The Effect of Auriculotherapy on Anxiety and Physiological Parameters of Male Coronary Angiography Patients: A Single-blind Randomized Clinical Trial

Published:August 26, 2022DOI:



      To determine the effect of auriculotherapy on anxiety and physiological parameters of male patients undergoing coronary angiography.


      A single-blind randomized clinical trial was performed in 2019 with 94 subjects selected by convenience sampling.


      The subjects were divided into 2 groups via random allocation. Two hours before angiography, all patients completed the Depression, Anxiety, and Stress Scale-21 items (DASS-21) and their physiological parameters (blood pressure, pulse rate, and respiratory rate) were measured 60 minutes before angiography. Auriculotherapy was performed on ear acupoints of patients in the experimental group for 4 minutes. In the control group, patients were given auricular acupressure in sham points. The anxiety and physiological parameters were re-measured 10 minutes after the intervention.


      Patients' anxiety was clinically lower in the experimental group (2.55 ± 0.27) compared to the control group (3.02 ± 0.33) (effect size = -1.42) after the intervention. There was no significant difference between 2 groups regarding physiological parameters after the intervention. However, the respiratory rates of patients were lower in the experimental group than in the control group (P < .001). After the intervention, physiological parameters significantly decreased in the experimental group compared to before the intervention (P < .001).


      Auriculotherapy reduces patient anxiety; therefore, it can be used as a complementary method before angiography.


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        • Gökçe E
        • Arslan S
        Possible effect of video and written education on anxiety of patients undergoing coronary angiography.
        J Perianesth Nurs. 2019; 34: 281-288
        • khezerloo S
        • Habibzadeh H
        • Rasouli D
        • Rahmani A
        ahangarzadeh rezai s. Effect of video information on anxiety level and hemodynamic parameters of patients undrgoing coronary angiography.
        Nurs Midwifery J. 2018; 16: 295-302
        • Ziyaeifard M
        • Azarfarin R
        • Faritous Z
        • et al.
        Evaluation of lavender oil inhalation effects on blood pressure and heart rate in patients undergoing coronary angiography.
        Iran Heart J. 2017; 18: 29-33
        • Niknam-Sarabi H
        • Farsi Z
        • Butler S
        • Pishgooie AH
        Comparison of the effectiveness of position change for patients with pain and vascular complications after transfemoral coronary angiography: a randomized clinical trial.
        BMC Cardiovascular Disorders. 2021; 21: 1-10
        • Pouyesh V
        • Amaniyan S
        • Haji Mohammad Hoseini M
        • et al.
        The effects of environmental factors in waiting rooms on anxiety among patients undergoing coronary angiography: a randomized controlled trial.
        Int J Nurs Pract. 2018; 24: e12682
        • Shohani M
        • Mozafari M
        • Sayehmiria K
        • Amoozadeh MH
        Investigation of anxiety of patients undergoing coronary angiography in Imam Hossein Hospital of Mehran in 2016.
        Indian J Forensic Med Toxicol. 2018; 12: 232-236
        • Sariglu G
        • Özgüler M
        • Atmaca M
        Determination of health anxiety, anxiety level, and somatosensory amplification levels in individuals with normal coronary angiography.
        Anatolian Journal of Psychiatry/Anadolu Psikiyatri Dergisi. 2016; 17: 30
        • Bidgoli MM
        • Taghadosi M
        • Gilasi H
        • Farokhian A
        The effect of sukha pranayama on anxiety in patients undergoing coronary angiography: a single-blind randomized controlled trial.
        J Cardiovasc Thorac Res. 2016; 8: 170-175
        • Teymouri F
        • Rajai N
        • Farsi Z
        • Pourmirzai M
        The effects of inhaling lavender fragrance on stress and anxiety during sheath take out in patients after coronary angiography.
        J Medicinal Plants. 2019; 18: 78-89
        • Correa HP
        • Moura CdC
        • Azevedo C
        • Bernardes MFVG
        • Mata LRFPD
        • Chianca TCM
        Effects of auriculotherapy on stress, anxiety and depression in adults and older adults: a systematic review.
        Rev Esc Enferm USP. 2020; 54: 1-11
        • Tan JY
        • Molassiotis A
        • Wang T
        • Suen LK
        Adverse events of auricular therapy: a systematic review.
        Evid Based Complementary Altern Med. 2014; 2014 (2014): 1-21
        • Gao J
        • Chen G
        • He H
        • et al.
        The effect of auricular therapy on blood pressure: a systematic review and meta-analysis.
        Eur J Cardiovasc Nurs. 2020; 19: 20-30
        • Rastegarzade H
        • Abedi P
        • Valiani M
        The effect of auriculotherapy on labor pain intensity in nulliparous women.
        Anesthesiology and Pain. 2015; 6: 54-63
        • Kurebayashi LFS
        • Turrini RNT
        • Souza TPBD
        • Marques CF
        • Rodrigues RTF
        • Charlesworth K
        Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial.
        Rev Lat Am Enfermagem. 2017; 25: 1-9
        • Mora B
        • Iannuzzi M
        • Lang T
        • et al.
        Auricular acupressure as a treatment for anxiety before extracorporeal shock wave lithotripsy in the elderly.
        J Urol. 2007; 178: 160-164
        • Qu F
        • Zhang D
        • Chen LT
        • et al.
        Auricular acupressure reduces anxiety levels and improves outcomes of in vitro fertilization: a prospective, randomized and controlled study.
        Sci Rep. 2014; 4: 1-7
        • Wang S-M
        • Peloquin C
        • Kain ZN
        The use of auricular acupuncture to reduce preoperative anxiety.
        Anesthesia & Analgesia. 2001; 93: 1178-1180
        • Taghadosi M
        • Deldadeh M
        • Mansoorzadeh K
        • Gilasi H
        • Afazel M
        Effects of simultaneous acupressure and auriculotherapy on patient anxiety before coronary angiography: a randomized controlled trial.
        Complement Med J. 2016; 6: 1624-1633
        • Mousavi FS
        • Golmakani N
        • Bahrami Taghanaki HR
        • Saki A
        • Akhlaghi F
        Effects of auriculotherapy on post cesarean anxiety.
        Iran J Obstet, Gynecol Infertil. 2017; 20: 50-60
        • Falah F
        • Sajadi SA
        • Pishgooie AH
        Effect of a mobile-based educational app on blood pressure of patients with hypertension.
        BMJ Military Health. 2020; e001577
        • Ma HW
        • Chang ML
        • Lin CJ
        A systematic review of acupressure for the application on nursing practice.
        Hu Li Za Zhi. 2007; 54: 35-44
        • Jung ES
        • Chang AK
        Effects of auricular acupressure in patients on hemodialysis.
        J Nurs Res. 2020; 28: e106
        • Jouya S
        • Golmakani N
        • Mazloum SR
        • Abdi H
        • Yousefi Z
        Effect of auriculotherapy with vaccaria seeds on the anxiety of female colposcopy candidates.
        The Iran J Obst, Gynecol Infertil. 2018; 21: 70-79
        • Asghari A
        • Saed F
        • Dibajnia P
        Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample.
        Int J Psychol. 2008; 2: 82-102
        • Coker A
        • Coker O
        • Sanni D
        Psychometric properties of the 21-item depression anxiety stress scale (DASS-21).
        African Research Review. 2018; 12: 135-142
        • Zawislak D
        • Zur-Wyrozumska K
        • Habera M
        • Skrzypiec K
        • Pac A
        • Cebula G
        Evaluation of a polish version of the Depression Anxiety Stress Scales (DASS-21).
        J Neurosci Cogn Stud. 2020; 4: 1-7
        • de Oliveira CMC
        • de Assis BB
        • Mendes PG
        Lemos IC, de Sousa ALC, Chianca TCM. Auriculotherapy in nursing professionals during the coronavirus pandemic: a multiple case study.
        Rev. eletrônica enferm. 2021; 23: 1-9
        • Sharif F
        • Moshkelgosha F
        • Molazem Z
        • Kalyani MN
        • Vossughi M
        The effects of discharge plan on stress, anxiety and depression in patients undergoing percutaneous transluminal coronary angioplasty: a randomized controlled trial.
        Int J Community Based Nurs Midwifery. 2014; 2: 60-68
        • Salehpoor G
        • Rezaei S
        • Hosseininezhad M
        Quality of life in multiple sclerosis (MS) and role of fatigue, depression, anxiety, and stress: a bicenter study from north of Iran.
        Iran J Nurs Midwifery Res. 2014; 19: 593-599
        • Torabizadeh C
        • Rousta S
        • Gholamzadeh S
        • Kojouri J
        • Jamali K
        • Parvizi MM
        Efficacy of education delivery through multimedia and text messaging on the psychological parameters of patients scheduled for coronary angiography: a single-blind randomized controlled clinical trial.
        BMC Cardiovascular Disorders. 2021; 21: 1-9
        • Farsi Z
        • Sajadi SA
        • Eslami R
        Effects of peer education and orientation tour on anxiety in patient candidates for coronary angiography.
        Nurs Midwifery Stud. 2016; 5: e31624
        • Hanifi N
        • Bahraminejad N
        • Mirzaei KAT
        • Ahmadi F
        • Khani M
        • Taran L
        The effect of orientation program on stress, anxiety and depression of patients undergoing coronary angiography.
        Iran J Nurs Res. 2012; 7: 1-8
        • Jamshidi N
        Stress, anxiety and depression in patients before coronary angiography.
        Zahedan J Res Med Sci (ZJRMS). 2012; 13: 29
        • Wang K
        • Shi HS
        • Geng FL
        • et al.
        Cross-cultural validation of the depression anxiety stress scale–21 in China.
        Psychol Assess. 2016; 28: e88
        • Dietzel J
        • Cummings M
        • Hua K
        • Hahnenkamp K
        • Brinkhaus B
        • Usichenko TI
        Auricular acupuncture for preoperative anxiety protocol of systematic review and meta-analysis of randomized controlled trials.
        Medicines. 2020; 7: 1-9
        • Valiani M
        • Ashtari F
        • Mansourian M
        The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (Parallel Design).
        Acta Med Mediterran. 2018; 34: 561-567
        • Vieira A
        • Hinzmann M
        • Silva K
        • Santos MJ
        • Machado J
        Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial.
        Eur J Integr Med. 2018; 20: 188-192
        • Olshan-Perlmutter M
        • Carter K
        • Marx J
        Auricular acupressure reduces anxiety and burnout in behavioral healthcare.
        App Nurs Res. 2019; 49: 57-63
        • Valiee S
        • Bassampour SS
        • Nasrabadi AN
        • Pouresmaeil Z
        • Mehran A
        Effect of acupressure on preoperative anxiety: a clinical trial.
        J Perianesth Nurs. 2012; 27: 259-266
        • Mohebbi Z
        • Moghadasi M
        • Homayouni K
        • Nikou MH
        The effect of back massage on blood pressure in the patients with primary hypertension in 2012-2013: a randomized clinical trial.
        Int J Community Based Nurs Midwifery. 2014; 2: 251-258
        • Yeh ML
        • Chang YC
        • Huang YY
        • Lee TY
        A randomized controlled trial of auricular acupressure in heart rate variability and quality of life for hypertension.
        Complement Ther Med. 2015; 23: 200-209
        • Wang SM
        • Gaal D
        • Maranets I
        • Caldwell-Andrews A
        • Kain ZN
        Acupressure and preoperative parental anxiety: a pilot study.
        Anesthesia & Analgesia. 2005; 101: 666-669
        • Wang S-M
        • Kain ZN
        Auricular acupuncture: a potential treatment for anxiety.
        Anesthesia & Analgesia. 2001; 92: 548-553
        • Wang L
        • Cheng W
        • Sun Z
        • et al.
        Ear acupressure, heart rate, and heart rate variability in patients with insomnia.
        Evid Based Complementary Altern Med. 2013; 2013: 1-4
        • Li L
        • Zhang K
        • Shi N
        Effects of the traditional Chinese auricular point therapy combined with relaxation training on patients with hypertension and anxiety.
        Biomedical Research. 2017; 28: 5224-5228
        • Khoram B
        • Yoosefinejad AK
        • Rivaz M
        • Najafi SS
        Investigating the effect of acupressure on the patients’ anxiety before open-heart surgery: a randomized clinical trial.
        J Acupunct Meridian Stud. 2020; 13: 169-173
        • El-Saadawy D
        Effect of acupressure on dyspnea and fatigue among patients with chronic obstructive pulmonary disease.
        J Educ Pract. 2013; 4: 50-61
      1. Yildirim D, Yildiz CC. The effect of acupressure on vital signs, acute pain, stress and satisfaction during venipuncture: Single-blind, randomized controlled study. Eur J Integr Med. 2021;44(101343):1–10.