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Mindfulness-based stress reduction (MBSR) is one type of complementary practice that has had positive results in a variety of settings. Originally funded for research by NCCAM, MBSR started in the Stress Reduction Clinic at the University of Massachusetts in 1979. This approach has had positive results for clients with cancer, rheumatoid arthritis, chronic low back pain, and many other conditions. In mental health, MBSR can be combined with cognitive therapy to help treat depression, and is offered to caregivers to help deal with the caregiving burden (Hou et al., 2014). Lastly, MBSR is available as an online course, making it available to people who cannot attend in person or in their local area.

NCCIH studies a wide variety of complementary and alternative therapies:

• Alternative medical systems include homeopathic medicine and naturopathic medicine in Western cultures, and traditional Chinese medicine, which includes herbal and nutritional therapy, restorative physical exercises (yoga and Tai chi), meditation, acupuncture, and remedial massage.

• Mind–body interventions include meditation, prayer, mental healing, and creative therapies that use art, music, or dance.

• Biologically based therapies use substances found in nature, such as herbs, food, and vitamins. Dietary supplements, herbal products, medicinal teas, aromatherapy, and a variety of diets are included.

• Manipulative and body-based therapies are based on manipulation or movement of one or more parts of the body, such as therapeutic massage and chiropractic or osteopathic manipulation.

• Energy therapies include two types of therapy: biofield therapies, intended to affect energy fields that are believed to surround and penetrate the body, such as therapeutic touch, qi gong, and Reiki, and bioelectric-based therapies involving the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, and AC or DC fields. Qi gong is part of Chinese medicine that combines movement, meditation, and regulated breathing to enhance the flow of vital energy and promote healing. Reiki (which in Japanese means universal life energy) is based on the belief that when spiritual energy is channeled through a Reiki practitioner, the patient’s spirit and body are healed.


Clients may be reluctant to tell the psychiatrist or primary care provider about the use of CAM. Therefore, it is important that the nurse ask clients specifically about use of herbs, vitamins, or other health practices in a nonjudgmental way.

Psychiatric Rehabilitation Psychiatric rehabilitation involves providing services to people with severe and persistent mental illness to help them to live in the community. These programs are often called community support services or community support programs. Psychiatric rehabilitation focuses on the client’s strengths, not just on his or her illness. The client actively participates in program planning. The programs are designed to help the client manage the illness and symptoms, gain access to needed services, and live successfully in the community.

These programs assist clients with activities of daily living such as transportation, shopping, food preparation, money management, and hygiene. Social support and interpersonal relationships are recognized as a primary need for successful community living. Psychiatric rehabilitation programs provide opportunities for socialization, such as drop-in centers and places where clients can go to be with others in a safe, supportive environment. Vocational referral, training, job coaching, and support are available for clients who want to seek and maintain employment. Community support programs also provide education about the client’s illness and treatment and help the client to obtain health care when needed.

It is important to include the client in an active role in identifying rehabilitation goals. There is often a disparity between what health-care professionals view as the client’s needs and what the client perceives as valuable. Offering services that meet each client’s most important goals can significantly improve his or her quality of life and promote recovery and well-being. Counseling, advocacy, and mentoring by peers are becoming more common in community mental health service programs with positive results (Lewis et al., 2012). Consumer-run mental health programs are less common, but their numbers are on the rise. See Chapter 4 for discussion on recovery.