Journal of Oriental Neuropsychiatry (동의신경정신과학회지)

The Korean Society of Oriental Neuropsychiatry (대한한방신경정신과학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of Emotion Freedom Techniques on Academic Stress in Korean Medical Students: A Single-Group Pre-Post Study

  • Lee, Seung Hwan (Solsol Korean Medicine Clinic) ;
  • Han, Sang Yun (The Office of Korean Medicine Education Daejeon University College of Korean Medicine) ;
  • Lee, Soo Jin (Department of Psychology, Kyungsung University) ;
  • Chae, Han (School of Korean Medicine, Pusan National University) ;
  • Lim, Jung Hwa (Department of Neuropsychiatry, Pusan National University Korean Medical Hospital)
  • Received : 2022.02.25
  • Accepted : 2022.03.25
  • Published : 2022.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: Academic stress poses a significant risk for the mental health of medical students, and a feasible group intervention program for managing academic stress is required. The purpose of this study was to examine the clinical effectiveness of emotional freedom techniques (EFT) on the mental health of Korean medical students. Methods: The class of first-year medical school students (n=36) participated in an after-school EFT group intervention program comprising six sessions (15 minutes/session, three weeks) to analyze its clinical effectiveness as a single-group test-retest clinical study. The changes in the Perceived Stress Scale (PSS), Test Anxiety Inventory (TAI), Positive and Negative Affect Schedule (PANAS), and State-Trait Anxiety Inventory (STAI) scores were examined using a paired t-test and Cohen's D at post-EFT and two-week follow-up. Results: There were significant curtailments at post-EFT and follow-up measures in TAI-Total (t=2.704 and t=3.289), TAI-Worry (t=2.297 and t=2.454), TAI-Emotionality (t=2.763 and t=3.654), PSS-Negative Perspective (t=2.659 and t=3.877), and PANAS-Negative Affect (t=2.885 and t=3.259) subscales, however not in PSS-Positive Perspective (t=-1.279 and t=-1.101) and PANAS-Positive Affect (t=0.194 and t=-0.122) subscales. The trait anxiety (t=2.227) was significantly mitigated in the post-EFT measure and the state anxiety (t=2.30) in the follow-up measure. Conclusions: The EFT group intervention alleviated test stress, negative affect, and anxiety in the Korean medical students. This study contributes to an understanding of academic stress and EFT intervention in the competitive environment of medical education.

Keywords

Acknowledgement

This work was supported by clinical research grant from Pusan National University Hospital in 2021.

References

  1. Min SK, Shin WC, Kim KI, Chung JI, Kim DK. Comparison of Quality of Life between Medical Students and General College Students. J Korean Neuropsychiatr Assoc. 2000;39(6):1054-60.
  2. Han SS, Lee SY, Choi WS, Kim SJ, Park SB, Lee SY. Depression and Its Infl uencing Factors among Korean Medical and Engineering Students in Urban Areas using Zung Self-Rating Depression Scale. KJFM. 2009;30(7):539-48.
  3. Frajerman A, Morvan Y, Krebs MO, Gorwood P, Chaumette B. Burnout in medical students before residency: A systematic review and meta-analysis. Eur Psychiatry. 2019;55:36-42. https://doi.org/10.1016/j.eurpsy.2018.08.006
  4. Lee KH, Ko Y, Kang KH, Lee HK, Kang J, Hur Y. Mental Health and Coping Strategies among Medical Students. Korean J Med Educ. 2012;24(1):55-63. https://doi.org/10.3946/kjme.2012.24.1.55
  5. Guthrie E, Campbell M, Black D, Creed F, Bagalkote H, Shaw C. Psychological stress and burnout in medical students: a five-year prospective longitudinal study. J Roy Soc Med. 1998;91(5):237-43. https://doi.org/10.1177/014107689809100502
  6. Kim SH, Han SY, Kim JD, Choi SM, Lee SJ, Lim JH, et al. Study on Stress and Burnout in Medical Education at the School of Korean Medicine. J of Oriental Neuropsychiatry. 2015;26(2):103-16. https://doi.org/10.7231/JON.2015.26.2.103
  7. Yoong CK, Hung ECS, Pin HY, Ithnin HB, Sangit NB, Kwee OS, et al. Stress among medical students in a medical college of South India. Educ Health. 1999;12:63-9.
  8. Kim YH. Moderating Effect of Positive and Negative Emotions upon the Relations of Dysfunctional Beliefs with Stress of College Students [master's thesis]. Daegu: Keimyung University;2014:1-48.
  9. Dhami DB, Singh A, Shah GJ. Prevalence of Depression and Use of Antidepressant in Basic Medical Sciences Students of Nepalgunj Medical College, Chisapani, Nepal. Journal of Nepalgunj Medical College. 2018;16(1):32-6. https://doi.org/10.3126/jngmc.v16i1.24224
  10. Fond G, Bourbon A, Boucekine M, Messiaen M, Barrow V, Auquier P, Lancon C, Boyer L. First-year French medical students consume antidepressants and anxiolytics while second-years consume non-medical drugs. J Affect Disord. 2020;265:71-6. https://doi.org/10.1016/j.jad.2020.01.035
  11. Brandt J, Leong C. Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research. Drugs R D. 2017;17(4):493-507. https://doi.org/10.1007/s40268-017-0207-7
  12. Ferguson JM. SSRI Antidepressant Medications: Adverse Effects and Tolerability. Prim Care Companion J Clin Psychiatry. 2001;3(1):22-7. https://doi.org/10.4088/PCC.v03n0105
  13. Sportel BE, de Hullu E, de Jong PJ, Nauta MH. Cognitive bias modification versus CBT in reducing adolescent social anxiety: a randomized controlled trial. PloS One. 2013;8(5):e64355. https://doi.org/10.1371/journal.pone.0064355
  14. Brown LA, Forman EM, Herbert JD, Hoffman KL, Yuen EK, Goetter EM. A randomized controlled trial of acceptance-based behavior therapy and cognitive therapy for test anxiety: A pilot study. Behav Modif. 2011;35(1):31-53. https://doi.org/10.1177/0145445510390930
  15. Yeom YR, Choi KB. The Effect of Mindfulness Meditation Programs on Nursing College Students'Perceived Stress, Depression, and Self-efficacy. J East-West Nurs Res. 2013;19(2):104-13. https://doi.org/10.14370/JEWNR.2013.19.2.104
  16. Cho H, Ryu S, Noh J, Lee J. The Effectiveness of Daily Mindful Breathing Practices on Test Anxiety of Students. PloS One. 2016;11(10):e0164822. https://doi.org/10.1371/journal.pone.0164822
  17. Koffel E, Bramoweth AD, Ulmer CS. Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review. J Gen Intern Med. 2018;33(6):955-62. https://doi.org/10.1007/s11606-018-4390-1
  18. Hazell CM, Greenwood K, Fielding-Smith S, Rammou A, Bogen-Johnston L, Berry C, Jones AM, Hayward M. Understanding the Barriers to Accessing Symptom-Specific Cognitive Behavior Therapy (CBT) for Distressing Voices: Reflecting on and Extending the Lessons Learnt From the CBT for Psychosis Literature. Front Psychol. 2018;9:727. https://doi.org/10.3389/fpsyg.2018.00727
  19. Sears SR, Kraus S, Carlough K, Treat E. Perceived Benefits and Doubts of Participants in a Weekly Meditation Study. Mindfulness. 2011;2(3):167-74. https://doi.org/10.1007/s12671-011-0055-4
  20. Clond M. Emotional Freedom Techniques for Anxiety: A Systematic Review With Meta-analysis. J Nerv Ment Dis. 2016;204(5):388-95. https://doi.org/10.1097/NMD.0000000000000483
  21. Rancour P. The Emotional Freedom Technique: Finally, a Unifying Theory for the Practice of Holistic Nursing, or Too Good to Be True?. J Holist Nurs. 2016;35(4):382-8. https://doi.org/10.1177/0898010116648456
  22. Church D. Clinical EFT as an evidence-based practice for the treatment of psychological and physiological conditions. Psychology. 2013;4(8):645-54. https://doi.org/10.4236/psych.2013.48092
  23. Leskowitz E. How Tapping into "Energy" Can Trigger a Paradigm Shift in Biomedicine. J Altern Complement Med. 2018;24(6):525-7. https://doi.org/10.1089/acm.2018.0073
  24. Feinstein D. Energy psychology:Efficacy, speed, mechanisms. Explore. 2019;15(5):340-51. https://doi.org/10.1016/j.explore.2018.11.003
  25. Craig G. The EFT Manual. 2nd ed. Seoul: Koonja. 2013:79-130.
  26. Bach D, Groesbeck G, Stapleton P, Sims R, Blickheuser K, Church D. Clinical EFT (Emotional Freedom Techniques) improves multiple physiological markers of health. J Eevid Based Integr Med. 2019;24:2515690X18823691.
  27. Liza V. Stress Management Techniques:evidence-based procedures that reduce stress and promote health. Health Sci J. 2011;5(2):74-89.
  28. Church D, Stapleton P, Yang A, Gallo F. Is Tapping on Acupuncture Points an Active Ingredient in Emotional Freedom Techniques? A Systematic Review and Metaanalysis of Comparative Studies. J Nerv Ment Dis. 2018;206(10):783-93. https://doi.org/10.1097/NMD.0000000000000878
  29. Swingle PG, Pulos L, Swingle MK. Neurophysiological indicators of EFT treatment of post-traumatic stress. Subtle Energies & Energy Medicine. 2004;15(1):75-86.
  30. Church D, Yount G, Rachlin K, Fox L, Nelms J. Epigenetic Effects of PTSD Remediation in Veterans Using Clinical Emotional Freedom Techniques: A Randomized Controlled Pilot Study. American Journal of Health Promotion. 2018;32(1):112-22. https://doi.org/10.1177/0890117116661154
  31. Stapleton P, Buchan C, Mitchell I, McGrath Y, Gorton P, Carter B. An initial investigation of neural changes in overweight adults with food cravings after emotional freedom techniques. OBM Integrative and Complementary Medicine. 2019;4(14):10.21926.
  32. Nelms JA, Castel L. A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Trials of Clinical Emotional Freedom Techniques (EFT) for the Treatment of Depression. Explore (NY). 2016;12(6):416-26. https://doi.org/10.1016/j.explore.2016.08.001
  33. Sebastian B, Nelms J. The effectiveness of emotional freedom techniques in the treatment of posttraumatic stress disorder: A meta-analysis. Explore (NY). 2017;13(1):16-25. https://doi.org/10.1016/j.explore.2016.10.001
  34. Kalla M, Simmons M, Robinson A, Stapleton P. Emotional freedom techniques (EFT) as a practice for supporting chronic disease healthcare: a practitioners' perspective. Disability and Rehabilitation. 2018;40(14):1654-62. https://doi.org/10.1080/09638288.2017.1306125
  35. Suh JW, Chung SY, Kim SY, Lee JH, Kim JW. Anxiety and anger symptoms in Hwabyung patients improved more following 4 weeks of the emotional freedom technique program compared to the progressive muscle relaxation program: a randomized controlled trial. Evid Based Complement Alternat Med. 2015:1-9.
  36. Salas MM, Brooks AJ, Rowe JE. The immediate effect of a brief energy psychology intervention (Emotional Freedom Techniques) on specific phobias: A pilot study. Explore (NY). 2011;7(3):155-61. https://doi.org/10.1016/j.explore.2011.02.005
  37. Lee J, Chung S, Kim J. A comparison of Emotional Freedom Techniques-Insomnia (EFT-I) and Sleep Hygiene Education (SHE) for insomnia in a geriatric population: a randomized controlled trial. Energy Psychol. 2015;7(1):22-9.
  38. Weersing VR, Brent DA, Rozenman MS, Gonzalez A, Jeffreys M, Dickerson JF, et al. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry. 2017;74(6):571-8. https://doi.org/10.1001/jamapsychiatry.2017.0429
  39. Stapleton P, Bannatyne AJ, Urzi KC, Porter B, Sheldon T. Food for Thought: A randomised controlled trial of emotional freedom techniques and cognitive behavioural therapy in the treatment of food cravings. Appl Psychol Health Well Being. 2016;8(2):232-57. https://doi.org/10.1111/aphw.12070
  40. NECA [Internet]. c2022. nHTA Report;2019 May 20 [cite 2022 Mar 11]. Available from:https://nhta.neca.re.kr/nhta/application/nhtaU0509V.ecg?app_seq=3874&app_sch_result=3
  41. NICE [Internet]. c2022. NICE guideline [NG116];2018 Dec 5 [cite 2022 Mar 11]. Available from:https://www.nice.org.uk/guidance/ng116/evidence
  42. Sezgin N, Ozcan B. The effect of progressive muscular relaxation and Emotional Freedom Techniques on test anxiety in high school students: A randomized blind controlled study. Energy Psychol J. 2009;1(1):23-9. https://doi.org/10.9769/EPJ.2009.1.1.NS
  43. Boath E, Stewart A, Carryer A. Tapping for success: A pilot study to explore if emotional freedom techniques (EFT) can reduce anxiety and enhance academic performance in university students. IPIHE. 2013;1(3):1-13.
  44. Patterson SL. The effect of emotional freedom technique on stress and anxiety in nursing students: A pilot study. Nurse Educ Today. 2016;40:104-10. https://doi.org/10.1016/j.nedt.2016.02.003
  45. Church D, Brooks AJ. The effect of a brief EFT (Emotional Freedom Techniques) self-intervention on anxiety, depression, pain and cravings in healthcare workers. Integrative Medicine: A Clinician's Journal. 2010;9(5):40-4.
  46. Church D, Stapleton P, Mollon P, Feinstein D, Boath E, Mackay D, et al., editors. Guidelines for the treatment of PTSD using clinical EFT (Emotional Freedom Techniques). Healthcare; 2018: Multidisciplinary Digital Publishing Institute.
  47. Kim MJ. Development of the Korean form of the test anxiety inventory. Journal of the Korean Academy of Child and Adolescent Psychiatry. 1991;2(1):32-42.
  48. Spielberger CD. The test anxiety inventory. Palo Alto, CA: Consulting Psychologist Press Inc. ; 1980.
  49. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983:385-96.
  50. Lee JE. The Effects of Self-Complexity and Self-Efficacy on Depression and Perceived Stress [master's thesis]. Suwon:Ajou University;2005:1-41.
  51. Hewitt PL, Flett GL, Mosher SW. The Perceived Stress Scale: Factor structure and relation to depression symptoms in a psychiatric sample. J Psychopathol Behav Assess. 1992;14(3):247-57. https://doi.org/10.1007/BF00962631
  52. Lee HH, Kim EJ, Lee MK. A Validation Study of Korea Positive and Negative Affect Schedule: The PANAS Scales. Kor J Clin Psychol. 2003;22(4):935-46.
  53. Spielberger C, Gorsuch R, Lushene R, Vagg P, Jacobs G. Manual for the state-trait anxiety inventory Palo Alto, CA: Consulting Psychologists Press; 1983.
  54. Croyle KL, Weimer AA, Eisenman R. Context of assessment changes relationships between test anxiety and related variables. Int J Adolesc Youth. 2012;17(1):11-20. https://doi.org/10.1080/02673843.2011.645625
  55. Egloff B. The independence of positive and negative affect depends on the affect measure. Pers Individ Differ. 1998;25(6):1101-9. https://doi.org/10.1016/S0191-8869(98)00105-6
  56. Yoon MY, Lee SK, Sohn KW, Lee SJ, Park SH, Yang JW, et al. Psychological Analysis of Sasang Types using PANAS. J Physiol & Pathol Korean Med. 2011;25(2):345-51.
  57. Fox L. Is acupoint tapping an active ingredient or an inert placebo in emotional freedom techniques (EFT)? A randomized controlled dismantling study. Energy Psychol J. 2013;5(2):15-26.
  58. Yune SJ, Park KH, Chung WJ, Lee SY. The Effects of Attribution Tendencies, Academic Stress, and Coping Efficacy on Academic Adjustment of Medical Students. Korean J Med Educ. 2011;23(3):167-74. https://doi.org/10.3946/kjme.2011.23.3.167
  59. Yoo GS, Shin DW. Effects of Stress Coping Styles on Academic Burnout and Employment Stress among Undergraduate Students. Korea Journal of Counseling. 2013;14(6):3849-69. https://doi.org/10.15703/kjc.14.6.201312.3849
  60. Lee CS, Kim YJ. Moderated Effects of Coping Strategies of Stress: Based on Gender Differences of University Students. Studies on Korean Youth. 2004;15(2):183-213.
  61. Folkman S, Lazarus RS, Gruen RJ, DeLongis A. Appraisal, coping, health status, and psychological symptoms. J Pers Soc Psychol. 1986;50(3):571. https://doi.org/10.1037/0022-3514.50.3.571
  62. Yu R, Ho SC. Psychometric evaluation of the perceived stress scale in early postmenopausal Chinese women. Psychology. 2010;1:1-8. https://doi.org/10.4236/psych.2010.11001
  63. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063-70. https://doi.org/10.1037/0022-3514.54.6.1063
  64. Kalla M. Supporting chronic disease healthcare through remote emotional freedom techniques (EFT) treatment and self-care: An evaluation using the WHO determinants of health. Ener Psychol Theor Res Meth. 2016;8:55-66.
  65. Church D, David I. Borrowing Benefits: Clinical EFT (Emotional Freedom Techniques) as an Immediate Stress Reduction Skill in the Workplace. Psychology. 2019;10(07):941-52. https://doi.org/10.4236/psych.2019.107061
  66. Palmer-Hoffman J, Brooks AJ. Psychological Symptom Change after Group Application of Emotional Freedom Techniques (EFT). Energy. 2011;3(1):1-6. https://doi.org/10.1016/0360-5442(78)90051-8
  67. Welch KL, Beere DB. Eye movement desensitization and reprocessing: a treatment efficacy model. Clin Psychol Psychother. 2022;9(3):165-76. https://doi.org/10.1002/cpp.323
  68. Elofsson UO, von Scheele B, Theorell T, Sondergaard HP. Physiological correlates of eye movement desensitization and reprocessing. J Anxiety Disord. 2008;22(4):622-34. https://doi.org/10.1016/j.janxdis.2007.05.012