Psychiatry · Medical Literature
Laser Auriculotherapy for Anxiety Symptoms Across Diverse Populations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Abstract
Anxiety disorders are highly prevalent conditions associated with substantial psychosocial burden, and low-level laser therapy auriculotherapy (LLLT-AT) has emerged as a non-invasive intervention with potential neuromodulatory effects for anxiety management. This systematic review aimed to evaluate the effects of LLLT-AT on anxiety symptoms across diverse populations. The review was conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420251159376). Randomized controlled trials comparing LLLT-AT with sham, placebo, or active interventions were identified through searches in PubMed, Web of Science, Scopus, CINAHL, MEDLINE, ScienceDirect, Cochrane Library, PEDro, and Google Scholar. The literature search was last updated on 2 July 2026. Risk of bias was assessed using RoB 2 and certainty of evidence using GRADE. Six RCTs involving 386 participants were included. Meta-analysis suggested significant reductions in post-treatment anxiety symptoms favoring LLLT-AT compared with control interventions (SMD = -0.65; 95% CI: -1.17 to -0.13), although substantial heterogeneity was identified (I2 = 78.9%). Significant reductions were also observed for pain intensity and disability, while adverse eventst analyses demonstrated lower risks of ear pain, hyperemia, and itchy ear following LLLT-AT. However, sensitivity analyses excluding studies with high risk of bias yielded a non-significant effect for anxiety outcomes (SMD = -0.35; 95% CI: -0.94 to 0.25). Interpretation of the findings should be considered cautiously due to substantial heterogeneity and the very low-to-low certainty of evidence for anxiety outcomes. Across all outcomes, the certainty of evidence ranged from very low to low, with very low certainty for anxiety outcomes and low certainty for pain intensity, disability, and adverse eventsoutcomes (ear pain, hyperemia, and itchy ear). LLLT-AT may represent a promising non-invasive complementary intervention for anxiety-related symptoms; however, these findings should be interpreted cautiously given the limited evidence base and substantial heterogeneity. Further high-quality randomized controlled trials with standardized protocols and longer follow-up assessments are required.
Clinical relevance
Anxiety disorders impose a substantial psychosocial burden globally, and many patients seek non-pharmacological or complementary interventions, particularly those with contraindications or intolerance to conventional therapies. This systematic review and meta-analysis addresses an evidence gap regarding low-level laser therapy auriculotherapy (LLLT-AT), a non-invasive neuromodulatory modality, by synthesizing all available RCT-level data across diverse clinical populations. Clinicians should be aware of both the preliminary signal of benefit and the significant methodological limitations before considering LLLT-AT as an adjunctive option in anxiety management.
Key findings
1. Six RCTs enrolling a total of 386 participants were included, with LLLT-AT compared against sham, placebo, or active control interventions across diverse populations. 2. Pooled meta-analysis demonstrated a statistically significant reduction in post-treatment anxiety symptoms favoring LLLT-AT over controls (SMD = -0.65; 95% CI: -1.17 to -0.13); however, this effect size is of moderate magnitude and the confidence interval approaches the null. 3. Substantial statistical heterogeneity was identified across included trials (I² = 78.9%), undermining the reliability and generalizability of the pooled estimate. 4. Sensitivity analyses restricted to studies with low risk of bias yielded a non-significant effect for anxiety outcomes (SMD = -0.35; 95% CI: -0.94 to 0.25), indicating that the primary pooled result is heavily influenced by high-risk-of-bias studies. 5. LLLT-AT was also associated with significant reductions in pain intensity and disability outcomes, with low certainty of evidence for these endpoints per GRADE assessment. 6. Adverse event analyses indicated lower risks of ear pain, hyperemia, and pruritus (itchy ear) following LLLT-AT compared to controls; overall certainty of evidence ranged from very low (anxiety outcomes) to low (pain, disability, and adverse events) per GRADE.
Practice implications
Given that sensitivity analyses restricted to low-risk-of-bias RCTs failed to demonstrate a statistically significant anxiolytic effect (SMD = -0.35; 95% CI: -0.94 to 0.25), clinicians should not adopt LLLT-AT as a standalone or first-line intervention for anxiety disorders, and its use should be limited to a carefully selected adjunctive role within a multimodal treatment framework pending higher-quality evidence. Patient selection should prioritize those who are poor candidates for pharmacotherapy or who have not responded adequately to established psychological interventions, with explicit shared decision-making regarding the very low-to-low certainty of evidence. Future institutional adoption should be deferred until high-quality RCTs with standardized auricular point protocols, validated anxiety outcome measures, and adequate long-term follow-up are available to resolve the substantial heterogeneity (I² = 78.9%) that currently limits evidence synthesis.