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Herbs for Anxiety Mini Reference
The Herbs for Anxiety Mini Reference was created to assist integrative psychotherapists and other health care workers in educating patients and their treatment teams on the potential benefits and risks of integrating 26 herbs into treatment plans.
Clinical herbalism should only be practiced within the confines of the federal and state laws in which you reside. If licensed, herbalism should only be practiced under that license, if it is in the best interest of the patient, and if herbalism is within the scope of practice of that license and within your scope of competency. This reference should not be construed as a means of anyone practicing clinical herbalism without the requisite training needed to do so safely.
Instead, this reference is for education purposes only, and should be used to educated patients and their treatment teams on the benefits and risks of herbs according to the empirical literature and experiences of clinical master herbalists. This reference is not to be used to provide patients with herbal recommendations; rather it is to be used to help professionals in their ethical obligation to reasonably support patients in their herbal healing beliefs while simultaneously maintaining patient safety.
The Herbs for Anxiety Mini Reference (HAMR) is as much of a tool to encourage dialog between mental health professionals and patients as it is a source of information. It is recommended that at intake patients are asked if they currently use any herbs or supplements.
When doing so keep the following in mind:
- Patients' who choose to use herbs frequently do so because of deeply held healing beliefs (Burton, Falkenberg, Smith, Zhang, & Zhang, 2013).
- Herbs can create clinically significant outcomes in patients suffering from mental and emotional issues (Mischoulon & Rosenbaum, 2008).
- Herbs can create clinically significant negative side effects if taken at improper doses or if contraindications exist (Ernst, 2003).
- Drug-herb interactions exist and potential interactions are a primary concern when patients use medications and herbs simultaneously (AARP & NCCAM, 2011).
- Research indicates that patient compliance to medication frequently increases when herbs are taken at the same time (Sarris, 2007).
- Research has found that 47% of patients select herbs based off information obtained from the television, radio, internet, or family and friends (AARP & NCCAM, 2011).
- Outside of a few popular herbs, western trained physicians are rarely educated on the benefits and risks of herbs (Pirotta, Cohen, Kotsirilos, & Farish, 2000; see also Sarris, 2007).
- Patients frequently do not report their use of herbs to physicians because 1) patients sense that physicians do not have enough time to consider and integrate herbs into their treatment plan, 2) patients assume that because herbs are natural they are therefore safe and have no need to report them to their physician, and 3) patients fear being criticized by their physicians for taking herbs and subsequently being told to stop using them. (Verhoef, White, & Doll, 1999; Barnett, Shale, Elkins, & Fisher, 2014).
Suggested steps for how the Herbs for Anxiety Mini Reference (HAMR) might be used include:
1)Identify the herb(s) being used by the patient.
2)After the herb(s) the patient is using have been identified, obtain additional information that will be helpful to you in looking the herb up and coordinating care. Ask these additional questions using therapeutic skill, doing so places you in a trusted position allowing you to obtain important information regarding patients' use of herbs. Types of questions that might be asked include:
- The reasoning behind the patient's use of the herb(s). Are they using it because it is connected to a deeply held healing belief or simply because it was advertised on the radio?
- If known or easily accessible, what is the Latin name of the herb(s) being used? o What medications are they taking and have they checked to confirm that the herb(s) does not interact with them?
- Have they informed their prescribing physician of their use of herbs? If not, why not?
- What has been the patient's perceived effect of the herb(s)?
- How much of the herb(s) do they use on a daily and weekly basis?
- What form of the herb(s) are they taking (tea, liquid extract/tincture, capsule, etc.)?
- Are they working with an herbalist, or has this herb been self-prescribed? If so, who is the herbalist and what herbal training do they have? Are they open to you contacting their herbalist to coordinate care?
3)Check to see if the herb(s) is in the HAMR using the Herbs for Anxiety Quick Reference.
4)The HAMR contains all the herbs empirically indicated and those agreed on by master herbalists as useful in addressing anxiety as found in Einerson (2017). There are likely additional herbs empirically indicated by pharmacological research that were not identified in the reviews referenced. See Einerson (2017) for additional details.
5)Turn to each herb and help the patient/treatment team understand the level of evidence supporting the herb, its drug-interactions, warnings, contraindications, and suggested dosage.
The example provided above is simply an example of how the HAMR might be used, in reality the HAMR can be used at any time in the therapeutic process to support the patient, educate the treatment team, and to reasonably assist in keeping patients safe. Regardless of how the HAMR is used to educated patients, it is important that the clinician understand the subjective nature of the tool.
For example, the safety ratings and primary effect for each herb, and the level of support the herb has, each derive from the collective opinion of master herbalists and are not definitive in nature. Additionally, the comments, in narrative form, obtained by master herbalistsare not 'collective' opinions, but are instead the opinion of a single master herbalist. The exception being when a statement is followed by a set of parenthesis, such as (3); this indicates the number of herbalists who contributed to this statement—in this example, three. Research on herbs is limited thus the information these master herbalists have provided are important and helpful in educating patients and other clinicians on the use of these herbs.
To quickly become familiar with the type of information in the HAMR, see Figure 1 below.
Example of information found in the Herbs for Anxiety Mini Reference
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For additional information regarding the sources, methods used, and conclusions made regarding information provided by master herbalists see Einerson (2017).