A Literature Review on Holistic Well-Being and Dopamine Fasting: An Integrated Approach.

Popularly known as dopaminergic detox or dopamine fasting, it is a concept that aims at reducing dependence on instant satisfaction gratification and overstimulation to attain mental clarity, lessen anxiety, and be able to enjoy everyday events again. Digital detox has been a part of the dopamine fasting concept for several years now. However, some critics argue that this notion has no scientific proof behind it and may fail to deal with the problem of dopamine dysregulation. Some intense types of dopamine fasting which include extreme isolation or strict dieting can result in damage to mental health as well as physical fitness. The objective of the article is to understand what dopamine fasting means and see the literature and evidence available on the topic. Indexes like PubMed, Scopus, OVID, Embase, and Google Scholar were searched using the keywords to understand the existing knowledge about dopamine fasting. The literature review was then written to incorporate the understanding in a way that can be implemented practically. Recent studies have shown that individuals who engage in dopamine-fasting-like ideologies may experience reduced impulsive behaviors, increased focus on tasks, and reduced overwhelm. However, extreme forms of dopamine fasting can lead to feelings of loneliness, anxiety, and malnutrition, which can have detrimental effects on mental and physical health. Hence, the effects of dopamine fasting can vary greatly among individuals, and there is no one-size-fits-all approach. It is essential to consider individual needs and preferences when incorporating dopamine fasting into one's lifestyle and explore alternative practices that align with the principles of dopamine fasting. Understanding and respecting these differences is crucial in determining the most suitable strategies for maintaining a balanced dopamine response and overall psychological health. The benefits of dopamine fasting can be tremendous if done correctly but it depends on every individual to find the correct way and in the modern day, the practices can become tough to implement.

Enhancing Substance Use Disorder Recovery through Integrated Physical Activity and Behavioral Interventions: A Comprehensive Approach to Treatment and Prevention.

The global issue of substance abuse demands ongoing initiatives aligned with the United Nations Sustainable Development Goals. With drug use remaining prevalent worldwide, interventions are critical to addressing the associated health challenges and societal implications. Exercise and physical activities have emerged as integral components of substance use disorder (SUD) treatment, offering promising avenues for prevention, intervention, and recovery. Recent research underscores the efficacy of exercise in reducing substance cravings, promoting abstinence, and improving overall well-being. However, integrating exercise into SUD recovery programs presents challenges such as dropout rates and cultural considerations. This paper synthesizes existing literature on exercise integration into SUD recovery, highlighting strategies for enhancing treatment outcomes and addressing barriers to exercise adherence. Drawing on cognitive-behavioral therapy, experiential learning, motivational interviewing, and goal-setting techniques, the holistic approach outlined in this paper aims to empower individuals both mentally and physically, fostering resilience and supporting long-term recovery. In conclusion, new initiatives need to be taken by advocating for inclusive policies, promoting community engagement, and fostering collaborations across sectors. By doing so, stakeholders can optimize the effectiveness of exercise programs and contribute to sustainable rehabilitation efforts for individuals with SUD.

Focal dystonia in musicians, a literature review.

BACKGROUND: Musician's focal dystonia (mFD) is a rare, neurological, task-specific disorder that mainly affects the upper extremity (especially the hands) and generally appears as a painless muscular incoordination that can mark the end of a musician's professional career. The present literature review intends to highlight the current understanding of musician's focal dystonia, its underlying neural mechanisms and the role of prevention and treatment in physiotherapy, psychotherapy and other fields as occupational therapy. PURPOSE: The aim of the present literature review was to gain an overview of mFD in the medical, psychological and physical therapy literature and investigate what strategies for diagnosis and rehabilitation are available today. STUDY DESIGN: The present article is a literature review, based on the search for full-text publications with the goal of comparing the main strategies for mFD rehabilitation and prevention presented in the literature. METHODS: This literature review compared many relevant papers and studies available in literature today for mFD epidemiology, neural mechanisms, treatment and prevention, to discuss what we know today and highlight the aspects that can still be enhanced in the future. RESULTS: According to our results, current literature gives a good understanding of mFD epidemiology, but further studies are needed to fully comprehend the neurological aspects and develop more rehabilitation strategies, especially in the psychological field. Our research also highlighted the need for a multidisciplinary approach that considers both physical and psychological aspects. CONCLUSIONS: Physical rehabilitation strategies are helpful but, considering the amount of psychological aspects involved in mFD, a holistic approach should be considered and developed in the future. Finally, prevention must have a primary role in mFD treatment, raising awareness around it and, possibly, avoiding its development.

Weight Loss Programs: Why Do They Fail? A Multidimensional Approach for Obesity Management.

PURPOSE OF REVIEW: Despite the prevalence of weight loss programs, their success rates remain discouraging, with around half of individuals regaining lost weight within two years. The primary objective of this review is to explore the factors contributing to the failure of weight loss programs and to provide insights into effective weight management strategies. RECENT FINDINGS: Factors contributing to the failure of weight loss programs include the impracticality of restrictive diets, potential metabolic impacts, limited focus on lifestyle changes, genetic predispositions, psychological influences, socioeconomic status, and medical conditions. A holistic approach considering these factors is crucial for safe and sustainable weight loss. Key findings indicate the importance of holistic approaches to weight management, including lifestyle modifications, medical interventions, and behavioral and psychological strategies. Effective weight loss strategies emphasize low-calorie, nutrient-rich diets, regular physical activity, and interventions tailored to individual needs. Combining multiple approaches offers the best chance of successful weight management and improved health outcomes. This review provides insights into the complexities of obesity management and the factors contributing to the failure of weight loss programs. It highlights the necessity of adopting a holistic approach that addresses dietary habits, physical activity, genetic factors, psychological well-being, and socioeconomic influences. Recommendations include implementing lifestyle modifications, medical interventions when necessary, and integrating behavioral and psychological support to achieve sustainable weight loss and mitigate the global health challenge posed by obesity.

Stress Factors for the Paediatric and Adult Palliative Care Multidisciplinary Team and Workplace Wellbeing Solutions.

BACKGROUND: Palliative care is a challenging specialty, especially when it comes to caring for children with serious life-limiting conditions and supporting their families. Workers face significant challenges and experience major impacts on their wellbeing. We conducted a qualitative study to understand the sources of stress in the palliative care team, their work expectations, and how they can cope with the demands. METHODS: We used an online questionnaire about the causes of stress, the impact of the COVID-19 pandemic and the ways in which support is needed in the workplace. RESULTS: Of the 56 palliative care professionals who participated in the survey, 57.1% considered the main causes of stress to be high workload, difficult emotional burdens (55.4%) affecting their outlook on life (61.2%), the death of patients (46.4%), and communication with patients' families (26.8%). The COVID-19 pandemic increased stress levels for the majority of respondents (89.3%). The need for specialised training (53.6%), support groups, psychological counselling and adapted organisational policies was highlighted. CONCLUSIONS: The study demonstrates the importance of understanding the needs of both paediatric and adult palliative care staff in order to provide optimal care and support their balance in this demanding area of the healthcare system.

What frailty can tell us about ageing well: towards an alternative paradigm to 'successful ageing'.

This paper considers the concept of successful ageing by means of a dialogue with the concept of frailty. This dialogue reveals the limits and blindspots of both concepts as well as their apparent dichotomy and the importance of understanding both the objective and subjective experience of ageing. In particular, the dialogue highlights that both frailty and successful ageing are social constructs that derive their meaning from what society values (autonomy, youthful capacities). They cannot by themselves account for the fact that flourishing and frailty are often found together whilst conversely successful ageing may not bring satisfaction. I argue that the arts and humanities supply us with conceptual and methodological tools with which to revisit what it is to age well offering a holistic approach that combines sensitivity both to older people's lived experience and to the underpinning material conditions and embodied realities. For this purpose, and building on previous scholarship in cultural gerontology, I suggest the unique value of concepts and frameworks associated by Simone de Beauvoir. When brought into alignment with the tenets of cultural and narrative gerontology, these concepts facilitate a rich understanding of the nuances and paradoxes of flourishing in deep old age which can also aid in restorying both old age and the life course more generally. I illustrate this through two examples: a feminist self-help guide to ageing, which accepts both limitations and growth and a film that imagines the possibilities of authentic ageing even despite a context of poverty, patriarchy and Alzheimer's Disease.

Exploring the transformative impact of traditional Chinese medicine on depression: Insights from animal models.

Depression, a prevalent and complex mental health condition, presents a significant global health burden. Depression is one of the most frequent mental disorders; deaths from it account for 14.3% of people worldwide. In recent years, the integration of complementary and alternative medicine, including traditional Chinese medicine (TCM), has gained attention as a potential avenue for addressing depression. This comprehensive review critically assesses the efficacy of TCM interventions in alleviating depressive symptoms. An in-depth look at different research studies, clinical trials, and meta-analyses is used in this review to look into how TCM practices like herbal formulations, acupuncture, and mind-body practices work. The review looks at the quality of the evidence, the rigor of the methods, and any possible flaws in the current studies. This gives us an idea of where TCM stands right now in terms of treating depression. This comprehensive review aims to assess the efficacy of TCM interventions in alleviating depressive symptoms. In order to learn more about their possible healing effects, the study also looks into how different types of TCM work, such as herbal formulas, acupuncture, and mind-body practices.

Designing combinational herbal drugs based on target space analysis.

BACKGROUND: Traditional oriental medicines (TOMs) are a medical practice that follows different philosophies to pharmaceutical drugs and they have been in use for many years in different parts of the world. In this study, by integrating TOM formula and pharmaceutical drugs, we performed target space analysis between TOM formula target space and small-molecule drug target space. To do so, we manually curated 46 TOM formulas that are known to treat Anxiety, Diabetes mellitus, Epilepsy, Hypertension, Obesity, and Schizophrenia. Then, we employed Absorption, Distribution, Metabolism, Excretion, and Toxicity (ADMET) properties such as human ether-a-go-go related gene (hERG) inhibition, Carcinogenicity, and AMES toxicity to filter out potentially toxic herbal ingredients. The target space analysis was performed between TOM formula and small-molecule drugs: (i) both are known to treat the same disease, and (ii) each known to treat different diseases. Statistical significance of the overlapped target space between the TOM formula and small-molecule drugs was measured using support value. Support value distribution from randomly selected target space was calculated to validate the result. Furthermore, the Si-Wu-Tang (SWT) formula and published literature were also used to evaluate our results. RESULT: This study tried to provide scientific evidence about the effectiveness of the TOM formula to treat the main indication with side effects that could come from the use of small-molecule drugs. The target space analysis between TOM formula and small-molecule drugs in which both are known to treat the same disease shows that many targets overlapped between the two medications with a support value of 0.84 and weighted average support of 0.72 for a TOM formula known to treat Epilepsy. Furthermore, support value distribution from randomly selected target spaces in this analysis showed that the number of overlapped targets is much higher between TOM formula and small-molecule drugs that are known to treat the same disease than in randomly selected target spaces. Moreover, scientific literature was also used to evaluate the medicinal efficacy of individual herbs. CONCLUSION: This study provides an evidence to the effectiveness of a TOM formula to treat the main indication as well as side effects associated with the use of pharmaceutical drugs, as demonstrated through target space analysis.

Understanding Alcohol Relapse in Liver Transplant Patients With Alcohol-Related Liver Disease: A Comprehensive Review.

Alcohol-related liver disease (ALD) presents a significant global health concern, with liver transplantation being a crucial intervention for patients in the advanced stages of the disease. However, the persistent risk of alcohol relapse in transplant recipients with ALD remains a formidable challenge. This comprehensive review explores the multifaceted nature of alcohol relapse, from its underlying factors to strategies for prevention. It highlights the importance of rigorous pre-transplant assessments, effective post-transplant interventions, and the role of multidisciplinary care teams in mitigating the risk of relapse. Furthermore, the review underscores the significance of adopting a holistic approach to ALD and transplantation, acknowledging the interconnectedness of medical, psychosocial, and psychological factors. With this holistic approach, we aim to enhance patient outcomes, reduce relapse rates, and ultimately improve the overall quality of life for individuals affected by ALD.

Enhancing End-of-Life Care Through Yoga.

This editorial explores the integration of yoga into end-of-life care, emphasizing its potential to enhance the quality of life, comfort, and dignity of patients. Rooted in over 5,000 years of history, yoga's holistic approach, encompassing physical, mental, and spiritual practices, aligns seamlessly with the goals of end-of-life care. We discuss the benefits of incorporating yoga's diverse practices, such as physical postures, breathing exercises, and meditation, particularly in palliative care settings. These practices offer significant improvements in physical health, psychological well-being, and spiritual fulfillment, especially pertinent for older adults and patients with serious illnesses like HIV and cancer. The philosophical underpinnings of yoga, emphasizing acceptance, harmony, and peace, provide a framework for a dignified and peaceful transition, resonating deeply with the concept of a 'good death'. However, challenges exist in integrating yoga into end-of-life care, including limited research, cultural and religious considerations, physical and emotional limitations of patients, and logistical constraints within healthcare settings. Ethical considerations are also paramount, focusing on patient-centered approaches, respect for individual beliefs, informed consent, and patient autonomy. The editorial concludes by underscoring the need for further research to evaluate the long-term effects of yoga in end-of-life care and to establish comprehensive ethical guidelines. The integration of yoga offers a multifaceted approach to address not only physical discomfort but also provide emotional and spiritual solace for terminally ill patients, thereby enhancing the overall quality of end-of-life care.

An ayurvedic evaluation & treatment of multiple myeloma: A case report.

This case report discusses the management of multiple myeloma in a 59-year-old male patient through an integrative approach of Ayurvedic and conventional medical care. The patient presented with symptoms of pain in ribs, fatigue, nausea, weight loss, and mental stress. After undergoing chemotherapy and steroid therapy, the patient opted for Ayurvedic treatment instead of a recommended bone marrow transplant. Ayurvedic examination revealed imbalances in Vata and Pitta doshas, affecting various body tissues and mental state. The Ayurvedic regimen led to the recovery of the patient without adverse effects. This case highlights the role of Ayurvedic medication in managing multiple myeloma, warranting further research and clinical trials for broader validation.

Psychometric properties of the client-centred rehabilitation questionnaire-is derived from a large and varied group of rehabilitation users.

PURPOSE: The purpose of this study was to inspect and establish the factor structure of the Icelandic Client-Centred Rehabilitation Questionnaire [CCRQ-is] and investigate the service experiences of a large and varied sample of rehabilitation users. MATERIALS AND METHODS: Altogether 499 rehabilitation users completed the questionnaire. Confirmatory and exploratory factor analysis was conducted for analysis of items. Mann-Whitney's U and Kruskal-Wallis test was used to compare subscale responses based on participants' characteristics. RESULTS: Four factors explained 53,2% of the variance: Respect and attentiveness, Interaction with significant others, Responsiveness to needs and preferences and Education and enablement. Subscales showed internal consistency from 0.72-0.91 and 0.92 for the whole instrument. The subscale Respect and attentiveness represented user centred rehabilitation the most and Interaction with significant others the least. Significant differences in relation to health conditions and age were obtained on all four subscales and differences by gender on one subscale. CONCLUSIONS: Our results suggest the CCRQ-is is a reliable tool that can be used with rehabilitation users with a broad range of characteristics within the Icelandic context. The extent to which the intersection of age, gender and health issues influence users' perception of services needs to be further scrutinized.

Increasingly users of rehabilitation have complex and composite health issues as physical and mental health conditions commonly co-exist.The four subscale Client-Centred Rehabilitation Questionnaire [CCRQ-is] demonstrated strong reliability for assessing the client-centredness of rehabilitation services for people with different health issues in Iceland.People receiving rehabilitation for mental health reasons seem to find the service to be less client-centred than other rehabilitation service users.The lowest scores on the CCRQ-is were consistently found on the dimension Interaction with significant others.The key role often played by families during and after the rehabilitation process should be recognized.

Flemish equine veterinarians' perceptions on the use of and client communication about complementary and alternative veterinary medicine.

BACKGROUND: Complementary and alternative veterinary medicine (CAVM) is increasingly popular in horses. As CAVM usage could have risks, client-veterinarian communication about CAVM is crucial. OBJECTIVES: Evaluating equine veterinarians' attitude towards CAVM, their CAVM usage and veterinarian-client communication about CAVM. STUDY DESIGN: Cross-sectional study. METHOD: A telephone survey was conducted among equine veterinarians providing ambulatory care on a daily or weekly basis. The first section of the survey included questions about the veterinarians' attitude towards CAVM and their CAVM usage. The second section focused on veterinary-client communication about CAVM. RESULTS: When herbs are included as CAVM modality, 83% of the participants applied CAVM. Nighty-eight percent had already communicated with horse owners about CAVM and 81% agreed to be open to talk about CAVM. However, 95% agreed that sometimes CAVM usage takes place without disclosure to the veterinarian. The majority of participants communicated about CAVM on a weekly (40%) or daily (22%) basis, most often in person during consultations (99%) or via phone (32%). The median percentage of conversations about CAVM initiated by the owner was 50% (range 50%-80%). When the veterinarian initiated the conversation, this was usually by mentioning it as a treatment option, mostly in addition to conventional treatments. Some participants directly asked about CAVM use in the information-gathering phase. MAIN LIMITATIONS: A convenience sample was used due to lack of data on the number of equine veterinarians in Flanders. Potential favourability bias with higher participation of veterinarians interested in CAVM. CONCLUSION: Equine veterinarians generally had a positive attitude towards CAVM use, although this depended on the specific modality. Veterinarian-client communication about CAVM occurs frequently in ambulatory care. An open dialogue with horse owners about CAVM is important to provide information about CAVM and thus enable them to make informed decisions concerning CAVM usage, together with their veterinarian.

INTRODUCTION/CONTEXTE: La médecine complémentaire et alternative (CAVM) est de plus en plus populaire chez les équins. Comme l'utilisation de la CAVM peut entrainer des risques, la communication entre le vétérinaire et le client à propros de la CAVM est cruciale. OBJECTIFS: Évaluer l'attitude des vétérinaires équins par rapport à la CAVM, leur utilisation de la CAVM et leur communication aux clients en lien avec la CAVM. TYPE D'ÉTUDE: Étude transversale. MÉTHODES: Un sondage téléphonique des vétérinaires équins fournissant un service ambulatoire journalier ou hebdomadaire a été fait. La première partie du sondage incluait l'attitude des vétérinaires vis­à­vis la CAVM et leur usage de la CAVM. La seconde partie se concentrait sur la communication vétérinaire­client à propos de la CAVM. RÉSULTATS: Lorsque les herbes étaient incluses en tant que modalités de la CAVM, 83% des participants appliquaient la CAVM. Quatre­vingt­dix­huit pourcents avaient déjà parlé de la CAVM avec des propriétaires de chevaux et 81% étaient ouvert à l'idée d'en parler à leur client. Par contre, 95% étaient d'accord pour dire que la CAVM est parfois utilisée sans le mentionner au client. La majorité des participants parlaient de la CAVM sur une base hebdomadaire (40%) ou journalière (22%), le plus souvent durant les rendez­vous (99%) ou par téléphone (32%). Le pourcentage médian de conversations initiées par les propriétaires, à propos de la CAVM était de 50% (étendu 50­80%). Lorsque le vétérinaire initiait la conversation à ce sujet, c'était le plus souvent en mentionnant la CAVM comme option de traitement, plus particulièrement comme étant un ajout aux traitements conventionnels. Certains participants ont demandé de l'information directement à propos de la CAVM durant la phase de récolte de l'information. LIMITES PRINCIPALES: Un échantillon de convenance a été utilisé en raison du manque de données par rapport au nombre de vétérinaires équins dans les Flandres. Biais favorable possible en cas de participation plus élevée des vétérinaires intéressés par la CAVM. CONCLUSIONS: Les vétérinaires équins ont généralement une attitude positive par rapport à la CAVM, parfois dépendant spécifiquement de la modalité de traitement. Les communications vétérinaire­client à propos de la CAVM se produisent très fréquemment en pratique ambulatoire. Un discours ouvert avec les propriétaires de chevaux à propos de la CAVM est important afin de fournir de l'information sur la CAVM et de ce fait, leur permettre de faire une décision éclairée en ce qui à trait à l'utilisation de la CAVM, en accord avec leur vétérinaire.

Industry perspective on a holistic container closure integrity approach to parenteral combination products.

Biologics are being developed more and more as parenteral combination products with drug delivery devices. The maintenance of sterility is imperative for such medical devices throughout their life cycle. Therefore, the container closure integrity (CCI) should, preferably, be built into the overall process, and not just demonstrated during the final testing of the combination product. The integrity is an important Critical Quality Attribute (CQA) and in the scope of specific considerations and studies during the combination product life cycle i.e., design robustness, assembly processes, storage (to end of shelf life), and shipping prior to patient use. The goal of this paper is to summarize an industry holistic approach to ensure CCI, for a combination product, and to build a scientifically based justification that Quality (in terms of CCI) is built into the overall process. Current analytical approaches used for characterization or Good Manufacturing Practice (GMP) CCI testing during combination product development will be described. However, the use of quality by design (QbD) during product development can reduce or eliminate routine batch level or stability testing of the combination product.

A Comprehensive Review of Modifiable Cardiovascular Risk Factors and Genetic Influences in Dementia Prevention.

Dementia poses a growing global health challenge, demanding a multifaceted approach to prevention. This comprehensive review delves into the interplay between modifiable cardiovascular risk factors and genetic influences in dementia prevention. We examine key risk factors, including hypertension, diabetes, hyperlipidemia, obesity, smoking, and physical inactivity, elucidating their impact on dementia risk and the underlying biological mechanisms. Genetic factors, notably familial Alzheimer's disease (FAD) and the apolipoprotein E (APOE) gene, are explored in detail, offering insights into their contributions to dementia susceptibility. Importantly, we highlight the complex interrelationship between genetics and modifiable risk factors, emphasizing the need for personalized prevention strategies. Integrating lifestyle modifications and genetic considerations, a holistic approach is paramount in dementia prevention. Implications for public health initiatives and clinical practices underscore the urgency of tailored interventions. Our call to action urges continued research, precision medicine implementation, and collaborative efforts to mitigate the burden of dementia and enhance cognitive well-being globally.

Environmental neurology: Concepts and short history of an interdisciplinary approach to etiology, treatment and prevention.

Environmental Neurology (EN), a sub-discipline of Neurology and Neurological Sciences, favors an interdisciplinary collaboration allowing a holistic approach to understanding the impact of environmental factors on the nervous system and their relationship with neurological diseases. Several examples of diseases and conditions show the large scope of subjects addressed by EN. The EN sub-discipline focuses on both individual and population issues thus joining patient care and public health, respectively. Neuropathogenesis is addressed by several major questions: How do the environment and nervous system interact? Which exogenous factors can trigger neurological disease? When, where and how do they act? What are the therapeutic implications, and how can these disorders be controlled or prevented. To answer such questions, we address the incentive for, philosophy of and methods developed by EN, which seeks to safeguard Brain Health and, thus, the quality of life.

Task Oriented Training For Stroke Rehabilitation: A Mini Review.

Stroke is the leading global cause of death and disability and the need for stroke rehabilitation services in increasing. The usual stroke rehabilitation protocol involves a combination of therapeutic exercises, occupational therapy, speech therapy and counselling sessions depending upon the severity of the deficit and associated co-morbidities. However, there is a need for better protocols and new therapies for improving outcomes after stroke rehabilitation. The term 'task-oriented training' (TOT) refers to guided rehabilitation training of patients' limb function using goal oriented tasks, which can be used to enhance neuroplasticity in brain after injury. Task oriented training could be modified with action selection and environmental enrichment to fulfill the limitations of stroke like, holistic approach, outcome/goal based intervention, proper dosage for desirable outcomes. This mini review provides an overview of the TOT and to identify gaps and challenges in stroke rehabilitation related to integrating TOT.

A holistic approach in epidemics.

This paper explores the concept of a holistic approach in preventing and responding to epidemics. Epidemics are defined as the occurrence of an illness or health-related event exceeding normal expectations within a specific community or region. Holism emphasizes viewing systems as a whole rather than a collection of parts. In the context of epidemics, a holistic approach considers not only medical interventions but also social, economic, psychological and environmental factors that influence disease transmission and management. The impact of climate change on epidemic response, the understanding of the significance of animal health and agriculture, the consideration of art, culture and societal factors, the exploration of the use of technology and innovation, the addressing of limitations in resources and the provision of enhanced support for the mental and emotional well-being of individuals and affected communities, are parts of this holistic approach. By integrating them, innovative practices as well as cross-sectoral and interdisciplinary techniques can be employed. Such an approach has the potential to enhance epidemic prevention and response strategies, ultimately contributing to positive public health outcomes.

Medication-free mental health treatment: a focus group study of milieu therapeutic settings.

BACKGROUND: Medication-free treatment within mental health care aims to offer therapeutic support as an alternative to psychotropic medication. Introducing milieu therapy for severely mentally ill persons in a medication-free unit requires significant changes to the traditional medication-based psychiatric setting. The present study examines how milieu therapists experience working with medication-free treatment for people with severe mental health challenges. The research question was "What may be required to succeed with medication-free treatment in milieu therapeutic settings?" METHODS: A qualitative study with four focus groups were conducted with 23 milieu therapists from three inpatient units in two mental health institutions. Thematic analysis was performed. RESULTS: One main theme was identified: medication-free treatment involves therapists and patients working together on holistic and personal health promotion. This common thread links the four themes: helping patients to make changes in their life; having time to focus on the individual patient; being a professional companion; and working together as a team with the patient. CONCLUSIONS: A holistic approach is necessary for medication-free treatment to succeed. This requires working together in multidisciplinary teams with a focus on the individual patient. Milieu therapists must engage and take more responsibility in the patient's process of health promotion. A change from a medical to a humanistic paradigm within mental health care is needed.