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Ask an expert - neuro and psycho logical - anxiety

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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
 
andhttp://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. 

A:  A great deal depends on the precise definition of 'panic attack' which you use. It's the same as with people suffering from 'anxiety'; as a disease label it is far too imprecise because it tells you very little about what they actually experience.

Certainly from a western or conventional medical perspective, the lack of precision in the definition is a factor which has made for very little research in this area. There are no significant studies of which we are aware which would allow us to make any claim, however much qualified, about whether acupuncture may help. On the other hand, it is our experience that many people with panic attacks do benefit from acupuncture treatment, and we need to explain a little about how Chinese medicine works to understand this.

The symptoms which someone experiences remain the same whatever system of medicine one uses. The Chinese medicine system, however, is based on an entirely different understanding of the physiology of the body, and sees the whole system as a flow of energy, called 'qi', whose balance, rhythm and flow determine someone's overall state of health. The Organs, always capitalised when we talk about them in this system, all have unique functions which are much wider than their western equivalents, and the skill of the practitioner lies in being able to work from seeing the symptoms in this context and to make sense of where the flow of energy has been compromised. There are a number of diagnostic signs which are independent of symptoms which allow the practitioner to hone in on what needs to be treated. It is quite possible that two people with the same symptoms could be offered two entirely different treatments.

What you may need to do to get a better sense of whether your panic attacks are amenable to treatment is to visit a local BAcC member and see if they can offer you a brief face to face assessment in which they can see whether the specific symptoms which you experience give them a sense that your problem might be helped. The chances are that they will say yes; although each person is unique and different there are often patterns which are most associated with the main features of panic attacks and some fairly standard treatments - after all, with a 2500 year history of treatment Chinese medicine has been dealing with this sort of problem for a very long time.

The key thing is to set measurable outcomes. These will help you, if you decide to have treatment, to assess whether it is having an effect. We often encourage people to keep diaries because it is easy not to notice how much, or how little, progress there has been.

Q:  My 15 year old son has anger management problems and gets angry very easily. Recently he hurt a smaller boy at school and in the past has caused damage. Even his school admits there is time when they have to leave him alone. Youth Mental Health was a waste of time and I am trying to get our GP get bloods tests etc..can acupunture help him?

A:  There is no doubt that Chinese medicine as practised in the UK has developed something of a reputation for dealing with emotional issues. Over the last decade the use of acupuncture for problems like anxiety and depression has been researched with encouraging results. We often talk about 'inappropriate' emotions, ones which get stuck and trap the patient in a state which does not change with the circumstances of their life.
 
Theoretically the same should apply to anger. Chinese wisdom is that we house each of the emotions equally, and respond appropriately to all the vicissitudes of life. If our overall balance is out of kilter, then we exhibit inappropriate reactions which are diagnostically significant. To be angry a great deal of the time could well be traced back to specific patterns of energy, and there is a chance that correcting these patterns, in which stagnation and blockage invariably play a part, might reduce the occurrence of a problem.
 
There is, of course, no evidence for this in trials - these will be some long way back in the queue behind the more measurable health issues like headaches and backaches. Empirically, though, we know that acupuncture can help to reduce emotional problems, and there is a chance that your son might be helped by treatment.
 
However, we have to say that without a more thorough clinical assessment of what is happening to him we could not give an unreserved recommendation. If the anger is a manifestation of a much more complex psychological background you may find that many practitioners feel out of their depth in patient management, and may be reluctant to take your son on as a patient. Your best bet is to see a BAcC member local to you for a face to face assessment of what might be possible. Most members network and know which of their colleagues are better able to handle cases where some additional experience and background may be necessary, so it is likely that you will be directed to the best place for your son. 
 
As a final aside, we should point out that we have come across a number of cases such as your son's where cranial osteopathy has been used to great effect. If his birth was at all difficult there is a chance that there has been some movement in the structure of the skull, and we have heard of cases where treatment even as late as twenty years after birth can smooth the energies and have profound effects on the patient. Many women have their newborns treated by a cranial osteopath within days of the birth specifically to correct any minor traumas or mis-shaping which the birth process can cause. 

Q:  My wife  suffers from spasmophilia syndrome. Its all related to her mind status. Here you call it panic attack, but in France is well know. Its also a magnesium deficiency ,so physically sometimes she suffes from big tiredness. Especially when she has to face the long commuting. Sometimes she cant walk or the face muscle become hard then she cant talk or her eyes blur in a way that she cant see for fews minutws. My question is the following, is there any help for this?  I do not expect  a cure because the spasmophilia is pretty much impossible to cure. So I was wondering in which way  acupunture can help.

A: As you say, spasmophilia is sometimes referred to as panic attacks, although we have to say that the typical symptoms are a little more extreme than the usual panic attack patient we see.

 

 

As you can see from our fact sheets on anxiety.  Please click here

 

 

 

 

there is a small amount of evidence which suggests that acupuncture may have a role to play in treating severe anxiety, but we were unable to find any papers which dealt with the treatment of panic disorders directly, possibly because of the difficulty of pinning down a definition precise enough for research.

 

 

The strength of Chinese medicine is that working with an entirely different theoretical base makes possible a diagnosis unique to the individual patient.This is able to make sense of the symptoms which they experience through an understanding of the flow of energy in the body, called 'qi', and its flow and balance, and through a functional understanding of the organs which takes a much wider view of these functions than the west, involving body, mind and spirit. This can sometimes offer explanations for what is going on which fit well with the experience which the person has, and can also offer treatment possibilities based on this. The French acupuncturist Yves Requema, for example, makes specific reference to spasmophilia in his work, and suggests a number of treatment possibilities.

 

 

As you say, a total remission from symptoms might be a little much to expect, and this always means that you have to take care when committing to courses of treatment. In the UK we tend to set a review point at four or five sessions and try to establish some clearly measurable outcomes to assess whether the treatment is having an effect. Otherwise people can find themselves ten sessions or more in for what amount to a substantial amount of cash without any real change.

 

 

About 300 or more members of the BAcC also practise Chinese herbal medicine and belong to the RCHM, and it is possible that this may also offer a route to some lessening of the symptoms. The advantage is that small daily treatments can often produce a much better incremental effect when faced with a chronic conditions like this. Finding someone who can provide both modalities might be a very worthwhile option.

 

 

We believe that most conditions are capable of improvement, but the key question is how much improvement and how sustainable it is. If the effects are short-lived and cannot be maintained, then it is probably not worth pursuing treatment with any form of therapy, even though it might produce short periods of calm.

 

 

A:  From a Chinese medicine perspective the anxiety and the dyspepsia may form part of a much larger picture, so although a BAcC member would be very interested in your dyspepsia and exactly how it manifested, they would be equally interested in the anxiety and how that had developed and now manifested.
 
From a Chinese medicine perspective everything is viewed from an understanding of body mind and spirit as a form of energy, called 'qi', which flows in defined patterns in the body and whose rhythms and balance directly affect our health and wellbeing. There is also a very profound sense that everything is inter-connected, so where conventional medicine sees symptoms separately and even sometimes treats them separately (a counsellor for anxiety, a gastro-enterologist for stomach disorders) a Chinese medicine practitioner may see causal patterns between symptoms or more likely both symptoms coming from an entirely separate cause. Treating a symptom in isolation would be rather like turning off an alarm rather than dealing with the fire.
 
This interconnectedness means that acupuncture research, while it is helpful, rarely reflects the sophistication of the system of medicine, dealing as it does with named conditions in isolation from everything else. That said, there is some evidence that acupuncture can help with anxiety, as our factsheet shows

Please click here
 
 
and equally some evidence for the treatment of gastro-intestinal disorders

please click here
 
 
In neither case is the research data solid enough for us to lay claim to efficacy, but we have found both anxiety and digestive problems like reflux, to be among the top twenty conditions with which patients present to our members, and since most referrals come from word of mouth, this suggests that others before them have had treatment and said 'you ought to try this.'
 
There are many other questions we would need to ask before we could offer anything more definite, however, not least of which is whether you are taking medications for the anxiety and the possibility that these, from our perspective, are directly or indirectly causal in the digestive disorder. Even from a conventional perspective there are often side effects associated with anxiolytics, and it may be worth checking any leaflets to see whether this is the case. If so, you need to discuss with your doctor a possible change of tablet.
 
The best course of action is to visit a BAcC local to you and seek a brief face to face assessment in which they can tell you whether, based on what they can see, they believe acupuncture treatment may be of benefit to you.  

 


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