ANXIETY AND ACUPUNCTURE
Presented Second Australian International Congress on Contemporary Acupuncture. Melbourne 1982.
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.
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.
|Anxiety with Pain||Treated with Acupuncture||54|
|Anxiety and Pain||Treated with Acupuncture & Hypnosis||11|
|Anxiety no pain||Treated with Acupuncture||6|
|Anxiety no pain||Treated with Acupuncture & Hypnosis||8|
Anxiety with pain 65 Treated with Acupuncture.
|Symptom Profile||Number||Greatly Helped||Helped||Not Helped|
|Low back Pain||12||50%||50%||-|
|Sinus &/ Hayfever||12||83%||16%||-|
Anxiety with pain 65 Treated with Acupuncture and Hypnosis.
|Symptom Profile||Number||Greatly Helped||Helped||Not helped|
|Low back Pain||2||1||1|
|Sinus &/ Hayfever||3||3|
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. (Has the situation changed over the last 16 years?)
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. Knowing that if the 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 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 a harmless or beneficial adaptive response cannot be achieved and it is for this reason, I think acupuncture's function today includes 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 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 combined with 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 the Medicare Acupuncture item number 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 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. That the community is becoming increasingly concerned about drugs and their related side effects will give further impetus to the trend towards non-drug management. 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.
Note: The author went on to treat over 3,000 chronic pain patients with a combination of Acupuncture and Hypnosis/Relaxation training and came to the conclusion that the combination of therapies was worthwhile for chronic pain and anxiety patients.