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Research Paper
The International Journal of Indian Psychology
ISSN 2348-5396 (Online) | ISSN: 2349-3429 (Print)
Volume 9, Issue 3, July- September, 2021
DIP: 18.01.192.20210903, DOI: 10.25215/0903.192
http://www.ijip.in
© 2021, Patel V. & Pandey N.; licensee IJIP. This is an Open Access Research distributed under the terms of the
Creative Commons Attribution License (www.creativecommons.org/licenses/by/2.0), which permits
unrestricted use, distribution, and reproduction in any Medium, provided the original work is properly cited.
Effectiveness of EFT on Suicidal Ideation among Young Adults
Vikrant Patel
1
*, Dr. Neerja Pandey
2
ABSTRACT
The present study examines the effectiveness of Emotional Freedom Technique (EFT) as an
intervention for suicidal ideation among young adults. Suicide has been documented in
various literature wherein its definition has constantly changed. So has the definition of
suicidal ideation. As a result, there is no universally accepted consistent definition for either.
An enormous part of our society including the young adults, commit suicide every year. The
current situation calls for an easily assessable and effective intervention that can be
implemented to deal with suicidal ideation, and eventually suicide. Respondents between the
age of 18 and 40 years were assessed for the presence of suicidal ideation using Columbia-
Suicide Severity Rating Scale at the beginning and end of intervention. 8 participants out of
20 respondents were provided with intervention. Participants were taken for initial EFT
session to get better insight in their distress causing issues that lead them towards suicidal
ideation and to provide them with the grasp of how EFT is conducted. Participants were then
instructed to practice EFT on themselves on daily basis for next 21 days. In post intervention
assessment EFT not only proved to be effective on suicidal ideation but it also provided
participants with necessary insight, created and enhanced self-love and made them self-aware
and efficient in handling their emotions. EFT is cost effective, easy to use technique that can
be used for all emotions and body pains anytime, anywhere and any number of times.
Keywords: EFT, Suicide, Young Adults, Suicidal Ideation
uicide has been a part of long and colossal human history since recorded time. Suicide
as a word is of recent origin. This word does not appear in The Old Testament nor in
the early writings of Christians and not even in one of the earliest English language
works defending suicide, the Biathanatos (Donne, 1664)1. The Romans used different
phrases and most common phrases used were sibi mortem consciscere (“to produce his own
death”), vim sibi inferre (“to cause violence to himself”), or sua manu cadere (“to fall by his
own hands”) (Evans et.al.,1998:15)1. As stated in Oxford English Dictionary suicide, as a
word, was first used in English in 1651, derived from modern Latin word suicidium which
was produced by combining the Latin pronoun for “self” and the verb “to kill” (Evans
et.al.,1998:15)1. Suicide is a barbarous word, more precisely derived from sus, a sow, and
from pronoun sui as it were a swinish (means, beastly) part for a man to kill himself (Philips,
1
M.A in Clinical Psychology, Amity Institute of Behavioural and Allied Sciences, Amity University, Lucknow
Campus, UP, India
2
Assistant Professor Psychology, Amity Institute of Behavioural and Allied Sciences, Amity University,
Lucknow Campus, UP, India
*Corresponding Author
Received: July 26, 2021; Revision Received: September 18, 2021; Accepted: September 30, 2021
S
Effectiveness of EFT on Suicidal Ideation among Young Adults
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 2037
1662)1. In 1752, almost a hundred years later this word appeared in France, in the
Dictionnaire de Trevoux (Evans et.al.,1998:15)1.
Suicide
Durkheim, a French sociologist, gave his definition of suicide as “the termination of an
individual’s life, resulting directly from negative or positive act of the victim himself, which
he knows will produce this fatal result” (Durkheim,1897)2. Suicide is also defined as “the act
of voluntarily or intentionally taking one’s own life” (Encyclopaedia Britannica, 1994-
1997)1. Edwin S. Schneidman, considered as father of contemporary suicidology,
emphasized the idea of pain as an important part in suicidal thinking and behaviour.
(Schneidman,1993)3. Suicide has become a major problem related to public mental health
conditions (National Institute of Mental Health 2019)4. ICD-10-CM defines suicide as the
act of intentionally killing one-self 5. It also defines and differentiates between Suicidal
Individuals and Suicide Attempters, and both cases are identified by ICD-9-CM or ICD-10-
CA diagnoses codes.
Suicidal Ideation
The act of terminating one’s own life is result of suicidal ideation formation. Suicidal
Ideation is defined as thinking about, considering or planning suicide as provided by Centres
for Disease Control and Prevention, (Crosby et al.,2011)6. It is also a formation of passive
thoughts about wanting to be dead or active thought about killing oneself, not accompanied
by preparatory behaviour (Posner et al., 2007)7. Three-step theory (3ST) of suicide shows
potential to improve understanding and predictions of suicide, suicide behaviour and suicide
ideation. Pain and hopelessness, connectedness and suicidal capacity are key concepts of
3ST (Klonsky et al., 2015) 6.
The Columbia-Suicide Severity Rating Scale (C-SSRS)8 was administered for assessment of
suicidal ideation. Two versions of C-SSRS, ‘Lifetime and recent Version’ and ‘Since Last
Visit version’ were used in the present research. ‘Lifetime and Recent version’ was used for
pre intervention assessment and ‘Since Last Visit version’ was used for post intervention
assessment.
Intervention
American Psychological Association 9 defines psychological intervention as “any action on
part of a psychotherapist to deal with the issues and problems of a client. The selection of
intervention is guided by the nature of the problem, the orientation of the willingness and
ability of the client to proceed with the treatment”.
Emotional Freedom Technique (EFT) was used as an intervention in this research. Inspired
by the works of Dr. Roger Callahan, a clinical psychologist who worked on healing phobias,
trauma, stress etc., Gary Craig 10 (his student) developed tapping technique called Emotional
Freedom Technique (EFT) which is a body/mind self-help method. It combines gentle touch
together with mindfulness and vocal attention to thoughts and feelings 11.
Rationale
The rate of suicide among young adults is an axiomatic fact to assign all possible
psychological tools and interventions that effectively assess suicidal tendencies and help
prevent suicide. Several published researches show effectiveness of EFT on different mental
health conditions. To the best knowledge of the scholar, none of them had suicidal ideation
Effectiveness of EFT on Suicidal Ideation among Young Adults
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 2038
as core of the research and most of them were from other countries. He could find only three
Indian publications that have used EFT and one conference presentation.
REVIEW OF RELATED LITERATURE
Klonsky et.al. (2016)6 describe suicidal ideation in The Three Step Theory (3ST) stating that
it starts with pain regardless of its source. However, pain alone will not cause suicidal
ideation.
Turner et.al. (2012)12 showed that risk of suicidal ideation was 2.4 times greater in youth
who experienced peer victimization in the previous year, 3.4 times greater among those who
were sexually assaulted, and 4.4 times greater among those who were exposed to
maltreatment, relative to children who were not exposed to such types of victimisations.
According to Dugas E. et.al, (2012)13 depression symptoms in grade 9, 10 and 11 were
found to be independent predictors of suicidal ideation in young adults. Armstrong et.al.
(2013)14 found that depression, anxiety and suicide represent important mental health
problems in India. Dalglish et.al. (2015)15 have showed that suicidal ideation was associated
with job insecurity, lifetime unemployment and recent unemployment. Hatchel et.al.
(2019)16 highlighted that LGBTQ exhibit high risk population for suicidal ideation and
behaviour. Study done by Park, SY. (2020) 17 revealed that immigration and language factors
influence depressive symptoms and suicidal ideation. Ernst et.al. (2020)18 reported that
loneliness was the predictor of severe anxiety symptoms and suicidal ideation in long-term
childhood cancer survivors
Moore-Hafter et.al. (2019)19 reported that EFT allows people to release and transform the
way uncomfortable feelings like hurt, guilt, fear, or anger affect their proper functioning and
experiences. Church et.al. (2011)20 conducted research to test the effectiveness of EFT in
reducing the intensity of traumatic memories in abused adolescents of juvenile homes and
the study showed that EFT was fast and effective intervention for reducing psychological
trauma. Boath et.al. (2012)21 reviewed the quality of randomised controlled trials known as
RCT’s (Randomized controlled trials are prospective studies that measure the effectiveness
of a new intervention or treatment 22). Literature search showed EFT to be effective in
treatment of PTSD, Fibromyalgia, Phobias, test anxiety and athletic performance. Only
EMDR was found to be superior to EFT. Sebastian et.al. (2016)23 performed meta-analysis
to determine the effectiveness of EFT in the treatment of PTSD and found that four to five
EFT sessions are an efficacious treatment for PTSD with a variety of population. Nelms
et.al. (2016)24 systematically reviewed and found that Clinical EFT (evidence-based practice
combining elements of cognitive and exposure therapies with the manual stimulation of
acupuncture points) was highly effective in reducing depressive symptoms in a variety of
settings and population. Warrier A. (2018)25 conducted study to test the effectiveness of
EFT on anxiety and Quality of Life and har results supported the potential of EFT as a cost-
effective intervention to reduce anxiety and thereby help improve quality of life. According
to Jasubhai et.al. (2018)26 EFT treatment produced marked improvement in depression in
subjects suffering from anxiety and depression. Pandey (2020)27 conducted research using
case study method to examine the extent to which EFT is effective as a tool in resolving
anxiety showed promising results.
Despite its proven effectiveness with issues like chronic pains, phobias, anxiety, trauma,
depression, fear of public speaking, academics, PTSD and many more, efforts to study the
efficacy of EFT in India is in its early stage.
Effectiveness of EFT on Suicidal Ideation among Young Adults
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 2039
METHODOLOGY
Hypothesis: EFT will minimise the suicidal ideation among young adults.
Variables: EFT (Independent Variable) and Suicidal Ideation (Dependent Variable).
Tools: Columbia-Suicide Severity Rating Scale (C-SSRS) Lifetime and Recent Version for
pre intervention assessment; Columbia-Suicide Severity Rating Scale (C-SSRS) Since last
visit Version for post intervention assessment.
Sample size: Out of 20 respondents between the age range of 22 and 33 (both males and
females), 10 respondents were found with suicidal ideation and 8 (1 male and 7 females)
agreed to participate in the intervention program using EFT. Purposive sampling method
was used for data collection using multi method research design both qualitative (case study)
and quantitative (pre-test and post-test). Inclusion criteria: Participants having lifetime
history and/or recent suicidal ideation as per C-SSRS guidelines and who consented to
practise EFT for minimum 21 days.
Procedure
Participants went through initial EFT session(s) at the beginning of which they assessed
their current subjective unit of distress (SUD). SUD is an introspective technique for
experienced emotional and psychosomatic discomfort, on a scale from zero to ten, ten being
the highest level of distress and 1 or 0 being is no distress. The aim was to bring SUD down
to either zero or one. Later they practiced on their own for 21 days consistently to make it a
habit, since it takes at least 21 days for new habit to develop (Dr. Maxwell Maltz, 1960)28.
According to Hebb’s rule 29 synaptic efficacy increases due to persistent and repeated
stimulation of post synaptic cell by pre synaptic cells which result in formation of stronger
neuronal pathway. Hence, the consistent practice of EFT will result in eradication of old
catastrophic neuronal pathways causing emotional imbalance and conflicts. The researcher
was in contact with each participant through telephone taking feedback. Post intervention
assessment was done after 21 days of EFT practice.
RESULT ANALYSIS
Table 1: Details of Participants Including the Pre-Intervention C-SSRS Assessment
Outcome
S. NO.
NAME
AGE
GENDER
SIS
SIIR
HOSA
HOSH
1
XXX11
32
F
5
25
YES
NO
2
XXX12
22
F
4
12
NO
NO
3
XXX13
22
F
4
16
NO
NO
4
XXX14
24
M
4
16
YES
NO
5
XXX15
22
F
4
11
NO
NO
6
XXX16
22
F
4
13
YES
YES
7
XXX17
22
F
4
11
YES
YES
8
XXX18
24
F
4
15
YES
NO
*Data shown here was collected after briefing participants about confidentiality clause.
Abbreviation used:
SIS – Suicidal Ideation Score
SIIR – Suicidal Ideation Intensity Rating
HOSA – History of Suicide Attempt.
HOSH – History of Self Harm.
Effectiveness of EFT on Suicidal Ideation among Young Adults
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 2040
Table 2: Details of Initial EFT Session(s) Conducted on Participants
S NO.
NAME
NOS
NOR
TTT
PRE – SUD
POST - SUD
1
XXX11
1
4
104min
7
0
2
XXX12
1
5
91min
10
3
3
XXX13
1
3
48min
5
3
4
XXX14
1
2
51min
10
1
5
XXX15
3
6
115min
10
2
6
XXX16
1
1
50min
3
0
7
XXX17
1
5
60min
8
0
8
XXX18
1
1
80min
7
3
*SUD was noted both at commencement and termination of session.
Abbreviations used:
NOS – Number of Sessions
NOR – Number of Rounds
TTT – Total Time Taken
SUD – Subjective Unit of Distress
Table 3: Pre and Post Intervention C-SSRS Suicidal Ideation Score (SIS) and Suicidal
Ideation Intensity Rating (SIIR) of Participants
S.NO
NAME
PRE- INTERVENTION
POST INTERVENTION
1
XXX11
SIS = 5
SIIR = 25
SIS = 0
SIIR = 0
2
XXX12
SIS = 4
SIIR = 12
SIS = 0
SIIR = 0
3
XXX13
SIS = 4
SIIR = 16
SIS = 0
SIIR = 0
4
XXX14
SIS = 4
SIIR = 16
SIS = 0
SIIR = 0
5
XXX15
SIS = 4
SIIR = 11
SIS = 0
SIIR = 0
6
XXX16
SIS = 4
SIIR = 13
SIS = 0
SIIR = 0
7
XXX17
SIS = 4
SIIR = 11
SIS = 0
SIIR = 0
8
XXX18
SIS = 4
SIIR = 15
SIS = 0
SIIR = 0
*Post intervention assessment was taken after the gap of minimum 21 days.
Abbreviation used:
SIS – Suicidal Ideation Score
SIIR – Suicidal Ideation Intensity Rating
Hypothesis – EFT will minimize the suicidal among young adults.
Table 4: Paired T-Test Analysis of Suicidal Ideation Pre-test and Post-tests.
VARIABLES
N
MEAN
SD
t
p value
SIGNIFICANT
SIS PRETEST
08
4.125
0.35
33
0.05
YES
SIS POST TEST
08
0
Abbreviation used
SIS – Suicidal Ideation Score.
SD – Standard Deviation.
p<0.05, significant at one tailed.
Effectiveness of EFT on Suicidal Ideation among Young Adults
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 2041
RESULT DISCUSSION
Hypothesis i.e., EFT will minimise the suicidal ideation among young adults has been
accepted. The mean score of suicidal ideations in pre-test and post-test are 4.125 and 0
respectively. The standard deviation is 0.35 and 0 respectively at df (degree of freedom) 7
and which is significant at level of p<0.05. Therefore, we can say that EFT is effective in
lessening the suicidal ideation among young adults (Table 4).
Aim of the study was to assess Effectiveness of EFT as an intervention for Suicidal Ideation
among Young Adults. It included the respondents who were found with suicidal ideation
after the initial C-SSRS assessment (Table 1) and consented to participate in the intervention
(N=8).
They were given the initial EFT session(s) using their most pressing issue. This gave them
exposure and idea of how EFT is conducted. EFT session(s) consisting of many rounds
brought down their SUD to a significantly lower level (Table 2). It also provided them with
insight into their unhealthy negative thought-emotion patterns.
Participants either had history or had recent issues resulting in suicidal ideation or both. The
most common issues leading to suicidal ideation were hopelessness, helplessness, anxiety,
fear, loneliness, meaninglessness, guilt and dissatisfaction or disappointment with people
around them, with themselves that further lead towards other issues and caused a lot of
emotional pain and distress.
“I can’t love myself” or “I hate myself” were commonly observed statements during the
sessions instead of “I love and accept myself”. Feelings of emptiness, crying, neglected,
abandonment, fear, anxiety, confusion, distortion of thoughts, sinking, heaviness, sadness
and loneliness were most prominently reported emotions. This shows how negative schema
and resultant emotions affect individuals so deeply. These emotions were acknowledged and
brought down significantly. Physical distress in various body parts like in the head, back of
neck, spine, calf, chest and hands was also reported and were taken care of then and there.
Session was terminated when post session SUD levels were lower than pre session level.
Post intervention assessment results showed absence of suicidal ideation and suicidal
behaviour in each and every participant. Increase in self-esteem, self-awareness, emotional
balance, tolerance and insight was commonly reported by the participants after the
completion of intervention.
Tapping on certain accupoints while focusing on the distress releases troubling emotions.
Through verbalisation, participants take ownership of their situations and thoughts as the
root cause of their issues come into their conscious awareness. Persistent practice of EFT
conduces changes in thought patterns, emotions and subsequent behaviour by breaking the
old catastrophic pattern/s. Thus, creating new mental postulate along with new neuronal
pathways. Eradication of old pathways and creation of new ones generally takes 21 days
(Maxwell Maltz), therefore minimum 21 days was required to measure effectiveness of EFT
as an intervention for suicidal ideation which was evident in post intervention assessment
(Table 3).
CONCLUSION
The primary condition required for any therapy to work effectively is the readiness to
change in individual who is in desperate need of it. This need results in motivation,
Effectiveness of EFT on Suicidal Ideation among Young Adults
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 2042
commitment, discipline and honesty which guides individual towards changes that are
progressive, constructive, self-empowering and insightful. In researcher’s own experience,
an individual might be aware of a situation through past experiences, but the realisation of
certain aspects of the same experience provides insights and it is completely up to an
individual whether he or she is ready to utilise those insights by internalizing them with time
and practice to bring profound changes in their life. This three-step process of knowing,
realising and internalizing is extremely effective and helpful for any individual to break
patterns, be it at thought level or emotional level or both.
EFT effectively reboots our personal energy system at a steady pace appropriate for us.
Once rebalancing is initiated, we start feeling better, more relaxed, peaceful and serene in
reference to our specific issues. Uncomfortable emotions, thoughts, feelings and body
responses change with persistent and prolonged use of EFT.
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Acknowledgement
The author(s) appreciates all those who participated in the study and helped to facilitate the
research process.
Conflict of Interest
The author(s) declared no conflict of interest.
How to cite this article: Patel V. & Pandey N. (2021). Effectiveness of EFT on Suicidal
Ideation among Young Adults. International Journal of Indian Psychology, 9(3), 2036-2044.
DIP:18.01.192.20210903, DOI:10.25215/0903.192
