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Ask an expert - neuro and psycho logical - anxiety

18 questions

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.

A:  As our fact sheets show

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/anxiety.html

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/headache.html

there are growing bodies of evidence suggesting that acupuncture is a beneficial treatment for all the things from which you suffer. The evidence, while good, is not quite to the standard which means we could say unequivocally that you would benefit, but this is as much a comment on the kind of research which is demanded rather than the quality of the results themselves. Randomised double blind control trials are good for pill testing but not so effective with treatments with many variables, like acupuncture.

The great strength of Chinese medicine, however, is not that it treats this or that condition, but that it treats the person. This is why twenty people with headaches may be treated twenty different ways. Clearly some points will have a direct effect, but treatment is not the equivalent of an aspirin, and the practitioner will be at pains to discover why this symptom appears in you and not in someone experiencing similar external stresses. The best treatment always combines treating the symptoms within the context of their overall pattern, and the pattern is the primary factor. Indeed, in ancient times some of the older systems used to treat the people without necessarily taking any notice of individual symptoms, in the simple but effective belief that a system in balance took care of its own problems.

The best advice we can offer is that you visit a BAcC member local to you, and see if they are prepared to give up a little time without charge to discuss whether your specific presentation. Anxiety and depression are rather broad labels which cover a huge range of possibilities, and sometimes we have to say to patients that what they are dealing with requires more of a talking therapy approach than we can offer. Given that it is rare for mental and emotional issues to arise without accompanying physical changes, even where these do now generate symptoms, a practitioner of Chinese medicine may well be able to see overall patterns which give them confidence that they may be able to help.

It can be a real challenge, however, to set meaningful targets for change - some days you may feel good, other days not so. Diaries and written commentaries are often a feature of seeing whether things really have changed; we all tend to forget good days last week if today started badly.

We have seen a number of articles published in the popular press in the last few years which show that acupuncture treatment for these types of problem appears to have worked, and in theory there is no reason why it shouldn't work for you too. We hope that it may.

Q:  I think I have been suffering with anxiety and depression for 4 years.  I am going to see a mental health doctor also I will be having a mri scan shortly to see if there is anything else wrong.I am wondering if acupuncture may help?

A:  We have produced factsheets on both of these areas:
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html
 
and

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/anxiety.html
 
which give some cause for optimism, as does a heavily publicised research trial by BAcC member Hugh Macpherson and colleagues published very recently
 
 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001518

 

There is also a link on our home page today to a new study about anxiety


http://www.acupuncture.org.uk/public-content/public-pr-press-releases/3546-anxiety-the-silent-sufferers.html


However, we could do worse than reproduce the text of a piece we provided for Anxiety UK some months ago.


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 always, though, we still think that the best advice we can give is that you contact a BAcC member local to you to see if acupuncture would be appropriate for your own unique circumstances. 

We think that this remains sound advice, although the fact that the doctor has ordered an MRI scan does leave open the possibility that were factors involved in the onset and not mentioned in your question which may point to a physiological basis. However, in cases where there is a clear external cause the problems tend to be self-generating, i.e. people who are anxious start to become anxious about being anxious, so even when a physical cause has been identified a pattern may have developed where the anxiety continues.

In any event, acupuncture treatment will certainly do you no harm and the style of the consultation, which usually allows patients a great deal of time to talk through the issues which affect them can often be very helpful in itself.

 

Q: Does acupunture work for anxiety disorder I take a mild antidepresent but they don't help.

A:  A:  We have produced factsheets on both of these areas:
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html
 
and

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/anxiety.html
 
which give some cause for optimism, as does a heavily publicised research trial by BAcC member Hugh Macpherson and colleagues published very recently
 
 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001518

There is also a link on our home page today to a new study about anxiety

http://www.acupuncture.org.uk/public-content/public-pr-press-releases/3546-anxiety-the-silent-sufferers.html

However, we could do worse than reproduce the text of a piece we provided for Anxiety UK some months ago.

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 always, though, we still think that the best advice we can give is that you contact a BAcC member local to you to see if acupuncture would be appropriate for your own unique circumstances. 

As far as finding someone in your area is concerned, there is a postcode search facility on our home page www.acupuncture.org.uk which will enable you to find the nearest available practitioner - entering 'Dagenham' may not pick put a practitioner who is much closer but lives just over a town border. The best thing to do is to see if the practitioners near you are willing to spend a little time with you to discuss whether acupuncture treatment may be the best option. Most are very honest; if they think there are better options for you they will say so. The majority, though, treat a great many people with anxiety and depression, sometimes as a main complaint and sometimes alongside a main complaint.

The only caution is that conditions like this can have good days and bad days. This can make it a little harder to work out whether things are getting better, so it's always good to identify things which happen in your life where changes in how you feel or respond will be clearer.

 

Q: I'm a 57 year old male, and suffer from hypertension.  In my capacity as an electrician, I have on two different occations worked in a Chinese surgery where two different practitioners have advised me that after 10 to 12 sessions of accupuncture I can come off my blood pressure medication. What are your thoughts on this?

The factsheet on our website  outlines a number of systematic reviews and randomised control trials which show some positive evidence for the effect of acupuncture on hypertension/high blood pressure. Taken as a whole the evidence is not quite good enough for us to make unequivocal claims for the efficacy of treatment, but there are certainly a great many patients who, alongside their western medication, use acupuncture regularly to help to maintain a relaxed approach to life and to help to break the cycle of anxiety/tension leading to high BP leading to anxiety/tension into which people can become 'locked'.
 
Clearly the ancient Chinese did not have sphygmomanometers to measure blood pressure, and the diagnosis of the patient rested on the symptoms raising from the high BP which they experienced and some of the signs which a Chinese medicine practitioner looks for when taking the pulse at the wrist, looking at the tongue and a number of other indicators of imbalance. Not surprisingly the overlap between high BP and some of the syndromes into which the symptoms are grouped is very imprecise. This is one reason, for example, why research can prove problematic because the same reading of the BP in 20 patients can arise from 20 different diagnoses in Chinese medicine, which is not helpful if you're trying to standardise all the elements in a piece of research.
 
The best course of action, as we say in nearly every response, is to visit a local BAcC member and ask their advice face to face. There are no rules about how many sessions someone should have for a condition, and a great deal will depend on whether in the practitioner's view the problem is a part of a much deeper pattern of distress or whether there are simple problems like blockages in the energy flow which mght be the prime cause. All that we ask our members to do is to remember to set reasonable outcomes, to review treatment regularly and certainly to review progress after four or five sessions to ensure that it is worth continuing and to make sure that the patient is happy to keep coming in.  
However, we would add that from a conventional medical perspective there are many reasons why someone can have high blood pressure, and not all of them are capable of resolution. Some may be managed effectively with a combination of medication and acupuncture, and some are capable of management by acupuncture alone. The chances that the problem can be solved once and for all are not that high that one could predict this outcome with confidence.
 
Of course, it may be that the Chinese doctors whom you saw recognised factors which from their perspective gave them confidence that you hypertension could be dealt with once and for all, but even if this were the case any reduction in medication needs to be managed carefully with the co-operation of your GP. The risks from sudden withdrawal from medicines which control your BP can be considerable, but there os no reason why a carefully monitored programme of reduction should not be possible.
 


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