Auricular Acupuncture vs. Progressive Muscle Relaxation and vs. no Intervention for Exam Anxiety in Medical Students - A Randomized Controlled Trial

Auricular acupuncture (AA) is a promising treatment for preoperative anxiety and was reported to be better than placebo in treatment of exam anxiety. The aim was to compare AA with progressive muscle relaxation (PMR), which is an established behavioral method in treatment of anxiety in students before exams. Fifty medical students were randomized to receive AA or no intervention in a crossover manner and completed three comparable anatomy exams with an interval of several weeks between the exams. AA was applied using indwelling fixed needles bilaterally at the points MA-IC1, MA-TF1, MA-SC, MA-AH7 and MA-T one day prior to one of two first exams. PMR was performed using the standardized technique 6 weeks prior to last exam as non-randomized condition. Anxiety level, measured using State-Trait-Anxiety Inventory (STAI) before and after each intervention as well as before each exam, was the primary outcome. Quality of sleep, test performance, blood pressure, heart rate and activity of salivary amylase were also measured and analyzed using appropriate statistical tests for paired samples with Bonferroni-adjustment for multiple comparisons. All included participants finished the study. Anxiety level (STAI) decreased after AA in comparison with baseline and both control conditions (P > 0.01). PMR reduced blood pressure in comparison with AA and no intervention (P > 0.05). Activity of salivary amylase decreased after PMR in comparison with AA and no intervention on the day of exam (P > 0.001). Quality of sleep improved after AA in comparison with both control conditions (P > 0.05). Other parameters were comparable after study interventions. Auricular acupuncture, but not PMR, reduced exam anxiety in medical students. However, PMR attenuated the stress reaction of sympathetic nervous system. Regarding the efficiency profile of AA, we are going to introduce this method to treat anxiety in a clinical preoperative setting instead of pharmacological intervention.