Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: A randomized controlled trial

Anxiety is a very common problem among university students, especially during testing and exam periods. This condition is not limited to emotional discomfort but can significantly affect young people's physical health, compromising the immune system and causing hormonal changes that can lead to the development of various health problems. Traditionally, anxiety treatment in Western medicine is based on medications such as benzodiazepines, antidepressants, and barbiturates. However, these treatments are not always effective for all patients, and approximately one-third of people with anxiety disorders do not respond adequately to conventional medications, in addition to facing risks of side effects and dependence.

Given this reality, interest is growing in alternative and complementary therapies, such as auricular acupuncture, which may offer a safer and more natural approach to anxiety management.

This study aimed to assess the efficacy of auricular acupuncture (applied to the ear) in treating anxiety in university students during the period preceding exams. To this end, Portuguese researchers conducted a rigorously controlled, prospective, randomized, and blinded experiment, characteristics that ensure the scientific reliability of the results. A total of 69 university students participated in the research, including 49 women and 20 men, with a mean age of approximately 21 years. All participants were inexperienced with acupuncture, did not use psychotropic medications, and had no known psychiatric or thyroid disorders.

The students were divided into three groups: an experimental group that received true auricular acupuncture with semipermanent needles at specific points related to anxiety treatment, a placebo group that received needles at points with no therapeutic effect on anxiety, and a control group that received no treatment. Treatment was applied one week before the exam period, with needles remaining in place for 48 hours.

Results clearly demonstrated the efficacy of auricular acupuncture in treating student anxiety. Researchers used three different methods to assess anxiety levels: the State-Trait Anxiety Inventory (STAI), a visual analog scale for anxiety (VAS), and an assessment of the neurovegetative state based on tongue analysis according to the principles of traditional Chinese medicine. Only the group that received true auricular acupuncture had a statistically significant reduction in anxiety levels. This improvement was observed across all three assessment methods used, reinforcing the validity of the findings.

Interestingly, the study revealed that 15.5% of students had moderate to severe anxiety, and 12% showed some anxiety trait, even when assessed two weeks before the start of exams, demonstrating that academic anxiety is indeed a prevalent problem among university students.

For patients and healthcare professionals, these results represent an important contribution to the available therapeutic arsenal for anxiety treatment. Auricular acupuncture proved to be a safe technique, with few adverse effects, rare contraindications, and theoretically reduced cost compared to conventional pharmacological treatments. This therapeutic modality may be especially valuable for students who prefer to avoid medications or who have not responded adequately to conventional treatments. Additionally, the use of semipermanent needles that remain in place for up to 48 hours represents a practical advantage, prolonging the therapeutic effect without the need for daily sessions.

The technique is based on the principle that stimulation of reflex points on the ear can relieve symptoms in other parts of the body through activation of autonomic nervous system responses, including the vagus, trigeminal, and cervical plexus nerves.

Despite the promising results, the study presents some important limitations that should be considered. The sample included significantly more women than men, which precluded an adequate statistical analysis of gender differences in treatment response — an aspect that recent research suggests is relevant to acupuncture efficacy. Another limitation was the lack of psychophysiological measurements of "qi" or "deqi" (the specific sensation that occurs during acupuncture stimulation and is considered essential for clinical efficacy according to traditional Chinese medicine). Additionally, the study only assessed short-term effects, and future research is needed to determine whether benefits are maintained over longer periods.

The researchers acknowledge that it would be valuable to conduct additional studies with larger and more gender-balanced samples, including "deqi" measurements and long-term assessments to further consolidate the scientific evidence on this promising complementary therapeutic modality for anxiety management in academic contexts.