My introduction to alternative therapies came when I graduated from medical school in 1977 with high grades and a disappointed outlook on medicine. I decided to drop out and live on the road in a van. Actually, my plan was to drive to Peru to climb mountains and explore the jungle.
In a Peruvian frontier town, I hired an indigenous man with a dugout canoe and an outboard motor to take me into the jungle. When the engine broke and we needed help with repairs, we were greeted on the trail by angry men with machetes from a local clan.
After a test of my sincerity and manhood, I was introduced to the shaman of the clan. I witnessed him journeying to other planes of reality to bring energy to his suffering clients. Most of them got better, but not the children with intestinal parasites. This was the only time I told anyone on my trip I was a doctor. I told the shaman I would like to give the sick children antihelminthics (i.e., antiparasitic medication) and rather than being offended, he was overjoyed. He said his medicine was not strong enough, but mine might be.
His humility and common sense hit me like a lightning bolt. There is a place for Western medicine in healing, I concluded. Being in the jungle with an indigenous healer who was open to the use of Western medicine helped me realize that medicine could play an important role in a mindfully constructed healing plan. Although medicine taken when not needed can interfere with healing and can be unnecessarily harmful, medicine taken when it is needed can help restore natural healing and it can save lives. In that moment, the shaman healed my ambivalence about Western medicine. I could see there was a way to bring holistic healing and medicine together.
My mission since my “aha” moment with the shaman has been to relieve suffering by promoting the natural flow of healing by using conventional as well as alternative or holistic approaches. Along the way, I have personally experienced many healing approaches as I have sought healing for myself from adversity and trauma earlier in life. I have also studied various healing approaches, all with an eye trained on studies showing positive outcomes. I only recommend a healing approach if there is scientific evidence that it can do some good.
I use the term “healing guidance” because that is what effective alternative therapies do—they guide the flow of healing. In the hands of skillful and well-trained therapists, incredible gains can be made without using medicine. I am interested in alternative methods of healing because I am interested in anything that may help relieve suffering by promoting the natural flow of healing. In addition, there is scientific evidence that many alternative therapies work very well.
The natural flow of healing can be accomplished with the conscious guidance of healing through counseling and psychotherapy, with body and energy work (i.e., acupuncture, therapeutic massage, yoga therapy), and with spiritual guidance such as Twelve Step programs, pastoral counseling, and shamanic healing.
Let us take a look at a few of the approaches some may consider alternative. I have divided them into three categories: conscious guidance, body and energy work, and spiritual guidance.
Psychotherapy is a form of conscious guidance, and while some forms of psychotherapy are now considered mainstream, others may still be considered alternative. Most types of psychotherapy have been shown to be effective.
In a sixteen-week study of the treatment of moderate to severe depression, antidepressants were compared to cognitive behavioral therapy (CBT; DeRubeis et al., 2005; Hollon et al., 2005). After sixteen weeks, 57.5 percent of the people treated with medicine had a good effect compared to 58.3 percent of those treated with therapy. In this study, therapy was just as good as medicine after four months.
The researchers went a step further. After the four months of treatment, they stopped treatment with both medicine and therapy. Then they went back one year later to see how the subjects were doing. Of those who had taken medicine, 76 percent had relapsed into clinical depression at the one-year mark. Of those who had received psychotherapy, only 31 percent relapsed (Hollon et al., 2005). The psychotherapy group did more than twice as well as the medicine group, showing that therapy had a lasting effect while medicine did not.
Sometimes considered an alternative approach, eye movement desensitization reprocessing (EMDR) can make fast and measurable improvements in distress caused by trauma.
EMDR has been the subject of considerable scrutiny. Some clinicians are thrilled with it, and others think it is no better than the methods used in standard CBT—that is, using relaxation techniques and positive thoughts about yourself—to work through past traumas.
Most studies have shown EMDR to be as effective as or more effective for trauma resolution than general supportive therapy (Bradley, Greene, Russ, Dutra, & Westen, 2005). Doing some EMDR work parallel to the work being done in psychodynamic psychotherapy can help dissolve trauma while ongoing therapy continues.
Childhood trauma usually responds less effectively than adult trauma to any type of treatment, including EMDR (van der Kolk et al., 2007). Trauma that happened long ago, especially in childhood, tends to be more hardened than more recent trauma. For this reason, EMDR sometimes takes longer or has to be repeated more often for childhood trauma than for adulthood trauma.
Body and Energy Work
Body and energy work is a tale of two anatomies. Although there is considerable overlap, energy work primarily engages meridians and chakras, while body work primarily involves muscles and bones. Both sets of anatomies have a long history of study, with detailed descriptions dating back thousands of years. To call such approaches “alternative” defies their very long record of effectiveness.
Therapeutic massage has been used around the world since about 2500 BC to treat many conditions. Today those conditions include anxiety and depression. Students of therapeutic massage become acquainted with both physical and energy anatomies. Although most of their work is with muscles and bones, some of what they do involves acupressure (meridians) and positioning (chakras). Most massage therapists spend their time working to release tight muscles, but many are also capable and knowledgeable energy healers.
Routine massage therapy can be just as effective as psychotherapy for depression and anxiety. In a 2004 meta-analysis, thirty-two studies were reviewed on the effectiveness of massage therapy for depression and anxiety (Moyer, Rounds, & Hannum, 2004). They found that even with a single massage session, 64 percent of the participants achieved a significant reduction of both anxiety and depression. When the subjects returned for multiple massages, 77 percent of the participants had a substantial decrease in anxiety, and 73 percent had a substantial reduction of depression. The results were comparable to the benefits of psychotherapy (Moyer et al., 2004). Even in the absence of trauma release, routine massage therapy can play a powerful role in helping the mind to heal.
Energy work uses the anatomy of meridians and chakras; streams; and collections of energy called qi—also spelled chi and pronounced “chee”—that flow in and around the physical body. Qi is also known as vital force, life force, or life energy (Flowers, 2006). It is the precious energy of life that keeps people going. Long ago in the East, many practitioners thought it more important to work directly with vital energy rather than tinker with the body. They created detailed drawings and descriptions of energy anatomy and described how it must remain open and flowing in order to maintain good health.
More than three thousand studies have been conducted on the effectiveness of acupuncture (Colquhoun & Novella, 2013). The studies that have focused on acupuncture for depression have been mixed, but generally favorable. One study (Ernst, Lee, & Choi, 2011) showed insufficient evidence that acupuncture helps depression, while another showed it to be helpful (Zhang, Chen, Yip, Ng, & Wong, 2010). A review of eight well-constructed studies showed acupuncture to be an effective treatment for depression (Wang et al., 2008). Another review of thirteen studies shared that acupuncture combined with antidepressants had a significantly better outcome than using antidepressants alone (Chan, Lo, Yang, Chen, & Lin, 2015).
Numerous research studies have shown that acupuncture can help reduce anxiety. In a very large review of many studies, researchers concluded that plenty of evidence supports the effectiveness of acupuncture for anxiety. Acupuncture was shown to be just as effective as CBT in a comparison study (Errington-Evans, 2012).
Acupuncture also did as well as CBT in a study comparing the two treatments for posttraumatic stress disorder (PTSD; Hollifield, Sinclair-Lian, Warner, & Hammerschlag, 2007). In the study, the people who received acupuncture did just as well as those who received CBT. The positive effect remained when people were checked again three months after their treatments. This suggests that acupuncture, like psychotherapy, may have lasting results. Acupuncture and psychotherapy both have this advantage over medication.
Aside from being a pleasant social activity and a good workout for the body, yoga is good for the mind. It is increasingly recognized as a therapeutic technique.
Traditional yoga involves an energy system comprising seven primary chakras or energy centers. They are located roughly from the base of the spine, up to the forehead (i.e., the “third eye”), and on the crown of the head. When chakras are aligned, opened, and flowing freely, life energy is helping to heal illness and keep the body healthy.
Practitioners, called “yogis,” describe great physical, emotional, and spiritual benefits in health and energy.
Just as there are many types of psychotherapy, there are many schools of yoga. Most of them benefit the mind
as well as the body. Three aspects of yoga have recently been shown to have therapeutic benefit for the mind beyond what would be expected from exercise and meditation.
Iyengar yoga, named after B. K. S. Iyengar, is a form of yoga that enhances strength, flexibility, and balance mainly with asanas (body postures) and pranayama (breath control). It was studied as a therapeutic technique in a group of depressed people who had only a partial response to their antidepressant medication. Of the seventeen people who completed the classes, eleven had complete remission of their depression. Yoga was thus demonstrated as an effective therapy for depression (Shapiro at al., 2007).
In another study, shavasana was used with depressed university students (Khumar, Kaur, & Kaur, 1993). Shavasana is an asana (i.e., body posture) sometimes called “corpse pose.” To perform shavasana, you lie on your back with your arms at a forty-five-degree angle. You close your eyes and breathe slowly and deeply. You scan your body for tense muscles and relax them. You then rid yourself of thoughts as you become aware of your breathing and enter a deeper state of mind. The university students did well with it. Every one of them experienced reduction of depression compared to a group of control students who did not regularly perform shavasana.
Sudarshan Kriya Yoga (SKY)
Sudarshan Kriya yoga (SKY) is a yogic breathing practice that uses various types of cyclical breathing patterns. SKY has been taught to more than 6 million people worldwide. In Western science terms, it appears to reduce depression by stimulating the vagus nerve—in addition to reducing anxiety, direct vagus nerve electrical stimulation has been found to help treat depression.
It has also been suggested that SKY releases hormones like oxytocin that produce feelings of well-being. SKY has been shown to reduce cortisol (the stress hormone) levels and raise serum brain-derived neurotrophic factor (BDNF) levels; elevated BDNF levels correlate with relief of depression (Janakiramaiah et al., 2000).
In a remarkable SKY study involving severely depressed people, yoga was compared to electroconvulsive therapy (ECT) and to imipramine, a powerful antidepressant. ECT did best, with 93 percent of people achieving remission of depression (i.e., becoming symptom free). The imipramine group came next at 73 percent. The big surprise was that the SKY group achieved 67 percent remission without any other treatment (Janakiramaiah et al., 2000).
I do not recommend that people count on SKY alone for a severe case of depression, but it might help boost the effectiveness of whatever else they are doing.
SKY has also been helpful for stress-related anxiety, depression, and insomnia following trauma. It has been used successfully for people experiencing these symptoms after wars, earthquakes, floods (the 2004 Southeast Asia tsunami), terrorism (the 9/11 attacks), and hurricanes (Katrina in New Orleans).
Some choose to deepen their spiritual practice within the guiding structure of a religion. Others choose a Twelve Step recovery program, nonreligious prayer sessions, or the help of a shaman or a psychic healer. Plenty of evidence suggests that deepening your spiritual practice will help you on the path of healing. I have known people who declare themselves atheists and nonetheless have rich spiritual lives. Some of them commune with nature and others achieve transcendence by meditating and being in the moment. Whatever your spiritual path may be, following it is likely to heal anxiety or depression.
Prayer Helps Healing
Plenty of evidence shows that prayer and participation in religious or other spiritual practices speed healing. Well over one thousand scientific studies have shown a strong link between prayer and health (Dossey, 1997). Twenty-three research studies on “distant healing” (i.e., prayer without touching the person) were reported in the Annals of Internal Medicine (Astin, Harkness, & Ernst, 2000). Thirteen of those studies (57 percent) showed “statistically significant treatment effects”—in other words, a positive effect from prayer. These results are superior to those in many studies of psychiatric medications.
Dawson Church, a psychologist and author of The Genie in Your Genes (2009), summarized the results of many studies: “In order for prayer and intentionality to be powerful, it must be deeply (personally) and sincerely engaged.”
As you might expect, prayer works best when you really mean it. A group of sociologists explored the idea that the power of prayer affects people’s degree of personal engagement. They demonstrated that the nature of people’s
relationship to theirs idea of God has a strong bearing on the outcome, showing that having a kind, loving God results in greater relief of anxiety than having an angry, vengeful one.
Psychologist Lisa Miller and her colleagues reported in The American Journal of Psychiatry the results of a remarkable ten-year study of religion and depression (Miller et al., 2012). Miller and her colleagues studied people who were at high risk of developing depression because of having a strong family history. In the study, they found a 90 percent reduction in risk if people reported that religion or spirituality was highly important to them. Simply attending religious services was not enough, however. Those who attended religious activities but did not feel a strong spiritual connection did not derive the same benefit. A high, personal importance placed on spirituality was needed for protection against a likely case of inherited depression.
After meeting that shaman in the Peruvian Amazon and watching him in action, I became intrigued. What was he doing during his ceremonies? Many of the people I saw while I was there complained of depression. He seemed to help them, and I became interested.
Shamanism is the oldest and the longest continuously practiced form of spiritually guided healing on our planet. Cave drawings greater than thirty thousand years old depict shamanic healing ceremonies. The rhythmic percussion of a rattle can help shamans self-induce a trance state. They then journey in a nonordinary reality to find power animals and spirits to help heal their suffering clients. Actions by shamans that may seem purposeless actually engage a complex inner world. During a shamanic trance, shamans are seeking and bringing healing energy to stricken patients (Harner, 1990).
To this day, shamanism is practiced worldwide. If you have ever been in a drumming or chanting circle, you may have experienced a degree of transport into a mildly or even deeply meditative or trance-like state. This is sometimes called “neo-shamanism.” Repetitive or monotonous percussion can facilitate, through a concept called “entrainment,” a nonordinary reality. Drummers, dancers, and singers have reported varying levels of meditative transport. When done deliberately and repetitively, drumming, chanting, and movement can lower anxiety and relieve depression. Some Western practices of music therapy and movement therapy are designed in this way to relieve anxiety and depression.
Although you may find some of those concepts unfamiliar or even far-fetched, many do not. The Lancet Psychiatry, a highly esteemed academic journal, took an interest in shamanic and other traditional healing activities, surveying thirty-two studies from twenty countries, many focused on shamanic healing (Nortje, Oladeji, Gureje, & Seedat, 2016). The authors concluded, “Traditional healers can provide an effective psychosocial intervention,” pointing out that “traditional healers form a major part of the mental health workforce worldwide.” The researchers concluded that traditional healers help common depression and anxiety, but have less effectiveness with severe bipolar and psychotic disorders (Nortje et al., 2016).
Some people use shamanic practice for personal growth, self-development, or self-healing. Experienced shamans use their skills to heal someone else. Many years of study and practice are needed to be able to use shamanic journeying to help someone else safely and effectively. If you seek the help of a shaman, be sure that person is well-trained and experienced.
Everyday Shamanic Wellness
Shamanic healing does not have to be complicated. It can be as easy as a walk in the park.
You already know how good it can be for you to connect with nature—a walk in the woods, on the beach, or in a park can do wonders. Climbing out of your car, or getting away from your computer or your cubicle, and immersing yourself in nature is more than calming; it is healing. It refreshes your mind as well as your spirit as it aligns your inner nature with the nature around you.
This basic principle of shamanic healing through contact with nature can be enhanced by strong intention. In Japanese, it is called shinrin-yoku, roughly translated as “the medicine of being in the forest” (Park, Tsunetsugu, Kasetani, Kagawa, & Miyazaki, 2010). It has also been called “forest bathing.” Studies have shown it to have substantial health benefits (Park et al., 2010).
When you bathe in the forest or elsewhere in nature, take time to soak it in. Listen with your ears. See with your eyes. Feel with your skin and hair. Soak it into your pores. Breathe it into your spirit. Let your nature harmonize with the nature around it. Be still with nature and let yourself be healed by it.
Take Your Daily MEDS
To fully empower the flow of healing, I recommend attending to these simple elements of daily life that are too often overlooked, assumed, or forgotten by clinicians and their clients. Some of these suggestions may not be alternative therapies, but any type of therapy will more likely succeed if these easy suggestions are followed. I call them “MEDS,” and I write more prescriptions for these MEDS—that is, mindfulness, exercise, diet, and stress management—than I do for pharmaceuticals. A daily MEDS practice is an important base for all therapeutic healing methods. Having a daily MEDS practice will help you and your clients physically, mentally, and spiritually and there is plenty of evidence that it will help relieve anxiety and depression.
Practice can be as easy as taking a deep breath and really noticing where you are and what you are doing. Mindfulness meditation does not take much longer. Stilling the mind by relaxing the body and focusing on the breath takes only minutes each day and can produce remarkably positive effects.
One study of mindfulness meditation showed it works better than medication for relief of anxiety (Hoge et al., 2013). Furthermore, the researchers showed that meditation lacked the side effects of pharmaceuticals and it produced long-lasting benefits for the brain.
Mindfulness meditation has been studied in the laboratory (Kaliman et al., 2014). A single eight-hour day of meditation practice was actually shown to alter the genetic expression of inflammation. Compared to the start of the day, there was a measurable decrease in circulating inflammatory markers by the end of a day of meditating. Some forms of depression and anxiety are known to involve inflammatory activity, which can be reduced to certain anti-inflammatory medications. This study showed that meditation had a similar effect.
Exercise, I am convinced, is the best drug one can take. Exercise has also been shown to increase the amount of BDNF in the brain, which is essential for good brain health. It stimulates the formation of new brain cells, increases the brain’s capacity to absorb new information, and improves neuroplasticity, which is the capacity of the brain to handle stress (Cotman & Berchtold, 2002).
With aerobic activity, levels of endorphins and enkephalins are boosted, and stress-producing cortisol levels are
reduced. Over time, exercise is associated with greater satisfaction with life. In a large study in the International Journal of Psychiatry in Medicine, exercise was declared to be “an effective and cost-efficient treatment alternative for a variety of anxiety disorders” (Carek, Laibstain, & Carek, 2011).
In a very convincing landmark study, exercise was compared to clomipramine, a medication known to help panic disorder, and to a placebo. Over the course of ten weeks, forty-six people with known panic disorders were divided into three groups and “treated” with aerobic exercise, clomipramine, or a placebo. The exercise group did so well that the authors concluded that exercise alone would be a valuable treatment of panic disorder for people who are unwilling or unable to take medication. It is significant that a healing enhancer like exercise could be classified as a form of treatment for panic disorder (and depression) by prestigious medical journals (Broocks et al., 1998). It is also significant that something that can be good for your body can help ease your mind.
Guidelines and studies have shown that food is medicine that tastes good. Avoiding sugar is a good idea for everyone, and avoiding gluten can, for those sensitive to its inflammatory effects, report reduction in anxiety and depression.
Even if you do not have celiac disease or gluten sensitivity, your anxiety or depression could be worsened by gluten. In his book Grain Brain (2013), neurologist and nutritionist David Perlmutter writes, “It is (my) belief that gluten is a modern poison.” He shows convincingly that “Inflammation . . . is the cornerstone of many brain disorders,” and advises a gluten-free diet to prevent damage to the brain.
The health benefits of the Mediterranean diet have been studied extensively. A Spanish study, the Prevención con Dieta Mediterránea (PREDIMED), which means “prevention with Mediterranean diet,” followed 7,500 people ages fifty-five to eighty (Martinez-González et al., 2015). One-third of the study group simply reduced fat in their diet. One-third ate a Mediterranean diet supplemented with nuts. The final third followed a Mediterranean diet supplemented with extra virgin olive oil. Within five years, the two groups using the Mediterranean diet were 30 percent less likely to suffer a heart attack or stroke or to die from heart-related causes (Estruch et al., 2013).
One group supplemented the Mediterranean diet with extra nuts. They consumed 30 grams per day of mixed nuts: 15 grams of walnuts, 7.5 grams of hazelnuts, and 7.5 grams of almonds. The surprising finding was that the group who added nuts to their Mediterranean diet had a reduction of 25 percent of incidents of depression. Investigators looked at a subgroup of people who had adult-onset, type 2 diabetes and included walnuts in their diet: they had a 41 percent reduction of depression compared to the people who did not include any nuts in their diet (Sánchez-Villegas et al., 2013).
We have known since 1999 that omega-3 fatty acids can help stabilize the mood fluctuations of bipolar disorder (Stoll et al., 1999). Omega-3 fatty acid in the form of eicosapentaenoic acid (EPA) was also found to be helpful for depression.
Imbalances in the microbiome (the 40 trillion bacteria in your gut) have been linked with anxiety and depression (Dinan, Stilling, Stanton, & Cryan, 2015) and research suggests that microbiome imbalances causing emotional distress can be partially reversed with properly selected probiotics. Probiotics that help you have a more positive outlook are called “psychobiotics.” An eight-week randomized controlled trial comparing the probiotic bifidobacterium longum to placebo showed that twice as many people who took the probiotic experienced significant reduction of
depression and significant improved quality of life compared to those who took the placebo (Pinto-Sanchez et al., 2017). Brain imaging studies of those who felt better showed reduced limbic activity, suggesting that the probiotic in the gut improved activity in the brain—the work of a true psychobiotic.
Stress management is a simple and inexpensive form of genetic engineering. By reducing harmful stress, the reduction in cortisol can turn harmful genes off and healthy genes on. The equation G x E means genes affected by environment, a relationship that is being passionately studied. It may be easier said than done, but working fewer hours, disengaging from workplace drama, sleeping more, and spending less can do wonders for our genes!
The more often “alternative” methods of assisting healing are practiced, the more likely they are to become absorbed into mainstream treatments. The advantage that alternative methods have over conventional treatments is often being seen as working in cooperation with the natural flow of healing rather than simply chasing symptoms with treatments. Keeping a focus on assisting the natural flow of healing is fundamental to helping people reduce their suffering. It is by assisting the individuals’ natural flow of healing that we are least likely to harm and most likely to help.
No matter what alternative and holistic healing practices you may chose for yourself or recommend to your clients or patients, be sure the practices will be safe and that they do not conflict with anyone’s religious beliefs. Although the alternative therapies I discussed in this article have scientific merit, they may not be well suited to the needs of your clients or patients. If you are uncertain if your recommendation is safe or well suited, be sure to have your clients or patients seek a second opinion. This is especially important if a higher level of care, such as medicine, rehab, or hospitalization, may be needed.
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