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Health Psychology and NES: difficulties and challenges
Professor Anna van Wersch PhD Full Professor of Psychology Teesside University, Middlesbrough, UK NES Health conference Santa Clara, 27 September 2013
Introduction § Rationale § Book § Aim Research framework § Psychological theories § Methods & Analysis Results § Infoceuticals § miHealth Conclusion and way forward
INTRODUCTION
Ra#onale § Through mother interested in Complementary and Alternative Medicine (CAM) – Acupuncture
§ Member of Dutch ABB (physicians and biophysics medicine)
§ 2006: ABB conferenceà NES § Followed NES training in Netherlands and UK
§ Contact with Sarah Turner § Development and support for research
Complementary Medicine and Health Psychology
Published with Open University Press in 2009
§ 5 years to write § Sabbatical – study tour China § received positive reviews in Health
Psychology Update and the Journal of Health Psychology, and has been quoted as
“... this book is an eclectic and thought-‐provoking read for health psychologists. I echo the authors’ hope that it will inspire colleagues to look beyond traditional biomedicine and begin to explore the exciting new possibilities for theory and research...................” (Bishop, F. (2011) Journal of Health Psychology 16(8) 1277–1278)
Difficul#es § to obtain research grants in CAM
§ have to meet my university target of £150.000 with other more conventional research (breast cancer, OCPD, male pill)
§ to get research published in conventional peer reviewed journals § discouraged to publish in low Impact Factor CAM journals
§ colleagues whisper; and name my CAM research ‘Anna’s funny interests’
§ even one NES patient calls me the ‘nutty professor’
Challenges § Book aims to encourage health psychologists to do CAM
research § undergraduate and MSc students love the topic
§ Book acknowledges different model of the person § biology versus physics § psychological social self theories versus inner self experiences
§ Scientific understanding related to post-‐modernist epistemologies rather than positivism § RCT as gold standard and quantitative methods are not the only way to obtain ‘scientific truth’
§ Pragmatism (William James) and pluralistic combination of qualitative and quantitative methods are as as valid
§ nomadic research philosophy of Fox (1999) based on postmoderist philosophical ideas of Levinas, Deleuze and Guattari
§ Participatory research: researcher (health psychologist) has a caring and engaging role
Aim of NES research
§ to demonstrate in a logical, systematic, analytical and critical way how NES diagnostic and treatment tools impact on the quality of life of the users in a triad relationship NES
USER PRACTITIONER
§ In this triad, placebo effects are assumed to be part of the diagnostic and treatment effect as placebo means ‘I will please’
RESEARCH FRAMEWORK
Biophysics-‐psychosocial model of stress and illness: role of NES?
CULTURAL Stress CONTEXT
-‐ Coping style +
-‐ Social Support + -‐ Lifestyle and psychological profile +
-‐ Stress management + -‐ Immunology +
Illness Health
Stress: out of balance § Stressful life events (Holmes & Rahe, 1967)
death of a spouse, child, close other moving house illness
§ Daily hassles (Kanner et al., 1981) car breaking down loosing purse traffic jam
§ Silent stressors (van Wersch, 2007)
guilt unhappiness pain (physical and psychological) feeling unwell – ‘un-‐ease’
Stress experience
§ Acute stress: -‐> NES: scan, ESR, ES8 ú Fight-‐flight response (Canon, 1914; 1939) ú Autonomic Nervous System
§ Chronic stress: -‐> NES: protocol ú General Adaptation Syndrome (GAS) (Selye, 1936, 1950) Alarm-‐> Resistance-‐>Exhaustion
ú Hypothalamic Pituitary Adrenocortisol (HPA) axis
Coping strategies
Over 100 distinguished, for example: praying crying looking for information exercising music smoking, excessive alcohol use, drugs keeping busy, to not thinking about it keep acting as normal USE OF NES
Coping func#ons* § Adaptive coping -‐> NES: protocol emotional relief approaching re-‐appraisal
§ Maladaptive coping -‐> NES: scan denial and avoiding stoical accepting anger repression or alexithymia self destruction
* Lazarus and Folkman (1984); Eysenck (1985); Cox and Ferguson (1998);
Social Support
§ House (1984):
ú Emotion -‐> NES: practitioner ú Information -‐> NES: scan, miHealth: friend? ú Tangible (money, food, lift to hospital) ú Esteem -‐> NES: protocol
Lifestyle ú Smoking
ú Drinking
ú Drugs ú Exercise
ú Diet
ú NES: protocol, miHealth (is it enough?)
Psychological profile
§ Personality ú Type A, Type C ú Hardy personality
§ Motivation ú Intrinsic role NES? ú Extrinsic scan and protocol?
§ Control miHealth ú Internal ú External ú Powerful Others
Psychological profile
§ Self competence (Harter, 1984) ú Social, academic, athletic, appearance, hobbies ú Self worth
§ Embodiment ú Bodily awareness -‐> scan and protocol; miHealth
ú Body image
§ Life orientation ú Optimism ú Pessimism
Psychological profile
§ Quality of Life (QoL) (Rotterdam Symptom Checklist, de Haes et al., 1990)
ú Physical, Psychological
§ Happiness
§ Loneliness
§ Sexuality NES scan and protocol; miHealth
Stress management
§ People’s choice: § Own way of stress management
§ Health Psychologist’s choice
ú Music therapy ú Relaxation/meditation ú Art therapy ú Laughter therapy
NES protocol and miHealth (e.g. Inner piece; Chinese circle)
Immunology
§ Body’s cellular and molecular defence force § Guard against detrimental cell damage and invading foreign organisms called antigens
§ 2 types:
ú Humoral immunity ú Cell-‐Mediated immunity
Different immunological response § Acute stress versus chronic stress § Chronic stress associated with down regulated immunity: ú less trafficking of circulating lymphocytes ú less efficient lymphocytes ú fewer circulating NK cells ú lowered cytotoxiticy ú lowered secretion of (non-‐specific) sIgA
(Bartrop et al., 1977; Schleifer etal., 1983; Kiecolt-‐Glaser et al., 1987; 1993)
§ NES scan: protocol (e.g. ED13; ES1,2,3 ) and miHealth
Pain: Gate-‐Control Theory (Melzack & Wall, 1963)
Pain: The McGill Pain Ques#onnaire (Melzack, 1975)
§ 4 classes of 78 word descriptors of pain: ú sensory (x=42; e.g. throbbing, pinching, burning) ú affective (x=14; e.g. exhausting, punishing, cruel) ú evaluative (x=5; e.g. annoying, miserable, unbearable) ú miscellaneous (x=17; e.g. radiating, tearing, torturing)
§ Total pain score: sum of ticked words of the 4 classes
§ Present Pain Intensity (PPI) 0-‐5 intensity scale: 0: no pain 1: mild 2: discomforting 3: distressing 4: horrible 5: excruciating § Map of body to indicate areas of pain
Pain: The McGill Pain Ques#onnaire (Melzack, 1975)
Methods § Epistemology is Pragmatism with a nomadic participatory research philosophy in which practitioner also acts as the researcher
§ A triangulated multiple case design has been used in which pluralistic qualitative as well as quantitative methods have been applied
§ 7 participants have been selected with an Opportunity Sampling Method:
§ n=4 for NES infoceutical treatment only § n=3 with the NES miHealth
§ Ethics has been obtained from the Ethics Committee of the School of Social Sciences and Law, Teesside University, Middlesbrough, UK
§ All participants completed an informed consent form and ticked the disclaimer on the NES web-‐site and gave permission for their recordings, emails and scans to be used
§ All participants were interviewed before and after their treatment regarding their complaints and quality of life
§ For the research with infoceuticals, participants were
given a monthly diary
§ For the miHealth participants were asked to complete the McGill pain scale before and after the treatment and for sending emails giving their pain scores post treatment
§ miHealth treatments were audio and videorecorded
Analysis § All data were analysed using phenomenological interpretation of coherency (looking for the important overall picture for that person in their individual context)
§ Pain scales were analysed according to Melzack’s (1975) instructions:
1. Total sum of words used to describe pain ∑= 2. Present Pain Intensity (PPI)
RESULTS PROJECTS USING NES INFOCEUTICALS
Project with people with a variety of physical complaints
§ Has been designed and carried out under close supervision with Sarah Turner for an MSc Health Psychology student (Marie Aspland) and has been presented at the London conference in 2010
§ Results are published in a report on the NES website: § http://www.neshealth.com/research/research-‐trials/physical-‐complaints.aspx Aspland, M. & van Wersch, A. (2010). Biopsychosocial exploration of the NES health system approach on the health and wellbeing of people with a variety of physical complaints.
Project with woman suffering from Mantle Cell Lymphoma
§ Woman, lawyer, aged 54 diagnosed with Mantle Cell Lymphoma, very distressed
§ 4 scans with following protocol: 24/01/2010: PL ED6 ED7 ED13 21/02/2010: PL ED6 ED10 EI1 Liberator 2/04/2010: BFA ED2 ED5 ED11 Liberator 10/06/2010: ED1 ED7 ED10 EI4 EI12 ET1
§ also used ESR for panic attacks § we tried to assess Cortisol en IgA for immune measures – too much blood on swabs prevented analyses; too tired to complete diary
§ in July 2010 woman received medical treatments including bone marrow transplant – during that time she only used ESR – which she is still using now
§ recorded interview in which she indicated that NES had helped her to cope with her stress related to her disease. Also liberator freed her of a very deep seated guilt emotion related to a lover dying while on its way to see her 15 years ago
§ I used emotional writing (Pennebaker, 1981) as a technique along side the infoceuticals to free her guilt and to ask for forgiveness
§ She is currently fit and healthy and calls me the ‘nutty professor’ and whispers when we discuss NES which I think is a great shame!
Project with man with high fa#gue, low mood, throat ache, not much voice
§ Man, self employed, aged 58, suffering from depleted energy and not coping with daily stress for 8 months
§ Went several times to GP and hospital for blood and urine tests and scans. He suffered from Medical Unexplained Symptoms (MUS) as no diagnosis could be given. The GP provided him with antibiotics for his throat but no improvement was noticed.
§ I offered him a NES scan, which he gratefully accepted
§ He was scanned twice with the following protocol: 15/03/2013: BFA PL ED1 ED9 17/04/2013: BFA PL ED2 ED9
§ He kept a diary for the first month in which his fatigue scores were as follows:
66754612223243334753834433221 § I have a recorded interview after the first month. We found out that he had been taking 28 drops of ED9 in stead of 15 around the time that the fatigue scores increased again and when he suffered from unusual headaches (described in diary)
§ He furthermore spoke in the interview that he had been feeling better and that he thinks it was thanks to the infoceuticals
§ Other changes during this month were that his usual surrealistic dreams changed to reality dreams, and that he did not have his normal hunger feelings 3-‐4 hours after his meal – both no impact on QoL
§ The second scan revealed Liberator red and ES8 orange and the following interesting mind data:
§ Core emotion: communication Brainstem Hologram: request request both in red Cerebellum Hologram: soiled in orange
Cerebral Medulla Hologram: profound loss in orange Cerebral Cortex Hologram: speak speak in red and orange § We both agreed that speak, request, communication might be associated with his throat ache and his still not very strong voice and that he should wonder what it could be related to
§ He told me later that he had about 10 years ago received a painful email from a dear friend but never dare to ask why that was sent with what meaning. A couple of weeks after the scan he approached that person and they spoke about it
§ He has not been back for another scan and unfortunately never gave me his second diary – as he had stopped taken the drops because he felt so much better.
Project with pregnant woman suffering from depression and history of sexual abuse § Woman, lawyer, aged 35, 6 months pregnant
contacted me while being in panic as previous NES consultant had stopped
§ She found my name on the Internet and needed to see me that day – I was at work but freed some time
§ At her first visit she came with her mother in law (as she was scared to be on her own and could not drive) she was using anti-‐depressives, and cried all the way through
§ This was 18 months ago. She still comes monthly for her scan, but she never kept to the protocol, nor did she ever completed my diary
Over the months she has been seeing a psychotherapist and kinesiologist as well, plus she reads and takes whatever her tied finger and thumb bow tell her to use -‐ vitamins, minerals as well as infoceuticals as she has a stock of all of them.
§ Her baby has been born and is healthy. There was a phase in which the baby suffered from severe eczema, and she wanted me to scan the baby as well. I contacted Rainer for advice on the use of infoceuticals on babies. I gave her Aloe Vera instead and discussed ways in which she might let go of the baby a bit more as she acted as a very clingy and anxious mother
§ Currently she is in employment again, is off the anti-‐depressives, did not cry at last month’s scan for the first time, and the baby’s eczema has cleared.
Woman who had cured herself from MS but was very stressed
§ Woman, widow, 63, ex MS patient (diagnosed 16 years ago), suffering from immense stress and unhappiness
§ Her protocols were: 3/09/2012 PL 1/10/2012 PL ED4 ED6 29/10/2012 PL ED4 ED6 2/01/2013 PL ED2 ESR 4/02/2013 EI11 ET15 BS Hologram 4/03/2013 ED3 ED16 ES15 2/04/2013 EI2 EI8 ES5 9/05/2013 ED3 E9
§ She followed her protocols, but for the first 5 scans indicated in her interviews to remain very stressed and unhappy
§ Clarifying her stress and coping styles it emerged that she could not stay in her house – if she was out she felt better – memories of the illness and death (coffin in room) of her husband in the house haunted her. We discussed a possible move, the idea of which already made her feel lighter
§ Since she moved to her new apartment her stress has disappeared and she feels happy again. Without NES this realisation might never have come to light.
§ Since then she indicated not to need any further NES treatment
RESULTS PROJECTS USING NES MIHEALTH
Project with woman with severe neck and shoulder pain § Woman, secretary, aged 32, had been in severe neck and shoulder pain for 8 months and off work
§ She had an MRI scan and nothing severe was noticed
§ She had six weeks treatments of a physiotherapist-‐ who thought the problem was positioned between the cervical spine C6 C7; and she used Ibuprofen 400mg several times per day and during the night
§ I gave her 3 treatments on consecutive days § She completed the McGill pain questionnaire 6 times (3 Before and 3 After)
§ 1st treatment: ú Off body according to protocol: SMF-‐A3 SMF-‐A6 SMF-‐C6
She did not feel anything ú On body: Physical rejuvenation (freq.5; ampl.7; 5 minutes) ú Matrix carrier (freq.5; ampl.7; 5 minutes) ú Biocell (freq.5; ampl. 10; 5 minutes)
She felt better
§ 2nd treatment: ú On body: Matrix carrier (freq.5; ampl.10; 10 minutes) ú Biocell (freq.5; ampl. 12; 10 minutes) ú Physical rejuvenation (freq.5; ampl.12; 10 minutes)
ú Inner piece (freq.5; ampl.12; 10 minutes) She commented: ‘very relaxing’; ‘feels warm’; ‘feels better’
§ 3rd treatment: ú On body: Matrix carrier (freq.5; ampl.15; 10 minutes) ú Biocell (freq.5; ampl. 20; 10 minutes) ú Physical rejuvenation (freq.5; ampl.15; 10 minutes)
ú Inner piece (freq.5; ampl.10; 10 minutes) She could move her neck with no pain – again warm and relaxing
§ Results McGill pain scores: Sensory Affective Evaluative Miscellaneous ∑ PPI
B A B A B A B A B A B A 1 7 3 2 0 1 1 3 1 13 5 4 2 2 3 2 1 0 1 0 2 0 7 2 4 2 3 1 0 0 0 1 1 2 0 4 1 1 1 very good results: pain in 3 days from 13 to 1; and 4 to 1
§ From: Liz Sharps [[email protected]] Sent: 22 April 2013 17:51 To: Van Wersch, Anna Subject: RE: pain scores
§ Hi Anna The pain scores are as follows: 12/04/13: AM .5, increasing to a 1.5 at around 3pm where it remained 13/04/13 No change, AM .5, increasing to a 1.5 at around 3pm where it remained 14/04/13 AM, .5 but with travelling to the airport for 7am and the flight being 5 hours, the pain score had increased to a 3 by about 2pm where it remained until about 7pm when it decreased to a .5. 15/04/13 the pain was back to a .5 at 8am in the morning but it remained at a .5 for the rest of the day.
§ from 16/04/13 I woke at around 8am each morning and the pain was not really noticeable at all, this was the case for the rest of the week and has not changed since although i have not done any strenuous activity during this time at all. I think the MiHealth may have contributed to this improvement as you will see that within a week the pain decreased and stayed at this level and I now expect to be back at work next week although I expect that the pain scores will increase with computer use and desk work. Should you require any further information, please do not hesitate to contact me. Thanks again. Elizabeth
§ From: Liz Sharps [[email protected]] Sent: 05 May 2013 11:21 To: Van Wersch, Anna Subject: RE: pain scores
§ Dear Anna Just to update you that since my last score update up until now the pain seems to have diminished to the point where I have been almost pain free. I have also started some physical exercise, light jogging. I think that the MiHealth has really made a difference in the pain levels and would be interested in following the progress of the study. Should you require any further information please do not hesitate to contact me. I am returning to work on 14 May and have a hight adjustable desk which i hope will make a difference to the levels of pain I experience. Thanks again, Elizabeth
Project with man with severe back pain § Man, student, aged 40, had been in severe back pain for 5 months and difficulty sitting and sleeping
§ He has been suffering from on and off back pain for 18 years – postman – heavy 30 kg bag
§ Had physiotherapy, did yoga, uses painkillers Codydramol 8 per day
§ I gave him 2 treatments two weeks apart § He completed the McGill pain questionnaire 4 times (2 Before and 2 After)
§ 1st treatment: (on chair) ú Off body according to protocol: SMFA3 SMFMR8 SMFMR7
He did not feel anything ú On body: Physical rejuvenation (freq.5; ampl.5; 5 minutes) ú Muscles (freq.5; ampl.7; 5 minutes)
He felt tingling in face and right arm; difficult to sit
§ 2nd treatment: (on massage bed) ú On body: Physical rejuvenation (freq.5; ampl.12; 7 minutes) Muscle (freq.5; ampl.23; 7 minutes) ú Matrix carrier (freq.5; ampl. 23; 9 minutes) ú Biocell (freq.5; ampl. 6; 9 minutes) ú relaxed, warm, one painful spot which needed avoiding – on right scapula
§ Results McGill pain scores: Sensory Affective Evaluative Miscellaneous ∑ PPI
B A B A B A B A B A B A 1 6 6 2 0 3 2 2 3 13 11 2 1 2 3 4 1 0 2 2 1 1 7 7 2 2 results first treatment slightly better than second treatment – but overall not much change in pain scores
§ From: MEIGHAN, CHRIS [[email protected]] Sent: 12 May 2013 19:16 To: Van Wersch, Anna Subject: Weekly update
§ Hi Anna § § The day after we met I felt really run-‐down all over but it probably was the grass pollen and I hadn't taken any pain killers since that morning. I felt bad till Friday afternoon when I had started taken my pain killers again that morning.
§ § Regards § Chris
§ From: MEIGHAN, CHRIS [[email protected]] Sent: 19 September 2013 21:52 To: Van Wersch, Anna Subject: RE: update
§ Hello Anna
§ I'm very well thank you. I hope I find you well too.
§ What I can remember, I think I had a temporary relief from pain following your treatment. However, the pain persisted for quite a while until recent changes. My wife bought me a few sessions with her personal trainer and as well as giving me appropriate weight lifting exercises to strengthen upper body muscles that will relieve the strain on my back, he also said that I don't eat enough protein!!
§ Consequently, what little protein I get primarily goes to my immune system and that there is not enough to fight the inflammation in my muscles. I've also taken up yoga again.
§ § Today, 5 weeks after first treatment, I'm on top of the situation. I feel discomfort particularly when I have a lot of workload at work but I feel 'better' which, in turn, helps me cope with my daily workload.
§ § Regards § Chris §
Project with young woman with rheumatoid arthri#s (RA) in knee § woman, student, aged 23, came to see me and
was late because she could not get up the stairs easily – her left knee was very swollen and she could not bend it because of intense pain
§ she had been diagnosed with RA since she was 18
§ uses painkillers ibuprofen 400mg several times during the day and at night
§ she had 1 treatment on that same day § she completed the McGill pain questionnaire 2 times (1 Before and 1 After)
§ Treatment:
ú Off body according to protocol: SMF-‐A8 She felt warmth and pain in back of knee – no change
ú On body: Joint(freq.5; ampl.7; 5 minutes) ú Physical rejuvenation (freq.5; ampl.7; 5
minutes) ú Biocell (freq.5; ampl. 7; 3minutes) ú felt less pain – could move knee more
ú Biocell (freq.5; ampl.9;5 minutes) She could bend her knee; pain less than at start; swelling had shrank
§
§ Results McGill pain scores: Sensory Affective Evaluative Miscellaneous ∑ PPI
B A B A B A B A B A B A 1 10 4 3 0 4 0 2 0 19 4 4 1 results very good: overall pain score reduced from 19 to 4; pain intensity from 4 (horrible) to 1 (mild)
§ From: DISMORE, LORELLE [[email protected]] Sent: 06 April 2013 09:36 To: Van Wersch, Anna Subject: Pain Scores
§ Hi Anna,
§ Here are my scores ....
§ 5th April 2013, I would score my pain at 1 as when I wake up I am usually at my worst, I slept the whole night through and usually I wake up during the night in pain, however, I did take Ibuprofen before I went to bed to sleep. As the day progressed whilst at work I would rate my pain at 2 as my knees started to stiffen as I was sat for 5 hours and only had a 15 minute break.
§ 6th April, Again I have woke up without any pain in my knee so I would score this 1, 0 if possible. Again I took Ibuprofen before I went to sleep, I slept the whole night through.
§ § Regards, § Lorelle
Lorelle is now so positive about the miHealth that she would like to do a PhD on the miHealth and RA.
Together we have written a PhD proposal for a bid, unfortunately that was turned down. We are now looking for donations for the miHealth Rheumatoid Arthritis Fellowship through Teesside University tax-‐relieved donation system.
CONCLUSION AND WAY FORWARD
Conclusion § Most projects revealed positive influence of the
infoceuticals and NES miHealth on people’s quality of life
§ Treatment period for infoceuticals varied from 1 to 18 months; for miHealth 1 to 3 times
§ In stress theory, NES was mostly used as a coping strategy to balance the acute as well as chronic stress related to not feeling well
§ For one man the scan confronted maladaptive coping in anger avoidance and facilitated constructive coping function through talking things through
§ For one woman NES acts also as Social Support -‐ even though stress is balanced NES has become ‘a friend’ which she cannot let go off
For one man NES was not the chosen option for pain relief – other lifestyle changes were pursued such as exercise and diet change
For several participants, the use or not use of painkillers seem to have effected the NES treatment
For some, NES acted as a facilitator for positive actions not always necessarily directly related to the treatments (moving house, communicating)
These projects show the individuality of the NES experience revealed through the analysis of pluralistic methods of: scan results, scores obtained from the use of validated scales (questionnaires) written and recorded interviews, video-‐recorded treatment sessions, dairies, and email correspondence; a unique experience that might be difficult to capture in RCTs.
In sum, difficulty is that Complementary Medicine is not
been taken serious in the scientific biomedical world as its effects are harder to proof –
CAM is still seen as the result of the placebo: Medical students response to a CAM lecture (Reilly, 2001,
p. 94. in van Wersch et al., 2009, p.58) ‘Oh’ – (the emotional tone that surrounds the subject) ‘Isn’t’ – (the preconception) ‘It’ – (the idea that it is just one thing) ‘Just’ – (the diminutive, what does it matter anyway?) ‘Placebo response’ – (singular) But as I have intended to shown with my research there are other legitimate scientific ways to demonstrate its effects!
Way forward – take on the challenge! § To obtain funding for scholarships to enhance the understanding and effects of NES on quality of life in
general and stress and pain in particular; and to enable students keen to do research with NES to do so
§ Donations to the Teesside University Fellowship scheme is possible
§ Personal named fellowships are common § Teesside University have registered as a charity with ACF. The American Fund for Charities is a US 501(c)(3) tax-‐exempt organisation.
§ Further information: page http://www.americanfund.info/donors.html
Thank you for listening!
Any questions?