THE EFFECTS OF ACUPUNCTURE AND AROMATHERAPY ON THE TREATMENT OF STRESS ____________ A Capstone Project Presented to the Doctoral Faculty of Pacific College of Oriental Medicine ____________ In Partial Fulfillment of the Requirements for the Degree of Doctor of Acupuncture and Oriental Medicine __________ by East Haradin, L.Ac. San Diego, 2013 Copyright 2013 All Rights Reserved THE EFFECTS OF ACUPUNCTURE AND AROMATHERAPY ON THE TREATMENT OF STRESS ____________ A Capstone Project Presented to the Doctoral Faculty of Pacific College of Oriental Medicine ____________ by East Haradin, L.Ac. Approved by: ________________________________________ ___________________________ Ed Lamadrid, DAOM, L.Ac., LMT, Chair Date ________________________________________ ___________________________ Kathleen Padecky, Certified Aromatherapist Date iii ABSTRACT Objectives: The aim of this study was to determine if aromatherapy combined with acupuncture was more effective than acupuncture alone in reducing stress levels. Design: Randomized, double-blind, placebo-controlled pilot study. Participants: Fourteen women with high stress levels were recruited from an in-house residential drug and alcohol rehabilitation center. Intervention: Participants were randomly assigned to either an aromatherapy group (N = 6) or a placebo group (N = 8). All participants received an acupuncture treatment once a week for 6 consecutive weeks. Outcome Measures: The Perceived Stress Scale (PSS) and SF12v2 Health Survey (quality of life measurement) were the instruments used in this study. Results: The stress levels as measured by the PSS were significantly reduced in both groups (p < 0.05) independently. The aromatherapy group experienced a greater reduction in PSS and a greater increase in SF12v2 Healthy Survey scores compared to the placebo group. A between groups analysis did not result in a significant difference for the PSS scores (p > 0.05). However, a statistical difference was found between groups for SF12v2 scores (p < 0.05). Conclusions: Between groups analysis did not support the hypothesis that aromatherapy combined with acupuncture reduces stress significantly more than acupuncture alone. However, the aromatherapy group experienced a significantly iv higher increase in the quality of life scores compared to the placebo group. These results may be due to a small sample size, and more research is warranted. Keywords: acupuncture, aromatherapy, stress. v TABLE OF CONTENTS Chapter I: PROBLEM FORMULATION AND DEFINITION.. 1 Background of the Problem.. 3 Statement of the Problem. 6 Purpose of the Study. 7 Research Hypothesis. 7 Null Hypothesis.. 7 Theoretical Assumptions.. 7 Importance of the Study. 9 Scope of the Study.. 10 Definition of Terms.. 11 Summary. 12 Chapter II: LITERATURE REVIEW. 14 Historical Perspectives. 14 Theoretical Literature. 16 Related Research Studies. 22 Summary of Literature Findings. 24 Chapter III: RESEARCH METHODS.. 25 Research Approach. 25 Research Design. 25 vi Null Hypothesis.. 29 Participant Selection. 29 Instrumentation. 31 Data Collection. 32 Data Analysis.. 32 Methodological Assumptions. 33 Limitations of Study. 34 Organization of Remainder of Study.. 34 Chapter IV: RESEARCH FINDINGS. 35 Description of Participants. 35 Descriptive Demographics. 36 Findings Related to the Hypothesis.. 37 Perceived Stress Scale Scores. 37 SF12v2 Health Survey Scores.. 39 Post-Hoc Tests.. 43 Paired Students t-Test. 44 Summary. 45 Chapter V: CONCLUSIONS, DISCUSSION, AND RECOMMENDATIONS.. 47 Research Hypothesis. 47 Null Hypothesis.. 47 Conclusions. 48 Discussion. 48 vii Strengths of the Study. 50 Limitations of the Study. 50 Recommendations for Future Research.. 51 Implications for the Profession. 54 REFERENCES. 55 APPENDICES Appendix A: Consent to Participate in Research. 62 Appendix B: Perceived Stress Scale. 69 Appendix C: SF12v2 Health Survey. 71 Appendix D: Participants Wanted Flyer. 75 Appendix E: Inclusion/Exclusion Criteria Checklist. 77 Appendix F: ANOVA Tests and Power Analysis for PSS and SF12v2. 79 viii LIST OF TABLES Table 1: Research Design Pretest-Posttest Control Design. 26 Table 2: Demographics Data—Age. 36 Table 3: Perceived Stress Scale Pretest and Posttest Mean Scores.. 44 Table 4: SF12v2 Health Survey Pretest and Posttest Mean Scores. 44 Table 5: Paired Student’s t-Test. 45 ix LIST OF FIGURES Figure 1: Pretrial PSS scores—Group A (aromatherapy). 38 Figure 2: Pretrial PSS scores—Group B (placebo). 38 Figure 3: Perceived Stress Scale results—Group A (aromatherapy).. 39 Figure 4: Perceived Stress Scale results—Group B (placebo).. 39 Figure 5: Perceived Stress Scale results comparison between Groups A and B.. 40 Figure 6: Pretrial SF12v2 scores Group A (aromatherapy). 41 Figure 7: Pretrial SF12v2 scores Group B (placebo).. 41 Figure 8: SF12v2 health survey results—Group A (aromatherapy). 41 Figure 9: SF12v2 health survey results—Group B (placebo). 42 Figure 10: SF12v2 health survey pre- and posttrial results comparison. 43 x Chapter I PROBLEM FORMULATION AND DEFINITION Stress1 continues to be a problem in the United States (American Psychological Association [APA], 2012). In 2011, Americans rated their average stress level as 5.2 on a scale from 1 to 10, where 1 is little or no stress and 10 is a great deal of stress. Thirty-nine percent said that their stress had increased over the past year, and 22% reported experiencing extreme stress2 (APA, 2012). It was recently determined that 75% to 90% of all doctor visits are for stress-related ailments and complaints (Mental Health America, 2013; WebMD, 2013). Furthermore, Occupational Safety and Health Administration (OSHA) declared stress a hazard of the workplace, costing American industry more than $300 billion dollars annually due to absenteeism, turnover, diminished productivity and medical, legal and insurance costs (IMS3 Institute for Healthcare Informatics, 2012). Despite these statistics, Americans are not being given adequate support for stress management. In 2012, 53% of Americans surveyed by the APA reported 1Stress is defined as “the non specific result of any demand upon the body, be the effect mental or somatic” (Gates, 2001, p. 390). 2Extreme stress is defined as a scale of an 8, 9, or 10 on a 10-point scale, where 1 is little to no stress and 10 is a great deal of stress (APA, 2013). 3The IMS moniker stands for Intercontinental Medical Statistics, which is the original name for the company. 1 receiving little to no stress management support from their health care providers (APA, 2013). Lack of support becomes problematic over time as chronic stress has been shown to lead to a number of severe conditions including: anxiety, depression, insomnia, hypertension, stroke, myocardial infarction, diabetes, irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, auto-immune disorders, emphysema, hypertension, and even some cancers (Cohen et al., 2012; Karpen, 1996; Pert, Dreher & Ruff, 1998; Stahl & Hauger, 1994). The most common treatment strategy for these conditions listed is the prescribing of pharmaceuticals. This strategy is costly and does not address the root causes of stress. In 2011, Americans spent $263 billion dollars on prescription drugs (Centers for Medicare & Medicaid Services, 2012). This is a significant increase over the $234.1 billion dollars spent in 2008, which is more than double the amount spent in 1999 (Gu, Dillon, & Burt, 2010). Furthermore, it was found that even patients with insurance spent $49 billion dollars out-of-pocket on prescription drugs in 2010 (IMS, 2012). Several treatment options are available when considering the treatment of stress. Some of the more common treatments are: Cognitive Behavioral Therapy (CBT), relaxation techniques, meditation, biofeedback, yoga or other related exercise, massage, acupuncture, aromatherapy, acupressure and/or prescription drugs (Karpen, 1996). Out of these options, the prescription of psychotropic drugs, such as benzodiazepines and/or antidepressants, are most prevalent amongst primary care physicians (van Rijswijk, Borghuis, van de Lisdonk, Zitman, & van Weel, 2007). These pharmaceuticals have been known to be habit forming, as well as associated 2 with several negative side effects (Lader, Tylee, & Donoghue, 2009; van Rijswijk et al., 2007). Examples of the harmful side effects include: 1. Benzodiazepines (common brand names such as Valium and Xanax) have been shown to cause dementia as well as impairments in cognition, memory, coordination, and balance (Anthierens et al., 2010); and 2. Prozac and Zoloft, common brand names falling under the category of antidepressants, have been shown to come with the following side effects: nausea, headaches, flu.