The positive effects of complementary and alternative medicines (CAM) as part of service provision for people with intellectual disabilities
The use of complementary and alternative medicines (CAM) has been researched quite extensively among the general population and among various clinical populations; however little research has been undertaken in investigating the use of such therapies by people with intellectual disabilities.
In a study conducted by the Department of Complementary Medicine, University of Exeter (Long, Huntley and Ernst 2001), it was proposed that stress and anxiety are the number-one conditions which are deemed to benefit most from CAM, with therapies such as reflexology, massage, and yoga being recommended as suitable treatments for stress and anxiety. There is recent evidence to suggest that in a population of sufferers of mental health disorders and psychological stress, healing by gentle touch reduces stress, anxiety and depression and increases relaxation and ability to cope, and it ‘safely complements standard medical treatment’ (Weze et al. 2006). Other studies have measured the effect of reflexology and Hatha Yoga (a form of yoga that focuses on helping the person to calm their breathing), finding that they significantly reduced anxiety and stress (Wardell and Engebretson 2001).
Other research has shown CAM to have positive impacts on the quality of life of people in other health care settings, e.g. for the elderly, special care baby units (Griffiths 1996), cancer patients (Hodgson 2000) and dialysis patients (Yildirim and Fadiloglu 2006).
Staff at Walkinstown Association sought to investigate the possible benefits that experiencing a sustained period of CAM therapy would have on challenging behaviours and on the perceived quality of life of people receiving services.
In order to investigate the effectiveness of CAM therapy in a population of individuals with intellectual disability and challenging behaviour, Walkinstown Association has provided an ongoing holistic service. This holistic service offers various complementary and alternative medicine sessions to people who use services within the organisation.
Some of the therapies provided by Walkinstown Association include classes in back massage, neck massage, reiki, body harmony, Indian head massage, shoulder massage, arm massage, leg massage, relaxation techniques (e.g. breathing exercises), facial massage and hand massage. Participants were provided with at least weekly CAM sessions, with sessions lasting a maximum of one hour (depending on the person’s chosen therapy).
Research was conducted with people who use services at Walkinstown Association day service. All participants had a diagnosis of intellectual disability. They were male and female with ages ranging from 24–76. A total of 17 participants were included in the research (10 female, 7 male). Participants were both self-referrals and staff-referrals to the holistic services.
Prior to the experimental period participants, completed a Quality of Life Questionnaire (Schalock and Keith 1993), while participants’ keyworkers completed a challenging behaviour checklist (The Behaviour Problems Inventory (Rojahn et al. 2001)). After the experimental period, participants and their keyworkers once again filled in the same forms. In addition to this, participants were also invited to take part in a focus group to discuss the CAM therapy provided to them.
All CAM sessions took place in the snoezelen room located in the service’s day centre. Each CAM session took place for a maximum of one hour. Depending on the therapies used and on the wishes of the participants, some sessions were of a shorter duration. The choice of therapies provided to participants depended on their own wishes and the qualifications of the therapist.
The research produced results of both a quantitative and qualitative nature. The research highlighted a general reduction in measurements of challenging behaviour (including self-injurious behaviour, stereotype behaviour and aggressive behaviour) after a period of sustained CAM therapy, while illustrating a significant reduction in the frequency of self-injurious behaviour. Additionally the research pointed to an increase in participants’ perception of their quality of life; particularly, their level of ‘satisfaction’ was shown to be significantly higher after the period of CAM therapy.
Enrolling focus groups as a part of the research process provided the researchers with valuable insight into the direct experience of people receiving CAM services. The predominant theme to emerge from the focus groups was the sense of relaxation participants experienced during their respective sessions. For some, this sense of relaxation persisted when their session had ended. Examples of comments made were: ‘Back rubs help me to relax at the end of the day……I’m all loosened up and then I feel super in the evening……I feel relaxed when I go home after a massage…..The next morning when I get up I do be grand.’ Indeed, the effects of relaxation techniques in reducing challenging behaviour have been demonstrated in previous research (Lopata 2003).
The benefits that CAM sessions had on participants’ sleeping patterns were also noted as an emerging theme, with comments such as: ‘I sleep through the night when I have a massage; normally I would not sleep well at night….. I sleep well after the massage because it relaxes you and helps you sleep and you wake up in the morning and you’re fresh again.’ This is an important factor to consider as previous research has shown a correlation between poor sleeping patterns and challenging behaviour (Brylewski and Wiggs 1999).
Some participants also noted how they felt their CAM session affected the physical pain they experience. Comments included: ‘I go around the house and do a few jobs and the pain would be gone…… It helps to make the pain go away.’
Some participants also commented on the importance of the relationship that they had with the holistic therapist during sessions: ‘I like it when she [holistic therapist] talks to me when I am getting the hand massage…… I think she [holistic therapist] is great and is very gentle with her massage.’
In addition to examining emerging themes in the focus groups, there were also direct questions asked to participants pertaining to different aspects of the CAM sessions. Participants were specifically asked as to whether they thought the number of sessions available to them and the duration of sessions were adequate. There was a general feeling among the participants that they would like to avail of more than one session a week (preferably two sessions per week), while most were satisfied with the duration of their sessions. (The duration of most sessions was dependent on the wishes of the participant to begin with.) Additional information arising from the focus groups included a wish by some participants that the CAM therapies to be transferred from the day centre to the participant’s home. Interestingly, there were also requests from participants for therapies that are not currently on offer (e.g. yoga classes and music therapy). In addition to this, participants were also able to identify minor changes they would like to see in their own individual sessions—e.g. longer rest periods after a massage and having their eyes covered when receiving a facial massage.
The positive information gathered from the questionnaires and focus groups with participants in the current study highlights the potential benefits that CAM therapy can have for people with intellectual disability and challenging behaviour. This service has been shown to be very popular with the participants. This could have practical implications for voluntary, private and government agencies supplying services to people with intellectual disabilities, in how they allocate resources, especially as services are being led more and more by the philosophy of person-centred services. In addition to this, if further in-depth research is carried out to investigate the effect of CAM therapies, they may be found to have practical implications on how services respond to behaviours which challenge.
The current study indicates overall participant satisfaction for the CAM service and indicates that CAM therapy does have a positive effect on certain indicators of challenging behaviours (e.g. relaxation, sleeping patterns). The fact that there were general reductions in various facets of challenging behaviour (including self-injurious behaviours, aggression, stereotype behaviour) after the sustained period of CAM therapy further strengthens the argument for CAM therapies to be considered as part of a holistic approach to working with people who present with challenging behaviours.
Based on the information gathered in the current study, there appears to be a desire on the part of people with intellectual disabilities to be offered more and varied types of CAM therapy as part of an overall package of service provision.