Mind-Body Interventions

Abstract

In the past decade, we have seen an increase in the popularity of mind-body medicine as an alternative or complement to traditional health care interventions. This paper explores the history of mind-body medicine and how particular mind-body interventions focusing on stress reduction and relaxation can be useful complements to social work practice. Four types of mind-body interventions are described, research on their effectiveness is reviewed, conclusions are drawn, and the applicability to social work practice is discussed. Given existing empirical support for the effectiveness of these interventions, the authors suggest that efforts at both the systems and individual levels, including changes in social work education, can be made to enhance their use in traditional health settings, as well in other types of settings.     

Health benefits of primary care social work for adults with complex health and social needs: a systematic review

The prevalence of complex health and social needs in primary care patients is growing. Furthermore, recent research suggests that the impact of psychosocial distress on the significantly poorer health outcomes in this population may have been underestimated. The potential of social work in primary care settings has been extensively discussed in both health and social work literature and there is evidence that social work interventions in other settings are particularly effective in addressing psychosocial needs. However, the evidence base for specific improved health outcomes related to primary care social work is minimal. This review aimed to identify and synthesise the available evidence on the health benefits of social work interventions in primary care settings. Nine electronic databases were searched from 1990 to 2015 and seven primary research studies were retrieved. Due to the heterogeneity of studies, a narrative synthesis was conducted. Although there is no definitive evidence for effectiveness, results suggest a promising role for primary care social work interventions in improving health outcomes. These include subjective health measures and self‐management of long‐term conditions, reducing psychosocial morbidity and barriers to treatment and health maintenance. Although few rigorous study designs were found, the contextual detail and clinical settings of studies provide evidence of the practice applicability of social work intervention. Emerging policy on the integration of health and social care may provide an opportunity to develop this model of care.     

The effectiveness of social marketing interventions for health improvement: what's the evidence?

OBJECTIVES: To review the effectiveness of social marketing interventions designed to improve diet, increase physical activity, and tackle substance misuse. STUDY DESIGN AND METHODS: This article describes three reviews of systematic reviews and primary studies that evaluate social marketing effectiveness. All three reviews used pre-defined search and inclusion criteria and defined social marketing interventions as those which adopted six key social marketing principles. RESULTS: The reviews provide evidence that social marketing interventions can be effective in improving diet, increasing exercise, and tackling the misuse of substances like alcohol, tobacco, and illicit drugs. There is evidence that social marketing interventions can work with a range of target groups, in different settings, and can work upstream as well as with individuals. CONCLUSIONS: Social marketing provides a very promising framework for improving health both at the individual level and at wider environmental and policy-levels. Problems with research design, lack of conceptual understanding or implementation are valid research concerns.     

Good intentions and received wisdom are not good enough: the need for controlled trials in public health

In the 1970s Archie Cochrane noted that many healthcare procedures and forms of organisation lacked evidence of effectiveness and efficiency, and argued for improved methods of evaluation, moving from clinical opinion and observation to randomised controlled trials (RCTs). His arguments gradually became accepted in medicine, but there has been considerable resistance among policymakers and researchers to their application to social and public health interventions. This essay argues that opposition to RCTs in public health is often based on a false distinction between healthcare and community settings, and sometimes on a misunderstanding of the principles of RCTs in health care. It suggests that just as in medicine, good intentions and received wisdom are not a sufficient basis for making public policy and allocating public funds for social or health improvement.     

Using available clinical information in practice-based research: mining for silver while dreaming of gold

Social workers in health and mental health settings routinely collect and record enormous quantities of clinical information about clients, psycho-social interventions and client responses to these interventions. Despite its abundance and non-intrusiveness, social work researchers generally have ignored available clinical information, claiming that it is unreliable and subject to too many threats to validity to warrant serious consideration as a data source. Instead, many researchers have advocated "gold standard" experimental studies, employing standardized instruments and prospective data-collection. As a result, the research potential of retrospective studies based on available clinical information has been relatively unexplored and untested. This paper asserts that available clinical information can be converted into valuable retrospective, data-bases for practice-based research studies. Exemplars of such studies in health and mental health settings are provided as are guidelines for their conduct.     

How place matters: unpacking technology and power in health and social care

The devolution of care into nontraditional community-based settings has led to a proliferation of sites for health and social care. Despite recent (re)formulations of 'evidence-based' approaches that stress the importance of optimizing interventions to best practice by taking into account the uniqueness of place, there is relatively little guidance in the literature and few attempts to systematically 'unpack' key dimensions of settings most relevant to policy, practice and research. In this paper, we explore how place matters for health and social care. In effect, we propose making place the lens through which to view practice, and not simply an interesting sideline focus. We focus specifically on (a) the emplacement of power relations in health and social care in and across settings; and (b) the pervasive (and often unrecognised) influence of technology on and in place (both 'mundane' and more visible 'high' technologies) as arguably among the most significant and pervasive (and often overlooked) dimensions of place pertinent to health and social care in both traditional (institutional) and nontraditional (community) settings. Drawing on diverse disciplinary literatures, we seek to make visible certain issues and bodies of work that health professionals may not be aware of, and which often remain inaccessible to practitioners and applied researchers on account of their density, complexity, and specialised terminology. In particular, drawing on the rich tradition of cultural studies, we advance the culture of place as a rubric for understanding the complex interrelationship between power, technology, culture, and place. Several fruitful avenues for place-sensitive research of health and social care practice (and its effects) are suggested.     

Using Available Clinical Information in Practice-Based Research

SUMMARY

Social workers in health and mental health settings routinely collect and record enormous quantities of clinical information about clients, psycho-social interventions and client responses to these interventions. Despite its abundance and non-intrusiveness, social work researchers generally have ignored available clinical information, claiming that it is unreliable and subject to too many threats to validity to warrant serious consideration as a data source. Instead, many researchers have advocated “gold standard” experimental studies, employing standardized instruments and prospective data-collection. As a result, the research potential of retrospective studies based on available clinical information has been relatively unexplored and untested. This paper asserts that available clinical information can be converted into valuable retrospective, data-bases for practice-based research studies. Exemplars of such studies in health and mental health settings are provided as are guidelines for their conduct.     

Public health interventions and SARS spread, 2003

The 2003 outbreak of severe acute respiratory syndrome (SARS) was contained largely through traditional public health interventions, such as finding and isolating case-patients, quarantining close contacts, and enhanced infection control. The independent effectiveness of measures to "increase social distance" and wearing masks in public places requires further evaluation. Limited data exist on the effectiveness of providing health information to travelers. Entry screening of travelers through health declarations or thermal scanning at international borders had little documented effect on detecting SARS cases; exit screening appeared slightly more effective. The value of border screening in deterring travel by ill persons and in building public confidence remains unquantified. Interventions to control global epidemics should be based on expert advice from the World Health Organization and national authorities. In the case of SARS, interventions at a country's borders should not detract from efforts to identify and isolate infected persons within the country, monitor or quarantine their contacts, and strengthen infection control in healthcare settings.     

Hierarchies and cliques in the social networks of health care professionals: implications for the design of dissemination strategies

Interest in how best to influence the behaviour of clinicians in the interests of both clinical and cost effectiveness has rekindled concern with the social networks of health care professionals. Ever since the seminal work of Coleman et al. [Coleman, J.S., Katz, E., Menzel, H., 1966. Medical Innovation: A Diffusion Study. Bobbs-Merrill, Indianapolis.], networks have been seen as important in the process by which clinicians adopt (or fail to adopt) new innovations in clinical practice. Yet very little is actually known about the social networks of clinicians in modern health care settings. This paper describes the professional social networks of two groups of health care professionals, clinical directors of medicine and directors of nursing, in hospitals in England. We focus on network density, centrality and centralisation because these characteristics have been linked to access to information, social influence and social control processes. The results show that directors of nursing are more central to their networks than clinical directors of medicine and that their networks are more hierarchical. Clinical directors of medicine tend to be embedded in much more densely connected networks which we describe as cliques. The hypotheses that the networks of directors of nursing are better adapted to gathering and disseminating information than clinical directors of medicine, but that the latter could be more potent instruments for changing, or resisting changes, in clinical behaviour, follow from a number of sociological theories. We conclude that professional socialisation and structural location are important determinants of social networks and that these factors could usefully be considered in the design of strategies to inform and influence clinicians.     

Faith-based organizations, science, and the pursuit of health

Over the last three decades, there has been increasing interest in the role that faith-based organizations (FBOs) can play in promoting health and health care access among underserved populations. Although the research literature on church-based health interventions is growing, there are relatively few rigorous evaluations of their effectiveness in addressing health and health care outcomes. Establishing a national faith-based health research network is an excellent opportunity to create an evaluative infrastructure and generate new research on health programs and their effectiveness in FBO settings.     

The effectiveness of self‐care support interventions for children and young people with long‐term conditions: a systematic review

Children's health policy has highlighted the need to develop self‐care programmes. However, there is a lack of evidence on which to base the development of such programmes. This paper reviews the published research on the effectiveness of self‐care support interventions for children and young people with asthma, cystic fibrosis and diabetes. A systematic search was conducted of a range of electronic databases, supplemented by searching the reference lists of retrieved papers and published reviews. Retrieved studies were assessed against quality and eligibility criteria by two independent reviewers. The results were narratively synthesized to examine the effectiveness of self‐care support interventions on health status, psycho‐social well‐being, condition‐related knowledge, health service use and participant satisfaction. The search strategy identified 4261 papers which were screened against the review inclusion criteria. A total of 194 papers were assessed as being potentially eligible for inclusion with 15 papers being judged as adequate to include in the review. There is strong evidence of the effectiveness of interventions that target children/young people; use e‐health or group‐based methods; that are delivered in community settings. There is no evidence that interventions that focus on parents alone or are delivered only in hospital settings are effective. While there is some evidence to inform the development of self‐care support programmes, there is a need for well‐designed trials of interventions that are feasible to transfer into real‐life settings and which involve parents and children in their development.     

Mind-body health: research, clinical, and policy applications

PURPOSE OF THE REVIEW. This critical review presents an overview of the development in the field of mind-body medicine over the last 10 years and has taken tentative steps toward suggesting the components of a new model of health based on psychoneuroimmunology. While documenting the major shortcomings of present research design, methodology, data analysis, and subsequent hypotheses, this article points out areas of sufficient promise for practical and responsible clinical applications of the research. SEARCH METHOD USED. A thorough review of the clinical and experimental medical literature related to the interaction between mind and body is presented, and the new and complex research in the field of psychoneuroimmunology is analyzed. SUMMARY OF IMPORTANT FINDINGS. Despite the mixed and sometimes conflicting findings in current research, there is an increasingly compelling body of scientific evidence indicating that mind-body interactions are at the root of both health and disease. Research demonstrates that psychological factors seem to play a causal role in the onset and course of many chronic disorders and that psychological, emotional, psychosocial, and behavioral interventions have at least as much proof of effectiveness as many purely medical treatments. MAJOR CONCLUSIONS. There is a substantial growing body of scientific and clinical knowledge which demonstrates an inextricable interaction between mind and body. Such an approach empowers individuals and organizations to assume greater responsibility for health as a basis for the development of a true health care system.     

The knowledge and use of alternative therapeutic techniques by social work practitioners: a descriptive study

A survey of use of alternative therapeutic methods was distributed to 1,000 clinical/direct service social work practitioners; a sample of 321 reported on their use of alternative techniques. Approximately three-quarters of the respondcnts used or referred mind-body techniques or community health alternatives. These two techniques accounted for about two-thirds of all alternative practices. Manual healing was used or referred by about one-third of all practitioners and professionalized alternative medicine was used by about 30%. Other methods, including botanical, pharmacological, and biological alternatives, diet and nutrition, and parapsychology were each used by fewer than 10% of the respondents. Social workers were most knowledgeable about mind-body techniques and community-based alternatives.     

Developing an evidence base for policies and interventions to address health inequalities: the analysis of "public health regimes"

Systematic reviews have become an important methodology in the United Kingdom by which research informs health policy, and their use now extends beyond evidence-based medicine to evidence-based public health and, particularly, health inequalities policies. This article reviews the limitations of systematic reviews as stand-alone tools for this purpose and suggests a complementary approach to make better use of the evidence. That is, systematic reviews and other sources of evidence should be incorporated into a wider analytical framework, the public health regime (defined here as the specific legislative, social, political, and economic structures that have an impact on both public health and the appropriateness and effectiveness of public health interventions adopted). At the national level this approach would facilitate analysis at all levels of the policy framework, countering the current focus on individual interventions. It could also differentiate at the international level between those policies and interventions that are effective in different contexts and are therefore potentially generalizable and those that depend on particular conditions for success.     

Mind-body medicine: state of the science,implications for practice

BACKGROUND: Although emerging evidence during the past several decades suggests that psychosocial factors can directly influence both physiologic function and health outcomes, medicine had failed to move beyond the biomedical model, in part because of lack of exposure to the evidence base supporting the biopsychosocial model. The literature was reviewed to examine the efficacy of representative psychosocial-mind-body interventions, including relaxation, (cognitive) behavioral therapies, meditation, imagery, biofeedback, and hypnosis for several common clinical conditions. METHODS: An electronic search was undertaken of the MEDLINE, PsycLIT, and the Cochrane Library databases and a manual search of the reference sections of relevant articles for related clinical trials and reviews of the literature. Studies examining mind-body interventions for psychological disorders were excluded. Owing to space limitations, studies examining more body-based therapies, such as yoga and tai chi chuan, were also not included. Data were extracted from relevant systematic reviews, meta-analyses, and randomized controlled trials. RESULTS: Drawing principally from systematic reviews and meta-analyses, there is considerable evidence of efficacy for several mind-body therapies in the treatment of coronary artery disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. We found moderate evidence of efficacy for mind-body therapies in the areas of hypertension and arthritis. Additional research is required to clarify the relative efficacy of different mind-body therapies, factors (such as specific patient characteristics) that might predict more or less successful outcomes, and mechanisms of action. Research is also necessary to examine the cost offsets associated with mind-body therapies. CONCLUSIONS: There is now considerable evidence that an array of mind-body therapies can be used as effective adjuncts to conventional medical treatment for a number of common clinical conditions.     

Applicability and transferability of interventions in evidence-based public health

The context in which public health programmes operate can play an important role in influencing their implementation and effectiveness. An intervention that has been shown to be effective in one setting may turn out to be ineffective somewhere else, even supposing it can be implemented there. Therefore, systematic reviews of public health interventions should appraise the applicability of the intervention process and the transferability of the intervention effectiveness to other localities. However, applicability and transferability appraisal is seldom reported in systematic reviews of public health and health promotion interventions. This paper aims to introduce an innovative approach to bridging this gap. A list of attributes that may impact on applicability and transferability can be developed, based on knowledge of the proposed intervention. Then the applicability and transferability of the intervention to the local setting can be rated, and given a score, based on knowledge of the local setting. This approach provides a useful tool for evaluating public health interventions and provides a reliable basis for informed decision making in resource-poor settings, where rigorous primary studies are lacking and where very limited resources put a high demand on evidence-based approaches to health promotion.     

Strengthening the parent-child relationship: a review of family interventions and their use in medical settings

The quality of family functioning is important for both psychological well-being and physical health. This review describes family interventions that aim to improve the strength of the parent-child relationship and considers ways in which these approaches can be applied to physical health care. This review first describes the development of family therapy in dealing with children's behavioural and emotional difficulties. As shown in psychotherapeutic settings, parenting skills can affect children's emotional well-being and ability to control their own conduct. Intervention strategies that focus on developing the ability of parents to provide a benign and nurturing parenting style are considered. The review then considers how the principles of family therapy can be applied to settings where physical health is the central issue. In medical settings, families are not only affected by medical interventions but they can also serve to facilitate or hinder clinical effectiveness. Illustrations of how these interventions can be applied in medical settings are provided. Although a practising clinician will need training in using family therapy techniques, it may be possible to recruit a family therapist to help in particular cases.     

A scoping review to understand the effectiveness of linking schemes from healthcare providers to community resources to improve the health and well‐being of people with long‐term conditions

The prevalence of people living with long‐term conditions is increasing, accompanied by an increased expectation that patients will become more involved in self‐management. Long‐term conditions are associated with increased social isolation and poor physical and mental health. But there remains a gap in health provision between providing medical treatment and effectively addressing psychosocial well‐being. One potential way of addressing this gap is by utilising social interventions which link patients from health services to community‐based sources of support. However, the mechanisms involved in the delivery of interventions providing that link and their effectiveness remain unclear. This review adopted the methodological framework for conducting scoping studies, searching for both academic and grey literature on social interventions which link people from healthcare settings to a range of community and voluntary sector organisations. A literature search between May and June 2013, involving five electronic databases, hand searching of two journals and the use of Google search engine, identified seven studies relevant to the review question. In terms of key characteristics and mechanisms of the interventions, mental health conditions and social isolation were the most common reasons for referral to the interventions, and referrals were usually made through general practices. Almost all the interventions were facilitator‐led, whereby the facilitator worked to identify and link participants to appropriate community‐based resources. In regard to health and social outcomes and their cost‐effectiveness, studies reported improvement to participants' psychological and social well‐being as well as their decreased use of health services, although there were limited measures of participants' physical health outcomes. Interventions for linking patients from healthcare setting to community‐based resources target and address psychosocial needs of participants. The review identified involvement of health professionals in aiding the referral of patients to the intervention and the role of the intervention facilitators as key components of the interventions.     

Primary care treatment for child and adolescent neuropsychiatric conditions in remote rural Punjab, Pakistan - a cross-sectional survey

Background Pakistan is one of the most populous regions of the world. Previous work has demonstrated that there is reliance on traditional healthcare systems when seeking psychiatric care; however, there is a lack of information on help seeking for child and adolescent population. The aim of this study was to describe types of treatments and families’ perceptions of the effectiveness of those treatments for childhood neuropsychiatric disorders in remote rural Punjab. Method Cross‐sectional survey of consecutive attendees at an advertised mental health consultation day in a remote rural area. Results The effectiveness of these treatments, as rated by patients and their families, was variable, with highest reported effectiveness for general practitioner treatments. In families with a past history of care from a general practitioner, those who had epilepsy reported treatments to be more effective than those with mental retardation. Carers and users described consulting five different types of primary healthcare practitioners that used both physical and psychotherapeutic treatments. Conclusions There is considerable variation in treatments available for child and adolescent neuropsychiatric disorders in remote rural areas of Punjab, a large proportion of which are considered ineffective by the users and carers. This highlights the need to develop effective interventions for child and adolescent neuropsychiatric conditions that can be administered by primary health workers. Our data suggest that the need for this is greatest for mental retardation.     

Anti-anxiety medications: a review for social workers

Social workers in mental health settings frequently participate in the treatment of clients with incapacitating anxiety. Medication is often included among the interventions for these clients. Social workers, who specialize in psychosocial interventions, also have key roles in the assessment and monitoring of medication effects. The purpose of this article is to provide social workers with an overview of the pharmacological treatment of anxiety so that they can carry out their range of interventions more effectively. Included is information about types of medication and their dosages, positive and adverse effects, interactions of medication with other interventions, and special concerns with children and adolescents.