The Effect of Emotional Freedom Techniques on Death Anxiety and Cancer‐Related Anxiety in Patients Undergoing Oncological Surgery: A Randomized Controlled Trial

ABSTRACT

This study was conducted to investigate the effect of emotional freedom techniques (EFT) on death anxiety in patients experiencing postsurgery cancer‐related anxiety. A total of 120 oncological surgical patients were randomly allocated to either the intervention group (n = 60) or the control group (n = 60). Data were collected from February 2025 to September 2025 as a randomized controlled trial. While EFT (once a day, for 3 days) was applied to the patients in the intervention group in addition to the clinical procedure, the control group only followed the clinical procedure without any intervention. Following EFT, participants in the intervention group showed statistically significant reductions in both cancer‐related anxiety and death anxiety scores (p < 0.001). The decrease in subjective distress scores in the intervention group after EFT was found to be significant (p < 0.001). When the intervention and control groups were compared based on their final test scores, the intervention group had lower levels of cancer‐related anxiety, death anxiety, and subjective distress (p < 0.05). Clinical EFT application demonstrated immediate postintervention efficacy in reducing death anxiety, cancer‐related anxiety, and subjective distress. However, due to the absence of a long‐term follow‐up period, these findings reflect acute psychological stabilization.

1. Introduction

Surgical oncology is a subspecialty of general surgery that focuses on multidisciplinary work related to the diagnosis and treatment of tumors [1, 2]. Oncological surgeries are performed for various purposes. Depending on the purpose, prophylactic, diagnostic, palliative, curative, and excisional surgical procedures may be performed [3, 4]. Patients who have undergone oncological surgery for prophylactic or diagnostic purposes, without yet having received a diagnosis of malignant tumor, experience a very serious fear of cancer in the postoperative period [4, 5].

Fear of cancer can be biological, psychological, social, or secondary (fear of recurrence) [4, 6]. Custers et al. [7] found that colorectal cancer survivors experienced very high levels of fear of cancer recurrence in their study measuring this fear. Fear of cancer is referred to in the literature as carcinophobia or cancerphobia [3, 4, 7]. Carcinophobia is a condition observed in individuals at risk of a fatal disease, causing them distress and leaving realistic and deep scars [7, 8]. Patients experiencing cancer phobia experience serious death anxiety due to uncertainties such as abnormalities in the course of the disease and when and how treatment will end [4, 5].

Complementary methods improve the quality of nursing care by alleviating or suppressing undesirable conditions that arise owing to the high levels of fear and anxiety experienced by patients in the postoperative period. One such method, emotional freedom techniques (EFT), is an easy‐to‐apply, cost‐free treatment method used as a preventive therapy [6, 9, 10, 11]. Clinical EFT operates through a somatic‐cognitive mechanism where percussive tapping on designated mechanoreceptors sends afferent signals to the brain, downregulating amygdala hyperarousal and reducing cortisol secretion more rapidly than conventional cognitive‐only desensitization models [12, 13, 14]. EFT is a method based on energy psychotherapy and is an application that uses cognitive and physical elements together to eliminate negative emotions and emotional and physical discomfort. In response to stress, stress hormones are released, and subsequently, the amygdala and other cerebral regions involved in stress responses are activated. If this cycle is not interrupted, the physical and psychological consequences that occur in the individual begin to become chronic over time [6, 11, 15]. In EFT, tapping is performed on 12 energy meridian end points (acupressure points) while sending messages to the emotional body (subconscious) with suggestive phrases [6, 16, 17]. Stimulating acupuncture points intervenes more quickly in the overstimulation cycle of the sympathetic nervous system compared to other types of desensitization [12, 13, 14, 18], thereby reducing symptoms more rapidly [6]. The application reveals imbalances in the energy meridians, balancing the system as a whole and enabling the body to reset its stress response [19, 20, 21]. Additionally, EFT has been extensively researched and proven effective in treating depression, anxiety, phobias, and posttraumatic stress disorder (PTSD) [9, 10]. The efficacy of EFT has been examined in over 100 randomized controlled trials [15, 22].

A study conducted in Australia to evaluate the effectiveness of cognitive behavioral therapy (CBT) and EFT in the treatment of depression and anxiety found a significant reduction in symptoms at 3‐ and 6‐month follow‐ups [23]. Church and colleagues' study showed that EFT is an effective treatment for reducing stress biomarkers [2]. In Tack and colleagues' study, it was noted that the use of EFT for cancer‐related cognitive impairment in cancer survivors improved quality of life [1]. An examination of previous studies indicated no studies examining the effect of emotional freedom techniques on death anxiety in patients with cancer‐related anxiety. The original aspect of this study is that it is the first to examine the effect of EFT on death anxiety in patients experiencing cancer‐related anxiety after surgery.

2. Methods

2.1. Aim

The aim of this study is to examine the effect of EFT on death anxiety in patients experiencing cancer‐related anxiety after surgery.

2.2. Study Design

The study was carried out as a randomized controlled trial model on patients undergoing oncological surgery in the surgical clinics of a university hospital in Türkiye between February 2025 and September 2025. This research protocol was prepared following the CONSORT statement [24].

2.3. Participants

Patients who had undergone cancer surgery were included in the study. Inclusion criteria included being at least 18 years old, having undergone oncological surgery, and having no visual, hearing, or psychiatric impairment. The exclusion criteria included refusal to participate or withdrawal from the study, being under 18 years of age, and having a previous cancer diagnosis.

2.4. Sample Size

The sample size calculation performed using the G‐Power program with an effect size of 0.7, a margin of error of 0.05, a confidence interval of 0.95, and a power of 95% determined that a minimum of 120 patients was required, with 60 patients in each group. The sample included patients who met the inclusion criteria and were selected using a random sampling method that was not representative of the population. A total of 13 patients were excluded from the study; eight did not meet the inclusion criteria, while five declined to participate (Figure 1).

FIGURE 1.

Research flowchart.

2.5. Randomization

The study used block randomization (1:1 ratio, two blocks). Numbers between 1 and 120 were randomly assigned to two blocks using an algorithm in web‐based software called Sealed Envelope [25]. A lottery was held to determine which block would include the first patient. The first block was assigned to the control group, and the second to the intervention group.

2.6. Outcome Measures

In this study, outcomes were evaluated using a four‐part questionnaire, and the details of each measurement instrument are presented below.

2.7. Patient Characteristic Form

This form, consisting of 13 questions, was prepared by the researchers to record patients' sociodemographic and medical characteristics.

2.8. Subjective Units of Disturbance Scale (SUDS)

This scale, commonly used in energy therapies, enables individuals to rate their discomfort on a 0–10 scale, with 0 representing no discomfort and 10 representing the highest level of discomfort [20, 21]. There is no requirement for this score to correspond to the actual severity of the discomfort at the time of measurement. What is important is that the individual assesses their own discomfort at that moment and assigns a score. This score serves as a concrete and fundamental starting point for the individual's condition at the beginning of the application and reflects the change that occurs at the end of the application [21].

2.9. Cancer Anxiety Scale

Developed by Bleiker and colleagues in 2013, the scale was translated into Turkish by Özlem Üner in 2017. The scale is a 4‐point Likert‐type scale with no sub‐dimensions and consists of 8 items. The minimum possible score is 8, and the maximum is 32, with higher scores indicating greater anxiety about cancer. In an analysis conducted by Özlem Üner for Turkish validity and reliability, the Cronbach's alpha reliability coefficient was found to be 0.87 [3].

2.10. Death Anxiety Scale (DAS)

Developed by Templer in 1970, the scale was translated into Turkish by Sarıkaya and Baloğlu in 2013 [26]. The scale consists of 20 items on a 5‐point Likert scale and three sub‐dimensions (uncertainty of death, exposure, suffering). This scale, which is evaluated between 0 and 80 points, has cutoff points of 0–29 indicating low, 30–59 indicating moderate, and 60–80 indicating high levels of death anxiety. A Turkish validation study conducted by Sarıkaya and Baloğlu showed that the scale's total Cronbach's α was 0.95 [26].

2.11. Data Collection

Data collection was carried out by the researchers via face‐to‐face interviews from February 2025 to September 2025. There were no adverse events in either group during the course of the study.

2.12. EFT Session for Intervention Group

After arriving at the clinic following surgery and stabilizing, patients were administered a pretest consisting of a patient information form, subjective distress unit, cancer anxiety scale, and death anxiety scale. Researchers provided EFT training to patients and requested EFT application. They were asked to apply it once a day for 3 days. After 3 days, the subjective distress unit, cancer anxiety scale, and death anxiety scale were administered as a posttest. The Clinical EFT sessions were delivered individually by the primary researcher, who are Associate Professor Remziye CİCİ with certified institutional training in Clinical EFT frameworks, ensuring absolute protocol fidelity and adherence to standardized guidelines.

EFT is an application that works on cognitive and energetic levels. Therefore, exposure therapy is primarily applied to individuals in EFT. Exposure therapy involves comparing the individual with the situation that triggers a stress response, known as the trigger, during the application. The trigger is reminded to the individual to make them aware and conscious of their discomfort. This activates the amygdala and creates a threat warning. While the stimulus is kept active in the individual's mind, that is, while the individual is conscious of the problem, touch therapy is started at the same time. In this way, cognitive transition and energetic oscillation occur simultaneously in individuals. Touch therapy is the stage of EFT where taps are applied to the meridian points on the upper part of the body. Stressful situations can cause blockages in the individual's energy flow. The stimuli applied at this stage aim to correct and improve the disrupted energy flow, that is, to restore the balance between “Yin and Yang.” These forces correspond to the sympathetic and parasympathetic systems, respectively. Stimulation of acupuncture points reaches the brain via nerve fibers and, after being interpreted there, activates various mechanisms through reflex and neurochemical pathways [12, 13, 14, 18]. These mechanisms work as follows. During touch therapy, negative stimuli to the brain are reduced, ensuring that inactive signals are sent to the brain. The hippocampus also records the situation in which the stimulus is safely activated without causing a stress response. The neural pathways that trigger the stress response are permanently altered, and thus the individual does not experience a stress response when encountering the trigger without limbic arousal. Unlike traditional psychotherapy techniques, in EFT, after acupressure point touch therapy, the individual gains strength by repeating short and meaningful sentences about their problems—that is, “setup statements of self‐acceptance” and “reminder phrases”—and lasting change can be achieved in a very short time [12, 13, 14, 19, 20]. It is also known that EFT, which lasts approximately 30 min per session, can demonstrate its effects in a single session [19, 20, 21].

https://www.reddit.com/r/InternalFamilySystems/comments/1g5oc5u/to_those_of_you_who_do_tapping_combined_with_ifs/?tl=tr

2.13. Intervention Protocol (EFT Application Guidelines)

The EFT protocol consists of six structured stages. In the first stage, participants identify and rate their level of subjective distress and form a statement of self‐acceptance related to the issue. The second stage, known as the setup phase, involves repeating a setup statement such as “Despite the problem I have mentioned, I fully accept myself as I am.” The third stage represents the somatic component, during which the individual or practitioner taps 12 acupressure points—five on the head, two on the body, and five on the hands—five to ten times in sequence. The fourth stage, the 9 Gamut Procedure, simultaneously stimulates both hemispheres of the brain through a series of nine actions, including specific eye movements, humming, and simple counting, while continuously tapping the gamut point on the back of the hand. In the fifth stage, the tapping sequence is repeated on the opposite side of the body to reinforce relaxation and cognitive balance. Finally, in the sixth stage, the subjective distress level is reassessed using the SUDS scale to evaluate the change, and the session is concluded [11, 19, 20, 21, 27, 28].

2.14. Control Group

Patients in the control group were administered a patient introduction form, a subjective discomfort unit, a cancer anxiety scale, and a death anxiety scale as pretests after arriving at the clinic following surgery and stabilizing. No interventions outside the clinical protocol were performed on patients in the control group. Three days later, the subjective distress unit, cancer anxiety scale, and death anxiety scale were administered as a final test.

2.15. Statistical Analysis

All statistical analyses were performed using SPSS software (version 25.0). The normality of the data distribution was verified using the Kolmogorov–Smirnov test, while descriptive statistical tests, such as means, standard deviations, and percentages were used to describe demographic and clinical characteristics. Differences in categorical variables were analyzed using the chi‐square test, while independent sample t‐tests were used for baseline continuous data comparisons. To evaluate the true efficacy of the intervention and avoid the inflation of Type I errors from isolated within‐group comparisons, a Two‐Way Repeated Measures ANOVA (Group × Time) model was utilized. The primary focus of the statistical inference was the Group × Time interaction effect to determine whether changes in cancer anxiety, death anxiety, and subjective distress scores over the two temporal periods (pretest vs. posttest) differed significantly between the intervention and control cohorts. Pairwise within‐group continuous data transitions were monitored via paired sample t‐tests. Standardized effect sizes were reported using Cohen's d along with their respective 95% Confidence Intervals (CI). A 95% confidence interval and a two‐tailed significance threshold of p < 0.05 were considered for all omnibus tests and interaction models.

2.16. Ethical Considerations

Ethical approval for this study was obtained from the Non‐Interventional Clinical Research Ethics Committee of Fırat University (Decision No: 2024/02‐47, dated February 1, 2024). The study registration was obtained from ClinicalTrials.gov under the number NCT06816576 on 06 February 2025. The aim of the study was explained to the participants by the researchers, who stated that the information would be kept confidential, that they could withdraw from the study at any time, and that the data obtained would only be used in this research. The participants voluntarily signed the participant consent form and participated in the study. The principles of the Declaration of Helsinki were adhered to throughout the study.

3. Results

3.1. Participants

Table 1 shows the results of descriptive tests regarding the personal characteristics of patients and homogeneity tests performed between the control and intervention groups. Homogeneity tests conducted between the control and intervention groups revealed no statistically significant differences in terms of age, gender, education and marital status, economic status, occupation, presence of chronic disease, hospitalization duration, surgical history, and time to diagnosis (p > 0.05). Based on these results, the individual characteristics of the control and intervention groups were similar, and there was a homogeneous distribution (Table 1).

TABLE 1.

Sociodemographic and clinical characteristics of patients undergoing oncological surgery.

Sociodemographic and clinical characteristics	Experimental group (n = 60)		Control group (n = 60)		Homogeneity testing and significance
	N	%	N	%	χ 2/p
Sex
Female	24	40.0	21	35.0	χ 2: 0.142 p: 0.706
Male	36	60.0	39	65.0
Marital status
Married	46	76.7	43	71.7	χ 2: 0.174 p: 0.677
Single	14	23.3	17	28.3
Education level
Literate	5	8.3	6	10.0	χ 2: 3.794 p: 0.579
Primary education	10	16.7	11	18.3
High school	17	28.3	15	25.0
Associate's degree	10	16.7	17	28.3
Undergraduate	12	20.0	7	11.7
Postgraduate	6	10.0	4	4.0
Income level
Income less than expenses	27	45.0	26	43.3	χ 2: 0.209 p: 0.901
Income equals expenses	22	36.7	21	35.0
Income more than expenses	11	18.3	13	21.7
Occupation
Officer	14	23.3	16	26.7	χ 2: 1.140 p: 0.888
Worker	9	15.0	12	20.0
Self‐employed	7	11.7	6	10.0
Agricultural Worker/Farmer	11	18.3	8	13.3
Retired	19	31.7	18	30.0
Previous surgery
Yes	13	21.7	18	30.0	χ 2: 0.696 p: 0.404
No	47	78.3	42	70.0
Chronic disease
Yes	52	86.7	55	91.7	χ 2: 0.345 p: 0.557
No	8	13.3	5	8.3
Diagnosis time
0–1 week	21	35.0	26	43.3	χ 2: 2.277 p: 0.685
2–3 week	12	20.0	14	23.3
4–5 week	13	21.7	11	18.3
6–7 week	8	13.3	4	6.7
8 weeks and above	6	10.0	5	8.3

	($\overline{x}$ ± SD)	Min–Max	($\overline{x}$ ± SD)	Min–Max	Homogeneity testing and significance
Age (years)	55.31 ± 10.37	(38–79)	53.10 ± 9.00	(33–70)	t: 1.250, p: 0.214
Duration of hospitalization (days)	3.38 ± 2.21	(1–11)	3.16 ± 1.73	(1–10)	t: 0.596, p: 0.553

Note: $\overline{x}$, mean; χ ², chi‐square test; t, independent samples t‐test, p < 0.05.

Abbreviation: SD, standard deviation.

3.2. Cancer‐Related Anxiety

Table 2 shows the intra‐group and inter‐group comparisons of cancer‐related anxiety levels in the intervention and control groups after surgery. There was no statistically significant difference between the cancer‐related anxiety scores of the intervention and control groups before EFT (p = 0.885). After EFT, the cancer‐related anxiety score decreased in the intervention group, and the intra‐group difference was statistically significant (p < 0.001, 95% CI: 2.57 to 4.99). No statistically significant change was observed in the cancer‐related anxiety score of the control group after EFT (p = 0.890, 95% CI: −0.67 to −0.77).

TABLE 2.

Intra‐group and inter‐group comparisons of postoperative cancer‐related anxiety levels.

Cancer‐related anxiety levels		Experimental group (EFT)	Control group	Inter‐group comparison
		$\overline{x}$ + SD	$\overline{x}$+ SD	Test b /p
Pretest		18.58 ± 4.94	18.48 ± 1.97	t: 0.146, p: 0.885
Posttest		14.80 ± 4.57	18.43 ± 1.83	t: −5.708, p < 0.001 *
Intra‐group comparison	Test a /p	t: 6.257, p < 0.001 *	t: 0.139, p: 0.890
Effect size	%95 CI	2.57345 to 4.99321	−0.67198 to −0.77198
	d	0.794	0.026
Group × Time Interaction				F = 18.412, p < 0.001

Note: $\overline{x}$, mean; d, Cohen's d. The bold values represent statistically significant results (p < 0.05 or p < 0.001).

Abbreviations: CI, confidence interval; SD, standard deviation.

^a Paired samples t‐test.

^b Independent samples t‐test.

^* p < 0.05, interaction effect calculated via Two‐Way Repeated Measures ANOVA.

The Two‐Way Repeated Measures ANOVA model showed a significant Group × Time interaction effect, F = 18.412, p < 0.001. When the final test scores for cancer‐related anxiety were compared between the intervention and control groups, the difference between them was statistically significant (p < 0.001). The intervention group had a lower level of cancer‐related anxiety based on the final test score (Table 2).

3.3. Death Anxiety

Table 3 shows the intra‐group and inter‐group comparisons of postoperative death anxiety levels in the intervention and control groups. There was no statistically significant difference between the death anxiety scores of the intervention and control groups before EFT (p = 0.933). After EFT, the death anxiety score decreased in the intervention group, and the intra‐group difference was statistically significant (p < 0.001, 95% CI: 4.16 to 6.04). No statistically significant change was observed in the death anxiety score of the control group after EFT (p = 0.475, 95% CI: −1.16 to −2.46).

TABLE 3.

Intra‐group and inter‐group comparisons of postoperative death anxiety levels.

Death anxiety levels		Experimental group (EFT)	Control group	Inter‐group comparison
		$\overline{x}$ + SD	$\overline{x}$+ SD	Test b /p
Pretest		51.26 ± 3.06	51.20 ± 5.27	t: 0.085, p: 0.933
Posttest		46.16 ± 3.73	50.55 ± 6.96	t: −4.297, p < 0.001 *
Intra‐group comparison	Test a /p	t: 10.855, p < 0.001 *	t: 0.719, p: 0.475
Effect size	%95 CI	4.15988 to 6.04012	−1.15912 to −2.45912
	d	1.494	0.025
Group × Time Interaction				F = 43.118, p < 0.001

Note: $\overline{x}$, mean, d, Cohen's d. The bold values represent statistically significant results (p < 0.05 or p < 0.001).

Abbreviations: CI, confidence interval; SD, standard deviation.

^a Paired samples t‐test.

^b Independent samples t‐test.

^* p < 0.05, interaction effect calculated via Two‐Way Repeated Measures ANOVA.

The analysis showed a significant Group × Time interaction effect for death anxiety scores, F = 43.118, p < 0.001. When the final test scores for death anxiety were compared between the intervention and control groups, the difference between them was statistically significant (p < 0.001). The intervention group had a lower level of death anxiety based on the final test score (Table 3).

3.4. Subjective Discomfort Levels

Table 4 shows the intra‐group and inter‐group comparisons of the subjective discomfort levels of the intervention and control groups after surgery. There was no statistically significant difference between the subjective discomfort scores of the intervention and control groups before EFT (p = 0.675). After EFT, the subjective discomfort score decreased in the intervention group, and the intra‐group difference was statistically significant (p < 0.001, 95% CI: 0.51 to 1.43). No statistically significant change was observed in the subjective discomfort score of the control group after EFT (p = 0.355, 95% CI: −0.17 to −0.47).

TABLE 4.

Intra‐group and inter‐group comparisons of postoperative subjective distress levels.

Subjective distress levels (SUDS)		Experimental group (EFT)	Control group	Inter‐group comparison
		$\overline{x}$ + SD	$\overline{x}$ + SD	Test b /p
Pretest		4.48 ± 1.48	4.40 ± 1.90	t: 4.20, p: 0.675
Posttest		3.51 ± 1.46	4.25 ± 1.57	t: −2.460, p: 0.015 *
Intra‐group comparison	Test a /p	t: 4.218, p < 0.001 *	t: 0.932, p: 0.355
Effect size	%95 CI	0.50808 to 1.42526	−0.17197 to −0.47197
	d	0.659	0.086
Group × Time Interaction				F = 11.234, p = 0.001

Note: $\overline{x}$, mean, d, Cohen's d. The bold values represent statistically significant results (p < 0.05 or p < 0.001).

Abbreviations: CI, confidence interval; SD, standard deviation.

^a Paired samples t‐test.

^b Independent samples t‐test.

^* p < 0.05, interaction effect calculated via Two‐Way Repeated Measures ANOVA.

The interaction model showed a significant Group × Time interaction effect, F = 11.234, p = 0.001. When the subjective distress posttest scores of the intervention and control groups were compared, the difference between them was statistically significant (p = 0.015). The intervention group had a lower level of subjective distress based on the posttest score (Table 4).

4. Discussion

This study aimed to investigate the effect of EFT on death anxiety in patients experiencing postsurgery cancer‐related anxiety. While no significant difference was found between the pretest cancer anxiety levels of the intervention and control groups (p > 0.05), a significant decrease was found in the intervention group after EFT (p < 0.001). This result was supported by the significant Group × Time interaction model (F = 18.412, p < 0.001). No study directly examining cancer‐related anxiety with EFT has been found in the literature. Zheng and colleagues conducted a large meta‐analysis that examined 10 randomized controlled trials involving 774 cancer patients. The meta‐analysis reported that EFT resulted in significant improvements in anxiety and depression levels [29]. Similarly, Salarirad et al. [30] found that EFT reduced anxiety levels in cancer patients. In a study examining the immediate effect of short‐term energy psychology intervention (EFT) on specific phobias, Salas and colleagues reported that EFT significantly reduced anxiety associated with phobias [11]. Another study reported that EFT is effective in psychological conditions such as phobias and posttraumatic stress disorder [28]. Almeida et al. [31] reported that EFT was not effective in cancer patients experiencing fear of recurrence. Although the research results are not identical to this study, the finding that EFT applied to cancer patients and those in the postoperative period improves symptoms such as anxiety and depression is consistent with our findings. It is suggested that the effect of EFT arises through mechanisms that regulate emotional responses and provide physical relaxation, downregulating stress pathways and modulating the amygdala pathway via percussive tapping on acupuncture points [12, 13]. In this context, EFT can be considered an applicable, easy, noninvasive method, especially for individuals who experience intense anxiety related to cancer in the postoperative period.

The study found that the pretest results for death anxiety levels were similar in the intervention and control groups after the operation (p > 0.05). However, after EFT was applied to the intervention group, a significant decrease in death anxiety was found in patients compared to the control group (p < 0.001). The high effect size obtained in the intervention group (d = 1.494), combined with the significant Group × Time interaction (F = 43.118, p < 0.001), shows that EFT has a strong effect on death anxiety. No study directly examining death anxiety with EFT in patients undergoing surgery has been found in the literature. Therefore, comparisons were made with studies involving different sample groups. A systematic review reported that EFT improves death attitudes in cancer patients [29]. Considering that death attitudes have sub‐dimensions such as death anxiety, accepting death as a natural process, and accepting death as a cure or escape from illness, this study supports our findings [32]. In a study examining the effect of EFT on death anxiety in elderly patients without cancer, unlike this study, it was reported that EFT did not produce a significant change in death anxiety [33]. Tack and colleagues reported in their study conducted between 2016 and 2020 on 121 patients with cancer‐related cognitive impairment that EFT had a positive effect on depressive states, fatigue, and quality of life in cancer patients [1]. Literature findings vary. As a unitary technique, EFT can be applied to many problems because these problems are linked to stress pathway responses, and the application protocol is designed to address this hyperarousal [14, 34]. EFT works on both cognitive and somatic levels. While the individual is made aware of and conscious of the distressing anxiety or discomfort using reminder phrases, the selected acupuncture points are tapped simultaneously, creating a cognitive shift and limbic desensitization [12, 13]. This result may be due to EFT's ability to reduce death anxiety by providing physical and cognitive relaxation through cognitive transition and somatic regulation.

The results of the study showed that the subjective distress levels of patients in the intervention group were significantly lower than those in the control group following the EFT application (p = 0.015), which was supported by the Group × Time interaction model (F = 11.234, p = 0.001). Since subjective distress measures the extent of distress caused by any problem in an individual [20, 21], this result demonstrates the effectiveness of EFT after application, indicating that EFT provides relief in patients and may be effective in reducing the distress caused by death anxiety in individuals. Cici and Özkan reported that EFT significantly reduced subjective distress levels in patients with lumbar disc herniation [19]. Salami [35] reported in his study that EFT reduced students' subjective distress levels to 0. Salas and colleagues reported that EFT was effective in reducing subjective discomfort levels in students [11]. This study's results are consistent with those reported in the literature. This indicates that EFT promotes somatic relaxation in individuals. Given the single‐center design of this study, these results suggest that EFT has potential for immediate distress relief in localized clinical protocols, though further trials are required to evaluate its long‐term durability.

4.1. Limitations

The fact that the research data was collected from a single‐center and therefore cannot be generalized to the entire population constitutes a limitation of this study. This study evaluated outcomes immediately following the 3‐day intervention window. Consequently, the durability and long‐term sustainability of EFT's effects on death anxiety remain unknown. Future multi‐center trials incorporating 3‐, 6‐, and 12‐month follow‐up assessments are strictly warranted.

5. Conclusions

Clinical EFT application demonstrated immediate postintervention efficacy in reducing death anxiety, cancer‐related anxiety, and subjective distress. However, due to the absence of a long‐term follow‐up period, these findings reflect acute psychological stabilization. In line with these results, EFT can be recommended as a complementary intervention to reduce death anxiety and psychological disturbances, especially in the postoperative period, as a noninvasive, easily applicable technique that can provide effective results in a short time. Raising awareness about EFT and its use in health professionals and providing training may increase clinical use. It may be recommended to plan studies to investigate the effectiveness of EFT in different groups, over a longer period of time and in different cancer types.

Author Contributions

Şerafettin Okutan: conceptualization, methodology, investigation, resources, data curation, writing – original draft, writing – review and editing, visualization, supervision, project administration, funding acquisition. Gürkan Kapikiran: conceptualization, methodology, formal analysis, investigation, resources, data curation, writing – original draft, writing – review and editing, supervision, project administration, funding acquisition. Remziye Cici: conceptualization, methodology, software, validation, resources, writing – original draft, writing – review and editing, supervision, project administration, funding acquisition. Seher Çevik Aktura: conceptualization, methodology, investigation, resources, data curation, writing – original draft, writing – review and editing, visualization, supervision, project administration, funding acquisition.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data supporting the findings of this study are available from the corresponding authors upon reasonable request.