Acupuncture for Anxiety – Trial
Traditional Chinese Medicine (TCM) and Acupuncture, a component of TCM, have a wide range of therapeutic applications, including the effective treatment of a variety of psychiatric disorders. With a focus on Anxiety and the application of the aforementioned modalities to treat this, this study poses the question, “can an underlying TCM pattern be identified and a combined needling and treatment protocol be used to treat anxiety effectively in a group?” In the West, Anxiety by definition is “…an emotion characterized by feelings of tension, worried thoughts, and physical changes…” and is also “…considered a future-oriented, long-acting response broadly focused on a diffuse threat.” (American Psychological Association, 2022). It is a natural behavioral, physiological and psychological response of the body to stress, developed through millennia of human evolution as a survival mechanism to keep the species alive and safe from danger. When a situation arises that is perceived as stressful, the sympathetic nervous system kicks in activating a cascade of hormones that speed up the heart rate, delivering more blood and oxygen to the extremities, and thus providing quicker reactions coupled with increased strength and speed. This allows for the situation to be escaped from or fought against. Once the danger is dealt with the parasympathetic nervous system is designed to activate, relaxing the body back to balance. As can be seen, anxiety is a helpful emotion when acute but prolonged periods of stress triggering anxiety can cause the emotion to become chronic and over time develop into a debilitating disorder. The International Classification of Diseases, 11th Edition (ICD-11) lists 28 disorders that come under the umbrella term ‘Anxiety and/or Fear-related Disorders’, including Panic Disorder, Obsessive Compulsive Disorder (OCD), Generalized Anxiety Disorder (GAD), and Social Anxiety Disorder (SAD), all of which have the emotion of anxiety at their core. Incapacitating symptoms of all these disorders include: difficulty controlling worry, an inability to concentrate or focus on anything else, nervousness, panic, hyperventilation, gastrointestinal issues, and avoidance of things that trigger the anxiety (International Classification of Diseases, 2022). Mental Health UK estimates over 8 million people, around 11.9% of the total UK population, experience some form of anxiety at any one time, and this number continues to rise (Mental Health UK, n.d). Of the population who suffer with anxiety related disorders in the UK, Panic disorder effects approximately 0.6%, OCD effects around 1.2%, GAD effects around 5%, and SAD effects around 10% (Anxiety UK, n.d). Mainstream interventions in the West for the treatment of anxiety and related disorders are primarily talking therapies such as Cognitive Behavioural Therapy (CBT) or medications like Serotonin Reuptake Inhibitors (SSRIs). There are however a number of common pitfalls with both of these interventions which deter patients from undergoing treatment, including fear of adverse reactions to pharmaceutical drugs or the possibility of long-term side effects. Furthermore, possible lengthy referral waiting times for Improving Access to Psychological Therapies (IAPT) treatments provided by the NHS is often a patient concern. In a poll of 535 adults the Royal College of Psychiatrists (2022) found around 23% of IAPT referrals had a wait time of 12 weeks or more, 12% waited 6 months plus and 6% were left waiting for more than a year before beginning treatment (Royal College of Psychiatrists, 2022). Due to the aforementioned issues some patients have with mainstream treatment, people are turning more and more to Complementary and Alternative Medicine (CAM) which is defined as any treatment that does not fall within the parameters of mainstream health care. Whereas conventional medicine is allopathic, using invasive drugs, procedures or surgery to address symptoms and disease, complementary medicine utilises a ‘natural’ more holistic approach. Many different therapies come under CAM including Traditional Chinese Medicine (TCM) and Acupuncture. As previously mentioned, TCM and Acupuncture are effective treatments of Anxiety. A number of studies have been performed that show the positive effect of acupuncture on situational anxiety [ (Bae, Bae, Min, & Cho, 2014) (Klausenitz, et al., 2016)], for example, Karst et al., 2007, who performed a randomized controlled trial (RCT) into the efficacy of auricular acupuncture on dental anxiety, in which there were 3 treatment groups – auricular acupuncture, placebo-auricular acupuncture, and midazolam (drug intervention). They found that the patients who received the auricular acupuncture were significantly less anxious compared with the placebo group (Karst, et al., 2007). Similarly, numerous systematic reviews and meta-analyses have also demonstrated the efficacy of acupuncture treatment (Amorim, et al., 2018). Yang et al., 2021 looked at 20 RCTs designed to treat GAD, 18 of which were published in Chinese, and found that acupuncture was effective on anxiety symptoms (Yang, Yang, Huang, Ren, & Li, 2021) He et al., 2014 designed a scalp acupuncture protocol, focusing on two new areas of stimulation, for the treatment of 2 patients with anxiety disorders. Patient 1 had GAD with nighttime panic attacks and received 4 sessions; Patient 2 had Posttraumatic Stress Disorder (PTSD) with irritability, insomnia, severe anxiety and flashbacks along with back, chest and joint pain from military injuries and received 6 sessions. They found their scalp acupuncture protocol to be significantly effective for the treatment of both patient’s anxiety disorders and symptoms (He, Chen, Pan, & Ying, 2014). Traditional Chinese Medicine, acupuncture and their principles grew out of Daoism (Taoism), an ancient Chinese thought and belief system still practiced today. The fundamental principle of the above disciplines is that the Cosmos and all its form is animated by Qi, the original energy of the universe and the singular building block of creation and existence. All things come from Qi and are Qi. Qi and all its manifestations are composed of opposing components, Yin and Yang, and each manifestation has its own unique and varied yin-yang orientation defining the physical and non-physical make up all things, including the human body, emotions, the spirit and so on. This fundamental concept is best represented in the Taijitu, the Daoist and TCM Yin-Yang Symbol, shown in Figure 1. Furthermore, whilst everything in existence is “separate” it is also inherently interconnected and therefore, changes