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Problem severity in people using alternative therapies for anxiety difficulties

South London and Maudsley NHS Trust, Maudsley Hospital, London SE5 8AZ

Mark Kenwright, Nurse Therapist and Isaac Marks

Professor of Experimental Psychopathology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF

	Abstract

Top Abstract Introduction The study Findings Discussion References

 
AIMS AND METHOD

The use of alternative therapies by people with mental health problems seems to be rising. Are the people who access alternative therapies those with mild or more severe problems? A postal survey was undertaken of enquirers responding to a teletext article on self-help psychotherapies for obsessive—compulsive disorder and agoraphobia. Respondents were asked to rate the severity and duration of their problem and the therapies and services they had used.

RESULTS

Of 326 questionnaires sent out, 113 (35%) completed questionnaires were returned. Seventeen (15%) respondents had sought no help for their anxiety problems, 76 (67%) had been treated by their general practitioner (GP), 62 (55%) by a psychiatrist or psychologist and 48 (42%) had used alternative therapies. People who had sought help from their GP did not rate their problems significantly more severe than those who had not sought treatment. Those who had been treated by a psychiatrist or psychologist and those who had used alternative therapies rated their problem as being significantly more severe than those who had not sought help for it.

CLINICAL IMPLICATIONS

In this selected sample it was the more severe anxiety sufferers who had used alternative therapies.

	Introduction

Top Abstract Introduction The study Findings Discussion References

 
Alternative medical therapies are functionally defined as interventions neither taught widely in medical schools nor generally available in mainstream hospitals. National surveys suggest that alternative medicine is popular throughout the industrialised world. In a UK-wide postal survey of 1200 people with agoraphobia (Marks & Herst, 1970), 15% had seen a religious or spiritual healer for their phobia, and they had taken two to three times longer (mean of 57 months) to seek that help than to seek help from general practitioners (GPs) or psychiatrists, respectively. The rate of 15% is like the one in seven proportion of members of the UK Consumers' Association in 1985 who had visited a non-conventional practitioner in the preceding 12 months; this rate rose to almost one in four in 1991 (Consumers' Association, 1992).

In 1993 the National Association of Health Authorities and Trusts showed that £1 million of public money was spent on purchasing complementary treatments (Goldbeck-Wood et al, 1996). This use of alternative therapies is set to rise. Estimated expenditures in the USA for alternative therapy services by the general population increased 45% between 1990 and 1997 and were conservatively estimated at $21 billion in 1997 (Eisenberg et al, 1998). The same authors found that in the USA the therapies increasing the most included self-help groups, herbal medicine, massage, megavitamins, folk remedies, energy healing and homeopathy.

	The study

Top Abstract Introduction The study Findings Discussion References

 
A small article was placed on the BBC teletext community pages on ‘Self treatment for anxiety’ to advertise the Maudsley Hospital's computer-aided self-help services for obsessive—compulsive disorder and agoraphobia. Information on the service and a survey questionnaire was sent to 326 enquirers who disclosed their address. Respondents were asked to rate the severity and duration of their problem and the therapies and services they had previously used, both conventional and alternative.

A simple tick box questionnaire was devised asking respondents whether they had been treated for their anxiety disorder by: (a) their GP; (b) a psychiatrist; (c) a psychologist; (d) a nurse therapist; (e) a community psychiatric nurse; (f) a hypotherapist; (g) self-help therapy; and/or other therapies, and they were asked to specify which ones. Respondents were also asked to rate the severity of their problem on a 0-8-point scale (0, problem absent; 8, problem very severe, disturbing/disabling). Respondents were also asked to rate how long they had had their phobias or obsessive—compulsive problems on a six-point scale (less than 1 year, 1-2 years, 2-5 years, 5-10 years, 10-20 years or over 20 years).

	Findings

Top Abstract Introduction The study Findings Discussion References

 
One hundred and thirteen (35%) completed questionnaires were returned. Fifteen per cent of respondents had received no treatment (conventional or alternative) for their anxiety problem. Seventy-six (67%) had been treated by their GP, 62 (55%) by a psychiatrist or psychologist and 30 (27%) by a nurse therapist or community psychiatric nurse, while 48 (42%) had received alternative therapies for their anxiety. Thirty-four (55%) of the respondents who had been treated by a psychiatrist or psychologist had also used alternative therapies. The most popular alternative therapy was hypnotherapy, with 32 (28%) respondents having used it. Other alternative therapies used were: self-help therapy, n=18 (16%); autogenic training, n=4 (4%); cranial osteopathy, n=1 (1%); reflexology, n=1 (1%); acupuncture, n=1 (1%); and meditation, n=1 (1%). The self-reported severity and duration of problem were compared between respondents who had received no treatment, those who had been treated by their GP, those who had been treated by a psychiatrist or psychologist and those who had used alternative therapies (see Table 1).

Severity of problem
There was no significant difference in the self-rated severity of problem between the group who had received no therapy and those who had been treated by their GP (unpaired t-test, t=1.31, d.f.=91, P=0.51). The self-rated severity of problem in those who had received no therapy was less than in those who had been treated by a psychiatrist or psychologist (unpaired t-test, t=2.77, d.f.=77, P=0.01) and those who had used alternative therapy (unpaired t-test, t=2.29, d.f.=63, P=0.03). The self-rated severity of problem did not differ significantly between those treated by a psychologist or psychiatrist and those who had used alternative therapy (unpaired t-test, t=0.66, d.f.=108, P=0.51).

Duration of problem
There was no significant difference in the self-reported duration of problem between any of the four groups: no therapy compared with those treated by their GP (unpaired t-test, t=0.27, d.f.=91, P=0.79), with those who had been treated by a psychiatrist or psychologist (unpaired t-test, t=1.59, d.f.=77, P=0.12) and with those who had used alternative therapies (unpaired t-test, t=0.80, d.f.=63, P=0.42).

	Discussion

Top Abstract Introduction The study Findings Discussion References

 
The response rate of the study (35%), while low, is average for postal surveys (Parten, 1950; Kerlinger, 1973), but does mean conclusions can only be tentative. Our population is also likely to be skewed towards those who use alternative therapies because they were responding to an article on self-help therapy. A large minority of our group used hypnotherapy (28%), which is not widely used in other European countries (Fisher & Ward, 1994). None admitted to using homeopathy, probably because we did not specifically ask about homeopathy.

Within our sample, self-reported duration of problem was not associated with treatment-seeking behaviour, but self-rated severity of problem did. The more severe anxiety sufferers had been treated by a psychiatrist or psychologist and had used alternative therapies. Our findings agree with those of Astin (1998), who found poorer health predicted more alternative therapy use in 1035 randomly selected individuals who had agreed to participate in mail surveys. Our findings also agree in two respects with those of Marks & Herst (1970). First, of the 1200 people with agoraphobia surveyed the 5% with no past medical treatment for their phobia were no more severe than those treated by a GP for their phobia. These untreated 5% were, however, more shy about confiding in anyone (not only doctors) and took longer to seek help from anyone not only for their phobia, but also for their physical illnesses — the present study did not examine the latter issue. The second similarity was that the people with agoraphobia in Marks & Herst's study who had been treated by a GP for their phobia were less severe than those who had had psychiatric out-patient treatment for it.

Our findings in a selected sample suggest that more severe anxiety sufferers use both mental health services and alternative therapies more. In our sample over half of respondents (55%) who had been treated by a psychiatrist or psychologist had also used alternative therapies. In view of these findings, as clinicians, we need to educate ourselves as to the alternative therapies available, their efficacy and side-effects and we need to actively ask patients about their use.

	References

Top Abstract Introduction The study Findings Discussion References

 
ASTIN, J. (1998) Why patients use alternative medicine: results of a national study. Journal of the American Medical Association, 279, 1548-1553.[Abstract/Free Full Text]

CONSUMERS' ASSOCIATION (1992) Regulation of Practitioners of Non-Conventional Medicine. London: Consumers' Association.

EISENBERG, D., DAVIS, R., ETTNER, S., et al (1998) Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. Journal of the American Medical Association, 208, 1569-1575.

FISHER, P. & WARD, A. (1994) Complementary medicine in Europe. British Medical Journal, 309, 107-110.[Free Full Text]

GOLDBECK-WOOD, S., DOROZYNSKI, A., GUNNAR LIE L., et al (1996) Complementary medicine is blooming worldwide. British Medical Journal, 313, 131-133.[Free Full Text]

KERLINGER, F. N. (1973) Foundations of Behavioural Research. New York: Holt, Rinehart & Winston.

MARKS, I. M. & HERST, E. R. (1970) A survey of 1200 agoraphobics in Britain. Social Psychiatry, 5, 16-24.

PARTEN, M. (1950) Surveys, Pools, and Samples: Practical Procedures. New York: Harper & Row.

This Article Abstract Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Graham, C. Articles by Marks, I. Search for Related Content PubMed Articles by Graham, C. Articles by Marks, I.