This randomized controlled trial investigated the effect of emotional freedom techniques (EFT) on the severity of nausea-vomiting and anxiety in early pregnancy.
Design:
The sample consisted of 131 pregnant women in the experimental and control groups between 6 and 16 weeks of pregnancy attending an antenatal clinic. Participants were randomly assigned to receive training on EFT or a control group. Data were collected using a personal information form, subjective experiences, the Pregnancy-Related Anxiety Questionnaire, and the Pregnancy-Unique Quantification of Emesis. Both groups attended two visits, a week apart. The participants in the EFT group received a session of EFT at each visit and completed two EFT sessions as home assignments, 2 and 4 days after the first visit. The participants in the control group attended two visits a week apart and completed assessments but did not receive EFT.
Results:
There were 55 women in each group who completed the study, and the groups were similar in terms of baseline measures, including socioeconomic status, smoking status, previous pregnancy, severity of nausea-vomiting, and total pregnancy-related anxiety. EFT significantly reduced anxiety levels from the baseline to the second session (fear of delivery, worries about bearing a handicapped child, concern about one's own appearance) and total pregnancy-related anxiety (total pretest 29.85 ± 9.87, post-test 20.67 ± 8.38; p < 0.001), while the control group showed no reduction in pregnancy-related anxiety (total pretest 26.1 ± 7.79, post-test 25.98 ± 8.49; p = 0.933). Although nausea-vomiting was reduced in both groups over the two-session period, at the end of treatment, the EFT group had significantly lower nausea intensity (EFT group 4.4 ± 1.81, control group 5.36 ± 2.48; p = 0.02).
Conclusions:
EFT is a nonpharmacologic intervention that can be effective in reducing nausea, vomiting, and anxiety in early pregnancy.
Clinical Trials Registration Number:
NCT05337852
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References
1.
KohlheppLM, HollerichG, VoL, et al.Physiological changes during pregnancy. Anaesthesist, 2018; 67(5):383–396; doi: 10.1007/s00101-018-0437-2
2.
MotoskoCC, BieberAK, PomeranzMK, et al.Physiologic changes of pregnancy: A review of the literature. Int J Womens Dermatol, 2017; 3(4):219–224; doi: 10.1016/j.ijwd.2017.09.003
3.
ChangS.The meridian system and mechanism of acupuncture—A comparative review. Part 1: The meridian system. Taiwan J Obstet Gynecol, 2012; 51(4):506–514; doi: 10.1016/j.tjog.2012.09.004
4.
StefanovM, PotrozM, KimJ, et al.The primo vascular system as a new anatomical system. J Acupunct Meridian Stud, 2023; 6(6):331–338; doi: 10.1016/j.jams.2013.10.001
5.
ClondM.Emotional freedom techniques for anxiety: A systematic review with meta-analysis. J Nerv Ment Dis, 2016; 204(5):388–395; doi: 10.1097/NMD.0000000000000483
6.
SalasMM, BrooksAJ, RoweJE. The immediate effect of a brief energy psychology intervention (Emotional Freedom Techniques) on specific phobias: A pilot study. Explore, 2011; 7(3):155–161; doi: 10.1016/j.explore.2011.02.005
7.
SebastianB, NelmsJ. The effectiveness of Emotional Freedom Techniques in the treatment of posttraumatic stress disorder: A meta-analysis. Explore, 2017; 13(1):16–25; doi: 10.1016/j.explore.2016.10.001
8.
StapletonPB, TrudeR, MackintoshG, et al.Online delivery of emotional freedom techniques in the treatment of food cravings and weight management: A randomised controlled trial. OBM Integr Complement Med, 2019; 4(4):1904065; doi: 10.21926/obm.icm.1904065
9.
KallaM, SimmonsM, RobinsonA, et al.Making sense of chronic disease using Emotional Freedom Techniques (EFT): An existential view of illness. Explore, 2020; 16(4):214–224; doi: 10.1016/j.explore.2020.03.006
10.
Zilcha-ManoS, ShaharB, FisherH, et al.Investigating patient-specific mechanisms of change in SET vs. EFT for depression: Study protocol for a mechanistic randomized controlled trial. BMC Psychiatry, 2021; 21(1):287; doi: 10.1186/s12888-021-03279-y
11.
OkyayEK, UçarT. The effect of Emotional Freedom Technique and music applied to pregnant women who experienced prenatal loss on psychological growth, well-being, and cortisol level: A randomized controlled trial. Arch Psychiatr Nurs, 2023; 2023:101–112; doi: 10.1016/j.apnu.2023.04.027
12.
BakerBS, HoffmanCJ. Emotional Freedom Techniques (EFT) to reduce the side effects associated with tamoxifen and aromatase inhibitor use in women with breast cancer: A service evaluation. Eur J Integr Med,, 2015; 7(2):136–142; doi: 10.1016/j.eujim.2014.10.004
13.
VuralPI, AslanE. Emotional freedom techniques and breathing awareness to reduce childbirth fear: A randomized controlled study. Complement Ther Clin Pract, 2019; 1(35):224–231; doi: 10.1016/j.ctcp.2019.02.011
14.
ErsunA, ZaybakA. Analysis of the effects of emotional freedom techniques on dysmenorrhea. J Ege Univ Nurs Facult, 2012; 28(2):13–21.
15.
BakırN, Irmak VuralP, KörpeG. The effects of emotional freedom techniques on coping with premenstrual syndrome: A randomized control trial. Perspect Psychiatr Care, 2022; 58(4):1502–1511; doi: 10.1111/ppc.12957
16.
MehdipourA, AbediP, AnsariS, et al.The effectiveness of emotional freedom techniques (EFT) on depression of postmenopausal women: a randomized controlled trial. J Complement Integr Med, 2022; 19(3):737–742; doi: 10.1515/jcim-2020-0245
17.
GüdücüN, ÖzcanNK. The effect of emotional freedom techniques (EFT) on postpartum depression: A randomized controlled trial. Explore, 2023; 19(6):842–850; doi: 10.1016/j.explore.2023.04.012
18.
BachD, GroesbeckG, StapletonP, et al.Clinical EFT (Emotional Freedom Techniques) improves multiple physiological markers of health. J Evid Based Integr Med, 2019; 24:1–12; doi: 10.1177/2515690X18823691
19.
BlacherS.Emotional Freedom Technique (EFT): Tap to relieve stress and burnout. J Interprof Educ Pract, 2023; 30:100599; doi: 10.1016/j.xjep.2023.100599
20.
CraigG, BachD, GroesbeckG, et al.Emotional Freedom Techniques (EFT) for traumatic brain injury. Int J Healing Caring, 2009; 9(2):1196–1206.
21.
HartmanS.Energy EFT (Translation: Ekin DURU). Pegasus Publications: Istanbul; 2016; pp. 5–48.
22.
ChurchD, StapletonP, SabotD. App-based delivery of clinical Emotional Freedom Techniques: Cross-sectional study of app user self-ratings. JMIR MHealth UHealth, 2020; 8(10):e18545; doi: 10.2196/18545
23.
KarakayalıAy Ç, Aksoy DeryaY. The relationship between birth fear and psychosocial health level of nausea-vomiting severity in pregnancy: An example from Turkey. Curr Psychol, 2021; 2011:1–11; doi: 10.1007/s12144-021-01907-0
24.
DurankuşF, AksuE. Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: A preliminary study. J Matern Fetal Neonatal Med, 2022; 35(2):205–211; doi: 10.1080/14767058.2020.1763946
25.
MoyerCA, ComptonSD, KaselitzE, et al.Pregnancy-related anxiety during COVID-19: A nationwide survey of 2740 pregnant women. Arch Womens Ment Health,, 2020; 23:757–765; doi: 10.1007/s00737-020-01073-5
26.
Mızrah ŞahinB.Investigation of factors associated with nausea and vomiting in pregnant women. J Health Sci Med, 2021; 4(4):457–461; doi: 10.32322/jhsm.924353
27.
KorenG, BoskovicR, HardM, et al.Motherisk—PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol, 2002; 186(5): 228–231; doi: 10.1067/mob.2002.123054
28.
SucuM.The comparison of PUQE (Pregnancy-Unique Quantification of Emesis and nausea) scoring with physical examination and laboratory findings in evaluation of the indications for inpatient therapy in women with nausea and vomiting. Medical Specialization Thesis, Çukurova University, Faculty of Medicine, Department of Gynecology and Obstetrics, Ankara, Türkiye; 2009.
29.
Van den BerghBR.The influence of maternal emotions during pregnancy on fetal and neonatal behavior. J Prenat Perinat Psychol Health, 1990; 5(2):119.
30.
HuizinkAC, DelforterieMJ, ScheininNM, et al.Adaption of pregnancy anxiety questionnaire–revised for all pregnant women regardless of parity: PRAQ-R2. Arch Womens Ment Health, 2016; 19(1):125–132; doi: 10.1007/s00737-015-0531-2
31.
DeryaYA, TaşhanST, DumanM, et al.Turkish adaptation of the pregnancy-related anxiety questionnaire-revised 2: Validity and reliability study in multiparous and primiparous pregnancy. Midwifery, 2018; 6(2):61–68; doi: 10.1016/j.midw.2018.03.006
32.
DeanAG, SullivanKM, SoeMM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version. Available from: www.openepi.com [Last accessed: September25, 2021].
33.
GökbulutN.The effect of foot massage on pregnant women with hiperemezis gravidarum on the severity of nausea, vomiting and the level of anxiety related to pregnancy. PhD Thesis, Department of Midwifery, Malatya, Türkiye; 2021.
HaahrM.“True Random Integer Generator.” True Random Number Service. Available from: www.random.org [Last accessed: November20, 2021].
36.
IBM Statistics. IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0.IBM Corp.: Armonk, NY; 2013.
37.
GeorgeD, MalleryP.IBM SPSS Statistics 26 Step by Step: A Simple Guide and Reference. Routledge: New York; 2019.
38.
GrantS, Mayo-WilsonE, MontgomeryP, et al.CONSORT-SPI 2018 explanation and elaboration: Guidance for reporting social and psychological intervention trials. Trials, 2018; 19(1):406; doi: 10.1186/s13063-018-2735-z
39.
ACOG Practice Bulletin No. 189. Nausea and vomiting of pregnancy. Obstet Gynecol, 2018; 131(1):e15.
40.
TopçuGB, AteşNA, KüğcümenG. Nausea and vomiting management in pregnancy. Institute Health Sci J, 2019; 4(2):29–33.
41.
Regodón WallinA, TielschJM, KhatrySK, et al.Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: An observational cohort study. BMC Pregnancy Childbirth, 2020; 20(1):545; doi: 10.1186/s12884-020-03141-1
42.
ColemanVH, CarterMM, MorganMA, et al.Obstetrician-gynecologists' screening patterns for anxiety during pregnancy. Depress Anxiety, 2008; 25(2):114–123; doi: 10.1002/da.20278
43.
PatilCL, AbramsET, SteinmetzAR, et al.Appetite sensations and nausea and vomiting in pregnancy: An overview of the explanations. Ecol Food Nutr, 2012; 51(5):394–417; doi: 10.1080/03670244.2012.696010
44.
AdlanAS, ChooiKY, Mat AdenanNA. Acupressure as adjuvant treatment for the inpatient management of nausea and vomiting in early pregnancy: A double-blind randomized controlled trial. J Obstet Gynaecol Res, 2017; 43(4):662–668; doi: 10.1111/jog.13269
45.
KeleşoğluDMD, BayramDM. The relationship between vitamin D levels and the nausea and vomitting of pregnancy. Medical Expert Thesis, Çukurova University, Faculty of Medicine, Department of Gynecology and Obstetrics, Ankara, Türkiye; 2016.
46.
Mitchell-JonesN, FarrenJA, TobiasA, et al.Ambulatory versus inpatient management of severe nausea and vomiting of pregnancy: A randomised control trial with patient preference arm. BMJ Open, 2017; 7(12):e017566; doi: 10.1136/bmjopen-2017-017566
47.
YılmazAN.Haptonomi ve sanal gerçeklik uygulamasının plansız gebeliklerde anksiyete, bağlanma ve gebeliğin kabulüne etkisi: Bebeği hayal edebilmek. PhD Thesis; 2021.
48.
NacarG, ÜnverH, DeryaYA, et al.Prenatal Tarama Testleri Yaptırmanın Gebelik Anksiyetesine Etkisi. Ann Health Sci Res, 2018; 7(2):35–40.
49.
MardjanM, PrabandariYS, HakimiM, et al.Emotional freedom techniques for reducing anxiety and cortisol level in pregnant adolescent primiparous. UNNES J Public Health, 2018; 7(1):1–6; doi: 10.15294/ujph.v7i1.19212
50.
DincerB, InangilD. The effect of Emotional Freedom Techniques on nurses' stress, anxiety, and burnout levels during the COVID-19 pandemic: A randomized controlled trial. Explore, 2021; 17(2):109–114; doi: 10.1016/j.explore.2020.11.012
51.
CiciR, ÖzkanM. Effects on anxiety and vital signs of the emotional freedom technique and music before surgery for lumbar disc hernia. Altern Ther Health Med, 2022; 1(28):5.
52.
ChatwinH, StapletonP, PorterB, et al.The effectiveness of cognitive behavioral therapy and emotional freedom techniques in reducing depression and anxiety among adults: A pilot study. Integr Med Clin J, 2016; 15(2):27.
53.
SohKS.Current State of Research on the Primo Vascular System. In: The Primo Vascular System. (SohKS, KangKA, HarrisonDK. eds.) Springer New York: New York, NY; 2012, pp. 25–39.
54.
DeadyM, CollinsDJ, JohnstonDA, et al.The impact of depression, anxiety and comorbidity on occupational outcomes. Occup Med Oxf Engl, 2022; 72(1):17–24; doi: 10.1093/occmed/kqab142
55.
GalloF.Energy Tapping for Trauma: Rapid Relief from Post-Traumatic Stress Using Energy Psychology. New Harbinger Publications: Oakland; 2007.
56.
PepeM, EgeE. The Impact of early pregnancy-period nausea and vomiting on the anxiety level. J Women's Health Nurs, 2019; 5(1):22–40.
57.
RancourP.The emotional freedom technique: Finally, a unifying theory for the practice of holistic nursing, or too good to be true?. J Holist Nurs, 2017; 35(4):382–388; doi: 10.1177/0898010116648456
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