From the British Acupuncture Council (BAcC) Team
Recent systematic reviews of the evidence have found consistently positive results in trials of acupuncture for anxiety (Amorim 2018: thirteen randomised controlled trials (RCTs) https://www.ncbi.nlm.nih.gov/pubmed/29705474; Goyata 2016: six RCTs https://www.ncbi.nlm.nih.gov/pubmed/27355312). They were able to reach stronger conclusions than the earlier UK reviews (Pilkington 2013 https://pubmed.ncbi.nlm.nih.gov/24215924/) due to more accumulated data, hence acupuncture is seen as a promising treatment option that might help to reduce the use of drugs. Psychiatric health professionals have rated it as effective and safe, and facilitating communication with their patients (Landgren 2019 https://pubmed.ncbi.nlm.nih.gov/30605358/).
Most of the research trials have dealt with anxiety associated with specific stressful situations, for example pre-operative, exam-related or stressful work. These trials have often used auriculotherapy for its convenience and effectiveness, such as this recent example with hospital nurses suffering high levels of stress (Kurebayashi 2017 https://pubmed.ncbi.nlm.nih.gov/28403335/). Three different methods of stimulating the ear points were used alongside a control. Needle stimulation was most effective and reduced anxiety levels significantly more than for the control group. In an example with body acupuncture, a retrospective analysis on 379 patients in a hospital emergency department showed significant improvement for stress and anxiety scores after acupuncture (Burns 2019 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676760/).
The largest of the reviewed studies that was not focused on a stressful situation recruited 120 primary care patients with various symptoms of emotional distress, including anxiety (Arvisdotter 2013 https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/1472-6882-13-308). Both acupuncture alone, and acupuncture integrated with psychological therapy, were more effective than conventional treatment.
There has been little research on generalised or chronic anxiety, and very little for people diagnosed with an anxiety disorder. To address this gap the British Acupuncture Council (BAcC) has been working with the charity Anxiety UK to gather generalised anxiety outcomes data from patients having a course of six acupuncture treatments as in usual practice. Preliminary results on 30 patients indicate that the effectiveness is at least as good as that seen with psychological therapies such as CBT. A similar effect is emerging from the evaluation of a second BAcC project on anxiety.
Generalised anxiety commonly accompanies other conditions across a wide spectrum of illness. Clinical research has shown the benefits from acupuncture when anxiety is associated with serious conditions such as MS, stroke and cancer, with musculoskeletal conditions, with gastrointestinal and urinogenital disorders, and particularly with other mental health conditions, including depression, substance misuse, eating disorders, insomnia and post-traumatic stress disorder (PTSD: see below).
Acupressure has also proved to be an effective intervention for anxiety, whether delivered by a practitioner or self-administered. In a randomised trial in the USA, cancer survivors suffering from fatigue (n=288) used self-administered acupressure daily for six weeks, leading to a greater reduction in anxiety and stress than in the usual care group (Zick 2018 https://pubmed.ncbi.nlm.nih.gov/30687806/).
Stress
Stress is commonly bracketed together with anxiety and is also associated with many other illnesses, both as a causative factor and as a measured outcome in research studies. Even more so than with anxiety, the effect of acupuncture on stress has been studied mostly as a secondary outcome of treatment for the primary symptom/illness, which could be anything from back pain to urinary incontinence. Nearly all of these trials show positive effects but there is little clinical research on stress per se.
In a recent study where stress was the primary diagnosis, 207 family carers were recruited; fatigue, insomnia, depression and generally poor quality of life were associated symptoms (Cheung 2020 https://pubmed.ncbi.nlm.nih.gov/32096884/). This was another trial using self-administered acupressure, delivered over eight weeks. Compared to those who had no acupressure there was a large effect on stress and other symptoms, larger than normally seen with conventional behavioural interventions. The benefits were still apparent 12 weeks later.
Post-traumatic stress disorder
In a systematic review of seven randomised trials there were significant differences favouring acupuncture (versus any comparison group) on PTSD symptoms, at post-intervention and at longer follow-up (Grant 2018 https://www.ncbi.nlm.nih.gov/pubmed/28151093).
PTSD is another area where the BAcC has been research-active. A before and after observational study demonstrated very large improvements in the PTSD outcome measure, such that none of the patients completing the course of six sessions were still classed as having PTSD. The participants were all forces veterans (Healthwatch Norfolk 2018 https://healthwatchnorfolk.co.uk/news/acupuncture-shown-to-be-an-effective-treatment-for-veterans-with-ptsd/). Acupuncture is also much used for treating veterans in the US, through the Department of Veterans Affairs (VA), and for serving personnel within the military.
Conclusions
All of the reviews on acupuncture and anxiety emphasise that further large, high-quality studies are needed to substantiate the results presented here. Nevertheless, from the evidence to date acupuncture appears to be at least as effective as drug treatment and without the side effects. It has plausible mechanisms (Pilkington 2013 https://pubmed.ncbi.nlm.nih.gov/24215924/; British Acupuncture Council 2011 LINK to BAcC Fact Sheet on anxiety; Evidence Based Acupuncture 2018 https://www.evidencebasedacupuncture.org/present-research/acupuncture-anxiety-2/), can be delivered individually, in groups, or even self-administered (hence low cost), and used alone or in combination with conventional treatment (pharmacological or psychological). This makes acupuncture well suited both for private practice and as a referral option for the NHS.
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