Laser Auriculotherapy for Anxiety Symptoms Across Diverse Populations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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.