The term, “integrative medicine” (IM) defines an approach to healing that explores the whole person, including individual values and lifestyle, while making use of all appropriate and evidence-informed therapeutic modalities, health care professionals, and disciplines to promote optimal well-being. Behavioral medicine is uniquely situated to implement an IM framework for several reasons. First, a central component in behavioral medicine is the biopsychosocial model. This model encompasses an assessment of the unique biological, psychological, social, cultural, and environmental influences on the whole person. Biological contexts include age, sex, genetic vulnerabilities, medications, substances of abuse, physical injuries, and medical illnesses. Psychological contexts include traumatic experiences, psychological defenses, and traits. Social contexts include community support, social skills, major life transitions, employment, cultural beliefs, values, spirituality, and access to health care. Second, both IM and behavioral medicine appreciate that healing occurs on multiple levels and that there is a bidirectional relationship between the mind and body. Last, IM and behavioral medicine share an emphasis on the therapeutic alliance and partnership between patients and those who contribute to their care.
THE EVOLUTION OF CONVENTIONAL MEDICINE & INTEGRATIVE MEDICINE
While pharmaceutical and surgical therapies have been central to advances in medical treatment, there has been a growing awareness of therapies used in place of conventional medicine, or “alternative medicine.” The United States’ National Institutes of Health (NIH) addressed this interest by establishing the Office of Alternative Medicine in 1991. In 1998, the center’s name changed to the National Center for Complementary and Alternative Medicine (NCCAM). The term, “complementary medicine” was added to reflect nonmainstream modalities used together with conventional medicine, rather than in place of conventional medicine, and five domains were classified (Table 35-1). In 2014, the center’s name changed again to the National Center for Complementary and Integrative Health (NCCIH) as “complementary approaches have grown in use to the point that Americans no longer consider them an alternative to medical care.” The term “integrative medicine” emphasizes the concept of integrating elements of what has been thought of as complementary or alternative medicine, particularly those with evidence to support their use, into health care.
Table 35-1.Five domain system for classifying complementary and alternative medicine modalities. ||Download (.pdf) Table 35-1. Five domain system for classifying complementary and alternative medicine modalities.
|Domain ||Examples |
|Biologically based therapies ||Dietary interventions, vitamins, minerals, supplements, herbal/botanical medicines |
|Mind–body interventions ||Meditation, relaxation and breathing techniques, guided imagery, hypnosis, biofeedback, yoga, tai chi, qigong, expressive arts therapies, spiritual practices, and other forms of “directed” attention |
|Manipulative and body-based methods ||Osteopathic manipulative therapy, chiropractic spinal manipulation, massage therapy, physical therapy |
|Alternative or whole medical systems ||Traditional Chinese medicine, ayurveda, naturopathic medicine, homeopathy, Polynesian medicine, Unani-Tibb medicine, traditional African medicine, traditional Mayan medicine |
|Energy therapies ||Acupuncture, tai chi, qigong, reiki, therapeutic or healing touch, bioenergetic therapy, and other methods that affect the body’s “bioelectric” field |