Download NYU COLLEGE OF ARTS AND SCIENCE NYU Child Study Center

 1 NYU COLLEGE OF ARTS AND SCIENCE
NYU Child Study Center (Child and Adolescent Mental Health Studies, CAMS)
Complementary and Alternative Mental Health Syllabus
Course Number: CAMS-UA 103-001 (14811)
4 credits
Instructors:
Marianne Chai, MD, Clinical Instructor, New York University School of Medicine.
Dr. Chai is the Medical Director of the New York Center for Living, supervises training
psychiatrists, and is in psychiatry private practice in Manhattan where she specializes in treating
children, adolescents, young adults and those struggling with addictive disorders. She received
her Bachelor’s degree from Barnard College and her Medical Doctorate from the University of
Miami School of Medicine. Dr. Chai completed her residency training in general psychiatry at
the NYU School of Medicine University, followed by a Child Psychiatry Fellowship at the NYU
Child Study Center and an Addiction Psychiatry Fellowship at the NYU Division of Alcoholism
and Substance Abuse. Dr. Chai had an extensive background in ballet prior to begin her career in
medicine. Her interests are in the history and politics of medicine, the expressive and creative
arts therapy, integrative bodywork, spirituality, psychotherapy and group therapy.
Contact: [email protected] and [email protected]
Phone: 646.504.6069
Beata “Bliss” Lewis, MD, Clinical Assistant Professor, New York University School of
Medicine. Dr. Lewis is in psychiatry private practice in Brooklyn and Manhattan. She received
her Bachelor’s degree in biology from Harvard College and her Medical Doctorate from Harvard
Medical School. Dr. Lewis completed residency in general psychiatry at Columbia University
and Child Psychiatry Fellowship at the NYU Child Study Center. Prior to her work at NYU, Dr.
Lewis taught and studied medical anthropology and psychiatry on a Fulbright Scholarship in
Russia. Dr. Lewis is interested in mind-body medicine, yoga, mindfulness, hypnosis, nutrition,
herbs and supplements, and psychotherapy.
Contact: [email protected]
To schedule office hours appointment please email: [email protected]
Phone: 646.606.2663 (calls only, no text)
Course description:
Complementary and alternative treatments comprise the most rapidly expanding segment of
American healthcare. This course will examine the role of non-conventional care in the mental
wellness of children, adolescents and young adults. We will survey the historical, clinical, and
scientific aspects of traditional medical systems of China and India, mind-body treatments,
biologically based alternative therapies, body-based treatments and spirituality. In addition, we
will investigate the social, political, and economic forces influencing the role and status of
complementary and alternative medicine in America. Students will assess these practices by
2 participating in class discussion, reviewing research literature, and engaging in experiential
exercises.
Aims of the Course:
Knowledge
Students will be able to:
1. Define Complementary and Alternative Medicine (CAM) and the classification of CAM
treatments;
2. List and describe examples of commonly used CAM therapies in the United States;
3. Identify how CAM use is related to socio-demographic characteristics, values, and
beliefs;
4. Evaluate the social, political and economic forces shaping the status, role and use of
CAM;
5. Describe the potential impact of selected CAM (yoga, Ayurveda, Chinese Medicine, etc.)
therapies on stress reduction, illness prevention, and health promotion; and
6. Identify potential safety issues associated with selected CAM therapies, such as
interactions with other CAM therapies, interactions with conventional medicine, side
effects, and contraindications.
Skills
Students will be able to:
1. Compare the conventional medicine paradigm with various complementary paradigms
with respect to concepts such as clinical effectiveness, standards of evidence, clinical
trials, wellness, healing, and placebo response;
2. Critically evaluate the evidence pertaining to selected CAM therapies for the prevention
and treatment of specific mental health conditions;
3. Reflect on their own culturally based values and belief systems, attitudes, and CAM
related knowledge, and describe how these might affect their approach to self-care,
health, wellness, and healing; and
4. Identify the key concerns with research on CAM.
Syllabus:
Session 1. Introduction to Alternative, Complementary and Integrative Medicine
In the first session we will define alternative, complementary and integrative medicine and
review the prevalence of various non-conventional approaches. According to the National
Center for Health Statistics, the use of CAM has increased markedly. In 2007, 12 percent of
American children and 40 percent of adults used CAM. The same year Americans spent $33.9
billion out of pocket on visits to CAM practitioners and purchases of CAM products and made
354 million visits to practitioners of CAM. We will analyze factors leading to increased CAM
use and discuss the implications of these trends for American medicine. We will review the
principles of integrative medicine. We will review course requirements and expectations and
outline the overall objectives of the course.
3 Required Reading:
1. Kemper, K., Vohra, S., Walls, S. (2008). The Use of Complementary and Alternative
Medicine in Pediatrics, the Task Force on Complementary and Alternative Medicine the
Provisional Section on Complementary, Holistic, and Integrative Medicine Pediatrics,
122, 1374-1386.
http://pediatrics.aappublications.org/content/122/6/1374.long
Session 2. History of Complementary & Alternative Medicine in America, Homeopathy
(MC)
We will survey the history of alternative medicine in America. Special attention will be given to
the political and economic factors driving this longstanding controversy, and contrast that with
the wider acceptance of alternative medical practices today. We will broadly examine the most
popular Jacksonian Era health practices, and provide adetailed overview of homeopathy.
Required Reading:
1. Article: Jonas, W, Kaptchuk, T, Linde, K. A critical overview of homeopathy. Annals
of Internal Medicine 138.5 (Mar 4, 2003): 393-9.
2. Crews, R.L. Introductory Workbook in Homeopathy. Pages 1-8.
Optional Reading:
1. Bivins, A. Alternative Medicine? A History. Oxford: Oxford University Press, 2007
2. Whorton, J. Nature Cures: The History of Alternative Medicine in America. Oxford:
Oxford University Press, 2002
Session 3. The Science of Exercise: Movement in Medicine (MC) & Expressive
Psychotherapies (MC)
Expressive therapies, such as art, music, and drama therapy, encourage self-awareness through
creativity and sensory exploration. These modalities are suggested to help individual’s process
and communicate nonverbal memories, and alter emotions, feelings and mood states. We will
provide a broad introduction into this vast field focusing on the evidence for the therapeutic use
of music therapy, followed by an experiential in class exercise.
In the second half of class we will turn our attention to exploring the science of exercise.
Growing evidence for the neuroprotective effects of exercise suggests a role for aerobic exercise
in treatment and prevention of mental disorders in children and adolescents. We will discuss the
neurobiology of exercise focusing on Brain Derived Neurotrophic Factor (BDNF). BDNF
mediates many of the benefits of exercise on the brain by exerting protective effects on neurons,
promoting synaptic plasticity, and stimulating neurogenesis.
Required Reading:
1. Chapter excerpt. Malchiodi, C. (2005). Expressive Therapies. (pp. 1-15). Guilford
Publications. History, Theory, and Practice. Available at:
http://www.psychologytoday.com/files/attachments/231/malchiodi3.pdf
4 2. Solanki, MS, Zafar, M, Rastogi, R. Music as a therapy: role in psychiatry. Asian Journal
of Psychiatry. 2013 Jun;6(3):193-9. doi: 10.1016/j.ajp.2012.12.001. Epub 2013 Jan 25.
3. Book: Ratey, J.J. (2008). Spark: The Revolutionary New Science of Exercise and the
Brain Chapter 1, 2, 4, 6 (pp. 9-56, 85-112, 141-166). New York, NY: Little, Brown and
Company.
Optional Readings:
1. Riley, S. (2001). Art therapy with adolescents. Western Journal of Medicine, 175(1), 5457. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071468/
Session 4. Spirituality and Psychedelic Therapy (MC)
Spirituality is complex and multidimensional, if not controversial. There is some evidence to
suggest that faith and attendance at religious functions has health benefits. Current research
presents itself with experimental design problems, difficulty with endpoint evaluations, and for
some, issues of ethical or moral boundaries. In this class we will examine the current research on
spirituality, religion, prayer and health outcomes and explore reasons for an increased interest in
spirituality. We will also examine the history of hallucinogenic drugs as medical treatments, and
explore the resurgence of interest and insights in the field.
Required Readings:
1. Levin, J. (2010). Religion and Mental Health: Theory and Research. International Journal
of Applied Psychoanalytic Studies Int. J. Appl. Psychoanal. Studies.
2. Johnson, M., Richards W., Griffiths, R. (2008). Human hallucinogen research: guidelines
for safety. J Psychopharmacol. 2008 Aug;22(6); Only pages 1-6 are required; remainder
is optional.
3. Mueller, Paul, et al. Religious involvement, spirituality, and medicine: Implications for
Clinical practice Mayo Clinic Proceedings; Dec 2001; 76, 12; pg. 1225
Optional Reading:
4. Book: Galanter, M. (2000). Spirituality and the Healthy Mind: Science, Therapy, and the
Need for Personal Meaning (pp. 5-48. 68-93, 149-170). New York, NY: Oxford
University Press.
5. Grob,C (1994) Psychiatric Research with Hallucinogens: What have we learned?
Yearbook of Ethnomedicine and Study of Consciousness 3:
6. Smith, H. Do Drugs Have Religious Importance? The Journal of Philosophy, Vol LXI,
No. 18, September 17, 1964
Session 5. Traditional Medicine Systems: Chinese Medicine (MC)
Traditional Chinese Medicine (TCM) is one of the most complex, highly developed traditional
healing theories in the world. Like many other types of traditional medicines, TCM, has its own
5 unique cultural and philosophical background. It emphasizes harmony with the universe,
balance, diet and prevention, with a focuses on stimulating the body's natural curative powers. In
this class, we will broadly survey the historical and philosophical background of TCM, followed
by an introduction to the key concepts, diagnostic techniques and therapies of TCM.
Required Readings:
1. Beinfield, H., Korngold, E. (1995, March). Chinese Traditional Medicine: An
Introductory Overview. Alternative Therapies, 1 (1), 44 - 52.
2. Book: Servan-Schreiber, D. (2004). In The Instinct to Heal: Curing Depression, Anxiety
and Stress without Drugs and Without Talk Therapy (pp. 109-121). New York, NY:
Rodale Books.
Optional Reading:
1. Kaptchuk, T. (2000). The Web That Has No Weaver: Understanding Chinese Medicine.
McGraw Hill Publishers, New York, NY.
2. Beinfield, H., Korngold, E. (1992). Between Heaven and Earth: A Guide to Chinese
Medicine. Ballantine Books, New York, NY.
Session6. Special Topics in Alternative Medicine, Extra-Credit group presentations, Midterm Review
Students may earn up to 2% extra credit towards their midterm grade by doing a group
presentation. Presentations will be based on having an experience of a CAM treatment modality
covered during the first half of the class. For example, each student in the group will engage in a
TCM practice, exercise regimen, homeopathic intervention, expressive therapy, dance, spiritual
experience or a special topic approved by Dr. Chai.
Students will present on the history of the modality, describe the mechanism, and describe the
experience of the activity. Groups will consist of between 3-5 students for a 7-10 minute
presentation.
Each student will submit a one-page research review of the topic and description of the
experience, and is responsible for posting it on NYU Classes.
Session 7.
MIDTERM EXAM + Extra-Credit group presentations
6 MIND-BODY MEDICINE (SESSIONS 8, 9, 10, 11)
Session 8. Yoga and Ayurveda (BL)
Yoga is becoming increasingly popular for promoting wellness and is gaining increasing
research evidence for treatment of mental and physical conditions. Yoga was developed in India
during the Vedic period and aims to bring the body, mind and spirit into harmony through a
system of ethics, exercise, breathing and meditation. Yoga is a component of various evidencebased stress reduction programs, such as the Mindfulness Based Stress Reduction Program.
Ayurveda originated in India several thousand years ago as a comprehensive medical system and
a lifestyle guide. The goal of Ayurveda is a balance of the body, mind and spirit to create health
and prevent illness. Ayurvedic treatments aim to cure disease by cleansing the body of
substances that are considered toxic. Ayurveda recommendations typically include lifestyle
changes, herbs, special diets, yoga, mediation, and massage. Students will experience a
breathing and yoga practice in class. Please wear comfortable clothing to class.
Required Reading:
1. Desikachar, T.K.V. (1995). The Heart of Yoga: Developing a Personal Practice.
Rochester, NY: Inner Traditions International. Read: Chapters 1-3, pp. 5-23; Chapter 8,
pp. 79-85; Chapters 11-12, pp. 97-118 (45 pages total)
2. Book: Lad, V. (1993). Ayurveda: A Practical Guide: The Science of Self-Healing.
Alburquerque, NM: The Ayurvedic Press.
Chapters 1, 2, 6, 7, 9, and 13 are optional, remaining chapters are required reading.
Session 9. Mind-Body: The Mind-Body Connection and Placebo (BL)
Extensive research evidence documents the connection between the mind, body and belief
systems. We will continue learning about the mind-body connection and the science behind the
placebo response.
Required Readings:
1. Article: Gilbert, M. (2003). Weaving Medicine Back Together: Mind-Body Medicine in
the Twenty-First Century. Journal of Complementary and Alternative Medicine, pp. 563570.
2. Article: Walach, H., Jonas, W. (2004). Placebo Research: The Evidence Base for
Harnessing Self-Healing Capacities. Journal of Complementary and Alternative
Medicine, pp. S-103 – 3-112.
Session 10. Mind-Body: Mindfulness and Meditation (BL)
PAPERS DUE BEGINNING OF CLASS by email word document and a printed copy in
class
Emerging evidence suggests that mindfulness and meditation practices change the biology of the
brain and affect mood and physiological function of those who meditate. The concept of
mindfulness originated in Eastern philosophy, yet it is neither esoteric nor religious in nature.
Mindfulness consists of non-judgmental, present moment awareness. Mindfulness training aims
7 at gradually strengthening the ability to observe instead of reacting, allowing individuals to gain
a richer and more accurate perception of reality. Numerous psychotherapeutic approaches,
including dialectical behavior therapy (an evidence-based psychotherapy for individuals who are
chronically emotionally unbalanced) teach mindfulness. A body of evidence demonstrates that
programs utilizing mindfulness benefit a great variety of patients. We will study the Eastern
philosophy roots of mindfulness and Buddhist psychotherapy, and the modern applications of
mindfulness to mental health treatment. We will experience a mindfulness practice in class.
Required Readings:
1. Book: Kabat-Zinn, J., (1990). Introduction and Chapters 1-4. In Full Catastrophe Living:
Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness (pp. 1-74).
New York, New York: Bantam Dell.
Optional Reading:
2. Book: Epstein, M. (1995). Thoughts Without a Thinker. New York, NY: Basic Books.
(Audiobook available on Audible.com)
Session 11. Mind-Body: Clinical Applications of Mind-Body Medicine (Biofeedback &
Hypnosis) (BL)
Biofeedback involves receiving information about one’s own physiological states to alter brain
activity, blood pressure, heart rate, and other bodily functions typically not controlled
voluntarily. Heart rate variability (HRV) is a type of biofeedback and has been found to be a
marker of physiological resilience, and emotional flexibility.
Hypnosis is used to alter maladaptive psycho-physiological responses through encouragement of
narrowly focused attention and heightened responsiveness to new ideas and associations. The
use of hypnosis in children has been documented since ancient times in various cultural accounts
of induction of trance-like states in healing, religious and initiation rituals.
Required Reading:
1. Book: David Servan-Schreiber. The Instinct to Heal: Curing Depression, Anxiety and
Stress without Drugs and Without Talk Therapy (pp. 1-98).
BIOLOGICAL TREATMENTS (SESSION 12 & 13)
Session 12. Nutrition 1 (BL)
The use of herbal medications and dietary supplements has increased markedly in the United
States since the passing of the Dietary Supplement Health and Education Act (DSHEA) of 1994.
During sessions 10 and 11, we will discuss how these products are employed today among
children and adolescents in America. Recent studies indicate that children’s diets are not
balanced and that only one percent of children meet food pyramid guidelines. We will explore
the role of nutrition in child and adolescent mental illness and consider some of the sociopolitical
aspects of the diet of American children. We will discuss nutritional deficiencies, organic and
locally grown food, elimination diets, and various diets.
Required Readings:
1. Pollan, M. (2008). In Defense of Food: An Eater’s Manifesto. Read: Parts I and II, pp.
19 -136.
8 Optional Extra Credit 2%:
1. Watch a food/diet/nutrition related documentary film or read a food/diet/nutrition related
book and implement a change to your diet. Monitor how you feel after implementing the
diet change. Please use your good judgment and be reasonable and safe.
Write a 1 to 2 page summary of the film or book and your experience with implementing
a change to your diet. Please email your summary to Dr. Lewis by Tuesday evening
before class.
OPTIONAL FINAL EXAM REVIEW SESSION APRIL 30TH 8:45AM – 9:30AM
Session 13. Nutrition 2: Nutrition and Dietary Supplements (BL)
As we continue our discussion of nutrition and discuss dietary supplements and herbal
medications.
Required Reading:
1. Book: Pollan, M. (2008). In Defense of Food: An Eater’s Manifesto. Read: Part III, pp.
137 -201.
Session 14. Final Exam, Conclusions and The Future of Complementary and Alternative
Mental Health
First half of the class will be dedicated to the in-class final exam.
In the final session we will engage in a class discussion about the future direction of American
medicine, addressing questions such as: Why CAM is highly popular despite limited research
evidence? What are the implications of CAM use for allopathic medicine? What are the benefits
and risks of integrating CAM approaches into conventional medicine practice? What is the role
of integrative medicine in modern society? We will also revisit the social, political, and
economic factors that determine the status of CAM and influence the future developments in
integrative care. Students will complete their presentations and share their personal experiences
with CAM during the course.
Required Readings:
NO NEW READINGS, REVIEW FOR THE FINAL EXAM
Course Book List with Amazon.com new book prices. Audiobooks are OK.
1. The Heart of Yoga. $12
2. Ayurveda: A Practical Guide: The Science of Self Healing. $6
3. The Instinct to Heal: Curing Depression, Anxiety and Stress without Drugs and Without
Talk Therapy. $10
4. Spark: The Revolutionary New Science of Exercise and the Brain. $14
5. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain
and Illness. $14
6. Optional: Thoughts without a Thinker. $12
9 7. Optional: The Web That Has No Weaver: Understanding Chinese Medicine. $14 (new)/
$5 (used)
8. Optional: Spirituality and the Healthy Mind: Science, Therapy, and the Need for Personal
Meaning. $15 (new)/ $6 (used)
9. In Defense of Food: An Eater’s Manifesto. $10
Grading
1. Final Exam (35%). The final exam will consist of multiple choice and short answer
questions covering the material presented in class and in the assigned readings. Final
exam will be given in the first half of class on Dec 14th, 2013.
2. Midterm Exam (30%). Midterm exam will be given in class on June 19th. The midterm
will cover material covered in reading and lecture for classes 1 to 6. The midterm will
include multiple choice, fill in the blank, and short answer questions.
3. Paper (30%). 5-7 page paper on a CAM topic of your choice, addressing the following:
(1) Pick a treatment modality (ex. Mediation, yoga, acupuncture, St. Johns wort,
multivitamin, EMDR, biofeedback, HRV, dance, exercise, prayer, psilocybin,
Ayurvedic herbs, chiropractic etc.) and a mental health issue or category (ex.
Depression, anxiety, insomnia, anger, stress, overeating, ADHD, trauma in
children, etc.) While it is easier to find articles on common topics such as
mindfulness or acupuncture, we encourage you to write on whatever interests you
and less common topics.
(2) Find at least 3 research articles published in scientific journals relevant to
your topic of choice. You may go to NYU Medical Library website and access
databases such as Pubmed with Full Text. http://hsl.med.nyu.edu/journalsdatabases-and-books.
(3) Write an introduction, thesis, body of paper and a conclusion.
(4) A thesis is a sentence that identifies the main idea, central purpose of your
essay. What are you trying to say in your paper? It serves as the organizing
principle for the essay and appears at the end of the introductory paragraph. (ex.
“EMDR is a well established treatment for trauma in adults, but additional
research is needed to prove that it is safe and effective for children”; or “Omega 3
fatty acids may be helpful for ADHD in children.”)
(5) In your paper describe the research studies you found and how they support
your thesis statement. Think about how good the studies are and how strongly do
these studies support your thesis?
The paper is due by class time as an email attachment word document file (PDF
file or other formats will not be accepted) to [email protected] and
[email protected]. Papers turned in after the beginning of class time will be
penalized 10% of grade per week of delay. Please bring printed, stapled paper to class.
Please pick your topic early and ask if you are not sure if your topic is suitable.
10 4. Class Participation, Reading (5%). Students will be evaluated based upon their
participation in class as evidenced by their comments, preparation, contribution to class
debates, and evidence of knowledge of the reading assignment.
***** Laptop and other electronic device use is not permitted in class as it interferes
with class participation *********
5. Attendance Policy and Extra Credit. Please make an effort to be present for every
class and sign the attendance sheet. We understand that various circumstances may come
up and perfect attendance is not always possible, so we allow missing 2 classes without
providing an excuse. If you miss a third class please provide appropriate
excuse/documentation from doctor. You can earn 5% extra credit by having perfect
attendance.
The doctor of the future will give no medicine, but will interest his patient in the care of
the human frame, in diet and in the cause and prevention of disease.
- THOMAS EDISON