2. to evaluate the effectiveness of emotional freedom techniques (eft) bb
TRANSCRIPT
Barbara Baker, PhD
Senior Research Fellow
Caroline Hoffman, PhD
Clinical and Research Director
The Haven Breast Cancer Support Centres
London – Hereford – Leeds, UK
www.thehaven.org.ukRegistered Charity No. 1061726
To evaluate the effectiveness of Emotional Freedom Techniques (EFT) to reduce the side effects caused by Tamoxifen and Aromatase
Inhibitors in women with breast cancer: a preliminary service evaluation
Introduction
The Haven charity provides welcoming day centres which provide free in-depth individualised programmes of psychological support and complementary therapies to anyone affected by breast cancer
Background
• Women with breast cancer show poor adherence to Tamoxifen and Aromatase Inhibitors (AIs), mainly due to side effects
• Need for self-help tools to improve quality of life• Emotional Freedom Techniques (EFT) – gentle tapping on
specific acupuncture points whilst focusing on negative emotion or symptom
• EFT may improve psychological distress in individuals with post-traumatic stress disorder, phobias and anxiety
• No research studies published on effect of EFT in cancer
Background
• Visitors to the Haven centres say that EFT helps to relieve both physical and emotional symptoms:
“Tapping for pain in neck helped”
“Can now deal with these things that bother me (that didn’t before) by tapping which makes things clearer”
Aims
• To develop a self-EFT protocol for women with breast cancer with Tamoxifen or Aromatase Inhibitor-associated menopausal symptoms, such as fatigue, hot flushes, joint pains and mood disturbance.
• To test the effectiveness of the self-EFT protocol for addressing menopausal symptoms.
EFT – What is it?
• EFT is a form of emotional acupuncture without the needles based on the premise that all negative emotions are the result of a disruption in the body’s energy system.
• EFT works by clearing the blockage by tapping on the end points of the body’s energy meridians, while tuning the mind to the issue in question.
• Set-up: tapping on Karate Chop point accompanied by saying out loud -
Even though I have “this problem” I deeply and completely love and accept myself
• Sequence: a word that describes “this problem” is repeated aloud each time the points are tapped in sequence
EFT Tapping points
Methods• Invitation emails sent to active Visitors to London and
Leeds Havens• Three week course of EFT, one session of 3 hours/wk• Questionnaires on mood, pain, fatigue, endocrine
symptoms and hot flushes/night sweats plus hot flush diary at baseline, weeks 6 and 12.
• 7-day home practice sheets, each week for first 6 wks• Feedback form at 6 wks• Follow-up group at 8 wks
EFT Protocol
• Week 1: Taught EFT protocol, given The Haven at Home DVD
• Week 2: Check progress and troubleshoot• Week 3: Fine tune according to individual needs• Weeks 4-8: EFT use for self-help• Week 8: Follow-up group including EFT session • Weeks 9-12: EFT use for self-help
Analysis of Findings
Non-parametric statistical tests:• Wilcoxon Signed Rank Test used to compare
questionnaire scores at baseline (T1) with 6 weeks (T2) and with12 weeks (T3), and to compare T2 and T3
• Friedman Test used to compare all three time-points• Analysed with SPSS software v20
Flow Diagram of Service Evaluation44 women accepted invitation to take part
31 women2 dropped out
13 women1 dropped out
Baseline assessment:28 completed questionnaires28 completed hot flush diaries
Baseline assessment:12 completed questionnaires11 completed hot flush diaries
Assessment at 6 weeks:3 dropped out12 completed questionnaires12 completed hot flush diaries
Assessment at 6 weeks:2 dropped out due to illness6 completed questionnaires6 completed hot flush diaries
Final Assessment at 12 weeks:1 dropped out12 completed questionnaires11 completed hot flush diaries
Final Assessment at 12 weeks:6 completed questionnaires6 completed hot flush diaries
LONDON LEEDS
Findings: Comparison of side effects of Tamoxifen and AIs
• 40 women completed baseline questionnaire:– Tamoxifen, n=19– Letrazole (Femara), n=11– Anastrazole (Arimidex), n=7– Exemestane (Aromasin), n=3
• Hot flushes/night sweats and fatigue frequent for both Tamoxifen and AIs users
• Aches and pains more frequent in AIs users• Mood swings more common in Tamoxifen users• Less frequent side effects in both groups- nausea,
lowered sex drive and vaginal dryness/discharge
Findings: Profile of Mood States (POMS)
Significant improvements at T2 and T3 vs T1:• Total Mood Disturbance (TMD)• Tension/Anxiety• Depression/Dejection• Fatigue/Inertia
Significant improvements at T2 vs T1:• Vigour/Activity• Confusion/bewilderment
No significant difference between T2 and T3 for TMD or any of the subscales
Findings: POMS significance values
POMS scale *T1 vs T2 **T1 vs T3
Total Mood Disturbance p<0.005 p<0.008
Tension/anxiety p<0.003 p<0.028
Depression/dejection p<0.006 p<0.020
Vigour/Activity p<0.039 NS
Fatigue/Inertia p<0.008 p<0.033
Confusion/bewilderment p<0.004 NS
*Total Mood Disturbance, n=14; POMS subscales, n=17 ** Total Mood Disturbance, n=14; POMS subscales, n=16
Findings: Profile of Mood States (POMS)
Findings: FACT-Endocrine Symptoms
There were no significant changes in FACT-ES scores over the three time periods
Findings: Brief Pain Inventory
• 24 of 34 (70%) respondents had pain other than everyday pain
• Most who took medications for pain had relief to varying degrees
• Significant decrease in mean pain interference score at T3 vs T1 (p<0.042, n=11)
• No significant changes in pain severity rates, either individually (worst, least, on average, right now) or summed as mean pain severity score
• Trend in increase of average pain at T2 vs T1 (p<0.056, n=11)
Findings: Brief Pain Inventory
Findings: Brief Fatigue Inventory• 28 of 30 (93%) felt unusually fatigued in the last week• Fatigue now was significantly decreased at both T2 and
T3 vs T1• Usual fatigue in the last 24 hrs was significantly lower at
T3 vs T1• Worst fatigue was significantly lower at T2 vs T1• Mean fatigue interference score significantly decreased
at both T2 and T3 vs T1• Mean global fatigue score significantly lower at T2 vs T1
Findings: Brief Fatigue Inventory
Fatigue scale T1 vs T2 T1 vs T3
Fatigue now (n=10)
p<0.018 p<0.048
Usual fatigue in last 24 hrs (n=10)
NS p<0.046
Worst fatigue in last 24 hrs (n=10)
p<0.041 NS
Mean Fatigue Interference (n=12)
p<0.025 p<0.041
Mean Global Fatigue (n=12)
p<0.012 NS
Findings: Brief Fatigue Inventory
Findings: Hunter’s HFNS Scale• 21 of 32 (66%) had 1-10 hot flushes/day at T1• Similar proportion had 1-5 hot flushes/day at T2 and T3• Severity of hot flushes changed from moderate to mild• Most who responded had 1-5 night sweats/night
throughout the study period• Severity of night sweats changed from moderate to mild• Problem Rating Score significantly decreased at T2
(p<0.026) and T3 (p<0.002) vs T1• Problem Rating Score significantly decreased between
T2 and T3 (p<0.008)
Findings: Hot Flush Diary
• Total and moderate severity hot flushes significantly decreased at both T2 (p<0.008; p<0.05) and T3 (p<0.015; p<0.035) vs T1.
• Moderate severity hot flushes significantly decreased between T2 and T3 (p<0.018)
Findings: Hot Flush Diary
Comments
• Since doing the Emotional Freedom Technique I have found the hot flushes have become less severe and not so frequent.
• Whilst I still suffer from bouts of depression they haven't escalated to a severe, hopeless bout since I began EFT.
Conclusions
This preliminary service evaluation has shown that EFT shows considerable potential as a self-help tool to manage the side effects associated with hormonal therapies, specifically hot flushes/night sweats, fatigue and mood changes, in women with breast cancer.
