Mental Health Service Users' Experiences of Receiving Ear Acupuncture as a Complement in Psychiatric Care in ICELAND – A Qualitative and Quantitative Pilot Study

Depression, insomnia, cravings, and anxiety are significant and often long-lasting health problems. As medication has limited effect and often side effects, complementary methods such as ear acupuncture are used in mental health care. To describe mental health care users' experiences of ear acupuncture, including ratings of sleep, anxiety, depression, stress, pain, and cravings. This mixed methods study included in- and outpatients at a mental health rehabilitation service in Iceland. Standardized ear acupuncture (NADA-style) was offered as a complement to usual care. Eight participants rated sleep (the primary outcome), cravings, pain, anxiety, stress, and depression in questionnaires pre- and post-ten acupuncture sessions. Six participants were interviewed. Interviews were analysed with reflexive thematic analysis. Cravings, pain, anxiety, stress, and depression reportedly decreased after ten treatments, and sleep improved. In the interviews, participants described the burden of mental illness eased by NADA. The most prominent theme was the experience of palpable, obvious, instant relaxation brought by the needles inserted in their ears. Participants described a state in between sleep and wakefulness. The relaxation was predictable and longed for. Anxiety, distress and stress would diminish, often instantly, and the stress of daily life became less of a weight. Muscles, tense from anxiety and vigilance, would relax. Being able to taper down medication and thereby avoid side effects was also greatly appreciated. Participants wanted to continue with NADA, and they absolutely recommended acupuncture to others. The knowledge that NADA provided helped give them hope. Increased well-being led to greater activity and self-confidence, resulting in more social interactions and further progress through the long recovery journey. No severe side effects were reported. Participants' prior attitude towards acupuncture did not affect their self-rated effect. This study supports earlier findings that ear acupuncture is feasible, safe, and appreciated as a complement to mental health nursing.