Complementary and Integrative Health (CIH) – What Nurses Should Know
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“The future of mental health is innovative care models that support the integration of conventional and complementary and integrative health (CIH) treatments. As evidence for the benefits of CIH grows, there’s going to be even greater patient demand. Providers need to be knowledgeable, informed, and open-minded.”Dr. Elena Geiger-Simpson, Clinical Assistant Professor, University of Minnesota School of Nursing
According to 2012 data from the National Center for Complementary and Integrative Health (NCCIH), more than 30 percent of adults and 12 percent of children use alternative or complementary treatments. Such treatments generally fall into three categories: nutritional, psychological, or physical interventions.
But the territory is vast: yoga, meditation, tai chi, mindfulness, vitamins, dietary supplements, music, and dance can all qualify as complementary or alternative treatments, and function as a part of integrative health.
It’s important to distinguish between the terms alternative, complementary, conventional, and integrative, though they overlap. The NCCIH defines an alternative treatment as one used instead of conventional medicine; if it’s used together with conventional medicine, it’s considered complementary. Integrative health brings the two terms together, emphasizing multimodal interventions that consider the whole patient.
Complementary and integrative health (CIH) treatments have an important role to play in the future of mental health. But this is not an area without risks. To learn more about the benefits, dangers, and future of alternative treatments in mental health, read on.
Meet the Expert: Elena Geiger-Simpson, DNP, PMHNP-BC
Dr. Elena Geiger-Simpson is a clinical assistant professor at the University of Minnesota School of Nursing. She earned her DNP from the University of Minnesota. As part of her role, she mentors, advises, and precepts DNP students. She also holds a certificate in integrative therapies and healing practices.
Dr. Geiger-Simpson has presented on a wide variety of topics related to psychiatry and mental health at nursing symposiums and conferences. In 2021, she received the DAISY Exceptional Mentor Award. She is a member of the Integrative Health and Healing (IHH) Knowledge Representation Research Team at UMN.
The Benefits of Alternative or CIH Treatments in Mental Health
“In recent years, there’s been more recognition around the limitations of conventional treatments,” Dr. Geiger-Simpson says. “There’s also been more openness to integrative approaches. Patients are asking about them, and many are already using them.”
Complementary and integrative health (CIH) treatments have grown in popularity recently, but they are by no means new. Treatments related to Ayurveda and Chinese medicine date back thousands of years. And classification as an alternative treatment doesn’t necessarily make it less effective than conventional Western medicine: cognitive behavioral therapy (CBT) was once considered a form of alternative medicine, and is now firmly in the mainstream.
“CIH in mental health may provide a wide array of benefits,” Dr. Geiger-Simpson says. “Conventional medicine doesn’t always fully resolve a patient’s symptoms, and CIH interventions can offer more choice for the patient.”
CIH treatments may improve a person’s mood, energy, and sleep cycle. They may decrease anxiety. Treatments that fall under the physical and psychological categories, in particular, tend to have fewer side effects than conventional pharmacological interventions for mental health issues.
Some treatments may help reduce side effects of other medications, or reduce the number of medications a person needs to take. They may even have positive side effects for a person’s overall health and well-being, stretching beyond simply addressing a specific mental health diagnosis.
“Integrative approaches may also provide a patient with greater self-efficacy in managing symptoms,” Dr. Geiger-Simpson says. “They can feel better equipped as a result, building lifelong coping skills and tools.”
The Dangers of Alternative or CIH Treatments in Mental Health
Unfortunately, for every effective alternative treatment, there are many more ineffective ones. There have been relatively few randomized controlled trials, particularly in alternative psychiatric modalities. Altogether, research regarding alternative treatments still needs to be more comprehensive, or as rigorous, as it is with conventional treatments; that research gap forms the main boundary between their classifications.
Just as with conventional treatments, alternative treatments come with risks. Dietary supplements, in particular, may have adverse interactions with pharmaceuticals or other supplements; furthermore, a lack of standardized regulation means patients don’t always know what dose or potency they’re getting. Supplements can also impact disease processes or put patients at risk of dangerous side effects. These supplements are sold over the counter or endorsed online, which may provide a false sense of security.
“There is a lot of misinformation out there,” Dr. Geiger-Simpson says. “Natural does not equal safe. When considering CIH treatments in mental health, nurses and patients need to weigh the benefits, the risks, and the available evidence.”
Another concern is patients who veer too far into alternative treatments, to the point that they eschew conventional interventions. Some mental health conditions still require conventional, evidence-based medications; avoiding them in pursuit of ‘natural’ remedies can cost patients time and money while worsening their symptoms and delaying recovery.
Mental health providers need to ask, not expect their patients to tell them about any alternative treatments they use. A 2013 study found that most psychiatric patients do not disclose their use of complementary and alternative medicines to their healthcare providers, largely because they think those healthcare providers wouldn’t be interested in or knowledgeable about the subject. But a lack of communication about the topic can have its own adverse effects, negatively impacting care.
“We can’t make assumptions,” Dr. Geiger-Simpson says. “Providers should be open and collaborative in treatment planning, incorporating the patient’s preferences as long as they are ethical, legal, safe, and minimize risk.”
The Future of Alternative or CIH Treatments in Mental Health
The future of alternative and CIH treatments for mental health is an exciting, experimental place. New connections are being explored in psychedelic-assisted therapy, in the relationship between mental health and gut health, and in the power of mindfulness and meditation.
More research is needed, both in experimental alternative treatments and in contemporary ones. The results of that research can contribute to reducing misinformation in the public and a broader awareness within the medical community. As adoption increases and providers collaborate on complementary interventions, insurance providers should extend reimbursement to cover evidence-based treatments, making them more affordable and accessible.
“The future of mental health is innovative care models that support the integration of conventional and CIH treatments,” Dr. Geiger-Simpson says. “As evidence for CIH grows, there’s going to be even greater patient demand. Providers need to be knowledgeable, informed, and open-minded.”
Additional Resources on Alternative or CIH Treatments in Mental Health
To learn more about the benefits, risks, and future of alternative treatments in mental health, check out some of the resources below.
- Complementary Therapies for Clinical Depression: An Overview of Systematic Reviews (BMJ 2018)
- Contemporary and Alternative Medicine for Mental Health (MHA 2016)
- Expecting the Unexpected: When Use of Complementary Alternative Medicine Goes Wrong (AJP 2020)
- National Center for Complementary and Integrative Health (NCCIH)
- Psychedelic-Assisted Therapy: Emerging Treatments in Mental Health Disorders (Am J Nurs 2021)