Source: by Joe C. Chang, MAOM, Dipl OM, LAc.
More than 1.5 million US military personnel have deployed to Iraq or Afghanistan since the start of military operations in 2001.
The purpose of this article is to evaluate the evidence for the efficacy of acupuncture in the treatment of posttraumatic stress disorder (PTSD) through a literature review of the current research. Since studies on the use of acupuncture for the treatment of PTSD are lacking, studies assessing acupuncture’s role in mitigating individual symptoms of PTSD, such as migraines, anxiety, depression, and insomnia, as well as the modulatory effects of acupuncture on the limbic system, were also included in the literature review.
More than 1.5 million US military personnel have deployed to Iraq or Afghanistan since the start of military operations in 2001.1 Approximately 300,000 Iraq and Afghanistan war veterans suffer from PTSD or major depression, and about 320,000 may have experienced at least a mild concussion or brain injury in combat, according to the RAND Corporation study titled The Invisible Wounds of War.2 According to the study, the baseline prediction of 2-year post-deployment PTSD treatment costs for a typical service member returning from Iraq or Afghanistan (an E-5 with 5 to 7 years of service) range from $5,635 to $13,935. One-year post-deployment treatment costs range from $27,259 to $32,759 for mild traumatic brain injury (TBI), and 1-year post-deployment treatment costs range from $268,902 to $408,519 for moderate or severe TBI.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classifies PTSD as an anxiety disorder that includes 3 main symptoms: re-experiencing, avoidance, and hyperarousal.3 Symptoms of re-experiencing include recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions; having recurrent distressing dreams of the event; acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated); having intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; and having physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the trauma. Symptoms of avoidance include persistent efforts to avoid thoughts, activities, places, people, feelings, or conversations associated with the trauma; inability to recall an important aspect of the trauma; markedly diminished interest or participation in significant activities; feelings of detachment or estrangement from others; and feelings of “numbness” on the inside (eg, inability to have loving feelings). Symptoms of hyperarousal include difficulty falling or staying asleep, irritability with outbursts of anger, difficulty concentrating, exaggerated startle responses, and symptoms of hypervigilance.
PTSD is complex to treat due to the similar symptomatology it shares with TBI. Among individuals with PTSD, the most common comorbidities are with depression, substance use, and other anxiety disorders.4 TBI has been associated with increased risk of psychiatric disorders—specifically anxiety, depressive disorders, and substance use.5 Additionally, PTSD was strongly associated with mild TBI in a study published in 2008 in the New England Journal of Medicine by Hoge et al.6 Overall, 43.9% of soldiers who reported loss of consciousness met the criteria for PTSD, as compared with 27.3% of those with altered mental status, 16.2% of those with other injuries, and 9.1% of those with no injuries.
With the complexities in the treatment of PTSD, the Pentagon is seeking new ways to treat troops suffering from combat stress or brain damage by researching such alternative methods as acupuncture, meditation, yoga, and the use of animals as therapy. In 2008, the Pentagon spent $5 million to study these therapies.
Only 1 published study has specifically assessed the effectiveness of acupuncture in the treatment of PTSD. It’s important to note that the research found acupuncture to be effective on civilians with PTSD, and that a majority of the 84 participants in this study (62%) suffered trauma before the age of 12, 21% experienced trauma between the ages of 12 and 17, and 17% of the participants experienced trauma as an adult.7 Participants diagnosed with PTSD were randomized to either acupuncture treatment, an integrated cognitive-behavioral therapy (iCBT) group, or a wait-list control (WLC). Compared to the WLC condition, acupuncture provided large treatment effects for PTSD. PTSD symptoms scores declined significantly from baseline to end treatment of both the acupuncture group and the CBT group. In addition, treatment effects for depression, anxiety, and impairment were similar to effects for PTSD, and both treatment groups improved significantly more than the WLC group. Symptom reductions at end-treatment were maintained at the 3-month follow-up for both interventions (iCBT and acupuncture) as compared to the WLC group.
Although studies on the use of acupuncture for the treatment of PTSD are lacking, studies assessing acupuncture’s role in mitigating individual symptoms of PTSD, such as migraines, anxiety, depression, and insomnia do exist. Results of a recent randomized, controlled trial published in JAMA investigated the effectiveness of acupuncture compared with sham acupuncture and with no acupuncture in patients with migraine.8 The research demonstrated that both the sham acupuncture and acupuncture were more effective than no acupuncture. A total of 302 patients were randomized into 3 groups: sham acupuncture group, acupuncture group, and a WLC group. Acupuncture and sham acupuncture were administered by specialized physicians and consisted of 12 sessions per patient during 8 weeks. Patients completed headache diaries from 4 weeks before to 12 weeks after randomization and from weeks 21 to 24 after randomization. Main outcome measures were the differences in headache days of moderate or severe intensity between the 4 weeks before and weeks 9 to 12 after randomization. The proportion of responders (reduction of headache days with moderate or severe pain by at least 50%) was 51% in the acupuncture group, 53% in the sham acupuncture group, and 15% in the WLC group. Similarly, Spence et al demonstrated that 10 weekly sessions of acupuncture improved anxiety, depression, and insomnia and increased urinary melatonin levels in anxious adults diagnosed with insomnia.9
Clinical and experimental data suggest that at least some acupuncture clinical results are mediated in the central nervous system.
Clinical and experimental data suggest that at least some acupuncture clinical results are mediated in the central nervous system.10,11 Functional MRI (fMRI) and PET studies on acupuncture at specific acupuncture points have demonstrated significant modulatory effects on the limbic system and subcortical structures.12 fMRI neuronal signal reduction in the limbic system is not surprising in view of the therapeutic effects of acupuncture for disorders involving PTSD, anxiety, depression, and substance abuse.13,14,15 Hui et al noted that acupuncture stimulation on a specific acupuncture point (ST36) produced a reduction in neuronal activity, particularly the limbic/paralimbic structures and limbic areas in the cerebrum (ie, amygdala, hippocampus, cingulate, septal area, temporal pole, frontal pole, ventromedial prefrontal cortex). This study could possibly explain the sedating effects of acupuncture on patients with anxiety disorders, which could be an effective treatment plan for PTSD patients with severe hyperarousal (ie, difficulty falling or staying asleep, irritability with outbursts of anger, exaggerated startle responses, hypervigilance).
Even though current research studies on the use of acupuncture for the treatment of PTSD is scarce, current research suggests that acupuncture may be an efficacious treatment option for PTSD. One randomized controlled trial on the use of acupuncture for PTSD on the civilian population demonstrated significant reductions in PTSD symptoms scores from baseline to end-treatment in the acupuncture group. Additionally, treatment effects for depression, anxiety, and impairment in the acupuncture group improved significantly more than the WLC group. Studies assessing acupuncture’s role in mitigating individual symptoms of PTSD, such as migraines, anxiety, depression, and insomnia, demonstrate significant reductions in these symptoms for the studies’ participants. Clinical and experimental data also suggest that at least some acupuncture clinical results are mediated in the central nervous system. fMRI and PET studies on acupuncture at specific acupuncture points have demonstrated significant fMRI neuronal signal reduction in the limbic system. This study could possibly explain the sedating effects of acupuncture on patients with anxiety disorders, which could be an effective treatment plan for PTSD patients with severe hyperarousal.
1 Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008;358(5):453-463.
2 Tanielian TL, Jaycox LH. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Recovery. Arlington, VA: RAND Corporation; 2008.
3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Washington D.C.: American Psychiatric Association; 2000.
4 Tanielian TL, Jaycox LH. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Recovery. Arlington, VA: RAND Corporation; 2008.
6 Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008;358(5):453-463.
7 Hollifield M, Sinclair-Lian N, Warner TD, Hammerschlag R. Acupuncture for posttraumatic stress disorder: a randomized controlled pilot trial. J Nerv Ment Dis. 2007;195(6):504-513.
8 Linde K, Streng A, Jurgens S, et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA. 2005;293(17):2118-2125.
9 Spence DW, Kayumov L, Chen A, et al. Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report. J Neuropsychiatry Clin Neurosci. 2004;16(1):19-28.
10 Hui K, Liu J, Makris N, et al. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Hum Brain Mapp. 2000;9(1):13-25.
11 Hui K, Liu J, Marina O, et al. The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage. 2005;27:479-496.
13 Hollifield M, Sinclair-Lian N, Warner TD, Hammerschlag R. Acupuncture for posttraumatic stress disorder: a randomized controlled pilot trial. J Nerv Ment Dis. 2007;195(6):504-513.
14 Hui K, Liu J, Makris N, et al. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Hum Brain Mapp. 2000;9(1):13-25.
15 Hui K, Liu J, Marina O, et al. The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage. 2005;27:479-496.
Huffington Post: 03/16/2013 10:41 am
Good news, acupuncture fans: It really does help relieve stress. And now, a new study is giving a closer look at why.
The new study explores the biological mechanisms involved in acupuncture's stress-relieving abilities, something science has yet to fully understand.
The researchers discovered that stress hormones were lower in rats that had received electronic acupuncture. Results were published in the Journal of Endocrinology.
"Many practitioners of acupuncture have observed that this ancient practice can reduce stress in their patients, but there is a lack of biological proof of how or why this happens. We're starting to understand what's going on at the molecular level that helps explain acupuncture's benefit,” study researcher Dr. Ladan Eshkevari, an associate professor of nursing at Georgetown University School of Nursing and Health Studies, said in a statement.
For the study, Eshkevari and colleagues designed a series of tests with electronic acupuncture to ensure that each rat received the exact same dose of pressure. Eshkevari targeted the spot below the knee, or the “Zusanli” point, with the needle. This area is the same in rats and humans and it is reported that stimulating it can alleviate stress and other conditions.
For the 10-day experiment, researchers split the rats into four groups. One group was a control group with no added stress and no acupuncture; one group was made to be stressed out for an hour each day but didn't receive acupuncture; one group was made to feel stressed for an hour each day but received "sham" acupuncture by their tails; and one group was made to feel stressed and received the genuine acupuncture treatment at the Zusanli area.
The body secretes an assortment of hormones into the bloodstream as a reaction to stress, which the researchers were then able to measure in the rats. They assessed blood hormone levels secreted by the hypothalamus, the pituitary gland and the adrenal gland -- together these are known as the hypothalamus pituitary adrenal (HPA) axis. They also measured a peptide involved in creatures' "fight or flight" responses, called NPY.
Researchers discovered that the "...electronic acupuncture blocks the chronic, stress-induced elevations of the HPA axis hormones and the sympathetic NPY pathway,” Eshkevari said in the statement.
Since stress has been linked with detrimental health effects includingheart disease and even brain shrinkage it’s important to study any measures to combat its detrimental nature.
How To Treat Anxiety With Essential Oils
June 8, 2015 by Cynthia Bowman
One of the most effective uses for essential oils is to treat anxiety. It’s as simple as enjoying the oil’s scent or receiving a massage with a favorite essential oil blend. A UK study of psychiatric patients diagnosed with anxiety and depressive disorders found that aromatherapy, combined with massage, reduced anxiety and improved mood over a six-month period of use.
But besides increasing calm and well-being, using essential oils to treat anxiety also reduces the chances of developing stress and anxiety-related disease and complications like sleep problems, allergies, diabetes, arthritis, heart disease and cancer.
How Essential Oils Work in Anxiety TreatmentEssential oils contain active and highly concentrated plant essences. And treating anxiety with essential oils offers quick results. According to a study conducted by scientists at the Institute of Pharmaceutical Chemistry at the University of Vienna, Germany, the healing compounds in essential oils can be found in the bloodstream as quickly as five minutes after skin application.
While essential oils can be used topically, aromatherapy, or the inhaling of essential oils, is the most powerful way to treat anxiety.
[Aromatherapy] seeks to unify physiological, psychological and spiritual processes to enhance an individual’s innate healing process. — National Association for Holistic Aromatherapy
When you smell an essential oil, cells in the nose receive the aroma molecules and send signals to the limbic system of the brain. The limbic system rules the emotions, which is why smelling certain essential oils often triggers emotions including a sense of peace, joy, contentment or excitement.
Besides triggering emotions, the limbic system is directly connected to the parts of the brain that control blood pressure, heart rate, breathing, memory, stress levels, and hormone balance. Feeding the limbic system with healing essential oils balances emotions and the functions that the limbic system controls.
Further Reading: 9 Essential Oils For Hormonal Imbalance & How To Use Them
Aromatherapy MethodsThere are many creative ways to enjoy essential oils aromatherapeutically. While high-quality candles are a popular way, here are some other ways to use essential oils for treating anxiety through aromatherapy:
When Using Essential Oils for Anxiety, Less is MoreAccording to a study published in the European Journal of Cardiology, one hundred young, non-smoking workers were placed in a room and exposed to an aromatherapy diffusion of bergamot essential oil for an hour before being measured for anxiety indicators like heart rate and blood pressure.
Results showed reduced blood pressure and heart rate for between 15 and 60 minutes after the start of exposure. “Our results suggest that exposure to essential oil for 1 hour would be effective in reducing heart rate and blood pressure,” said Dr Chuang.
Don’t overdo it, since exposure longer than an hour does not improve results and may actually over-stimulate you, creating the opposite effect.
Which Essential Oil Should You Use for Anxiety?
It’s often a matter of preference, since essential oils elicit emotional reactions unique to each person. If an essential oil uplifts your spirits, chances are it’s helpful in treating anxiety. Five of the most commonly used essential oils for anxiety include:
1. Clary sage
A 2010 research study conducted by the Department of Basic Nursing Science, Korea documented that clary sage essential oil has antidepressant-like effects useful after highly stressful situations. The same department also found that clary sage may even be more powerful than lavender for anxiety treatment in women.
Bergamot is part of the citrus family and is fresh and uplifting. A study conducted using bergamot essential oil concluded that even ten minutes of weekly inhalation of bergamot oil resulted in a significant reduction of blood pressure and heart rate, while balancing nerves and reducing anxiety. The study authors selected elementary school teachers known to work under significant stress as their subjects.
This plant’s name comes from the word angel. Folklore claims that an angel revealed the plant’s healing properties to a monk during a time of terrible plague.
A study involving three different lab tests with mice comparing the effects of angelica essential oil versus the anti-anxiety drug diazepam concluded that both angelica oil and diazepam create an anti-anxiety effect. The important takeaway of this study is that angelica oil is as effective in treating anxiety as its drug counterpart, but more natural and side effect-free.
4. Sweet orange
While all citrus essential oils are uplifting and great to combat anxiety and depression, Yale Scientific cited a study from the Mie University School of Medicine that found that patients with depression needed smaller doses of antidepressant medications after citrus aromatherapy treatments like sweet orange essential oil.
Perhaps the most versatile and popular of all essential oils, lavender is great for relaxation, heart health and well-being in general. There are many studies proving the effectiveness of lavender on stress, depression and anxiety.
A study showed that lavender essential oil aromatherapy reduced serum cortisol, which plays a main role in a healthy cardiovascular system and how the body responds to stress. The researchers concluded that, “These findings suggest that lavender aromatherapy has relaxation effects and may have beneficial acute effects on coronary circulation.”
Lavender essential oil is an effective substitute for anxiety medications. Researchersinvestigated the use of lavender for Generalized Anxiety Disorder. An oral lavender oil capsule preparation taken over six weeks was shown to effectively relieve generalized anxiety comparable to lorazepam, a powerful anti-anxiety drug.
Essential Oil Tips for Anxiety From the Experts
With all the options available in treating anxiety with essential oils, it’s time to put the studies to practice. We’ve asked 12 experts about their most effective ways to use essential oils in the treatment of anxiety. Here’s their advice:
1. Mitra Shirmohammadi
Registered Holistic Nutritionist and founder of Nutriholist.com
Essential oils can have a very powerful effect on our mood, emotions and behavior. For anxiety, essential oils such as Bergamot, Basil, Clary Sage, Frankincense, Lavender, Marjoram, Palmarosa and Ylang Ylang have been shown quite helpful.
2. Audrey “Christie” McLaughlin, RN
Registered Nurse and Certified Clinical Medical Assistant, wholebeingRN.com
Christie works with every age range from kids to the elderly to reduce anxiety including fear of flying. While each approach is different, Christie suggests, “Depending on the client, several different modalities may be used from topical to aromatic or even reflexology points,” when using essential oils.
3. Val Silver
Holistic Wellness Educator and Coach, holistic-mindbody-healing.com
Val loves using essential oils to treat mild to moderate anxiety:
My favorite EO when feeling stressed or anxious is lavender. Rose is also beautiful. Just the act of slowing down and taking a slow deep breath of the oil from my warmed cupped palms calms me down. I love to take an EO breath break when feeling stressed, overtired or anxious at work.
4. Nancy Illman
Plant-based Energy Healer, about.me/nancyillman
Nancy is a Harvard graduate and former attorney who now works with clients to achieve better health and happiness in their lives. She leads a mood management class in Takoma Park, MD on Wednesday evenings in which she helps people learn to find the right essential oils for their needs.
She is particularly fond of vetiver, a grass found in Haiti that is often used in men’s fragrances. Vetiver has been particularly helpful to herself and her clients in combating negative thoughts.
5. Marie Y. Lemelle, MBA
Publicist, Producer and Manager about.me/marie_lemelle/
Marie is a highly successful business woman managing clients and a busy lifestyle gracefully. Her anti-anxiety essential oil of choice is peppermint.
I never leave home without peppermint essential oil. I am addicted to its quick remedy to a variety of issues. I rub the oil only into the palm of my hands, cup my hands over my mouth and nose and breathe in until the feeling of anxiety, is gone. If I’m driving, I hold the open bottle up to my nose and breathe in deeply. It helps with anxiety, panic attacks, fainting, queasiness, allergies to pet dander, motion sickness, fear or uneasiness flying.
6. Sharon Dickey
Certified Health & Wellness Coach, myreasony.net
Sharon uses essential oils for anxiety daily in two ways: “I rub it directly on my skin and I diffuse it by mixing with water in a spray bottle for misting.”
7. Lewis Harrison
Healer and Spa Owner, www.TheCatskillsbedandBreakfast.com
Lewis has worked with essential oils for more than 30 years and uses a signature essential oil combination throughout his spa and private practice: “A mixture of jasmine and lavender oil works wonders for anxiety attacks. We use it in the hot tub, in foot reflexology and in atomizers.”
8. Madeline Given, CNC
Certified Holistic Nutritionist madelinenutrition.com
Madeline is a certified holistic nutritionist and essential oils user, educator and distributor. “My interest in essential oils came first and foremost from my desire to combat general anxiety.”
Her favorite soothing essential oil is cedarwood:
Cedarwood is woodsy, warm and the balsamic aroma is powerful when applied to the feet before bedtime — it includes natural compounds called sesquiterpenes that create a very comforting atmosphere when diffused.
9. Valerie Bennis
Certified Aromatherapist, Essence of Vali, http://www.essenceofvali.com
Valerie creates custom essential oil blends for her clients. She keeps an ever-growing recipe book of custom formulas with the names and profiles of the clients she created them for.
Three of my favorite oils for anxiety are: cedarwood, rosewood and spruce. They are grounding oils when one feels fragile, off-center and ridden with anxiety. Massaging the feet after mixing these oils in a carrier is very beneficial. Bathing with essential oils and using an aromatherapy mist will also take the edge off anxiety.
Valerie also suggests a drop of a favorite essential oil on the corner of a pillowcase for a good night’s sleep.
10. Denise Baron
Wellness Educator and Reikki Master, Ayurvedaformodernliving.com
Denise is a lifestyle expert, wellness coach and author of the upcoming book, Nourish, Heal and Discover. She took interest in essential oils in order to help her sister through anxiety and depression.
Denise uses a range of oils for her clients and friends but advises that, “What works for one may not work for another. Also take into account what season it is.”
11. Tony DeYoung
Digital Marketing and Growth Hacking Consultant, Hello Heart App
Tony combines the time-tested art of essential oils with the latest in high-tech innovation like the Hello Heart app for the iPhone and Apple Watch. “At Hello Heart, we research many non-pharmaceutical options for people with high blood pressure to actually try. We look at food, exercise and even essential oils,” he states.
Tony suggests using essential oils’ anxiety reducing properties to enhance heart function:
Apply [essential oils] using a coconut oil based salve and apply to reflex points for the heart like the sole of the left foot, and below the ring finger of your left hand.
Want to try any of the essential oils mentioned in this article to help treat anxiety? You can purchase all of the essential oils referred to in this article from this page on Mountain Rose Herbs.
"Everything has life and deserves great respect."