Anxiety is very common – in fact, it is the most common mental health condition in Australia. On average, 1 in 3 women and 1 in 5 men in our country report experiencing anxiety at some point in their lives; and 1 in 7 people will be diagnosed with a clinical anxiety disorder in any given year (1). There are 13 different sub-classifications of anxiety disorders listed in the medical literature, encompassing a wide range of physical, emotional and mental symptoms. It is a complex and pervasive condition that can have a dramatic impact on people's quality of life, and is generally treated using medication.
Acupuncture has been proposed as a positive therapeutic intervention that can reduce measurable levels of anxiety, and the research in this field is growing by the day. In this blog post I'd like to summarise some of the best research and discuss the benefits and risks of considering acupuncture as part of your therapeutic repertoire.
How does acupuncture compare to conventional treatments?
Conventional treatment of anxiety primarily includes medication (e.g. antidepressants and benzodiazepines) and psychotherapy (e.g. Cognitive Behavioural Therapy).
Recent research suggests that acupuncture can have comparable (similar or better) results to conventional anxiety treatments. For example, a 2016 systematic review concluded that ‘the effects from acupuncture for treating anxiety have been shown to be significant as compared to conventional treatments.’ (2) A more recent 2018 systematic review evaluated 13 clinical studies and found that every single study “reported an anxiety decrease for their treatment group relative to the control groups.”, where three of these studies had medication as their controls. (3)
One study of 120 randomised patients found that when compared to conventional treatment including medication and psychotherapy, acupuncture reduced the symptoms of anxiety and depression twice as much as conventional therapy (4). And another randomised controlled trial found that for patients with chronic anxiety that didn't respond to conventional treatment, acupuncture showed statistically significant improvements that were maintained for 10 weeks after treatment concluded (5). These are very promising results.
The benefits - how does acupuncture work with anxiety?
From a Chinese medicine perspective, acupuncture helps to relieve anxiety by addressing the underlying patterns of disharmony unique to each individual. A trained practitioner will look at how anxiety is manifesting for that person on a physical, emotional and mental level and will tailor their treatment accordingly based on traditional wisdom and modern empirical evidence.
From a Western scientific perspective, acupuncture is believed to have a simulating effect on the nervous system, regulating the levels of various neurotransmitters and hormones such as serotonin, dopamine, ACTH, noradrenaline and GABA. These changes alter the brain's mood chemistry to help change negative emotional states (6, 7, 8).
The stress-relieving effects of acupuncture have also been investigated. Research indicates that acupuncture can activate the parasympathetic nervous system, or the relaxation response, via the HPA axis, the hippocaampus, and Heart Rate Variability (9, 10, 11). This can greatly benefit people experiencing anxiety as it is often closely associated with high stress levels, and acupuncture can help to reverse stress-induced changes in behaviour or biochemistry.
Acupuncture has also been shown to be of benefit to specific patient populations experiencing anxiety. For instance, electro-acupuncture has been shown to offer benefit to lung cancer patients experiencing anxiety during palliative care (12). Acupuncture has demonstrated promising results in a pilot study of acupuncture for children and adolescents with generalised anxiety (13). And even very basic acupuncture or acupressure on one particular point, Yin Tang, has been shown to significantly reduce anxiety levels in preoperative patients (14). (You can watch a recent Facebook Live I did explaining how to do acupressure on Yin Tang here).
Research into acupuncture for anxiety is a burgeoning field, this is just the tip of the iceberg. We can be sure that further insights will continue to be revealed with time.
The risks - can acupuncture make anxiety worse?
There are no published studies indicating that acupuncture can make anxiety worse. However, just as no medical intervention is completely risk-free, you need to be aware that there are some very small general risks that come with acupuncture treatment.
The most common side effect that people experience with acupuncture is a small amount of pain (a pinprick) as the needles are inserted. In about 3-5% of treatments, a very tiny amount of bleeding occurs when the needles are removed, and in an even smaller number of treatments, there can be a small bruise at the site afterwards. Other, very rare complications are usually linked to inappropriate treatment by an improperly trained practitioner (for example, someone doing “dry needling”).
It is very important to note that if you are currently having conventional treatment for anxiety, such as medication, you need to keep this up whilst getting acupuncture. Stopping your medication to try acupuncture instead without discussing this with your doctor first puts you at risk of worsening symptoms. Please always always discuss stopping medication with your doctor.
The bottom line
Acupuncture may be a beneficial, low-risk therapeutic option for people with anxiety. More research is needed, however the current research indicates great promise, as well as a very low incidence of side effects. Please note that for the majority of the studies cited, treatments were provided at least weekly (or twice weekly), with an average of 10 treatments per person. Acupuncture is not a quick fix and you need to commit to a series of treatments for optimal results.
It is crucial that you find an acupuncturist who is properly trained, qualified and registered with the Chinese Medicine Board of Australia (a subsidary of AHPRA), like me. It is also important that you either continue or investigate conventional treatment options for anxiety, including counselling or medication. You might also want to utilise other holistic approaches such as meditation, exercise, high quality nutrition and other complementary therapies to help reduce stress and improve your overall levels of wellbeing.
If you have any questions please always feel free to contact me. And if you have found this article helpful, please share it with people who may also benefit from this information.
1. Australian Bureau of Statistics. (2008). National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Cat. no. (4326.0). Canberra: ABS.
2. Goyata SL, Avelino CC, Santos SV, Souza Junior DI, Gurgel MD, Terra FS. Effects from acupuncture in treating anxiety: integrative review. Rev Bras Enferm. 2016 Jun;69(3):602-9.
3. Amorim, D., Amado, J., Brito, I., Fiuza, S. M., Clinical, N. A. T. I., 2018. (n.d.). Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research. Elsevier. http://doi.org/10.1016/j.ctcp.2018.01.008
4. Arvidsdotter, T., Marklund, B., & Taft, C. (2013). Effects of an integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients–a pragmatic randomized controlled trial. BMC Complementary and Alternative Medicine, 13(1), 308. http://doi.org/10.1186/1472-6882-13-308
5. Errington-Evans N. (2015). Randomised controlled trial on the use of acupuncture in adults with chronic, non-responding anxiety symptoms. DOI: 10.1136/acupmed-2014-010524
6. ZHOU Qi-zhi,ZHAO Ji-lan,CAI Ding-jun,YU Shu-guang,WEI Jiao-lu,WU Qiao-feng,PENG Xiao-hua,WANG Wei,XU Hai-yang(Laboratory of Acu-moxibustion,College of Acu-moxibustion and Tuina,Chengdu University of TCM,Chengdu,China) (2008). Regulation effects of electro-acupuncture on monoamine neurotransmitter and GABA in rats with chronic emotional stress-induced anxiety. China Journal of Traditional Chinese Medicine and Pharmacy;2008-10
7. Noah Samuels MD, Cornelius Gropp MD, Shepherd Roee Singer MD & Menachem Oberbaum MD (2008) Acupuncture for Psychiatric Illness: A Literature Review. Behavioral Medicine, 34:2, 55-64, DOI: 10.3200/BMED.34.2.55-64
8. Yang TY1, Jang EY1, Ryu Y2, Lee GW1, Lee EB1, Chang S1, Lee JH1, Koo JS3, Yang CH1, Kim HY (2017). Effect of acupuncture on Lipopolysaccharide-induced anxiety-like behavioral changes: involvement of serotonin system in dorsal Raphe nucleus. BMC Complement Altern Med. 2017 Dec 11;17(1):528. doi: 10.1186/s12906-017-2039-y.
9. Yue N1, Li B2, Yang L1, Han QQ1, Huang HJ1, Wang YL1, Wang J1, Yu R1, Wu GC1, Liu Q3,4, Yu J (2018). Electro-Acupuncture Alleviates Chronic Unpredictable Stress-Induced Depressive- and Anxiety-Like Behavior and Hippocampal Neuroinflammation in Rat Model of Depression. Front Mol Neurosci. 2018 May 31;11:149. doi: 10.3389/fnmol.2018.00149. eCollection 2018.
10. Yao H, Wei D, Cai D, Yu S, Zhang C, Wei J, Xiao X, Zhou Q. (2016). Effects of acupuncture on ANP and CNP in adrenal gland and CORT in plasma in rats with chronic emotional stress anxiety. Zhongguo Zhen Jiu. 2016 Feb;36(2):169-74. [Article in Chinese]
11. Sparrow K1, Golianu B (2014). Does Acupuncture Reduce Stress Over Time? A Clinical Heart Rate Variability Study in Hypertensive Patients. Med Acupunct. 2014 Oct 1;26(5):286-294.
12. Hu YQ1, Wu YF1, Hou LL (2017). The Effectiveness of Electrical Acupuncture Stimulation in Reducing Levels of Self-reported Anxiety of Lung Cancer Patients during Palliative Care: A Pilot Study. Iran J Public Health. 2017 Aug;46(8):1054-1061.
13. Leung B1, Takeda W2, Holec V (2018) Pilot study of acupuncture to treat anxiety in children and adolescents. J Paediatr Child Health. 2018 Apr 6. doi: 10.1111/jpc.13910. [Epub ahead of print]
15. Kwon CY1,2, Lee B (2018) Acupuncture or Acupressure on Yintang (EX-HN 3) for Anxiety: A Preliminary Review. Med Acupunct. 2018 Apr 1;30(2):73-79. doi: 10.1089/acu.2017.1268.
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