Objective: This systematic review and meta-analysis aim to evaluate the efficacy of acupuncture in reducing anxiety by synthesizing evidence from randomized controlled trials (RCTs).
Methods: A comprehensive search was conducted across six databases-AMED, CINAHL, CENTRAL, Embase, Ovid MEDLINE, and PubMed-for RCTs published in English up to January 22, 2025. Eligible studies included patients with anxiety complications and compared RCTs comparing manual acupuncture (MA) with sham acupuncture (SA) or usual care or wait list control (UC/WLC) were included if anxiety was assessed as the primary outcome using validated measures. SMDs with 95% CIs were calculated using a random-effects model, and heterogeneity was assessed using I² and REML. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 (RoB 2) tool.
Results: A total of 20 RCTs with 1462 participants were included. MA significantly reduced anxiety at post-treatment compared to SA (SMD = -1.06, 95% CI: -1.74 to -0.39, p = 0.0005, I² = 94%) and UC/WLC (SMD = -1.35, 95% CI: -2.26 to -0.44, p = 0.00006, I² = 59%). The effect was maintained at follow-up when compared to SA (SMD = -0.78, 95% CI: -1.21 to -0.35, p < 0.00001) but not significant compared to UC/WLC (SMD = -0.60, 95% CI: -1.68 to 0.49, p = 0.12). RoB assessment showed low risk in 14 studies, while others had unclear allocation concealment and blinding issues. Seventy-nine adverse events were reported, mainly transient discomfort, minor bleeding, or localized pain, with no severe events.
Conclusion: MA effectively reduces anxiety symptoms in the short term, with effects sustained at follow-up when compared to SA but not UC/WLC. Further research is needed to confirm long-term efficacy and standardize methodologies. Acupuncture remains a promising, safe, and minimally invasive therapy for chronic anxiety.
Clinical trial registration: The review protocol was preregistered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD420250621404) and can be accessed at https://www.crd.york.ac.uk/PROSPERO/view/CRD420250621404.
Keywords: acupuncture; anxiety; mental health; meta‐analysis; systematic review.
© 2025 Wiley Periodicals LLC.