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Scott Webb: Integrative therapy is a combined approach to care, which includes traditional Western medicine combined with holistic methods and therapy treatment options. And joining me today to discuss the benefits of treating the whole person in both residential and outpatient settings is Dr. Maureen Schwehr. She's a naturopathic doctor and Director of Integrative Services with Sierra Tucson.

Scott Webb (Host): This is Let's Talk: Mind, Body, Spirit by Sierra Tucson. Sierra Tucson ranked number One best Addiction Treatment Centers 2021 in Arizona by Newsweek. I'm Scott Webb

Scott Webb: Doctor, it's a great to have your time today. We're going to talk primarily about integrative therapy. But before we get there, I know that you're a naturopathic doctor and I guess I want to know what does that mean exactly and how does it affect your approach to care?

Dr. Maureen Schwehr: I love being a naturopathic doctor. And one of the things that's so interesting about my profession is I think there's a lot of misinformation out there about it. Naturopathic medicine is a specialty where we're our own kind of medical providers and there's actually six naturopathic medical schools in the United States and two in Canada. And my training was sort of, in my opinion, best of both worlds. I had a lot of basic medical training, anatomy, biochemistry. I learned about medications. I learned how to diagnose. And in addition, I had an awful lot of training on nutrition. I learned about herbs and supplements. I learned about other kinds of approaches, like ayurvedic medicine and traditional Chinese medicine. So I have kind of a broad spectrum. And what that allows me to do is to have a bigger toolbox in being able to provide services for people.

So my dream has always been to work in an integrative environment. I've always wanted to work side-by-side with other medical providers. And I think that I'm so lucky that I get to do that, especially in a mental health and addiction setting, because it provides me such an opportunity to actually have all of our patients' need met.

Scott Webb: Yeah. And I can see how that would really benefit patients and, you know, clients and folks there at Sierra Tucson. So let's talk about that. You mentioned integrative medicine, integrative approach. So what is integrative therapy?

Dr. Maureen Schwehr: I think it's a word that's overused so much in our vernacular. Everyone claims to be integrative. It's a great sales pitch, et cetera. For me, integrative means that you have a variety of treatments available that are able to meet people at all levels. What that means is you have things that are be able to meet their needs cognitively, like talk therapy, cognitive behavioral therapies. It also means medically you can look at everything, whether that's psychiatric or medical, as in there's diabetes, going on also in this person. It also means that we can have therapies available that are body work such as acupuncture, massage, craniosacral therapy, and also things to sort of meet someone's soul like music therapy and equine therapy.

Scott Webb: Wondering when you're treating patients, when and why do you consider this type of treatment or therapy for a particular patient?

Dr. Maureen Schwehr: When I'm meeting with someone, I'm always kind of listening in two different ways. So part of me is listening from a very doctor perspective. I'm thinking about things like nutritional status. Are they eating enough of the proper things? Are they digesting their food properly? Are their hormones balanced?

And another part of me is listening to people's stories. And so what I mean by that is I'm listening to their way of how they interact with the world, what's their filter. If someone, for instance, grows up in a home where they never feel really properly taken care of and they didn't get their needs met, then they can have a story of like it's never enough, things are never enough. If they didn't feel safe, they might have a story of the world's not a safe place and people will hurt me. So I listened to that because I do take that mind, body, spirit piece really literally.

What happens is that whatever happens to us in our world, we have an emotional response to, and that emotional response affects our body. So for instance, if someone had grown up in a home where there was a lot of yelling and screaming, then their nervous system is going to be set to have a lot of anxiety. They're going to react to things more than they want to. And then I can understand how that's going to, for instance, mean that their cortisol levels too high, which can cause inflammation in the body, which can cause heart disease, which can lead to insomnia. So what I'm doing is I'm listening on both those pieces. And then what I try to do is put together a program that actually meets all of their needs.

One of the new things that I've been learning about lately is polyvagal theory. And what polyvagal theory does is it explains how our nervous system reacts to stressors. Deb Dana, who's a therapist who writes a lot about polyvagal theory, calls it the science of safety. And there, what they recognize is that our nervous systems are always in one of three settings. So one of those settings is the ventral vagal, which is like you feel safe and engaged and happy. And then if you're feeling scared, you're going to go into sympathetic mode, which is fight or flight. If you're overwhelmed or if something's really scary, you go into ventral dorsal vagal, which is actually like the freeze mode.

So depending on where someone is at in their nervous system setting, I choose therapies to be able to help them more. So for instance, if someone is really overwhelmed, if they're depressed, if they're isolating, then I would recommend for them therapies that get them up and moving. So yoga might be a good option or Qigong, even just going out for a walk or I've told people to get a dog before, because I felt like they needed something to make them get up and walk every morning.

If they're in the fight or flight mode, then I'm going to look at therapies that help calm their nervous system. So if someone's extremely anxious, then medication may be the best choice for that. But also things that'll help are things like massage and body work, somatic experiencing, EMDR. And what I try to do is put together a whole program to help them be able to move into a phase where they're able to have a normal nervous system response.

Scott Webb: This is so interesting. And if I'm hearing you correctly, you know, this really sounds very specific to the person, really tailored to an individual person, which sort of breaks with the norms for most of us, right? Because it does feel like in traditional medicine, it's kind of a one-size-fits-all. So maybe you can give us some examples of how integrative therapies are used there at Sierra Tucson and how you really tailor and focus these things on individual people?

Dr. Maureen Schwehr: One of the first people, this is a good example of kind of looking for the cause, I was working with a woman. She was middle-aged and she had developed depression. That was so severe that she was basically not getting out of bed, not interacting with anyone. So when I met with her, what I always do is I ask people, when this happened, you know, what happened? I ask for the story, cause that gives me clues as to where things are coming from. So what really had happened to her when I got the whole story was this. She was someone with trauma in her background, but she had done a pretty good job of finding lots of love and meaning in her life. She had a good family, a job she loved. So she was doing okay, but as she was getting older, she started to gain weight. So she went on one of those no-carb diets, which were very popular at the time. So she started to lose weight, which she loved, but then she started to not feel very good. Then, right around then, she went to her OB-GYN and told her she had a little bit of depression, some fatigue, and also her menstrual cycles were irregular. So the OB-GYN put her on birth control pills to be able to help her regulate her cycles. And then she went into a really deep depression. At that point, she went to her primary care doc who gave her an SSRI, and then she felt foggy and depressed and was not doing well.

So when I met with her, I'm looking at the causes and so my perspective was really this, what had happened with her was when she went on a no-carb diet, no-carb diets don't have B vitamins, because our B vitamins come primarily from whole grains or we as a society spray B vitamins on our white bread and pasta. So she was probably low in B vitamins and that was sort of where she started feeling fatigued. She would have been okay, but once she got on the birth control pills, most women as they get older are low in progesterone and birth control pills are mostly estrogen. So what happened is her mood sank because her progesterone was now so low that she developed a lot of depression.

SSRI is most likely did not help her because she didn't actually have enough B vitamins or nutrients on board to make serotonin, so the medication wasn't effective. What I did is I told her, "You need to eat whole grains. You need to have a more balanced diet." I took her off the birth control pills. I tested her. Her progesterone was indeed low. I gave her some bioidentical progesterone, a good B vitamin, and she came back. Actually, she felt great after a couple of weeks. So I think she was such a great example of explaining how you need to look for the cause of things. For her, it was all a very kind of biological approach that was needed.

If you don't mind, I'll give you an example of someone coming from a different direction. So we recently had a woman who came to treatment. She was an older woman and she'd been in a relationship that was really quite abusive. And she was very flat. And one of the psychiatrist I worked with came to me and then just said, "I just don't really know with this person if the cognitive decline is because there's like some sort of early dementia or is this depression," like he was really unsure where it was, "Because I feel like there's just something wrong." And he actually requested shiatsu, which is a Japanese form of body work that's really good at working on the meridians and the whole body. So we talked about it. We did do some cognitive testing. But before that even came back, I signed her up with one of our therapists, a shiatsu practitioner here. So she had one shiatsu. And this is unusual, but for her, it was what she needed. One shiatsu session with this very amazing practitioner we have who just is very present and loving, and it was like her old self came back. What was happening there is she had gone into that freeze mode because she had been unsafe for so long, that she sort of forgot what it felt like to feel safe. And her nervous system was stuck in this really freeze state. And one really loving treatment with someone who was present and who used the meridian system to help kind of wake up the body was able to bring back her true self again.

Scott Webb: It's really amazing. And it does sound to me a bit like trying to figure out how the dominoes fell, right? What was the first domino and how did they all fall and almost sort of reverse engineering, going back and saying, "Okay, let's try to get back to the root cause of all of this and start there," which is really amazing and obviously really beneficial for patients. Wondering how these therapies work in an outpatient setting?

Dr. Maureen Schwehr: One of the great things about having these therapies in inpatient residential, and I'm always encouraging people to go outside their comfort zone and try new things, is I tell people this is a great place for them to be able to experience new things, to see what works and see what seems to be effective for them. The great thing then is that all of these therapies are available in outpatient settings. We have a PHP program here and we are able to offer some of those services here. And when I'm meeting with someone wherever they're discharging to, I'm helping to set them up with networks or people in their communities, so they can continue to do that. So if someone got a lot of benefit from acupuncture, I'll help them find some acupuncturists in their area. If someone really benefited from equine therapy, then they might find an equine therapist. Or sometimes I'll even just recommend that they find a horse rescue place near their home that they can volunteer at because just being near horses is therapeutic for many people.

Scott Webb: As we're getting close to wrapping up here. I want you to talk specifically about trauma and mood and how the different therapeutic approaches might help those folks.

Dr. Maureen Schwehr: I think that what's wonderful about the last 10 or 15 years is that we're really starting to recognize trauma as an underlying cause for an awful lot of problems, both physical and emotional and mental. And integrative therapies are really such a great addition in the trauma field.

I read an article recently from a doctor talking about there's all this talk right now about Will Smith slapping, the slap he did at the awards. And it was all about looking at that from a trauma response perspective. Like, could this be a trauma response with what we know about his past? And what I loved about the article was it went on to talk about how so many of us have trauma responses. If we grow up in a home where we were expected to always get A's and we were sort of punished if we weren't able to accomplish that and it wasn't really what was naturally easy for us, that ends up being really traumatic and it can mess with our nervous system.

Therapies that I love are things that cross more than one of the kind of main parts of our body. So if you think of mind, body spirit, mind is the cognitive; brain, our logical brain; body is the whole house that we live in; and spirit is that sort of emotional brain. We know now from neuroscience that that's actually the limbic system. So therapies that cross more than one, so if someone is doing, for instance, somatoemotional dialoguing, so they're actually getting body work and the therapist is asking them to visualize allowing healing into a place, visualize allowing an area to relax, that's hitting on all those parts. The body is getting its needs met, the mind is looking at things differently and the emotional body is feeling cared for. Those are the kinds of therapies that can be really beneficial. So we know somatic experiencing, EMDR, hypnotherapy, craniosacral therapy, yoga, equine therapy, there's so many beautiful trauma therapies that are being developed. And what they often do is they meet the body's needs in a way that is sort of deeper and emotionally satisfying.

Scott Webb: You know, doctor, one of the things I've learned from hosting these for Sierra Tucson, you know, that mind, body, spirit is not just a marketing slogan. Everybody who comes on here really embraces that peace, mind, body, spirit. And it's so great to have you explain it this way. It actually really helps me to fully understand what those words mean in practical terms for actual patients. So I'm sure there are a lot of new and exciting developments in this area in your approach to care. So maybe you could just tell us about some of them.

Dr. Maureen Schwehr: One of the things that I have noticed has been happening lately that I'm so excited about is I have noticed that there seems to be a more open approach to including all of these kinds of therapies in so many new and different places. And I am so heartened to see that I was originally from Minnesota and I had been talking to some acupuncturists who work in a small town clinic, so their hospital and their clinic in a small town in Northern Minnesota actually has an acupuncturist on staff and a massage therapist on staff that's able to work with their patients. I've noticed that people are more open to seeing how useful this is. I've noticed that I'll be at a barbecue and there'll be some 78-year-old person there and they hear what I do and they'll say, "Oh, I just had craniosacral therapy. I thought that was so great."

I think one of the things that I'm most excited about is to see how all of these therapies are becoming more available and that they're being included in a lot more settings so that the world is starting opening up to having a broader way of looking at how we heal.

Scott Webb: Well, I love it. I feel like everybody should have one of you there, you know, a naturopathic doctor. I can really understand better now the benefits to patients coming at them from this holistic approach. As you talked about earlier, having this toolbox and having a bunch of tools in there, and I think all patients benefit from that, but especially at Sierra Tucson. So thank you so much for your time. You stay well.

Dr. Maureen Schwehr: Thank you very much.

Scott Webb: For more information, visit sierratucson.com or call 800-842-4487. Sierra Tucson, we work with most insurance.

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This is Let's Talk: Mind, Body, Spirit from Sierra Tucson. I'm Scott Webb. Stay well.