Emotional Freedom Technique (EFT): Tap to relieve stress and burnout

Abstract

The effects of the COVID-19 pandemic have exponentially increased stress, anxiety and burnout levels for all healthcare professionals and students. The psychological effects of working with COVID-19 patients and the physical stress of working under distressing conditions exacerbate an already stressed workforce. Working long hours, shift work, short staffing, demanding workloads, dealing with death and dying and conflicts with management, other staff and disciplines and poor communication between disciplines are among the issues that can lead to burnout, anxiety and depression. Emotional Freedom Technique (EFT) or tapping is a holistic practice that is easy to learn and apply to self and produces relief from stress, anxiety and the symptoms of burnout within in minutes. There are many websites, videos, and tutorials which can teach and support the healthcare practitioner in the practice of EFT.

1. The challenges of COVID-19 to health care professionals and students

Nursing, by its very nature, is a high stress work environment. The work is often physically stressful and emotionally draining. Working long hours, shift work, short staffing, demanding workloads, dealing with death and dying and conflicts with management, other staff and disciplines and poor communication between disciplines are among the issues that can lead to burnout, anxiety and depression.1, 2, 3, 4, 5, 6 According to Ref. 7; burnout is a significant health problem for US nurses who leave their positions. Nursing students are not immune from these stressors during their education, particularly during their clinical experiences. Some studies even report that student nurses experience higher levels of stress than students in other health related disciplines.8, 9, 10, 11

The effects of the COVID-19 pandemic have exponentially increased stress, anxiety and burnout levels for all healthcare professionals and students. The psychological effects of working with COVID-19 patients and the physical stress of working under distressing conditions exacerbate an already stressed workforce. The scoping review by¹² revealed that the 230 healthcare respondents had psychosocial problems ranging from anxiety of various levels, stress disorder, depression and insomnia. Nurses had higher rates of mental health effects than other healthcare providers. All these consequences were related to the risk factors of working long hours, having family issues; putting their health and their families' health in jeopardy, minimal or lack of PPE, and providing frontline care to COVID-19 patients.^{12 , 13} In a global study of 44 countries during the pandemic,¹⁴; found that of the 10,051 healthcare workers, physicians and “paramedical staff” (nurses), the stress levels of the respondents were 25.8% higher that the general population. This study noted that the increased stress levels among nurses leads to increased burnout and increased psychological distress causing nurses to leave nursing. In another study on the impact of the pandemic on 1200 nurses in the US, it was reported that 60% of acute care nurses experienced burnout, and another 75% are “feeling stressed, frustrated, and exhausted”.¹ Younger nurses have been especially hard hit by stress, anxiety and burnout. From this same US study, 69% of nurses under age 25 report having burnout, which is twice those older than age 25 or 30%. These younger nurses (46%) also indicated that they suffered a traumatic or distressing incident related to COVID-19. Of those nurses under age 35, 60% reported feeling anxious and 47% reported feeling depressed.¹

The most significant issues that need to be dealt with are the systemic ones. Nurses feel that their facility/institution does not support them. After three years of the pandemic nurses are still reporting the same issues – experiencing burnout, PTSD, and mental health challenges due to staffing shortages, working extended hours, being required to work “mandatory overtime,” and having unmanageable workloads^{1 , 3 , 7} When healthcare workers experience burnout and other mental health challenges, patient safety is put at risk, medical errors increase, hospital acquired infections increase, and the general health of the health care provider is jeopardized. The costs of burnout are staggering, for those leaving the field are $9 billion for nurses and $2.6 to $6.3 billion for physicians. Other essential workers are not even included in these numbers.¹³ It is imperative that nurses and students find a quick, easy, practice that produces relief from stress, anxiety and the symptoms of burnout. Emotional Freedom Technique (EFT) or tapping is a holistic practice that is easy to learn and apply to self and produces relief within minutes.

2. Emotional Freedom Technique and the evidence

Emotional Freedom Technique (EFT) is an evidenced-based practice which is grounded in the integrative field of energy psychology (EP) and integrates components of cognitive behavioral therapies, exposure therapy and body stimulation of acupressure points on the face and body.15, 16, 17, 18, 19 Because of EFT's acupressure component, it is commonly known as “tapping.” EFT begins with a simple statement of the issue of concern, called the “Set-up Statement.” The format used is “Even though I have a problem (e.g., stress, anxiety, etc.), I deeply and completely accept myself.” The first part of the statement is the exposure piece. The cognitive piece is the self-acceptance part of the statement. As this statement is being said, and repeated, tapping on acupressure points occurs. There are eight acupressure points on the face and upper body that have an effect that specifically affects stress reduction.^{15 , 16 ,} 18, 19, 20

There have been more than 100 peer-reviewed studies consisting of random controlled trials (RCT), systemic reviews, meta analyses, and outcome reviews, signifying the efficacy of EFT for both psychological and physiological indications.^{15 , 17 , 18} EFT is easy to learn how to use and apply, non-pharmacological, no cost, safe and effective in reducing the stress, anxiety and symptoms of burnout.^{15 , 17 , 21}

An ever increasing number of studies on the benefits of EFT for stress, anxiety and burnout, as well as for other conditions are being documented. Many of these studies demonstrate that EFT is effective as a self-help tool, and for use in healthcare settings by healthcare professionals and students. These studies are evaluated according to the American Psychological Association's Division 12 Task Force on Empirically Validated Treatments.²² Many studies have been conducted on the psychological effects on EFT. However, there is a dearth of studies on the physiological effects of EFT.

A study conducted by²³ examined the effects of EFT on the brain and pain (and other factors) using resting state functional magnetic resonance imaging (fMRI) pre and post intervention. This study not only reported decreased levels of pain, but also somatic symptoms, depression and anxiety. Also reported in this study is that EFT significantly increased happiness, quality of life and satisfaction with life. These results substantiate the effects of EFT as a valid intervention.

¹⁵ studied the effects of EFT on heart rate variability (HRV), heart coherence (HC), blood pressure (BP), and the endocrine system by assessing cortisol and the immune system by evaluating salivary immunoglobulin A (Sig A). These factors were studied in conjunction with psychological symptoms. The outcomes for this study demonstrated substantial decreases in the physiological markers (HRV, HC, BP, and the endocrine and immune systems) as well as the decrease in psychological indicators (anxiety, depression, PTSD, pain, and cravings). There was a positive increase in happiness, as well as in the immune system. The findings of this study support the use of EFT to have positive health and mental wellbeing effects.

3. Instructions and recommendations for use

Tapping may be done anywhere, however, it is best done in a place that is quiet and removed from a busy area. Tapping is done in a comfortable sitting position. No equipment or resources are needed. EFT can be used individually or in a group setting. To do a complete session of EFT takes only a few brief minutes (2–3 rounds/cycles) and the relief of stress and anxiety is almost immediate.²⁴

• 1.First, identify the issue that is causing difficulty. It can be anything - stress, anxiety, feelings of sadness or even physical complaints.
• 2.Then, frame the problem into a statement using this template: “Even though I have this problem [insert what is bothering you], I accept myself and how I feel.” This statement is said while tapping the meaty side part of the hand alongside the pinky finger (Fig. 1 ).
• 3.Repeat the statement as each acupoint is tapped on the body. This can be said out loud or it can be thought. This is a way to acknowledge those negative feelings. Tapping occurs on the eight acupressure points which correspond to the meridians of Chinese medicine. Tapping is thought to influence the flow of body energy (Fig. 2 ).³

Fig. 1.

Acupressure points

(thetappingsolution.com)

Fig. 2.

Eight acupressure points/meridians Chinese medicine

(thetappingsolution.com).

4. Strategies that promote regular practice

Being a busy and overworked professional, finding time to do tapping is always difficult. However, EFT is a quick and easy practice to learn and can be done anywhere – in the car before going to or from work, during a meal break or even in the bathroom. The most difficult challenge is to commit to doing the practice. Some other barriers to practicing tapping are “forgetting” to use EFT – set up reminders on all calendars. Another barrier is not having enough time – EFT is a practice that takes only a few minutes. Feeling awkward performing tapping can be another barrier– do it anyway and tap about it! Developing regular use of tapping is the best way to reduce stress, anxiety and symptoms of burnout.

5. Resources for continued exploration and/or guided practice

EFT is a practice that can be used on oneself to immediately reduces or alleviate stress, anxiety, worries and other inhibiting feelings. There are several resources that can be used readily to begin an EFT practice. Some of these resources are websites, videos, blogs and YouTube. All of these resources are free and may be accessed on all devices.

• 1.ANA Healthy Nurse Healthy Nation:

On this webpage of the American Nurses Association is a brief explanation of tapping and how it relieves stress and how nurses can benefit from tapping. It offers an easy to follow 4 step instructional guide to get tapping right away.

https://engage.healthynursehealthynation.org/blogs/8/2379?

• 2.The Tapping Solution

This website was founded by the Ortner siblings in 200. This webpage offers an extensive collection of information about tapping. The site offers hundreds of tapping meditations, videos, explanations and diagrams/pictures and free You Tube videos. All done in an easy to follow format.

https://www.thetappingsolution.com.

• 3.The Tapping Solution App

In 2018, the Tapping App was released. The app includes hundreds of Tapping Meditations that can be listened to and downloaded right to your phone. A study done by²⁵ using a sample of 270,461 users assessed the effects of the Tapping Solution App. The findings indicated that using the Tapping Solution App had similar efficacy as conventional tapping formats for relief of anxiety and stress.

https://www.thetappingsolutionapp.com.

• 4.EFTUniverse

This website was founded by Dawson Church, one of the pioneers in the use of EFT. The aim of Dr. Church is to provide the benefits of EFT tapping and meditation to a wide audience. The website offers a list of over 100 scientific papers about EFT research studies, as well as seminars, workshops, books, podcasts, free videos, free, live tapping circles, and certification. https://www.eftuniverse.com.

• 5.How to do the EFT Tapping Basics - The Basic Recipe

This website was created by Gary Craig who claims to be the founder of EFT. He provides EFT training videos which record the development of EFT from 1995 through today. The site provides many free tutorials, free a free newsletter, free e-book, practitioner listings and certification.

https://www.emofree.com/nl/eft-tutorial/eft-tapping-tutorial.html?Itemid=0.

6. Key takeaways

• •Healthcare providers and students are undergoing exceptional amounts of stress and anxiety with little to no readily available applications of how to achieve relief.
• •Emotional Freedom Technique (EFT) or Tapping is an effective, efficacious, and evidenced-based practice that can relieve feelings of stress and anxiety quickly and then practiced by the individual on their own.
• •Stress and anxiety reduction lead to feelings of well-being which support psychological health.
• •EFT is quick, noninvasive, non-pharmaceutical, no cost, easy to learn and apply, self-practice that produces relief from that stated problem, in any setting.