Disorders - Anorexia Nervosa
Zhang, Y., Li, G., Liu, C., Guan, J., Shi, Z.
Purpose: Depression disorder
is the most commonly diagnosed type of mental illness among youths. Although a plethora of evidence suggests a positive relationship between exercise
and lower levels of depression in youths, the findings regarding the variation in magnitude of this relationship are inconclusive with respect to the
preventive and therapeutic effects of different types of exercise. This network meta-analysis aimed to determine the best type of exercise for the
treatment and prevention of depression in youths.\rMethods: A comprehensive search of databases, including PubMed, EMBASE, The Cochrane Library, Web
of Science, PsychINFO, ProQuest, Wanfang, and CNKI, was conducted to identify relevant research on exercise interventions for depression in youth
populations. The risk of bias in the included studies was evaluated using Cochrane Review Manager 5.4 according to the Cochrane Handbook 5.1.0
Methodological Quality Evaluation Criteria. The network meta-analysis was performed using STATA 15.1 to calculate the standardized mean difference
(SMD) of all concerned outcomes. The node-splitting method was used to test the local inconsistency of the network meta-analysis. Funnel plots were
used to evaluate the potential impact of bias in this study.\rResult: Utilizing data extracted from 58 studies (10 countries, 4,887 participants), we
found that for depressed youths, exercise is significantly better than usual care in reducing anxiety (SMD = -0.98, 95% CI [-1.50, -0.45]). For non-
depressed youths, exercise is significantly better than usual care in reducing anxiety (SMD = -0.47, 95% CI [ -0.66, -0.29]). In the treatment of
depression, resistance exercise (SMD = -1.30, 95% CI [ -1.96, -0.64]), aerobic exercise (SMD = -0.83, 95% CI [-1.10 -0.72]), mixed exercise (SMD = -
0.67, 95% CI [-0.99, -0.35]), and mind-body exercise (SMD = -0.61, 95% CI [-0.84, -0.38]) all showed significant efficacy over usual care. For the
prevention of depression, resistance exercise (SMD = -1.18, 95% CI [-1.65, -0.71]), aerobic exercise (SMD = -0.72, 95% CI [-0.98, -0.47]), mind-body
exercise (SMD = -0.59, 95% CI [-0.93, -0.26]), and mixed exercise (SMD = -1.06, 95% CI [-1.37 to -0.75]) were all significantly effective compared to
usual care. According to the test of the surface under the cumulative ranking score (SUCRA), the ranking of exercises for the treatment of depression
in depressed youths is as follows: resistance exercise (94.9%) > aerobic exercise (75.1%) > mixed exercise (43.8%) > mind-body exercise (36.2%) >
usual care (0%). For the prevention of depression in non-depressed youths, resistance exercise (90.3%) > mixed exercise (81.6%) > aerobic exercise
(45.5%) > mind-body exercise (32.6%) > usual care (0%). Resistance exercise thus had the best comprehensive effect on both the treatment and
prevention of depression in youths (clusterank value = 1914.04). Subgroup analyses show that a frequency of 3-4 times per week, a duration of 30-60
min, and a length of more than 6 weeks were found to be the most effective interventions for depression (P > 0.001).\rConclusion: This study provides
compelling evidence that exercise is a viable intervention for improving depression and anxiety in young individuals. In addition, the study
emphasizes the importance of selecting the appropriate type of exercise to optimize treatment and prevention. Specifically, the results suggest that
resistance exercise, performed 3-4 times per week, with sessions lasting 30-60 min and a length of more than 6 weeks, yields optimal results for the
treatment and prevention of depression in young individuals. These findings have significant implications for clinical practice, particularly given
the challenges associated with implementing effective interventions and the economic burden of treating and preventing depression in young people.
However, it is worth noting that additional head-to-head studies are necessary to confirm these findings and strengthen the evidence base.
Nevertheless, this study provides valuable insights into the role of exercise as a potential treatment and preventative measure for depression in
young people.\rSystematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=374154, identifier: 374154.
Frontiers in
psychiatry Frontiers Research Foundation, 14 : 1199510
- Year: 2023
- Problem: Depressive Disorders, Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Mind-body exercises (e.g. yoga, tai chi, qigong), Physical activity, exercise
Wittek, T., Zeiler, M., Truttmann, S., Philipp, J., Kahlenberg, L., Schneider,
A., Kopp, K., Krauss, H., Auer-Welsbach, E., Koubek, D., Ohmann, S., Werneck-Rohrer, S., Sackl-Pammer, P., Laczkovics, C., Mitterer, M., Schmidt, U., Karwautz, A., Wagner, G.
Objective: The aim of
this study was examining the efficacy of the Maudsley Model of Anorexia Nervosa Treatment for Adolescents and Young Adults (MANTRa) compared to
individual psychotherapy that can be considered as standard in Austria (TAU-O). Method(s): In this cohort study, 92 patients between 13 and 21 years
suffering from full-syndrome, atypical or weight-restored anorexia nervosa (AN) received either 24-34 individual MANTRa sessions (n = 45) or TAU-O (n
= 47). Outcome variables were age- and sex-related BMI, eating disorder and comorbid psychopathology at 6-, 12- and 18-month post baseline as well as
acceptability of treatment and therapeutic alliance. Result(s): Both treatments resulted in significant improvements in age- and sex related BMI and
reductions in eating disorder and comorbid psychopathology over time with significant differences between groups in favour of MANTRa. The percentage
of participants with fully remitted AN was significantly higher in the MANTRa group compared to TAU-O at 18-month follow-up (MANTRa: 46% vs. TAU-O:
16%, p = 0.006). Satisfaction with both treatments was high. Conclusion(s): MANTRa is an effective treatment programme for adolescents and young
adults with AN. Randomised controlled trials comparing MANTRa with existing treatments are necessary. Trial registration: The trial was registered at
clinicaltrials.gov (Identifier: NCT03535714). Copyright © 2023 The Authors. European Eating Disorders Review published by Eating Disorders
Association and John Wiley & Sons Ltd.
European Eating Disorders Review., :
- Year: 2023
- Problem: Eating Disorders
(any), Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Weinert, T., Bernardoni, F., King, J., Steding, J., Boehm, I., Mannigel, M., Ritschel, F., Zepf, F., Roessner, V., Ehrlich, S.
Background: Previous studies have suggested that individuals recovered from anorexia nervosa (AN) are characterized by increased
serotonergic (5-HT) activity that might be related to elevated levels of anxiety. Assuming these traits to be also present in individuals at risk for
AN, it was further hypothesized that restricting food intake might be a means to temporarily alleviate dysphoric affective states by reducing central
nervous availability of tryptophan (TRP), the sole precursor of 5-HT. One study that supported this hypothesis found anxiolytic effects in
individuals with a history of AN during an experimentally induced short-term depletion of TRP supply to the brain. Method(s): In this placebo-
controlled, double-blind cross-over study, 22 patients weight-recovered from AN (recAN) and 25 healthy control participants (HC) completed
questionnaires assessing anxiety and momentary mood during acute tryptophan depletion (ATD), a dietary intervention that lowers central 5-HT
synthesis. Result(s): The ATD procedure effectively reduced the ratio of TRP to competing for large neutral amino acids in the peripheral blood,
indicating decreased TRP supply to the brain. Effects of ATD on anxiety and mood did not differ between recAN and HC. Bayesian null hypothesis
testing confirmed these initial results. Discussion(s): Our results do not support the hypothesis that short-term depletion of TRP and its impact on
the brain 5-HT reduces anxiety or improves mood in AN. As the evidence for the role of 5-HT dysfunction on affective processes in patients with AN is
limited, further studies are needed to assess its relevance in the pathophysiology of AN. Copyright © 2022, The Author(s).
European Archives of Psychiatry and Clinical Neuroscience, 273(1) : 209-
217
- Year: 2023
- Problem: Anxiety Disorders (any), Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Dietary advice, dietary change
Egbert, A. H., Gorrell, S., Smith, K.
E., Goldschmidt, A.
B., Hughes, E. K., Sawyer, S. M., Yeo, M., Lock, J., Le-Grange, D.
Objective: Family-based treatment (FBT) is a well-established intervention for adolescent anorexia nervosa
(AN). Although FBT is efficacious in promoting weight gain and improvements in psychological symptoms, for some adolescents, cognitive/attitudinal
recovery lags behind weight gain. This study conducted an exploratory post hoc analysis of outcomes of adolescents who achieved weight gain by the
end of FBT but continued to experience elevated psychological symptoms post-treatment. Method(s): Data were drawn from two randomised controlled
trials (RCTs) testing two forms of FBT (conjoint/whole family and parent-focussed). Descriptive statistics and generalised estimating equations were
used to examine differences in treatment outcomes between non-cognitive responders (NCRs) (those who regained weight but continued to experience
psychological symptoms) and full responders (FRs) (those who achieved both weight and cognitive restoration by the end of treatment) (n = 80; 83.7%
female, Agemean [SD] = 14.66 [1.73]). Result(s): By 12 months post-treatment, there were no differences in weight between NCRs and FRs.
However, NCRs had a slower trajectory of weight gain than FRs and continued to have elevated levels of psychological symptoms throughout the follow-
up period. Conclusion(s): A subset of adolescents appear to continue to experience clinically significant levels of eating pathology up to 12 months
after FBT even when weight restoration is achieved. Copyright © 2023 Eating Disorders Association and John Wiley & Sons Ltd.
European Eating Disorders Review, 31(3) : 425-
432
- Year: 2023
- Problem: Eating Disorders
(any), Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Dikstein, H., Gilon-Mann, T., Halevi-Yosef, R., Enoch-Levi, A., Hamdan, S., Gur, E., Haim, Y.
B., Lazarov, A., Treasure, J., Stein, D.
Patients with anorexia nervosa (AN) display elevated anxiety and
attention biases (ABs) in threat processing. Attention bias modification treatment (ABMT) is considered promising for anxiety disorders, but its
potential for AN is limited. In this study, 154 young women hospitalised because of AN were assigned to ED-related and anxiety-related threat
stimuli, or to a non-ABMT intervention control condition in a randomized control trial. Hundred-and-ten patients completed the study. ABMT was an
add-on to the regular inpatient treatment. Research participants completed two pretreatment training sessions and eight biweekly sessions of ABMT.
AB, ED-related symptoms, depression, anxiety and stress were assessed before and after ABMT in the research groups, and, similarly, 5 weeks apart, in
the controls. We found that despite the different patterns of change in AB between the three groups following ABMT, the reduction in AB, or the
between-group differences in AB-reduction, were not significant. While the severity of ED-symptoms, depression, anxiety and stress was reduced
following ABMT, or control condition, in all groups, there were no between-group differences in these changes. Changes in AB were not correlated with
baseline and pre-post-treatment changes in ED-related and comorbid symptomatology. Methodological and inpatient treatment-related considerations may
explain our negative ABMT-related results. Copyright © 2022 Eating Disorders Association and John Wiley & Sons Ltd.
European Eating Disorders
Review, 31(2) : 285-302
- Year: 2023
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Attention/cognitive bias
modification, Other service delivery and improvement
interventions
Balzan, R. P., Gilder, M., Thompson, M., Wade, T. D.
OBJECTIVE: This pilot study investigated the feasibility
and preliminary efficacy of the metacognitive training for eating disorders (MCT-ED) program in adolescents with anorexia nervosa (AN). We report
attrition and subjective evaluation as well as changes to cognitive flexibility, perfectionism and eating disorder pathology relative to waitlist
controls.\rMETHOD: Female (n = 35, aged 13-17 years) outpatients with a diagnosis of AN (n = 20) or atypical AN (n = 15) completed baseline measures
of cognitive flexibility, perfectionism, and eating disorder pathology (May 2020-May 2022). Participants were randomly allocated to either
treatment-as-usual (TAU) plus MCT-ED or TAU waitlist condition. All participants completed post-intervention and 3-month follow-up questionnaires.
\rRESULTS: The MCT-ED condition had a treatment attrition rate <15%. Participants provided positive evaluation of the program. There were large
between groups differences favoring MCT-ED at post-intervention and 3-month follow-up for concern over mistakes perfectionism (respective ds = -1.25,
95% CI [-2.06, -.45]; -.83, 95% CI [-1.60, .06]) with a significant group difference post-intervention but not 3-month follow-up.\rDISCUSSION:
Findings provide tentative support for the feasibility of MCT-ED as an adjunct intervention for young people with AN, however replication is needed
with a larger sample size to further explore its efficacy.\rPUBLIC SIGNIFICANCE: Metacognitive training for eating disorders (MCT-ED) is a feasible
adjunct intervention for adolescents with anorexia nervosa. The intervention, which targets thinking styles and is delivered online by a therapist,
received positive feedback, had high treatment retention, and led to reductions in perfectionism by the end of treatment compared to wait-list
controls. Although these gains were not sustained long-term, the program is suitable adjunct intervention for young people with eating disorders.
International Journal of
Eating Disorders, 09 : 09
- Year: 2023
- Problem: Eating Disorders
(any), Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
An, Z., Kwag, K. H., Kim, M., Yang, J. W., Shin, H. J., Treasure, J., Kim, Y.
R.
Objective: Heightened sensitivity toward social rejection has been implicated in
eating disorders (ED) and personality disorder (PD). This study examined the effect of a cognitive bias modification training (CBM-I) targeting the
interpretation of ambiguous social situations in individuals with comorbid ED and PD. Method(s): A total of 128 participants [33 with ED and PD, 22
with ED-only, 22 with PD-only, and 51 healthy controls (HC)] were recruited from a hospital and university settings, and included in the final
analyses. The participants were randomly assigned to a CBM-I task with benign resolutions or a control task with neutral resolutions in a
counterbalanced order in two sessions using a within-subject design. Interpretation bias toward social stimuli was measured using the ambiguous
sentence completion task before and after completing the assigned task. Result(s): The CBM-I task increased benign and decreased negative
interpretations with large effect sizes in the diagnostic groups, and with a moderate effect size in the HC group. Participants' anxiety levels were
also reduced after the task. The size of the change in negative interpretation was positively associated with baseline negative affect, and
negatively associated with baseline positive affect. Discussion(s): The results suggest that modifying interpretation bias has the potential as a
transdiagnostic target of treatment for ED and PD, and a fully powered clinical trial with consecutive sessions would be warranted. Public
Significance: Participants with eating disorders and/or personality disorder, and healthy controls completed a single session of a cognitive training
intervention targeting rejection sensitivity. The training produced a large decrease in negative interpretation in the diagnostic groups, and a
moderate effect in healthy controls. The findings indicate that training for positive processing of social information may be of value to augment
treatment in conditions such as eating disorders and personality disorder, in which there are high levels of rejection sensitivity. Copyright © 2023
Wiley Periodicals LLC.
International Journal of Eating
Disorders, 56(7) : 1341-1352
- Year: 2023
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Ziv, A., Barnea-Melamed, S., Meisman, A., Ofei-Tenkorang, N. A., O'Donnell, J., Altaye, M., Nash, J. K., Mitan, L., Gordon, C. M.
In this randomized pilot study, we examined the effects of yoga intervention on axial and peripheral bone mineral density (BMD),
disordered eating cognitions, anxiety, and depression in adolescent girls with anorexia nervosa (AN). Fifteen young women aged 13-18 years with AN or
atypical AN were randomized to either a Yoga group (n = 7), including twice-weekly yoga for 24 weeks plus standard outpatient care, or Non-Yoga group
(n = 8), who received standard outpatient care alone. Data from anthropometrics, mental health and eating behavior questionnaires, dual-energy x-ray
absorptiometry, and peripheral quantitative computed tomography measurements were obtained at baseline and 6 months. The adjunct of yoga to standard
treatment resulted in statistically significant improvement of axial BMD, depression, and disordered eating cognitions in comparison to the Non-Yoga
group. In conclusion, a gentle yoga intervention may be beneficial for improving bone and mental health in adolescent females with AN. Copyright ©
2023 Taylor & Francis.
Eating Disorders, 31(5) : 526-
532
- Year: 2023
- Problem: Anxiety Disorders (any), Depressive Disorders, Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Mind-body exercises (e.g. yoga, tai chi, qigong)
Jacobi, C., Vollert, B., Hutter, K., Von-Bloh, P., Eiterich, N., Gorlich, D., Barr-Taylor, C.
Background: Although preventive interventions
for eating disorders in general have shown promise, interventions specifically targeting individuals at risk for anorexia nervosa (AN) are lacking.
Objective(s): The aim of this study was to determine the efficacy of a guided, indicated web-based prevention program for women at risk for AN.
Method(s): We conducted a randomized controlled efficacy trial for women at risk for AN. Assessments were carried out at baseline (before the
intervention), after the intervention (10 weeks after baseline), and at 6- and 12-month follow-ups (FUs). A total of 168 women with low body weight
(17.5 kg/m2<=BMI<=19 kg/m2) and high weight concerns or with normal body weight (19 kg/m2
Journal of Medical Internet Research, 24(6) (no pagination) :
- Year: 2022
- Problem: Eating Disorders
(any), Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Godart, N., Dorard, G., Duclos, J., Curt, F., Kaganski, I., Minier, L., Corcos, M., Falissard,
B., Eisler, I., Jeammet, P., Berthoz, S.
BACKGROUND: Randomized controlled trials showed the efficacy of family therapy for anorexia nervosa during adolescence, but studies
examining its long-term beneficial effect are still needed. This article presents the results of a 54-month post-randomization follow-up of a
previously reported randomized controlled trial that compared two post-hospitalization outpatient treatment programs: Treatment As Usual alone versus
Systemic Family Therapy added to Treatment As Usual.\rMETHODS: A consecutive series of 60 female adolescents with anorexia nervosa (DSM-IV) were
randomized (30 per group). During the first 18 months, in the Treatment As Usual group, subjects received a multidisciplinary treatment. In the other
group, Systemic Family Therapy sessions targeting intra-familial dynamics were added to Treatment As Usual. At 54 months, the primary outcome was
defined using the Morgan and Russell global Outcome Categories (Good or Intermediate versus Poor). Secondary outcomes were the Global Outcome
Assessment Schedule score, body mass index, amenorrhea, number of hospitalizations, eating disorder symptoms, psychopathological features, and family
functioning. Analyses were carried out using an Intention-To-Treat with the Last Observation Carried Forward procedure. Data of 59/60 subjects were
available.\rRESULTS: At 54 months, significant effects in favor of adding Systemic Family Therapy to Treatment As Usual were shown for the Global
Outcome Categories (60% of Good/Intermediate versus 31% in the control group, p = .026), mean body mass index (p = .048), resumption of menses (70.0%
vs. 40% p = .020), and mental state score (p = .010). Family cohesion scores were lower in the Systemic Family Therapy group (p = .040).
\rCONCLUSIONS: Adding Systemic Family Therapy focusing on intra-familial dynamics to a multidimensional outpatient treatment program appeared to lead
to a better long-term outcome in young women who suffered from severe anorexia nervosa during adolescence.
Journal of Child Psychology & Psychiatry & Allied Disciplines, 63(11) : 1368-
1380
- Year: 2022
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Giombini, L., Nesbitt, S., Kusosa, R., Fabian, C., Sharia, T., Easter, A., Tchanturia, K.
Objective: Randomised controlled
trial (RCT) in adults with anorexia nervosa (AN) showed that Cognitive Remediation Therapy (CRT) enhances cognitive flexibility, abstract thinking
and quality-of-life. Despite inconsistent findings, CRT has the potential as an adjunct treatment for young people (YP) with AN. A feasibility RCT
was conducted in an inpatient setting. The study will also consider the effect of CRT in YP with AN and autistic symptoms. Method(s): Participants
were randomly allocated to the Immediate or Delayed condition to receive individual CRT sessions, in addition to standard treatment. A repeated
measures design was conducted. Result(s): Eighty participants were recruited. The neuropsychological measures were feasible for evaluating individual
CRT in YP. Significant improvements in set-shifting and central coherence were found, with no main effect between immediate and delayed condition.
Significant interactions were found between the condition, and autism spectrum condition (ASC) and No-ASC subgroup, with significant positive impact
of CRT on set-shifting in the No-ASC subgroup. There was some evidence that for the No-ASC subgroup, CRT was more effective if delivered at the start
of the treatment; and for the ASC subgroup, that CRT was more effective if delivered at the later stage of treatment. Conclusion(s): These findings
suggest that the overall positive effect of CRT in set-shifting and central coherence alongside standard treatment. They also indicate the importance
of screening for the presence of ASC which could require tailored CRT. Copyright © 2021 Eating Disorders Association and John Wiley & Sons Ltd.
European Eating
Disorders Review, 30(1) : 50-60
- Year: 2022
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Curzio, O., Billeci, L., Belmonti, V., Colantonio, S., Cotrozzi, L., De-Pasquale, C. F., Morales, M. A., Nali, C., Pascali, M. A., Venturi, F., Tonacci, A., Zannoni, N., Maestro, S.
Studies in psychiatric populations have found a positive effect of
Horticultural therapy (HCT) on reductions in stress levels. The main objective of the present pilot study was to evaluate the impact of the addition
of HCT to conventional clinical treatment (Treatment as Usual, TaU) in a sample of six female adolescents with anorexia nervosa restricting type
(AN-R), as compared to six AN-R patients, matched for sex and age, under TaU only. This is a prospective, non-profit, pilot study on patients with a
previous diagnosis of AN-R and BMI < 16, recruited in 2020 in clinical settings. At enrolment (T0) and after treatment completion (TF), psychiatric
assessment was performed. At T0, all the patients underwent: baseline electrocardiogram acquisition with a wearable chest strap for recording heart
rate and its variability; skin conductance registration and thermal mapping of the individual's face. An olfactory identification test was
administered both to evaluate the olfactory sensoriality and to assess the induced stress. One-way analyses of variance (ANOVAs) were performed to
analyze modifications in clinical and physiological variables, considering time (T0, TF) as a within-subjects factor and group (experimental vs.
control) as between-subjects factors. When the ANOVA was significant, post hoc analysis was performed by Paired Sample T-tests. Only in the HCT
group, stress response levels, as measured by the biological parameters, improved over time. The body uneasiness level and the affective problem
measures displayed a significant improvement in the HCT subjects. HCT seems to have a positive influence on stress levels in AN-R. Copyright © 2022
by the authors.
Nutrients, 14(24) (no pagination) :
- Year: 2022
- Problem: Eating Disorders
(any), Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Other complementary & alternative
interventions