Impact of a Single-Session of Havening

Abstract

Introduction: In the UK, the economic cost of absenteeism, loss in productivity and the demand on health care services is considerable. A substantial amount of time off work certified by a doctor is due to common mental disorders. There is a need for rapid and effective interventions at step 2 of the care system.

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Health Science Journal
ISSN 1791-809X
2015
Vol. 9 No. 5:1
1© Copyright iMedPub | This article is available in: www.hsj.gr/archive
Thandi Gursimran1,
Tom Deborah2,
Gould Matthew3,
McKenna Paul 4,
Greenberg Neil1
1 Academic Department of Military
Mental Health at King’s College London,
England
2. Chartered Occupaonal Psychologist and
Managing Director of Human Systems,
Buckinghamshire, England
3. Consultant Chartered Clinical
Psychologist Corporate Psychology,
Emirates Group, Dubai
4. Behavioural Scienst (D.Phil), Wilshire
Blvd, Beverly HIlls, CA
Correspondence: Gursimran Thandi
 gursimran.thandi@kcl.ac.uk
Academic Department of Military Mental
Health, King’s College London, Weston
Educaon Centre, 3rd Floor 10 Cutcombe
Road, London SES 9RJ
Tel: (+44) 207848 5210
Impact of a Single-Session of
Havening
Abstract
Introducon: In the UK, the economic cost of absenteeism, loss in producvity
and the demand on health care services is considerable. A substanal amount of
me o work cered by a doctor is due to common mental disorders. There is a
need for rapid and eecve intervenons at step 2 of the care system.
Objecve: The impact of a single-session of a brief intervenon, called Havening,
in addressing depression, anxiety and impaired funconing in the workplace are
presented.
The aim of this study was to explore the ecacy of a single-session of Havening in
improving self-reported impaired occupaonal funconing.
Methods: Twenty-seven parcipants completed the Paent Health Quesonnaire
depression module (PHQ-9), Generalised Anxiety Disorder Assessment (GAD-7)
and the Work and Social Adjustment Scale (WSAS) before, 1-week and 2-months
aer the Havening intervenon.
Results: The single-session of the Havening intervenon had a posive impact
on probable depression (PHQ-9), probable anxiety (GAD-7) and work and social
adjustment (WSAS) scores over me. The scores on all three measures improved
over me. A signicant eect for me was observed PHQ-9 (χ2(2) =30.79 , p<0.001),
the GAD-7 (χ2(2) = 38.18, p<0.001) and the WSAS (χ2(2) = 22.62, p<0.001).
Conclusion: The single-session of Havening proved ecacious in reducing self-
reported symptoms on the PHQ-9, GAD-7 and the WSAS in a sample of parcipants
who reported being occupaonally impaired.
Keywords: Brief-intervenon; Anxiety; Depression; Occupaonal impairment;
Havening
Introducon
Recent data suggest that around 15% of the population may
be affected by common mental health disorders, such as
depression, generalised anxiety disorder, panic disorder,
obsessive-compulsive disorder (OCD), post-traumatic stress
disorder (PTSD) and social anxiety disorder [1]. According to
the Office of National Statistics, the 1-week prevalence rates
were 4.4% for generalised anxiety disorder, 3.0% for PTSD and
2.3% for depression [2].
In industrialised nations, mental health disorders are the
leading cause of sickness-related absence [3]. In the UK,
47-61% of the total time off work certified by a doctor is
accounted for by common mental disorders [4] and 37% of
all claims for employment support allowance are due to
common mental disorders [5]. As a result, the economic cost
of absenteeism, loss in producvity and demand on health care
services is considerable [6].
These data have led to improved provision of psychological
therapies in the treatment of depression and anxiety to, at least
in part; help ensure that the pool of people who are t to work
is enlarged. One of the long-term aims of the improved provision
of psychological therapies is to reduce the cost of Incapacity
Benet leading to potenal savings for the Department of
Work and Pensions (DWP). Furthermore, the introducon of
new therapeuc provision, such as the Improving Access to
Psychological Therapies (IAPT) iniave, has aimed to overcome
the previously unbalanced provision of psychological therapy,
long waing mes, and lack of consistency in implemenng NICE
guidelines for depression and anxiety [7]. However, there is sll

2This article is available in: www.hsj.gr/archive
ARCHIVOS DE MEDICINA
ISSN 1698-9465
2015
Vol. 9 No. 5:1
Health Science Journal
ISSN 1791-809X
room for improvement in the provision of psychological therapies
including the need to explore the ecacy of brief intervenons [8].
Brief intervenons have proven to be eecve in depression,
anxiety and loss as well as substance use disorders, such as
harmful drinking [9]. The WHO Brief Intervenon Study Group
found that ve minutes of simple advice was as eecve as 20
minutes of counselling [10]. They help to ll the gap between
primary prevenon eorts and more intensive treatment for
individuals who have clinically signicant disorders such as
psychosis, depression associated with suicidality and serious
alcohol use disorders [11].
Havening is a novel brief intervenon being ulised in the
treatment of depression and anxiety. Havening aims to treat
depression and anxiety symptoms caused due to traumac
encoding of negave events [12] by using sensory input to alter
thoughts, mood and behaviour. During Havening, the negave
event and the associated emoonal state are recalled and the
praconer applies a gentle touch to the forearms, which is
coupled with distracng tasks. This process increases the levels of
serotonin which can disrupt reconsolidaon of the link between
the traumac memory of the event and the distress it causes [13].
Given the potenal versality of Havening in treang trauma
related mental health problems, [12] if shown to be eecve it
could be a useful therapy for step 2 of a stepped care system [1].
Aim
The aim of this study was to evaluate the impact of a single-
session of the Havening intervenon on self-reported symptoms
of probable depression, symptoms of probable anxiety and work
and social adjustment scores in a sample of parcipants who
reported being occupaonally impaired.
Method
A snowball recruitment method was used whereby parcipants
were recruited, by a psychologist, who contacted individuals,
via email, who had reported being occupaonally impaired as a
result of depression and / or anxiety. Recipients of the email were
asked to pass it on to other professionals they knew who might
want to seek help for self-reported mental health problems.
It is not possible to ascertain how many people in total would
have received the recruitment email although the inial direct
approach was made to 37 individuals.
A between subjects design was used to test the impact of a
single administraon of Havening on the scores of self-reported
depression, anxiety and funconal impairment. Data were
collected before the Havening intervenon (T1), one week
aer the intervenon (T2) and two months aer (T3). The data
collected from parcipants were completely anonymous and it
is not possible to idenfy parcipants from the resulng arcle.
Parcipants, who reported being occupaonally impaired
due to depression or anxiety, were oered the opportunity to
receive a single-session of Havening to assist them in regaining
their occupaonal tness. According to the parcipants all self-
reported symptoms had persistently impaired their occupaonal
funconing. Parcipants completed the PRIME-MD Paent
Health Quesonnaire (PHQ-9), the PRIME-MD Generalised
Anxiety Disorder Assessment (GAD-7) and the Work and Social
Adjustment quesonnaires (WSAS).
The PHQ-9 is a measure of depressive symptoms oen used in
primary care; it enquires about each of the 9 DSM-IV depression
criteria as “0” (not at all) to “3” (nearly every day). The maximum
score of the PHQ-9 is 27; lower scores demonstrate lower levels
of depression. Scores of 5, 10, 15, and 20 represent cut-o points
for mild, moderate, moderately severe and severe depression
respecvely. The diagnosc validity of the 9-item PHQ-9 has been
established primary care and obstetrical sengs and studies show
that PHQ-9 scores > 10 have a sensivity of 88% and a specicity
of 88% for major depressive disorder. The internal consistency
of the PHQ-9 has been shown to be high. A study involving two
dierent paent populaons produced Cronbach alphas of 0.86
and 0.89 [14].
The GAD-7 is a self-report quesonnaire for screening generalised
anxiety disorder. GAD-7 has seven items which measure severity
of various signs of generalized anxiety disorder according to
reported response categories of “not at all,” “several days,”
“more than half the days,” and “nearly every day”. Scores of 5, 10
and 15 are cut-o points for mild, moderate, and severe anxiety
respecvely. Validaon studies have shown that the GAD-7 has
sensivity of 89% and specicity of 82% for generalized anxiety
disorder [15].
The WSAS is a simple 5-item paent self-report measure that
assesses the impact of a person’s mental health dicules on
their ability to funcon in terms of work, home management,
social leisure, private leisure and personal or family relaonships.
The WSAS asks parcipants to rate the extent to which their
problems were aecng work and social life. Validaon studies
of the WSAS have shown that it is a reliable and valid measure
of impaired funconing, with a reported Cronbach's alpha range
from 0.70 to 0.94 [16].
Havening is a protocol based intervenon and there are three
ways in which it can be delivered; facilitated Havening (directly
delivered by the therapist), facilitated self-Havening (therapist
present) and self-Havening (no therapist). This session used both
facilitated and facilitated self-Havening. The Havening facilitator
demonstrated the process on ve of the 30 parcipants.
Parcipants were asked to:
i. Find an exact word or phrase that represented their current
emoonal dicultly. Parcipants scaled the word/phrase
from 1-10, with 10 being the highest/most distressing score.
ii. Clear their mind or to think about something nice.
iii. Use both their hands to tap on both their collarbones whilst
opening and closing their eyes twice.
iv. Connue tapping, keep their head sll, and to move their
eyes fully to the le and to the right and then down to the
le and down to the right and nally in a full circle clockwise
and then an clockwise in front of their face, keeping their
head sll.

3
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ARCHIVOS DE MEDICINA
ISSN 1698-9465
2015
Vol. 9 No. 5:1
Health Science Journal
ISSN 1791-809X
v. Place their arms across their chest and close their eyes;
whilst their eyes were closed, the facilitator asked them to
imagine walking up a ight of stairs and to count out loud
from 1 to 20 with each step that they took.
vi. With consent, the facilitator (or the parcipants
themselves if self-Havening) gently rubbed the sides of
the parcipant’s arms, for the duraon of the counng,
whilst counng with them.
vii. Re-scale the emoon 1-10. And the procedure (ii – vi) was
repeated with the visual element and auditory element
changed slightly; i.e. instead of climbing up stairs it was to
visualise skipping over a rope and instead of counng 1-20
parcipants hummed Happy Birthday.
viii. Allow their arms drop and relax, to move their eyes in
circles and then to close their eyes, whilst the researcher
stroked the sides of their arms again 5 mes and used
the words “Let it Go” on the nal stroke. Finally the
parcipants were asked to open their eyes and scale the
feeling on 1-10 again. This was repeated unl the scale
was given 1-3.
Instrucons were given to the those parcipants who had not
experienced facilitated-Havening on how to conduct facilitated
self-Havening which was then carried out in pairs with the
facilitator ensuring that parcipants were comfortable with the
procedure. Havening connued unl parcipants felt that their
dicules had improved considerably (scoring three or less)
or did not improve any further. Parcipants were reminded to
complete their quesonnaire one week and two months aer the
Havening intervenon.
Data were collected using an online survey tool and then
transferred into SPSS for analysis. Due to the data not fullling the
assumpons of normality, and due to small numbers, the non-
parametric Freidman test, followed by Post-hoc Wilcoxon signed
rank tests using the Bonferroni correcon, was conducted to
compare scores at T1 (before Havening), T2 (one-week following
Havening) and T3 (two-months aer Havening). All analyses were
performed using SPSS for windows version 18.0.
Results
The study had a follow-up rate of 86% with 27 parcipants
compleng the quesonnaire at all three me points. Sixty-
seven per cent of the parcipants reported that they had been
experiencing the occupaonal impairment for more than two
years and 22% reported having experienced the problem for
between one and two years (Table 1).
The results showed a signicant eect for me from T1 – T3 on
the PHQ-9 (χ2(2) =30.79 , p<0.001), the GAD-7 (χ2(2) = 38.18,
p<0.001) and the WSAS (χ2(2) = 22.62, p<0.001). Post-hoc analysis
with Wilcoxon signed-rank tests was conducted with a Bonferroni
correcon applied, resulng in a signicance level set at p < 0.017.
Overall, parcipants reported an improvement on all mental
health measures, which were sustained at two months, aer the
Havening intervenon. Parcipants reported stascally signicant
changes in scores from before to one-week aer Havening on the
PHQ-9 (Z = -4.28, p <0.001), the GAD-7 (Z = -4.37, p <0.001), and
WSAS (Z = -3.56, p <0.001). A reducon in scores was reported
2-months aer the Havening treatment on the PHQ-9 (Z = -4.03,
p <0.001), the GAD-7 (Z = -4.29, p <0.001) and the WSAS (Z = -3.45,
p <0.001) (Table 2).
Discussion
This report presents the results from a single-session of Havening
in treang self-reported depression, anxiety and occupaonal
impairment. The results demonstrate that a single-session of
Havening had a posive eect on reducing scores on the PHQ-9, GAD-
7 and WSAS. Parcipants reported that this improvement in scores
was sustained one-week and two-months aer the intervenon.
Age n (%)
25-29 1 (4)
30-34 1 (4)
35-39 3 (11)
40-49 11 (41)
50+ 11 (41)
Marital status
Married 13 (48)
Living with a partner 3 (11)
In a long-term
relaonship 1 (4)
Single 4 (15)
Separated 1 (4)
Divorced 4 (15)
Widowed 1 (4)
Employment status
Employed 13 (48)
Self-employed 7 (26)
Rered 3 (11)
Unemployed 4 (15)
Duraon of
problem
A month – a year 3 (11)
One – two years 6 (22)
More than two years 18 (67)
Table 1 Demographic details of Havening sample.
Note: Number and percentage, may not add up to 100%
Scales Friedman test Wilcoxon Signed-Ranks test P Value
(vs. T1)
T2 T3
x2(2), p-value z, p-value z, p-value
PHQ-9 30.79, 0.00*** -4.28, 0.00*** -4.03, 0.00***
GAD-7 38.18, 0.00*** -4.37, 0.00*** -4.29, 0.00***
WSAS 22.62, 0.00*** -3.56, 0.00*** -3.45, 0.00***
Table 2 Friedman test and post-hoc Wilcoxon Signed-Ranks test with
Bonferroni correcon to test for signicant changes in scores from T1
– T3.
Note: Wilcoxon Signed-Rank Test using Bonferroni adjustment (new p
value: 0.05/3 = 0.017), *** p <0.001, ** p<0.01, * p<0.05, n.s = non-
signicant.

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ARCHIVOS DE MEDICINA
ISSN 1698-9465
2015
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Health Science Journal
ISSN 1791-809X
These ndings are in line with previous evaluaons of a similar
psychosensory therapy. A randomised controlled trial compared
the eecveness of psychosensory therapy, which included
an extrasensory smulus in the form of tapping alongside
diaphragmac breathing, for specic phobias, such as insects,
rats and spiders. Following a single session of diaphragmac
breathing, paents who received this psychosensory therapy
showed an improvement in their phobias which was sustained
over me [17]. Similarly, in a randomised trial of 5000 paents,
psychosensory therapy was more eecve in treang common
mental health problems than Cognive Behaviour Therapy (CBT)
or medicaon. Furthermore, at one-year follow-up, the paents
receiving the psychosensory treatment were less prone to
relapse or paral relapse than those receiving CBT or medicaon
[18]. However, it must be noted that the evaluaon by Andrade
and colleagues [18] was limited in its generalisability by informal
record-keeping, subjecve outcome assessments, and variables
that were not rigorously controlled.
The results of this study suggest that Havening might be a suitable
therapy in step 2 of the care system given the posive impact
of a single-session which can be self-facilitated. Systemac
reviews for anxiety and depression [19] have evaluated various
aspects of self-help intervenons and have endorsed their use
as intervenons for mild to moderate anxiety and depression.
Furthermore, some self-help therapies for depression have been
shown to have an enduring eect at follow-up [20]. Guided self-
help intervenons have been imbedded within the mental health
services, in the form of IAPT, which provide assessments and oer
brief self-help intervenons, cognive restructuring and support
with computerised CBT programmes.
Our data show that the Havening intervenon may well be
capable of rapidly improving depression, anxiety and impaired
funconing through a single-session. Furthermore, the eects
of the therapy were not short-lived as our results showed that
parcipants reported sustained improvement up to two-months
aer the Havening process. Since the Havening technique is
simple enough to administer to subjects and teach them how to
re-administer it during future episodes of distress, it could oer
a substanal advantage over more complicated intervenons
which can only be delivered by high trained therapists over
mulple sessions if more robust, comparave trials of Havening
connue to demonstrate that it is eecve.
Limitaons of the Study
This study is limited by its small sample size, lack of control
group and that the sample selecon was opportunisc which
is therefore likely to be non-representave of the working
populaon. Furthermore, the parcipants were all healthcare
professionals who are likely to be more engaged and open to
psychotherapy. Given the limitaons of this study the results
should be regarded as preliminary.
Conclusions
The single-session of the Havening intervenon resulted in
improved scores on the PHQ-9, GAD-7 and the WSAS and
these improvements were sustained over me. The Havening
intervenon could prove to be a useful and cost-eecve
intervenon for common mental disorders at step 2 of the care
system.

5
© Under License of Creative Commons Attribution 3.0 License
ARCHIVOS DE MEDICINA
ISSN 1698-9465
2015
Vol. 9 No. 5:1
Health Science Journal
ISSN 1791-809X
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