Acupressure · Atlas

1. Introduction

Version followed: acupressure as practised within Chinese medicine and Asian bodywork, using the point names published in the sources below (e.g. PC6 Neiguan). Two forms are covered: (a) wrist PC6 stimulation, including acupressure wristbands, as assessed in the Cochrane review by Lee et al. (2025); (b) self-administered acupressure taught in a short structured course, following the Hong Kong insomnia trial by Yeung et al. (2022). Practitioner-delivered hands-on acupressure appears here only as something to refer to. A psychotherapist does not deliver it.

What it is. Practitioners and self-carers press defined points on the skin, usually with the fingers. Michael Reed Gach founded the Acupressure Institute in 1976. His publisher describes self-care acupressure as finger pressure on skin points that supports the body's self-healing, and says his book complements conventional medical care rather than replacing it [source: Penguin Random House, Acupressure's Potent Points]. Gach also originated Acu-Yoga, which combines acupressure and yoga [source: same].
How change is said to happen, by tradition. In Chinese medicine, points lie on meridians (channels), and pressing them is said to influence the flow of qi. These are concepts of that tradition, not established anatomy or physiology. The Yeung et al. course taught "meridian theory" as background for locating points [source: Yeung et al. 2022]. Independent reviews test effects on outcomes such as nausea, sleep or anxiety. They do not test the traditional mechanism.
Evidence status, briefly. Postoperative nausea and vomiting: compared with sham, PC6 stimulation reduced nausea and vomiting, with low-certainty evidence. It was not clearly different from antiemetic drugs [source: Cochrane, Lee et al. 2025]. Pregnancy nausea: the evidence is limited and generally of poor quality. Two of 18 trials found that wristbands helped mild symptoms. RCOG guidance says ginger and acupressure "may be used for mild to moderate symptoms" [source: NIHR Evidence summary of O'Donnell et al. 2016; RCOG Green-top 69 as quoted there]. NICE's own position on acupressure in pregnancy is [uncertain: not verified]. NICE's 2021 antenatal evidence review did include acupressure trials [source: NICE NG201 evidence review tables]. Secondary sources attribute to NICE a suggestion to try ginger [source: GPnotebook]. Pre-procedure anxiety: a small meta-analysis found a medium short-term effect against sham, with high heterogeneity [source: Au et al. 2015]. Insomnia: one randomised trial found self-administered acupressure did better than sleep hygiene education on insomnia severity [source: Yeung et al. 2022]. Acupressure is not a treatment for cancer or any other physical disease. Where it is used for symptoms, it supports medical care and does not replace it [synthesis].

2. Framework

For a psychotherapist, acupressure is something a client may use, or be referred for, alongside therapy. The therapist does not run it as a therapy. The framework below has four stages: decide, screen, connect to qualified teaching or a device, and integrate.

Stage A: Identify a fit. Goal: notice when a symptom has some evidence for acupressure as a self-care add-on. Examples are nausea (postoperative, or mild pregnancy nausea) and possibly insomnia or anticipatory pre-procedure anxiety. Move on when the client is interested and the symptom has been medically assessed [synthesis; evidence as in section 1].
Stage B: Screen and obtain medical clearance. Goal: rule out red flags. These include pregnancy (point cautions), persistent or severe vomiting, skin damage at the points, bleeding tendency or bruising, cognitive impairment and acute suicide risk. The last two were exclusion criteria in the Yeung trial [source: Yeung et al. 2022; Huachiew TCM; synthesis]. Move on when red flags are absent or the client's doctor or midwife has agreed.
Stage C: Connect to qualified teaching, a practitioner, or a device. Goal: make sure point location and technique are taught by someone trained. In the Yeung trial, the teachers were registered Chinese medicine practitioners with at least five years of clinical experience [source: Yeung et al. 2022]. Asian bodywork credentials are covered under 4.2. For wristbands, the client follows the manufacturer's instructions [synthesis].
Stage D: Integrate and review. Goal: support practice, record effects and adverse effects, and fold the body experience into therapy. Stop or refer back to the practitioner if harm or distress appears [synthesis].
Format and session count. The self-acupressure course in the trial ran as two group training sessions a week apart. Participants practised at home, kept daily logbooks and received phone reminders. A competency checklist covered point location, technique, strength and frequency [source: Yeung et al. 2022]. No standard number of practitioner sessions is given in the sources cited [uncertain: not verified]. This guide gives no pressure, duration or frequency instructions. Those belong to the teaching practitioner or the device instructions.

3. Guiding principles

Medical assessment first. Nausea, vomiting, sleep loss and pain can signal medical problems, so ask whether the doctor or midwife knows before suggesting self-care [synthesis].
Attribute the tradition. Speak of meridians and qi as the ideas of Chinese medicine ("in Chinese medicine this point is said to..."), never as fact [synthesis].
State the evidence honestly. Say what reviews found, such as "low certainty" against sham for postoperative nausea, so the client's choice is informed [source: Cochrane, Lee et al. 2025].
Stay within competence. Talk-therapy codes require you to work within your training and refer on: UKCP item 23, "Offer only the forms of therapy in which you have had adequate training"; BACP para 13; AAMFT 3.10 [source: UKCP 2019 item 23; BACP 2018 para 13; AAMFT 2015 3.10]. No source cited describes a psychotherapist teaching acupressure within mental-health care. Treat teaching it as outside a talk-therapy role unless your training and code allow it [uncertain: not verified].
No hands-on work by the psychotherapist. None of the mainstream codes (BACP, UKCP, BPS, HCPC, APA, AAMFT) has an explicit touch clause. All of them prohibit sexual contact. Body-psychotherapy codes (USABP, EABP) regulate touch directly [source: BACP 2018 and 2026; UKCP 2019; BPS 2009; HCPC 2023; APA; AAMFT 2015; USABP Code VIII; EABP 2020]. Do not press points on a client [synthesis].
Consent before and during any touch, by whoever delivers it. The client may refuse or end touch "at any time". Consent is revisited, not given once. Genital or sexual touch is "always inappropriate" [source: USABP Code VIII]. A chaperone can be offered [synthesis].
Self-touch is the client's choice. In self-acupressure the client controls the pressure and can stop. That makes it a lower-threat option for clients with trauma histories, but it can still trigger body memories [synthesis].
Coordinate parallel care. When a client sees another practitioner for related work, discuss it with them to avoid confusion [source: EABP 6.b].
Watch for adverse effects and pass them on. Mild effects are documented. Wristbands can cause skin irritation, blistering, redness and pain [source: Cochrane, Lee et al. 2025]. Self-acupressure can cause bloating, stomach ache, pain or bruising at the points, and dizziness [source: Yeung et al. 2022]. Report adverse effects to the practitioner or the client's doctor.

4. Intervention inventory

These are the psychotherapist's own interventions around acupressure. Point location, pressure technique, duration and frequency are not given here. They are taught by qualified practitioners or set out in device instructions.

4.1 Suitability and safety screening conversation

Purpose / when. Use this when a client asks about acupressure or wristbands, or when a symptom such as nausea, poor sleep or anticipatory anxiety comes up where acupressure might be a self-care add-on [synthesis].
Steps.
1. Ask whether the symptom has been medically assessed, and by whom. Persistent or severe vomiting, possible dehydration, or new unexplained symptoms go to the GP, midwife or other medical team first [synthesis].
2. Ask about pregnancy or possible pregnancy. A Thai TCM clinic lists GB21 (Jianjing), ST12 (Quepen), LI4 (Hegu), SP6 (Sanyinjiao) and BL60 (Kunlun) as points to avoid in pregnancy. It states they may "trigger uterine contractions" and raise the risk of miscarriage or preterm labour [source: Huachiew TCM]. That claim comes from Chinese acupoint-massage texts. Independent evidence for it is [uncertain: not verified], but the caution is widely taught, so pass it on. The same clinic advises against tuina in early pregnancy (under 12 weeks), with a history of miscarriage or preterm labour, cervical insufficiency, placenta praevia, gestational diabetes, high blood pressure or pre-eclampsia, or severe varicose veins [source: Huachiew TCM]. Pregnant clients need their midwife or obstetrician's agreement [synthesis].
3. Ask about skin damage, bruising or bleeding tendency (including anticoagulant use), and painful areas at likely points. Clients with any of these should check with their doctor first [synthesis].
4. Screen for exclusions that the Yeung trial used for self-acupressure: cognitive impairment, significant suicide risk, other sleep disorders such as sleep apnoea or narcolepsy, and shift work. Recent acupuncture or acupressure was also excluded, for trial reasons [source: Yeung et al. 2022]. Where suicide risk is present, risk assessment and safety planning come first [synthesis].
5. Ask how touch, including self-touch, feels for the client, and about any trauma history linked to the hands, feet, abdomen or neck. These areas hold points used in the insomnia protocol: PC6 and HT7 at the wrist, KI1 on the sole, CV12 on the upper abdomen, GV20 on the crown, GB20 at the base of the skull [source: Yeung et al. 2022; synthesis].
6. Summarise the evidence in plain terms, with its certainty (section 1), and record the conversation [synthesis].
Example language (illustrative). "Before we think about acupressure, has your doctor or midwife seen you about the nausea? I'd like to check a few safety questions first, including whether you might be pregnant, because some points are traditionally avoided in pregnancy."
Watch for. Medical red flags. Pregnancy uncertainty. Clients hoping acupressure will replace medical treatment; correct this gently. Discomfort when you mention body areas. A sign it's working: the client can name the reasons to check with a doctor and the points to avoid.

4.2 Referral to a qualified acupressure or Asian bodywork practitioner

Purpose / when. Use this when the client wants practitioner-delivered acupressure, or needs to be taught self-acupressure properly [synthesis].
Steps.
1. Explain who is qualified where the client lives. In the Yeung trial, teachers were registered Chinese medicine practitioners in Hong Kong [source: Yeung et al. 2022]. In the US, NCCAOM offers Asian Bodywork Therapy certification (title Dipl.ABT). It started through credentials review in 1996, with the first written exam in October 2000 [source: Acupuncture Today 2002]. Which states license Asian bodywork specifically, and AOBTA's current standards, are [uncertain: not verified]. Canada: five provinces regulate massage therapy through a college (Ontario, BC, New Brunswick, Newfoundland and Labrador, PEI). Elsewhere practitioners belong to competing associations [source: HHR Canada; CBC 2021]. Whether a given acupressure practitioner falls under a massage college is [uncertain: not verified]. Australia: there is no national registration for massage. The National Code of Conduct sets minimum standards for unregistered health workers, and state complaint bodies such as HaDSCO in WA enforce it [source: HaDSCO 2022]. Associations such as AMT run their own complaint processes [source: AMT]. UK: whether acupressure is on any accredited register is [uncertain: not verified].
2. Give the client questions to ask: training and credential, register or association, complaints route, consent and chaperone policy, what clothing stays on, and what the practitioner will and will not touch [synthesis].
3. Do not take referral fees [source: EABP 5.d].
4. With the client's consent, agree what information you will share, and how [synthesis; EABP 6.b].
Example language (illustrative). "If you'd like hands-on acupressure, that's for a trained practitioner, not me. Here are the credentials to look for, and some questions you can ask them before you book."
Watch for. Practitioners who claim to cure disease, or who discourage medical care. Vague credentials. No complaints route. A sign it's working: the client chooses a practitioner whose credentials and complaints route they could check.

4.3 Preparing a client with a trauma history for practitioner-delivered acupressure

Purpose / when. Use this before a first hands-on session for a client whose history includes physical or sexual violation, medical trauma, or dissociation when touched [synthesis].
Steps.
1. Explore what the client expects, which areas feel safe, and which feel off-limits [synthesis].
2. Rehearse how the client will stop the session: words, a hand signal, or sitting up. Make clear that refusing or ending touch at any time is their right [source: USABP VIII.5].
3. Help them plan the requests they will make: stay clothed, have points explained before each one is touched, avoid named areas, use self-pressure instead of practitioner pressure, keep the door or a chaperone arrangement, choose who will be present [synthesis].
4. Make clear that consent continues through the session. The USABP code expects consent to be monitored over time, because problems may surface only later [source: USABP VIII.3–4].
5. State the boundary plainly: genital or sexual touch is "always inappropriate" in any therapeutic context [source: USABP Code]. Explain what to do if a boundary is crossed (see 4.8) [synthesis].
6. Agree on a grounding plan for after the session, and book a follow-up therapy session [synthesis].
Example language (illustrative). "Let's decide now how you'll say stop, so you don't have to work it out on the table. You can stop at any point, even halfway through a point."
Watch for. Compliance without real willingness ("I'll be fine"). Freezing when the session is described. Dissociation in the run-up. If several of these appear, consider self-acupressure or postponing [synthesis]. A sign it's working: the client can say their stop signal and their limits out loud.

4.4 Supporting PC6 wristband use for nausea

Purpose / when. Use this when a client facing surgery, or in early pregnancy with mild nausea, asks about acupressure bands. Wristbands are a noninvasive form of PC6 stimulation [source: Cochrane, Lee et al. 2025; NIHR Evidence].
Steps.
1. Confirm that the medical team knows about the nausea. For surgery, the anaesthetic team decides on antiemetics. Reviewed evidence shows PC6 stimulation is not clearly better than antiemetic drugs. Added to antiemetics, it reduced vomiting, though that evidence is very low certainty [source: Cochrane, Lee et al. 2025].
2. Give the evidence in plain terms. Postoperative: low certainty that it beats sham. Pregnancy: limited, mostly poor-quality evidence; RCOG says acupressure "may be used" for mild to moderate symptoms [source: NIHR Evidence].
3. Direct the client to the band's instructions for placement, or to a midwife or practitioner. Do not position the band yourself [synthesis].
4. Ask the client to check the skin under the band. Skin irritation, blistering, redness and pain have been reported [source: Cochrane, Lee et al. 2025].
5. In therapy, work with what goes with the nausea: anticipatory anxiety, fear of vomiting, low mood in pregnancy [synthesis].
Example language (illustrative). "Some research suggests these bands may reduce nausea after surgery a little, though the evidence isn't strong. They aren't a substitute for anti-sickness medicine. If you try one, follow the instructions on the pack, and tell the nurses or your midwife."
Watch for. Vomiting that won't stop, signs of dehydration, or no improvement: refer back to medical care. Skin damage. A client stopping prescribed medicine. Fear of vomiting (emetophobia) that drives compulsive band use is a matter for psychological treatment [synthesis]. A sign it's working: the client reports usable symptom change, or makes a calm decision to stop.

4.5 Supporting a structured self-acupressure course (insomnia model)

Purpose / when. Use this when a client with insomnia disorder wants a self-care method and joins a course taught by qualified practitioners. It is modelled on Yeung et al. (2022) [source: Yeung et al. 2022].
What the course contained, as the trial describes it. There were two group sessions a week apart, led by registered Chinese medicine practitioners. Session 1 covered an introduction to acupressure and meridian theory, group practice locating the points, and technique training. Session 2 reviewed home practice, answered questions and included a final technique check. The points were GV20 (Baihui), CV12 (Zhongwan), GB20 (Fengchi; the source spells it "Fenchi"), PC6 (Neiguan), HT7 (Shenmen) and KI1 (Yongquan). Participants practised each night for four weeks, kept daily logbooks, had twice-weekly phone reminders and a contact number, and were encouraged to continue afterwards [source: Yeung et al. 2022].
Steps for the therapist.
1. Screen first (4.1). The trial's exclusions included pregnancy, cognitive impairment and significant suicide risk [source: Yeung et al. 2022].
2. Help the client find a qualified teacher (4.2). Point location and technique come from the teacher, not from you [synthesis].
3. Invite the client to bring their practice log to sessions. Review adherence and effects without judging [synthesis; logbooks as in Yeung et al. 2022].
4. Keep evidence-based insomnia care in view. The trial compared self-acupressure with sleep hygiene education, not with CBT for insomnia. Whether it should be offered instead of or alongside CBT-I is [uncertain: not verified]. Offering it as an add-on rather than a replacement is [synthesis].
5. Use the practice as a cue for a wind-down routine, if the client wants that [synthesis].
Example language (illustrative). "How did the nightly practice go this week? Let's look at your log together. Which nights did you do it, and what did you notice afterwards?"
Watch for. The trial's adverse events: bloating, stomach ache, pain or bruising at points, and dizziness after pressing. All were mild and settled on their own [source: Yeung et al. 2022]. Pressing harder to "make it work". Using the practice to put off medical review of possible sleep apnoea. A sign it's working: lower insomnia severity on a validated measure. The trial used the ISI. Describe it, do not copy its items [source: Yeung et al. 2022].

4.6 Discussing acupressure for anticipatory, pre-procedure anxiety

Purpose / when. Use this when a client fears a medical procedure and asks about acupressure. A meta-analysis found a medium short-term effect against sham for pretreatment anxiety. The most common points were EX-HN3 (Yintang) and HT7 (Shenmen). Heterogeneity was substantial, and only five trials were pooled [source: Au et al. 2015].
Steps.
1. Treat procedural anxiety with your usual evidence-based approach first. Present acupressure as a possible add-on [synthesis].
2. If the hospital or a practitioner offers acupressure, help the client ask for an explanation and consent for each point. Yintang is on the face, so touch there may feel intrusive [synthesis].
3. Afterwards, review what helped [synthesis].
Example language (illustrative). "A few small studies suggest acupressure may ease anxiety just before a procedure. If it's offered, you can say yes or no to each point. We'll keep practising the coping plan as well."
Watch for. Relief that never extends beyond the moment. Avoidance being reinforced. Discomfort with facial touch. A sign it's working: the client goes through the procedure with less distress and keeps their coping skills.

4.7 Integrating body experience after acupressure

Purpose / when. Use this in the session after a client has had practitioner acupressure or started self-practice [synthesis].
Steps.
1. Ask open questions about sensations, emotions, images and memories that came up during or after [synthesis].
2. Separate the client's experience from claims about the tradition. A client may report "energy moving". Accept that as their experience and their description, and neither confirm nor dispute it as fact [synthesis].
3. Link the experience to therapy goals: being able to feel and tolerate sensation, setting limits, self-soothing [synthesis].
4. If trauma material surfaced, go at the client's pace and use your usual stabilisation methods [synthesis].
Example language (illustrative). "What did you notice in your body during the session, and afterwards? Was there anything that surprised you, or felt uncomfortable?"
Watch for. Distress or dissociation that came up but was not spoken about in the bodywork session. Idealising the practitioner. Dependence. A sign it's working: the client can describe their experience and say what they choose next.

4.8 Recognising and passing on adverse effects and boundary violations

Purpose / when. Use this whenever a client reports physical harm, distress, or touch that felt wrong [synthesis].
Steps.
1. Physical effects. Ask about skin damage, bruising, pain, dizziness or gastric symptoms [source: Cochrane, Lee et al. 2025; Yeung et al. 2022]. Advise stopping, and refer to the practitioner or doctor if effects persist or are significant [synthesis].
2. Boundary violations. Listen without leading. Genital or sexual touch is never part of legitimate practice [source: USABP Code]. Explain the client's complaint routes: the practitioner's college, register or association (for example a Canadian provincial massage college; in Australia, AMT or a state health complaints entity under the National Code), and the police where a crime may have occurred [source: CBC 2021; HaDSCO 2022; AMT; synthesis].
3. Follow your own code and local law on safeguarding and on reporting duties for vulnerable adults [synthesis].
4. Write down what the client said, in their own words [synthesis].
Example language (illustrative). "Thank you for telling me. What happened is not your fault. You have options for reporting it, and we can go through them at your pace."
Watch for. Self-blame. Minimising ("maybe it was part of the treatment"). Pressure from the practitioner. A sign it's working: the client feels believed and knows what they can do next.

4.9 Collaborative care and information sharing

Purpose / when. Use this when the client sees an acupressure practitioner, midwife or physician alongside therapy [source: EABP 6.b].
Steps. Get explicit consent to share information. Agree who handles what: physical technique stays with the practitioner, psychological work with you. Share relevant cautions, such as dissociation when touched, with the client's agreement. Review the arrangement regularly [synthesis; EABP 6.b].
Example language (illustrative). "Would it help if I let your practitioner know you'd like each point explained before it's touched? I'd only share what you agree to."
Watch for. Mixed messages about medical care. Role confusion. The client feeling discussed rather than included. A sign it's working: consistent messages to the client and a clear division of roles.

5. Handling problems

The sources say little about problems in psychotherapy practice. All guidance in this section is [synthesis] unless a source tag says otherwise.

No effect. Review the evidence honestly. Effects are modest and the evidence is low certainty [source: Cochrane, Lee et al. 2025; Au et al. 2015]. Check with the teacher that the client's technique is right, rather than increasing intensity. Return to first-line care, and drop acupressure without treating it as a failure.
Pressing harder or more often. Escalation can cause bruising or pain, which were reported adverse events [source: Yeung et al. 2022]. Treat it as a sign of desperation. Explore the driver, and refer technique questions back to the teacher.
Magical expectations, or medical care replaced. Restate that acupressure supports medical care and does not replace it [source: Penguin Random House description]. With consent, involve the client's doctor if prescribed treatment is being stopped.
Overwhelm or flashbacks during touch. The client uses the stop signal agreed under 4.3, which they have a right to [source: USABP VIII.5]. In therapy: stabilise, review whether hands-on work suits them now, and offer self-acupressure or postponement.
Resistance to the tradition, or discomfort with a spiritual framing. Present the practice as the client's choice. Separate it from belief: "you don't need to accept the meridian idea to try it".
Non-adherence to home practice. Use the log without shaming. Look for practical barriers such as bedtime chaos or privacy. Weigh whether the method fits the client's values. The trial kept adherence high with logbooks and phone reminders [source: Yeung et al. 2022].
Rupture over a suggestion. The client may feel the therapist is dismissing their problem as "just stress" or pushing alternative medicine. Acknowledge it, explain your reasoning, and drop the suggestion if that is the client's choice.
Pregnancy uncertainty, or a pregnancy found during self-practice. Pause practice that includes the traditionally cautioned points (GB21, ST12, LI4, SP6, BL60) [source: Huachiew TCM]. Ask the client to check with their midwife.
Severe or persistent nausea and vomiting in pregnancy. Treat it as a medical matter and refer promptly. Do not suggest wristbands instead of medical review. NICE's specific position on acupressure is [uncertain: not verified].
Practitioner boundary concerns (pressure to undress beyond what is needed, sexualised remarks, secrecy). Follow 4.8.
Clients wanting the therapist to press points in session. Decline. This is outside a talk-therapy role unless your code and training allow it, and the mainstream codes require working within competence [source: UKCP 2019 item 23; BACP 2018 para 13]. Offer a referral instead.

Sources

Web sources:

Books and reports cited:

Gach, M. R. (1990). Acupressure's Potent Points: A Guide to Self-Care for Common Ailments. Bantam. Details as given on the publisher's page.
O'Donnell, A., McParlin, C., Robson, S. C., et al. (2016). Systematic review and economic assessment of treatments for nausea and vomiting in pregnancy (title paraphrased). Health Technology Assessment, 20(74). Cited as reported by NIHR Evidence.
Royal College of Obstetricians and Gynaecologists (2016). Green-top Guideline No. 69. Quoted as reported by NIHR Evidence.

[uncertain: not verified]: NICE's specific recommendation wording on acupressure in pregnancy; UK register or accreditation for acupressure practitioners; US state licensing of Asian bodywork and AOBTA's current standards; the exact location of PC6, which should be taken from device instructions or a qualified practitioner.

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