Background: Auriculotherapy, a form of therapy that involves stimulating specific points on the ear auricle, has garnered attention for its potential in holistic stress management in adults, aligning with broader patient-centered therapeutic approaches. Objective: The aim of this study was to evaluate the effectiveness of auriculotherapy for stress relief in adults. Methods: A comprehensive search of nine databases (PubMed, Scopus, CINAHL, Web of Science, Ovid Medline, Cochrane Library, RISS, KMbase, and KISS) was performed, yielding 553 studies. Of these, 12 were selected for meta-analysis based on the inclusion criteria, which considered demographic data, types of auriculotherapy, intervention characteristics, auricular points, and stress-related outcomes. The risk of bias was also evaluated for each selected study. Results: The meta-analysis results (n = 12) indicated that auriculotherapy was significantly superior to the control group in terms of subjective stress index, blood pressure, heart rate variability, and pulse rate, as well as improving low-frequency (LF) and high-frequency (HF) heart rate components and their ratio (LF/HF) in adults. Additionally, the subgroup analysis indicated a trend where the effect size of acupressure may be larger than that of acupuncture. Conclusions: Our findings underscore auriculotherapy's efficacy in reducing stress in adults, advocating for its integration into nursing curriculums as a viable clinical intervention for stress management. Promoting its application in clinical environments could complement holistic, patient-centric care paradigms.
BaeS. H.KimK. Y. (2021). The stimulation effects of auricular acupressure with magnetic pellets on stress-related brain wave and heart rate variability changes in university students. Journal of Health Care and Life Science, 9(2), 345–354. https://doi.org/10.22961/JHCLS.2021.9.2.345
2.
BerntsonG. G.CacioppoJ. T. (2004). Heart rate variability: Stress and psychiatric conditions. In CacioppoJ. T.TassinaryL. G.BerntsonG. G. (Eds.), Dynamic electrocardiography (pp. 57–64). Wiley. https://doi.org/10.1002/9780470987483.ch7
3.
BidwellS.JensenM. F. (2003). Using a search protocol to identify sources of information: The COSI model. In: TopferL. A.AustonI. (Eds.), Etext on health technology assessment (HTA) information resources [Internet]. National Library of Medicine. https://www.nlm.nih.gov/archive/20060905/nichsr/ehta/chapter3.html#COSI
4.
ChaN. H.ParkY. K.SokS. R. (2017). Effects of auricular acupressure therapy on stress and sleep disturbance of middle-aged women in South Korea. Holistic Nursing Practice, 31(2), 102–109. https://doi.org/10.1097/HNP.0000000000000197
5.
CherneckyC. C.BergerB. J. (2012). Laboratory tests and diagnostic procedures. Elsevier Health Sciences.
6.
ChoiS. Y.KimY. J.KimB. (2022). Effect of auriculotherapy on musculoskeletal pain: A systematic review and meta-analysis. Journal of Korean Academy of Nursing, 52(1), 4–23. https://doi.org/10.4040/jkan.21121
7.
CorreaH. P.MouraC. D. C.AzevedoC.BernardesM. F. V. G.MataL. R. F. P. D.ChiancaT. C. M. (2020). Effects of auriculotherapy on stress, anxiety and depression in adults and older adults: A systematic review. Revista da Escola de Enfermagem da U S P, 2020, 54, e03626. https://doi.org/10.1590/S1980-220X2019006703626.eCollection 2020
8.
DamascenoK. S. M.OliveiraG. M.BeltrameM.CoelhoJ. M. F.PimentelR. F. W.MercesM. C. D. (2023). Effectiveness of auriculotherapy on stress reduction in health workers: A controlled randomized clinical trial. Revista Latino-Americana de Enfermagem, 30, e3771. https://doi.org/10.1590/1518-8345.5992.3771
9.
GaoJ.ChenG.HeH.LiuC.HeQ.LiJ.WangJ. (2020). The effect of auricular therapy on blood pressure: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 19(1), 20–30. https://doi.org/10.1177/1474515119876778
10.
GoG. Y.ParkH. (2020). Effects of auricular acupressure on women with irritable bowel syndrome. Gastroenterology Nursing, 43(2), E24–E34. https://doi.org/10.1097/SGA.0000000000000332
11.
HigginsJ. P.ThompsonS. G.DeeksJ. J.AltmanD. G. (2003). Measuring inconsistency in meta-analyses. British Medical Journal, 327(7414), 557–560. https://doi.org/10.1136/bmj.327.7414.557
12.
HigginsJ. P. T.ThomasJ.ChandlerJ.CumpstonM.LiT.PageM. JWelchVA, editors. (2021). Cochrane handbook for systematic reviews of interventions version 6.2 (updated February 2021). Cochrane. https://training.cochrane.org/handbook
13.
KaushikA.VasudevA.AryaS. K.PashaS. K.BhansaliS. (2014). Recent advances in cortisol sensing technologies for point-of-care application. Biosensors & Bioelectronics, 53, 499–512. https://doi.org/10.1016/j.bios.2013.09.060
14.
KertesD. A.KaminH. S.LiuJ.BhattS. S.KellyM. (2018). Putting a finger on the problem: Finger stick blood draw and immunization at the well-child exam elicit a cortisol response to stress among one-year-old children. Psychoneuroendocrinology, 93, 103–106. https://doi.org/10.1016/j.psyneuen.2018.04.021
KimB.ParkH. (2023). The effects of auricular acupressure on blood pressure, stress, and sleep in elders with essential hypertension: A randomized single-blind sham-controlled trial. European Journal of Cardiovascular Nursing, 22(6), 610–619. https://doi.org/10.1093/eurjcn/zvad005.
17.
KowalM.Coll-MartínT.IkizerG.RasmussenJ.EichelK.StudzińskaA.KoszałkowskaK.KarwowskiM.NajmussaqibA.PankowskiD.LieberothA.AhmedO. (2020). Who is the most stressed during the COVID-19 pandemic? Data from 26 countries and areas. Applied Psychology: Health and Well-Being, 12(4), 946–966. https://doi.org/10.1111/aphw.12234
18.
KurebayashiL. F. S.SilvaM. J. P. D. (2014). Efficacy of Chinese auriculotherapy for stress in nursing staff: A randomized clinical trial. Revista Latino-Americana de Enfermagem, 22, 371–378. https://doi.org/10.1590/0104-1169.3239.2426
19.
KwonS. J.ParkJ. S. (2011). Analysis of Korean nursing research on auricular acupuncture and ear acupressure therapy. Keimyung Journal of Nursing Science15(1), 103–114.
20.
LazarusR. S.FolkmanS. (1984). Stress, appraisal, and coping. Springer.
LeeS.ParkH. (2021). Effects of auricular acupressure on blood pressure and stress responses in adults with prehypertension. Journal of Korean Academy of Fundamentals of Nursing, 28(1), 175–185. https://doi.org/10.5977/jkasne.2021.27.2.175
23.
LeeS. N.KimB.ParkH. (2021). The effects of auricular acupressure on stress, anxiety, and depression of outpatient nurses in South Korea. Complementary Therapies in Clinical Practice, 44, 101447. https://doi.org/10.1016/j.ctcp.2021.101447
24.
LiuY.AlmeidaD. M.RovineM. J.ZaritS. H. (2018). Modeling cortisol daily rhythms of family caregivers of individuals with dementia: Daily stressors and adult day services use. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 73(3), 457–467.
25.
LorenzT. K. (2021). Autonomic, endocrine, and psychological stress responses to different forms of blood draw. PLoS One, 16(9), e0257110. https://doi.org/10.1371/journal.pone.0257110
26.
LuG. D.NeedhamJ. (2012). Celestial lancets: a history and rationale of acupuncture and moxa. Routledge.
27.
OlesonT. (2013). Auriculotherapy manual: Chinese and Western systems of ear acupuncture (4th ed). Churchill Livingstone.
28.
PageM. J.McKenzieJ. E.BossuytP. M.BoutronI.HoffmannT. C.MulrowC. D.ShamseerL.TetzlaffJ. M.AklE. A.BrennanS. E.ChouR.GlanvilleJ.GrimshawJ. M.HróbjartssonA.LaluM. M.LiT.LoderE. W.Mayo-WilsonE.McDonaldS.MoherD. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. British Medical Journal, 372, n71. https://doi.org/10.1136/bmj.n71
29.
PradoJ. M. D.KurebayashiL. F. S.SilvaM. J. P. D. (2018). Experimental and placebo auriculotherapy for stressed nurses: Randomized controlled trial. Revista da Escola de Enfermagem da USP, 52, e03334. https://doi.org/10.1590/S1980-220X2017030403334
30.
RoS. O.LeeH. Y.LeeJ.KimM. (2013). Effects of auricular acupressure on menstrual pain, dysmenorrhea, and academic stress in women college students. Korean Journal of Adult Nursing, 25(3), 356–364. https://doi.org/10.7475/kjan.2013.25.3.356
31.
SajadiS. A.RahimiV.FarsiZ.FournierA. (2023). The effect of auriculotherapy on anxiety and physiological parameters of male coronary angiography patients: A single-blind randomized clinical trial. Journal of Perianesthesia Nursing, 38(1), 102–107. https://doi.org/10.1016/j.jopan.2022.05.074
32.
SapolskyR. M. (2004). Why zebras don't get ulcers: The acclaimed guide to stress, stress-related diseases, and coping. Holt Paperbacks.
33.
SchünemannH.BrożekJ.GuyattG.OxmanA. (Eds.). (2013). Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Updated October 2013.GRADE Working Group. https://gdt.gradepro.org/app/handbook/handbook.html
34.
SeokD. E. (2012). Stress and psychoneuroendocrine immunology. Goong Media.
35.
SterneJ. A.SavovićJ.PageM. J.ElbersR. G.BlencoweN. S.BoutronI., et al. (2019). Rob 2: A revised tool for assessing risk of bias in randomised trials. British Medical Journal, 366, l4898. https://doi.org/10.1136/bmj.l4898
36.
TrinhD. T. T.NguyenQ. C. T.BuiM. M. P.NguyenV. D.ThaiK. M. (2022). Heart rate variability during auricular acupressure at heart point in healthy volunteers: a pilot study. Evidence-based Complementary and Alternative Medicine, 2022, 1019029. https://doi.org/10.1155/2022/1019029.eCollection 2022
37.
ValianiM.AshtariF.MansourianM. (2018). The effect of auriculotherapy on stress, anxiety, and depression in MS patients: A double blind randomized clinical control trial (parallel design). Acta Medica Mediterranea, 34, 561–5677. https://doi.org/10.19193/0393-6384_2018_2s_89
38.
WeissmanD. G.MendesW. B. (2021). Correlation of sympathetic and parasympathetic nervous system activity during rest and acute stress tasks. International Journal of Psychophysiology, 162, 60–68. https://doi.org/10.1016/j.ijpsycho.2021.01.015
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