Benjamin Kligler

Multimodal Mind/Body Group Therapy for Chronic Depression: A Pilot Study

Chronic depression is a highly debilitating psychobiological disorder that affects mind, body, and spirit. The need for effective integrative treatments for depression is fueled by high recurrence and relapse rates, as well as growing consumer demand for natural and holistic approaches that recognize depression is a systemic problem. A 24-week multimodal group treatment program was piloted to assess whether psychoeducation, lifestyle modification, meditation, and mind/body skills training would reduce symptomatology and improve overall balance and well-being in nonmedicated patients with moderate depression. The group treatment was conducted in a healing space associated with an academic integrative medicine center. Fourteen adult patients (mean age = 51.7 years) participated in two treatment groups (seven patients per group). Treatment efficacy was evaluated by changes on the Beck Depression Inventory (BDI-II), the primary outcome measure, completed at pretreatment (week zero), posttreatment (week 12), and two follow-up points (weeks 16 and 24). Positive affect and overall well-being were assessed using the Symptom Checklist-90 Revised, the Life Orientation Test, the Short Form Health Survey-12, and the Psychological Well-Being Index. Comparisons of pretreatment and posttreatment scores on the BDI-II showed a clinically significant decline in depressed mood and negative affect (P < .001), as well as significant improvement across the positive affect and well-being measures. This outcome, which was statistically sustained for six months, suggests that a multimodal holistic mind/body group approach can benefit a segment of the chronically depressed population.

Integrative Medicine Patients Have High Stress, Pain, and Psychological Symptoms

CONTEXT Integrative medicine (IM) is a rapidly growing field whose providers report clinical success in treating significant stress, chronic pain, and depressive and anxiety symptoms. While IM therapies have demonstrated efficacy for numerous medical conditions, IM for psychological symptoms has been slower to gain recognition in the medical community. OBJECTIVE AND DESIGN This large, cross-sectional study is the first of its kind to document the psychosocial profiles of 4182 patients at 9 IM clinics that form the BraveNet Practice-Based Research Network (PBRN). RESULTS IM patients reported higher levels of perceived stress, pain, and depressive symptoms, and lower levels of quality of life compared with national norms. Per provider reports, 60% of patients had at least one of the following: stress (9.3%), fatigue (10.2%), anxiety (7.7%), depression (7.2%), and/or sleep disorders (4.8%). Pain, having both physiological and psychological components, was also included and is the most common condition treated at IM clinics. Those with high stress, psychological conditions, and pain were most frequently treated with acupuncture, IM physician consultation, exercise, chiropractic services, diet/nutrition counseling, and massage. CONCLUSION With baseline information on clinical presentation and service utilization, future PBRN studies can examine promising interventions delivered at the clinic to treat stress and psychological conditions.

OA05.04. Inpatient acupuncture care: establishing hospital-wide policy and service at Beth Israel Medical Center (NYC)

Methods An outpatient IM clinic was established in 2000 in association with BIMC offering primary care and modalities including acupuncture therapies, which in turn established a outpatient record of safety. In 2008, we developed a post-graduate Fellowship training program in inpatient care for licensed acupuncturists, setting policy and procedures that included scope of practice, recommendations for verbal informed consent and options for individual or blanket physician permission to treat per Department. Fellows worked two four hours shifts per week for one year. The Fellowship director gave lectures on acupuncture research relevant to specialties at Department Grand Rounds. Patients verbal consent was required, an INR of 4 or less, and a platelet count of at least 25,000.

P03.01. Characteristics of residents and training sites influence successful completion of the Integrative Medicine in Residency program

Methods Resident and residency site characteristics were examined to determine factors influencing completion of the Integrative Medicine in Residency (IMR) curriculum for the 2011 graduating class. Completion criteria included finishing ≥80% of the online courses plus a final score on the medical knowledge test of ≥70%. Resident characteristics used as predictors included demographics; medical school type [US MD, DO, foreign medical graduates (FMG)]; and, responses to a post-match survey administered before the residency began in 2008 on previous participation in CAM courses or experiences, importance of the IMR in choosing residency, and interests in learning IM and applying IM after graduation. Site characteristics included: extent of IM in the residency culture (e.g., faculty practicing IM consultations; IM consultation on site; an IM 4th year fellowship at the site); faculty characteristics (i.e., faculty leader IM fellowship trained; faculty leader with designated IM teaching time); and curriculum delivery (i.e., using the IMR plus other IM teaching/rotation/electives; monthly IM case conferences; resident IM clinical application).

P02.112. Mind-body medicine therapies for the depression spectrum: a systematic review

Purpose This paper aims to systematically compare and contrast the evidence for the use of mind-body therapies to address varying degrees of depressive symptoms in populations with and without other chronic co-morbidities. Systematic literature searches of PubMed (Medline), Embase, CINAHL, and the 7 databases encompassed by Current

P02.03. Decreased medication use and cost savings in inpatient oncology through a yoga-based integrative medicine approach.

Purpose The Urban Zen (UZ) Initiative at Beth Israel Medical Center was a pilot project evaluating the impact of a multi-faceted “optimal healing environment” intervention on quality of life and cost outcomes for inpatients on a medical oncology floor. Little research exists on the question of potential cost savings. This poster presents a summary of our findings on cost outcomes from this Initiative.

P02.94. Acupuncture to decrease disparities in outcomes of pain treatment (ADDOPT): preliminary outcomes

Methods >Primary care physicians at four community health centers in the Bronx, NY referred adult patients with chronic pain due to osteoarthritis, neck or back pain for acupuncture. The acupuncture was offered weekly for up to 14 weeks at the primary care sites, delivered by student/preceptor teams from the Swedish Institute and the Pacific College of Oriental Medicine. Using a repeated measures design we evaluated changes in pain and function over a 6-month period as compared to baseline. Outcome measures were collected during a 6-week pre-treatment phase for baseline measures and then at 2, 4, 8, 12, and 16 weeks, with a final assessment at 6 months.