Post-traumatic stress disorder (PTSD) is a severe, long lasting psychological reaction to a distressing event, which can cause significant impairment (Reed 2012). It can develop after a major traumatic event (such as a serious accident, a violent personal assault or military combat), and can affect people of all ages.
The general signs of stress can vary from one individual to the next (NHS Choices 2011). They may manifest physically as an illness, tiredness or lethargy, or as symptoms such as sore, tight muscles, dull skin, lank hair, or erratic sleep patterns. Mental stress can result in depression, mood swings, anger, frustration, confusion, paranoid behaviour, jealousy or withdrawal. Specific signs of PTSD include vivid memories of the traumatic event, such as flashbacks when awake or nightmares when asleep; hyperarousal, when the person is hypervigilant for threats and may have insomnia, irritability and difficulty concentrating; and an inability to experience feelings or amnesia about parts of the event (Reed 2012; NICE CKS).
Symptoms usually start in the first month after the traumatic event. In about 15% of people, symptoms can be delayed by months or years, but they usually appear within 6 months (Reed 2012; NICE CKS). In around 65% of adults, symptoms resolve naturally, although this may take several months. In the rest, symptoms are longer lasting and can be severe.
Conventional treatments for PTSD include medication such as anti-anxiety drugs, cognitive behavioural therapy and relaxation techniques (NHS Choices 2011).
NHS Choices. Post-traumatic stress disorder [online].Available: http://www.nhs.uk/Conditions/Post-traumatic-stress-disorder/Pages/Introduction.aspx
NICE Clinical Knowledge Summaries. Post-traumatic stress disorder.
Reed RV et al. Post traumatic stress disorder. BMJ 2012; 344 e3790
How acupuncture can help
This factsheet looks at the evidence for acupuncture in the treatment of PTSD. There are related factsheets on anxiety, stress and depression.
There are preliminary positive findings for acupuncture in the treatment of chronic anxiety associated with PTSD. A systematic review of acupuncture for PTSD found that the evidence of effectiveness is encouraging (Kim 2013): all four reviewed randomised controlled trials (RCTs) indicated that acupuncture was equal to or better than orthodox treatments, or that it added extra effect to them when used in combination. Three of the four are Chinese studies that used earthquake survivors and one similar RCT (Wang 2012) was too recent to be included in the review. It found that both electroacupuncture and paroxetine resulted in significantly improved scores for PTSD, but that the improvement was greater with electroacupuncture. There is also some evidence that the acupuncture effects may continue for at least a few months after the treatment course is finished (Hollifield 2007).
A review that looked at the effects of combining brief psychological exposure with the manual stimulation of acupuncture points in the treatment of PTSD and other emotional conditions found evidence suggesting that tapping on selected points during imaginal exposure quickly and permanently reduces maladaptive fear responses to traumatic memories and related cues (Feinstein 2010).
Kim’s review (Kim 2013) also included two uncontrolled trials (they too had positive outcomes). A more recent uncontrolled pilot study found that acupuncture appeared to be a therapeutic option in the treatment of sleep disturbance and other psycho-vegetative symptoms in traumatised soldiers (Eisenlohr 2012).
Although more high quality trials are needed to substantiate these results, the overall evidence does lie promisingly in a positive direction, and, given the very low level of side effects and lack of demonstrably superior outcomes from other interventions, acupuncture could be considered as one possible therapeutic option alongside the existing repertoire. (See table overleaf)
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being.
Research has shown that acupuncture treatment may specifically benefit anxiety disorders and symptoms of anxiety and stress by:
- Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010);
- Regulating levels of neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brain’s mood chemistry to help to combat negative affective states (Lee 2009; Zhou 2008);
- Stimulating production of endogenous opioids that affect the autonomic nervous system (Arranz 2007). Stress activates the sympathetic nervous system, while acupuncture can activate the opposing parasympathetic nervous system, which initiates the relaxation response;
- Reversing pathological changes in levels of inflammatory cytokines that are associated with stress reactions (Arranz 2007);