Four-Week Self-Administered Acupressure Improves Depressive Mood

doi:10.4236/psych.2012.329121

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Psychology

2012. Vol.3, Special Issue, 80 2-804

Published Online September 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.329121

802

Four-Week Self-Administered Acupressure Improves

Depressive Mood

Yasuhiro Honda1, Akira Tsuda1, Satoshi Horiuchi2,3

1Kurume University, Kurume, Japan

2Health Sciences University of Ho k k a i d o, Sapporo, Japan

3Japan Society of the Promotion of Science, Kojimac h i , Japan

Email: [email protected]

Received July 7th, 2012; re v ised August 9th, 2012; accepted September 3rd, 2012

Acupressure is a Chinese medical technique that involves application of pressure to acupuncture points on

the body. This study aimed to examine whether a four-week self-administered acupressure course could

reduce depressive mood. Sixteen male and nine female college students (33.2 ± 10.0 years) who majored

in acupuncture and moxibustion medicine were randomly assigned to either a self-administered acupres-

sure group or a control group. The participants in the self-administered acupressure group were instructed

to conduct five acupressure sessions three times a day (morning, midday, and night). Each session in-

cluded applying pressure on three points on the left and right side of the neck for five seconds. The con-

trols were asked to continue their daily routine. Depressive mood levels were measured at baseline, two

weeks later, and following intervention. Depressive mood levels were similar between both groups at

baseline. It decreased two weeks later and remained constant until the end of the intervention. Depressive

mood levels were significantly lower in the self-administered acupressure group than in the control group

at two weeks from baseline and after intervention. These results provide initial evidence that self-admin-

istered acupressure may improve depressive mood.

Keywords: Acupressure; Depressive Mood; Self-Management; College Students

Introduction

Depression is a common mental disorder (Kessler, Chiu,

Demler, Merikangas, & Walters, 2005), and it adversely affects

quality of life and limits daily functioning (Wells, 1997). De-

pressive disorders are thought to exist on a continuum (Cuijpers,

de Graaf, & van Dorsselaer, 2004); therefore, it is important to

not only manage depressive disorders but also symptoms such

as subthreshold depression, which don’t meet the diagnostic

criteria for mood disorders. Although professional treatments

(e.g., pharmacological or psychological therapies) a re essential,

many people diagnosed with major depression do not receive

treatment (Andrews, Sanderson, Slade, & Issakidis, 2000).

Self-management is a useful alternative to professional treatments

(Morgan & Jorm, 2008) and is commonly employed in milder

forms of depression (Jorm, Griffiths, Christensen, Parslow, &

Rodgers, 2004; Jorm, Medway, Christensen, Korten, Jacomb,

& Rodgers, 2000). Although the public considers this approach

helpful (Jorm, Nakane, Christensen, Yoshioka, Griffiths, & Wata,

2005), some people may engage in non-effective or self-de-

feating habits such as alcohol and substance use (Morgan &

Jorm, 2008). Therefore, the authors believe that it is important

to examine the efficacy of certain self-management methods

before recommending them as new treatments.

Morgan and Jorm (2008) reported a variety of self-manage-

ment methods that are effective for depression. Unfortunately,

no single method has been effective in all individuals. Individ-

ual preferences and needs should be considered, and it is essen-

tial to introduce newer self-management methods to improve

depressive mood.

Acupressure, which is a Chinese medical treatment, is a po-

tentially useful method for self-management of depressive

mood. The meridian theory proposes that the energy of the life,

Qi, flows through meridians (invisible channels in the body).

Energy flow that is too slow, fast, turbulent, or static (i.e., Qi

imbalance) causes disturbances in mental and physical health.

Acupressure involves applying pressure on the traditional acu-

puncture points without puncturing the skin, and aims to correct

Qi imbalance. Once an individual learns to accurately apply

pressure to particular acupuncture points, acupressure can be

self-administered. Self-administered acupressure is cost-free

and can be used along with conventional treatment for depress-

sion management, such as cognitive reframing (Honda, Tsuda,

& Horiuchi, in press).

Several studies have been conducted to examine efficacy of

acupressure on depressive symptoms. Most of these studies

reported that acupressure administered by professionals im-

proved depressive symptoms (Cho & Tsay, 2004; Kang, Sok, &

Kang, 2009; Tian & Krishnan, 2006; Tsay, Cho, & Chen, 2004),

except the study of Mehling, Lown, Dvorak, Cowan, Horn,

Dunn, Acree, Abrams, & Hecht (2012), which reported that

acupressure administered by professionals did not improve de-

pression.

In contrast, a limited number of studies have been conducted

to investigate the efficacy of self-administered acupressure on

depressive symptoms (Elder, Gullion, Debar, Funk, Lindberg,

Ritenbaugh, Meltesen, Gallison, & Stevens, 2012; Hyde, 1989).

Hyde (1989) reported that acupressure wristbands, a self-man-

agement tool, improved depression. However, Elder et al. (2012)

found that the Tapas Acupressure Technique (TAT®), selfap-

plied light pressure to specific points, did not improve depression.

Y. HONDA ET AL.

The survey of the literature revealed that there are no pub-

lished studies conducted in a sample of college students. Step-

toe, Tsuda, Tanaka, and Wardle (2007) reported that a rela-

tively large number of college students scored higher than the

cut-off point on standardized measures such as the Beck De-

pression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh,

1961). Therefore, it is essential to manage symptoms including

depressive symptoms in college students. Demonstrating the

efficacy of self-administered acupressure for improving depres-

sive sympt oms in a sample of college students can contribute to

the field by providing a new method for self-management of

depressive symptoms.

This study aims to determine whether a four-week self-ad-

ministered acupressure course could improve depressive mood

in a sample of Japanese college students. Depressive mood is

one of depressive symptoms. The hypothesis of the study was

that the acupressure course would improve depressive mood.

Method

Participants

The participants included 16 male and 9 female college stu-

dents [mean age, 33.2 years; standard deviation (SD) = 10.0]

majoring in acupuncture and moxibustion medicine. None of

the participants reported the use of any medications or pre-

sented with a history of current or previous physical or psychi-

atric illnesses. They were included in the study for the follow-

ing two reasons (Honda et al., in press): First, the participants

had a greater knowledge of acupuncture points compared with

students majoring in other subjects, which is essential for accu-

rate pressure application to improve Qi imbalance. Second, the

first author of this paper was a member of the teaching staff at

the college. Unfortunately, due to a lack of published data, we

could not determine the degree of representation of the partici-

pants to the Japanese students majoring in acupuncture and

moxibustion medicine.

Outcome Measure

Among depressive symptoms, the present study focused de-

pressive mood. The outcome was measured using the Depres-

sion-Dejection subscale of the Japanese version of the Profile

of Mood States-short form (Yokoyama, 2006). The participants

were asked to report their mood states over the past week on a

five point Likert scale. Raw scores were converted into T

scores (mean = 50, SD = 10) according to the manual.

Intervention

The self-administered acupres sure method, reporte d by Honda,

Tsuda, and Horiuchi (2012), was employed. Participants com-

pleted five acupressure sessions by themselves in the morning,

at midday, and at night. Briefly, each session included pressing

six acupressure points on the neck (three points on the left and

right sides each) for five seconds, with sufficient pressure

without causing discomfort. Approximately three of four par-

ticipants reported that the session was not too lengthy, was easy

to incorporate into in their daily lives, and was interesting

(Honda et al., 2012).

Procedure

This study commenced in mid-January and ended in Febru-

ary 2012. The participants were scheduled to answer their se-

mester examinations at the end of February. The university’s

institutional review board approved the participants’ consent

forms and the study protocol. After explaining the purpose and

the study procedure, the participants signed written informed

consent forms. Thirteen participants were randomly selected

and assigned to a self-administered acupressure group (SG).

The remaining participants were assigned to a control group

(CG). The participants in SG completed the self-administered

acupressure course described above. The first author sent a

message of encouragement to the SG participants once a week.

The controls were requested to continue their daily routine. The

Depression-Dejection subscale was used at baseline, two weeks

later, and following intervention.

Analysis

A repeated measure analysis of variance (ANOVA) was

conducted with time point as a within-subject factor and group

as a between-subject factor. Depression-Dejection subscale

score (D score) was used as the dependent variable.

Results

Figure 1 indicates D scores at the three assessment periods

(at baseline, two weeks later, and following intervention) in SG

and CG. ANOVA revealed a significant effect of time by group

interaction [F(2, 46) = 9.08, p < .01]. Subsequent analyses of

the interaction indicated a significant effect of time period only

in CG [F(2, 46) = 9.62, p < .01]. D score in SG decreased sig-

nificantly from baseline to two weeks later (p < .05) and re-

mained constant until the end of the intervention. Subsequent

analyses also revealed a significant effect of group at the two-

week time period [F(1, 23) = 4.69, p < .05] and following in-

tervention [F(1, 23) = 4.67, p < .05].

Discussion

This study examined the efficacy of a four-week long self-

Note: SG = self-administered acupressure group; CG = control group; *p < .05 (vs.

CG), $p < .05 (vs. Baseline).

Figure 1.

Depressive mood levels at baseline, two weeks later, and following

intervention in the self-administered acupressure group and the control

group.

Y. HONDA ET AL.

804

administered acupressure course for decreasing the levels of

depressive mood in a sample of Japanese college students. De-

pressive mood levels decreased significantly in participants

who self-administered acupressure; however, this change was

not observed in the controls, which provides preliminary but

important evidence that self-administered acupressure can de-

crease depressive mood levels in Japanese college students.

The provision of a new self-management method for depres-

sive mood is important. The importance of self-management

methods has been described by Morgan & Jorm in 2008. A

limited number of depressed people receive medical treatments

(Andrews et al., 2000), and self-management methods may be

beneficial for these people. Some individuals engage in ineffec-

tive or self-defeating activities to manage depressive symptoms,

therefore, it is important to determine the efficacy of any new

self-management method. Although a variety of methods/techniques

are recommended for the self-management of depressive symp-

toms, no single method is effective in all individ uals. There f or e ,

it is essential to identify a range of self-management methods to

meet an individual’s specific needs and preferences. Moreover,

self-administered acupressure is simple and cost-free. By dem-

onstrating that self-administered acupressure potentially im-

proves depressive mood, this study provides useful information

regarding self-management of depressive mood in college stu-

dents.

This study focused on the depressive mood levels of Japa-

nese college students. Managing depressive mood is important

in this population because previous studies in Japan have re-

ported that a relatively high number of college students scored

above the cut-off point on standardized depression measures

(Steptoe et al., 2007). Depression adversely affects productivity;

therefore it is important to manage depressive mood and symp-

toms in this population from a school health perspective.

A limitation of this study was that participants were college

students majoring in acupuncture and moxibustion medicine

and were expected to have a more accurate and extensive

knowledge of acupuncture points compared with college stu-

dents majoring in other subjects. Moreover, the participants

may have been pressurized to support the hypothesis of efficacy

of acupressure because they were students of one of the authors

and were majoring in acupuncture and moxibustion medicine. It

is important to replicate the current findings in other popula-

tions and groups of college students and to try to exclude these

confounding factors. Finally, the sample size of this study was

small. Thus, it is required to replicate the findings of this study

in a future study with a larger number of the participants.

Acknowledgements

This research was supported by a Grant-in-Aid for Scientific

Research (A) (18203035) and (B) (22330196) from Japanese

Society for the promotion of Science to AT.

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