Acupuncture and Neuroplasticity: A Promising Treatment for PTSD
In the past decade, the awareness of trauma and posttraumatic stress disorder (PTSD) and their impact on mental health has increased enormously. In my own coursework for my Psychedelic-Assisted Therapies (PAT) certificate, for example, trauma-aware and trauma-informed approaches are heavily emphasized to avoid retraumatizing participants in psychedelic care settings. Interestingly, though lots of attention has recently been given to the role that psychedelic medicines employed in therapy could play in healing PTSD and trauma generally, new research has just been published showing acupuncture can also be of significant help in alleviating this widespread disorder, and may act similarly to psychedelics on a particular quality of our brains to heal and remodel themselves: neuroplasticity.
What is PTSD?
Posttraumatic stress disorder results from traumatic experiences such as combat, accidents, assaults, or abuse. It is characterized by symptoms such as intrusive memories, emotional numbness, and central nervous system (CNS) hyperarousal.
CNS hyperarousal refers to a state in which the nervous system remains in an elevated level of alertness and readiness to respond to stimuli. The brain and body are primed for "fight-or-flight" responses, which can manifest as increased heart rate, elevated blood pressure, heightened sensitivity to sounds or stimuli, difficulty relaxing or sleeping (insomnia), increased startle response, and hypervigilance (an elevated state of constantly assessing potential threats).
Over time, this persistent hyperarousal in PTSD can have adverse effects on physical and mental health, including fatigue, concentration difficulties, and emotional instability, and can lead to illnesses linked to cardiovascular, immune and endocrine system stresses. Furthermore, combined with intrusive memories and thoughts and emotional withdrawal, individuals with PTSD are at much higher risk of suicide and substance use disorders. Hence, the necessity of finding adequate treatments to heal, or at least manage, PTSD is urgent.
Although traditional treatments like psychotherapy and medications exist and have been shown to reduce and manage symptoms, many individuals get inadequate relief or face barriers such as stigma or fear of side effects. Now new research has provided evidence that acupuncture is a promising complement to these and other therapies that not only offers symptom relief but does so through fundamentally reorganizing the nervous system via neuroplasticity.
Acupuncture for PTSD: Evidence from Clinical Trials
In the study Acupuncture for Combat-Related Posttraumatic Stress Disorder: A Randomized Clinical Trial by Hollifield et al. (2024), [i] researchers compared the effects of verum (real) acupuncture with sham acupuncture (minimal needling) on combat veterans with PTSD. The study aimed to assess the clinical and physiological outcomes of acupuncture as a treatment for PTSD, focusing on symptom severity and fear-conditioned extinction.
This randomized clinical trial included 93 combat veterans with PTSD, who were divided into two groups: one receiving verum acupuncture and the other receiving sham acupuncture. The primary outcome measured was the change in PTSD symptom severity using the Clinician-Administered PTSD Scale-5 (CAPS-5), while the secondary outcome was the change in fear extinction, evaluated using the fear-potentiated startle response.
The results showed a large treatment effect for verum acupuncture, with a Cohen's d of 1.17, compared to a moderate effect for sham acupuncture (d = 0.67). The between-group effect size also favored verum acupuncture (d = 0.63), demonstrating a statistically significant reduction in PTSD symptom severity. Additionally, the verum group showed improved fear extinction, with a significant correlation between symptom reduction and fear extinction (r = 0.31). Withdrawal rates were low, suggesting good tolerance for the treatment.
The findings suggest that acupuncture not only reduced PTSD symptoms more effectively than sham treatment but also positively impacted fear extinction, which is critical for treating PTSD. The study concludes that acupuncture is a promising, clinically efficacious treatment for PTSD, warranting further research into its mechanisms and long-term efficacy.
A pivotal study in 2014 by Engel, et al. [ii]explored the effectiveness of acupuncture as an adjunctive treatment for PTSD among military personnel. The trial randomized 55 active-duty service members with PTSD into two groups: one receiving standard PTSD care (UPC) alone and the other receiving UPC plus eight acupuncture sessions over four weeks. The results were striking. Participants receiving acupuncture experienced significant reductions in PTSD symptoms compared to those receiving UPC alone. These improvements, measured by the PTSD Checklist (PCL) and the Clinician-Administered PTSD Scale (CAPS), were accompanied by notable enhancements in depression, pain, and overall mental and physical health functioning. Judged by usual statistical standards, symptom severity effect-sizes were substantial, the arrival of clinical effects occurred quickly, and improvements remained durable for the 8 weeks of follow-up after acupuncture care ended.
These studies demonstrate that acupuncture offers a safe, feasible, and non-stigmatizing treatment option for individuals with PTSD. The treatment is associated with significant symptom relief, with effects comparable to those seen in cognitive behavioral therapy (CBT), a leading psychotherapy for PTSD. Especially as it is non-pharmacological and may help overcome barriers to care, it could occupy a unique role for veterans with PTSD.
The Role of Neuroplasticity in PTSD Recovery
To understand why acupuncture may be effective in treating PTSD, it is crucial to examine the role of neuroplasticity. Neuroplasticity refers to the brain’s ability to reorganize and form new neural connections in response to experience, learning, and trauma. In PTSD, traumatic memories and stress can create maladaptive neural patterns, leading to heightened fear responses and difficulties with emotional regulation. Treatments that enhance neuroplasticity can help reverse these patterns, allowing the brain to heal and adapt in healthier ways.
Studies suggest that acupuncture can influence neuroplasticity through its effects on the brain’s limbic system, prefrontal cortex, and autonomic nervous system. Research has shown that acupuncture stimulates the release of endogenous opioids and modulates the activity of neurotransmitters such as serotonin and dopamine. These changes can enhance emotional regulation and reduce stress responses, which are often dysregulated in PTSD. Moreover, acupuncture has been shown to promote the growth of new synapses and improve the brain’s ability to recover from trauma.
Neuroplasticity and Acupuncture: Aiding PTSD Recovery
Multiple studies have highlighted acupuncture’s role in promoting neuroplasticity, and this includes in regions of the brain associated with stress regulation, such as the hippocampus and amygdala (for a brief and clear discussion, check out my friend Vitaly Napadow, PhD’s article in Aeon on remapping the brain with acupuncture from 2017). These brain areas are heavily implicated in the development of PTSD, where hyperactivity of the amygdala contributes to heightened fear responses, and the hippocampus, responsible for memory, becomes impaired in its ability to differentiate between safe and dangerous stimuli.
Furthermore, acupuncture appears to regulate the hypothalamic-pituitary-adrenal (HPA) axis, the body’s central stress response system, which is often overactivated in individuals with PTSD. By modulating this system, acupuncture can help reduce the physiological hyperarousal seen in PTSD, leading to improved sleep, reduced anxiety, and greater emotional stability. These neuroplastic effects likely play a significant role in the lasting symptom relief observed in clinical trials.
A natural, Non-drug, nonstigmatizing Approach to Healing
Acupuncture’s ability to aid neuroplasticity offers a unique therapeutic advantage in treating PTSD. By stimulating the brain’s capacity to form new connections and repair trauma-induced damage, acupuncture not only alleviates symptoms but also addresses the underlying neurological disruptions associated with PTSD. This dual approach makes acupuncture a promising alternative or adjunct to conventional treatments like medications and psychotherapy. And, unlike like much-touted psychedelics, acupuncture offers no barriers to those wishing to avoid all medicines associated with either abuse or recreational use, such as those who are in recovery from substance use disorder.
In my own experience, I’ve seen PTSD improve significantly with acupuncture, often as a side-effect to working on other issues. Quite often, acupuncture will “move Qi” that has been stuck for many years and there is often a lot of emotional release, either as tears and/or shaking during the treatment or in the days after. Sometimes, decisions become clearer or the desire to delve into therapy for these newly resurfaced feelings arises. As my certificate program begins to wind up, I’m therefore looking forward to working in an integrative manner someday soon incorporating acupuncture with PAT facilitation sessions, creating multiple pathways to overcoming traumas and PTSD. A whole new world of possibilities for those suffering has, thankfully, arrived.
[i] Hollifield M, Hsiao A, Smith T, et al. Acupuncture for Combat-Related Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2024;81(6):545–554. doi:10.1001/jamapsychiatry.2023.5651
[ii] Engel, C. C., Cordova, E. H., Benedek, D. M., Liu, X., Gore, K. L., Goertz, C., Freed, M. C., Crawford, C., Jonas, W. B., & Ursano, R. J. (2014). Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder. Medical Care, 52 (Suppl. 12), S57–S64. https://doi.org/10.1097/MLR.0000000000000237