Can Acupuncture help my Anxiety?

Mental health disorders affect almost 50% of the adult population at some point in their lifetime at a cost of approximately $220 billion annually worldwide, $10.6 billion nationally. (Australian Bureau of Statistics, 2018 Australian Institute of Health and Welfare [AIHW], 2020). In Australia, the National Survey of Mental Health and Wellbeing (Australian Government, 2009) states that 20% of the adult population currently suffer from a mental health disorder of which 14% is related to an anxiety disorder, this equates to 1 in 7 people (AIHW, 2021). 

Anxiety disorders include, general anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, and post-traumatic stress disorder (PTSD) (Australian Government, 2021). The manifestations of anxiety disorders are generally long term and chronic in nature with anxiety being defined as a continuous feeling of dread, fear, and imminent tragedy, or tension and uneasiness. 

Currently the clinical guidelines for the treatment of anxiety specify include prescribing routine  antidepressants or anxiolytic and cognitive behavioural therapy (CBT). However, may people find this treatment ineffective and costly hence, people are looking for alternative and effective treatments such as Acupuncture and herbal medicine.

The diagnosis of anxiety in Traditional Chinese Medicine (TCM) depends on detailed diagnostic measures and evaluation of presenting signs and symptoms, the assessment of which determines an individualised treatment protocol for the patient (Pilkington, 2010).

In TCM Anxiety is a manifestation of disturbance of the Heart Spirit/Shen and is associated with the Heart and Kidney. However, each of the major (Zang) organs can be involved and anxiety can manifest as a result of excess, deficiency, or stagnation. Typically, excess syndromes are associated with stagnant Liver Qi or hyperactive Liver yang creating Heart fire, Liver fire or Stomach fire. A combination of Spleen deficiency causing phlegm and stagnation can lead to Heart phlegm fire disturbing the Shen. A deficiency of Yin, Blood and Qi of either the Heart and or the Kidney are the deficient manifestations of anxiety (Ross, J. 1995). Essentially what this means it that our heart doesn’t have enough nourishment and cannot “house” our spirit any longer and it “floats” and gets disturbed. Its like when you (your Spirit) don’t feel safe somewhere you want to run and leave. When you are grounded and feel safe, your Spirit is content.

Figure 1. Aetiology of Anxiety and Insomnia (Fig.34.3 Ross, J. 1995).

Acupuncture, including auricular acupuncture is one of the TCM modalities used for treatment of symptoms associated with anxiety. Current evidence suggests that body Acupuncture and Auricular Acupuncture is an effective clinical treatment, however, Black et al., (2011), states that evidence of efficacy is still controversial.

Research on acupuncture and auricular acupuncture for anxiety has been growing, however most of the research is focusing on chronic anxiety such as GAD and PTS.

Mental health is of utmost concern at the moment and Acupuncture may offer sufferers of anxiety a safe and effective, evidence based treatment to reduce anxiety and help lessen the burden of stress. Worldwide people are suffering the impact of the covid pandemic and many are experiencing heightened anxiety, distress and depression which are having devastating effects on their lives. Bäuerele et als 2020, cross sectional study surveyed 15,704 German residents aged over 18 found that there was a 65.2% prevalence in psychological distress, 44.9% prevalence of anxiety, 14.3% prevalence in depression and a 59% prevalence in Covid related fear amongst the participants. Extended lockdowns have also been linked with increased levels of stress, anxiety and depression (Shah et al 2021).

To assess the effects of acupuncture on treating anxiety, Goyata et al 2014 systematic review of studies between 2001 and 2014, concluded that acupuncture was a statistically significant treatment for anxiety as compared to conventional medical drug treatment. Their review classified studies according to strength of evidence and found 57.9% of the studies showed strong evidence in support of acupuncture. It was concluded that acupuncture was deemed to be an effective treatment for anxiety and can reduce the need for medication.  

A systematic review by Amorim et al in 2018, on the safety and effectiveness of acupuncture and electroacupuncture treatment for people with anxiety disorders, reviewed clinical trials published between 2007 and 2017. The researchers concluded that the evidence showed acupuncture lowered anxiety in study participants however, they also found a high degree of variability in the design and methodology of the trials. Amorim et al suggested given the growing interest and understanding of the mechanisms of acupuncture and overall positive findings, the main problem with the quality of evidence was that there was no standard protocol for anxiety treatment, different points were used in different studies and anxiety measures and outcome measures varied. The main reason for the varied treatment protocols goes back to TCM diagnosis, which is always specific for each patient and never standard for everyone. Hence 2 people may suffer from anxiety, but the underlying problem and TCM diagnosis can be very different, hence they may receive a different acupuncture point prescription.

Researchers have also identified that the value of scientific research needed to not only use quantitative measures such a s change in anxiety levels flooding acupuncture, but also biological effects of anxiety and measure the changes in those parameters as well. Amorim et al identified only 5 of 13 included studies measured the biological effect of acupuncture. One study of immune parameters known to be affected by stress, found acupuncture had strong modulatory effects on the immune system and brought the immune parameters closer to healthy control subjects. Another study measured neurotransmitter and hormone levels in control groups against groups receiving acupuncture or acupuncture and pharmacotherapy, found acupuncture produced an improvement in anxiety measures and reduced the incidence of side effects to the drugs used in the trials. Three other studies measuring anxiety with either heart rate variability, skin conductivity or electrical brain activity all found a decrease in anxiety measures in acupuncture groups as compared to controls. This suggests a far broader effect of acupuncture than just a reduction of the psychological symptoms of anxiety.

Before an acupuncturist administers acupuncture they carefully consider the symptoms of the patient and diagnoses them according to the principles and philosophy of Chinese Medicine and creates a treatment plan according to an individual diagnosis. Hence, people with anxiety can have different diagnoses, meaning that the acupuncture treatment for each patient may not be the same. There are however, several acupuncture points which are commonly used to help “settle the Shen” and calm the mind which are more commonly used for symptoms associated with anxiety. 

Acknowledging the traditional practice and application of Chinese Medicine, Amorim et al suggested future research should include a standard acupuncture formula in order to improve study design and allow for easier analysis of results. The authors concluded that overall research confirms acupuncture as a safe and effective treatment for anxiety with far fewer side effects than conventional medicine, the need for well designed studies using both quantitative and biological measures and standardised treatment protocols need to be used in future research (Amorim et al 2018).  

A similar review from 2019 by Li et al concluded the same outcome when comparing an acupuncture group with a control group stating that acupuncture for anxiety was more effective than the control, however, methodological flaws in the research necessitate the need for higher quality evidence (Li et al 2019).

It can be concluded that a review of research between 2001 and 2019 shows that acupuncture is effective in the treatment of anxiety and benefits biological function as well. However due to the variable methods of testing, measuring, treatment, use of points and analysis of the effects, standardisation in research needs to be implemented in order to improve the quality of the evidence.

References

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