Effects from acupuncture in treating anxiety: integrative review

Goyatá, Sueli Leiko Takamatsu; Avelino, Carolina Costa Valcanti; Santos, Sérgio Valverde Marques dos; Souza Junior, Deusdete Inácio de; Gurgel, Maria Dorise Simão Lopes; Terra, Fábio de Souza

doi:10.1590/0034-7167.2016690325i

Brasil

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REVIEW • Rev. Bras. Enferm. 69 (3) • May-Jun 2016 • https://doi.org/10.1590/0034-7167.2016690325i linkcopy

Effects from acupuncture in treating anxiety: integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: to evaluate the scientific evidence that is available in the literature on the effects of acupuncture for treating anxiety and on the quality of such studies.

Method: the study is an integrative review of CINAHL, LILACS, PUBMED-PICO, SciELO, and The Cochrane Library between 2001 and 2014. Keywords anxiety, acupuncture therapy, acupuncture, and anxiety disorders were combined among themselves to ensure a wide search of primary studies.

Results: among 514 articles, 67 were selected to be fully read and 19 were included. Among these, 11 were found to have strong evidence levels. Among the six articles about randomized clinical studies, five were found to be of reasonable quality. Two studies used acupuncturist nurses to perform their interventions. Its results showed positive and statistically significant effects from using acupuncture for treating subjects with anxiety.

Conclusion: acupuncture seems to be a promising treatment for anxiety; however, there is a need for improving the methodological quality of the research on this field.

	Articles found	Selected articles	Excluded articles	Included articles
CINAHL	41	8	7	1
LILACS	29	7	6	1
PUBMED-PICO	398	46	30	16
SciELO	5	2	2	0
The Cochrane Library	41	4	3	1
TOTAL	514	67	48	19

Study Type	Level of evidence^* * Gershon RR, Karkashian CD, Vlahov D, Kummer L, Kasting C, Green- McKenzie J. et al. Compliance with universal precautions in correctional health care facilities. J Occup Environ Med 1999;41(30):181-9.	n	%
Meta-analysis, systematic review of a randomized clinical trial, controlled randomized clinical trial	I	11	57.9
At least one well designed controlled randomized clinical trial	II	-	-
Clinical trial, not randomized	III	1	5.3
Cohort study, case-control study	IV	3	15.8
Systematic review of descriptive or qualitative studies	V	2	10.5
Descriptive or qualitative studies	VI	2	10.5
Opinion from authorities or report from committee of specialists	VII	-	-
Total	7	19	100

Title	Year Country	Design/number of patients	Interventions	Outcomes
Effects of an integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients - a pragmatic randomized controlled trial⁽¹⁵⁾.	2013 Sweden	Randomized controlled clinical trial n = 120	Integrative treatment (IT) versus acupuncture therapy (AT) versus conventional treatment (CT)	The integrative treatments and acupuncture therapies resulted in statistically and clinically significant reduction of anxiety in patients of primary care services. In 4 weeks, the differences between the groups were IT-CT (p = 0.005) and AT-CT (p = 0.006). The same way, both AT and IT have improved significantly more than the CT (both p < 0.001) of the 8-week baseline.
The effect of acupuncture on working memory and anxiety⁽²⁷⁾.	2013 USA	Randomized controlled clinical trial n = 90	Acupuncture treatment versus conventional treatment	Subjects undergoing acupuncture treatments reported having a lower anxiety state, after their interventions than subjects going through conventional treatments (26.14 vs. 29.63, p = 0.0146).
Acupuncture for Anxiety in Lactating Mothers with Preterm Infants: A Randomized Controlled Trial⁽¹⁴⁾.	2013 Brazil	Randomized controlled clinical trial n = 29	Acupuncture treatment versus placebo	The data were collected before and after the treatments, and submitted to a blind rater. Before and after the treatment, the difference in STAI - State for both groups was not statistically significant (p = 0.888), although the analyses inside the groups was significant for both of them (p < 0.005). Saliva corticol levels remained unchanged after the treatments in both groups (p = 0.480).
Auricular Acupressure as a Treatment for Anxiety in Prehospital Transport Settings⁽²⁸⁾.	2003 USA	Randomized controlled clinical trial n = 36	Ear acupressure treatment on the relaxation point versus sham point	The patients who were submitted to ear acupressure treatment in the relaxation group reported having significantly less anxiety than the patients in the sham group when they arrived the hospital (p = 0.002).
The use of auricular acupuncture to reduce preoperative anxiety⁽²⁹⁾.	2001 USA	Randomized controlled clinical trial n = 91	Traditional Chinese medicine group, Relaxation group versus Control group	After the interventions, there were significant differences among the three groups (p = 0.014). The patients in the relaxation group were found to have less anxiety as compared to the patients in the control group (p = 0.01). The anxiety in the patients in the traditional Chinese medicine group was not found to significantly differ as compared to the control group (p = 0.28) and to the relaxation group (p = 0.37).
Auricular acupuncture: a potential treatment for anxiety⁽³⁰⁾.	2001 USA	Randomized controlled clinical trial n = 55	Shenmen group versus Relaxation group versus Sham group	There were significant differences among the three treatment groups (p = 0.001). A post hoc analysis showed that the patients in the relaxation group were found to be significantly less anxious in 30 minutes (p =0.007) and 24 h (p=0.035), as compared to the patients in both the shenmen and sham group, and less anxious in 48h (p =0.042), as compared with the patients in the shenmen group.

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[TFN3] CINAHL, LILACS, PUBMED-PICO, SciELO, and The Cochrane Library databases, 2001 - 2014.