Self-Therapy For People Who ENJOY Learning About Themselves

Everyone wonders what their dreams mean, and there are many complicated systems one can use to learn about them. Since any attempt at looking inward is rewarding, all of these systems probably help some.

But don't miss the obvious.

The obvious thing about dreams is this:
Dreams help us to maintain our beliefs when these beliefs have been threatened by the reality of daily experience.

THE IMPORTANCE OF MAINTAINING OUR BELIEFS

We each have a unique and very personal "world view." We use it to make sense out of our lives. Each of us needs to believe that our view of the world is right.

Since no one has a perfect world view, our world view must be changeable.

When we think our world view might be wrong we start to feel afraid.

Our dreams protect us from haphazardly changing our minds about how the world works.

In our dreams we create experiences which show us we were right all along even when we weren't!

Think of this simple example when you work on your dreams:

A little boy believes that "all men with beards are scary."
One day a bearded man visits his home and is kind to him all day long. That night the boy wonders if bearded men really are scary. He's almost sure that they are not, but changing his mind about it seems scary too. So he has a frightening dream in which a bearded man chases him.

When he wakes up, he goes back to believing that all bearded men are scary. End result: He has learned nothing from his real life experience the day before.

It's as if our dreams are saying:
"I've made up my mind. Don't confuse me with the facts."

WHAT TO NOTICE

Four questions to use when analyzing your dreams:

1. How did I feel at the very end of the dream itself? (In the dream, not after you woke up.)

2. What was the most emotionally significant thing that happened the day before you had this dream? (What gave you the strongest good or bad feeling?)

3. How was the feeling at the end of the dream the opposite of the strong feeling you had yesterday?

4. What could you learn if you decided to throw your dream away and just learn from the real experiences you had the day before?

A LITTLE HELP FROM YOUR FRIENDS

If you've followed this so far you can see that in a sense our dreams are lying to us.

Since this is so, it can be very difficult to analyze our own dreams. When we try to analyze our own dreams we are continually tempted to lie to ourselves

Ask a very close friend to help you. Tell them about your dream and about yesterday and try to give them complete answers to the four questions. Then ask them to catch you if you seem to be lying to yourself.

Often, you will see no connection at all between yesterday's events and your dream but your friend will say it's really obvious to them! Ask them to explain what they see.

It helps to use a pencil and paper and refer to the four step process shown above. Somehow seeing our statements in writing helps to overcome denial.

Recurring dreams are more complicated. If you have recurring dreams you'll need to think about what's been bothering you since these dreams started (rather than just since yesterday). Also, because recurring dreams indicate a long-standing conflict, it is unlikely that you will be able to analyze them well enough on your own. Try it on your own first, but ask for help if you realize it's not working. If the dreams cause you a lot of pain, ask a therapist to help.

DREAMS THAT SEEM REAL

If your dream still seems real to you hours or days after the dream itself, you are beginning to confuse fantasy and reality. The conflict behind this particular dream is extremely important for you to figure out. Get help if either the dreams or the sense that they are "real" don't go away!

Therapists work in different ways. If your therapist doesn't feel confident in analyzing the dream but does feel competent at helping you with the problem the dream is about, that's fine. It's the problem you need help with, not the dream.

next: Are You Considering Therapy?

Chapter 94 of Adam Khan's book Self-Help Stuff That Works

IN ORDER TO FIND a love for life, you'll need to know what your strongest interest is. What really interests you? What do you love to talk about, read about, do, have, play with? If you don't know the answer to those questions, or if the answers are a bunch of minor interests rather than one major interest, forget about finding a mate until you know what your "passion" is. But once you know that, finding a mate is easy: Pursue your interest and see who shows up.

Let's say you love sailing. If you want to find someone you'll love to talk to, you'll need to find someone as interested in sailing as you are. Otherwise, although the two of you may have a functional relationship, you'll be living in different worlds. Our deepest purposes and interests are at the heart of who we are.

So join a sailing club, go to sailing classes and races. Pursue your interest. The people you meet in a sailing club are much more likely to be interested in sailing than the people you'd meet in a bar, for example.

The rush of hormones at the beginning of a relationship wears off. Sorry to say it, but it's true. No matter how attractive someone may be, that initial intense rush eventually dies down. But that's okay, because there's a deeper, more satisfying kind of love and attraction: the respect and affection between two people who share a common purpose or interest.

Raising children ends up being the common purpose between many married couples. But if child-raising doesn't intensely interest both of you, it isn't a good enough purpose to create and maintain the longtime happiness of a lifemate.

Two things need to be said. First, you'll never find the "perfect" mate. She or he may seem perfect for a while, but no one can meet every one of your ideals. In fact, some of your ideals are probably mutually exclusive, so meeting all of them is literally impossible. You'll eventually find faults in anyone because everyone has faults. When you find faults with your mate, remind yourself of that. Quit imagining that there is a perfect person out there somewhere. There isn't.

Second, even when you've found your lifemate, you'll sometimes be attracted to others. It's human. It doesn't mean anything except that you are a biological machine, built to breed. The human species (and every other species on the planet) has a built-in urge to multiply. Stick with your mate and don't let it be important that others attract you. Your response to yourself can simply be "So what if I'm attracted to someone? It doesn't mean anything." Stay true to your mate even when an occasional attraction inclines you temporarily to do otherwise. You'll be happier and healthier as a result.

You want to find a lifemate? Take up your strongest interest with enthusiasm and see who shows up. After you find the person you're looking for and the rush of hormones has worn off, accept the fact that your mate isn't perfect, that nobody is perfect, and remind yourself that it isn't important that you are occasionally attracted to others. Do this and you can live (pretty darn) happily ever after.

Pursue your interest and remind yourself:
Nobody's perfect and attraction to others is unimportant.

Do you lack self-esteem? You can feel better about yourself, and it's easier than you probably think. But there's a little-known fact you need to be aware of:
Your Inner Guide to Self-Esteem

Here's something to learn about dealing with people. Would you like more self-confidence? It's important. Find out how to increase yours:
Self-Confidence

If you want to earn more money while at the same time not increasing your stress, or if you want even less stress than you have now, read this:
Stress Control

Do you want to make a good first impression? Here's how:
Make Your Own Labels

next: Personal Propaganda

In my own life, I've found that "falling in love" is initially a kind of trance, where the two people involved feel all kinds of wonderful feelings for each other. This type of love starts out as a euphoric high, in which both partners focus on their similarities. They believe their match is made in heaven. They are convinced the magical feelings of friendship and love they share will conquer all barriers and problems and last happily ever after. Also during this initial phase of love, the accompanying sexual attraction and activity is generally quite intense and can, if allowed, "drive" the relationship.

Eventually, however, the euphoric feelings associated with falling in love give way to reality. Both partners come down from the euphoric state of rapture. They wake up, in essence, and suddenly begin noticing their differences for the first time. They discover they have likes and dislikes—about each other. Their individualism begins to re-assert itself. Ego dominance and control issues arise, and can, if unchecked, eventually lead to abuse. The logistics of life start crowding out the in-love feelings and the relationship begins, seemingly, to crash and fall apart. The couple loses the feelings of attraction that initially brought them together and they begin, once again, looking for love by turning to a new partner, thus starting the whole cycle all over again.

According to Peck, Chopra, and other leading psychiatrists, the emotional high and the inevitable crash can take as long as two years to cycle through to completion. This is why a long term, non-sexual courtship tends to result in healthier, committed relationships. The courtship is also healthier and more relaxed when both partners are aware of and understand the course that "falling in love" takes.

At some point, then, the euphoric high reaches an end. Crises ensues. Rather than falling out of love and ending the relationship, partners who are aware of love's process can now begin the work of real, lasting love. At this critical juncture, where many relationships fall apart, a couple is ready for the next, higher phase of love, based on the initial feelings of attraction that first brought them together.

The euphoria of love is falling in love; the work of love is choosing to love. Choosing to treat each other with kindness. Choosing to keep the relationship alive and healthy. Choosing to give to one another. Choosing to remain friends despite conflicts. Choosing to negotiate conflicts to mutually-agreed resolutions. Choosing to combine their resources. Choosing to value and respect their differences. Choosing to create a beneficial partnership of independent, yet interdependent individuals.

Real, lasting love is a choice.

The only prerequisite for real love to continue is for both partners to simultaneously choose to engage in the work of love together. Both partners choose to build the relationship. Both partners are committed to creating a healthy home, where each of them is free to be their best self and where each of them is willing to encourage the other to be their best self and reach their greatest potential as individuals. Both partners agree to maintain the relationship, not out of need, but because each has a contribution and benefit to bring into the relationship. Both partners chose, together, despite any and all logistical problems that arise, to create and maintain a new reality of disciplined love for themselves and their children—a healthy reality where both partners can grow mentally and spiritually and can nurture, support, and encourage one another. In such a relationship, both euphoric love and love-by-choice will flourish and last.

next: Letting Go of Urgency

"The experience of love is all the same, what changes are our preferences."

We establish relationships with many different types of people. Our family members, neighbors, co-workers, friends, spouses, significant others, etc. We've been taught that the love is different depending on who we're loving. We even have different names for it such as agape for spiritual love and Eros for sexual love.

The emotion of love is the same regardless of who you feel it for. You want them to be happy, you accept them as they are, and you appreciate some aspect about them. So if love is the same, why does it feel so different depending on who you love?

The distinctions in the loving experience are apparent when we look at how we express our love. The emotions are the same, but how we express it is different depending on who we are loving. You may want to spend more time with your friends than your family members. You might enjoy different activities with your co-workers than you do with your spouse.

When and how we express love is determined by PREFERENCES. You may prefer to spend more time with someone who is outgoing, rather than quiet, or more serious rather than silly. You may be more physically attracted to someone who is short rather than tall, or younger rather than older. There are an endless number of qualities that we might prefer over others. And those preferred qualities determines who, when, and how we express our love.

The focus of this site is on romantic relationships, since this seems to be the area of most interest and concern. This is not surprising since these are the people who we're choosing to share our lives with.

Romantic Love Relationships

A romantic relationship is one where you have a deep feeling of connection to the other person. All systems are go. You accept them as they are, want them to feel good, and deeply appreciate who they are. And vice versa. They fit in with most, if not all, of your preferences in a life partner, i.e.; personality, life goals, beliefs and value systems, etc. One of the ways you desire to express your love for them through your sexuality. Sex is the one key element that distinguishes a romantic relationship from all other types.

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Great, all that sounds wonderful, but why is there so much pain in these types of relationships? (See "Is love painful?" section)

Read Also: Are You In Love or Infatuated?

next: Problems in Relationships

• Watch the video on Narcissistic Behaviors in Adolescence

Donovan, 16 years old, is incapable of loving and, therefore, has never loved you, his mother (or, for that matter, anyone else, himself included) in his entire life. His natural capacity to love and to return love was all but eliminated by his horrid childhood. We practice loving first and foremost through our parents. If they fail us, if they turn out to be unpredictable, capricious, violent, unjust - this capacity is stunted forever. This is what happened to Donovan: the ideal figures of his childhood proved to be much less than ideal. Abuse is a very poor ground to breed healthy emotions in.

Granted, Donovan - being the brilliant and manipulative person that he is - knows how to perfectly simulate and emulate LOVE. He acts lovingly - but this is a mere act and it should not be confused with the real thing. Donovan shows love in order to achieve goals: money, a warm house, food on the table, adoration (Narcissistic Supply). Once these are available from other sources - the former ones are abandoned callously, cold-heartedly, cruelly and abruptly.

You have been such a temporary stopover for Donovan, the equivalent of a full board hotel (no chores, no requirements on his time). Not only was he able to secure his material needs from you - he also found in you a perfect Source of Narcissistic Supply: adoring, submissive, non-critical, wide-eyed, approving, admiring, the perfect narcissistic fix. No Iframes

You describe a very disturbed young man with a clear NPD. He values intelligence above all, he uses foul language to vent his aggression (the narcissist resents his dependence on his Sources of Supply). The narcissist knows it all and best, is judgemental (without merit), hates all people (though he calls upon them if he needs something - he is never above exploiting and manipulation). When not in need, he does not contact his "friends", not even his "girlfriend". After all, emotions ("sensitivity") are a deplorable weakness.

In the pursuit of narcissistic gratification, there is no place for hesitation or pause. You put it succinctly: he will do nothing for others, nothing matters to him if it is not for himself. As a result, he lets people down and refrains almost religiously from keeping promises and obligations.

The narcissist is above such mundane things as obligations undertaken. They counter his conviction that he is above any law - social or other, and this threatens his grandiosity.

The narcissist, being above reproach (Who is qualified to judge him, to teach him, to advise him?), inevitably reverts to blaming others for his misdeeds: they should have warned/reminded/alerted him. For instance: they should have woke him up if they desired his precious company and wanted him to keep a date.

The narcissist is above normal humans and their daily chores: he doesn't think that he needs to attend classes (that others do. This is the unspoken continuation of this sentence). Other people should do so because they are inferior (stupid). This is the natural order of things - read Nietzsche. Most narcissists are predictable and, therefore, boring.

To love a narcissist is to love a reflection, not a real figure. Donovan is the most basic, primitive type: the somatic (or anal) narcissist, whose disorder is centred around his body, his skin, his hair, his dress, his food, his health. Some of these preoccupations attain a phobic aura ("freaky with germs") and that is a bad sign.

Hypochondriasis could be the next mental step. But Donovan is in great danger. He should seek help immediately. His NPD - as is usually the case - has been and is still being compounded by other, more serious disorders. He is led down a path of no return. Donovan is constantly depressed. Maybe he has had few major depressive episodes but he is distinctly dysphoric (sad) and anhedonic (hates the world and finds pleasure in nothing). He alternates between hypersomnia (sleeping too much) and insomnia (not sleeping for two days). This is one of the surest signs of depression.

Narcissists suffer, by their nature, from an undulating sense of self-worth and from all-pervasive feelings of guilt and recrimination. They punish themselves: they dress in ragged clothes contrary to their primary predilections and they direct their pent up aggression at themselves. The result is depression.

Donovan also seems to suffer from a schizoid personality. These people prefer to stay and work in their rooms, in solitary confinement, chained to their computers and books - to any social encounter or diversion. They rarely possess sufficient trust in others and the requisite emotional baggage to develop stable interpersonal relationships. They are miserable failures at communicating and confine their interactions to first degree relatives.

The total picture is that of a young person suffering from a Borderline Personality Disorder with strong narcissistic and schizoid hues. His reckless and self-destructive spending and his eating irregularities point in this direction. So does the inappropriate affect (for instance, smiling while pretending to shoot people). Donovan is a menace above all to himself.

Borderline patients entertain suicide thoughts (they have suicidal ideation) and tend finally to act upon them. This aggression can perhaps be directed elsewhere and result in catastrophic consequences. But, at best, Donovan will continue to make people around him miserable.

Treatment - psychoanalysis and other psychodynamic therapies included - is not very effective. My advice to you is to immediately stop your "unconditional love". Narcissists sense blood where others see only love and altruism. If - for masochistic reasons - you still wish to engage this young person, my advice to you would be to condition your love. Sign a contract with him: you want my adoration, admiration, approval, warmth, you want my home and money available to you as an insurance policy? If you do - these are my conditions. And if he says that he doesn't want to have anything to do with you anymore - count your blessings and let go.

next: Narcissism's Clarion Call - A Dream Interpreted

Question:

Many of the symptoms and signs that you describe apply to other personality disorders as well (example: the histrionic personality disorder or the borderline personality disorder). Are we to think that all personality disorders are interrelated?

Answer:

All personality disorders are interrelated, in my view, at least phenomenologically. We have no Grand Unifying Theory of Psychopathology. We do not know whether there are - and what are - the mechanisms underlying mental disorders. At best, mental health professionals register symptoms (as reported by the patient) and signs (as observed). Then, they group them into syndromes and, more specifically, into disorders. This is descriptive, not explanatory science. Sure, there are a few theories around (psychoanalysis, to mention the most famous) but they all failed miserably at providing a coherent, consistent theoretical framework with predictive powers.

Patients suffering from PDs have many things in common:

1. Most of them are insistent (except those suffering from the Schizoid or the Avoidant Personality Disorders). They demand treatment on a preferential and privileged basis. They complain about numerous symptoms. They never obey the physician or his treatment recommendations and instructions.

2. They regard themselves as unique, display a streak of grandiosity and a diminished capacity for empathy (the ability to appreciate and respect the needs and wishes of other people). They regard the physician as inferior to them, alienate him using umpteen techniques and bore him with their never-ending self-preoccupation.

3. They are manipulative and exploitative because they trust no one and usually cannot love or share. They are socially maladaptive and emotionally unstable.

4. Most personality disorders start out as problems in personal development which peak during adolescence and then become personality disorders. They stay on as enduring qualities of the individual. Personality disorders are stable and all-pervasive - not episodic. They affect most of the areas of functioning of the patient: his career, his interpersonal relationships, his social functioning.

5. The patient is not happy, to use an understatement. He is depressed, suffers from auxiliary mood and anxiety disorders. He does not like himself, his character, his (deficient) functioning, or his (crippling) influence on others. But his defences are so strong, that he is aware only of the distress - and not of its reasons to it.

6. The patient with a personality disorder is vulnerable to and prone to suffer from a host of other psychiatric disturbances. It is as though his psychological immunological system has been disabled by the personality disorder and he falls prey to other variants of mental sickness. So much energy is consumed by the disorder and by its corollaries (example: by obsessions-compulsions), that the patient is rendered defenceless.

7. Patients with personality disorders are alloplastic in their defences. In other words: they tend to blame the external world for their mishaps. In stressful situations, they try to pre-empt a (real or imaginary) threat, change the rules of the game, introduce new variables, or otherwise influence the external world to conform to their needs. This is as opposed to autoplastic defences exhibited, for instance, by neurotics (who change their internal psychological processes in stressful situations).

8. The character problems, behavioural deficits and emotional deficiencies and instability encountered by the patient with personality disorder are, mostly, ego-syntonic. This means that the patient does not, on the whole, find his personality traits or behaviour objectionable, unacceptable, disagreeable, or alien to his self. As opposed to that, neurotics are ego-dystonic: they do not like who they are and how they behave on a constant basis.

9. The personality-disordered are not psychotic. They have no hallucinations, delusions or thought disorders (except those who suffer from a Borderline Personality Disorder and who experience brief psychotic "microepisodes", mostly during treatment). They are also fully oriented, with clear senses (sensorium), good memory and general fund of knowledge.

The Diagnostics and Statistics Manual [American Psychiatric Association. DSM-IV-TR, Washington, 2000] defines "personality" as:

"...enduring patterns of perceiving, relating to, and thinking about the environment and oneself ... exhibited in a wide range of important social and personal contexts."

It defines personality disorders as:

A.An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:

1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events);

2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response);

3. Interpersonal functioning;

4. Impulse control.

B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.
F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug abuse, a medication) or a general medical condition (e.g., head trauma).

[American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, Washington, 2000]

Each personality disorder has its own form of Narcissistic Supply:

1. HPD (Histrionic PD) - Sex, seduction, flirtation, romance, body;
2. NPD (Narcissistic PD) - Adulation, admiration;
3. BPD (Borderline PD) - Presence (they are terrified of abandonment);
4. AsPD (Antisocial PD) - Money, power, control, fun.

Borderlines, for instance, can be construed as NPDs with an overwhelming fear of abandonment. They are careful not to abuse people. They DO care deeply about not hurting others - but for the selfish motivation of avoiding rejection. Borderlines depend on other people for emotional sustenance. A drug addict is unlikely to pick up a fight with his pusher. But Borderlines also have deficient impulse control, as do Antisocials. Hence their emotional liability, erratic behaviour, and the abuse they do heap on their nearest and dearest.

next: Depression and the Narcissist

• Watch the video on Is the Narcissist Ever Really Sorry?

Question:

Doesn't the narcissist EVER feel sorry for his "victims"?

Answer:

The narcissist always feels bad. He experiences all manner of depressive episodes and lesser dysphoric moods. He goes through a full panoply of mood disorders and anxiety disorders. He experiences panic from time to time. It is not pleasant to be a narcissist.

But he has a diminished capacity to empathise, so he rarely feels sorry for what he does. He almost never puts himself in the shoes of his "victims". Sure, he feels distressed because he is intelligent enough to realise that something is wrong with him in a major way. He compares himself to others and the outcome is never favourable. His grandiosity is one of the defence mechanisms that he uses to cover up for this disagreeable state of things. But its efficacy is partial and intermittent. The rest of the time, the narcissist is immersed in self-loathing and self-pity. He is under duress and distress most of his waking life. In a vague way, he is also sorry for those upon whom he inflicts the consequences of his personality disorder. He knows that they are not happy and he understands that it has something to do with him. Mostly, he uses even this to aggrandise himself: poor things, they can never fully understand him, they are so inferior. It is no wonder that they are so depressed.

When confronted with major crises (a traumatic divorce, a financial entanglement, a demotion) - the narcissist experiences real, excruciating, life-threatening pain. This is the narcissist's "cold turkey", his withdrawal symptoms. Narcissistic Supply is, like any other drug, habit forming (psychologically). Its withdrawal has broad implications, all severely painful.

Only then is the answer unqualified, unequivocal and unambiguous: yes, the narcissist is in pain - when devoid of his stream of adoration and other positive reinforcements.

next: Other Personality Disorders

We often expect our love partner to make the best choices for themselves and our relationship and when they are not our choices, we often get angry or disappointed. . . or both. Most people call this situation a problem; a problem we create by our expectations.

Try this: "no expectations, fewer disappointments." It's that simple. Not easy. Simple.

No expectations equal unconditional love. We all experience the need to have healthy choices exercised and when they don't show up, we either chose to have conversations about them or not. If the choices are abusive and therefore unacceptable, we begin to think about making a responsible choice to leave the relationship. However, always picking our lover apart because their choices are not the ones we would make can only point the relationship in the direction of failure.

"Okay," you say, "that's nice, but everyone has expectations!" Perhaps.

Today's lesson to learn is this: unfulfilled expectations always cause problems. Think about it. Your most recent issue with your partner relates in some way to an expectation that you had that didn't get fulfilled. Right?

Instead of being consistently confused by what you "expect" from your partner (and seldom get), focus and communicate your "needs." Most people do not do this. First, "you" must be clear about what you need from the relationship. Second, let your partner in on your little secret.

If we could accept the notion that everyone is doing the best they can, regardless of whether their choices are our choices, our attitude about our relationship would improve and perhaps the relationship we have would become the relationship we enjoy being in.

In my experience as a relationship coach, I would rate "unfulfilled expectations" as number 2 in a list of relationship problems.

What are your comments on this?

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next: Relationship Derailment

Thoughtful quotes about death and endings.

Words of Wisdom

"It's perfectly safe. It's like taking off a tight shoe." (Emmanuel)

"We men die because our faces were not watered enough." (Pat Conroy, Beach Music)

"To die will be an awfully big adventure." (James M. Barrie)

"Death is nature's way of saying, 'your table is ready." (Robin Williams, taken from DO IT, John Roger and Peter Mcwilliams)

"All men should try to learn before they die what they are running from, and to, and why." (James Thurber)

"Death has to be waiting at the end of the ride, before you truly see the earth, and feel your heart, and love the world." (Jean Anouilh)

"Death is not a period but a comma in the story of life." (author unknown)

"The end is where we start from." (T. S. Eliot)

"It matters not how a man dies, but how he lives." (Denis Diderot)

"Among the dead there are those that still have to be killed." (Desnoyers)

next:Dreams and Visions

Overview of complementary and alternative therapies. What they are, who uses alternative therapies and why.

On this page:

• What Is CAM?
• CAM Therapies Included in the Survey
• How Many People Use CAM
• Who Uses CAM Most CAM
• Domains Used the Most
• CAM Therapies Used the Most
• Use of Natural Products
• Health Conditions Prompting CAM Use
• Reasons for Using CAM
• Spending on CAM
• Future Reports

Americans are using complementary and alternative medicine (CAM). But, it is often asked, how many Americans? What therapies are they using? For what health problems and concerns?

The most comprehensive and reliable findings to date on Americans' use of CAM were released in May 2004 by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics (NCHS, part of the Centers for Disease Control and Prevention). They came from the 2002 edition of the NCHS's National Health Interview Survey (NHIS), an annual study in which tens of thousands of Americans are interviewed about their health- and illness-related experiences. The 2002 edition included detailed questions on CAM. It was completed by 31,044 adults aged 18 years or older from the U.S. civilian noninstitutionalized population. Some highlights from these findings begin with the section "CAM Therapies Included in the Survey". To obtain the full report, go to the end of this document.

What Is CAM?

CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine--that is, medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and their allied health professionals, such as physical therapists, psychologists, and registered nurses.^a

In CAM, complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine. While some scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies--questions such as whether these therapies are safe and whether they work for the diseases or medical conditions for which they are used. The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge.

^a Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine. Some conventional medical practitioners are also practitioners of CAM.

CAM Practices

Biologically based practices use substances found in nature, such as herbs, special diets, or vitamins (in doses outside those used in conventional medicine).

Energy medicine involves the use of energy fields, such as magnetic fields or biofields (energy fields that some believe surround and penetrate the human body).

Manipulative and body-based practices are based on manipulation or movement of one or more body parts.

Mind-body medicine uses a variety of techniques designed to enhance the mind's ability to affect bodily function and symptoms.

Whole medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States.

CAM Therapies Included in the Survey

The survey included questions on various types of CAM therapies commonly used in the United States. These included provider-based therapies, such as acupuncture and chiropractic, and other therapies that do not require a provider, such as natural products, special diets, and megavitamin therapy. (See a complete list of therapies that were included.)

The results were analyzed including and excluding two therapies--(1) prayer specifically for health reasons and (2) megavitamins--because earlier national surveys did not consistently include these therapies.

Unless noted otherwise, the statistics are for CAM use during the 12 months prior to the 2002 survey.

CAM Therapies Included in the 2002 NHIS

An asterisk (*) indicates a practitioner-based therapy. For definitions of any of these therapies, see the full report or contact the NCCAM Clearinghouse.

• Acupuncture*
• Ayurveda*
• Biofeedback*
• Chelation therapy*
• Chiropractic care*
• Deep breathing exercises
• Diet-based therapies

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  • Vegetarian diet
  • Macrobiotic diet
  • Atkins diet
  • Pritikin diet
• Energy healing therapy*
• Folk medicine*
• Guided imagery
• Homeopathic treatment
• Hypnosis*
• Massage*
• Meditation
• Megavitamin therapy
• Natural products
  • (nonvitamin and nonmineral, such as herbs and other products from plants, enzymes, etc.)
• Naturopathy*
• Prayer for health reasons
  • Prayed for own health
  • Others ever prayed for your health
  • Participate in prayer group
  • Healing ritual for self
• Progressive relaxation
• Qi Gong
• Reiki *
• Tai chi
• Yoga
• Ornish diet
• Zone diet

Fig. 1: CAM Use by U.S. Adults Click to enlarge

Fig. 2: CAM Use by Race/Ethnicity Click to enlarge

How Many People Use CAM

In the United States, 36% of adults are using some form of CAM. When megavitamin therapy and prayer specifically for health reasons are included in the definition of CAM, that number rises to 62%. (See figure 1.)

Who Uses CAM Most

CAM use spans people of all backgrounds. But, according to the survey, some people are more likely than others to use CAM. Overall, CAM use is greater by:

Women than men People with higher educational levels People who have been hospitalized in the past year Former smokers, compared with current smokers or those who have never smoked This survey was the first to yield substantial information on CAM use by minorities, and the major findings so far are shown in figure 2.

The full report provides more details about the characteristics of people who use CAM.

Fig. 3: CAM Use by Domain and Whole Medical Systems Click to enlarge

Fig. 4: 10 Most Common CAM Therapies Click to enlarge

Fig. 5: Top 10 Natural Products Click to enlarge

Fig. 6: Disease/Condition for Which CAM is Most Frequently Used* Click to enlarge

Fig. 7: Reasons People Use CAM Click to enlarge

CAM Domains Used the Most

When prayer is included in the definition of CAM, the domain of mind-body medicine is the most commonly used domain (53%). (See figure 3.) When prayer is not included, biologically based therapies (22%) are more popular than mind-body medicine (17%).

CAM Therapies Used the Most

Prayer specifically for health reasons was the most commonly used CAM therapy. (See figure 4, which shows the percentage of people using each of the 10 most common therapies.) Most people who use CAM use it to treat themselves, as only about 12% of the survey respondents sought care from a licensed CAM practitioner.

Use of Natural Products

As shown in figure 4, about 19% (or one-fifth) of the people surveyed used natural products. See figure 5 for the most commonly used natural products and for the percentages of natural product users who took those products.

Health Conditions Prompting CAM Use

People use CAM for a wide array of diseases and conditions. According to the survey, Americans are most likely to use CAM for back, neck, head, or joint aches, or other painful conditions; colds; anxiety or depression; gastrointestinal disorders; or sleeping problems. (See figure 6.) It appears that CAM is most often used to treat and/or prevent musculoskeletal conditions or other conditions involving chronic or recurring pain.

Reasons for Using CAM

The survey asked people to select from five reasons to describe why they used CAM. (See figure 7.) Results were as follows (people could select more than one reason):

• CAM would improve health when used in combination with conventional medical treatments: 55%
• CAM would be interesting to try: 50%
• Conventional medical treatments would not help: 28%
• A conventional medical professional suggested trying CAM: 26%
• Conventional medical treatments are too expensive: 13%

The survey found that most people use CAM along with conventional medicine rather than in place of conventional medicine.

Spending on CAM

The NHIS did not include questions on spending on health care, but the report authors cited spending figures from national surveys conducted in 1997. Those surveys found that:^1,2

• The U.S. public spent an estimated $36 billion to $47 billion on CAM therapies in 1997.
• Of this amount, between $12 billion and $20 billion was paid out-of-pocket for the services of professional CAM health care providers.
• These fees represented more than the public paid out-of-pocket for all hospitalizations in 1997 and about half of what it paid for all out-of-pocket physician services.
• $5 billion of out-of-pocket spending was on herbal products.

Future Reports

NCCAM plans to collaborate with the NCHS to analyze the survey findings further. Among the areas of interest to the researchers are how CAM use relates to various health-related behaviors, race, and gender, and whether there are differences between people who use only CAM or only conventional medicine, and those who use both. Future reports will be published.

¹Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998;280(18):1569-1575.

²Centers for Medicare & Medicaid Services. 1997 National Health Expenditures Survey. Centers for Medicare & Medicaid Services Web site. Available at http://www.cms.hhs.gov/.

About NCCAM
NCCAM, a component of the National Institutes of Health, is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.

To Obtain the Report
The report's citation is Barnes P, Powell-Griner E, McFann K, Nahin R. CDC Advance Data Report #343. Complementary and alternative medicine use among adults: United States, 2002. May 27, 2004. It is available, along with a press release and graphics, at http://nccam.nih.gov/news/camstats.htm.

For More Information
To learn more about CAM, including individual CAM therapies, visit the NCCAM Web site at www.nccam.nih.gov, or call the NCCAM Clearinghouse toll-free in the U.S. at 1-888-644-6226. Services include fact sheets, other publications, and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice or referrals to practitioners.

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