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Foundations of Methodology in Integrative Mental Health Care

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An Integrative Paradigm for Mental Health Care

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Abstract

Current research and clinical methodologies in mental health care are reviewed and critiqued. Randomized controlled trials and other quantitative research designs do not adequately address complex synergistic mechanisms involved in many Western medical and CAM interventions. Treatment planning in Western medicine generally overlooks evidence for CAM modalities, and treatment planning in non-Western systems of medicine generally excludes evidence for Western medical approaches. The limitations of evidence-based medicine are discussed. Practice-based evidence is an important concept in personalized medicine that is emerging in response to the limitations of EBM. Novel research methodologies and their potential applications to studies on CAM and integrative modalities are described. Different research questions pertaining to Western medicine, CAM, or integrative medicine call for a variety of research methodologies. The limitations and benefits of different research designs should always guide the choice of study design especially when complex, multilevel interventions are being investigated. Mixed methods research designs that combine quantitative and qualitative research methods may help elucidate complex dynamic interactions between synergistic factors that influence outcomes in response to integrative treatment regimens. Methods for determining outcomes in clinical integrative mental health care are described including measures of cost-effectiveness, cost–utility analysis, and cost–benefit analysis. Finally, recent innovations in expert panels and their implications for more effective, more cost-effective, and more individualized clinical guidelines are discussed.

“Acquire the art of detachment, the virtue of method, and the quality of thoroughness, but above all the grace of humility.”

—Sir William Osler, MD

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References

  • Abbott, R., & Lavretsky, H., (2013, March). Tai Chi and Qigong for the treatment and prevention of mental disorders. Psychiatric Clinics of North America, 36(1), 109–119.

    Google Scholar 

  • Aickin, M. (2002). Beyond randomization. Journal of Alternative and Complementary Medicine, 8(6), 765–772.

    Article  Google Scholar 

  • Aickin, M. (2003). Participant-centered analysis in complementary and alternative medicine comparative trials. Journal of Alternative and Complementary Medicine, 9(6), 949–957.

    Article  Google Scholar 

  • Barker Bausell, R. (2009, December). Are positive alternative medical therapy trials credible?: Evidence from four high-impact medical journals. Evaluation & the Health Professions, 32(4), 349–369.

    Article  Google Scholar 

  • Barry, C. A. (2006). The role of evidence in alternative medicine: Contrasting biomedical and anthropological approaches. Social Science & Medicine, 62(11), 2646–2657.

    Article  Google Scholar 

  • Bengston, W. (2004). Methodological difficulties involving control groups in healing research: Parallels between laying on of hands for the treatment of induced mammary cancers in mice to research in homeopathy. Journal of Alternative and Complementary Medicine, 10(2), 227–228.

    Article  Google Scholar 

  • Berkowitz, B. (2016). The patient experience and patient satisfaction: Measurement of a complex dynamic online. Journal of Issues in Nursing, 21(1), 1.

    Google Scholar 

  • Bishop, F., & Holmes, M. (2013). Mixed methods in CAM research: A systematic review of studies published in 2012. Evidence-Based Complementary and Alternative Medicine, 2013, 187365.

    Article  Google Scholar 

  • Bloom, B. S., Retbi, A., Dahan, S., & Jonsson, E. (2000). Evaluation of randomized controlled trials on complementary and alternative medicine. International Journal of Technology Assessment in Health Care, 16(1), 13–21.

    Article  Google Scholar 

  • Caspi, O., & Bell, I. (2004). One size does not fit all: Aptitude x treatment interaction (ATI) as a conceptual framework for complementary and alternative medicine outcome research. Part II: Research designs and their applications. Journal of Alternative and Complementary Medicine, 10(4), 698–705. Mary Ann Liebert Publications.

    Article  Google Scholar 

  • Caspi, O., & Burleson, K. O. (2007, Winter). Methodological challenges in meditation research. Advances in Mind-Body Medicine, 22(3–4), 36–43.

    Google Scholar 

  • Caspi, O., Millen, C., & Sechrest, L. (2000). Integrity and research: Introducing the concept of dual blindness. How blind are double-blind clinical trials in alternative medicine? Journal of Alternative and Complementary Medicine, 6(6), 493–498.

    Article  Google Scholar 

  • Cassidy, C. M. (2002). Commentary on terminology and therapeutic principles: Challenges in classifying complementary and alternative medicine practices. Journal of Alternative and Complementary Medicine, 8(6), 893–895.

    Article  Google Scholar 

  • Churchill, W. (1999). Implications of evidence based medicine for complementary and alternative medicine. Journal of Chinese Medicine, 59, 32–35.

    Google Scholar 

  • Coates, J. R., & Jobst, K. A. (1998). Integrated healthcare: A way forward for the next five years? A discussion document from the Prince of Wales’s Initiative on Integrated Medicine. Journal of Alternative and Complementary Medicine, 4(2), 209–247.

    Article  Google Scholar 

  • Colloca, L., Jonas, W. B., Killen, J., Miller, F. G., & Shurtleff, D. (2014). Reevaluating the placebo effect in medical practice. Zeitschrift für Psychologie, 222(3), 124–127.

    Article  Google Scholar 

  • Coulter, I., Elfenbaum, P., Jain, S., & Jonas, W. (2016). SEaRCH™ expert panel process: Streamlining the link between evidence and practice. BMC Research Notes, 9, 16.

    Article  Google Scholar 

  • Coulter, I. D., Herman, P. M., & Nataraj, S. (2013). Economic analysis of complementary, alternative, and integrative medicine: Considerations raised by an expert panel. BMC Complementary and Alternative Medicine, 25(13), 191.

    Article  Google Scholar 

  • Defining and describing complementary and alternative medicine. Panel on Definition and Description, CAM Research Methodology Conference, April 1995. (1997). Alternative Therapies in Health and Medicine, 3(2), 49–57.

    Google Scholar 

  • Dossey, L. (1995). How should alternative therapies be evaluated? Alternative Therapies, 1(2), 76–85.

    Article  Google Scholar 

  • Ernst, E. (1998a). Establishing efficacy in chronic stable conditions: Are “N = 1 study” designs or case series useful? Forschende Komplementarmedizin, 5(1), 128–130.

    PubMed  Google Scholar 

  • Ernst, E. (1998b). Single-case studies in complementary/alternative medicine research. Complementary Therapies in Medicine, 6, 75–78.

    Article  Google Scholar 

  • Fisher, P., van Haselen, R., Hardy, K., Berkovitz, S., & McCarney, R. (2004). Effectiveness gaps: A new concept for evaluating health service and research needs applied to complementary and alternative medicine. Journal of Alternative and Complementary Medicine, 10(4), 627–632.

    Article  Google Scholar 

  • Fontanarosa, P., & Lundberg, G. (1998). Alternative medicine meets science. Journal of the American Medical Association, 280, 1618–1619.

    Article  Google Scholar 

  • Fortin, M., Bamvita, J. M., & Fleury, M. J. (2018). Patient satisfaction with mental health services based on Andersen’s Behavioral Model. Canadian Journal of Psychiatry, 63(2), 103–114.

    Article  Google Scholar 

  • Gelenberg, A., Thase, M., Meyer, R., Goodwin, F., Katz, M., Kraemer, H. C., et al. (2008). The history and current state of antidepressant clinical trial design: A call to action for proof-of-concept studies. The Journal of Clinical Psychiatry, 69(10), 1513–1528.

    Article  Google Scholar 

  • Gray, G. (2004). Concise guide to evidence-based psychiatry. Washington, DC: American Psychiatric Publishing.

    Google Scholar 

  • Haynes, B. (1999). A warning to complementary medicine practitioners: Get empirical or else. British Medical Journal, 319, 1629–1632.

    Article  Google Scholar 

  • Hoenders, R., Appelo, M., & de Jong, J. (2012). Integrative medicine: A bridge between biomedicine and alternative medicine fitting the spirit of the age. Sociology Mind, 2, 441–446.

    Article  Google Scholar 

  • Hoenders, H. J., Bos, E. H., de Jong, J. T., & de Jonge, P. (2012). Temporal dynamics of symptom and treatment variables in a lifestyle-oriented approach to anxiety disorder: a single-subject time-series analysis. Psychother Psychosom. 81(4):253–5.

    Google Scholar 

  • Jakovljevic, M. (2014, March). The placebo-nocebo response: Controversies and challenges from clinical and research perspective. European Neuropsychopharmacology, 24(3), 333–341.

    Article  Google Scholar 

  • Jensen, P. B., Jensen, L. J., & Brunak, S. (2012). Mining electronic health records: Towards better research applications and clinical care. Nature Reviews Genetics, 13(6), 395–405.

    Article  Google Scholar 

  • Johnston, B. C., & Mills, E. (2004). N-of-1 randomized controlled trials: An opportunity for complementary and alternative medicine evaluation. Journal of Alternative and Complementary Medicine, 10(6), 979–984.

    Article  Google Scholar 

  • Jonas, W., Crawford, C., Hilton, L., & Elfenbaum, P. (2017). Scientific evaluation and review of claims in health care (SEaRCH): A streamlined, systematic, phased approach for determining “what works” in healthcare. Journal of Alternative and Complementary Medicine, 23(1), 18–25.

    Article  Google Scholar 

  • Kaptchuk, T. J. (2002). The placebo effect in alternative medicine: Can the performance of a healing ritual have clinical significance? Annals of Internal Medicine, 136(11), 817–825.

    Article  Google Scholar 

  • Lake, J. (2001). Qigong. In S. Shannon (Ed.), Complementary and alternative medicine in psychiatry. New York: Academic.

    Google Scholar 

  • Leach, M. J., & Tucker, B. (2017, January–February). Current understandings of the research-practice gap from the viewpoint of complementary medicine academics: A mixed-method investigation. Explore (NY), 13(1), 53–61.

    Google Scholar 

  • Lin, Y., Zhu, M., & Su, Z. (2015, November). The pursuit of balance: An overview of covariate-adaptive randomization techniques in clinical trials. Contemporary Clinical Trials, 45(Pt A), 21–25.

    Google Scholar 

  • Linde, K. (2000). How to evaluate the effectiveness of complementary therapies. Journal of Alternative and Complementary Medicine, 6(3), 253–256.

    Article  Google Scholar 

  • Liverani, A. (2000). Subjective scales for the evaluation of therapeutic effects and their use in complementary medicine. Journal of Alternative and Complementary Medicine, 6(3), 257–264.

    Article  Google Scholar 

  • Long, A. (2002). Outcome measurement in CAM: Unpicking the effects. Journal of Alternative and Complementary Medicine, 8(6), 777–786.

    Article  Google Scholar 

  • Mercer, S. L., De Vinney, B. J., Fine, L. J., Green, L. W., & Dougherty, D. (2007, August). Study designs for effectiveness and translation research identifying trade-offs. American Journal of Preventive Medicine, 33(2), 139–154.

    Google Scholar 

  • Morstyn, R. (2013). Escaping the behavioural ‘spin’ of evidence-based psychiatry: Merleau-Ponty’s ontology of truth. Australasian Psychiatry, 21(4), 311–314.

    Article  Google Scholar 

  • Murphy, E. (1997). The logic of medicine. Baltimore, MD: Johns Hopkins University Press.

    Google Scholar 

  • Oh, K., Kim, K. S., Park, J. W., & Kang, J. (2007). Quality evaluation of randomized controlled trials on complementary and alternative medicine. Asian Nursing Research (Korean Society of Nursing Science), 1(3), 153–164.

    Article  Google Scholar 

  • Pincus, T., & Sokka, T. (2006). Evidence-based practice and practice-based evidence. Nature Clinical Practice Rheumatology, 2(3), 114–115.

    Article  Google Scholar 

  • Richardson, J. (2002). Evidence-based complementary medicine: Rigor, relevance and the swampy lowlands. Journal of Alternative and Complementary Medicine, 8(3), 221–223.

    Article  Google Scholar 

  • Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: What it is and what it isn’t. British Medical Journal, 312, 71–72.

    Article  Google Scholar 

  • Shah, N. H. (2013). Mining the ultimate phenome repository. Nature Biotechnology, 31(12), 1095–1097.

    Article  Google Scholar 

  • Smith, R. (1991). Where is the wisdom? British Medical Journal, 303(6806), 798–799.

    Article  Google Scholar 

  • Smolders, M., Laurant, M., Verhaak, P., Prins, M., van Marwijk, H., Penninx, B., et al. (2010, March). Which physician and practice characteristics are associated with adherence to evidence-based guidelines for depressive and anxiety disorders? Medical Care, 48(3), 240–248.

    Article  Google Scholar 

  • Tilburt, J. C. (2008, October). Evidence-based medicine beyond the bedside: Keeping an eye on context. Journal of Evaluation in Clinical Practice, 14(5), 721–725.

    Article  Google Scholar 

  • Turner, R. N. (1998). A proposal for classifying complementary therapies. Complementary Therapies in Medicine, 6, 141–143.

    Article  Google Scholar 

  • Verhoef, M., Casebeer, A., & Hilsdew, R. (2002). Assessing efficacy of complementary medicine: Adding qualitative research methods to the “gold standard”. Journal of Alternative and Complementary Medicine, 8(3), 275–281.

    Article  Google Scholar 

  • Verhoef, M., Koithan, M., Bell, I. R., Ives, J., & Jonas, W. (2012). Whole complementary and alternative medical systems and complexity: Creating collaborative relationships. Forschende Komplementärmedizin, 19(Suppl. 1), 3–6.

    Article  Google Scholar 

  • Vickers, A. (1999). Evidence-based medicine and complementary medicine. ACP Journal Club, 130, A13–A14.

    PubMed  Google Scholar 

  • Vuckovic, N. (2002). Integrating qualitative methods in RCTs: The experience of the Oregon Center for CAM. Journal of Alternative and Complementary Medicine, 8(3), 225–227.

    Article  Google Scholar 

  • Walach, H. (2001). The efficacy paradox in randomized controlled trials of CAM and elsewhere: Beware of the placebo trap. Journal of Alternative and Complementary Medicine, 7(3), 213–218.

    Article  Google Scholar 

  • Walach, H., Falkenberg, T., Fonnebo, V., Lewith, G., & Jonas, W. B. (2006). Circular instead of hierarchical: Methodological principles for the evaluation of complex interventions. BMC Medical Research Methodology, 6, 29–29.

    Article  Google Scholar 

  • White, A., Resch, K., & Ernst, E. (1996). Methods of economic evaluation in complementary medicine. Forschende Komplementarmedizin, 3, 196–203.

    Google Scholar 

  • Williams, C. M., Skinner, E. H., James, A. M., Cook, J. L., McPhail, S. M., & Haines, T. P. (2016, August 17). Comparative effectiveness research for the clinician researcher: A framework for making a methodological design choice. Trials, 17 (1), 406.

    Google Scholar 

  • Wilson, K., Mills, E. J., Ross, C., & Guyatt, G. (2002). Teaching evidence-based complementary and alternative medicine: 4. Appraising the evidence for papers on therapy. Journal of Alternative and Complementary Medicine, 8(5), 673–679.

    Article  Google Scholar 

  • Zhang, H. L. (2004). Qigong commentary. Journal of Alternative and Complementary Medicine, 10(2), 228–230.

    Google Scholar 

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Authors and Affiliations

  1. Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ, USA

    James H. Lake

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Lake, J.H. (2019). Foundations of Methodology in Integrative Mental Health Care. In: An Integrative Paradigm for Mental Health Care. Springer, Cham. https://doi.org/10.1007/978-3-030-15285-7_5

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