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    Posttraumatic Stress Disorder – Analysis of Articles

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    Chesney, M., Lao, L., Vegella, P., Magyari, T., Robertson, M. B., Berman, B., & Kimbrough, E. (2014). Acupuncture and Mindfulness-Based Stress Reduction Among Female Child Abuse Survivors: A Randomized Waitlist-Controlled Pilot Study. Journal of Alternative & Complementary Medicine, 20(5), A87–A87. https://doi.org/10.1089/acm.2014.5229.abstract

    The purpose of the present study was to examine the efficacy of mindfulness-based stress reduction (MBSR) and Acupuncture (AT) compared to Wait-List Control (WLC) among female child abuse survivors to reduce psychological distress. Wait list control is where participants do not receive active therapy and are put on a wait list. Methods: Eighty-three adults were randomized to receive one of the three treatments. Treatments were done for 8 weeks. Results were measured using self-report assessments, including the PTSD Checklist (PCL), the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Inventory (PSQI) and the Mindfulness Attention Awareness Scale (MAAS).

    These assessments were conducted at baseline, 4, 8 and 12 weeks. The results showed that both MBSR and AT significantly improved mindfulness and depressive symptoms but the effect was not continued at 12 weeks. AT significantly improved PTSD symptoms and sleep quality. The researchers who performed the study concluded that the results merit additional exploration of acupuncture for mindfulness, and claim that the study of this therapy is important for this patient population.

    Hollifield, M. (2011). Acupuncture for Posttraumatic Stress Disorder: Conceptual, Clinical, and Biological Data Support Further Research. CNS Neuroscience & Therapeutics, 17(6), 769–779. https://doi.org/10.1111/j.1755-5949.2011.00241.x

    The purpose of this paper was to review the potential value of acupuncture and demonstrate the need for additional research regarding acupuncture for PTSD. The paper offers background on “modern western medicine’s” view of PTSD including variables, causal events, and pathology. The same sections are also presented from the viewpoint of acupuncture and traditional Chinese medicine. Cognitive behavioral therapy (CBT) is presented as the traditional widely accepted treatment it is however associated with nonengagements and high withdrawal rates. This paper compares CBT with acupuncture and indicated that acupuncture therapy also had significant reduction in symptoms similarly to CBT. In addition 63% of those treated with acupuncture no longer met DSM-IV diagnostic criteria for PTSD.

    Symptoms remained reduced for 3 months post treatment. The review also interestingly mentions differences in results for males and females which is explained by differences in the limbic-paralimbic-neocortical network. The paper addresses how acupuncture effects systems relevant to PTSD pathology including the CNS and neural pathways, the HPA axis, the ANS, genetics, as well as inflammation. The detailed descriptions on how acupuncture effects each of these symptoms is helpful to explain the mechanism of the treatment’s effects on PTSD. The paper concludes that both Chinese medicine and modern western medicine view PTSD as a complex illness however comparative clinical trials are needed in order for the use of acupuncture to be supported as healthcare for PTSD.

    Hong, C., & Efferth, T. (2015). Systematic Review on Post-Traumatic Stress Disorder Among Survivors of the Wenchuan Earthquake. Trauma, Violence & Abuse, 17. https://doi.org/10.1177/1524838015585313

    This review article explored PTSD cases from the 2008 Wenchuan earthquake including epidemiology, neuropathology, biochemistry, genetics, and treatment approaches such as phytotherapy, Chinese herbs, and acupuncture. The review states that acupuncture is extensively used to treat trauma and symptoms such as insomnia. Studies mentioned indicate that acupuncture is effected for treating trauma, headaches, depression, anxiety, chronic pain, and disturbed sleep. In addition the use of electroacupuncture was shown to have greater improvement in patients with PTSD than paroxetine alone. The paper gives an analysis of the assessment methods and different scales used to evaluate PTSD that are often also used in these studies to determine improvement of symptoms.

    The authors claim that there is no consensus regarding the reliability of these scales and larger sample sizes are necessary as well as standardized methods. They recommend that Chinese herbs and acupuncture have promising effects but that improvements to the methodologies are necessary for standardized diagnostics and better data. Unlike other papers which have just concluded that more research is needed this paper makes the recommendations that the affected populations that are studied should be better defined regarding risk factor. They also recommend that the efficacy and safety of Chinese medicine be studied.

    Hoon B. Lee. (2015). Post-Traumatic Stress Disorder Treated with Traditional Chinese Medicine: A Case Report. Meridians: The Journal of Acupuncture & Oriental Medicine, 2(2), 23–28.

    The purpose of this paper was to provide a case study of a patient afflicted with PTSD, a condition generally treated with pharmaceuticals that can lead to dependency and/or addiction. This case identifies a 23 year old female who developed PTSD after mental and physical abuse. The medications she was initially on caused her side effects and were discontinued. Instead the treatment prescribed by Hoon included acupuncture, moxibustion, and herbal medicine for five weeks. Hoon reports that after treatment the patient was then well enough to go back to school and get a job which she previously was not able to.

    From this he concludes that Tradition Chinese Medicine (TCM) is an alternative treatment to PTSD when pharmaceuticals are not effective. The paper describes background of PTSD as well as acupuncture and gives a diagnostic assessment of PTSD from the view of TCM as well as a thorough description of the treatment and what each treatment targets. This source does provide a different view on the treatment of PTSD, one from an actual Chinese medicine practitioner. This source may be helpful for other TCM practitioners. However, this source is not conclusive evidence that the treatment is effective. It only offers an explanation of a single patient’s experience.

    Huang, W., Johnson, T., Kutner, N., Halpin, S., Weiss, P., Griffiths, P., & Bliwise, D. (2018). Acupuncture for treatment of persistent disturbed sleep: A randomized clinical trial in veterans with mild traumatic brain injury and post-traumatic stress disorder. Annals of Physical and Rehabilitation Medicine, 61, e89. https://doi.org/10.1016/j.rehab.2018.05.191

    This source explores one specific symptom of PTSD; sleep quality. Reduced sleep quality is one of the most highly prevalent symptoms associated with PTSD, and is difficult to treat. This purpose of this clinical trial is to evaluate real acupuncture as compared to sham acupuncture and its effects in persistent sleep disturbance of veterans with mTBI and PTSD. The study included sixty veterans with history of mild traumatic brain injury (mTBI) and sleep disturbance. The veterans were randomized into 2 groups and received 10 treatment sessions.

    The results were measured with the Pittsburgh Sleep Quality Index (PSQI) score, and wrist-actigraphy assessed objective sleep measurements. Those receiving real acupuncture had a global PSQI score improvement of 4.4 points and actigraphically measured sleep efficiency improvement of 2.7%. In contrast, patients who received sham acupuncture only had a 2.4 point PSQI improvement and measured sleep efficiency decreased 5.3%. The study concluded that acupuncture was effective for those with mTBI and PTSD.

    King, H. C., Spence, D. L., Hickey, A. H., Sargent, P., Elesh, R., & Connelly, C. D. (2015). Auricular acupuncture for sleep disturbance in veterans with post-traumatic stress disorder: a feasibility study. Military Medicine, 180(5), 582–590. https://doi.org/10.7205/MILMED-D-14-00451

    The purpose of this study was to assess the feasibility and adequacy of an auricular acupuncture insomnia regimen among veterans with PTSD and sleep disturbance. The study used wrist actigraphy, subjective sleep times and quality ratings, as well as the Pittsburgh Sleep Quality Index. Thirty veterans were randomly assigned treatments after 7 days of sleep data collection.

    The acupuncture intervention group received a total of 9 treatments over three weeks. Significant differences were found between the control group and the group that received acupuncture. Those who received the acupuncture treatment reported it to be an acceptable treatment. The Pittsburgh Sleep Quality Index showed improvement in the acupuncture group as compared to the control group. The researchers concluded that acupuncture treatment may improve sleep quality among veterans with PTSD however like other studies it also suggested that large scale clinical trials are necessary to examine acupuncture’s effect on sleep.

    Lijuan Huang, Wenji Luo, Hua Zhu, Shaohui Zhou, & Kuibo Zhang. (2015). Effect of Wrist-ankle Acupuncture on Post Traumatic Stress Disorder after Work-related Injury. International Journal of Clinical Acupuncture, 24(4), 251–254. https://doi.org/10.3103/S1047197915040079

    The purpose of this study was to examine the effect of wrist-ankle acupuncture on PTSD specifically after a work related injury. Sixty two patients were randomly divided into control and experimental groups. One group received only paroxetine while the other received paroxetine in conjunction with acupuncture. The researchers wanted to examine if acupuncture reduced adverse effects of the standard antidepressant treatment and improve efficacy. Results were assessed with the Clinical Administered PTSD Scale (CAPS), Hamilton Depression Rating Scale for Depression (HAMD), and Hamilton Anxiety Scale (HAMA) before, 6 and 12 weeks after treatment.

    The results showed significant differences between groups in regards to all three scores as well as the observed adverse reactions. The symptoms were relieved after one week of acupuncture treatment. The paper states that although there is no name for PTSD in Chinese medicine, there is a recognition of the symptoms as well as a long history of acupuncture used as a treatment for emotional disorders. They conclude that the treatment can improve memory and cognitive problems of those affected with mental health disorders as well as reduce the severity of adverse reactions of medication. Once again it is stated that there is a lack of large scale controlled studies and the use of acupuncture needs further research.

    Wang, Y., Hu, Y., Wang, W., Pang, R., & Zhang, A. (2012). Clinical Studies on Treatment of Earthquake-Caused Posttraumatic Stress Disorder Using Electroacupuncture. Evidence-Based Complementary and Alternative Medicine. https://doi.org/10.1155/2012/431279

    The purpose of this study was to determine the efficacy and safety of electroacupuncture on patients experiencing earthquake induced PTSD. 138 patients were randomly assigned to an electroacupuncture group or a paroxetine group. Results were measured using evaluated using Clinician-Administered PTSD Scale (CAPS), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Treatment Emergent Symptom Scale (TESS). The results showed improvement of symptoms in both groups as compared to their initial symptoms. However, they suggested that the results in the group receiving acupuncture were more significant.

    This study was quite interesting because the group receiving acupuncture treatment was not also receiving the pharmacological treatment as well and it is indicated that acupuncture alone is more effective that the traditional medication used to treat PTSD. The study also examined safety and observed a large variety of adverse effects in the paroxetine group whereas the acupuncture side effects included minor needle pain, superficial bleeding and minor hematoma. Body temperature, pulse, respiration, blood parameters, and liver and kidney function showed no significant changes after the electroacupuncture treatment. The paper concludes that electro-acupuncture is an effective treatment for many disorders and has no adverse effects. They also recommend that further research is done about the clinical and biological effects of electroacupuncture for PTSD. This paper was financially supported by The Administration of Traditional Chinese Medicine and therefore may have had associated bias.

    Wang, Y., Jiang, H., Meng, H., Li, J., Yang, X., Zhao, B.,Bao, T. (2017). Antidepressant Mechanism Research of Acupuncture: Insights from a Genome-Wide Transcriptome Analysis of Frontal Cortex in Rats with Chronic Restraint Stress. Evidence-Based Complementary and Alternative Medicine. https://doi.org/10.1155/2017/1676808

    The purpose of this study was to test whether acupuncture affects chromic stress and depression in rats. The study also explores the antidepressant mechanism of acupuncture in the frontal cortex by RNA sequencing. Differentially expressed gene analysis was used to identify response genes. Gene sets involved in inflammatory response, extracellular space, chemokine signaling pathway, TNF signaling pathway, and Toll-like receptor signaling were identified.

    The frontal cortex genome wide transcriptomes in depressed rats under chronic stress was investigated using RNA sequencing and suggested an antidepressant effect of acupuncture. It was determined that the effect of acupuncture is achieved by affecting multiple targets which explains why it may be more effective in treating psychosis than drug therapies which have only a single target. The study indicates that not only does acupuncture have an antidepressive affect in rats but also determines part of the mechanism of the effect. Depression is an important symptom of PTSD however a study in rats cannot be immediately applied to humans.

    Wen, X. et al. (2018). Randomized single-blind multicenter trial comparing the effects of standard and augmented acupuncture protocols on sleep quality and depressive symptoms in patients with depression. Psychology, Health & Medicine, 23(4), 375-390. https://10.1080/13548506.2017.1363399

    The purpose of this study was to compare standard and augmented acupuncture of depression and sleep disturbances. 140 cases with clinical insomnia were randomly assigned to groups and received two sessions weekly for six weeks. Symptoms were assessed at baseline, week three, the end of treatment, and four weeks post treatment. The results were measured using PSQI and HAMD scales. It was seen that the augmented group had more significant improvement than the standard group. Improvement stopped after treatment.

    The augmented treatment included the insertion of intradermal needles after removing the standard treatment needles. This was aimed to extend the treatment effect. They found that the augmented treatment had advantages for treating sleep disturbances and depression. This paper may indicate that extended acupuncture treatments are effective however it may not provide the most relevant information for my research question, and therefore most likely will not be useful for my research review.

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    Posttraumatic Stress Disorder – Analysis of Articles. (2022, Nov 29). Retrieved from https://artscolumbia.org/posttraumatic-stress-disorder-analysis-of-articles/

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