---
title: "Anxiety"
url: "https://acuiq.com/wiki/evidence/anxiety"
updated: 2026-10-09
last_verified: 2026-10-09
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-09"
reading_minutes: 5
sources: 9
---

# Anxiety

_What systematic reviews report on acupuncture for generalised anxiety disorder and for anxiety before surgery, and where the NICE anxiety guideline stands._

Acupuncture research on anxiety splits into two literatures that answer different questions. One studies generalised anxiety disorder (GAD), a long-lasting condition of excessive worry, with courses of treatment over weeks. The other studies the anxiety people feel before an operation, with ear acupuncture, acupressure or body acupuncture given beforehand. Cochrane has not reviewed either, so this page reports other systematic reviews, the earliest a [2007 review](https://doi.org/10.1136/aim.25.1-2.1) by Pilkington and colleagues at the University of Westminster. Searching to 2004, they found 12 controlled trials: four in GAD or the older diagnosis of anxiety neurosis, six in anxiety around surgery, and none for panic disorder, phobias or obsessive-compulsive disorder.

## Generalised anxiety disorder

Pilkington’s team found that every GAD trial reported a positive result, but that the reports lacked basic methodological detail and compared acupuncture with such a range of treatments that the findings were hard to interpret. The reviews since have pooled far more trials. Their main outcome is the Hamilton Anxiety Rating Scale (HAMA), scored by a clinician, where a lower score means less anxiety. GRADE, where a review reports it, is the scale reviewers use to say how much confidence a result supports, from high to very low.

| Review | Trials (people) | Comparison | Finding | Certainty |
| --- | --- | --- | --- | --- |
| [Yang 2021](https://doi.org/10.1186/s12991-021-00327-5) | 20; 18 published in Chinese | Any control | Anxiety lower with acupuncture, standardised mean difference 0.41 | Not graded |
| [Li 2022](https://doi.org/10.1097/MD.0000000000030076) | 27 (1,782) | Any control | HAMA 0.8 points lower | Risk of bias mostly unclear |
| [Lai 2025](https://doi.org/10.1186/s12991-025-00614-5) | 19 of 41 | Acupuncture alone vs medication | HAMA 1.8 points lower | Low or very low |
| Lai 2025 | 20 of 41 | Acupuncture plus medication vs medication | HAMA 2.3 points lower | Low or very low |
| Lai 2025 | 3 of 41 | Acupuncture vs sham | HAMA 3.5 points lower | Low or very low |
| [Jiang 2025](https://doi.org/10.3389/fneur.2025.1682400) | 14 (968) | Acupuncture vs sham | HAMA 2.7 points lower; GAD-7 questionnaire 3.0 points lower | Low to very low |

The 2025 review by Lai and colleagues searched to August 2025 and included 41 trials with 3,209 participants in all. It rated most trials as having “some concerns” about bias, and reported lower rates of adverse events in the acupuncture groups. The review by Jiang and colleagues, which set out to measure the effect over sham specifically, found the difference modest and the trials inconsistent with one another, and also reported better scores for sleep and mood. Sham acupuncture is a control procedure built to resemble acupuncture; [Sham acupuncture](/wiki/research/sham-acupuncture) covers the kinds in use and why none is inert. Each of these reviews closes by calling for larger, higher-quality trials.

## Anxiety before surgery

Pilkington’s review found the surgical trials better reported than the GAD trials, with early indications that ear acupuncture reduced anxiety more than needling at sham points and might match drug treatment, though measured on subjective scales with blinding that could not be guaranteed. Three later reviews measured the same question in different ways.

A [2022 review](https://doi.org/10.1016/j.jclinane.2021.110581) by Usichenko and colleagues, from Greifswald, Berlin and McMaster University in Canada, pooled 15 trials of auricular stimulation, the stimulation of points on the outer ear, with 1,603 patients. Against sham, anxiety scores were lower with ear stimulation (standardised mean difference 0.72; 8 trials, 701 patients; moderate certainty). Against no intervention the difference was larger (1.01; 4 trials, 420 patients) but rated very low certainty. Against benzodiazepines, a class of sedative drugs, it found no difference (3 trials, 158 patients; very low certainty). No trial reported a serious adverse effect.

A [2021 review](https://doi.org/10.1016/j.joim.2020.10.007) by Tong and colleagues pooled 12 sham-controlled trials of acupuncture with 916 patients. Scores on the state scale of the State-Trait Anxiety Inventory (STAI-S), which asks how anxious a person feels at that moment, were 9.1 points lower with acupuncture, rated moderate quality; visual analogue scores, a mark on a line, were 1.4 points lower, rated low quality. HAMA scores did not differ, rated very low quality.

A [2023 review](https://doi.org/10.1016/j.ijnurstu.2023.104531) by Xie and colleagues at the University of Hong Kong pooled 24 trials of acupressure, pressing on points without needles, with 2,537 adults from five countries. Against usual care or placebo, preoperative anxiety was lower with acupressure (standardised mean difference 1.30), with heart rate 4.6 beats a minute lower and systolic blood pressure 6 mmHg lower; the trials varied widely (I² 86%). It found no significant difference between acupressure given by health professionals and acupressure people gave themselves. [Ear acupuncture](/wiki/techniques/ear-acupuncture) and [Acupressure](/wiki/techniques/acupressure) describe the two methods.

## What guidelines say

NICE’s guideline on generalised anxiety disorder and panic disorder in adults, [CG113](https://www.nice.org.uk/guidance/cg113/chapter/Recommendations), published in January 2011 and last updated in June 2020, does not mention acupuncture in its recommendations. [Clinical guidelines](/wiki/evidence/clinical-guidelines) compares other guideline bodies.

## What the reviews could not settle

The GAD evidence rests on trials rated low or very low certainty, many of them published in Chinese, and in Lai’s review only 3 of 41 trials compared acupuncture with sham. No trial for panic disorder, phobias or obsessive-compulsive disorder appeared in Pilkington’s search, and none of the later reviews on this page covers them. Before surgery, the comparison with sham is better supported, but it measures how anxious people feel before an operation, not a lasting disorder, and the size of the effect varies widely between trials. None of these reviews could say which points or how many sessions matter.

AcuiQ’s [anxiety page](/symptoms/anxiety), with the related [generalised anxiety](/symptoms/anxiety-generalized) and [preoperative anxiety](/symptoms/anxiety-preoperative) pages, lists the protocols individual studies prescribed, each with its citation. [Depression](/wiki/evidence/depression) and [Insomnia](/wiki/evidence/insomnia) cover two conditions that appear alongside anxiety in some trials.

### Sources

1. Pilkington K, Kirkwood G, Rampes H, Cummings M, Richardson J, Acupuncture for anxiety and anxiety disorders: a systematic literature review, Acupuncture in Medicine 2007 — https://doi.org/10.1136/aim.25.1-2.1
2. Yang XY, Yang NB, Huang FF, Ren S, Li ZJ, Effectiveness of acupuncture on anxiety disorder: a systematic review and meta-analysis of randomised controlled trials, Annals of General Psychiatry 2021 — https://doi.org/10.1186/s12991-021-00327-5
3. Li M, Liu X, Ye X, Zhuang L, Efficacy of acupuncture for generalized anxiety disorder: a PRISMA-compliant systematic review and meta-analysis, Medicine 2022 — https://doi.org/10.1097/MD.0000000000030076
4. Lai J, Wang Y, Yao X, et al., Efficacy of acupuncture for generalized anxiety disorder: a systematic review, Annals of General Psychiatry 2025 — https://doi.org/10.1186/s12991-025-00614-5
5. Jiang H, Ma R, Huang Y, Li X, Hao Y, Efficacy of acupuncture versus sham acupuncture on generalized anxiety disorder: a meta-analysis of randomized controlled trials, Frontiers in Neurology 2025 — https://doi.org/10.3389/fneur.2025.1682400
6. Usichenko TI, Hua K, Cummings M, et al., Auricular stimulation for preoperative anxiety: a systematic review and meta-analysis of randomized controlled clinical trials, Journal of Clinical Anesthesia 2022 — https://doi.org/10.1016/j.jclinane.2021.110581
7. Tong QY, Liu R, Zhang K, Gao Y, Cui GW, Shen WD, Can acupuncture therapy reduce preoperative anxiety? A systematic review and meta-analysis, Journal of Integrative Medicine 2021 — https://doi.org/10.1016/j.joim.2020.10.007
8. Xie W, Ye F, Yan X, et al., Acupressure can reduce preoperative anxiety in adults with elective surgery: a systematic review and meta-analysis of randomised controlled trials, International Journal of Nursing Studies 2023 — https://doi.org/10.1016/j.ijnurstu.2023.104531
9. National Institute for Health and Care Excellence, Generalised anxiety disorder and panic disorder in adults: management (CG113), published 2011, last updated June 2020 — https://www.nice.org.uk/guidance/cg113/chapter/Recommendations