The placebo element in Bach flower therapy

A review of seven published studies (Ernst 2010) states that “the most reliable clinical trials do not show any differences between flower remedies and placebos”. The validity of these results could be questioned, because clinical trial design inevitably distorts the way the Bach system is used, for example by giving all subjects a standard mixture instead of letting them take part in selecting their own combination of remedies. But in any case, considering that the remedies do help a majority of the clients seen in real life practice, does it really matter if they are “just placebo”?

Maybe it is time to replace the term “placebo” because of its negative connotations. At worst, it conjures up an image of dishonest charlatans charging fat fees for giving sugar pills to neurotic women with imaginary ills. But research has shown that a placebo element is involved in every intervention, including orthodox medical and surgical treatments as well as complementary and alternative therapies, and for “real” diseases as well as functional symptoms. By stimulating the body’s own self-healing capacity, with no risk of side effects, the placebo effect can be a powerful force for good.

Bach flower treatment could mobilise the placebo effect in several ways:

  • Through deciding to explore a new therapy that is natural, gentle and pleasant to use, clients experience positive expectations and a sense of choice and control.
  • Talking in a relaxed setting with a practitioner who is empathic and non-judgmental is therapeutic.
  • Analysing specific negative emotions and attitudes according to the Bach system offers a new way of understanding problems.
  • Taking the remedies four times daily provides a reminder of the positive feelings they are designed to instill.

Image: White Chestnut, a remedy for worrying thoughts.

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Bach flower remedies and orthodox psychiatry: a comparison

After working as a psychiatrist in England, I became a Bach flower practitioner in New Zealand. The Bach flower remedies are a long-established complementary therapy intended to improve emotional balance. While not an adequate treatment for serious forms of mental illness, they can be used for the same sort of problems – anxiety and phobias, mild to moderate depression, responses to loss or stress, adjustment reactions, relationship difficulties – that often present in mental healthcare settings. Without a clinical trial, it would be impossible to say whether Bach flower therapy, orthodox psychiatric treatment or a combination of both works best. There are several points of contrast between the two approaches, as outlined below.

The style of interview: The traditional psychiatric interview and mental state examination involves asking patients a great many questions, covering not only the detail of their present complaints, but also their life history and social circumstances. This elicits a great deal of information, some of which may be highly relevant for future management, but some patients may find it intrusive or feel it does not allow them enough time to express their real concerns. A Bach consultation, in contrast, is more exclusively focused on current emotional state, and it is up to the clients to reveal as much or as little as they wish. Practitioners may ask for clarification, but do not probe too deeply – a key word is Simplicity. I believe this is more relaxing and therapeutic for those on the receiving end, however it may mean that important material – for example symptoms of a medical disorder, or suicidal ideation – is missed.

The diagnostic assessment: Psychiatrists assign their cases to a diagnostic category from the official classification systems, ICD or DSM. These categorisations are valuable in enabling research into the causes and treatments for different conditions. Bach practitioners, in contrast, make little or no use of diagnostic groups but aim to understand exactly what negative emotions the individual is currently experiencing; for example the same client might be feeling fear for no apparent reason, combined with regrets about the past and lack of confidence to apply for a new job.

Medication: A great advantage of Bach flower remedies over psychotropic drugs is their lack of side effects or interactions. They can also be more accurately tailored to the individual case, as up to six of the 38 flowers can be mixed together, giving rise to multiple possible combinations; suitable remedies for the fictional client described above would be Aspen, Honeysuckle and Larch. The key question is whether they work? Many authorities are sceptical, given that their mode of action is obscure and that most  published trials have shown no significant advantage over placebo. However most of the trials have not used the remedies correctly, having given all subjects the same mixture rather than individual prescriptions chosen at interview. The lack of scientific validation stands in contrast to the worldwide popularity of the therapy, still continuing 90 years since it was first developed by Dr Edward Bach. I have found that about 80% of clients respond well, a success rate comparable to that seen with psychotropic drugs. I have not been able to find any randomised trials comparing Bach flowers with antidepressants or anxiolytics, and would be pleased to hear of any that I have missed.

Relationship with patients/clients: While doctor-patient relationships are no longer so authoritarian as in the past, the doctor (or other orthodox clinician) is in charge, the patient has a passive role, and there are firm professional boundaries. With Bach flower treatment there is a more informal and egalitarian relationship, with clients being encouraged to take part in choosing the remedies they need. I have never found this familiarity abused, having had many friends as clients, and clients who have become friends. It is stated in the Bach Foundation code of practice that clients remain responsible for their own well-being, and I believe this self-responsibility contributes to the success of the treatment – though it would not be appropriate for cases of severe psychiatric illness, which should not be treated solely by Bach flowers in any case.

Psychological treatments: In mental health settings, a range of psychotherapeutic techniques may be used either alongside or instead of drugs. Formal psychotherapy is not part of Bach flower treatment, although all practitioners need basic counselling skills, and some are qualified to use other methods that can successfully be combined with the flowers – I have used my life coaching training in this way.

Professional support: Clinicians working in a public health service are obliged to interact with colleagues, fulfil requirements for audit and continuing education, and attend meetings. All this helps with maintaining standards and keeping up-to-date, though can divert time and energy from direct patient care. In contrast, Bach flower practitioners often work in isolation and are not strictly regulated. They have more time and energy for their clients, and are very unlikely to cause them direct harm, but there is some risk they may fail to recognise a serious mental or physical disorder that needs prompt medical assessment.

A few psychiatrists around the world already use Bach flowers in their practice, and there seems no reason why these remedies could not be more widely integrated with orthodox treatments.

 

 

Comparing Bach flowers and homeopathy

What is the relationship between Bach flower remedies and homeopathic ones? Both are “energy medicines”, prepared from natural substances in dilutions too small to measure by chemical analysis.  Their mode of action is not understood, so as far as I know it is not possible to say what basic difference – if any – exists between them. Dr Edward Bach had studied homeopathy before discovering his flower remedies, and the two modalities certainly have some features in common. There are also several points of contrast, as listed below. It will be clear from what follows that the Bach system is much simpler than the homeopathic one.

* Bach flowers are prescribed on the basis of current emotional state, whereas the choice of homeopathic remedies requires a more detailed consultation taking both physical and psychological factors, both past and present, into account.

* Homeopathic remedies for particular disorders are identified on the basis of “provings”, according to the principle of “like treats like”. For example, if taking a certain remedy causes healthy volunteers to develop itching, that remedy might be effective for treating an itchy skin complaint. The Bach flowers, in contrast, were identified in a purely intuitive way by Edward Bach, who would experience a certain feeling such as anxiety or despair and then seek for a plant which would alleviate it.  

* There are thousands of homeopathic remedies to choose from, but only 38 Bach flowers.

* Homeopathic remedies may be derived from animal, plant or mineral sources, some of which are toxic in their original form. The Bach flowers are all (with the exception of Rock Water) made from non-poisonous plants.

* With classical homeopathy, the aim is to identify the single remedy which best resonates with the client. With Bach flowers, although there are some “type remedies” appropriate for different personalities, it is usual practice to choose a combination of several remedies up to a maximum of six.

* Homeopathic remedies are prescribed in a range of potencies and dosage regimes, whereas Bach flowers are taken on a simple standard schedule (4 drops 4 times a day).

Some practitioners say both systems can be used together, because they act at different “levels”, others believe they should be kept separate.

I am not a trained homeopath myself but have made some informal study of the system, and both Bach flowers and homeopathic remedies play a part in the plots of my three short novels.

 

Bach flowers in bereavement

My dear cat Felix died last month. On the blog which I created in his memory there is a post about ways of coping with the loss of a pet, which includes a brief mention of the Bach flower remedies. The remedies are equally relevant to human bereavement, and I thought I would expand on the subject here.

The process of grief does not conform to a particular timescale or sequence of stages, but is different for each individual, depending on many factors: the circumstances of the death, the bereaved person’s attitudes and emotions, the quality of their relationship with the deceased, and whether they believe in an afterlife. There can be a complex and apparently conflicting mixture of feelings, for example sadness over the death might be combined with relief that the strain of a long illness is over, which in turn might be a source of self-reproach.

As always with Bach flower treatment, it is best to choose flowers according to the emotions which are uppermost at the present time, without trying to analyse them too deeply. But one flower which might almost always be suitable is Star of Bethlehem. In the words of Dr Bach:

For those in great distress under conditions which for a time produce great unhappiness. The shock of serious news, the loss of someone dear, the fright following an accident, and suchlike. For those who for a time refuse to be consoled, this remedy brings comfort.

Many other flowers might also be relevant. Here are some examples, which are listed alphabetically because they do not belong in any particular sequence.

Agrimony: when grief is denied or suppressed, perhaps with the aid of drugs or alcohol

Gorse: when everything seems hopeless

Holly: for negative feelings towards others

Honeysuckle: for holding on to memories from the past

Olive: for mental or physical exhaustion

Pine: for feelings of guilt or self-blame

Sweet Chestnut: for unbearable anguish and despair

Some of these remedies are also relevant in cases of “anticipatory grief” when a loved one has a terminal illness but has not yet died. Other flowers to consider in this situation could include Red Chestnut for anxiety on behalf of the sick person, and Mimulus for fear about how the survivor is going to cope with the death when it does occur. Lastly, there is Rescue Remedy for use in acute situations such as news of a sudden death.

Nothing can take away the pain of losing a beloved person or pet, but the Bach flowers are among the remedies which can bring some comfort, especially when grief seems unduly severe, complicated or prolonged.

 

Bach flower remedies for writers

The Bach flower remedies are intended for self-help at times of emotional imbalance or life stress. Although their mode of action is not understood, and sceptics claim that they are ‘only’ placebos, they have gained world-wide popularity since being discovered in the 1930s by a British doctor, Edward Bach. There are 38 individual flower essences in the system, five of which are included in the well-known Rescue Remedy for use in crisis.

Having trained as a Bach flower practitioner myself, and run a client practice for several years, I have been impressed with how well most people respond to this safe and pleasant form of therapy. I have written a number of posts about them on my other WordPress blog, and a short ebook on Smashwords. Fuller information can be found on the Bach Centre website.

Four (fictional) case vignettes illustrating how these remedies might be helpful for writers are presented below. These are of course just simplistic examples; each writer has a unique personality and circumstances and is subject to the same challenges in life as anyone else. Remedies should always be selected on an individual basis according to the person’s current state of mind.

‘Lyn’ is a housewife and mother and freelance journalist who works from home. She is very efficient, but has difficulty in finding time and space for writing amid the demands and distractions of domestic life. Walnut to help her focus on her work despite what is happening around her; Centaury to be able to say ‘no’ when family members make unreasonable requests; and Elm to relieve her sense of being overburdened with responsibility.

‘Peter’ is determined to publish an influential book about improving healthcare for disadvantaged groups. After getting home from his full-time job he spends several hours writing and gets to bed very late, but his mind is so active that he cannot get to sleep. He is also feeling despondent and frustrated after having early drafts rejected by several agents. Vervain to help him relax and to moderate his over-enthusiasm for good causes; White Chestnut to calm his repetitive thoughts; Impatiens to curb his hastiness in submitting manuscripts before they are finished; and Gentian for his disappointment.

‘Sandra’ dreams of becoming a famous author, and has lots of different ideas for novels, but has not actually done much writing and often feels tired and unmotivated when she sits down at her desk to make a start. Clematis for becoming more grounded and putting ideas into practice; Hornbeam for the ‘Monday morning feeling’.

‘Matt’ has spent ten years on his first novel, making continually revisions but never quite feeling satisfied that it is good enough. Besides having doubts about the quality of his writing, he feels anxious about having his work read by other people, and about various aspects of publication and marketing. Larch to boost his confidence in his abilities; Mimulus for his shyness and understandable fears; and Rock Water for his perfectionist nature.

I would be interested in comments from anyone who has used the Bach flower remedies to assist with their writing, or any other creative process.

 

 

 

 

Evaluating Bach flower remedies: an audit of 100 treatments

A few years ago I carried out a review of the case notes of the first 100 clients treated in my Bach flower practice. This does not claim to be a scientific study, and would certainly not meet the requirements for publication in an academic journal, due to various limitations: it was retrospective rather than prospective, no standard questionnaires or other valid measurements were used, no independent assessment was carried out, and there was only enough information for a short-term follow-up. All the same, when I came across it again last week I thought some of my readers might be interested in a summary.

These 100 clients, a consecutive series, had come to my clinic either through word-of-mouth recommendations or through my website. They included 83 females and 17 males, and ranged in age between 8 and 87 years.

Their presenting complaints were often complex and multiple, but the most frequent main problems were anxiety (37 cases), depression (13 cases), and physical illness (13 cases). Others included adjustment to change or loss, relationship difficulties or long-term psychological imbalances.

Treatment was usually short-term: 39 clients received only one treatment bottle, and 24 had only two. Others chose to continue taking remedies for several months, and there were four clients who came back for 10 or more bottles.

Six clients did not attend for further appointments, but the other 94 provided progress reports after 2-3 weeks, that is after their first treatment bottle had finished. I classified the outcomes at this stage as follows:

Excellent or very good: 33. Clients in this group spontaneously mentioned feeling calmer, lighter, more focused, more in control, balanced, joyful or peaceful soon after starting their remedies. Comments included ‘The flowers are fantastic’, ‘I need another of those magic bottles’ and ‘I think I’m going to keep taking this stuff for the rest of my life’.

Moderately good: 38. These clients reported definite, but more subtle, changes for the better.

Slight improvement: 18. This category includes three clients who did not actually take the remedies but had found the consultation useful for ventilating and reframing their problems.

No change: 3.

Some of those who showed little or no response to their first treatment bottle went on to take further courses and reported a delayed benefit, but the follow-up on this group is too incomplete to be analysed.

Worse: 2. These two clients were unwilling to continue treatment because of marked healing reactions, despite having been advised that such reactions were usually only short-lived and often predicted a good response. Both of them felt ‘spaced out’ after taking their drops, and one reported worsening of her presenting complaint of tightness in the throat. About ten of the others had also reported healing reactions, of a milder degree, but continued with their treatment.

Though the data was not detailed enough to permit a separate study of individual symptoms, I noted that both physical and emotional complaints often improved alongside each other in those clients who responded well.

The results of this modest audit confirms what all Bach Foundation Registered practitioners already know – that the majority of clients find the Bach flowers to be an effective and pleasant treatment. How much of this benefit can be ascribed to the ‘placebo effect’ is impossible to tell from a descriptive study like this.

And finally: a note to say that my short novel Carmen’s Roses, in which the Bach flowers play a small role, is now available in various ebook formats on Smashwords – price just $2.99 USD. Please click here for details.

 

 

 

 

Update on introducing Bach flowers to medical doctors

My last post on this blog was about preparing a short talk on the Bach flower remedies for a group of doctors and medical scientists. Several readers asked me to report back, so here is a brief update following the event.

My talk seemed to be well received by the  audience, which represented a wide range of specialties: neurosurgery, rheumatology, oncology, paediatrics, general practice and others. Most of those present had never heard of the remedies before. There were plenty of questions, for example: are the same plants used for similar purposes in herbalism and pharmacology? how exactly did Dr Bach select his flowers? would just looking at the flowers have an effect? At least one person thought that the mode of action must be chemical, but another was familiar with the concept of vibrational healing, pointing out that plants have an energy field as demonstrated by Kirlian photography.

It was encouraging to receive so many positive and open-minded responses, and I was left wishing that there were more opportunities for orthodox clinicians and natural therapists to learn about each others’ work.