Complementary and alternative medicine is an emerging specialty practice area in the profession
By Mandy Lubas, OTR/L, and Emmy Vadnais, OTR/L
Holistic occupational therapy combines mind-body-spirit therapies with the best of occupational therapy practices to provide health, wellness and disease prevention services. We propose that it is a new and growing specialty as we observe more OTs receiving special training in holistic approaches and incorporating them into practice.
In fact, this trend is happening in all of healthcare. Not only are facilities providing holistic care and focusing on prevention and wellness-for example, a 2011 American Hospital Association survey found that 42 percent of hospitals offer complementary and alternative medicine (CAM) services, up from only 6 percent in 19981 -but healthcare practitioners are also frequently using CAM themselves. A 2011 study found that as many as 76 percent of healthcare providers used at least one form of CAM. This study concluded that the personal use of CAM by healthcare providers may influence the integration of CAM with conventional medicine.2 Additionally, education opportunities for health providers are increasing, including at the university level. The Consortium of Academic Health Centers for Integrative Medicine, a community of academic institutions which seeks to advance the principles and practices of integrative healthcare within academic institutions, has increased its membership from 11 to 51 since 2002.3
Meanwhile, the general public’s use of natural and holistic methods is increasing; the Centers for Disease Control and Prevention’s National Health Interview Survey showed adults’ use of CAM increased from 36 to 38.3 percent between 2002 and 2007.4 We, as OTs, need to embrace holistic approaches so we can bring the best possible care to our patients.
CAM and OT
For years, OTs have incorporated many holistic therapies into their practices, such as relaxation, guided imagery, sensory integration, myofascial release, music and listening therapy, art therapy, movement therapy, t’ai chi, hippotherapy and aromatherapy. Such holistic interventions are in line with the theory and scope of OT practice as seen in theOccupational Therapy Practice Framework.5 Further, AOTA asserts that CAM may be used responsibly by occupational therapists and occupational therapy assistants as part of a comprehensive approach to enhance engagement in occupation by people, organizations and populations to promote their health and participation in life.6
Holistic occupational therapy could be implemented throughout all stages in life. It can begin by teaching lifelong skills to children, be expanded to address the middle adult years to help individuals stay well longer, and to older generations to have more sense of hope that the end of life can be more pleasurable.
An OT could start a private practice focusing on a specific niche, such as clients with depression or anxiety. These are common diagnoses that can significantly affect the health of individuals throughout their lives. The OT could assess how depression or anxiety impacts their ability to function and participate in daily living. Holistic interventions such as yoga, meditation, relaxation techniques, guided imagery, acupressure, reflexology, diet and nutrition, energy healing and art therapy, among other approaches, may assist the individual to lower or manage the depression or anxiety so they can have more functional and meaningful lives. These interventions may also simultaneously prevent or mitigate the effects or onset of diseases that may develop down the road, such as cardiovascular disease, stroke, obesity, diabetes or cancer.
Integrating Holistic Approaches
Yoga, listening therapy, and health and wellness coaching are examples of how occupational therapists can implement holistic approaches into practice.
Yoga addresses an individual’s occupations by emphasizing balance in work, exercise, rest, play and leisure. Three components of yoga have permeated popular culture in the Western hemisphere. These are asana (postures), pranayama (breathing exercises) and meditation. Asanas are the physical postures that most people are familiar with. They can strengthen, tone and stretch the musculoskeletal system of the body while calming the mind. Meditation and pranayama can facilitate the relaxation response. The relaxation response has researched benefits of calming the nervous system by lowering blood pressure, heart rate and breath rate, and can create an overall sense of calm. It has been shown to lower stress, depression, anxiety, emotional and physical pain, and may help prevent illness by boosting the immune system.7
Listening therapy affects the auditory and vestibular systems when listening to filtered music through headphones. It helps to turn on the parts in the brain that are off, and to convert left-dominant listeners to right-dominant listeners, which improves auditory processing, cognition, timing and sequencing, balance, coordination, muscle tone, communication and emotional regulation. These multi-dimensional techniques address the nervous system-the sensory and motor systems, cognition, emotions and behavior.8
More OTs are interested in becoming certified as life coaches and health and wellness coaches as part of the holistic, wellness and prevention movement. However, we may not need to be certified to offer these types of services to clients, as OTs are trained in many of the same approaches. Life coaching uses activities as its main modality, and of the 11 competencies listed by the International Coach Federation, OTs learn most of them.9
Components that both OTs and life coaches share are: helping clients discover their own feelings, goals and objectives; effectively invoking inquiry for a greater understanding of the forces that determine emotions, feelings and self-awareness; helping clients create and design actions that will enable them to reach their goals and objectives; helping clients create a road map to personal growth and success; creating, developing, implementing and maintaining a treatment or coaching plan with results that are attainable, specific and measurable; and managing progress and accountability.9
A New Specialty?
The Mayo Clinic encourages and guides patients and physicians to consider holistic approaches in the Mayo Clinic Book of Alternative Medicine. Andrew Weil, MD, trains physicians in the specialty of Integrative Medicine (www.integrativemedicine.arizona.edu). There is even an American Holistic Medical Association that has been running since 1975 (www.holisticmedicine.org). The American Holistic Nurse’s Association is 5,700 members strong, and supports nurses who would like to become Certified Holistic Nurse Clinicians (www.ahna.org). It’s time for OTs to create their own specialty of holistic occupational therapy.
The predominant healthcare model in our country has been to treat the person once they have become sick or have received a diagnosis. We have the opportunity to offer our skills to those seeking ways to improve themselves-with and without diagnoses. We have the opportunity to assist individuals in staying well and engaging in their occupations as long as possible and before they become ill.
References available at www.advanceweb.com/OT or upon request.