Mental health conditions are complex, troubling, and can significantly impact your quality of life. But since the pandemic, conditions such as anxiety and depression have skyrocketed. Increasingly, people are looking for new ways to improve their mental health. With evidence-based medicine that safely integrates with conventional therapies, naturopathic doctors are very well suited to address the rising tide of mental health concerns afflicting people across the globe.
To learn more about how naturopathic medicine can help address a variety of mental health concerns, we sat down with two naturopathic doctors who are members of the specialty naturopathic association, Psychiatric Association of Naturopathic Physicians (PsychANP): Dr. Alex Tan, ND, PMHMP is a Naturopathic Physician and a Psychiatric and Mental Health Nurse Practitioner who’s been practicing in primary care for 15 years and mental health for four years. He was also the former president of PsychANP. Dr. Lachlan Crawford, ND, is a licensed naturopathic doctor in California and Ontario, Canada. She’s the Director of Integrative Medicine at Walden Behavioral Care, an inpatient and residential facility for eating disorders and psychiatric conditions in New England. She is the current president of PsychANP.
Three Ways That Naturopathic Doctors Use Integrative, Collaborative Care to Address Mental Health Conditions
Tan was recently interviewed as an upcoming guest on the Institute for Natural Medicine’s podcast, The ND Will See You Now, to discuss what naturopathic medicine has to offer patients experiencing mental health issues. After noting that NDs receive a great deal of training and exposure to mental health during their education and clinical years, he points to three main benefits of naturopathic medicine for mental health.
Seeing the whole person
“First, we have an orientation towards the whole person. When we think of mental health, we also think of the other things that could impact mental health, like biological and psychosocial systems. We also think about other health conditions that may impact mental health, such as gastrointestinal and hormone issues,” Tan explains. “It gives us a 3D view of our patients. And they like that because we’re whole people. We’re not just our brains or psyche.”
Getting to the root cause of illness
Second, Tan notes that naturopathic medical education includes training in the basic sciences, clinical sciences, and analyzing cases to get to the root causes. Using the example of treating depression with SSRIs (selective serotonin reuptake inhibitors, a commonly prescribed class of anti-depressant medications), he explains that traditionally, conventional medicine has focussed on one pathway at a time. In this case, the serotonin pathway. “As NDs, we are very aware that the root causes of illness don’t involve just one pathway. It’s a combination of different pathways. We’re not just bags of serotonin! So even in a field like psychopharmacology, our intuition to think of multiple pathways makes sense,” Tan observes.
Spending quality time with patients
For his third point, Tan refers to the findings from a 2014 study entitled Naturopathic Practice at North American Academic Institutions: Description of 300,483 Visits and Comparison to Conventional Primary Care.1Chamberlin SR, Oberg E, Hanes DA, Calabrese C. Naturopathic practice at north american academic institutions: description of 300,483 visits and comparison to conventional primary care. Integr Med Insights. 2014;9:7-15. doi:10.4137/IMI.S14124 “When you look at the top 15 reasons people come to see naturopathic doctors and conventional doctors, people actually come to see naturopathic doctors for mental health care more often. Compared to our conventional friends, consumers already recognize our ability to provide mental health care,” notes Tan. While naturopathic doctors already, on average, spend more time with their patients versus conventional doctors2Chamberlin SR, Oberg E, Hanes DA, Calabrese C. Naturopathic practice at north american academic institutions: description of 300,483 visits and comparison to conventional primary care. Integr Med Insights. 2014;9:7-15. doi:10.4137/IMI.S14124, Dr. Tan finds it particularly valuable in his specialty: “Mental health needs time. We need to get to know our patients and do counseling. The time we devote to patients makes us well suited to address mental health.”
“As NDs, we are trained to ask our patients, how’s your diet? How’s your sleep? How’s your exercise? Many of us also ask, how are your moods? What are your stressors? These are very good invitations for us to go into the mental health space with our patients.”
Dr. Alex Tan, ND, PMHMP
Using the Whole Person Approach to Address Eating Disorders
Eating disorders have been increasing since the pandemic. Dr. Lachlan Crawford, ND, who specializes in treating the condition, focuses on truly getting to know her patients to understand what fears and beliefs are driving their behaviors. Crawford uses integrative medicine while collaborating with other healthcare practitioners to offer comprehensive patient care.
Genetic factors and nutritional deficiencies
She notes that, like other mental health conditions, eating disorders have genetic and environmental contributing factors that we collect through life, including trauma and other mental health conditions, such as anxiety, OCD, and depression.3Yilmaz Z, Schaumberg K, Halvorsen M, et al. Predicting eating disorder and anxiety symptoms using disorder-specific and transdiagnostic polygenic scores for anorexia nervosa and obsessive-compulsive disorder. Psychological Medicine. Published online March 4, 2022:1-15. doi:10.1017/s0033291721005079 Through her integrative medicine lens, she also looks at nutritional deficiencies that may contribute, including zinc, essential fatty acids, B vitamins, and minerals. She may also track blood sugar levels throughout the day as that can sometimes drive feelings of anxiety, cravings, avoidance, and cause distress while eating.
The gut-brain axis and mental health
In recent years, she has focused on taking the gut lining into account when treating her patients. “Think about the gut lining as an essential organ that drives mental health. We’re learning a lot about the gut-brain axis, and how things that happen in the gut affect the brain, and how the brain affects what is happening in the gut,” explains Crawford. “I look to see if there has been any injury, history of an autoimmune condition, or digestive issue. Once I see if there is a root cause to heal, I support the gut microbiome through food, probiotics, prebiotics, whatever combination is going to work for that person.”
Heart rate variability biofeedback
Another tool that she uses quite often is heart rate variability biofeedback. “You use a very simple heart rate monitor that gives a visual display of what’s going on for your nervous system. You learn what helps you regulate your own internal nervous system so that you can understand that when you feel stressed, you have the ability to calm yourself down,” Crawford explains. “The integration of all of these tools is really important, which is why I love the naturopathic and integrative approach to eating disorders.”
What Does the Future of Mental Health Hold?
When asked about what the future of integrative, collaborative mental healthcare looks like, Tan doesn’t hesitate: “The future is bright! Our patients have made it clear that it’s a need. They’re asking for it. And having gone through the pandemic, all healthcare providers have become acutely aware of the importance of mental health.” In addition to the fact that NDs receive training that prepares them for mental healthcare, he notes that NDs are also trained in primary care.4Naturopathic Medicine. Psychiatric Association of Naturopathic Physicians Website. Accessed January 6, 2023. https://www.psychanp.org/naturopathic-medicine And according to Tan, mental health is part of primary care.
Tan envisions a future where all patients can access the full suite of tools that naturopathic medicine offers for mental health conditions. In addition to training in pharmacology, psychopharmacology, and the ability (in many states) to prescribe medications, he notes their ability to use other proven therapies for mental health. “We’re very adept at exercise prescriptions, behavioral activation, and motivational interviewing. We get a lot of training in building empathy with patients and using a supportive tone and approach.”
And when it comes to evidence-based research, Tan shares that with his patients too. Take exercise, for example. He often tells his patients that multiple studies show that exercise has a similar impact on depression as anti-depressant medications. But what he does next may differ from other healthcare providers who suggest ramping up their movement level. “Instead of saying, please go exercise, NDs go the extra mile and say, what motivates you to exercise? What kind of exercises do you like? We go more in-depth in explaining these behavioral interventions. And that’s a really good strength.”
As Crawford notes, it’s often challenging for people with mental health conditions to reach out for help. There can be a lot of stigma around mental health concerns, preventing people from seeking help even when it is readily accessible and affordable. Crawford would like to see a future where people with mental health concerns are not afraid to seek medical help because they truly realize they deserve the care that naturopathic doctors and other practitioners can provide.
“There is no health without mental health.”
PsychANP5Psychiatric Association of Naturopathic Physicians Website. Psychiatric Association of Naturopathic Physicians Website. Accessed January 6, 2023. https://www.psychanp.org/
The impact of PsychANPs work
The vision of PsychANP is “the universal availability of effective, efficient, compassionate care to prevent and treat psychological distress.”6Mission and Vision. Psychiatric Association of Naturopathic Physicians Website. Accessed January 6, 2023. https://www.psychanp.org/mission-and-vision.html “We have a great Board, and we all work on a volunteer basis to advance our profession in terms of our training, knowledge, skill set, and advocacy for providing mental health care,” Tan notes. They do this by holding an annual education conference, monthly meetings to discuss difficult cases, conducting research, working with the American Association of Naturopathic Physicians (AANP) on government advocacy, and creating more mental health residency opportunities for naturopathic doctors. And they have one more important project: creating a certification for naturopathic doctors in mental health. “This certification will signal to consumers that these Naturopathic Physicians have deep levels of interest, expertise, and extra training in mental health. It’s useful for consumers because it’s like a summary statement. It gives them confidence that this person has additional training beyond the extensive training we get as primary care providers,” Tan explains. By implementing such a certification, they follow in the footsteps of other naturopathic specialty associations like the Oncology Association of Naturopathic Physicians (OncANP), which supports the FABNO designation (Fellow of the American Board of Naturopathic Oncology), awarded to NDs who have undertaken their extensive training and passed rigorous exams.7About OncANP. Oncology Association of Naturopathic Physicians. Accessed January 6, 2023. https://oncanp.org/about-oncanp/,8FABNO Certification. Oncology Association of Naturopathic Physicians. Accessed January 6, 2023. https://oncanp.org/fabno-certification/
Footnotes
- 1Chamberlin SR, Oberg E, Hanes DA, Calabrese C. Naturopathic practice at north american academic institutions: description of 300,483 visits and comparison to conventional primary care. Integr Med Insights. 2014;9:7-15. doi:10.4137/IMI.S14124
- 2Chamberlin SR, Oberg E, Hanes DA, Calabrese C. Naturopathic practice at north american academic institutions: description of 300,483 visits and comparison to conventional primary care. Integr Med Insights. 2014;9:7-15. doi:10.4137/IMI.S14124
- 3Yilmaz Z, Schaumberg K, Halvorsen M, et al. Predicting eating disorder and anxiety symptoms using disorder-specific and transdiagnostic polygenic scores for anorexia nervosa and obsessive-compulsive disorder. Psychological Medicine. Published online March 4, 2022:1-15. doi:10.1017/s0033291721005079
- 4Naturopathic Medicine. Psychiatric Association of Naturopathic Physicians Website. Accessed January 6, 2023. https://www.psychanp.org/naturopathic-medicine
- 5Psychiatric Association of Naturopathic Physicians Website. Psychiatric Association of Naturopathic Physicians Website. Accessed January 6, 2023. https://www.psychanp.org/
- 6Mission and Vision. Psychiatric Association of Naturopathic Physicians Website. Accessed January 6, 2023. https://www.psychanp.org/mission-and-vision.html
- 7About OncANP. Oncology Association of Naturopathic Physicians. Accessed January 6, 2023. https://oncanp.org/about-oncanp/
- 8FABNO Certification. Oncology Association of Naturopathic Physicians. Accessed January 6, 2023. https://oncanp.org/fabno-certification/
