Anxiety and Acupuncture

Simon Strauss M.D.

Southport, Queensland
e-mail: simons@atnet.net.au

INTRODUCTION
 
79 patients with anxiety were treated with acupuncture. A sub group
of 19 were given a combined treatment of acupuncture and hypnosis.
The patients were both referred and self referred. Following
assessment they were divided into two broad categories. 65 with
anxiety and associated pain states. 14 with anxiety alone or associated
with non pain stress related illness. Follow up was carried out 6
months on average from the last treatment. No attempt was made at
double blind method methodology. Furthermore the treatment was
carried out in private practice. For these reasons this paper should be
regarded as a case series, rather than a clinical trial.
 
METHOD
 
The patients were treated twice a week until marked response was
noted and then once a week until stable, then reviewed at one month.
On discharge patients were advised to return on a p.r.n. basis. In the
anxiety plus pain group 54 were treated with acupuncture alone.
Eleven were treated with acupuncture and hypnotic techniques. In the
anxiety and no pain group 6 were treated with acupuncture and 8 with
acupuncture and hypnosis.
 
The acupuncture treatment was carried out according to the dictates of
Traditional Chinese medicine. If the associated painful or stress related
syndrome was the patient's main complaint, treatment was initially at
a symptomatic level. E.g. if the patient suffered with headache or neck
pain, then the painful state was treated first and then the underlying
or associated anxiety state was treated. Following traditional Chinese
Medicine's rule of treating the most acute contra-indication to health
first. The hypnotic techniques used were aimed at producing relaxation
and if needed strategies for increasing ego strength and methods for
dealing with ongoing stresses were utilised.
 
The changes provoked by both acupuncture and hypnosis were
frequently measured by biofeedback devices. The type of
measurement selected was dependent on the symptom complex. e.g.
patients with tension headaches with trigger points in trapezius (GB21)
then E.M.G. activity of trapezius was used. For migraines elevation of
digit temperature. When increased levels of sympathetic outflows
symptoms predominated. e.g. palpitations, sweaty palms or
hypertension, then the galvanic skin response was utilised. These
instruments are all cheap and readily available. They are simple to use
and provide a useful measure for the objective changes, precipitated
by acupuncture and or hypnosis.
 
RESULTS
Patient's Assessment.
 

Anxiety with Pain Treated with Acupuncture 54

  Greatly helped 65%
  Helped 24%
  Not helped 11%
     
Anxiety and Pain Treated with Acupuncture & Hypnosis 11
  Greatly helped 91%
  Helped 1%
  Not helped 8%
     
Anxiety no pain Treated with Acupuncture 6
  Greatly helped 5
  Helped 1
     
Anxiety no pain Treated with Acupuncture & Hypnosis 8
  Greatly helped 5
  Helped 3

 
Symptom Profile

Anxiety with pain 65 Treated with Acupuncture.

Symptom Profile Number Greatly Helped Helped Not Helped

Sleep Disturbance 48 31% 60% 8%
Headaches 46 67% 24% 8%
Neck Pain 37 76% 16% 8%
Vertigo 27 70% 18% 11%
Low back Pain 12 50% 50% -
Sinus &/ Hayfever 12 83% 16% -
Asthma 6 66% 33% -
 

 
 
 
Anxiety with pain 65 Treated with Acupuncture and Hypnosis.

Symptom Profile Number Greatly Helped Helped not helped

Sleep Disturbance 7 1 5 1
Headaches 9 8 1  
Neck Pain 7 6 1  
Vertigo 5 5    
Low back Pain 2 1 1  
Sinus &/ Hayfever 3 3    
Asthma 1   1  

 
 
 
 
 
 
 
 
DISCUSSION
 
It should be the Universities and the Medical Schools that conduct
trials of new treatment methods. However, currently in Australia little
is being done. Indeed a cynic might suggest that unless a Multi
National Drug Co. stands to profit from a research project, funding
would be difficult to obtain. Until our Government provides funds into
non drug research it will be up to the individual practitioners and their
societies to justify their work. It is in this spirit I have presented this
paper.
 
During 1980 I set up a new practice in Southport with the aim of
carrying out problem orientated acupuncture. In an effort to assess
the place of acupuncture as I practised it, within Western medicine in
Southport, I administered a multiphasic questionnaire to the patients
treated during the first 6 months. The average follow-up was made 6
months from the last treatment. A 75% response was obtained
excluding bad debtors and changes of address.
 
That acupuncture is effective for the treatment of stress and it
disorders has been recognised since ancient times. Traditional Chinese
medicine contains numerous references to the effects of the emotions
on bodily processes. Psychosomatic illness, a relatively new concept in
the West, was recognised and written about at least 200 years B.C.
Ancient Chinese literature describes and analyses in great detail, the
mind-body interface. The ancients stated that there were 5 emotions,
which in excess would effect the functioning of associated organs
leading to imbalance, resulting in physical or mental illness. These
relationships were summarised around 200B.C.
 
For example, 'obsession or overthinking injures the pi-spleen'. If the
over-thinking was prolonged, the 'pi-spleen's' function will be
distorted, leading to diarrhoea. This concept is then used to treat the
diarrhoea associated with over-thinking. That is the 'pi-spleen' is
treated, not the large intestine. Another example is that anger
damages the liver and if sustained will lead to depression due to
interference to the liver's functions of 'freeing'. For this reason the
liver is frequently treated for depression. Knowing that if the 5
emotions were not controlled and were sustained, imbalance would
occur, leading to either physical or mental illness, the ancients
practised a system to restore balance of homeostasis.
 
It has been a favourite theme of mine that acupuncture should not
have to justify itself by its results with chronic pain. That historically
acupuncture was mainly used to regulate premorbid disease states and
imbalances before they manifested as clinical illness.
 
Corson[1] states that when an animal is put in a situation in which it
cannot achieve an adaptive reflex, an abnormal biological reaction
takes place, involving visceral-endocrine functioning. These
maladaptations may lead to the development of psychopathology, e.g.
anxiety/phobias or physical illness e.g. hypertension, headaches, etc.
It is my contention that our society places many of us in situations
where an adaptive response cannot be achieved and it is for this
reason, I think acupuncture's main function today may be the
alleviation of psychosomatic disorders, produced by increasing
psychological and physiological stress in our environment. That
acupuncture can achieve such high rates of success with anxiety is
therefore very significant.
 
Of the anxiety and pain group treated with acupuncture alone, 65%
reported being very greatly helped, 24% helped and 11% being
unresponsive. The overall effectiveness rate for decrease in severity
and frequency of anxiety and reduction of drugs was 89%. The pain
states for this group's effectiveness rate was 91% with a greatly
helped group of 67%. It is significant that for the anxiety and pain
group treated with both acupuncture and hypnosis, the greatly helped
group re anxiety was 91%, re pain the greatly helped group was 85%.
i.e. an increase of 24% for anxiety and I5% for pain.
 
This increase in effectiveness rate and greatly helped rate by the
addition of hypnosis was not apparent in the anxiety and no pain
groups, perhaps due to too small a sample size. However the
increased effectiveness rates and greatly helped rates in the former
group could point to the development of new combined techniques.
 
I have been using acupuncture and hypnosis over the last 8 years.
With correct needling the hypnotic induction becomes remarkably
easy. It is my feeling that the combination of techniques is desirable
as it lowers the numbers of treatments required and increases the
greatly helped rates for anxiety and the associated pain states. It
should be mentioned since the advent of Medicare item 980 many of
my patients have been deprived of this mixed treatment system.
 
It makes me uneasy to present results with such high rates of success.
It should be remembered that the 25% of non-responders could be
weighted with negative responses. It would be simple minded to state
that acupuncture was a universal panacea. Clearly it has its limitations
and drawbacks. However for some illnesses if does offer an effective
non-drug approach, which because of acupuncture's unique ability to
regulate the autonomic nervous system and because it utilises the
bodies natural healing reflexes, gives us a method to actually improve
the health of the patient.
 
That we can increase acupuncture's effectiveness by the addition of
other techniques, such as biofeedback and hypnosis makes common
sense. Hopefully our detectors will see the wisdom of a system of
medicine that actually enhances the health of the patient, if only
because of its
tremendous effectiveness. That the community is becoming
increasingly concerned about drugs and their related side effects will
give further impetus to acupuncture' spread and acceptance. Already
some of my patients no longer believe that anxiety is due to a lack of
Valium.
 
1. Corson: Neuro-Endocrine and Behavioral Correlates of Constitutional
Differences Reflex, 4, 1969 pp265-286.

Presented Second Australian International congress on Contemporary

Acupuncture. Melbourne 1982.