| ObjectivesA randomized controlled study to assess the efficacy and safety of acupuncture for PTSD among Chilean people who suffer from bereavement.MethodsParticipantsNinety patients with traumatic stress disorder who met the inclusion criteria were recruited at the local outpatient clinic of the South American School of Traditional Chinese Medicine in Chile,following a promotion by Fundacion Mariposas.90 patients were included,with 2 shedding,and 88 valid cases were finally included.The study population was divided by random number method into an acupuncture group(44 cases),a control group(44 cases).TreatmentsThe acupuncture group was treated with basic treatment+acupuncture;the control group was treated with basic treatment+sham acupuncture.Basic treatmentsThe basic treatment is mainly psycho-dynamic,including cognitive behavioral therapy(CBT),Beck cognitive therapy and group psychotherapy.It consists of three components:group confessions and listening,identification of automatic thoughts and cognitive errors,and mutual empathy and soothing.Each session lasts 2 hours,twice a week,for a total of 10 sessions.AcupunctureSelection of acupuncture points:GV20(Baihui)and EX-HN 1(Sishencong)are selected as the main acupuncture points,and the supporting acupuncture points are selected as BL13(Feishu),BL15(Xinshu),BL19(Ganshu),BL21(Pishu)and BL24(Shenshu).Operation:The operating environment is in an acupuncture clinic or other quiet and comfortable environment.The subject is asked to assume a comfortable prone position,and the operator’s fingers and acupuncture point skin are disinfected before the needle is flicked in.The acupuncture point on the head was inserted flat at 0.3～0.5 inch and the acupuncture point on the back was inserted straight at 1.0～1.5 inch.After entering the needle,twist it slightly and stop when the Qi is obtained.The needles are left in place for 30 minutes and then removed.During this time,the patient is irradiated with an infrared therapy device to avoid getting cold.Treatments are given twice a week for a total of 10 treatments.Sham acupunctureAcupoint selection and positioning were same as the acupuncture group.Operation:The operating environment is in an acupuncture clinic or other quiet and comfortable environment.A disposable flat-tipped needle with a tube is used and the participant is instructed to assume a comfortable prone position.After the operator’s fingers and acupuncture point skin have been sterilized,the end of the needle is flicked with a tube needle.The patient’s skin is gently pressed with the needle but not pierced into the body.The head and back acupuncture points are twisted slightly so that the patient has the sensation of being pricked by the needle,but without the needle actually penetrating the acupuncture point.The treatment is held for 30 minutes without leaving the needle in place,during which time the patient’s back is irradiated with an infrared therapy device to avoid getting cold.The patient is treated twice a week for a total of 10 treatments.Evaluation timing and indicatorsBefore treatment(before the 1 st session),in the middle of treatment(after the 5th session)and at the end of treatment(after the 10th session).The CORE-10 scale was used to observe the differences in efficacy within and between groups at different time points,and the different dimensions within the CORE-10 scale were stratified for analysis.Adverse effects and side-effects experienced during the study were also recorded.StatisticsComparisons of differences between groups of statistical counts were made using the(corrected)chi-square test as appropriate for the type and distribution of the data;rank sum tests were used for hierarchical data.For measurement data,if they conformed to a normal distribution with a uniform variance,they were statistically described as mean plus or minus standard deviation(x±s)and t-tests were used(with independent samples t-tests for comparisons between groups and paired t-tests for within groups).If they did not conform to a normal distribution,they were statistically described by quartiles(R(P25,P50,P75))and the rank sum test(Kruskal-Wallis)was used,with two comparisons within groups using the rank sum test(Wilcoxon)and two comparisons between groups using the rank sum test(Mann-Whitney).Measures at multiple time points were analysed using repeated measures ANOVA,and comparisons between groups at each time point were analysed using multivariate ANOVA.All tests were two-sided and the test level was set at α=0.05.Results1.BaselineA total of 90 patients were included in this study,with 88 effective cases and 2 shedding cases,a shedding rate of 2.2%.There were 44 cases in the acupuncture group and 44 cases in the control group.There were no significant differences in age(P=0.259),gender(P=0.338),marital status(P=0.103),duration of illness(P=0.831),kinship with the deceased(P=0.933),cause of death of the deceased(P=0.125)and educational background(P=0.692)between the two groups before treatment at general baseline,which were comparable.2.Total CORE-10 scoreThe within-group effect was statistically significant on the time dimension by the Greenhouse-Geisser test(P=0.000<0.05),suggesting a remission over time in both groups,as indicated by the Mauchly sphericity test.The time*group dimension was also statistically significant(P=0.000<0.05),suggesting an interaction between the time and group dimensions.A between-subjects effect test showed a statistically significant relationship between the two groups on the group dimension(P=0.024<0.05).This suggests that the trend in indicators over time was different between the two groups and that there was a difference in efficacy between the two groups.The reduction in overall outcome indicators before and after treatment was greater in the acupuncture group than in the control group.3.CORE-10 anxiety dimension scoreThe within-group effect was statistically significant on the time dimension by the Greenhouse-Geisser test(P=0.000<0.05),suggesting a remission over time in both groups.The time*group dimension was also statistically significant(P=0.000<0.05),suggesting an interaction between the time and group dimensions.A between-subjects effect test showed a statistically significant relationship between the two groups on the group dimension(P=0.000<0.05).This suggests that the two groups had different trends in indicators over time and that there was a difference in efficacy between the two groups.The reduction in overall outcome indicators before and after treatment was greater in the acupuncture group than in the control group.4.CORE-10 depression dimension scoreThe within-group effect was statistically significant on the time dimension by the Greenhouse-Geisser test(P=0.000<0.05),suggesting a remission over time in both groups,as indicated by the Mauchly sphericity test.The time*group dimension was also statistically significant(P=0.000<0.05),suggesting an interaction between the time and group dimensions.A between-subjects effect test showed a statistically significant relationship between the two groups on the group dimension(P=0.000<0.05).This suggests that the two groups had different trends in indicators over time and that there was a difference in efficacy between the two groups.The reduction in overall outcome indicators before and after treatment was greater in the acupuncture group than in the control group.5.CORE-10 panic dimension scoreThe variance between the two groups was not equal by the Mauchly sphericity test(P=0.016<0.05),and the within-group effect was statistically significant on the time dimension by the Greenhouse-Geisser test(P=0.000<0.05),suggesting a remission over time in both groups.The time*group dimension was also statistically significant(P=0.000<0.05),suggesting an interaction between the time and group dimensions.A between-subjects effect test showed a statistically significant relationship between the two groups on the group dimension(P=0.000<0.05).This suggests that the two groups had different trends in indicators over time and that there was a difference in efficacy between the two groups.The reduction in overall outcome indicators before and after treatment was greater in the acupuncture group than in the control group.6.CORE-10 Obsession dimension scoreThe within-group effect was statistically significant on the time dimension by the Greenhouse-Geisser test(P=0.000<0.05),suggesting a remission over time in both groups,as indicated by the Mauchly sphericity test.The time*group dimension was also statistically significant(P=0.000<0.05),suggesting an interaction between the time and group dimensions.A between-subjects effect test showed no statistical significance in the group dimension(P=0.474>0.05).It is suggested that the trend of change in indicators over time was similar between the two groups and there was no significant difference in efficacy between the two groups.ConclusionAcupuncture is effective in treating PTSD symptoms caused by bereavement,including anxiety,depression and panic attacks after traumatic stress.The obsessive compulsive symptoms by such traumatic stress can be alleviated by acupuncture,but the effect is not significant. |
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