Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided.

OBJECTIVE Early school-based interventions provide the opportunity to attack stigmatizing attitudes before they are firmly entrenched, in a ubiquitous institutional setting, and thus may provide optimal conditions for reducing mental illness stigma in the overall population. This study evaluates the effectiveness of classroom-based interventions in reducing stigma and increasing understanding of mental illness and positive attitudes toward treatment-seeking among sixth-grade students. METHODS The ethnically/racially diverse sample (n=721) was 40% Latino, 26% white, and 24% African American; mean age was 11.5. In a fully-crossed design, classrooms from a school district in Texas were randomly assigned to receive all three, two, one, or none of the following interventions: a power-point- and discussion-based curriculum; contact with two college students who described their experiences with mental illness; and exposure to anti-stigma printed materials. Standard and vignette-based quantitative measures of mental health knowledge and attitudes, social distance, and help-seeking attitudes were assessed pre- and post-intervention. RESULTS Printed materials had no significant effects on outcomes and were grouped with the control condition for analysis. For eight of 13 outcomes, the curriculum-only group report significantly more positive outcomes than the control group; the largest between-group differences were seen for stigma awareness and action, recognition of mental illness in the vignettes, and positive orientation to treatment. The contact-alone group report significantly more positive outcomes on three vignette-based measures. CONCLUSIONS Results were most promising for a classroom-based curriculum, which can be relatively easily disseminated to and delivered by teachers, offering the potential for broad application in the population.

OBJECTIVES:To determine the effectiveness of a school-based curriculum, Eliminating the Stigma of Differences (ESD), in improving attitudinal and/or behavioral contexts regarding mental illness in schools and increasing the likelihood that youth seek treatment for mental health problems when needed.METHODS: We conducted a cluster randomized trial in sixth-grade classes from 14 schools in 2011 and 2012 with follow-up at 6-month intervals through 24 months (2012)(2013)(2014)(2015). Using a fully crossed 2 3 2 3 2 factorial design, we compared ESD to a no-intervention control and to 2 comparator interventions: (1) contact with 2 young adults with a history of mental illness and (2) exposure to antistigma printed materials. We implemented interventions in classrooms in an ethnically and socioeconomically diverse school district. There were 416 youth who participated in the follow-up, and 312 (75%) of these participated for the full 2 years. Outcome measures were knowledge and positive attitudes, social distance from peers with mental illness, and mental health treatment seeking.RESULTS: Youth assigned to ESD reported greater knowledge and positive attitudes and reduced social distance (Cohen's d = 0.35 and 0.16, respectively) than youth in the comparator interventions and no-intervention groups across the 2-year follow-up. Youth with high levels of mental health symptoms were more likely (odds ratio = 3.51; confidence interval = 1.08-11.31) to seek treatment during follow-up if assigned to ESD than if they were assigned to comparator interventions or no intervention.CONCLUSIONS: ESD shows potential for improving the social climate related to mental illnesses in schools and increasing treatment seeking when needed. ESD and interventions like it show promise as part of a public mental health response to youth with mental health needs in schools.WHAT'S KNOWN ON THIS SUBJECT: Attitudes toward mental illness develop early in life; youth with mental health problems encounter bullying, and only small proportions of those with mental health problems receive treatment. Limited evidence suggests that short-term improvements in preadolescents' knowledge and attitudes are possible.WHAT THIS STUDY ADDS: A cluster randomized, school-based intervention implemented in a multiethnic community sample shows that an antistigma curriculum intervention improves knowledge and attitudes, reduces exclusionary tendencies, and leads youth with mental health problems to seek treatment in a 2-year longitudinal follow-up study.

Differences in mental illness (MI) stigma among adolescents were examined cross-sectionally across race, ethnicity, and gender to identify target populations and cultural considerations for future antistigma efforts. An ethnically and socioeconomically diverse sample of sixth graders (N ϭ 667; mean age ϭ 11.5) self-completed assessments of their MI-related knowledge, positive attitudes, and behaviors toward peers with MI and adolescent vignettes described as experiencing bipolar (Julia) and social anxiety (David) symptoms. Self-reported race, ethnicity, and gender were combined to generate 6 intersectional composite variables: Latino boys, Latina girls, non-Latina/o (NL) Black boys, NL-Black girls, NL-White boys, and NL-White girls-referent. Linear regression models adjusting for personal and family factors examined differences in stigma using separate and composite race, ethnicity, and gender variables. In main effects models, boys and Latina/o adolescents reported greater stigma for some outcomes than girls and NL-White adolescents, respectively. However, intersectional analyses revealed unique patterns. NL-Black boys reported less knowledge/positive attitudes than NL-Black and White girls. NL-Black and Latino boys reported greater avoidance/discomfort than NL-White girls. Moreover, NL-Black girls and boys and Latina/o girls and boys wanted more social separation from peers with mental illness than NL-White girls; NL-Black boys also reported more separation than NL-White boys, NL-Black girls, and Latina girls. Finally, NL-Black boys and Latina girls wanted more distance from David than NL-White and Black girls. Vital for informing future antistigma interventions, this study generates new knowledge about how differences in views about MI exist across racial and ethnic identity, and how gender intersects with these perceptions.

Rationale: Parents are one of several key gatekeepers to mental health (MH) services for adolescents with MH problems. Parental MH stigma is a significant barrier to treatment, yet little is known about how stigma may bias parental recognition of mental illness in youth. Objective: This study examines how stigma influences a critical and early stage of the help-seeking process—the recognition of MH problems in preadolescents by their parents. Method: Parents from a school-based anti-stigma intervention study were analyzed. Logistic regressions examined the association of stigma with parental recognition of MH problems in their preadolescent child (10–12 years old) and that of two preadolescent vignette characters described as having bipolar disorder and social anxiety disorder. Results: The more parents desired their preadolescent child to avoid interaction with individuals with a mental illness—that is, to be more socially distant—the less likely these parents believed their child had a MH problem, controlling for parent-reported MH symptoms and other covariates. This pattern was prominent among parents who reported high symptoms in their child. Social distance had no bearing on whether parents recognized the vignette characters as having a problem. Avoidance of individuals with a mental illness and knowledge/positive MH attitudes were not associated with problem recognition. Conclusion: Stigmatizing attitudes of parents may be detrimental when trying to understand the psychopathology of their own preadolescent children but not preadolescents outside their family. Stigma may present itself as a barrier to problem recognition because it may impose a significant personal cost on the family, thereby affecting the help-seeking process earlier than considered by previous work.