Acupuncture’s efficacy in the treatment of psychological and somatic distress: an exploration of potential mechanisms from an attachment research perspective

A thesis submitted to the University of Bedfordshire, in fulfilment of the requirements for the degree of Doctorate of Philosophy.This thesis examines the effectiveness of acupuncture therapy in the treatment of psychological and somatic distress in the context of medically unexplained symptoms (MUS). Also, it explores the role of psychological attachment and experiential avoidance in an effort to explain potential mechanisms of acupuncture’s effect. Existing literature demonstrates some level of effectiveness of acupuncture therapy for the treatment of depression, anxiety and somatic symptoms. However, a lack of experimental rigor in methodology means that existing results cannot be shown to be superior to a placebo and thus current treatment protocols for patients with MUS do not include a recommendation of acupuncture therapy. MUS are defined as any set of symptoms that cannot be explained by organic disease, these clusters of symptoms are theorised to be of psychological aetiology. Sufferers of MUS find themselves stuck in a perpetual loop of secondary care referrals with little or no treatment options being made available. Whilst there is some evidence that talking therapies, such as cognitive behavioural therapy, are effective, their availability, efficacy and stigma mean they are often not desired by patients who suffer with MUS. Previous research has shown that insecure attachment predicts higher instances of, psychological and somatic distress, as well as MUS. Previous work undertaken by the author of this thesis also suggests that there may be a moderating effect of attachment in acupuncture therapy outcomes. In order to investigate acupuncture’s efficacy a double-blind randomised control trial was undertaken; 63 participants were randomised to receive either five treatments of genuine acupuncture or a non-penetrating sham form of acupuncture using the Park sham acupuncture device. A rigorous procedure ensured participant and practitioner blinding to group allocation. Primary measures of psychological (GHQ) and somatic (BSI) distress were taken at pre, post and follow-up time points (8 weeks). Secondary measures included general attachment (RQ), experiential avoidance (MEAQ) and client attachment to therapist (CATS). Results showed a significant effect of acupuncture over placebo in the reduction of both psychological (GHQ) and somatic distress (BSI). This therapeutic effect was maintained at 8-week follow-up. Further results showed moderation effects of secure attachment on somatic symptoms in the treatment group but not placebo group. Experiential avoidance also moderated somatic symptom outcomes in the treatment but not placebo group. A subsequent study utilising a quasi-experimental multi-centre methodology, which used identical measures to the previous experiment, revealed the same significant reduction of both psychological and somatic distress. This study consisted of 184 participants across five clinics, each participant receiving five sessions of acupuncture. Similar results were observed regarding moderation effects of secure attachment on treatment outcomes of somatic symptoms. Results also showed differences in moderation effects between participant with a MUS diagnosis vs. those without. Findings of both studies suggest acupuncture is an effective treatment for psychological and somatic distress, as well as MUS. The differences in attachment moderation effects between treatment and placebo may indicate acupuncture’s ability to elicit endogenous opioid release in the brain. However, further neurological studies are required to confirm this hypothesis