A more open paradigm
Recently published systematic reviews fail to show strong efficacy for widely used conventional pharmacological therapies for common psychiatric disorders such as MDD, bipolar disorder, schizophrenia, and dementia.8-13 In addition to growing concerns about the lack of efficacy, psychopharmacological agents are plagued by serious safety issues. Moreover, concerns about the limitations of contemporary biomedical treatments have been raised by leading figures in academic psychiatry.14
In response to the limitations of conventional care, research and clinical practices are becoming progressively more open to the rigorous examination of novel perspectives. This growing intellectual openness is giving rise to an integrative model of mental health care that draws from the best evidence in both conventional biomedical psychiatry and alternative modalities. Novel theories are being embraced by psychiatry that more adequately explain both normal conscious functioning and the complex factors that contribute to mental illness. These emerging theories are at the heart of a rapidly evolving paradigm called “integrative mental health care.” This will lead to more effective and more compassionate “whole person” mental health care that takes into account the complex biological, psychological, social, cultural, and possibly also spiritual causes and meanings of mental illness.
Important technological innovations that will become more widely used treatments of mental illness in the first half of the 21st century include transcranial magnetic stimulation, electroencephalographic biofeedback, and virtual reality expo-sure therapy (VRET). Biofeedback based on real-time monitoring of galvanic skin resistance and electroencephalography is being used to treat phobias and other anxiety disorders. Emerging findings suggest that biofeedback training based on heart rate variability significantly reduces stress and improves general feelings of emotional well-being in individuals who are subjected to acute job-related stress.15
Cognitive-behavioral therapy (CBT) is effective for a range of anxiety symptoms whether done in conventional outpatient therapy settings or via broadband videoconferencing.16 An effective therapeutic alliance can be achieved between therapist and patient using video-conferencing.17,18 Patients who are chronically anxious, and especially those with panic disorder or agoraphobia, are frequently too impaired by their symptoms to seek professional care. Others are geographically isolated and cannot obtain conventional CBT or pharmacological treatment for severe anxiety syndromes. The rapid growth in broadband Internet access will result in widespread use of biofeedback techniques by patients with portable devices based on existing computer technology.
Broadband videoconferencing using Internet technology is a cost-effective alternative mode of treatment delivery to homebound patients. Videoconferencing allows the therapist to demonstrate behavioral exercises for the patient, and both the therapist and the patient are able to accurately observe nonverbal behaviors.
Controlled studies confirm that VRET is more effective than conventional imaginal exposure therapy and is comparable to in vivo exposure therapy for some anxiety disorders.19,20 Many VRET tools are available that allow patients to use computer-based advanced exposure protocols through real-time videoconferencing anywhere high-speed Internet access is available.21
Within the next few decades, treatment of phobias, panic attacks, and other severe anxiety disorders will combine VRET with biofeedback, CBT, or mind-body practices. Broadband Internet connections will allow real-time interactions between patients and therapists in separate settings.
An evolving trend is the increased use of synergistic combinations of synthetic drugs and select natural products.22 Greater antidepressant efficacy has been shown when antidepressants are combined with SAMe, folic acid, l-tryptophan, or omega-3 fatty acids.22 Sarris and colleagues23 showed that efficacy is increased when N-acetylcysteine, magnesium, folic acid, or amino acids are combined with conventional mood stabilizers in patients with bipolar disorder. The use of natural products, including nutrients or botanicals, in combination with pharmacotherapeutic agents holds the potential for improving outcomes while reducing adverse effects by permitting reductions in effective doses of psychotropics and commensurate reduction of adverse-effect risks.
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