaviors Psychiatric Annals, 23, 365…373 Kendell, R E., Chalmers, J C., & Platz, C (1987) Epidemiology of puerperal psychoses British Journal of Psychiatry, 150, 662…673 Kendler, K S., Maclean, C., Neale, M., Kessler, R., Heath, A., & Eaves, L (1991) The genetic epidemiology of bulimia nervosa American Journal of Psychiatry, 148, 1627…1637 Kohout, J (2001) Who•s earning those psychology degrees? American Psychological Association Monitor, 32(2), 42 Kumar, R (1994) Postnatal mental illness:Atranscultural perspective Social Psychiatry and Psychiatric Epidemiology, 29, 250…264 Lampert, M B., & Lang, R M (1995) Peripartum cardiomyopathy American Heart Journal, 130, 860…870 Lane, C., & Hobfoll, S E (1992) How loss affects anger and alienates potential support Journal of Clinical and Consulting Psychology, 60, 935…942 Kerlikowske, K (2000) Breast cancer screening In M B Goldman & M C Hatch (Eds.), Women and health (pp 895…905) San Diego, CA:Academic Press Lee, C (1998) Women’s health: Psychological and social perspectives London: Sage Kessler, R C (2000) Gender and mood disorders In M B Goldman & M C Hatch (Eds.), Women and health (pp 997…1009) San Diego, CA: Academic Press Lee, C., & Slade, P (1996) Miscarriage as a traumatic event: A review of the literature and new implications for intervention Journal of Psychosomatic Research, 40, 235…244 Kessler, R C., McGonagle, K A., Swartz, M S., Blazer, D G., & Nelson, C B (1993) Sex and depression in the National Comorbidity Survey I: Lifetime prevalence, chronicity and recurrence Journal of Affective Disorders, 29, 85…96 Leibenluft, E (1999) Foreword In E Leibenluft (Ed.), Gender differences in mood and anxiety disorders (pp xiii…xxii) Washington, DC: American Psychiatric Press Kessler, R C., McGonagle, K A., Zhao, S., Nelson, C B., Hughes, M., Eshleman, S., et al (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Lennon, M C (1998) Domestic arrangements and depressive symptoms: An examination of housework conditions In B P Dohrenwend (Ed.), Adversity, stress, and psychopathology (pp 409…421) New York: Oxford University Press References 541 Leutz, W N., Capitman, J A., MacAdam, M., & Abrahams, R (1992) Care for frail elders: Developing community solutions Westport, CT: Auburn House Mitchell, J., Seim, H., Colon, E., & Pomeroy, C (1987) Medical complications and medical management of bulimia Annals of Internal Medicine, 107, 71…77 Lex, B W (1992) Alcohol problems in special populations In J H Mendelson & N K Mello (Eds.), Medical diagnosis and treatment of alcoholism (pp 71…154) Saint Louis, MO: McGraw-Hill Mitchell, J E (1995) Medical complications of bulimia nervosa In K D Brownell & C G Fairburn (Eds.), Eating disorders and obesity: A comprehensive handbook (pp 271…275) New York: Guilford Press Llewellyn, A M., Stowe, Z N., & Nemeroff, C B (1997) Depression during pregnancy and the puerperium Journal of Clinical Psychiatry, 58(15), 26…32 Mondanaro, J (1989) Chemically dependent women: Assessment and treatment Lexington, MA: Lexington Books Lurie, N., Margolis, K L., McGovern, P G., Mink, P J., & Slater, J S (1997) Why patients of female physicians have higher rates of breast and cervical cancer screening? Journal of General Internal Medicine, 12, 34…43 Lurie, N., Slater, J., McGovern, P., Ekstrum, J., Quam, I., & Margolis, K (1993) Preventive care for women: Does the sex of the physician matter? New England Journal of Medicine, 329, 478…482 Malacrida, R., Genoni, M., Maggioni, A P., Spataro, V., Parish, S., Palmer, A., et al (1998) A comparison of the early outcome of acute myocardial infarction in women and men New England Journal of Medicine, 338(1), 8…14 Marks, S R (1977) Multiple roles and role strain: Some notes on human energy, time and commitment American Sociological Review, 41, 921…936 Morahan, P S., Voytko, M L., Abbuhl, S., Means, L J., Wara, D W., Thorson, J., et al (2001) Ensuring the success of women faculty at AMC•s: Lessons learned from the National Centers of Excellence in Women•s Health Academic Medicine, 76, 19…31 Morokoff, P J., Harlow, L L., & Quina, K (1995) Determinants of prenatal care use in Hawaii: Implications for health promotion American Journal of Preventive Medicine, 11(2), 79…85 Moy, E V., & Christiani, D C (2000) Environmental exposures and cancer In M B Goldman & M C Hatch (Eds.), Women and health (pp 634…648) San Diego, CA: Academic Press Murray, C J L., & Lopez, A D (1996) Alternative visions of the future: Projecting mortality and disability, 1990…2020 In C J L Murray & A D Lopez (Eds.), The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020 (pp 325…395) Boston: Harvard University Press Marshall, N L., & Barnett, R C (1991) Race and class and multiple role strains and gains among women employed in the service sector Women and Health, 17, 1…19 Murray, L., & Cooper, P J (Eds.) (1997) Postpartum depression and child development London: Guilford Press Marshall, N L., & Barnett, R C (1993) Work-family strains and gains among two earner couples Journal of Community Psychology, 21, 64…78 Nadel, M V (1990) National Institutes of Health: Problems implementing policy on women in study population (U.S General Accounting Of“ce) Washington, DC: Author Marshall, N L., & Barnett, R C (1995, August) Child care, division of labor and parental well-being among two earner couples Paper presented at the meeting of the American Sociological Association, Washington, DC Narrow, W., Regier, D., Rae, D., Manderscheid, R W., & Locke, B Z (1993) Use of services by persons with mental and addictive disorders Archives of General Psychiatry, 50, 95…107 Martins, C., & Gaffan, E A (2000) Effects of early maternal depression on patterns of infant-mother attachment: A metaanalytic investigation Journal of Child Psychology and Psychiatry, 41, 737…746 McCormick, L H (1995) Depression in mothers of children with attention de“cit hyperactivity disorder Family Medicine, 27(3), 176…179 Nathanson, C A (1975) Illness and the feminine role: A theoretical review Social Science and Medicine, 9, 57…62 National Cancer Institute (1995) Cancer facts Washington, DC: Author National Center for Health Statistics (1996) Health, United States, 1995 Hyattsville, MD: Public Health Services National Osteoporosis Foundation (2001) Disease statistics fast facts Retrieved June 6, 2001, from www.nof.org/index.html Miller, A M., & Champion, V L (1997) Attitudes about breast cancer and mammography: Racial, income, and educational differences Women and Health, 26(1), 41…63 Ness, R (2000) Cardiovascular disease and cardiovascular risk in women In M B Goldman & M C Hatch (Eds.), Women and health (pp 753…755) San Diego, CA: Academic Press Miller, B A., & Downs, W R (2000) Violence against women In M B Goldman & M C Hatch (Eds.), Women and health (pp 529…540) San Diego, CA: Academic Press Neugebauer, R., Dohrenwend, B P., & Dohrenwend, B S (1980) Formulation of hypotheses about the true prevalence of functional psychiatric disorders among adults in the United States In B P Dohrenwend, B S Dohrenwend, M S Gould, B Link, R Neugebauer, & R Wunsch-Hitzig (Eds.), Mental illness in the United States (pp 45…94) NewYork: Praeger Miller, B A., Kolonel, L N., Bernstein, L., Young, J L., Jr., Swanson, G M., West, D., et al (Eds.) (1996) Racial/ethnic patterns of cancer in the United States 1988–1992 (NIH Publication No 96…4104) Bethesda, MD: National Cancer Institute 542 Women’s Health Psychology Neugebauer, R., Kline, J., O•Connor, P., Shrout, P., Johnson, J., Skodol, A., et al (1992) Depressive symptoms in women in the six months after miscarriage American Journal of Obstetrics and Gynecology, 166(1, Pt 1), 104…109 Neugebauer, R., Kline, J., Shrout, P., Skodol, A., O•Connor, P., Geller, P A., et al (1997) Major depressive disorder in the months after miscarriage Journal of the American Medical Association, 277(5), 383…388 Newton, K M., Lacroix, A Z., & Buist, D S (2000) Overview of risk factors for cardiovascular disease In M B Goldman & M C Hatch (Eds.), Women and health (pp 757…770) San Diego, CA: Academic Press Nezu, A M., & Nezu, C M (1987) Psychological distress, problem solving, and coping reactions: Sex role differences Sex Roles, 16(3/4), 205…214 Northwestern National Life (1992) Employee burnout: Causes and cures Minneapolis, MN: Author Novella, A., Rosenberg, M., Saltzman, L., & Shosky, J (1992) From the Surgeon General, U.S public health service Journal of the American Medical Association, 267, 3132 Nybo Andersen, A M., Wohlfahrt, J., Christens, P., Olsen, J., & Melbye, M (2000) Maternal age and fetal loss: Population based register linkage study British Medical Journal, 320, 1708…1712 Of“ce on Women•s Health (2000, May) Women’s health issues: An overview Retrieved March 2001, from www.4woman.gov/owh /pub/womhealth%20issues/index.htm O•Hara, M W., Schlechte, J A., Lewis, D A., & Varner, M W (1991) Controlled prospective study of postpartum mood disorders: Psychological, environmental and hormonal variables Journal of Abnormal Psychology, 100, 63…73 O•Hara, M W., & Swain, A M (1996) Rates and risk of postpartum depression„a meta-analysis International Review of Psychiatry, 8, 37…54 Pavalko, E K., & Woodbury, S (2000) Social roles as process: Caregiving careers and women•s health Journal of Health and Social Behavior, 41, 91…105 Pearson, G D., Veille, J C., Rahimtoola, S., Hsia, J., Celia, M., Hosenpud, J D., et al (2000) Peripartum cardiomyopathy: National heart, lung, and blood institute and of“ce of rare diseases (National Institutes of Health) workshop recommendations and review Journal of the American Medical Association, 283(9), 1183…188 Perry-Jenkins, M (1993) Family roles and responsibilities: What has changed and what has remained the same In J Frankel (Ed.), The employed mother and the family context (pp 245…259) New York: Springer Perry-Jenkins, M., & Crouter, A C (1990) Men•s provider-role attitudes: Implications for household work and marital satisfaction Journal of Family Issues, 11, 136…156 Pigott, T A (1999) Gender differences in the epidemiology and treatment of anxiety disorders Journal of Clinical Psychiatry, 60(Suppl 18), 4…15 Pike, K M., & Striegel-Moore, R H (1997) Disordered eating and eating disorders In S J Gallant, G Puryear Keita, & R RoyakSchaler (Eds.), Health care for women: Psychological, social, and behavioral influences (pp 97…14) Washington, DC: American Psychological Association Pinn, V W (1994) The role of the NIH•s Of“ce of Research on Women•s Health Academic Medicine, 69(9), 698…702 Pi-Sunyer, F X (1995) Medical complications of obesity In K D Brownell & C G Fairburn (Eds.), Eating disorders and obesity: A comprehensive handbook (pp 401…405) New York: Guilford Press Plichta, S (1992) The effects of women abuse on health care utilization and health status: A literature review Jacobs Institute for Women’s Health, 2(3), 154…163 Polivy, J., & McFarlane, T L (1998) Dieting, exercise, and body weight In E A Blechman & K D Brownell (Eds.), Behavioral medicine and women: A comprehensive handbook (pp 369… 373) New York: Guilford Press Post, R D (1982) Dependency con”icts in high achieving women: Toward an integration Psychotherapy: Theory, Research, and Practice, 19, 82…87 Post, R D (1987, August) Self sabotage among successful women Paper presented at the annual meeting of the American Psychological Association, New York Preston, D B (1995) Marital status, gender roles, stress, and health in the elderly Health Care for Women International, 16, 149…165 Putukian, M (1994) The female triad: Eating disorders, amenorrhea, and osteoporosis Medical Clinics of North America, 78, 345…356 Regier, D A., Farmer, M E., Rae, D S., Myers, J K., Kramer, M., Robins, L N., et al (1993) One-month prevalence of mental disorders in the United States and sociodemographic characteristics: The Epidemiologic Catchment Area study Acta Psychiatrica Scandinavica, 88, 35…47 Reich, R B., & Nussbaum, K (1994) Working women count! A report to the nation Washington, DC: U.S Department of Labor, Women•s Bureau Reifman, A., Biernat, M., & Lang, E L (1991) Stress, social support, and health in married professional women with small children Psychology of Women Quarterly, 15, 431…435 Repetti, R L (1993) The effects of workload and the social environment at work on health In L Goldberger & S Breznitz (Eds.), Handbook of stress: Theoretical and clinical aspects (pp 368…385) New York: Free Press Richardson, J L (1998) HIV infection In E A Blechman & K D Brownell (Eds.), Behavioral medicine and women: A comprehensive handbook (pp 659…663) New York: Guilford Press Rimer, B K., McBride, C M., & Crump, C (2001) Women•s health promotion In A Baum, T R Revenson, & J E Singer (Eds.), Handbook of health psychology (pp 519…539) Mahwah, NJ: Erlbaum References Robins, L., Helzer, J., Weismann, M., Orvaschel, H., Gruenberg, E., Burke, J D., et al (1984) Lifetime prevalence of speci“c psychiatric disorders in three sites Archives of General Psychiatry, 41, 949…958 Robins, L N., Locke, B Z., & Regier, D A (1991) An overview of psychiatric disorders in America In L N Robins & D A Regier (Eds.), Psychiatric disorders in America: The Epidemiological Catchment Area study (pp 258…290) NewYork: Free Press Rosenthal, C J., Sulman, J., & Marshall, V X (1993) Depressive symptoms in family caregivers of long stay patients Gerontologist, 33, 249…257 Roter, D., Lipkin, M., Jr., & Korsgaard, A (1991) Sex differences in patients• and physicians• communication during primary care medical visits Medical Care, 29, 1083…1093 Rouchell, A M., Pounds, R., & Tierney, J G (1999) Depression In J R Rundell & M G Wise (Eds.), Textbook of consultationliaison psychiatry (pp 121…147).Washington, DC: American Psychiatric Press Rowland, J H (1998) Breast cancer: Psychological aspects In E A Blechman & K D Brownell (Eds.), Behavioral medicine and women: A comprehensive handbook (pp 577…587) New York: Guilford Press Santonastaso, P., Pantano, M., Panarotto, L., & Silvestri, A (1991) A follow-up study on anorexia nervosa: Clinical features and diagnostic outcome European Psychiatry, 6, 177…185 Saraiya, M., Green, C A., Berg, C J., Hopkins, F W., Koonin, L M., & Atrash, H K (1999) Spontaneous abortion: Related death among women in the United States, 1981…1991 Obstetrics and Gynecology, 94(2), 172…176 Schlegel, M (2000) Women mentoring women Monitor on Psychology, 31(10), 33…36 Schulman, K A., Berlin, J A., Harless, W., Kerner, J F., Sistrunk, S., Gersh, B J., et al (1999) The effect of race and sex on physician•s recommendations for cardiac catheterization New England Journal of Medicine, 340(8), 618…625 Schulz, R., O•Brien, A T., Bookwala, J., & Fleissner, K (1995) Psychiatric and physical morbidity effects of dementia caregiving: Prevalence, correlates, and causes Gerontologist, 35, 771…791 Schulz, R., Visintainer, P., & Williamson, G M (1990) Psychiatric and physical morbidity effects of caregiving Journal of Gerontology: Psychological Sciences, 45, 181…191 Sechzer, J A., Denmark, F L., & Rabinowitz, V C (1994, March) Sex and gender as variables in cardiovascular research Paper presented at the Conference on Psychosocial and Behavioral Factors in Women•s Health: Creating an agenda for the 21st century, program of the American Psychological Association, Washington, DC Shear, K M., & Mammen, O (1995) Anxiety disorder in pregnant and postpartum women Psychopharmacological Bulletin, 31, 693…703 543 Sieber, S D (1974) Towards a theory of role accumulation American Sociological Review, 39, 567…578 Siegler, I C (1998) Alzheimer•s disease: Impact on women In E A Blechman & K D Brownell (Eds.), Behavioral medicine and women: A comprehensive handbook (pp 551…553) New York: Guilford Press Silbergeld, E K (2000) The environment and women•s health: An overview In M B Goldman & M C Hatch (Eds.), Women and health (pp 601…606) San Diego, CA: Academic Press Silverman, E K., Weiss, S T., Drazen, J M., Chapman, H A., Carey, V., Campbell, E J., et al (2000) Gender-related differences in severe early onset chronic obstructive pulmonary disease American Journal of Respiratory and Critical Care Medicine, 162, 2152…2158 Sinclair, D., & Murray, L (1998) Effects of postnatal depression on children•s adjustment to school British Journal of Psychiatry, 172, 58…63 Smith Barney Research (1997, April) The new women’s movement: Women’s healthcare Available from women•s health facts and links, The Society for the Advancement of Women•s Health Research, womens-health.org/factsheet.html Sobal, J (1995) Social in”uences on body weight In K D Brownell & C G Fairburn (Eds.), Eating disorders and obesity: A comprehensive handbook (pp 73…82) NewYork: Guilford Press Sokol, M S., & Gray, N S (1998) Anorexia nervosa In E A Blechman & K D Brownell (Eds.), Behavioral medicine and women: A comprehensive handbook (pp 350…357) New York: Guilford Press Steingart, R M., Packer, M., Hamm, P., Coglianese, M E., Gersh, B., Geltman, E M., et al (1991) Sex differences in the management of coronary artery disease New England Journal of Medicine, 325(4), 226…230 Stephen, E H., & Chandra, A (1997) Updated projections of infertility in the United States: 1995…2025 Fertility and Sterilization, 70, 30…34 Stewart, D (1992) Reproductive functions in eating disorders Annals of Medicine, 24, 287…291 Stewart, D E., & Robinson, G E (1995) Violence against women In J M Oldham & M B Riba (Eds.), Review of psychiatry (pp 261…282) ashington, DC: American Psychiatric Press W Stoffelmayr, B., Wadland, W C., & Guthrie, S K (2000) Substance abuse In M A Smith & L A Shimp (Eds.), 20 common problems in women’s health care (pp 225…262) NewYork: McGraw-Hill Stoney, C M (1998) Coronary heart disease In E A Blechman & K D Brownell (Eds.), Behavioral medicine and women: A comprehensive handbook (pp 609…614) New York: Guilford Press Thapar, A K., & Thapar, A (1992) Psychological sequelae of miscarriage: A controlled study using the general health questionnaire and the hospital anxiety and depression scale British Journal of General Practice, 42(356), 94…96 544 Women’s Health Psychology Thompson, L., & Walker, A J (1989) Gender in families: Women and men in marriage, work, and parenthood Journal of Marriage and the Family, 51, 845…871 Toner, B B (1994) Cognitive-behavioral treatment of functional somatic syndromes: Integrating gender issues Cognitive and Behavioral Practice, 1, 157…178 Walker, A J., Pratt, C C., & Eddy, L (1995) Informal caregiving to aging family members Family Relations, 44, 402…41 Whiteford, L M., & Gonzalez, L (1995) Stigma: The hidden burden of infertility Social Science in Medicine, 40, 27…36 Williams, K E., & Koran, L M (1997) Obsessive-compulsive disorder in pregnancy, the puerperium, and the premenstruum Journal of Clinical Psychiatry, 58, 330…334 Ursin, G., Spicer, D V., & Bernstein, L (2000) Breast cancer epidemiology, treatment, and prevention In M B Goldman & M C Hatch (Eds.), Women and health (pp 871…883) San Diego, CA: Academic Press Winkleby, M A., Fortmann, S P., & Barrett, D C (1990) Social class disparities in risk factors for disease: Eight-year prevalence patterns by level of education Preventative Medicine, 19, 1…12 U.S Bureau of the Census (1995) Income, poverty and valuation of noncash bene“ts: 1993 Current population reports (Series P-60, 198) Washington, DC: U.S Government Printing Of“ce Wise, R A (1997) Changing smoking patterns and mortality from chronic obstructive pulmonary disease Preventive Medicine, 26, 418…421 U.S Bureau of the Census (1997) Poverty in the United States: 1996 Current population reports (Series P-60, 198) Washington, DC: U.S Government Printing Of“ce Wisocki, P A (1998) Arthritis and osteoporosis In E A Blechman & K D Brownell (Eds.), Behavioral medicine and women: A comprehensive handbook (pp 562…565) NewYork: Guilford Press U.S Bureau of the Census (1999) United States population estimates, by age, sex, race, and Hispanic origin, 1990 to 1997 Available from www.census.gov/population/estimates/nation U.S Bureau of Labor Statistics (1991, January) Employment and earnings Washington, DC: U.S Government Printing Of“ce Wolf, P A (1990) An overview of the epidemiology of stroke Stroke, 21(Suppl 2), 4…6 U.S Bureau of Labor Statistics (1997a) Employment and earnings Washington, DC: U.S Government Printing Of“ce Yanovski, S Z., Nelson, J E., Dubbert, B K., & Spitzer, R L (1993) Binge eating disorder is associated with psychiatric co-morbidity in the obese American Journal of Psychiatry, 150(10), 1472…1479 U.S Bureau of Labor Statistics (1997b) Employment characteristics of families: 1996 Washington, DC: U.S Government Printing Of“ce Yee, J L., & Schulz, R (2000) Gender differences in psychiatric morbidity among female caregivers: A review and analysis Gerontologist, 40, 147…164 U.S Bureau of Labor Statistics (1998) Occupational injuries and illnesses: Counts, rates, and characteristics, 1995 [Bulletin 2493] Washington, DC: U.S Government Printing Of“ce Yudkin, P., & Redman, C (2000) Prospective risk of stillbirth: Impending fetal death must be identi“ed and pre-empted British Medical Journal, 320, 444 Ventura, S J., Peters, K D., Martin, J A., & Maurer, J D (1997) Births and deaths: United States, 1996 Monthly Vital Statistics Report, 46(1), 1…40 Zerbe, K J (1999) Women’s mental health in primary care Philadelphia: Saunders Waldron, I., & Jacobs, J A (1989) Effects of multiple roles on women•s health: Evidence from a national longitudinal study Women and Health, 15, 3…19 CHAPTER 23 Cultural Aspects of Health Psychology KEITH E WHITFIELD, GERDI WEIDNER, RODNEY CLARK, AND NORMAN B ANDERSON RACE/ETHNICITY 546 African Americans 546 Asian Americans/Pacific Islanders 547 Latino(a) Americans 548 Native Americans 550 Behavioral Treatment and Prevention Approaches for Ethnic Minorities 551 GENDER 552 Biological Factors 552 Behavioral Factors 553 Psychosocial Factors 553 Biobehavioral Factors 554 Gender, Treatment, and Prevention Approaches 554 SOCIOECONOMIC STATUS 555 Assessment of SES 555 SES and Health Status 556 Interactions of Ethnicity, SES, and Health 556 SES and Behavioral Risk Factors 557 SES and Psychosocial Risk Factors 557 SES and Prevention and Intervention Approaches 557 FUTURE RESEARCH DIRECTIONS 558 Considerations in the Study of Ethnicity, SES, Gender, and Health 558 CONCLUSION 559 REFERENCES 559 The composition of the United States is quickly becoming more demographically diverse, particularly in the number of people of color (e.g., Macera, Armstead, & Anderson, 2000) In addition, employment patterns among women have changed drastically since the 1950s For example, the participation of U.S women in the workforce has risen from 34% in 1950 to 60% in 1997 (Wagener et al., 1997) What implications does this social and economic diversity have for research in health psychology? It offers new and unique opportunities to examine how sociodemographic characteristics, health, and behavior are interconnected and creates new challenges for the improvement of health For example, we might examine how differences in diet related to acculturation impact the incidence of chronic illnesses, such as cardiovascular disease (CVD), among Hispanics who migrate to this country, compared to CVD rates in their country of origin In some cases, this means reexamining how well-studied biobehavioral relationships that contribute to increased incidence of disease may operate differently in certain people who may be adversely affected or protected due to social or contextual forces The National Institutes of Health (NIH) has responded to the growing research on sociodemographic factors that in”uence health In 1990, the Of“ce for Research on Minority Health was created by the director of the NIH The mission of this of“ce is to identify and supporting research opportunities to close the gap in health status of underserved populations, promote the inclusion of minorities in clinical trials, enhance the capacity of the minority community to address health problems, increase collaborative research and research training between minority and majority institutions, and improve the competitiveness and increase the numbers of well-trained minority scientists applying for NIH funding Similarly, in 1990, the Of“ce of Research on Women•s Health was established in the NIH Its mandate is to strengthen and enhance research focused on diseases and conditions that affect women and to ensure that women are adequately represented in research studies In February 1998, President Clinton committed the United States to the elimination of health disparities in racial and ethnic minority populations by the year 2010 This •call to armsŽ requires a better understanding of the current status of health among minorities as well as identifying how social and economic classi“cations in”uence the treatment of disease and implementing programs to promote health behaviors Responsive to these initiatives, this chapter provides a selective overview of health psychology research on sociodemographically diverse populations, with a focus on ethnicity, gender, and socioeconomic status (see chapter on aging by Siegler, Bosworth, & Elias in this volume) Last, we provide suggestions for future directions 545 546 Cultural Aspects of Health Psychology RACE/ETHNICITY There are similarities and differences across ethnic groups in relation to the prevalence of health, disease, and health behaviors To this end, we review reports on mortality and morbidity, major behavioral risk factors, and major biobehavioral risk factors among African Americans, Asian Americans, Latinos, and Native Americans separately We conclude this section with a brief review of behavioral treatment and prevention programs African Americans Morbidity and Mortality One of the most striking demographic characteristics in health statistics continues to be the difference between African Americans and Caucasians The age- and gender-adjusted death rate from all causes is 60% higher in African Americans than in Caucasians (U.S Department of Health and Human Services [DHHS], 1995a) This difference in death rates for African Americans persists until age 85 (DHHS, 1995b), resulting in a life expectancy gap of 8.2 years for men and 5.9 years for women (DHHS, 1995a) One of the major factors in this life expectancy gap is mortality from circulatory diseases For example, heart disease continues to be the leading cause of death in the United States (Gardner, Rosenberg, & Wilson, 1996; National Heart Lung and Blood Institute [NHLBI], 1985; Peters, Kochanek, Murphy, 1998) Trends suggest that while heart disease is decreasing among Caucasian men, it may be increasing in African American men (Hames & Greenlund, 1996) Similarly, African Americans experience higher age-adjusted morbidity and mortality rates than Caucasians not only for coronary heart disease but also for stroke (NHLBI, 1985) For example, the NHLBI examined the 1980 age-adjusted stroke mortality rates by state and found 11 states with stroke death rates that were more than 10% higher than the U.S average These states included Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia The NHLBI and others have designated these 11 states as the •Stroke Belt.Ž These •Stroke BeltŽ states also correspond with some of the highest populations of older African American adults Deaths associated with CVD arise from a myriad of risk factors including elevated blood pressure, cigarette smoking, hypercholesterolimia, excess body weight, sedentary lifestyle, and diabetes, all of which are in”uenced to varying degrees by behavioral factors (e.g., Manson et al., 1991; Powell, Thompson, Caspersen, Kendrick, 1987; Stamler, Stamler, & Neaton, 1993; Willet et al., 1995; Winkleby, Kraemer, Ahn, & Varady, 1998) The clustering (comorbidity) of coronary heart disease risk factors in African Americans appears to play an important role in excess mortality from coronary heart disease observed in African Americans (Potts & Thomas, 1999) Major Behavioral Risk and Protective Factors Tobacco Use In the general population, tobacco consumption slowed down when the deleterious health effects of cigarette smoking were made public in the 1950s Cigarette smoking prevalence reaches a peak between the ages of 20 and 40 years among both men and women and then decreases in later adulthood; but across all ages, smoking prevalence is higher among males than among females Smoking is more prevalent among African Americans than Caucasians (Escobedo, & Peddicord, 1996; Gar“nkel, 1997) Even among minority groups, African Americans experience the most signi“cant health burden ( Mortality and Morbidity Weekly Report [MMWR], 1998; •Response to Increases,Ž 1998) Diet The age-adjusted prevalence of overweight adults continues to be higher for African American women (53%) than for Caucasian women (34%; National Center for Health Statistics [NCHS], 2000) The prevalence of obesity among African American women has reached epidemic proportions (Flynn & Fitzgibbon, 1998) A number of studies attribute the high rate of obesity in women in part to differences in body images, suggesting that African American women subscribe to the belief that overweight bodies are more attractive, but the results are still not completely clear because of divergent methodologies (see Flynn & Fitzgibbon, 1998) Nutritional status, which contributes to obesity, among minority populations may be adversely affected by a number of factors associated either directly or indirectly with aging (Buchowski & Sun, 1996) Physical Activity In minority samples, physical activity has been linked to decreased risk for diabetes (D Clark, 1997; Manson, Rimm, and Stamp”er, et al., 1991; Ransdell & Wells, 1998), CVD (Yanek et al., 1998), and blood pressure regulation (e.g., Agurs-Collins, Kumanyika, Ten Have, & Adams-Campbell, 1997) Conversely, there is evidence to suggest that African Americans not exercise at the same rates as Caucasians (Sallis, Zakarian, Hovell, & Hofstetter, 1996; Young, Miller, Wilder, Yanek, Becker, 1998) Women of color, women over 40, and women without a college education have been shown to participate the least in a study of Race/Ethnicity leisure time physical activity (Ransdell & Wells, 1998) This may be due, in part, to differences in body perception and visual cues suggesting the need to regulate weight For example, in a study by Neff, Sargent, McKeown, Jackson, and Valois (1997), Caucasian adolescents were more likely to perceive themselves as being overweight as compared to African American adolescents This difference in perception could translate into unhealthy weight management practices during adulthood that impact long-term consequences for health (Neff, Sargent, McKeown, Jackson, & Valois, 1997) Sexual Behavior Young African Americans are emerging as a group at signi“cant risk for contracting human immunode“ciency virus (HIV; Maxwell, Bastani, & Warda, 1999) Data from the National Health and Social Life Survey (NHSLS) showed that African Americans were almost “ve times more likely to be infected by sexually transmitted diseases (STDs) than the other racial/ethnic group (Laumann & Youm, 1999) In another study, Cummings, Battle, Barker, and Krasnovsky (1999) found that 64% of African American women surveyed did not express AIDS-related worry Their results indicated that African American women were not protecting themselves by using condoms or by careful partner selection AlcoholAbuse Alcohol-related problems are strong predictors of intimate partner violence among African Americans (Cunradi, Caetano, Clark, & Schafer, 1999) Using data from two nationwide probability samples of U.S households between 1984 and 1995, Caetano and Clark (1999) found that the rates of frequent heavy drinking and alcohol-related problems have remained especially high among African American and Hispanic men In a study by Black, Rabins, and McGuire (1998), African Americans with a current or past alcohol disorder were 7.5 times more likely than others to die during a 28-month follow-up period Social Support Social factors such as social support (e.g., Cohen, & Syme, 1985; Dressler, Dos-Santos, Viteri, 1986; House, Landis, & Umberson, 1988; Strogatz & James, 1986; Williams, 1992) and religious participation (Livingston, Levine, & Moore, 1991) have been found to be important predictors of health outcomes Health is also adversely in”uenced by psychological factors such as hostility (Barefoot et al., 1991), anger (e.g., Kubzansky, Kawachi, & Sparrow, 1999), perceived stress (Dohrenwend, 1973; McLeod, & Kessler, 1990), and stress coping styles (S James, Hartnett, & Kalsbeek, 1983) Some previous research suggests associations between health and social support in African Americans (e.g., J Jackson, 1988; J Jackson, Antonucci, & Gibson, 1990; S James, 1984) From 547 this research, three conclusions can be drawn: (a) Social disorganization is related to elevated stroke mortality rates, (b) individuals in cohesive families are at reduced risk for elevated blood pressure, and (c) social ties and support play a positive role in reducing elevated blood pressure (J Jackson et al., 1990; S James, 1984) Major Biobehavioral Risk Factors The most studied biobehavioral risk factor for poor health among African Americans is cardiovascular reactivity Research by V Clark, Moore, and Adams (1998) showed that both low and high density lipoprotein cholesterol (LDL, HDL) were signi“cant predictors of blood pressure responses in a sample of African American college students They also found a positive correlation between total serum cholesterol and LDL, and stroke volume, contractile force, and blood pressure reactivity These “ndings suggest that cardiovascular reactivity to stress may be a new risk factor for heart and vascular diseases (V Clark et al., 1998) Research suggests that neighborhoods and socioeconomic status (SES) act as risk factors for stress reactivity for African Americans Lower family SES and lower neighborhood SES have been found to produce greater cardiovascular reactivity to laboratory stressors in African Americans (Gump, Matthews, & Raikkonen, 1999; R Jackson, Treiber, Turner, Davis, & Strong, 1999) Asian Americans/Pacific Islanders Morbidity and Mortality Heart disease and cancer are leading causes of death forAsians and Paci“c Islanders (APIs) Hoyert and Kung (1997) found a great variation in the leading causes of deaths by age among the API subgroups, which included Samoan, Hawaiian, Asian Indian, Korean, and Japanese They also found that ageadjusted death rates were the greatest and life expectancy was the lowest for Samoan and Hawaiian populations (Hoyert & Kung, 1997) Prevalence of diabetes has been found to be high among Hawaiians, which suggests that other Asian and Paci“c Island populations may share similar susceptibility to diabetes (Grandinetti et al., 1998) Major Behavioral Risk and Protective Factors Tobacco Use Relatively little is known about Asian American tobacco and alcohol use patterns The little that is known suggests that Chinese use less tobacco than other Western Systems of Healing The value of homeopathy as a treatment for depression is presently unknown because of the lack of substantiation by systematic research Davidson, Morrison, Shore, and Davidson (1997) reported a case study of a 47-year-old woman whose depressive and anxious symptoms improved on ”uoxetine (Prozac) and calcarea carbonica (a homeopathic remedy) The thorough review of homeopathy clinical trials by Kleijnen et al (1991) and the meta-analysis by Linde et al (1997) detected only one study related to depression Although this study (Ernst et al., 1998) produced a result in favor of homeopathy, the study was of low methodological quality Furthermore, two large reviews of the role of homeopathy in clinical medicine concluded that, except for the occasionally demonstrated bene“t, there was little scienti“c evidence to support the use of homeopathy in the majority of clinical settings (Watkins, 1994) Several problems exist in studying the ef“cacy of homeopathic treatments To provide some scienti“c rigor, most conventional clinical research involves administering the same remedy to all patients, which contradicts the philosophy of the idiographic approach involved in homeopathic treatments Furthermore, most homeopathic studies are case reports but not include methodologies that include multiple baselines or a reversal to baseline methodology Osteopathy Osteopathy, founded by Andrew Taylor Still, M.D (1823…1917), is a complete system of prevention, diagnosis, and treatment based on a •whole personŽ approach It posits that there is an interrelationship between the structure and function of the human body and that the body has the ability to self-regulate and self-heal Speci“cally, when the body is in a normal structural relationship with adequate nutrition, it is capable of maintaining its own defenses against diseases and other pathologic conditions (Micozzi, 1996; C M Nezu, Nezu, Baron, & Roessler, 2000) However, when there are alterations in the structural relationships of the body parts, the body has dif“culty resisting or recovering from illness It has been proposed that structural dif“culties in the body can cause numerous problems such as arthritis, headaches, emotional problems, breathing problems, heart problems, and digestive problems depending on which area in the musculoskeletal system is restricted or under stress (The Burton Goldberg Group, 1995) Recovery from these conditions is said to occur through normalization of body mechanics and the neuromusculoskeletal system via osteopathic manipulative treatment (OMT) It is important to distinguish between the actual practices of osteopathic physicians from osteopathic manipulative 593 treatments Osteopathic training in the United States blends conventional medical practices and training in biomedical sciences with osteopathic manipulative treatment approaches as an integrated system of health care Depending on the focus of the licensed osteopathic physicians, the actual practice of osteopathy may vary according to the area of specialty (Sirica, 1995) Therapeutic Approaches The diagnostic process in osteopathy emphasizes a close and personal relationship between the physician and patient because it is based on the premise that familiarity with a patient•s personality and habits is essential to providing highquality health care (Hruby, 1995) Because osteopathy evaluates the human body as an integral unit, treatment modalities are selected based on the patient•s report of signs and symptoms, along with a comprehensive patient history and examination in which the structure and function of the musculoskeletal system provides important clues to dysfunction (Micozzi, 1996) OMT is a therapeutic means of correcting these dysfunctions and is often prescribed in conjunction with other clinical modalities, including education on nutrition, lifestyle, breathing techniques, relaxation techniques, and postural correction to reduce tension to the affected areas of the body (C M Nezu et al., 2000) Although osteopathy is considered a comprehensive system of healing, it is best known for its reliance on the diagnostic and therapeutic value of the musculoskeletal system and OMT, which is a distinguishing hallmark of the osteopathic profession Different manipulative approaches available to the osteopathic physician include muscle energy, myofascial, counterstrain, and thrusting techniques (DiGiovanna & Schiowitz, 1991) Muscle energy techniques focus on directing muscles against a distinct counterforce such as increased tension or resistance The goal is to mobilize joints by gently tensing and releasing speci“c muscles to produce relaxation Myofascial techniques, also known as soft tissue techniques, focus on the continuous layer of connective tissue below the skin (i.e., fascia) that surrounds and bonds all of the body•s internal organs They are used to relax and release restrictions in the soft tissues of body In counterstrain techniques, somatic dysfunction is believed to have a neuromuscular basis These are functional and positional release methods used to relieve pain by placing the patient in a speci“c position to allow the body to relax and release muscular spasms that may have been caused by strain or injury Thrusting techniques are small, high velocity forces applied by a practitioner in an effort to alleviate joint dysfunction (e.g., by altering the range of motion available at a joint) 594 Complementary and Alternative Therapies Clinical Applications Research to date focuses on the philosophy of osteopathic medicine and manipulation techniques and less on treatment outcome Patients with HIV disease have been reported to use OMT for relaxation and pain management because of drug toxicity or disease progression (Micozzi, 1999) Treatment includes massage and myofascial release techniques to relax muscle tension, counterstrain techniques to relax and elongate muscle “ber for increased joint mobility and range of motion, muscle energy techniques to foster normalization of the musculoskeletal system, and visceral manipulation, which may potentiate normal physiologic function of individual organs (SMT) is most effective (Plamondon, 1995) The central focus of chiropractic practice is to determine when and where SMT is appropriate, and what type of adjustment is most appropriate in a given situation The most common form of chiropractic SMT is the high-velocity, low-amplitude thrust adjustment (HVLA), also known as osseous adjustment (Micozzi, 1996) It involves manual movement of a joint to the end point of its normal range of motion, followed by local pressure on bony prominences and then imparting a swift, speci“c, low-amplitude thrust for joint cavitation Although patients often report signi“cant functional improvements and healing effects following chiropractic adjustment, positive health changes have never been convincingly correlated with vertebral alignment (Micozzi, 1996; Winkel, Aufdemkampe, Matthijs, Meijer, & Phelps, 1996) Chiropractic Chiropractic, derived from the Greek word meaning •done by hands,Ž was founded by Daniel David Palmer in 1895 based on the premise that vertebral subluxation (a spinal misalignment causing abnormal nerve transmission) is the cause of virtually all disease and that chiropractic adjustment (a manual manipulation of the subluxated vertebrae) is its cure (Palmer, 1910) Similar to the fundamental principles of osteopathy and the foundation of the emerging holistic health or wellness paradigm, a chiropractic approach views human beings as possessing an innate healing potential Like osteopathy, structure and function are believed to exist in intimate relation with one another Hence, structural distortions of the spine are proposed to cause functional abnormalities, which may impede the communication and balance between the different branches of the nervous system (central, autonomic, and peripheral) that are required for health maintenance This is believed to result in injury or stress, causing pain Restoration and maintenance of proper bodily function involves realigning the spine to remove the pressure of bone impingement on spinal nerves to restore spinal joint mobility and nerve function Whereas osteopaths provide manual therapy to a variety of areas in the body, chiropractors focus speci“cally on spinal maladjustments A balanced, natural diet and exercise is also considered an important part of treatment for maintaining proper bodily function and optimal health Therapeutic Approaches Of the patients seeking chiropractors, 90% present with neuromuscular problems such as back pain, neck pain, and headaches, conditions for which spinal manual therapy Clinical Applications Several comprehensive reviews exist on clinical outcome studies in spinal manipulation Shekelle, Adams, Chassin, Hurwitz, and Brook (1992) analyzed nine randomized, controlled trials that tested the effects of spinal manipulation against various conservative treatments for patients with acute low back pain (e.g., back pain that does not result from fractures, tumors, infections, and vascular, abdominal, or urinary diseases) All nine studies found spinal manipulation to be ef“cacious, leading the authors to conclude that spinal manipulation hastens recovery from uncomplicated low back pain Findings from two other meta-analyses (Abenhaim & Bergeron, 1992; Anderson et al., 1992) provide some evidence of the short-term effectiveness of spinal manipulation in relieving acute and chronic back pain, although long-term effects of this treatment have not been adequately evaluated Chiropractic treatment has also been demonstrated to be more effective in treating the pain from muscle tension headaches than the tricyclic antidepressant amitriptyline for long-term relief of pain (Boline, 1991) Patients maintained their levels of improvement after treatment was discontinued, while those taking medication returned to pretreatment status in an average of four weeks following its discontinuation Further research is needed to address the question of long-term ef“cacy of spinal manipulation for different types of pain Other studies have focused on applying chiropractic manipulation to spinal cord injury patients (Fritz-Ritson, 1995; Woo, 1993), infantile colic (Klougart, Nilsson, & Jacobsen, 1989), and enuresis (Leboeuf et al., 1991; Reed, Beavers, Reddy, & Kern, 1994) The results generated from these studies are inconsistent and inconclusive because of limitations in research design Further research is needed to Eastern Systems of Healing determine the effectiveness of chiropractic manipulations in these populations EASTERN SYSTEMS OF HEALING Ayurveda Ayurveda, a Sanskrit word meaning •the science of life and longevity,Žis a major health system developed in India more than 5,000 years ago that emphasizes a preventive approach to health by focusing on an inner state of harmony and spiritual realization for self-healing It focuses on the whole organism and its relation to the external world because human beings are viewed as minute representations of the universe and contain within them everything that makes up the surrounding world The cosmos is believed to be composed of “ve basic elements (earth, air, “re, water, and space), which occur as the three doshas (vata, pitta, and kapha), or the basic bodily and mental human energy forces (Micozzi, 1996) Most people possess a combination of doshas, in which one dosha predominates When the three doshas are in equilibrium, health is said to be maintained When an imbalance occurs among them, body dysfunctions that lead to the manifestation of disease exist The cause of the imbalance may originate in the body, outside the body, or from spiritual sources In addition to the doshas, Ayurveda principles indicate that an individual is in”uenced by three mental states based on the qualities of balance, energy, and inertia (Micozzi, 1996) The mind is said to be in equilibrium when it is in the state of balance The mind is excessively active when it is in a state of energy and is inactive when it is in a state of inertia, with both states causing weakness in equilibrium Hence, the body and the mind can interact to create a healthy and functional, or unhealthy and nonfunctional, condition During the assessment phase, the Ayurvedic physician determines both the mental and physical conditions of the patient before proceeding with any form of diagnosis and treatment Treatment aims to restore the balance of the doshas or to maintain the proper balance of energy ”ow ( prana; C M Nezu et al., 2000) This can be achieved through a variety of methods such as meditation, exercise, diet, herbs, aromatherapy, oil massages, yoga, and medicated enemas (Spencer & Jacobs, 1999), with a main focus on lifestyle changes Although a centuries-old healing phenomena, Ayurveda was revived in recent decades by Maharishi Mahesh Yogi This speci“c reformulation of Ayurveda is known as Maharishi Ayurveda (MAV) •MAV promotes the idea of 595 consciousness as a primary importance in maintaining optimal health, and emphasizes meditation techniques as a way to develop integrated holistic functioning,Ž according to Micozzi (1996, p 243) The fundamental principles of MAV are similar to those of traditional Ayurveda However, the ultimate basis of disease in MAV is associated with losing a person•s sense of spiritual being Prevention and cure is focused primarily on restoring the conscious connection to the person•s spiritual core, enabling the full expression of the body•s •inner intelligence.Ž Therapeutic Approaches The two general courses of treatment in Ayurveda are prophylaxis and therapy (Micozzi, 1996) Prophylaxis is used to help a healthy person maintain health and prevent disease Therapy is used to help an ill person restore health When a person is diagnosed with an imbalance of the doshas, puri“cation therapy, alleviation therapy, or a combination of these is prescribed In puri“cation therapy, a patient might be given a purgative, such as an enema, to eliminate the dosha that is thought to be causing the disease Alleviation therapy uses the condiments honey, butter or ghee, and sesame or caster oil for the same purpose Once the individual returns to health, continuous prophylaxis is recommended based on a variety of methods such as diet, meditation, herbal regimens, and regular therapeutic puri“cation procedures In MAV, the most important technique in achieving overall well-being is transcendental meditation (TM), where •the mind transcends even the subtlest impulses of thought and settles down to the simplest state of awarenessŽ (Micozzi, 1996, p 246), a state known as transcendental consciousness Although MAV views unfolding consciousness as the single most important strategy of both disease prevention and cure, lifestyle, behavioral, and emotional factors can also have a great impact For example, traditional virtues such as respecting others, familial harmony, practicing nonviolence, pardoning others, and maintaining a positive emotional tone are understood to promote health for the individual•s mind and body, as well as for the community and society Clinical Applications Herbal remedy is an important component of Ayurvedic medicine Laboratory and animal studies have found cytotoxicity in some traditional and MAV remedies (Sharma et al., 1991; Smit et al., 1995), suggesting potential effectiveness in cancer treatments However, no randomized studies in humans have been conducted (Spencer & Jacobs, 1999) Some 596 Complementary and Alternative Therapies Ayurvedic herbal mixtures have been found to have bene“cial health effects The herbal mixture MA-631 may be used to prevent and treat atherosclerotic vascular disease (Hanna, Sharma, Kauffman, & Newman, 1994) Herbal mixtures MAK-4 and MAK-5 have been found to be effective in angina patients in signi“cantly reducing angina frequency and systolic blood pressure, and in improving exercise tolerance (Dogra, Grover, Kumar, & Aneja, 1994) The extant research surrounding TM appears to support its proposed bene“cial effects on health, suggesting that TM may be an effective complementary intervention for patients suffering from a variety of psychological and physical problems A Harvard study of elderly nursing home residents compared the practice of TM with two other types of meditation and relaxation techniques over a three-year period (Alexander, Langer, Newman, Chandler, & Davies, 1989) The study found that the TM group had the greatest reductions in stress and blood pressure, and the lowest mortality rate A meta-analysis on the effect of meditation and trait anxiety conducted at the Stanford Research Institute found that TM is approximately twice as effective as other meditation techniques at reducing trait anxiety (Eppley, Abrams, & Shear, 1989) TM has also been found in several studies to retard biological aging (Glaser et al., 1992), to signi“cantly reduce high blood pressure and cholesterol (Cooper & Aygen, 1978), and to help in giving up harmful habits such as cigarette smoking, heavy drinking, and illegal drug use by incorporating more healthy dietary and lifestyle changes (Alexander, Robinson, & Rainforth, 1994; Gelderloos, Walton, Orme-Johnson, & Alexander, 1991) These studies collectively suggest that practicing TM has bene“cial effects on health Traditional Chinese Medicine Similar to Ayurveda, traditional Chinese medicine (TCM) diagnostic and treatment strategies involve a search for imbalance and disharmony in each individual patient The philosophy of TCM begins with yin (shady side) and yang (sunny side), which are opposing but complementary forces that exist in a dynamic equilibrium (The Burton Goldberg Group, 1995) Like Ayruveda, TCM focuses on interrelation and interdependence of the whole organism with the external world In addition to being viewed in relation to their surroundings, yin and yang are also used to correlate the body and other phenomenon to the human experience of health and disease, and all health treatments are aimed at keeping yin and yang in balance Another concept that is crucial to understanding TCM is qi, often translated with the term energy or life force While the Western de“nition of energy is the capacity to work, qi implies that •the body is pervaded by subtle material and mobile in”uences that cause most physiological functions and maintain the health and vitality of the individualŽ (Micozzi, 1996, p 195) According to TCM, this vital energy system exists in the body along pathways called meridians or channels When energy is ”owing at normal levels, the body is balanced and healthy, resistant to disease, and can activate its own healing efforts When imbalances or blockages occur, physiological and pathological changes ensue Practitioners of TCM believe that all illnesses result from a disturbance of qi within the body In TCM, there is no distinction between mind and body TCM believes that an individual•s emotional and physiological experiences are reciprocal Hence, aspects of the human emotional experience are linked to speci“c physiological organs (e.g., anger is related to the liver, joy to the heart), and, thus, are causal factors in disease There are three categories for the causes of disease: external causes (i.e., wind, cold, “re, dampness, summer heat, and dryness, collectively referred to as •the six environmental evilsŽ), internal causes (i.e., joy, anger, anxiety, thought, sorrow, fear, and fright, collectively referred to as •the seven affectsŽ), and causes that are neither external nor internal (e.g., dietary irregularities, excessive sexual activity, overexertion, or complete inactivity; Micozzi, 1996) Each of the causes of disease disrupts the balance of yin and yang in the body and disrupts the free movement of qi Successful diagnosis and treatment are based on identifying the precise pattern of such imbalances This is accomplished by taking a comprehensive medical history, which includes asking about the nature of the patient•s complaints, the presence of any excessive activities such as sleeping or waking, diet, and sensations of •hotŽ and •cold.Ž Treatment involves helping the person regain health by reestablishing a normal balance and ”ow in the energy system, so that the body may heal itself All of the treatment modalities in TCM are designed to achieve this harmony Healthy individuals also practice these treatment modalities prophylactically to maintain health and prevent disease Therapeutic Approaches There are a number of therapeutic approaches in TCM, of which Qigong is the most powerful (Micozzi, 1996) Qigong is a form of exercise-stimulation therapy that proposes to improve health by redirecting mental focus, breathing, coordination, and relaxation to mobilize and regulate the movement of qi in the body to facilitate the body•s own healing capacities (Spencer & Jacob, 1999) Tai Chi Ch’uan (also called tai chi) is a type of martial art that uses slow, Eastern Systems of Healing purposeful motor-physical movements to achieve control and a more balanced physiological and psychological state This technique is particularly popular among senior adults, and has been endorsed by the National Institute of Aging Other TCM approaches include acupuncture, acupressure, massage (Tui Na), herbal medicine, and diet Acupuncture is employed to remove the obstruction causing the interruption of the ”ow of qi, or to redirect the ”ow of qi to where it is insuf“cient Thin needles are inserted super“cially on the skin throughout the body where meridian points are located (Spencer & Jacobs, 1999) To further enhance the movement of qi, acupuncture is often used in conjunction with heat (moxibustion) or electric current (electroacupuncture) Healing is proposed by restoration of a balance of qi ”ow within the body Acupressure uses the deep pressure of the “ngers or hands to stimulate meridian points and qi ”ow It is an effective self-care and preventative health care treatment for tensionrelated ailments (The Burton Goldberg Group, 1995) Acupressure is also prescribed to help decrease psychological distress by assisting persons to increase their body awareness and ability to cope with stress through release of built-up tension (Jacobs, 1996) Tui Na is a form of acupressure massage that uses techniques such as pushing, rolling, kneading, rubbing, grasping, percussion, and vibration to improve circulation and to stimulate stale blood and lymph from tissues (The Burton Goldberg Group, 1995) It is often used as an adjunct to acupuncture treatment, to increase the range of motion of a joint, or in populations where acupuncture is contraindicated (e.g., pediatric) A type of popular acupressure called Shiatsu (“nger pressure) originated in Japan and uses applied pressure for to 10 seconds in a rhythmic fashion Shiatsu uses the same points as acupressure, but a practitioner of shiatsu refers to such points as tsubo, rather than meridian points Shiatsu combines meridian point therapy with gentle stretching and both soft tissue and joint manipulation and relies on gravity, rather than muscular force, to operate Although magnetic therapy is not a TCM approach, it has recently gained popularity in the Chinese culture because of its self-help properties via the production of accessible devices such as magnetic bracelets and small magnets that can be easily adhered to the skin The belief is that magnets can heal and enhance health by placing them either along a particular meridian or directly over the area of dysfunction to remove the obstruction of qi ”ow Despite the increasing use of magnetic therapy as a form of self-help, empirical studies to support its proposed bene“ts are lacking (Dexter, 1997) Chinese herbal medicine is an integral part of Chinese culture and medical practice It includes not only plants, but also mineral and animal parts as listed in the traditional 597 Chinese material medica (also Liu, 1988; Spencer & Jacobs, 1999) Prescribing rules exist for consideration of the compatibilities and incompatibilities of substances, the traditional pairing of substances, and their combination for speci“c symptoms (Liu, 1988) All of the formulas are organized in such a way as to support the qi that is desired for returning the body to a balanced and harmonious state Maintaining a balanced diet in TCM is extremely important in maintaining health and in preventing, or recovering from, diseases and other pathological conditions Many of the foods that are used for therapy in TCM are also routinely prepared by families and are part of cultural practices Special foods, as characterized by their yin and yang properties, may be prepared when seasons change or when a person is ill These food preparations are aimed at keeping yin and yang in balance in the individual and preventing disturbance in qi ”ow Clinical Applications Most of the research studies in the literature on TCM focus on meridian point therapies such as acupuncture, electroacupuncture, and acupressure Thus far, the evidence on the ef“cacy of acupuncture in the management of chronic pain is controvertible One well-controlled study by Vincent (1989) demonstrated the long-term effectiveness of acupuncture in the treatment of migraine headaches There was a 43% reduction in past treatment pain scores and a 38% reduction in medication usage for the acupuncture group compared to the placebo group, and these results were maintained at fourmonth and one-year follow-up Patel, Gutzwiller, Paccand, and Marazzi (1989) examined the effectiveness of acupuncture for chronic pain in a meta-analysis of 14 randomized, controlled trials comparing acupuncture with placebo or standard care The pooled results suggest that acupuncture was effective in treating low back and chronic headache pain However, a second meta-analysis of 51 trials (ter Riet, Kleijnen, & Knipschild, 1990) found that most of the studies were of mediocre or poor quality with the best studies yielding contradictory results, raising signi“cant debate over effectiveness The bene“ts of acupuncture have also been explored in a variety of other conditions For example, acupuncture was found to be effective in the management of symptoms associated with withdrawal from a variety of addictive substances such as cocaine (Culliton & Kiresuk, 1996) Jobst (1995) concluded that acupuncture produced favorable effects in the management of patients with bronchial asthma, chronic bronchitis, and chronic disabling breathlessness Although there is no evidence that acupuncture is an effective treatment for 598 Complementary and Alternative Therapies cancer itself, there are claims that it may be effective in providing some relief from the side effects of cancer or the symptoms associated with conventional cancer treatments, such as pain control, and nausea and vomiting associated with chemotherapy (Vickers, 1996) Some bene“ts of acupressure are supported in the scienti“c literature For example, compared to sham acupressure, true acupressure was more effective in improving the quality of sleep in institutionalized residents (Chen, Lin, Wu, & Lin, 1999) In randomized controlled studies, acupressure treatment resulted in signi“cantly less nausea and vomiting than placebo in persons undergoing laparoscopy (Harmon, Gardiner, Harrison, & Kelly, 1999) and caesarean sections (Harmon, Ryan, Kelly, & Bowen, 2000) Acupressure also resulted in less nausea than treatment as usual in a sample of women with breast cancer undergoing chemotherapy treatment (Dibble, Chapman, Mack, & Shih, 2000) However, not all published studies support the ef“cacy of acupressure For example, acupressure was not effective at decreasing motion sickness in a double-blinded controlled study with a sample of male college students (Warwick-Evans, Masters, & Redstone, 1991) There is some support for the use of electroacupuncture in the treatment of depression Two randomized, controlled clinical trials compared the effects of electroacupuncture and amitriptyline hydrochloride in depressed patients (Luo, Jia, Wu, & Dai, 1990; Luo, Jia, & Zhan, 1985) Both studies found a signi“cant reduction in clinician•s ratings of depression scores after treatment for both groups; however, there were no signi“cant differences between groups Furthermore, a two- to four-year follow-up also found no signi“cant differences between groups in the rate of depression recurrence, with electroacupuncture having fewer side effects than antidepressant medication Additional well-designed studies are needed to further delineate the ef“cacy of meridian point therapies in the treatment of depression Clinical data for the ef“cacy of other TCM therapeutic approaches also exist Ryu et al (1996) studied the effects of Qigong and meditation on stress hormone levels in 20 subjects who were engaged in at least four months of Qigong training The results supported the stress-relieving bene“ts of such training However, the study lacked both a control group and random selection of treatment group participants As such, well-controlled studies are warranted to reach more conclusive results Although most studies on tai chi have limited generalizability because randomized trials with control groups were rarely used, positive cardiovascular changes (i.e., reductions in heart rate, blood pressure, and urinary catecholamines) have been demonstrated when comparing a participant•s own pretest and posttest scores in performance (Jin, 1992) Tai chi may also help in promoting cardiorespiratory functioning in elderly subjects (Lai & Lan, 1995), as well as enhancing positive mood (Jin, 1989, 1992) These results suggest that the practice of Qigong and tai chi may have stress-moderating functions OTHER COMMON HEALING APPROACHES Herbal Remedies Although frequently employed as part of the overall healing systems previously discussed, herbs have also been used as a sole treatment to promote healing and balance In the past two decades, herbal remedies for psychiatric and medical care have been increasingly used and investigated scienti“cally One survey suggests that in 1990, •Americans made an estimated 425 million visits to providers of unconventional therapyŽ (Eisenberg et al., 1993, p 247) Another survey found that between 30% and 70% of patients in developed countries use complementary and alternative medicine (Linde et al., 1996) Overall, early studies suggest that phytotherapy, the use of active substances found in plants, can enhance psychotherapeutic and medical treatment The phytotherapeutic substances, described next, have undergone some degree of scienti“c study Echinacea Echinacea, also known as purple corn”ower, is derived from the Greek word echinos, meaning •hedgehogŽ or •sea urchin,Ž a name given to the plant because of its spiky seed heads (Gunning, 1999) The herb is popular among Native Americans and in Germany, and is represented by nine species found in the United States Echinacea is classi“ed by the plant species used, the part of the plant processed, the mode of processing, and the mode of application (Grimm & Muller, 1999) A majority of studies have investigated echinacea for the treatment of colds and upper respiratory infections (URIs), chronic arthritis, cancer, chronic fatigue syndrome, wounds and ulcers, and chronic pelvic infections (e.g., see Grimm & Muller, 1999) A review of 13 published and unpublished, randomized, placebo-controlled trials of echinacea in the treatment of URIs found echinacea to be more effective than placebo in eight out of nine treatment trials by decreasing the severity and duration of URI symptoms (Barrett, Vohmann, & Calabrese, 1999) Other studies (Grimm & Muller, 1999; Melchart, Walther, Linde, Brandmaier, & Lersch, 1998) have not found such positive effects The active ingredient of echinacea is unclear Studies suggest that echinacea produces its effects via the immune Other Common Healing Approaches system (Gunning, 1999), such as inducing cytokine production (Bruger, Torres, Warren, Caldwell, & Hughes, 1997) or enhancing cellular immune function of peripheral blood mononuclear cells (See, Broumand, Sahl, & Tilles, 1997) In their review, Barrett et al (1999) highlight the dif“culty in comparing the research studies because different species are studied and there are no universally accepted standardization procedures Garlic Although commonly considered a food substance, garlic (Allium sativum) is a commonly prescribed supplemental herb for the treatment of high cholesterol Allicin is considered the active compound found in the garlic bulb Many of the studies investigate Kwai garlic powder tablets because it is standardized for alliin content (1.3% by weight) While Kleijnen, Knipschild, and ter Riet (1989) suggest that early studies on the ef“cacy of garlic were methodologically ”awed, more recent studies suggest garlic is effective in treating hypercholesterolaemia Two meta-analyses (Silagy & Neil, 1994; Warshafsky, Kamer, & Sivak, 1993) suggest that garlic reduces the high serum cholesterol levels considered to be a risk factor for coronary artery disease Warshafsky et al (1993) found 13 studies to meet their methodological criteria, and meta-analytic results suggested that garlic signi“cantly lowered cholesterol levels by about 9% in the experimental groups as compared to placebo The results of Silagy and Neil•s (1994) meta-analysis of the 16 trials meeting their standards for methodological quality found that garlic lowered serum cholesterol over one to three months and did not produce signi“cantly more adverse effects While several authors (Isaacsohn et al., 1998; Jain, Vargas, Gotzkowsky, & McMahon, 1993) criticized these early meta-analytic “ndings, more recent, randomized, controlled trials have found garlic to reduce ratios of serum total cholesterol (Adler & Holub, 1997) and decrease low-density lipoprotein cholesterol in healthy men (Jain et al., 1993; Steiner, Khan, Holbert, & Lin, 1996) Ginger Zingiber officinale, commonly known as ginger, has been primarily investigated for its antiemetic effects This research has been particularly important for individuals who suffer from motion sickness and from postoperative nausea, or who experience nausea and vomiting due to chemotherapy but are unable to take synthetic drugs because of side effects such as sedation and visual disturbances Several early studies found ginger to be more effective than placebo in alleviat- 599 ing gastrointestinal symptoms of motion sickness (Mowrey & Clayson, 1982), reducing symptoms of seasickness (Grontved, Brask, Kambskard, & Hentzer, 1988), reducing nausea (Bone, Wilkinson, Young, McNeil, & Charlton, 1990) and reducing the request for antiemetics (Phillips, Ruggier, & Hutchinson, 1993) in postoperative patients In addition, ginger has been studied for its antitumor effects (Koshimizu, Ohigashi, Tokudo, Kondo, & Yamaguchi, 1988) Vimala, Norhanom, and Yadav (1999) demonstrated that some, but not all, types of ginger inhibit Epstein Barr virus (EBV) activation without the cytotoxicity effects The authors suggest that populations with a high risk of cancer are •encouragedŽ to take plants with ginger, yet they also acknowledge that such use will not completely eliminate the disease Ginkgo Biloba Ginkgo biloba extract is derived from the maidenhair tree and has been studied primarily for its effect on the brain, dementia, and Alzheimer•s disease Active ingredients include Egb 761 (tapenoids), which have platelet-activating factor antagonistic properties, and gingkolides and ”avanoids (Oken, Storzbach, & Kaye, 1998) Three of the most popular preparations used in controlled trials include Tebonin, Tanakan, and Rokan, all of which are different names for the extract Egb 761 Various products available to the public contain different amounts of ginkgo biloba extract In their review of the literature, Itil and Martorano (1995) suggest ginkgo has been •proven effectiveŽin the treatment of tinnitus, sudden hearing loss, retinal damage, arthritic symptoms, vertigo, water retention, circulatory dysfunction, and agerelated dementia Early studies demonstrated the ef“cacy of Egb 761 on reducing the negative effects of experimentally induced stress on rats (Hasenohrl et al., 1996; Porsolt, Martin, Lenegre, Fromage, & Drieu, 1990; Rapin, Lamproglou, Drieu, & Defeudis, 1994) over other depressive medications (Porsolt et al., 1990) and over placebo (Porsolt et al., 1990; Rapin et al., 1994; Rodriguez de Turco, Droy-Lefaix, & Bazan, 1993) For instance, Rapin et al (1994) found Egb 761 to decrease plasma hormone levels such as epinephrine, norepinephrine, and corticosterone Alternatively, in their critical review of 40 controlled trials on Ginkgo and cerebral insuf“ciency in humans, Kleijnen and Knipschild (1992) found that only eight trials met criteria of good methodology, with only one showing positive effects compared with placebo on symptoms such as dif“culty concentrating, memory problems, confusion, lack of energy, tiredness, depressive mood, anxiety, dizziness, tinnitus, and headaches Similarly, a more recent meta-analysis of more than 50 articles (Oken et al., 1998) found only four studies (Hofferberth, 600 Complementary and Alternative Therapies 1994; Kanowski, Hermann, Stephan, Wierich, & Horr, 1996; Le Bars et al., 1997; Wesnes et al., 1997) that met the authors• standards for strong research methodology These authors concluded there to be a •small but signi“cant effectŽ of ginkgo biloba extract on cognitive function, such as memory and attention, in patients with Alzheimer•s disease (Oken et al., 1998) Likewise, studies have found ginkgo biloba to improve mild to moderate memory impairment in elderly patients (Rai, Shovlin, & Wesnes, 1991), memory and psychopathology (Hofferberth, 1994), as well as daily living and social behavior (Le Bars et al., 1997) Moreover, consistent with previous reviews, ginkgo biloba was found to have no signi“cant adverse effects Ginseng Ginseng, a popular herb in traditional Chinese medicine, is primarily used for its effects on anxiety, concentration, and physical stress Yun (1996) found Panax ginseng C A Meyer (Korean ginseng) to prevent the development of cancer in mice by inhibiting the proliferation of tumors He has also demonstrated a decrease in the risk of certain types of cancer in 1,987 pairs of humans when ginseng was ingested as a fresh extract or powder, as well as a decrease in the relative risk of cancer in a prospective population-based study of 4,634 adults Ginseng has also demonstrated to improve quality of life among healthy volunteers (Wiklund, Karlberg, & Lund, 1994), as well as improve mood, vigor, well-being, and psychomotor performance in patients with noninsulindependent diabetes mellitus (Sotaniemi, Haapakoski, & Rautio, 1995) Several studies investigating the mechanism of action through which ginseng works demonstrate antinociceptive effects of ginseng on stress-induced mice (H.-S Kim, Oh, Rheu, & Kim, 1992; Takahashi, Tokuyama, & Kaneto, 1992) Other studies suggest ginseng may enhance nitric oxide synthesis (Gillis, 1997), promote cytokine induction (Sonoda et al., 1998), or enhance natural killer cell activity in healthy subjects and in patients with chronic fatigue and acquired immunologic syndromes (Gillis, 1997) Kava Kava, which means •bitterŽ in Polynesian, is derived from a black pepper plant in the South Paci“c called Piper methysticum, or •intoxicating pepper.Ž Kava has been traditionally ingested as a drink, but recently sold in capsule form in health food stores in the United States Explorers• journals have documented the effects of kava for centuries: Kava has a numbing effect on the tongue when drunk, is tranquilizing and relaxing, and has genitourinary antiseptic qualities (Anonymous, 1988) However, too much kava can cause adverse effects such as dermopathy (Norton & Ruze, 1994), a skin condition characterized by scaly skin, gastrointestinal distress, and sleepiness (Cerrato, 1998), or a semicomatose state when it interacts with alprozam (Almeida & Grimsley, 1996) There are few randomized trials investigating the ef“cacy of kava on anxiety The majority of trials that exist are published in German These studies have found kava extract to be superior to placebo and comparable to oxazepam and bromazepam (Volz & Keiser, 1997) A randomized, placebocontrolled study of 101 outpatients with various anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised (DSM-III-R; American Psychiatric Association, 1987) criteria also found kava to be superior to placebo by reducing anxiety and causing fewer side effects (Volz & Keiser, 1997) The psychopharmacology of kava remains unclear Initial hypotheses suggested by investigators include: (a) Kava increases the number of binding sites of GABAA receptors (Jusso“e, Schmitz, & Hiemke, 1994); (b) it modulates the serotonin-1A receptor activity (Walden, Von Wegerer, Winter, & Berger, 1997; Walden, Von Wegerer, Winter, Berger, & Grunze, 1997); (c) it serves as reversible MAO-B inhibitors (Uebelhack, Franke, & Schewe, 1998); or (d) it inhibits NAϩ channels (Magura, Kopanitsa, Gleitz, Peters, & Krishtal, 1997) St Johns’ Wort St Johns• wort (SJW) is an herbal product resulting from the ”owering of the plant Hypericum perforatum L The plant•s oil has been used for centuries as a medicine to heal burns and improve mood Over the past two decades, the pharmaceutical industries have attempted to develop extracts of SJW for more popular and standardized use In Germany, SJW is the most widely prescribed treatment for depression, totaling more than 25% of prescribed antidepressants (Muller & Kasper, 1997) Overall, the research suggests SJW to be ef“cacious in reducing depressive symptoms and to produce signi“cantly fewer side effects as compared to popular antidepressants Studies comparing SJW to placebo have found antidepressive ef“cacy as well as high tolerability for SJW among patients with mild depression (Hansgen, Vesper, & Plouch, 1994; Hubner, Lande, & Podzuweit, 1994; Sommer & Harrer, 1994) SJW has also demonstrated to be as effective as imipramine (Vorbach, Hubner, & Arnold, 1994), maprotiline (Harrer, Hubner, & Podzuweit, 1994), and amitryptiline Other Common Healing Approaches (Wheatley, 1997), yielding a slightly better side effect pro“le Meta-analyses evaluating theses studies have found SJW to be between 1.5 to times more likely to produce an antidepressant response as compared to placebo, and to be equivalent in ef“cacy to tricyclic antidepressants, (see H L Kim, Streltzer, & Goebert, 1999; Linde et al., 1996) Research on the biological mechanisms through which SJW may exert its antidepressant effects suggests that similar to popular pharmaceutical antidepressants, SJW in”uences amine levels The main dif“culty in studying the biological mechanism of SJW pertains to the fact that several active constituents have been identi“ed from H perforatum (Nahrstedt & Butterweck, 1997) including hypericin (Muller, Rolli, Schafer, & Hafner, 1997), and hyperforin (Chatterjee, Bhattacharya, Wonnemann, Singer, & Muller, 1998; Laakmann, Schule, Baghai, & Kieser, 1998; Muller et al., 1997, 1998; Schellenberg, Sauer, & Dimpfel, 1998) Overall, research indicates that SJW may inhibit the synaptosomal reuptake of serotonin, dopamine, and norepinephrine (Muller et al., 1997, 1998; Muller & Rossol, 1994; Neary & Bu, 1999); upregulate postsynaptic serotonin receptors (TeufelMayer & Gleitz, 1997); and interfere with the central dopaminergic system (Butterweck, Wall, Lie”ander-Wulf, Winterhoff, & Nahrstedt, 1997; Franklin et al., 1999) Studies demonstrate that the main advantage to SJW is its more preferable side effect pro“le and tolerability to synthetic antidepressants The most common adverse side effects included gastrointestinal symptoms (0.6%), allergic reactions (0.5%), tiredness (0.4%), and restlessness (0.3%) (Woelk, Burkard, & Grunwald, 1994) In addition, hypericum has been found to be safer with regard to cardiac function than tricyclic antidepressants (Czekalla, Gastpar, Hubner, & Jager, 1997) While SJW appears to be a safe herbal remedy for depression when taken alone, the major danger with SJW seems to lie in its potential for drug interactions Current limitations in the research include lack of •well characterized populationsŽ (Cott, 1997); translation bias (Gaster & Holroyd, 2000); limited research on long-term ef“cacy, safety, and tolerance at various doses (Volz & Kieser, 1997); ef“cacy for severe depression (Gaster & Holroyd, 2000); and ef“cacy as compared to serotonin reuptake inhibitors Summary of Herbal Treatment Research In addition to the herbal remedies highlighted, more than 20,000 herbs are available to the public over the counter For a good review of herbal remedies frequently used in psychiatric practice, refer to Wong, Smith, and Boon (1998) Currently, the Dietary Supplement Health and Education Act 601 (DSHEA) does not require manufacturers to provide data on the safety, purity, and ef“cacy of their products (Wagner, Wagner, & Hening, 1998) Moreover, the Food and Drug Administration (FDA) does not regulate their use or standardize their purity or content (Lantz, Buchalter, & Giambanco, 1999) Therefore, individuals are able to self-prescribe herbs without the guidance of a physician, which may lead to adverse side effects and drug interactions For instance, Lantz et al (1999) discussed several case studies of elderly patients who developed serotonin syndrome (e.g., central and peripheral serotonergic hyperstimulation) from taking SJW in conjunction with their prescribed antidepressant It is important that clinicians appreciate the strength of these herbs and ask their patients about herbal use and educate them on the dangers of herbal and drug interactions Lantz et al also recommends that herbal remedies provide warning labels and that ef“cacy studies be subjected to •the same vigorous standardsŽ as prescription medications as related to ef“cacy and safety While the research suggests ef“cacy of a variety of herbal remedies, further research in required There is a need for studies with (a) larger sample sizes, (b) data assessing participants• ability to distinguish placebo from the herb, (c) better characterization of the active constituents and mechanisms of action, and (d) results on the effects of chronic dosing, side effects, and standardization of preparation Dietary, Nutrition, and Lifestyle Modification Dietary modi“cation has recently become a way for individuals to take an active role in their well-being and a way to prevent the onset of illness or reduce the negative consequences of disease Medical practitioners commonly recommend dietary modi“cation and lifestyle changes as a complement to traditional treatment, rather than as a sole alternative cure Very Low Fat Diets In 1988, the National Cholesterol Education Program (NCEP) published guidelines for the treatment of high cholesterol in adults The guidelines recommend dietary therapy for the lowering of LDL cholesterol (LDL-C) Speci“cally, they recommend an initial diet that includes an intake of total fat less than 30% of calories (National Cholesterol Education Program Expert Panel, 1998) Lichtenstein and Van Horn (1998) conducted a review of the literature on the ef“cacy of a very low fat diet, and reported that while there is •overwhelming evidenceŽ that reductions in saturated fat, dietary cholesterol, and weight are effective in reducing total 602 Complementary and Alternative Therapies cholesterol, LDL-C levels, and cardiovascular risk, the longterm effects remain unclear Macrobiotic Diets Macrobiotics stems from the Greek words macro, meaning large, and bios, meaning life A macrobiotic diet is composed of whole grains and cereals, vegetables (including sea vegetables), fruits, beans, nuts, and seeds A macrobiotic approach underscores social interactions, climate, geographic location, and diet as all-important lifestyle habits to promote well-being and longevity George Ohsawa is considered to be the founder of the macrobiotic diet, and it was popularized in the United States by Michio Kushi Two early studies support the theory that a vegetarian diet results in a signi“cant reduction in blood pressure among patients with hypertension (Margetts, Beilin, Vandongen, & Armstrong, 1986; Rouse, Beilin, Armstrong, & Vandongen, 1983) The use of macrobiotic in treatment of other medical conditions (e.g., cancer) remains controversial and has not been scienti“cally tested Atkins’ Diet In 1972, Robert Atkins published the book Dr Atkins’ Diet Revolution He proposed metabolic imbalance to be the cause of obesity and stated that many of today•s diseases, including diabetes, hypoglycemia, and cardiac disease, are a result of •carbohydrate intoleranceŽ (Atkins, 1972) Atkins proposed that carbohydrates prevent our bodies from ketogenesis, a process by which the body burns fat and turns it into fuel There are no scienti“c studies investigating ketogenic diets for the previously mentioned diseases, and therefore, these diets may be based more on theory than on scienti“c evidence However, ketogenic diets have been investigated for their ef“cacy in managing epilepsy and seizure disorder One study found that 54% of a group of children with intractable seizures who remained on a ketogenic diet reported a decrease in the frequency of their seizures by more than 50% three months after initiating the diet (Vining et al., 1998) Despite such “ndings, there is continued controversy regarding its use Roach (1998) argues that while there is •a clear biochemical rationale and a well-de“ned therapeutic objectiveŽ(p 1404), he urges for more rigorous investigations on safety and ef“cacy Gerson Method Nutrition has become increasingly used, though not necessarily empirically supported, by individuals diagnosed with cancer Max Gerson was a German-born physician who believed that •degenerativeŽ diseases such as cancer, arthritis, and multiple sclerosis are the result of extreme body toxicity Therefore, he advocated a special diet in the treatment of cancer, which included •detoxi“cationŽ of the body, a no-sodium, no-fat, high-potassium, and high-carbohydrate diet, as well as coffee enemas There are few studies investigating the ef“cacy of the Gerson Method; however, those that exist are methodologically ”awed One study (Hildenbrand, Hildenbrand, Bradford, & Calvin, 1995) investigated the ef“cacy of Gerson•s diet therapy with 153 patients diagnosed with melanoma and found the “ve-year survival rate to be 100% for individuals at Stage I and II, 72% for individuals at Stage IIIA, and 41% for individuals at Stage IVA While there was no placebo control group in this study, “ve-year survival rates were signi“cantly higher than the survival rates published in other studies It should be noted that the Gerson Method is highly controversial The American Cancer Society (ACS) reported a lack of evidence of the ef“cacy of the Gerson Method and urged people with cancer not to seek treatment with the Gerson Method (ACS, 1990) The ACS publicly acknowledges that while the dietary measures may have preventive utility, there is no scienti“c evidence than any nutritionally related regimen is appropriate as a primary treatment for cancer (ACS, 1993) Ornish Lifestyle Heart Trial Dean Ornish is well-known for his work with patients with coronary artery disease through vegetarian diet, exercise, and stress management on coronary atherosclerosis The Lifestyle Heart Trial (Ornish et al., 1990), a prospective, randomized, controlled trial of patients with coronary artery disease, demonstrated that this prescribed lifestyle modi“cation resulted in regression on coronary atherosclerosis as evidenced by a decrease in diameter stenosis The study, however, did not investigate the individual contributions of the various interventions (e.g., low-fat vegetarian diet, stopping smoking, stress management training, exercise) to the outcome measure Later studies (Gould et al., 1995; Ornish et al., 1998) investigated a similar lifestyle change program in patients with coronary artery disease over “ve years and found that the size and severity of perfusion abnormalities on dipyridamole positron emission tomography images decreased (improved) after risk factor modi“cation in the experimental group, compared with an increase (worsening) of size and severity in the control group Tactile Therapies Tactile therapies are de“ned as interventions that center on soft tissue or energy mobilization techniques performed by a Other Common Healing Approaches health care provider Such methods can be divided into soft tissue therapies, energy mobilization, and meridian point therapy Soft Tissue Therapies Encompassing a variety of treatment approaches, soft tissue therapies are geared toward decreasing dysfunction in muscles and fascia (i.e., the continuous subcutaneous layer of soft tissue throughout the body) Soft tissue therapies are purported to alleviate somatic organizational dysfunction, thus enhancing both psychological and physical health The goal of massage is to decrease muscular tension using strokes, kneading, and friction techniques Proposed bene“ts of massage include both psychological and physiological relaxation, facilitated ease with breathing, enhanced immune function, reduced anxiety, increased vigor, lessened pain, and improved sleep (Wanning, 1993) Positive effects from massage have been demonstrated in both adult and child populations (Field, Ironson, et al., 1996; Field, Morrow, et al., 1992) In one study, participants with depression and adjustment disorders were randomly assigned to receive a back massage or watch relaxing videos for 30 minutes over a “veday period (Field, Morrow, et al., 1992) Results demonstrated decreased depressive symptoms, anxiety, and salivary cortisol, as well as enhanced sleeping, for the massage group only Aromatherapy, the use of fragrances to augment mood and activity, is often used in conjunction with massage Aromatherapy uses speci“c essential oils from plants for therapeutic use For example, lavender is believed to have calming and analgesic effects, while ginger is deemed to incite stimulating, warming sensations (Jacobs, 1996) In one study, 122 patients in an intensive care unit were randomly assigned to massage, massage with lavender oil, or rest (Dunn, Sleep, & Collett, 1995) Only patients receiving massage with lavender oil demonstrated signi“cantly enhanced mood following intervention Aromatherapy can also be used via bathing, candles, and culinary manners Assessing the effects of aromatherapy ventilated throughout a room, one nonrandomized study demonstrated that depressed patients used less antidepressant medication after being exposed to citrus oils (Komori, Fujiwara, Tanida, Nomura, & Yokoyama, 1995) There are few empirical studies on aromatherapy, and the majority of those conducted use poor control and lack statistical analyses (Martin, 1996) In a review article, Evans (1995) suggests that the paucity of psychometrically sound studies makes it dif“cult to differentiate the bene“cial effects of aromatherapy from attention, social interaction, or the use of massage 603 Reflexology is a soft tissue mobilization centered on the foot This technique is based on the belief that distinct areas of the foot represent different parts of the body By applying pressure to speci“c regions of the foot, the corresponding body structure can be stimulated, promoting a health response For example, the head and sinus regions are mapped in the toes, and massage of the toes is believed to help alleviate headaches and sinus pressure A quasi-experimental study of persons with lung or breast cancer demonstrated positive effects on anxiety and pain following re”exology (Stephenson, Weinrich, & Tavakoli, 2000) Myofascial release and Rolfing are two additional types of soft tissue therapies, both of which are purported to decrease pain and enhance health The purpose of myofascial release is to free restrictions in the myofascial caused by physical or psychological stress using gentle pushing techniques against the client•s skin This technique is used to treat musculoskeletal dysfunction, headaches, chronic pain, and temporomandibular pain (Ramsey, 1997) Rol“ng also attempts to manipulate myofascial constraints, but, unlike myofascial release, it uses the forces of gravity and more vigorous pressure from the practitioner It has been suggested that Rol“ng permits increased muscular ef“ciency, decreases physiological stress on the body, and promotes neurological functioning (Jacobs, 1996); however, scienti“c studies to support these claims are not present in the literature Energy mobilization attempts to alleviate poor physical and psychological health that is said to result from disturbances in a person•s forces of energy For example, therapeutic touch (TT) involves techniques that are aimed at centering awareness and energy in the client Despite its name, this procedure does not necessarily involve direct contact with the client and may consist of the clinician•s hands being held over the areas of needed energy mobilization Some literature supports the ef“cacy of TT For example, the effects of TT in reducing anxiety were assessed in a sample of psychiatric in-patients (Gagne & Toye, 1994) Patients were randomly assigned to TT, mimic TT, or relaxation therapy Results demonstrated signi“cant decreases in anxiety for the TT and relaxation groups, with the former exhibiting greater bene“ts than the latter The group receiving mimic TT demonstrated no signi“cant changes An additional randomized study supports TT as being more effective than •calm touchŽ at decreasing the time necessary to soothe medically hospitalized children between the ages of two weeks to two years (Kramer, 1990) In a randomized study of elderly individuals with arthritis, both TT and progressive muscle relaxation interventions resulted in comparable and signi“cant improvements in pain, tension, and mood (Peck, 1998) However, not all studies support the bene“cial effects of 604 Complementary and Alternative Therapies TT (e.g., Olson, et al., 1997) A literature review and metaanalysis highlights the poor methodology implemented in TT studies but calculated an average effect size of 39 for TT (Winstead-Fry & Kijek, 1999) Reiki, another type of energy mobilization, means •universal life force energy.Ž Whereas TT involves the mobilization of energy in the client•s body, Reiki entails transferring or mobilizing energy from the clinician to the client It is based on the concept that all living creatures possess energy and that the human body is programmed to heal itself Practitioners of Reiki report positive effects of this technique on mood, psychological distress, pain, and functional abilities, but these results are based on patient case history reports A similar energy-based approach, polarity therapy, is based on the concept that the body holds an electromagnetic force, with a positive charge located cephalically and a negative charge situated toward the toes The clinician•s hands are believed to be conductors of energy When they are placed in certain areas of the client•s human energy “eld, the clinician attempts to facilitate energy movement in the client•s body This facilitation is believed to enhance energy ”ow and relaxation throughout the mind and body Scienti“c studies regarding its ef“cacy are absent Movement Therapies Movement therapies are complementary approaches to health that emphasize changes in the client•s bodily positions Leisure activity (e.g., casual walking) has been demonstrated to buffer anxiety in the face of stressors (Carmack, Boudreaux, Amaral-Melendez, Brantley, & de Moor, 1999) Active perimenopausal women reported less psychosomatic symptoms (e.g., irritability, headaches) and fewer sexual problems than those who were more sedentary (Li, Gulanick, Lanuza, & Penckofer, 1999) Some literature exists supporting the psychological bene“ts of aerobic exercise Correlational studies predominantly endorse positive psychological health in people who participate in aerobic exercise One study assessing more than 3,400 participants found that those who engaged in exercise two or more times each week reported less depressive symptoms, anger, cynical distrust, and stress compared to those exercising less or not at all (Hassmen, Koivula, & Uutela, 2000) This former group also reported a greater sense of social integration and perceived health Similarly, meta-analytic reviews revealed that those who exercise are signi“cantly less likely to be depressed (Craft & Landers, 1998) and to report distress (Crews & Landers, 1987) However, other meta-analyses demonstrate little (i.e., only one-half standard deviation; North, McCullagh, & Tran, 1990) or no (e.g., Schlicht, 1994) difference in psychological distress between exercisers and nonexercisers Intervention studies provide stronger evidence for the psychological bene“ts of aerobic exercise regarding psychological distress One study randomly assigned participants with dysphoric mood to cognitive therapy, aerobic exercise, or a combination of these two interventions over a 10-week period (Fremont & Craighead, 1987) Although no signi“cant differences were noted between the groups, all three demonstrated signi“cant decreases in depressive symptoms Similarly, older patients with major depressive disorder were randomly assigned to aerobic exercise (3 times per week), antidepressant medication (sertraline hydrochloride), or both for 16 weeks (Blumenthal et al., 1999) Results demonstrated all three groups signi“cantly improved on measures of depression, anxiety, self-esteem, life satisfaction, and dysfunctional attitudes from pre- to posttreatment, but no differences were noted between the groups following intervention Those receiving antidepressant medications did, however, demonstrate quicker enhancement of mood compared to those participating in aerobic exercise only A meta-analytic study demonstrated the effects of rehabilitative exercise programs on anxiety and depression in patients with coronary disease (Kugler, Seelbach, & Kruskemper, 1994) Speci“cally, exercise resulted in moderate decreases in both anxiety and depressive symptoms and did not differ signi“cantly from psychotherapy Similarly, breast cancer survivors randomly assigned to exercise or exercise plus behavior modi“cation demonstrated comparably signi“cant decreases in depressive symptoms and anxiety (Segar et al., 1998) The waitlist control (WLC) group in this study did not initially exhibit such declines in distress However, following the waiting period, those participants in the WLC who partook in the exercise program also exhibited signi“cantly diminished anxiety and depressive symptoms In addition to aerobic exercise, resistance exercise (e.g., weight lifting) has also demonstrated bene“cial effects on health (Tsutumi et al., 1998) Fox•s (1999) review of the literature on exercise and mental health supports the following conclusions: Exercise (a) is an effective treatment for clinical depression; (b) decreases state and trait anxiety; (c) enhances self-perceptions and, perhaps, self-ef“cacy; (d) improves mood; and (e) may improve cognitive functioning, especially in older adults Possible mechanisms of action may be in the physiological (e.g., release of endorphins), psychological (e.g., diversion, improved self-image), and/or social (e.g., social interactions, receiving attention) domains Other Common Healing Approaches Yoga incorporates exercise, static poses, breathing, relaxation, and meditation (Jacobs, 1996) The purpose of yoga is to •centerŽ the person•s mind, body, and spirit Speci“c hypothesized bene“ts include improving muscular and cardiovascular endurance, boosting the immune system, enhancing circulation, increasing muscular and cognitive ”exibility, and relaxation Yoga is often used as complementary therapy for medical disorders such as asthma, arthritis, HIV/AIDS, cancer, and coronary artery disease While there are several different types of yoga, Hatha yoga is most frequently practiced in the West Hatha yoga combines stretching, breathing, relaxation, and meditation (Wanning, 1993) Research supports positive bene“ts of practicing yoga Patients with epilepsy were randomly assigned to true yoga, sham yoga (i.e., similar but distinct postures), and a nontreatment control group (Panjwani, Gupta, Singh, Selvamurthy, & Rai, 1995) Decreases in galvanic skin response, as an indicator of sympathetic nervous system activity, were noted in the true yoga group only Another study compared yoga, relaxation (i.e., progressive muscle relaxation), and visualization in a group of healthy adults (Wood, 1993) Participants practiced for six, 25- to 30-minute sessions over a two-week period Following intervention, the yoga group reported increased mental and physical energy, alertness, and positive mood These bene“ts were signi“cantly greater than the other two groups The relaxation group was more tired and sluggish compared with yoga, and the visualization group reported more sluggishness and less contentment compared to those performing yoga Additionally, yoga has been integrated into cardiac rehabilitation programs (Ornish et al., 1998) Additional movement therapies conjectured to enhance mind and body health include the Alexander technique and Feldenkrais The Alexander technique is based on the concept that poor posture produces functional problems in the mind and body Those practicing this technique strive to work with unconscious thoughts and to correct poor postures, especially centered on the head, neck, and back One uncontrolled study investigated the effects of the Alexander technique on patients with Parkinson•s disease (Stallibrass, 1997) Following a series of lessons (mean number ϭ 12), participants demonstrated decreased depressive symptoms and increased functional abilities Similarly, Feldenkrais’ functional integration is based on the premise that pain and decreased movement are caused by poor usage patterns The goal of this movement therapy is to develop •freedom through awarenessŽ via •re-educatingŽ motor components by using slow, purposeful movements As a result, the body and mind are hypothesized to relax, 605 permitting ease with movement, thinking, and feeling One randomized controlled study investigating Feldenkrais movement was identi“ed (Johnson, Frederick, Kaufman, & Mountjoy, 1999) In this study, patients with multiple sclerosis participated in true or sham Feldenkrais sessions Only those participants in the true Feldenkrais intervention reported less perceived stress and anxiety Expressive Therapies Expressive therapies include techniques designed to increase the person•s awareness and expression of emotions Written emotional disclosure refers to writing about thoughts and feelings regarding a stressful or traumatic event This type of expressive therapy has consistently demonstrated positive effects on psychological well-being, mood, and physiological and general functioning (Smyth, 1998) Specifically, written emotional disclosure has resulted in greater positive mood, less negative mood, decreased anxiety, fewer somatic complaints, and less frequent physician visits for both students and unemployed adults (Greenberg & Stone, 1992; Pennebaker, 1993; Pennebaker, Colder, & Sharp, 1990) With regard to medical populations, patients with rheumatoid arthritis (RA) and asthma were randomly assigned to write about either stressful experiences or a neutral topic (Smyth, Stone, Hurewitz, & Kaell, 1999) Four months following intervention, those in the former group demonstrated signi“cant health bene“ts not gleaned from the group writing about neutral events Speci“cally, patients with RA demonstrated improvements in overall disease activity, while those with asthma demonstrated improved lung function Furthermore, 47% of those writing about stressful events, compared to 9% in the other group, demonstrated clinically signi“cant improvements Positive mood and enhanced physical function were also noted in another study in a group of patients with RA (Kelley, Lumley, & Leisen, 1997) Similar to the previous study, only participants randomly assigned to disclose stressful events (this time via verbal means) gained psychological and physical bene“ts, while those randomly assigned to discuss a neutral topic showed no psychological or physical health bene“ts Dance movement therapy (DMT) attempts to promote expression and reduce tension through movement It has been prescribed in the clinical literature to help treat children and adults with behavior problems or expressive dif“culties DMT is believed to help decrease negative effects of stress (e.g., tension, fatigue) by gaining a sense of control through (a) the spiritual aspect of dance, (b) moving (e.g., increased 606 Complementary and Alternative Therapies circulation), (c) distraction from stress, and (d) confronting stressors by projecting them in dance (Hana, 1995) While there are intervention studies investigating the bene“ts of DMT for patients with a range of psychological symptoms (Brooks & Stark, 1989; Stewart, McMullen, & Rubin, 1994), most were conducted with poor methodological control Music therapy (MT) involves the active or passive use of music to enhance health and express emotions (Achterberg et al., 1994) It has been used with adults and children who exhibit cognitive and affective de“cits In addition, patients with physical disabilities and chronic mental illness were reported to bene“t from MT (Achterberg et al., 1994) A review of the literature provides support for the use of MT to decrease anxiety associated with speci“c events (i.e., surgery and medical procedures) in some populations (i.e., cardiac patients and premature neonates; Snyder & Chlan, 1999; and patients with asthma; Lehrer et al., 1994) With regard to depression, one study observed the impact of elderly patients who were randomly assigned to either home-based MT, self-administered MT, or waitlist control (WLC) over an eight-week period (Hanser & Thompson, 1994) Results demonstrated both MT groups achieved a greater decrease in depression than those on the waitlist, and these bene“ts were maintained at a nine-month follow-up assessment Art therapy entails using drawing, painting, or sculpting to express oneself and increase self-awareness (Achterberg et al., 1994) Art therapy has been connected with mental health since the 1800s Few empirical studies have been conducted investigating the ef“cacy of art therapy as a treatment for speci“c medical or psychological disorders However, Anand and Anand (1997) discussed the bene“ts gleaned from art therapy in patients following laryngectomy Speci“cally, art therapy reportedly served as an adjunct assessment and treatment tool for patients who experience depression, anxiety, grief, and concern regarding physical appearance Mind/Body Therapies Complementary and alternative therapies categorized as mind/body interventions have often been derived from decades of psychological and behavioral science They are discussed in other chapters of this volume with regard to their ef“cacy in treatment of psychological and physical syndromes, such as pain, that are associated with various medical disorders These include many cognitive and behavioral interventions such as relaxation training, guided visualization, cognitive restructuring, behavior modi“cation, self-instructional training, stress inoculation training, prob- lem solving, anger management, and psychoeducation, as well as other psychological interventions such as hypnosis and supportive group counseling When employed to reduce psychological distress (e.g., anxiety and depression), to manage stress, or to treat a range of other behavioral disorders, many of these therapies are well-tested and thus considered standard approaches to treatment For example, many clinical interventions falling under the rubric of cognitive-behavioral treatment have been documented through numerous studies, reviews, and texts as effective for a wide range of psychological and behavioral problems (Beutler, Harwood, & Caldwell, 2001) Many are listed as empirically validated techniques Cognitive-behavioral therapies are markedly present among the list of empirically supported psychotherapies (Chambless & Hollon, 1998) When the focus of such therapies is on the reduction of medical symptoms and disease, their use may be viewed as alternative or complementary, because they have not been traditionally prescribed or employed in a medical context However, as many of the chapters in this volume indicate, mind/body strategies have shown promise as potentially effective strategies that can alter the occurrence, course, or management of medical syndromes Additionally, their potential effectiveness regarding many medically unexplained symptoms has been suggested (A M Nezu, Nezu, & Lombardo, 2001) This is particularly relevant with regard to the large percentage of individuals who seek medical care each year from their primary care physicians, in which there exists no identi“able underlying medical disease that can explain the persistent experience of certain physical symptoms (A M Nezu et al., 2001) Recent reviews concerning other interventions such as hypnosis have also shown promise as both alternative and complementary interventions for medical disorders such as obesity, insomnia, hypertension, asthma, irritable bowel syndrome, and dermatological disorders (Nash, 2001) Are all complementary and alternative therapies mind/ body? As traditional psychological interventions are more frequently applied to both medical and psychological parameters of disease, and as other complementary and alternative treatments described earlier in this chapter gain wider public attention and acceptance, the dichotomous line between medical and nonmedical symptoms, disorders and treatments can be rapidly blurred As such, the concept of mind/body therapies to maintain health and heal disease can be expanded to include almost all interventions based on the understanding that such conditions represent an interaction of physical, psychological, emotional, and spiritual factors Most of the interventions described in this chapter are •mind/bodyŽ therapies References COMMON THEMES From a health psychology perspective, several important themes emerge that concern the shared characteristics of alternative and complementary treatments in the context of an expanded mind/body rubric These include: A biopsychosocial model, which incorporates biological, immunological, psychological, spiritual, interpersonal, and environmental variables, characterizes an underlying mind/ body philosophy of most complementary and alternative approaches Psychological wellness is viewed as a critical component of health regarding most of these therapeutic systems Many psychological interventions, such as cognitive-behavioral therapy, group therapy, and hypnosis, may provide strategies that increase psychological well-being and decrease distress A holistic, individualized case assessment approach is a common method of diagnosis and treatment Although each healing approach may vary in the methodology, such as use of the interview, physical exam techniques, or tests that are administered, there is a marked tendency to design treatment speci“c to the individual case formulation rather than rely on a standard prescription or dosage strategy The underlying philosophy on which many complementary and alternative interventions are based view health as a state of harmony and energy balance, wherein the physical, emotional, mental, and spiritual aspects of energy are all given signi“cant weight and seen as interrelated Treatment ef“cacy is most often associated with stressrelated disorders and those diseases that have been etiologically linked to cognition, behavior, and lifestyle This covers a wide range of what have been historically considered medical disorders, such as cardiac problems, diabetes, immune functioning disorders, asthma, pain syndromes, and gastrointestinal disorders FUTURE DIRECTIONS Integration of Psychological Interventions and Complementary and Alternative Therapies Because psychological health is considered such an integral part of most complementary and alternative approaches, there is wide applicability for psychological interventions to be delivered in conjunction with these approaches as part of an overall health maintenance strategy Particularly helpful in this regard would be the widespread provision of psychoeducation and promotion of a biopsychosocial model, so that 607 patients can learn to view psychological interventions as part of a comprehensive treatment, rather than an indication that health providers have labeled them as •crazyŽ or diagnosed their problem as •all in their head.Ž Additionally, psychological interventions speci“cally shown to be ef“cacious with comorbid symptoms of anxiety and depression, which occur with high prevalence in patients with diagnosed dif“culties such as cancer or heart disease, can be integrated with ongoing treatment aimed at the cancer itself A Decision-Making Problem Because of the wide choice of treatments available, individuals who are interested in pursuing a more holistic approach to their health and incorporating complementary and alternative approaches are faced with the daunting task of sorting through myriad information Media and technology have made available to the general public both the access and marketing of information concerning a wide range of health choices possible Thus, when faced with a disease diagnosis, people are in the position of choosing from competing philosophies, therapies, and providers Such decisions are dif“cult enough„when compounded by the emotional impact of an illness, a person•s decision making can be further impaired (A M Nezu, Nezu, Friedman, Faddis, & Houts, 1998) Training patients in decisionmaking strategies, such as social problem-solving skills, as a way of coping with the many decisions they must confront may serve as a particularly useful intervention in this regard Problem solving, de“ned by D•Zurilla and Nezu (2001), is a •self-directed cognitive-behavioral process by which a person attempts to identify and discover effective and adaptive solutions for speci“c problems encountered in everyday livingŽ (p 212) Findings from a variety of studies have provided support for problem-solving therapy as a potent intervention to reduce stress, increase quality of life, and perhaps most germane to this discussion, increase sense of self-ef“cacy and con“dence in making decisions (A M Nezu et al., 1998) Training patients in such skills can increase the likelihood that patients will become active partners with their various health care providers, deriving maximum bene“t from the range and combination of treatment alternatives available REFERENCES Abenhaim, L., & Bergeron, A M (1992) Twenty years of randomized clinical trials of manipulative therapy for back pain: A review Clinical and Investigative Medicine, 15(6), 527…535 ... Health Psychology 160 High-Risk Work Environment, Good Results 140 120 100 80 60 40 20 Blue Collar (143 Clients) Aug-00 Jun-00 Apr-00 Feb-00 Dec -99 Oct -99 Aug -99 Jun -99 Apr -99 Feb -99 Dec -98 Oct -98 ... Blane, 199 8; Lynch, Kaplan, & Shema, 199 7; McDonough, Duncan, Williams, & House, 199 7) and early life experiences (D Barker, 199 5; Peck, 199 4; Rahkonen, Lahelma, & Huuhka, 199 7) are predictive of. .. outcomes (Kington & Smith, 199 7; Lillie-Blanton & Laveist, 199 6; NCHS, 199 8; Schoenbaum & Waidmann, 199 7; Schoendorf, Hogue, Kleinman, & Rowley, 199 2; D Williams, 199 6) A number of hypotheses have been
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