A Case Study: Combination of Complementary Therapies, Psychological Intervention and Orthodox Treatment for Depression


Miss Louise was a patient with the cardiovascular disease and taking treatment for the last two years. Due to a prolonged period of medical treatment, she was diagnosed with Major Depressive Disorder. Various psychological, medical and behavioural therapies and medicine were available to address the depressive symptoms of Miss Louise. 


Miss Louise was facilitated with conventional treatment and psychological management plan with the combination of Complementary Therapies. The orthodox treatment comprised of conventional medicine, biomedicine and mainstream medicine and other surgical methods to treat the patients. Unlike the conventional medicine, complementary therapies help to regain the balance between mind and body as all diseases and illness emerge due to min body imbalance through relaxation techniques, yoga, acupuncture, massages and herbs. Miss Louise was depressed due to the prolonged period of her treatment and least responsive to psychological interventions. Therefore complimentary therapies were used to overcome the depressive symptoms.
The initial causes of depression
Four days post-admission, the first team meeting took place to discuss Miss Louise case. She was stressed and anxious about her health condition due to multiple assessment procedures and lengthy treatment procedure. She used to live alone in her home and weekly or monthly used to connect with her children. Therefore, it can be assumed that due to loneliness she was more vulnerable towards stress and anxiety. Then the diagnoses for walking, speaking problem and muscular-skeletal, metabolic and cardio-respiratory needs further increased her anxiety and stress towards her current condition.
Advantages of Complementary Therapies
Complementary therapies are cheap but effective ways of healing the illness as it composed of natural ingredients that are readily available in kitchen and herbs. The literature also supports the complementary therapies for the treatment of multiple diseases such as stroke, cancer, diabetes, anxiety, depression and joint pain. Complementary therapies not merely useful for medical problems, but these are effective for mental, physical and emotional peace and stability.
The rigid body muscle and joint may also get benefit with the regular use of complementary therapies such as yoga, meditation and natural herbs. Some other treatments are helpful in relieving pain such as Acupuncture is very useful in reducing bodily pain. Although these therapies bring about a positive change in the speaking and walking skills, these therapies manifest some disadvantages as well. The complementary therapies take a long time for recovery that can be discouraging for some people. For example, if someone has a nagging headache and needs immediate restoration, or in case of emergency, immediate treatment is not possible. Therefore, people do not believe the effectiveness of complementary therapies. Complementary therapies require energy for gaining optimum health. This means significant changes needed to your lifestyles, such as modified diet and adaptability to deal with stressors. Sometime herbal remedies might interrelate with prescription drugs. Therefore conventional or complementary practitioner must inform about the medication used. The complementary practitioner suggests the therapies according to medicine intake or may advise modifying the treatments.
Miss Louis received the complementary therapy as recommended by the practitioner and bring about positive effects. For her joints and walking problem, she was given yoga exercises that were helpful and assisted her in waking. Yoga also helps in relieving the stress as the substantial body of researches indicates that yoga is a positive predictor of mental peace and negative e predictor of depression. For relieving the pain and rigid body muscle, she was served with Acupuncture that was also demonstrated the positive impact. Acupuncture and massages help in elevating the depressive symptoms on a very high scale. 
Barriers in Accessing the Complementary Therapies
Although complementary therapies are viral among people, these are not much commons like orthodox medicines or psychological interventions. People believe more in orthodox medication as compared to complementary therapies. Various factors influence the people to access to complementary treatment such as finance, availability, physical access, time, prejudice, beliefs, and cultural factors. Socioeconomic status is a primary reason for lack of access to conventional therapies as it takes long times and substantial cost, therefore, people least prefer its use.
On the other hand, the people with high socioeconomic status consult more conventional practitioner as they do not have expenses issues. The lack of awareness also serves as a critical hindrance to the use of conventional therapies. The media also plays a significant role in the promotion of complementary therapies. In the case of Miss Louise, she regularly received the complementary therapies with the recommendation of her psychologists to divert her stressful thinking and rigid body muscle, but before admitting to the hospital, she ignored the benefits of complementary therapies and never used it before.
The primary reason for avoiding complementary therapy was her physical access. She was 56 years old and could not access the therapeutic institution for taking massage and yoga or acupuncture. She needs someone support to obtain but as she used to live alone and her children used to live in another station. Another reason was her prejudices; she was not having a firm belief about the accuracy of complementary therapies. She had the biased way of thinking towards medical treatment and used to trust medications more than natural herbal remedy. The very third factor that limited her access to complementary therapy was the time issue. As these therapies take a long time to heal the patient, but Miss Louise was not able to continue these therapies for the extended period.
Combining orthodox and complementary approaches creates a new paradigm of mental and physical healthcare. This model teaches the patient the personal coping mechanisms through self-help approaches and patient training. Complementary Therapies offers a holistic approach to overcome the mental or physical illness. Due to lack of physical activity during the medical treatment, Miss Louise diagnosed with legs joint that causes the disturbance in walking. She was given complementary therapies for the treatment of musculoskeletal rigidity and depressive symptoms.
Complimentary Therapy


Acupuncture
The very first technique used to treat her depression as well as rigid body muscles was Acupuncture. Acupuncture is the way to place the needle in the patient back or neck to relieve pain and improve joint function or walking. Chinese discovered the acupuncture therapy with the belief that illnesses are signs of body imbalance. Harmony needs to recover from illness, by identifying the blockage point in the body. The needles insertion approximately for 20 minutes at right point relieves the blockage. Chinese often prescribed herbs in conjunction with acupuncture cure. Studies indicated that people reported the effectiveness of Acupuncture in reducing the upper and lower back pain. Another therapy of conventional therapy is viral among people for an active and flexible body is known as an s massage therapy. Miss Louise was least responsive toward this therapy. Therefore, she was given massage therapy. 


Massage
The Massage therapy is also useful in preventative treatment to maintain balance, muscle tone and posture and to relieve depression as well. It helped to support healthy connective tissue, reducing chronic pain, and maintain the position for the restricted range of leg movement. The mental suffering and the abnormal activity of serotonin restore through massage therapy. The massage was given using different techniques, such as squeezing, rolling, shaking, wringing, and smooth stroking movements. The results after long time message have seen regarding stretched muscles, proper circulation of blood and lymph and increased joint flexibility. It can also help with relaxation, ease the pain, peaceful sleep and reduce stress. Miss Louise was able to move her joint after getting regular massage therapy.
Herbal Therapy
The natural health product also beneficial to relieve such as Ginger and turmeric are herbs and prevalent medicine of India, Japan and China. Ginger and turmeric are renowned for its anti-inflammatory impact on musculoskeletal diseases. Garlic is the useful dietary supplement for the cure of heart disease, respiratory and hypertension and stress. Literate provide evidence that garlic plays a significant role in blood pressure reductions. Miss Louise also got benefit fit from these herbal treatments. Her blood pressure problem has been controlling through these herbs. 

Yoga
Yoga is a crucial part of complementary therapies regarded as a healer technique in musculoskeletal diseases to improve mental and muscular flexibility and strength, emotional stability, peace of mind and self-confidence. Studies have shown that yoga has a favourable effect on patients with walking or joint problems. A recent study indicated that yoga (Iyengar yoga) have an encouraging impact on, functional joint impairment, decreasing pain, stress and depression in patients with chronic upper or lower back pain. Miss Louise legs joint was found to be strict, though yoga treatment her joint were tried to make flexible enough to facilitate walking. In Miss Louise case the ginger (Phytochemicals and Plants, Acupuncture, massage and yoga played an essential role in recovering from musculoskeletal, chronic pain and depressive symptoms.  After massage therapy, she was able to as squeezing and shaking, her legs.
People Attitude towards Complimentary Therapies
The reaction of people towards Complementary therapies inconsistent concerning gender, socio-economic groups, age groups, lifestyle preferences, barriers to use, value, preferred treatments, and benefits.  The most commonly used complementary therapies include prayer, acupuncture, yoga, meditation, hypnosis, massage therapy, dietary supplements, chiropractic care, and natural products.
The literature indicates the healthy relationship between socioeconomic status and complementary therapies. The high socioeconomic status prefers yoga, massage and dietary supplements as compared to low socioeconomic status. The low socioeconomic status favours natural products such as herbs for the treatment of illness. Different age group also have the different inclination towards complementary therapies such as the Senior adults use herbal medicine, acupuncture and massage more frequently to treat back problems and chronic pain. The women also report more relaxation after complementary therapies as compared to males.
Validity and Reliability of Complementary Therapies
The widespread utilise of complementary among 40 per cent of U.S. population wonders the orthodox practitioner with a substantial challenge.  The effectiveness of complementary therapies is still a question for those people, and healthcare practitioners are mostly unfamiliar with the use and efficacy of the treatment. The problem by generally ask about complementary therapies is, Does it work? This query does not have a simple answer. The effectiveness of complementary therapy depends on multiple factors such as an approach to the patient, the efficacy of intervention, belief and response of the patient and the setting of the place. The effectiveness of therapy also reflects a particular characteristic of the expectancy or placebo effect.
Many studies indicated the effectiveness of complementary therapies and depressive disorders. The placebo effect has reported by those patients who were receiving orthodox treatment for the rigid muscle problem. An experimental study has been conducted divided the sample in the control and experimental group. The control group was given fake medicine, but they reported their condition better after taking medicine. Literature suggests that in all treatment patient expectancy and belief matter more than the medication. Another study has been conducted to assess the relationship between complementary therapies such as yoga to evaluate the effectiveness of the treatment. The participants were supposed to take regular yoga sessions biweekly for six months.
The experimental group took additional yoga sessions. For the assessment of balance and flexibility Stork Stand (SR) test, and Sit and Reach (SR) test were taken after and before the yoga sessions. Paired sample t-test and independent t-test result indicated the significant effect of yoga between and within the groups in pre and post yoga training. Considerable improvement was reported by the participants in the yoga group for balance (SS, P=0.003), flexibility (SR, P=0.016) and during the within-group comparison. Some other studies indicated the effectiveness of complementary therapies for natural herbs, massages and Acupuncture.
Some other studies indicated that people receive. Acupuncture regularly reported the least pain in their upper and lowered back as compared to those who did not receive any treatment. An experimental study has been conducted to see the reliability of the result as the experimental group were given an Acupuncture treatment whereas the control groups were shown as they were receiving Acupuncture therapy but infect they were not receiving any treatment. However, when they were asked to report their pain, they rated the pain level as similar to the control group did.
Another study was conducted to see the effectiveness of natural herbs; old age women were given garlic and ginger related medicine to treat the joint pain with the prescribed dietary plan. The results of the study also showed that a positive change had been noticed in their joint problem and mood stability.
A message is also a useful technique to relieve the joint inflexibility or muscles rigidity. A Meta-analysis study indicated that those people who received the regular body massage reported a very positive change. All literature showed the reliability, validity and validity of the effectiveness of complementary therapies.
Miss Louis also received some intervention for flexibility and balance such as Acupuncture and yoga. The acupuncture found to be highly associated with reliving bodily pain specifically Muscle skeletal pain. The natural herbs such as ginger and garlic also found to useful in joint flexibility. No, doubt the above therapies played a vital role in the advancement of human health care.
Recommendations
Miss Louise had been given multiple diagnoses by a healthcare team. The overwhelming dependence on a single research assessment or management methodology does not provide the accurate diagnosis. The various evaluations helped not merely in the diagnosis of illness but also supported in a recommendation of specific therapeutic intervention. The combination of orthodox, psychological interventions and complementary therapies brings about dramatic changes in patients. Miss Louise also got benefit from this combined therapeutic intervention, but there are few recommendations regarding Miss Louise case such the multiple diagnoses at the same time case some psychological symptoms among patient.
In Miss Louise case, she reported many symptoms of anxiety and depression. There must be multiple causes of anxiety or distress such as fear of getting the deadly or serious disease, fear of death and unfamiliarity with the complementary therapies. Studies have indicated that unfamiliarity and belief system plays a significant role in developing psychological problems among patients.
In the current time, complementary therapies have gained rapid progress in mainstream health care.  There is some code of conduct and code of ethics for conventional practitioner while professionally dealing with their patient. The very first ethical obligation for a complementary practitioner is to make the sound and healthy relationship with their clients regardless of race, gender, colour, and ethnicity. The confidentiality of illness and therapeutic techniques should not hurt the client in any way. Some studies indicate that the people who often consult for massage found to be anxious while exposing themselves. Another research suggests that the people feel shame about their illness, so it is obligatory for a practitioner to ensure parent that disease is just a temporary condition there is nothing to feel embraced or shame about it.
The behaviour of the practitioner must be courteous, respectful, dignified, and tact with the client. Their professional attitude must be sympathetic, hopeful, competent and positive that encourages the patient mental belief and outlook towards good health. Studies also support the fact that people beliefs diversely affect their recovery ratio, for example, an optimistic outlook for healing the pain or illness increases the probability of gaining good health. Miss Louise was treated in a very dignified and respectful way, although she was a bit anxious and pessimistic about her disease the practitioner good support and quality time altered her outlook towards pessimism. Several studies investigated the relationship between a sexual relationship between practitioner and client inclination. The finding of the studies indicated that the patient who takes massage therapy often found to have the sexual relationship with their practitioner. It is very unethical; a practitioner must ensure their ethical boundaries of professionalism.
The practitioner mental, physical and psychological fitness is the fundamental component and must be evaluated before treating the other clients. Studies indicated that psychologically, mentally and physically unfit patients might cause the alarming situation for their clients.  The practitioners must have the professional degree and comply with protocols and guidelines before therapeutic interventions.
The above therapies played a vital role in the advancement of human health care. The mix paradigm of orthodox and complementary treatment is very useful for patients of all ages. Although these contemporary techniques are serving humanity on a large scale, in the current modern civilisation, more advancement in health care is needed. The healthcare practitioners and researchers should pay more attention to develop or design therapies to treat the world spread diseases and work for the awareness of people at a local and international stage as well.