Acupuncture and Mindfulness-Based Stress Reduction among Female Child Abuse Survivors:
A Randomized Waitlist-Controlled Pilot Study
Catherine L. Dempsey PhD, MPH1*, Margaret Chesney PhD2 , Lixing Lao MD, PhD,LAc3-4, Trish Magyari, MS4,
Mary Bahr-Robertson4, Patti Vegella MS., MA.1, Brian Berman MD4, and Elizabeth Kimbrough PhD, MPH4**
1Center
for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University , 2 Osher Center for Integrative Medicine, University of California San Francisco,
3 University of Hong Kong, School of Chinese Medicine, 4 Center for Integrative Medicine, Department of Family and Community Medicine, University of Maryland School of Medicine
RESULTS
BACKGROUND
Adult survivors of childhood sexual abuse can suffer
psychological consequences, including Post Traumatic Stress
Disorder (PTSD), depression, and pain throughout their
lifetime. The present study examined the efficacy of MBSR
and Acupuncture (AT) compared to Wait-List Control (WLC)
among female child abuse survivors to reduce psychological
distress.
Acupuncture and Mindfulness and PTSD Symptomatology (Mixed Linear Regression Models)
Table 1: Predicted least square means of MAAS scores at
four time points for three treatment groups
Types of Treatment
Time Point
METHODS
Population:
• Eighty-three (N = 83) adult survivors were randomized to either mindfulnessBased Stress Reduction (MBSR), acupuncture treatment (AT) or a Wait-List
Control (WLC).
• White: 50% (N = 50); African American: 29% (N = 24)
• Household Income: < $20k 28% (N= 23%); $20-49k 24% (N= 20); $50-99k 33%
(N=27)
MAAS Measures
• Employment: Full and part-time: 51% (N = 63%); homemaker 12% (N=10);
disabled 17% (N = 14)
Treatment:
•
•
Beck Depression Inventory (BDI). The 21-item BDI-II addresses affective,
behavioral, biological, cognitive, and motivational symptoms of depression.
PTSD Checklist (PCL). Self-report measure of PTSD symptoms which
assesses frequency of occurrence on a 1- 5 scale of the 17 symptoms of PTSD.
•
Pittsburgh Sleep Quality Inventory (PSQI). A 19 item self report inventory of
sleep latency, duration, disturbance, quality and efficiency.
•
The Mindfulness Attention Awareness Scale (MAAS). The MAAS measures
mindfulness as receptive awareness and attention to the present moment.
Analyses:
• The SAS PROC MIXED procedures for repeated measures was used to
compute fixed effects (Little, Milliken, Stroup, Wolfinger & Schabenger, 2006).
Results
• Analyses indicate a significant interaction of time and groups. MBSR and AT
significantly improved mindfulness (F= 5.85; p= .00101). AT significantly
improved PTSD symptoms (F= 3.37; p =0052) and Sleep Quality (F =3.74; p
=0076). MBSR and AT significantly improved depressive symptoms (F= 2.78; p=
.0165), but this effect was not sustained at 8 or 12 weeks.
Wait List
Control
Baseline
3.26
3.68
3.59
4 Weeks
3.71
3.97
8 Weeks
4.16
12 Weeks
3.83
Time Point
Acupuncture
MBSR
Wait List
Control
Baseline
49.75
48.93
45.44
3.60
4 Weeks
41.35
39.90
45.48
4.36
3.60
8 Weeks
32.79
37.63
41.63
4.50
3.89
12 Weeks
35.09
37.64
42.07
Table 3: Significance tests on differences in mean PTSD scores
between three treatment groups at four times points
Time
Point
4
4 Weeks
8 Weeks
12 Weeks
Estimate of
Difference
Standard
Error
T Value
P Value
Baseline
Acupuncture versus MBSR
0.82
3.23
0.25
0.80
4 Weeks
1.45
3.74
0.39
0.70
8 Weeks
-4.84
4.01
-1.21
0.23
12 Weeks
-2.54
3.91
-0.65
0.52
Acupuncture versus Control
Figure 2:
Longitudinal trajectories of PTSD scores for 2 treatments and control
55
Acupuncture
MBSR
Wait List Control
50
PTSD Measures
Measures:
MBSR
Acupuncture
MBSR
Wait List Control
3
Baseline
• MBSR. Mindfulness-based stress reduction (MBSR). MBSR therapy comprised
eight, 2.5-hour classes for 8 weeks, plus a one-day retreat. MBSR includes
guided meditation, gentle hatha yoga, progressive body relaxation, and mindful
awareness skills (Kabat-Zinn, Massion, and Kristeller et al., 1995).
• Acupuncture. Participants received 2 treatments per week over 8 weeks for 3540 min ea. Acupuncture adhered to the national standard of the ’Clean Needle
Technique’ safety procedure. Participants were treated with 10 body and 2 ear
points: 7 major points on either the front or back of the body: Sishencong (4
points a set), Yintang, Du20, LI4, LR3, CV4, ST36 (front treatment) or
Sishencong (4 points a set), Du20, GB20, SP6, BL15, BL18, BL23 (back
treatment). (Berman, Lao, Langenberg, Lee, Gilpin, and Hochberg, 2004).
Acupuncture
5
• Mean Age: 45.8 years (range 21-72)
• Married: 47% (N = 39)
Types of Treatment
Figure 1:
Longitudinal trajectories of MAAS scores for 2 treatments and control
Demographics:
• Bachelor’s or graduate degree: 56% (N = 47)
Table 2: Predicted least square means of PTSD scores at
four time points for three treatment groups
45
40
4.31
3.26
1.32
0.19
4 Weeks
-4.13
3.64
-1.14
0.26
8 Weeks
-8.84**
3.87
-2.28
0.03
12 Weeks
-6.98*
3.78
MBSR versus Control
-1.85
0.07
Baseline
3.48
3.26
1.07
0.29
4 Weeks
-5.58
3.73
-1.50
0.14
8 Weeks
-4.00
3.99
-1.00
0.32
-1.14
0.26
12 Weeks
-4.44
3.89
*0.05 < P < 0.10; **0.01 < P < 0.05; *** P < 0.01
MBSR=Mindfulness Based Stress Reduction
35
30
Baseline
Baseline
4 Weeks
8 Weeks
12 Weeks
CONCLUSIONS and REFERENCES
• Study results provide evidence for the relief of PTSD symptoms with Acupuncture and warrant further investigation of
Acupuncture and MBSR for PTSD symptoms. Particularly interesting is the effectiveness of Acupuncture for
mindfulness, as well as PTSD symptoms and sleep quality. The results warrant further investigation of Acupuncture for
mindfulness, and perhaps studies of the combination of these two approaches for this important patient population.
Selected References:
• Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. Effectiveness of acupuncture as adjunctive
therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med 2004;141(12):901-10.
• Kabat-Zinn J, Massion AO, Kristeller J, et al. Effectiveness of a meditation-based stress reduction program in the
treatment of anxiety disorders. Am J Psychiatry 1992;149(7):936-43
* The opinions are that of the author's and not an official representation of the views of the DOD or USUHS
**Deceased. Dr. Kimbrough was the PI of this project and we dedicate our efforts in her memory. Funding: Mental Insight Foundation