Abstract
Objectives: Emerging studies found the potential effects of acupuncture for treating chronic pain and mental disorders, namely, depressive and anxiety disorders. Acupuncture is widely used for treating culture-related anger syndrome, Hwa-byung. This pilot trial aimed to investigate the feasibility of a clinical trial testing acupuncture for the psychosomatic symptoms of Hwa-byung.Methods: A total of 26 patients with Hwa-byung planned to be randomly assigned to the acupuncture or sham acupuncture groups. About 10 treatment sessions were applied over 4 weeks. The 100-mm visual analog scale was used to measure the six major Hwa-byung symptoms: stuffiness in the chest, heat sensations, pushing-up in the chest, feeling a mass in the throat, feelings of unfairness, and hard feelings. The criteria for assessing the success of this pilot trial were defined as improvement in three or more of the six Hwa-byung symptoms after treatment, with an effect size >0.2.Results: A total of 15 patients were finally included and randomly assigned to the acupuncture group (n = 7) or the sham acupuncture group (n = 8). After 10 treatment sessions, the Cohen's d effect sizes for acupuncture compared to sham acupuncture were >0.2 for each one of the six major Hwa-byung symptoms, which met our a priori criteria for success. Also, the effect size for the somatic symptoms of “stuffiness in the chest” was 0.81 (95% CI −0.40, 2.20), referring to a large effect size.Conclusions: Our results suggest that acupuncture treatment would be regarded as an acceptable intervention for a full-scale study of psychosomatic symptoms in patients with Hwa-byung.Trial Registration: cris.nih.go.kr, identifier: KCT0001732.
Highlights
Hwa-byung, a culture-bound syndrome in Korea, can be understood as a type of somatoform disorder, having typical somatic symptoms of stuffiness in the chest (Lee, 1997; Kwon et al, 2020)
The effect size for the somatic symptoms of “stuffiness in the chest” was 0.81, referring to a large effect size
Our results suggest that acupuncture treatment would be regarded as an acceptable intervention for a full-scale study of psychosomatic symptoms in patients with Hwa-byung
Summary
Hwa-byung, a culture-bound syndrome in Korea, can be understood as a type of somatoform disorder, having typical somatic symptoms of stuffiness in the chest (Lee, 1997; Kwon et al, 2020). Hwa-byung is likely to develop in people with anger suppressed for long durations (Lin, 1983). Hwa-byung is confined to Korean society, since anger is one of the most universal and basic human emotions that can be found under different names in other cultures, namely, “trapped housewife syndrome” in the USA (Min, 2008) and “Ataques De Nervios” in Mexico. It is suggested that Hwa-byung is more likely to be a psychiatric syndrome mainly suffering from somatic symptoms, rather than a variant of depression or anxiety disorder (Lee et al, 2012b)
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