For several thousand years, acupuncture has been used in China to address a wide variety of medical complaints and conditions, as well as mental and spiritual ones. Involving the insertion of small, thin needles—typically, between a half-dozen and 20—at various positions or “points” on the surface of the body over the course of up to an hour per session, acupuncture has been explained by traditional practitioners as a way of accessing and manipulating a “life-force energy” called qi that they believe to be flowing through the body.

Over the last half-century, practitioners of western medical science have attempted to analyze acupuncture’s effects on the body, its impact on the brain, as well as its efficacy in relieving pain, stress, depression, and other conditions. Findings have been highly varied, for a range of reasons. Among these: there are many ways of administering acupuncture, making it difficult to compare results across different applications.

There is another important difficulty for western science in trying to assess acupuncture (which also affects research on psychedelics). It’s very difficult to devise a “placebo” version of the treatments that is not readily distinguished from the real thing. Also, in many clinical tests, high rates of withdrawal by participants has limited the statistical power of collected data.

A team of researchers led by Michael Hollifield, M.D., of the VA Medical Center in Long Beach, California has been working on these issues for some years. In a paper recently published in JAMA Psychiatry, Dr. Hollifield and colleagues compared a standardized protocol for administering acupuncture with a “sham” version of acupuncture that they believe satisfies the requirements of an effective placebo, in the treatment of group of combat veterans diagnosed with PTSD. Members of the research team included Tanja Jovanovic, Ph.D., a 2015 BBRF Independent Investigator and 2010 Young Investigator; and Seth D. Norrholm, Ph.D., a 2008 BBRF Young Investigator.

Over a period of 4 years the team recruited 93 individuals for the trial. Of these, 85 were male; a majority were in their mid- or late-30s. A majority had had at least some college education; more than half were not currently employed; about half identified as Hispanic. Over 60% had either “moderate” or “moderate to heavy” combat experience. The PTSD-triggering event for each participant occurred during the time of their combat deployment. Three-fourths of the triggering events were combat-related (others included other violence or loss, sexual assault, or accident).

Each participant had received a PTSD diagnosis consistent with DSM-5 criteria. Each also had PTSD severity measured prior to the trial, at its midpoint, and after its conclusion. The gold-standard assessment tool called CAPS-5 was used; participants in the study were required to have a composite score of 26 or greater. The total group averaged about 36 on entry to the trial—considered by doctors to be “severe.” Primary symptoms of PTSD include intrusive memories, avoidance of triggering places or activities, hypervigilance, sleep problems, and depression and anxiety.

Participants had 15 weeks to receive 24 sessions, each involving 30 minutes of either active acupuncture or sham. Those in the active group had needles placed (sequentially) at a series of points on the front and back of the body that were standardized by Dr. Hollifield and colleagues in earlier research—the insertion points corresponding to places deemed important in traditional Chinese medicine. Those receiving the sham treatments had sessions that were the same in time, frequency, and duration as the active treatment group. The sham procedure was called by the team “minimal needling,” and did involve the insertion of needles into the body. Thus, like those receiving active treatment, those receiving “sham” therapy, too, experienced a distinct sensation produced by insertion of the needles. Three elements defined “sham,” the team explained: location of each needle 2 cm away from body insertion points used in the active treatments (points not expected to affect PTSD symptoms); very shallow insertion of the needles (less than one-quarter inch); and relative absence of stimulation due to the shallow insertion.

Videos made of each session offered no evidence that those receiving sham treatments were aware of this fact. Insertion points in both groups conformed to protocol about 98% of the time, the videos showed. In both groups, the sessions were well-tolerated. While 64 adverse events were reported, the team judged 54 to be unrelated to acupuncture. None of those that were related was deemed serious. Retention was high—7 individuals (about 8%) dropped out of the trial while it was in progress.

Assessments were made in the participants’ PTSD scores before, at the midpoint and after the trial. Active acupuncture resulted in a larger reduction in PTSD symptom severity than sham, the team reported. The CAPS-5 score in the acupuncture group declined from over 36, on average, to 18.6 (“threshold to moderate” symptoms); in the sham group, it declined from 36 to 26.7 (middle of the moderate range). The benefit received by those in the sham group was attributed to the classic placebo effect, which is thought to be due to the regular attention participants receive as well as the excellence of the facility where the sessions were given (the Long Beach VA Hospital, in this case).

The advantage of having active acupuncture was described by the team as “statistically significant and clinically meaningful.” Advantages in symptom reduction were seen in the active treatment group following the midpoint of the treatment course, but not before.

Another measurement made during the trial suggested the advantage and possible viability of acupuncture for PTSD. Each participant was tested before, during and after the trial for their fear-potentiated startle response—their involuntary reaction to a loud sound paired with an unpleasant stimulus. A key component of this test involves the ability to control the fear response after the aversive stimulus ceases, a process called “extinction,” which has been shown to be altered in PTSD. Results of this data indicated to the team that in those who received active acupuncture there was an enhanced extinction of learned fear—thought to be an important component in successful treatment of PTSD.

Various drug therapies for PTSD as well as talk therapies including cognitive behavior therapy are available for those suffering from PTSD. These do help a portion of patients, but are not effective for many others. Results of this trial, in the team’s view, suggest acupuncture “should be considered a rational choice” for treating PTSD “at least in combat veterans,” in view of the “moderate to large clinical and biological effects” it showed in the trial (i.e., respectively, reduction in symptom severity scores and enhanced extinction of learned fear).

Future trials are needed, among other things, to compare active acupuncture treatments with CBT and drug therapy approaches for PTSD, the team said.