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Ask an expert - neuro and psycho logical - anxiety

18 questions

A: Let's start with the relatively easy part of the question. Charges for acupuncture treatment vary across the country, and also vary within a region. As with all businesses, if the surroundings are in the more expensive area of town then the overheads will be greater and the cost will reflect this.

A first session of acupuncture can take up to an hour and a half while the practitioner gathers a great deal of information. In the Greater London area the cost of this is probably going to fall within a band from £50-£70. Subsequent sessions can be anything from half an hour to an hour, and the charge will be in the £40-£60 range. Outside London this might be close to £40-£60 for the first session, and £35- £50 for subsequent sessions.

There is an increasing number of what are called multibed clinics to try to make acupuncture more accessible to people who might find the costs a little steep, and while the treatment will be very similar it will take place in a group setting. Some people like this, others want a greater deal of privacy.

The number of sessions is impossible to say; each case is unique and different. What we would expect is that a practitioner reviews progress after the first four or five sessions, and proceeds from there with the full agreement of the patient. What has to be avoided is a kind of habit energy which leads to weekly bookings extending over months. It does happen! It is also important to try to establish effective measures of progress. Anxiety sufferers have good days and bad days, and it is helpful if there can be something which will let both patient and practitioner know that things changed. Otherwise it might depend on how someone feels that day, which is not a good marker.

As far as the value of treatment, we answered a similar query recently as follows: 

We produce a number of factsheets on the treatment of named conditions with acupuncture, one of which is on anxiety

The evidence is fair, and would appear to justify giving acupuncture treatment a go. It certainly won't do any harm, and will very possibly help.  Most of us treat a substantial number of patients with anxiety, although it would be fair to say that many come along for a different problem and find their anxiety lifting against their expectations. This does not surprise us; traditional acupuncture treats the person, not the condition, and it is quite common for people to feel 'better in themselves' after treatment for something as prosaic as sciatica or headaches. Obviously some of the 'feeling better' will be 'not being in pain', but people are very good at recognising the difference between not feeling pained and having a renewed spring in the step.

We wrote an article for Anxiety UK a couple of years ago, and we reproduce it here because it is a worthwhile summary of what we are trying to achieve:  ANXIETY AND ACUPUNCTURE

Anxiety is more than just being anxious. Just as migraine sufferers get righteously indignant when someone claims to be a fellow sufferer but can still get to work, eat and stand the daylight, so anxiety sufferers know that they bear only the slightest resemblance to people who feel a bit nervous or have ‘butterflies in the tummy.’ Clinical anxiety is a crippling affliction which can sometimes defy all of the medications and talking therapies that someone can throw at it.

Why, then, has acupuncture been found to be successful in treating it? The main reason is that in conventional medicine, there is no single treatment for each sufferer as each person has differing symptoms. However, in traditional acupuncture every patient is considered to be unique, and this means that the practitioners will be looking and listening very carefully to everything that the patient says to establish a diagnosis and find the specific keys to unlocking the patterns of the symptoms the patient is suffering. They will aim to identify the imbalances which cause the symptoms of anxiety, not just treat the symptoms themselves. This whole ‘package’ – taking the patient’s individual story seriously and giving them time to tell it, trying to hone precisely the diagnosis, and selecting the optimum way to use the least needles to achieve the greatest effect – has been found to be very effective.

The theory of traditional acupuncture is very straightforward. The free flow and internal balance of energy (Qi) is seen in eastern medicine as essential for good health. Any prolonged exposure to extremes or intense situations, be they physical, mental, emotional or spiritual, will cause the flow and balance to be affected. This disruption in balance then ripples through the whole system, causing symptoms which sometimes bear little apparent relation to the underlying causes. An acupuncturist’s skill lies in making sense of seemingly unconnected symptoms and understanding the unique nature of someone’s energies in such a way as to restore balance. A treatment plan may simply involve needles and moxibustion, the use of a warming herb, and tui na, a form of traditional Chinese massage, but can extend to address issues in someone’s diet, their exercise patterns and their lifestyle.

People sometimes ask why, if acupuncture is so successful, there isn’t much research to back up its claims and make it more freely available within conventional care. A major reason for this is the unique nature of treatment which resists putting people in pigeon holes and which changes as the person’s balance begins to improve. Both of these confound attempts to organise research according to western models where a named condition receives a single treatment and all other variables are taken out of the equation. In Chinese medicine the variables are called patients!

Where do our patients with anxiety come from? Word of mouth still remains the most common and most reliable form of referral, and more people have had acupuncture than you think. If you ask around your support groups you are almost certain to find someone who has tried acupuncture and found that it works. Perhaps this time it’s your turn!

People also usually want to know whether the treatment will ‘stick’, whether they have to keep on having acupuncture. Some don’t – a single course of treatment can set them on a good path which, as long as their life remains well-balanced and relatively stress-free, means that they will stay anxiety-free. Many, though, like to keep ‘tuned up’, and realise that spending a fraction of what they spend on keeping their cars roadworthy keeps the driver in good shape too.

As far as the number of sessions  is concerned it is very difficult to say.  Some people respond quickly and well, while others make only very slow progress. The key thing is to ensure that there really is some progress rather than just treating away month after month, and for this it would be important to set down some measurable outcome markers to know if things have changed. Anxiety is not consistent; sometimes people feel OK, sometimes they don't. Trying to find something which is based more on intuition and feeling is hard. The main thing is to establish when and whether to stop if the treatment is not producing much in the way of change.

Invariably we advise people to visit a local BAcC member. So much depends on the individual nature of someone's balance and energy that it is very hard to give generic answers offering precise advice. Most members are happy to give up a little time without charge to discuss what treatment may offer, and we are sure that you will enjoy talking to someone about what treatment may be able to offer you. 

A:  We would perhaps need a little more information before we could give a more definitive view.

 We imagine that by 'fear in certain situations' you might mean a specific phobic response, like to heights, dogs or even some people! A great deal would depend on whether the fear was consistent with some of the patterns in the body's energy, and therefore a rather more extreme reaction of a kind which was commonly experienced, or whether it was caused by a specific primary event. If it was the latter we suspect that other forms of treatment like hypnotherapy or even cognitive behavioural therapy might be a more precisely targeted response.

 That said, the word 'appropriate' appears in a great many explications of ancient texts, and arises from a basic premise that a person in balance will experience all emotions in reasonable proportion to the circumstances which cause them, Everyone grieves when they lose a loved one, but to grieve for twenty years or to not grieve at all would be unusual reactions. Of course, no-one is in perfect balance, and there are many imbalances which predispose people to have rather unpredictable emotional responses in certain situations or occasionally a stuck response, 'angry at everyone and everything.' In such cases, there may well be remedies within Chinese medicine which can point to ways of balancing the system up and reducing the impact of some of the emotional responses.

 In short, if the fear which you experience in some cases is an extreme case of a pattern which tinges all of your experience then acupuncture treatment could well help. The best thing to do, though, since we do not really have enough to go on here, is to contact a BAcC member local to you for advice. Most are very happy to give up a little time without charge to discuss whether treatment would be of benefit, and they will also almost certainly know of reputable therapists in other fields if they think that something like hypnotherapy would be a better bet.

Q: I have PTSD. I know acupuncture would not treat this, but could it help with the anxiety and sleep problems I have?

A: Strangely enough there is a small but growing amount of evidence that acupuncture treatment can be effective for PTSD. We found this 2013 systematic review

which looks at all the evidence from all the existing studies, and makes some encouraging noises. The conclusions to nearly all reviews of this kind are that larger and better designed studies are needed, but what evidence there is is quite positive.

There is no doubt that acupuncture treatment has been used for some of the component parts of PTSD, notably stress and anxiety, as well as with sleep problems. We have a number of factsheets on our website

which gather the evidence together, and we have answered a great many questions on all three which you can find rather easily through typing any into the 'site search' option on our home page.

What we invariably say in nearly every case, though, is that it is important to visit a local BAcC member for an informal chat to get a view about whether treatment can help your specific problems. PTSD can manifest for all sorts of reasons, and all of us will have treated patients over the years who have been badly affected by accidents, injuries and family traumas. There are ways of interpreting some of these through the diagnostic categories of Chinese medicine which can offer direct treatment options of specific energetic changes, not just an easing of symptoms over time. Each case is unique, though, and needs to be addressed as such.

Talking to a local BAcC member (and most of us don't charge for a short chat with a prospective patient) can often give the practitioner a better idea than we can offer here of whether treatment may work, and has the added advantage that you can meet them and see where they work before committing to treatment. The nature of PTSD is that when someone tries to address the issues involved, as invariably happens during the course of treatment, the patient needs to be able to trust the practitioner as someone they can do business with. If that rapport exists it can really help things along, as much as the converse is true. It is probably better to chat to two or three people to see where the best 'fit' is than to just go to the first or nearest. We are not counsellors, but we do listen intently, and for someone to feel that they can talk openly about their problems their often needs to be a good level of basic rapport.

Q:  I am interested in having acupuncture as I am suffering from a dissociative condition called Depersonalisation Disorder at the moment, and - in order to aid my recovery - am trying to reduce my anxiety levels. I am taking some anti-anxiety medication (Venlafaxine) and am on the waiting list to be seen by a specialist at The Maudsley but, in the meantime, thought it worth pursuing some other avenues. I just read the following on your website which prompted me to get in touch:

Research has shown that acupuncture treatment may specifically benefit anxiety disorders and symptoms of anxiety 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; Samuels 2008; Zhou 2008; Yuan 2007). Would you suggest I pursue acupuncture?

A:  The information which you quote is probably the least representative material on our website of what we actually do. There has been a considerable amount of research into acupuncture looking at the effect of treatment on specific chemical and hormone balances in the body, and unsurprisingly sticking needles in people does tend to change these. However, the acupuncture used in the studies is often very much formula/cookbook style of treatment (it has to be to meet the criteria for the gold standard of medical research, the randomised double blind control trial), and our usual take on this is to ask how much better the results would be if the treatment was tailored to the individual needs of the specific patient, as our work always is.

We do treat many patients with anxiety, as you know from looking at the factsheets where the information you quote comes from. However, we always take great care to understand what someone's experience of anxiety is, what it actually means to them to be anxious. Some people find this kind of talk odd, but disease labels like anxiety and depression can mean vastly different things to different people, and the pathological changes in someone physical, mental and spiritual functions can be very different and point in an almost limitless direction of potential treatments.

DPD is an odd condition, but it will not surprise you to know that that ancient Chinese had ways of understanding the feelings with which you may be familiar, such as the dissociation and feeling of being outside oneself. That does not necessarily mean that this offers treatment solutions in the modern world, but the way in which you experience some of the episodes may greatly enhance a practitioner's understanding of what is going on.

We think that there would be no harm in trying acupuncture, but we would very much recommend that before committing to treatment you arrange to meet a practitioner or number of practitioners in your area. You may find that some will be reluctant to take your case on; some may feel that it is not within their scope of practice or limits of competence. However, most will, and it would give you a chance to meet them and see where they work before committing.

Q: Two questions; the first, could you tell me the procedure for acupuncture to treat anxiety and second, could you tell me of any specialist acupuncturists that treat anxiety in my area. I live in Newark on Trent NG24.

A:  This may seem a little bit of a non-answer but there are no specific procedures for treating anxiety, nor specific points used for the treatment. The great strength of Chinese medicine is that it treats every person as a unique individual, and treatment is accordingly personalised to the unique needs of each individual. Western disease labels are useful but far too inclusive, and a practitioner of Chinese medicine will want to know exactly how you experience anxiety. There is a cluster of possible symptoms, and seen from a Chinese medicine perspective these will illuminate a diagnosis about how the system as a whole is coping. Treatment is then primarily aimed at restoring balance to the whole system in the simple but effective (from our point of view!) that a system in balance sorts itself out.

There are obviously some parts of the system which are more likely to be implicated in the usual suspects of anxiety, like palpitations, insomnia or panic attacks, but in Chinese medicine the symptom and the cause are rarely the same thing. Treating symptoms after a cook-book formula style may buy someone a little bit of remission, but will not be as effective as treating the underlying problem. This is where the true skill and art of the practitioner lies.

It also follows that there are no specialists in this area. We are all equally well trained to treat people, whatever their specific symptoms. There is a small number of areas like paediatrics and obstetrics where we are in the process of recognising what counts as expert practice, but we do not anticipate defining expert practice in areas like anxiety or depression for the foreseeable future. In fact in ancient China the specialist was somewhat looked down on for only treating a small range of problems, and the generalist was the most highly esteemed.

If you use the postcode facility on our home page you will be able to find a number of practitioners who are geographically closest to where you live. Most are more than happy to afford you a short time without charge to discuss how acupuncture may be of benefit to you, and this will give you an opportunity to meet them and see where they work, which many prospective patients find very reassuring.


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