Course Concept and Description:

This is the equivalent of a three credit, graduate level psychology course. Do not take this course if you are not able to handle such a course or not sufficiently motivated to work on your own. Complimentary and alternative (C & A) practices, including those which form the core of “behavioral medicine” are rapidly finding acceptance within the clinical community. Simultaneously, “accepted” practices are falling from favor as they are shown to be ineffective or even counterproductive. Patients now visit as many or more “alternative” providers as traditional providers and are spending billions of dollars on attempts to get care not available from the traditional medical community.  This course is intended to acquaint you with many of those practices which may become the new standard of care in the near future. It is also intended to help you learn to evaluate the strengths and weaknesses of the claims made by the proponents of these practices so you can more readily separate the real knowledge from the emotional advertising.

Specifically, this course intends to:

1. 1. Provide you with an introduction to the basic mechanisms and principles of behavioral medicine and its most common techniques.
   2. Provide you with a balanced overview of a selection of complimentary and alternative medicine interventions recently and currently practiced in the “West”.
   3. Provide information on the underlying psychophysiological mechanisms through which non-specific interventions are likely to produce very real effects.
   4. Provide you with practice in and techniques for objectively assessing the validity of claims presented in formats different than usually acceptable to current “Western” science.

Competencies: by the end of this class, students will be able to:

1. 1. Describe and discuss the basic mechanisms and principles of behavioral medicine and its most common techniques.
   2. Identify, describe and discuss a variety of complementary and integrative interventions currently practiced in traditional biomedical Western medicine.
   3. Identify and summarize the underlying psychophysiological mechanisms through which non-specific interventions are likely to produce evidence-based outcomes.
   4. Practice techniques for objectively assessing the validity of claims presented in formats different than usually acceptable to current traditional biomedical Western science.

Format:

This home study course is divided into 28 units. Each unit consists of one of more chapters of reading in the texts, sometimes an audiovisual lecture, review questions to be answered, and an e-mail or phone based discussion with me. The course begins with an introductory audiovisual lecture profusely illustrated by power-point slides.  

When you sign up for the course, the course materials will be sent to you via a large file transfer program.  After doing the reading for each unit (and attending the audiovisual lecture when provided), you will answer a brief series of essay questions about each topic, e-mail your answers to me, and then we will interact by e-mail or phone about each topic. This will give you an opportunity to ask questions and for me to fill in gray areas and provide additional information on topics of special interest to you.

The lecture portion of the course is presented through a series of audiovisual lectures profusely illustrated by power-point slides and movies. The audiovisual lectures are on power point slides. You will hear the instructor’s voice while viewing the power point sides. The lectures are between 1 ½ and 2 ½ hours in length. Reading assignments parallel the lectures. After watching the lecture and reading the assigned supporting files, you will answer a brief series of short essay review questions (which are in the review questions file on the course web site). The answered questions are then e-mailed to the instructor. You and the instructor will discuss each unit via e-mail chat after your answers are assessed. There is no need to complete the discussion with the instructor before proceeding to the succeeding lecture & chapters. It is expected that all review questions will be answered correctly and completely by the student. Any questions answered incorrectly or incompletely must be discussed and/or corrected.

Accessibility: Hearing impaired people can view the slides only as virtually all of the material presented in the lectures is typed onto the slides. Visually impaired people can concentrate on the verbal lectures as the slide material is repeated in the lecture accompanying each slide.

How you learn:

Our students learn by attending both pre-recorded lectures and live – real time – classes with instructors during which students and instructors can see and hear each other. It’s almost like being there in person. They also read texts and articles.

This is what a live class looks like:

The “screen shot” to the right shows an instructor and three students interacting in real time while looking at discussion material on their screens.

To see what a “prerecorded” lecture looks like, follow this link:  http://youtu.be/9xpEpAZOHtI

Accessibility:

Hearing impaired people can view the slides only as virtually all of the material presented in the lectures is typed onto the slides. Visually impaired people can concentrate on the verbal lectures as the slide material is repeated in the lecture accompanying each slide.

Accessing course materials:

All course materials are sent to you via a large file transfer program.

There is no need to print out any of the supporting material.

Each topic (subject) I cover consists of one or more Power-Point slide sets and readings in MS word and PDF files. The order of the lecture topics is listed at the end of the (a) course outline and (b) the review questions file. These files also list the readings which accompany each lecture.

The order of the presentation topics is listed (a) near the end of this overview and (b) in the review questions file.

If you are not familiar with biofeedback, you may want to read the MS Word text files entitled “rehab chapter” and “enabling chapter”.

This is intended to be an interactive course. A good portion of the money you spent on

 this course covers giving you my time and attention. Please take advantage of my

 availability to answer your questions – especially about how this material relates

 to biofeedback. Don’t wait for the end of the course to ask questions.       

The lectures are divided into individual recordings. Each recording is between 1/2 and 2 hours long. The lectures consist of a series of slides with my voice in the background.

Please note that the “slides” are not really the type of slides used to do a presentation in front of an audience. Rather, they are more like pages from a book intended to be viewed on your computer monitor. Thus, they have much greater density of material than would be found on a regular slide.

To hear my voice and to see the slides best, you need to view the slides using Power Point’s “view slide show” setting. When in Power Point, go to “view” on the top bar of the power point display. Select “view slide show” so the slide occupies your entire screen.

To advance slides, double click the down arrow key on your key board (not the arrow on the “2” key). You can see and hear the preceding slide by pressing the up arrow key. The slides are NOT set to advance automatically so you can spend as long on each as you wish.

To leave the slide show, move your cursor around slowly near the lower left edge of the screen until a small, translucent box appears on the slide. Click it for options including “end show”.  

If you are in the full screen “view slide show” and your computer’s sound is on, you should hear my voice without doing anything more. If you can’t hear me, something is wrong with your sound system.

Computer and Computer Knowledge Requirements:

Anybody with a modern computer and a bit of basic understanding of computer operation (at the level of being able to send e-mails) can play this course with minimal problems. You must have a computer (a) capable of connecting to the internet and running a typical internet program, (b) containing/running a modern word processor such as Microsoft word or Word Perfect, (c) the capability to play sounds such as music (has speakers and appropriate software which normally come with any modern computer), and (d) a slide viewing program such as Power Point (you can probably get a slide viewing program free off the internet if you don’t have one). Any modern (e.g., built within the last ten years), IBM style computer running Windows 98 and more recent platforms (e.g., XP or Windows 8) should be able to do this. Speed, hard disk size, and RAM are not factors for computers in the above category.

Dozens of students have used recent Apple products (MACs etc.) for the course however they frequently have more difficulty playing the course materials than PC users do.

If you are using a MAC type of computer, you must have a current version of “quicktime”. If you do not have it, you can download it for free from the web.

Prerequisites & professional training requirements:

The course is far easier for people who have taken undergraduate courses in general biology and general psychology. If you haven’t had them, contact us before registering. You will do much better in the course if you have already taken our “Anatomy and Physiology for Behavioral Clinicians” course.

This course is intended for licensed / certified clinicians, teachers and coaches. None of the instructional material offered will provide you with the clinical skills needed to apply the psychophysiological assessment and interventional techniques you will learn in the clinical environment unless you are already a trained clinician.

Faculty:

The course is given by Dr. Richard Sherman, Ph.D.  He is certified by BCIA, approved by BCIA to teach the general biofeedback certification course, and currently teaches A&P, Pelvic floor disorders, pain, and other courses. He is a professional psychophysiologist with extensive training (his Ph.D. is in biology & psychology), has nearly 30 years of experience in the field, and has published over 130 books, chapters, and articles (mostly in peer reviewed journals). Dr. Sherman is Director of the psychophysiology doctoral specialization at Saybrook University and has held many positions within the Association for Applied Psychophysiology and Biofeedback including president. Full CV available upon request and on the course web site.

 

Required Texts:

Mosby’s Complementary & Alternative Medicine: A Research-Based Approach; 3^rd edition or more recent. By Lyn W. Freeman. Published by Mosby of St. Louis Mo. In 2008. ISBN 978-0-323-05346-4.

Optional Texts

Complementary and Alternative Medicine in Rehabilitation Edited by Eric Leskowitz, Published by Elsevier (Churchill Livingston) of Edinburgh and New York. 2003, ISBN 0-443-06599-3.

Topic Outline / Reading & Listening Assignments:

1. Introduction – How medical practice changes – the history of C & A practices
Audiovisual lecture 1; MS word text file “concepts of disease” (NOTE,
this file is a crucial part of the course introduction.)

2. Evaluating credibility of claims for efficacy of C & A products and practices
Audiovisual lecture 2; Text file “CAM group size”

3. Potential indirect mechanisms Freeman chapters 1 – 4; Audiovisual lectures 4-6;
Text file

4. Relaxation Freeman chapter 5; Audiovisual lecture 9

5. Meditation Freeman chapter 6

6. Hypnotherapy Freeman chapter 8

7. Imagery Freeman chapter 9

8. Chiropractic Freeman chapter 10

9. Acupuncture & Traditional Chinese Medicine Freeman chapter 11

10. Homeopathy Freeman chapter 12

11. Massage Therapy Freeman chapter 13

12. Aroma Therapy Freeman chapter 14

13. Herbal Therapy Audiovisual lecture 5; Freeman chapter 15; Read text file
“Ginkgo doesn’t work”
14. Exercise Freeman chapter 16

15. Spiritual Medicine Freeman chapter 17

16. Therapeutic Touch Freeman chapter 18; text file entitled “healing touch”

17. Trigger Points Audiovisual lecture 6

18. Reiki Freeman chapter 19

19. Biofields Freeman chapter 20; Audiovisual lecture 4

20. Behavioral medicine Audiovisual lectures 7 – 9; Freeman chapter 7

21. Ethics of providing CAM Audiovisual lecture 10

22. Future of CAM Freeman chapter 21

When all requirements have been successfully completed, your course completion certificate will be e-mailed to you and BCIA will be informed that you completed the course.

 

Course Contents / Order of Lectures and Readings:

Set A: Topics 1 – 3

1. Introduction – How medical practice changes – the history of C & A practices
Audiovisual lecture 1; MS word text file “concepts of disease” (NOTE,
this file is a crucial part of the course introduction.)
a. What is the temporal relationship between currently accepted “standard” techniques and acceptance of alternative techniques by main-stream medicine?
b. What are several techniques making the transition from alternative to main-stream? Why are these making the transition while others are not (include two examples of techniques not successfully making the transition and say why)?
c. How are allopathic and alternative medicine techniques affected by the FDA and the “scientific” culture’s demands for objective proof that a treatment works?

2. Evaluating credibility of claims for efficacy of C & A products and practices
Audiovisual lecture 2; Text file “CAM group size”
a. Why did I include a lecture on credibility of alternative assessments and interventions in this course?
b. If you hear about a new technique, how are you going to decide whether to incorporate it into your practice? (Include the basic ideas of a “credibility” alert.)
c. What are “non-specific” effects and what impact do they have on a typical treatment? Do we want to keep them out of our treatments or include them?
d. Why do we need control groups in clinical studies?
e. Can you trust the “weight of clinical evidence”?
f. If you read that a technique has been clinically tested and works, what does that tell you about the theory underlying that technique?
g. How do you locate studies evaluating the effectiveness of alternative interventions?

3. Evaluating the safety of C & A products and practices
Freeman chapters 1 – 4; Audiovisual lectures 4-6.
a. Can the traditional small studies done to establish efficacy establish safety?
b. Discuss safety concerns relative to contamination of herbal products.
c. Does personality style influence health? Support your answer.
d. How do support groups influence health?
e. What is the difference in effect on depression of listening to any music and using music entrainment therapy? Why?
f. What are typical objective ways to determine the effects of a stressor on immune functioning?
g. Can the immune response be operantly conditioned?
h. What are typical changes in hormones and immune functioning just after marriage and after many years of marriage for happy and unhappy marriages?
i. How do males and females differ in their responses to stress?
j. Contrast Freeman’s description of the results of the group therapy study on cancer survival with findings that the analysis was done incorrectly because the groups were too small to represent the population and that the control group actually died earlier than expected while the experimental group died on time. The point here is to begin considering whether your texts are presenting too positive a picture of CAM.

Set B: Topics 4 – 7

4. Relaxation Freeman chapter 5, Audiovisual lecture 9, text file “CAM
neutral observers”
Note: questions a – f are intended to have “one word” answers supplemented with one sentence supporting the answer. There is NO need to write a paragraph on answers a-f.
a. Are there sufficient studies which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Are there studies about efficacy of the technique performed by “non-believers” and are some of the articles published in journals not associated with the profession?
c. Is there sufficient defense against “faking-good” in a sufficient proportion of the research articles to assure readers that the studies were actually conducted as stated and that the reported results are likely to be representative of what actually happened? In other words, did neutral observers participate in the studies? Neutral observers are usually professionals performing the outcome evaluations who are not related to the study, don’t know which group the subjects are in, have no “stake” in the study’s outcome, etc.
d. Are there studies comparing the efficacy of the technique with other techniques and, if so, were subjects randomized to which was received? Are the studies double blind?
e. Are there placebo controlled studies and, if so, (1) are the placebos believable, and (2) were the differences between the placebo effect and the treatment effect clinically significant upon follow-up?
f. Are the subjects in formal studies sufficiently well diagnosed and followed for sufficiently long after the end of the intervention for readers to feel that the techniques produced clinically significant changes in the condition(s) being treated?
g. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
h. Why would relaxation techniques help (1) depression and (2) pain not related to muscle tension?

5. Meditation Freeman chapter 6
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. What are the effects of rhythmic chanting (in mediation, prayer, song, etc.) on
the brain?
d. Why do groups of meditators make less use of the medical system than
groups of similar people?
e. What is the likely mechanism through which meditation reduces the use of
addictive substances?

6. Hypnotherapy Freeman chapter 8
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. What is the relationship between baseline EEG patterns and susceptibility to
hypnosis? Why would this make sense?
d. How could hypnosis result in anesthesia?
e. How could hypnosis cure real (bacteria based) warts?
f. Is autogenic training a form of hypnosis? Support your answer.

7. Imagery Freeman chapter 9
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. How could imagery affect (1) acne and (2) burns? (potential mechanism)
d. What are diagnostic, mental rehearsal, and end state types of imagery and
what is the evidence for their efficacy?
e. How can people increase their immune system functioning (as in the study of
salivary immunoglobulin A) using imagery?

 

Set C: Topics 8 – 11
8. Chiropractic Freeman chapter 10
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. What is the fatal flaw in basing the conclusion that chiropractic is efficacious for acute low back pain given that (1) the studies use an A-B-A design and (2) acute low back pain resolves without any intervention at the same rate and to the same extend as is shown by the results of the chiropractic studies?

9. Acupuncture & Traditional Chinese Medicine Freeman chapter 11
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. What is the relationship between acupuncture points and underlying
physiology? Which nerves does acupuncture stimulate?
d. What is “diffuse noxious inhibitory control” of pain and how does it work?
e. Why would acupuncture help asthma?

10. Homeopathy Freeman chapter 12
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. Explain the principles of (1) similars, (2) infinitesimal dose, and (3) specificity of the individual.
d. What are direct and indirect risks (including fabrication of illnesses) of homeopathy?
e. Comment on Brigo and Serpelloni’s study on Migraines (which used the standard black box model) discussed in Freeman/Lawlis.
f. How could homeopathy work?

11. Massage Therapy Freeman chapter 13
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. Does massage have long term effects?

Set D: Topics 12 – 19

12. Aroma Therapy Freeman chapter 14
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.

13. Herbal Medicine (Phytomedicine) Audiovisual lecture 5; Freeman chapter 15;
Read text file “Ginkgo doesn’t work”
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. What is the difference between herbal medicines and standard medicines
based on plants?
d. How can purchasers of herbal medicines be assured of quality and dosage of
the product?
e. Given the high levels of efficacy shown for many herbal medications and the
attendant negative side effects, should herbal medicines be controlled by
the FDA? Why or why not?

14. Exercise Freeman chapter 16
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that exercise may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. How does exercise effect stress responses?
d. How does exercise effect depression?

15. Spiritual Medicine Freeman 17
Read text file “CAM flying carpets”
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. What is the relationship between religousness and clinical outcomes?
d. Many studies have shown that people who attend religious services are less
sick than the general population. What is the fatal flaw in the assumption
underlying these studies?
e. Contrast the way the results of the studies reviewed in this section are
presented with the way they are presented in the article by M. Shermer (on
your CD under the name “flying carpets”).

16. Therapeutic Touch Freeman chapter 18, If you have not read it already, read the file “CAM therapeutic touch”.
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.

17. Trigger Points Audiovisual lecture 6
a. What is a trigger point? Include the underlying anatomy in your answer.
b. How do you detect a trigger point?
c. Where are several trigger points which cause headaches?
d. What is the evidence that trigger points actually exist?

18. Reiki Freeman chapter 19
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.

19. Electromagnetic Medicine Freeman chapter 20; Audiovisual lecture 4
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that electromagnetic therapies may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. Differentiate between the evidence for weak direct current magnets and for
pulsed field electromagnets.
d. Can the body’s own EM fields be used to identify medical problems?
e. Discuss the evidence supporting and potential mechanisms underlying the
efficacy of any two electromagnetic approaches to medical problems other
than headache.

Set E: Topics 20 – 22

20. Behavioral Medicine Audiovisual lectures 7 – 9; Freeman Chapter 7
a. Are there sufficient studies (including placebo controlled, double blind studies) which meet the basic criteria for a good clinical study (as presented in the credibility talk) to lead readers to believe that the technique may be effective for at least one condition? For which condition is there the strongest evidence?
b. Summarize the strengths and weaknesses of the evidence supporting the efficacy of the technique for any one condition and come to a conclusion about how well demonstrated the efficacy of the technique is relative to its proponent’s claims for all conditions.
c. Do you think it is appropriate for you to use behavioral medicine techniques in your practice? Explain your decision and include at least one example of a technique you would or would not use.

21. Incorporating Evidence-Based Complementary and Alternative Medicine to practice. Ethics and the decision to change practice. Audiovisual lecture 10.
a. Discuss the problem of providing and charging for non-validated treatments on a regular basis.
b. Discuss the problems inherent in dual relationships and conflict of interest.
c. When a patient’s insurance runs out before an ongoing treatment which is making progress is over, can you just drop the patient?
d. What is the duty to protect?

22. Future of CAM Freeman chapter 21
Based on (a) the material in Freeman’s chapter 21 and (b) your own knowledge of CAM, do you think CAM will spread into common practice? Explain your decision. Include at least one example.

End of review questions.