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
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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