wk5DisEvidence and Non-Evidence Based Treatment Options

Prior to beginning work on this discussion, please read both “Limitations to Evidence-Based Practice” and “Rationale and Standards of Evidence-Based Practice,”and listen to the

Case Studies in Non-evidence Based Treatment Part One

(if needed

transcript

Download transcript

for part one audio). On the last day of Week 5, listen to

Case Studies in Non-evidence Based Treatment Part Two

(if needed transcript Download transcriptfor part two audio).

For your initial post, you will choose one of the case studies from this week’s audio file selection on which to base your remarks. Based on the available information, evaluate the symptoms and presenting problems for the patient in the chosen case study and propose a provisional diagnosis. Describe one evidence-based treatment for this diagnosis and provide a rationale for your choice. Research at least two peer-reviewed articles to support your evidence-based treatment selection.

UAGC | Case studies in non evidence based treatment Part one-1 UAGC

Hello, and welcome to this discussion. My name is Dr. Steven Brewer, and this is the first of two audio files that will introduce case
studies in non evidence based treatment. But first, what is evidence based treatment? Evidence based treatments, or evidence
based practices, are generally those that are supported by peer reviewed scientific literature.

This definition may lead you to assume that non evidence based practices are those that have been disproven by peer reviewed
scientific literature, but that isn’t the case. Non evidence based practices are simply those practices that have not been supported
by peer reviewed literature yet. Joining me to talk more about non evidence based practices is Dr. Erick Cervantes, Assistant
Professor and Chair of the Complementary and Alternative Health Program at Ashford University. He’ll be sharing with us some
fascinating cases where evidence based practices fail to completely help a patient’s concerns.

Thank you Dr. Brewer. I appreciate this time. A little bit of background first, I have a relative by the name of Ivan S., and so Ivan is
a Navajo descent individual born in the area of the Navajo reservation in Arizona. And in his early years, between the age of 20-
years-old and 26-years-old, he was deployed to Iraq for a couple of tours in that war. In any event, the point is that the first time
they returned from that war, Ivan came back with a lot of anger management issues at home and began to have a lot of squabbles
with his wife and children, which was very different than what he was before.

He did another tour thereafter. Of course, there were other problems in the household prior to his next departure, but when he
returned it was very apparent that he was very much affected by the war. He was taken to the Naval hospital here in Southern
California. His mood became stoic, but his behavior continued to be very, very aggressive.

He began to beat his wife, began to beat his children, recurrent nightmares at night, night sweats, and many, many, many
problems. And he continued on to go into the Naval hospital with no– here in Southern California with no apparent relief of his
symptoms or his behavior. He began to drink, began to have issues with the law, and so to no– again, no rescue from conventional
practice with the medications and the treatment. He began to also go to see a counselor, but that also didn’t do very well.

OK so, a little bit of background on what we’ll call patient M.D., so at a very– she grew up, basically, in a very poor town, a
agricultural town of many, many migrants. Migrants of Mexican descent as well as Central American descent. Mother and father
married at an early age. Probably, I think there was seven children in her family, if I remember correctly of this case, and she was
one of the younger females of the family.

At that time and at this place, there were rival gangs that were part of her life, but as she began to go into her teenage years, she
began to experience a lot of attention from a lot of her male peers. But one time, at one point, she began to have problems with
these peers that were gang related, and then experienced gang rape from the age of 14 to 16. She belonged, actually, to one of
the rival gangs, so therefore, it was very apparent that her collusion or her involvement with the rival gang brought her into more
at risk for these things to happen.

Not that– not as a justification, but more of how these gangs relate to each other. She began to– then from that point, after 16,
she began to use more heavily both marijuana, meth, heroin, alcohol, and she expressed that, more than anything, she was trying
to drown out the anxiety, the fear, the panic attacks that she would experience on an everyday basis due to her belief that this
would happen again at any time soon. She at the age of 18, she disbanded from these gangs and began to have her own life,
trying to go to school, finish high school specifically.

She finished with the GED and was in and out of college between the ages of 19 and 24. And her family life, she dissociated
completely from her mother and father because she felt that she felt abandoned by them, specifically when she was trying to
address the trauma that she experiences so young. As a matter of fact, she even expressed to them that she was raped and that
she wanted some people to go to jail for it, but the parents did not proceed to help her out with any legal ramifications that would
come from that.

So she felt also disregarded, especially for what she wanted to do. Her parents actually blamed her for the rape, so she carries a
lot of rancor and a lot of anger towards her parents and manifest that in many ways towards her parents. She’s disrespectful. She
reports that she’s very disrespectful. She doesn’t really visit them that often, she has a lot of fights with them for many, many little
things.

She’s been in and out of relationships, very short term relationships. Mostly been intimate relationships, rather than more of a
whole relationships with peers, specifically male peers. She identifies as bisexual, but she prefers men, but still has a lot of issues
with men and constantly fights with men, physically fights with men and especially her partners.

Socially, now her focus is she’s an activist. She does a lot of work with migrant families trying to educate them, trying to empower
them. She also goes to rallies too for migrant rights and also undocumented rights, so she is very much like a social worker, as well
as an activist, and believes that she’s doing this because she, you know, she’s trying to give back for people that are also abused
and disregarded in this society.

She is very youth oriented, so she’s– a lot of her focus is educating youth and also preventing youth violence, specifically sexual
violence against youth and especially females. However though, on the other side of the spectrum, she’s so ardently a zealot,
actually, with these ways of being because she can’t take no for an answer. She does things by force, so in essence she
encompasses a very strong male, almost patriarchal attitude about things and she demands things to be done in a certain way,
which hampers a lot of her relationships with people. She can’t really form very good social bonds and really alienates a lot of
people with her force or with the way that she is in forcefully pushing her agenda on folks and forcefully pushing a lot of her–
yeah, mostly her agenda of helping youth, et cetera.

So I guess what I’m saying is that there definitely would be a better balance if she was a little more in tune with how she manifests
to people. Right now, you know, she would probably have more allies if she wasn’t so harsh in manifesting what her agenda is.
Again, as previously said, I said she suffers a lot from anxiety, she suffers from insomnia, she currently takes medication for
anxiety, and she continues to self-medicate with marijuana to also decrease the anxiety. She has some social phobia, but also very
outgoing, interesting enough, so she has both of those polarities, and suffers from panic attacks on a constant basis.

Really even more interesting from a kind of holistic way of looking at this is that she was recently diagnosed with uterine cancer,
and what that does from my perspective as a clinician and naturopathic doctor, what that tells me is that the energetic imprint of
that trauma obviously is well imprinted in the uterus, and the manifestation of that trauma is still there. So if she goes on to do
other work, specifically spiritual work or other forms of therapy, I think there’s a possibility to lift that cancer growth. And not from
a chemical perspective, you know, not from chemotherapy or radiation therapy, but more from a very intuitive, very mental,
emotional, and spiritual practice, so other recommendations will be given from that. So that’s the background on M.D.

Well, thank you Dr. Cervantes for that fascinating case study. Students your challenge as individuals looking at these cases is to
provide a provisional diagnosis for these patients, and then propose the treatments as discussed in the discussion forum.

UAGC | Case studies in non evidence based treatment Part two UAGC
Hello and welcome to this second audio file regarding non-evidence-based treatment. I hope you had fun with the discussion last
week. My name is Dr. Stephen Brewer, and I’m again joined by Dr. Erick Cervantes.

And before we get into the non-evidence-based treatments with those cases that Dr. Cervantes presented on last week, I’d like to
first talk about evidence-based practices a little bit, and the three general types of evidence-based practices out there.

So the first general type of evidence-based practice is the known efficacious, or well-established, treatment. Those are the ones
that we hear about quite often, like cognitive behavioral therapy for anxiety, or interpersonal psychotherapy for depression. Those
are all well-established treatments.

The second area is probably efficacious, and these are treatments that have some peer-reviewed scientific literature that support
them, but not enough to where the field will point to the treatment and say, yes that’s the definite go-to treatment for this
condition.

And then three are the experimental treatments. These are the cutting-edge treatments that don’t have almost any peer-reviewed
literature but they’re still being explored as treatments.

So I guess, Dr. Cervantes, my question is, is there something in complementary and alternative health or non-evidence-based
practice that is similar to these three categories?

Well, I mean, not necessarily “similar to,” per se, in these categories, because I think on some of these categories would basically
have– they would have these rhythms that they follow. It’s basically from top to bottom, the approach is that way.

From my perspective– from a naturopathic perspective, as well as, if anything, an alternative perspective– we consider empirical
evidence the most important evidence, really. So if something works, we just follow that. We know that that specific thing works.

But we also do not limit ourselves and put ourselves in a box, and say like, well, if that works– if we’ve seen that, that that works,
then we should just approach it that way. We think of something else like, well, that works for that person. That’s one individual.
What if we add that with another thing for the next individual?

Because again, from our perspective, this is individualistic medicine, or an individualistic approaches to any case– any case. So
again, empiricism to adaptation, rather than a belief that everybody is the same and then approaching that sameness with the
same approach. It’s more of, let’s actually look at the individual and what that individual needs.

So this isn’t sort of like, as you would with a keyboard, a hunt and peck for the letters. This is more of an informed approach that
will hopefully help the person. But it was informed by, what? It’s informed by previous experience, by shared knowledge in the
field?

Yeah, actually, it is. It’s from many, many years of known knowledge in the field. It’s passed down from practitioner to practitioner,
or from specific disciplines to different disciplines within the alternative health realm.

So let’s say, for example, someone comes in with a specific headache– specific headaches that also have vertigo and ringing in the
ears. Some people would just approach it, well, that might be a neurological thing, of course. But let’s provide him some
medication so that they can actually tone down that.

But from our approach, it’s like, well, what else is going on structurally? What else is going on mental emotionally? What else is
going on, perhaps, spiritually? But it’s interesting– not a lot of conventional doctors or maybe, perhaps, even other disciplines from
the conventional side will look at it like, maybe structurally we could do something.

And maybe when you look at structure and maybe, perhaps, a vertebra is out of place, then boom– you put that vertebra back in
place and all of a sudden you have this flow again of the nervous tissue as well as blood flow, et cetera. So you got to think outside
the box rather than just simply thinking, oh, reductionistically all that must be just on the nervous system and stuff, so.

Right, the great point about thinking outside the box. More and more psychologists are starting to recognize the importance of
thinking outside the box even though, for the past 50, 60 years or so, the zeitgeist has been evidence-based practice, and that
being the practices that are supported by scientific literature. We’re recognizing now that there are more and more practices out
there that have been passed down through the generations that have maybe we don’t know the why it works, but we know that it
works.

There are more and more of those out there that we have to embrace and that we have to at least recognize, especially when
we’re working with people from different cultures. I hear more and more psychologists using their own personal definition of
evidence-based approaches. And that being combining their experiences as a healer, the patient’s values and preferences, and the
scientific theories that many psychologists use. So it’s sort of the middle ground between, I guess, what you’re saying and what
the field has been demanding for such a long time now.

Yeah, Dr. Brewer, if I may add– I think it’s really– for me, from my standpoint– it’s rather arrogant to state that one knows
everything just based on what they’re reading as evidence base. That’s rather arrogant.

It’s more because I have to really pound this belief or this philosophy that the alternative people believe is that no individual is the
same. Everyone has lived in a different environment. So therefore, a different expression of being.

So you can’t approach, from one perspective, every individual. You have to approach an individual with multiple perspectives and
different approaches. And again, beating this horse here, thinking outside the box.

Well, it can’t be a cookbook.

Yeah, exactly.

You can’t just cookbook treatment approach for everybody, even though it may be easier to do that sort of thing on paper. In
reality, when we get into the field, that is not the case.

Yeah. Cookbook’s rather bland, then.

So this leads to another point regarding any practices that are not within the, quote unquote, “evidence base” being regarded as
quackery. This has been the more extreme reaction, I would say, from the evidence-based camp in trying to discredit any practices
that don’t yet have any scientific support to them.

To me, it seems like it’s throwing the baby out with the bathwater. There may be some practices out there that are harmful and
that, over time, we can show through the peer-reviewed literature, the scientific literature, that they are indeed harmful. But we
shouldn’t throw out every practice out there just because we haven’t gotten around to actually researching them yet. So I know
that you have something to say about the quackery aspect of the field.

Sure, sure. That’s a really good point. Without going to a lot, a lot of detail with the rest of the history of, basically, the territorial
fight between conventional doctors and alternative practitioners, the split actually between conventionalists and alternative
practitioners took place probably in the in the 1800s.

And actually, the 19th century when what began to happen was, I said a little bit before, René Descartes began to separate the
human being into three components, basically. Which was, one was a mental emotional component, and the other one was a body
component.

But interesting enough, what he didn’t regard was the spiritual component, which came way before that. Because there is
sufficient literature out there and historical literature that states that all cultures– specifically also Western cultures, speaking of
European cultures– that they all treated individuals from the spiritual aspect first, and then treated the mental emotional, and
then the body perspective.

We knew much more back in the day because we only knew about our environment, before we knew the micro level aspects of our
life. I’m specifically speaking to chemistry and constituents of chemistry.

We as human beings, literally, were much more connected to the spiritual aspect, and then the mental emotional and then the
body aspect, through rituals, ceremonial rites, and customs, as well as what we have around us, which were mostly were herbs
and other things.

Again back to the 1900s, René Descartes really split us, in that his philosophy was that we were more like a machine rather than
an actual, from our regard, a miracle of life. Often we don’t think of ourselves as these entities that traverse shortly around the
world– I mean, for a short time around the world, and then we move on.

So I know that’s more of an esoteric kind of perspective. But so they call that a Descartesian Split. Alternative folks didn’t have a
split, but conventional doctors rode on that wave for a long time and began to really provide evidence that they were, at a very
micro level, that there were these little machines or molecules working to express who we are.

So back to the issue of quackery, I think what it is– the difference between our approaches is that you have medical doctors that
treat only physical disease. From one– I mean, if you’re going to reduce it that way, they mostly treat trauma, as well– trauma as
in mechanical trauma, like in accidents or in burns, et cetera. But they also treat chronic disease and some acute diseases. But
again, for more from a body perspective.

Then you have the other split where you see counselors and psychologists and psychiatrists use only the mental emotional aspect.
And then you have the other conventional side, which is spiritual people– meaning religious individuals, clerks, clerics, et cetera–
they’re treating the spiritual aspect.

So you have these three different entities trying to address the population. Where, from our side, is like, well, we don’t think of
them all separately. We are thinking them all as an entity. So every individual is compulsive– the spiritual aspect, the mental
emotional aspect, as well as the mind and mental emotional.

So all of those together, that’s the way we approach it. And we’re called quacks for that. And it’s interesting that that’s the default
when that is the whole human being. And every individual, again, is very unique in their way of living, their way of expression, the
way they express themselves in their living environment.

So maybe, perhaps, that’s part of your question, or one I’m answering, but maybe perhaps you can lead me on a little bit further
than to other things.

I think that’s– you come to a great explanation and understanding of why you’re being called quacks as a field. Which I think is
unfortunate because, again, if you’re able to take all three of these components, combine them, and understand the whole of the
human being, therein is the holistic healing. You hear about holistic healing quite a bit. We don’t really understand what that
means, but what you just described– that is holistic healing.

And it could be that people in your field are ahead of your time. It could be 100, 200 years from now– we finally have all the
literature to back up what the treatments that you have and the approaches that your field is proposing. But for now, because we
have such a medicalized model and the medicalized model is so attached to the evidence base, it’s almost like there’s a willful
ignorance of anything that’s outside of that evidence base, unfortunately.

But if we could just take all the research from each of these three areas currently, combine them– which hasn’t been done yet, to
my knowledge– then we will have more support for your area and, perhaps, that’ll lead fewer people to calling you quacks. Maybe
they’re afraid of that. That could be the case.

When you were adding this, I was thinking that, from a medical standpoint, it’s almost– it’s hard to understand that you would
approach someone only from a body perspective and you’re only approach someone only from a mental emotional perspective,
and then spiritual. It’s hard to believe that.

Because what that happens is that, from an economic perspective, you’re approaching everybody– I mean, you’re pushing
someone monetarily. You’re not approaching someone from, again, what you said is holistically. You’re not– that is, in essence,
our medicine is one of sustainability rather than something that would be splitting them up to– just always money. We know that
there’s a pharmaceutical industrial complex, in some regard. And then we know that there’s a lot of money going into our medical
system, unfortunately, where we’re having a lot of issues and the–

What we have is sickness management system right now, rather than a health enhancement system.

Right, rather than a preventive, as well. Yeah, to add into that. So anyway, that’s a really interesting point you make.

Fascinating discussion on both these topics. And now, Dr. Cervantes, we’ll be talking briefly about what actually happened with
those case studies that we learned about last week.

Ivan, though, is a traditional Diné, Navajo. And instead of continuing on with the conventional practice or follow-through treatment,
he decided to seek out a medicine man in the Navajo Indian reservation. So he and his wife and children went to seek out help
from these elders and they sought out a medicine man there.

Basically, he partook of a ceremony that took place for three days. He entered at sundown on the first day and did not come out
of, what they call a hogan, until 3 days later, also after sunset.

During that time, the Diné performed, what they call, the Calling the Spirit Back, or Calling the Warrior Back, ceremony of that
Indian reservation. And Ivan returned from that trip from that medicine man, from that ritual and, little by little, regained his old
self.

So I think the point of this is that there are elements from different disciplines, and specifically natural medicine, where one really
needs to approach a case not solely from a chemical perspective, also in a trauma perspective, or mental emotional perspective,
but also seek out one that treats the spirit.

So from that medicine man, what he did was call the spirits back into his life and, therefore, Ivan returned to becoming a more
sustained individual. He came off of the medications on his own. He no longer sought out the intervention of counseling, and
began to practice other traditional Navajo ceremonies, which include the sweat lodges, Sundance, and tipi ceremonies.

So that’s the case– the first case where Ivan and where he’s now a better person– doesn’t have any behavioral issues, and PTSD
symptoms that he described previously are no longer with him.

The second case is of a 29-year-old female who sought out counseling due to being gang raped when she was 14 through 16 years
old. There were– she had a lot of issues with, obviously, with her parents due to the projection that, obviously, they didn’t protect
her at a youthful age. She began using drugs after that– drugs and alcohol, specifically methamphetamine and heroin.

And– which is interesting, though, she also began to seek out Native American ceremonies to also help her. During that process,
though, one of her elders, as she states, began to tell her that she acquired a specific spirit at a very young age.

And what that elder was saying is basically that she began to manifest the spirit that was put onto her from a male, from males,
because she was a very aggressive individual, always fought with everybody. So her demeanor was very– I guess you would just
describe it from a Chinese perspective as a young energy, rather than more of a female essence of a yin.

So in any event, the reason I’m mentioning this case is because the 29-year-old finally decided to take a further step in and do,
what they call also in Native American ways, a spirit ceremony as our previous case was. So, spirit retrieval ceremony.

And that took place, and again, when she had no resolved issues with Western medicine or Western approaches– which would be
counseling and other medication– she began to experience, after the ceremony, a lot of alleviation of her symptoms. Specifically
the anxiety that– actually, yeah, the anxiety.

A lot of issues with her sleep patterns– she wouldn’t be able to sleep very much. She would have constant nightmares. She was
often– she had panic attacks.

But little by little, after the ceremony, she began to find relief from that. She’s currently seeking, also, further assistance from a
naturopathic doctor who provides herbs and other types of counseling that are different than approaches from the conventional
approaches of counseling. And that’s it for that case.

Peer 1

The case that will be discussed is with patient M.D. A quick overview this patient is at an early adult age, however, the situations that occurred happened to the patient at a younger age, which was from ages 14-16 years old. The patient was aggressively sexually assaulted by multiple men. The patient lived in low poverty and was involved in gang relations due to the area they were living in and began to heavily use substances.

Based on the available information, evaluate the symptoms and presenting problems for the patient in the chosen case study and propose a provisional diagnosis.

The information presented by Brewer et al (2014) regarding patient M.D., is that the patient has informed that she has panic issues, anxiety issues, aggression, and resentment. The patient, has changed her life and become an activist for women however, she still has trouble adjusting socially and making connections normally. She also has experienced more aggression towards men due to her past experiences. This shows she has trouble trusting and letting go of fear. I believe the proposed diagnosis, would be Adjustment Disorder Diagnosis. This disorder according to Morrison (2014), the person dealing with an adjustment disorder is having the emotional feeling of being panicky, having anxiety symptoms, and even depressive symptoms.

Describe one evidence-based treatment for this diagnosis and provide a rationale for your choice.

Research at least two peer-reviewed articles to support your evidence-based treatment selection.

Cognitive behavioral therapy is one evidence-based treatment used for adjustment behavior. According to Soledad et al (2022), can help the patient adapt and or change their stressor, with information and communication technology. The technology used can help a patient with activities that are not as demanding and gives more adaptability to different tasks. As for the M.D. patient, this will benefit her to find ways to communicate and adapt to a more stress-free life.

Another study supports that cognitive behavioral therapy can help patients with adjustment disorders. Marco et al (2021), did a study that showed having continuous cognitive therapy, that helps patients process and make meaning of their stressors. The focus of cognitive therapy is to develop better coping and adjustments, to help reduce worry, anxiety, and panic and adjust better. This does only work if the patient wants help and is willing to continue the mental health care.

Examine your colleague’s initial post, and assume the proposed evidence-based treatment was ineffective. Using a sociocultural perspective, provide an explanation for why the evidence-based treatment may have been ineffective in this case. Describe at least one non-evidence-based treatment option as an alternative to evidence-based treatment in this case. Compare and contrast the failed evidence-based treatment with the proposed non-evidence-based treatment option. Justify the use of the proposed non-evidence-based treatment option for this patient (i.e., How does this treatment option meet the patient’s unique sociocultural needs?).

Peer 2

Based on the available information, evaluate the symptoms and presenting problems for the patient in the chosen case study and propose a provisional diagnosis.

For my chosen case study, I decided to discuss Ivan. Ivan is a Navajo descent who was born on a reservation in Arizona. From 20 to 26 Ivan served in the military and did multiple tours in Iraq. During his time in the military, he was able to come home during various points. His wife and children noticed how Ivan’s personality had changed and he displayed anger outbursts. First, it started as verbal abuse and then turned physical. After he was done with the military it had become obvious that the war had a significant impact on Ivan’s personality and behaviors. Ivan had a hard time managing his anger and began to abuse alcohol. It’s even reported that Ivan would wake up in a cold sweat after having frequent nightmares. Based on the available information and the symptoms Ivan is displaying, my provisional diagnosis for him would be post-traumatic stress disorder (PTSD). PTSD is a mental disorder that’s caused by a disturbing event where the individual either experiences it or observes it. Symptoms may include flashbacks, nightmares, and unease, as well as uncontrollable thoughts about the event (Mayo Clinic, 2023). War can be a traumatic event for all parties involved. Ivan spent six years in war and its apparent that it was a traumatic event in his life and the reason for the behaviors he is currently showing.

Describe one evidence-based treatment for this diagnosis and provide a rationale for your choice.

One evidence-based treatment I would consider for Ivan is Cognitive processing therapy (CPT). This is a specific type of cognitive behavioral therapy that has been effective in reducing symptoms of PTSD that have developed after an induvial experience a range of traumatic events. CPT focus on helping individuals get in control of their emotions and thought process after experiencing a traumatic event (Simpson, 2022). This approach would be beneficial to Ivan because he’s currently having a difficult time adjusting to life away from the war. Ivan has become more violent, has become addicted to alcohol, and has many run ins with police. With CPT, Ivan can learn how to control his thoughts and behaviors better. One study showed that CPT can be paired with Relapse Prevention, which is a Cognitive Behavioral Therapy designed to aid individuals with self-monitoring and coping with alcoholism. Research shows that a considerable number of individuals who deal with PTSD also have a higher risk of abusing alcohol (Simpson, 2022). CBT is an effective strategy to help veterans deal with PTSD. A study I found described how many veterans did not know of affective ways to manage their PTSD, however, after being part of an experiment in which veterans were brought to together for CPT training a majority of the veterans stated the training was beneficial to helping them identify issues associated to the symptoms of PTSD (Kehle-Forbes, 2022).

 

Examine your colleague’s initial post, and assume the proposed evidence-based treatment was ineffective. Using a sociocultural perspective, provide an explanation for why the evidence-based treatment may have been ineffective in this case. Describe at least one non-evidence-based treatment option as an alternative to evidence-based treatment in this case. Compare and contrast the failed evidence-based treatment with the proposed non-evidence-based treatment option. Justify the use of the proposed non-evidence-based treatment option for this patient (i.e., How does this treatment option meet the patient’s unique sociocultural needs?).