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Auricular acupuncture for insomnia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.ORCID iD: 0000-0003-0745-7882
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cognitive behavioural therapy for insomnia (CBT-i) is the most effective treatment for insomnia. Studies show that auricular acupuncture (AA) may alleviate insomnia symptoms.

The overall aim of the thesis was to compare treatment effects of auricular acupuncture (AA) with cognitive behavioural therapy for insomnia (CBT-i) on symptoms of insomnia, anxiety, depression, hypnotic drugs consumption and quality of life from short- and long-term perspectives.

Paper I had a qualitative approach with a descriptive design. 16 participants received group-treatment with AA during their protracted withdrawal phase and were interviewed about their experiences. They participants experienced a reduction in protracted withdrawal symptoms, improved subjective sleep quality, a strong sensation of peacefulness and increased wellbeing.

Paper II, III and IV present results from a randomised controlled trial in where the effects of group-treatment with AA and CBT-i were compared in short- and long-term using subjective (questionnaires and sleep diary) and objective (actigraphy) measurements.

The results showed that CBT-i was superior to AA in reducing insomnia symptoms in both the short and long run. Both groups experienced significant long-term reduction of depressive symptoms. Further, both groups managed to maintain a decreased intake of hypnotic drugs at the end of the treatment when compared to baseline measurement. Short-term reduction of symptoms of anxiety and depression improved only in the AA group. The results from the objective actigraph recordings showed that the AA group slept more and the CBT-i group less after the treatment and that sleep patterns in both groups reverted to pre-treatment levels after 6 months.

Conclusively: AA, as administered in this study, was not as good as CBT-i in treating insomnia symptoms, and should not be used as a stand-alone treatment for insomnia. Our results also demonstrate that prolonged sleep time does not necessarily yield better sleep, and that the perception of insomnia symptoms is not inevitably affected by sleep duration. AA was as effective as CBT-i in ending hypnotic drugs consumption. Moreover, AA was more successful than CBT-i in reducing symptoms of anxiety and depression in the short run. Further studies investigating AA for anxiety and depression are motivated.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , p. 61
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1330
Keywords [en]
auricular acupuncture, cognitive behavioural therapy, insomnia disorder, non-pharmacological, sleep disorder, treatment
National Category
Psychiatry
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-320045ISBN: 978-91-554-9905-1 (print)OAI: oai:DiVA.org:uu-320045DiVA, id: diva2:1088515
Public defence
2017-06-05, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Funder
Ekhaga Foundation, 2011 59Available from: 2017-05-15 Created: 2017-04-12 Last updated: 2017-05-16
List of papers
1. Patients’ experience of auricular acupuncture during protracted withdrawal
Open this publication in new window or tab >>Patients’ experience of auricular acupuncture during protracted withdrawal
2014 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 21, no 2, p. 163-169Article in journal (Refereed) Published
Abstract [en]

Over the last decades interest in using auricular acupuncture for substance dependence care has increased. The specific auricular acupuncture protocol used follows the National Acupuncture Detoxification Association (NADA) definition. This paper describes patients’ experiences of receiving auricular acupuncture during protracted withdrawal. Interviews were conducted with fifteen patients treated at an outpatient clinic for substance dependence. Content analysis was used to analyze the interviews. The analysis resulted in eight categories of positive experiences and five categories of negative experiences. The positive experiences were: Relaxation and wellbeing, Peacefulness and harmony, New behaviours, Positive physical impact, Importance of context, Anxiety reduction and Reduced drug- and alcohol consumption. The negative experiences were: Nothing negative, Disturbing context, Short term effect, Depending on someone else, Time consuming, Physical distrations and Remaining cravings. The conclusion of this study is that all respondents appreciated NADA treatment. This study supports further research on using NADA in addiction treatment to reduce suffering during protracted withdrawal and in other contexts.

Keywords
Auricular acupuncture, Substance dependence, Auricular acupuncture, Substance dependence
National Category
Nursing Neurology
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-188482 (URN)10.1111/jpm.12028 (DOI)000330798000009 ()23230968 (PubMedID)
Available from: 2012-12-17 Created: 2012-12-17 Last updated: 2017-04-18Bibliographically approved
2. Sleep patterns in a randomized controlled trial of auricular acupuncture and cognitive behavioral therapy for insomnia
Open this publication in new window or tab >>Sleep patterns in a randomized controlled trial of auricular acupuncture and cognitive behavioral therapy for insomnia
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2017 (English)In: Complementary Therapies in Clinical Practice, ISSN 1744-3881, E-ISSN 1873-6947, Vol. 28, p. 220-226Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to objectively examine how sleep patterns were affected in a short- and long-term perspective after auricular acupuncture (AA) and cognitive behavioral therapy for insomnia (CBT-i). Sixty participants with insomnia disorders (men/women 9/51; mean age of 60.5 years, (SD 9.4)), were randomized to group treatment with AA or CBT-i. Actigraphy recordings were made at baseline, post-treatment and 6-month follow-up. The CBT-i group reduced their time in bed, their actual sleeping time, their sleep latency and their actual time awake. The AA group slept longer, increased their time in bed and decreased their sleep latency post-treatment. The between-groups results differed in wake-up time, rising, time in bed, actual sleep time and actual wake time. The differences were not maintained six months later. In accordance with previous findings the results support the notion that the objective sleep time does not necessarily affect the subjective perception of insomnia.

Keywords
Actigraphy, Auricular acupuncture, Cognitive-behavioral therapy, Insomnia disorder, Non-pharmacological, Treatment
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-320044 (URN)10.1016/j.ctcp.2017.06.006 (DOI)000407722900030 ()28779933 (PubMedID)
Funder
Ekhaga Foundation, 2011 59
Available from: 2017-04-12 Created: 2017-04-12 Last updated: 2017-11-21Bibliographically approved
3. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage and treatment effects of anxiety-, depression and insomnia symptoms
Open this publication in new window or tab >>Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage and treatment effects of anxiety-, depression and insomnia symptoms
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2017 (English)In: European Journal of Integrative Medicine, ISSN 1876-3820, E-ISSN 1876-3839, Vol. 16, p. 15-21Article in journal (Refereed) Published
Abstract [en]

Introduction: The interest in non-pharmacological interventions for insomnia disorder has increased. The aim was to assess the immediate treatment effects of auricular acupuncture (AA) and cognitive behavioural therapy for insomnia (CBT-i) regarding discontinuation of hypnotic usage and symptoms of anxiety, depression and insomnia.

Method: Prospective randomised controlled study. Fifty-seven participants (mean age 61 years (SD 8.6)) with insomnia disorder and long-term use of non-benzodiazepine hypnotics received group-treatment with AA or CBT-i. Pre- and post-treatment measures included symptoms of anxiety, depression and insomnia via self-report questionnaires: Hospital Anxiety and Depression scale (HAD-A, HAD-D) and Insomnia Severity Index (ISI). Other sleep parameters and hypnotic consumption were measured with a sleep diary. Linear mixed models were performed to examine treatment effect over time within and between the groups.

Results: Seventy-one percent of the AA participants and 84% of the CBT-i participants managed to discontinue their hypnotic drug consumption post-treatment. Symptoms of anxiety and depression decreased within the AA group (HAD-A (p < 0.05), HAD-D (p < 0.05)) and insomnia symptoms decreased within the CBT-i group (ISI (p < 0.001)). The only between-group difference occurred in ISI (p < 0.001), in favour of CBT-i. According to the within-group sleep diary results, the CBT-i group went to bed later (p < 0.001), fell asleep quicker (p < 0.05), increased their sleep efficiency (p < 0.001) and self-rated sleep quality (p < 0.05) post-treatment.

Conclusions: Both groups ended/maintained low hypnotic drug consumption post-treatment. Short-term reductions occurred in the AA group in anxiety and depression symptoms and in the CBT-i group regarding insomnia symptoms.

Keywords
Auricular acupuncture, Cognitive behavioural therapy, Hypnotic consumption, Anxiety Insomnia Depression
National Category
Medical and Health Sciences Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-319923 (URN)10.1016/j.eujim.2017.10.002 (DOI)000417392500003 ()
Available from: 2017-04-12 Created: 2017-04-12 Last updated: 2018-03-08Bibliographically approved
4. Auricular acupuncture and cognitive behavioural therapy for insomnia - a randomised controlled study
Open this publication in new window or tab >>Auricular acupuncture and cognitive behavioural therapy for insomnia - a randomised controlled study
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2016 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, p. 214-214Article in journal, Meeting abstract (Other academic) Published
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-309495 (URN)000383445201011 ()
Conference
23rd Congress of the European-Sleep-Research-Society, SEP 13-16, 2016, Bologna, ITALY
Available from: 2016-12-05 Created: 2016-12-05 Last updated: 2017-04-18Bibliographically approved

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