Energy Psychology, EFT

Energy Psychology, EFT: A Mind-Body Approach

Energy Psychology (EP) is a family of therapies that combine Western psychology methods with Eastern energy-based healing principles. This mind-body approach allows EP to facilitate rapid, positive change. The most common form of EP is EFT, the emotional freedom techniques. More than 100 studies published in peer-reviewed journals document the effectiveness of these simple energy-based techniques.

The Meridians and Related Emotions

Understanding EP begins with an acceptance that we are more than meets the eye. Everything is energy, as the saying goes! For instance, acupuncturists have worked with meridians for thousands of years. In a nutshell, meridians can be though of as little energy highways that run through our bodies, carrying energy through our system. According to Traditional Chinese Medicine, each meridian is associated with a specific emotion or set of emotions. Because of this, you can release an emotional block (or a problem) when you stimulate its associated treatment point by tapping or rubbing it.

Here is a rundown of the meridian points and related emotions.

  Treatment Point Location Meridian Related Emotions
GV Above the mouth The Governing Vessel Associated with self esteem; moving forward
CF Below the mouth the Central Vessel Associated with shame; launching new projects
BL Inside eyebrow corner Bladder Trauma; aggravation, irritation
GB Outside corner of the eye Gallbladder Visceral anger: rage, fury, wrath
ST Under the eye Stomach Fear, anxiety
KI Just below the collarbone notches Kidney Anxiety
SP Under the armpits Spleen Worry
LV Bottom rib, under nipple Liver Anger
LU Thumb: outside corner of the nail Lung Grief
LI Index finger: outside corner of the nail Large intestine Guilt
PC Middle Finger: outside corner of the nail Pericardium Life-flow; sexual issues
HT Pinky Finger: outside corner of the nail Heart Anger about a specific issue
SI Outside edge of the hand Small intestine Vulnerability, sadness
3W Back of the hand, between the 4th and 5th metacarpals (leading to pinky and ring fingers) Triple warmer

(thyroid)

Pain, depression

 

The Meridian Treatment Points

Face/Head Points

TH: Many meridians run here

EB: Bladder meridian point

SE: Gallbladder meridian point

E: Stomach meridian point

UN: Governing Vessel point

Ch: Central Vessel point

 

Torso Points

CB: Kidney meridian point

UA: Spleen meridian point

LV: Liver meridian point

Hand Points

PC: Pericardium meridian point

LI: Large intestine meridian point

HT: Heart meridian point

LU: Lung meridian point

3W: Triple Warmer

SI: Small intestine

The Research

Peer-reviewed professional journals have published more than 100 research studies demonstrating the effectiveness of EP therapies. Importantly, this includes not just one-offs and case studies, but more than 50 randomized controlled trials, 40+ outcome studies, and four meta-analyses. (A meta-analysis depends on a pretty large group of studies, which are combined in order to draw conclusions with greater confidence.)

One striking study of veterans with PTSD showed that PTSD symptoms dropped after EFT treatment; after 10 sessions all the veterans were free from clinically diagnosable PTSD. This is so important, because we used to think PTSD was not treatable. More recently, the US government invested millions in a virtual-reality PTSD treatment center, which is cool -- but not very practical. The center is outside of DC, and did I mention expensive? Yet there are so many people who need treatment all over the country. EFT is a low-cost intervention which is simple, effective, and has virtually no negative side effects. In addition, clinicians and researchers have used EP to treat addictions, anxiety, depression, food cravings, phobias, sports performance, and stress.

EFT: The Emotional Freedom Techniques

One of the most common techniques in Energy Psychology is EFT. To use EFT, begin by bringing your problem to mind and allowing yourself to feel the emotions related to the problem. Then try to identify which emotion you feel most strongly. Rate that emotion on a 0-10 scale, with 0 meaning the problem does not exist, and 10 is the worst you've experienced.

Next, start tapping on the side of the hand, using all fingers from the other hand, while you repeat the setup statement (the problem, and an affirmation):

"Even though I (have this problem), I deeply and completely accept myself."

Note:

It doesn't matter which hand you use to tap, or which side you tap on. You can switch sides, tap on both sides, or just stick with one side…

Then tap the points while repeating the problem, using related statements such as "It feels terrible, it feels awful, I can't believe it, I feel so bad…"

Tapping sequence:

  1. TH Top of head
  2. EB Eyebrow corner
  3. SE Side of eye
  4. E Under eye
  5. UN Under nose
  6. Ch Chin, Under lip
  7. CB Collarbone
  8. UA Under arm

When you've finished tapping, take a deep breath, and reassess the problem on a 10-scale. If you have not achieved a "0", tap another round. Continue working until you have reached a 0.


The Gayatri: Most Ancient Mantram

The Gayatri is said to be the most ancient mantram known to humankind. It is a statement of aspiration and devotion, placing us on the sacred path of return.

Several English translations exist. I learned the following one years ago. It was given by the Tibetan master, Djwhal Khul.

Oh Thou Who givest sustenance to the Universe

From Whom all things proceed

To Whom all things return

Unveil to us the true Spiritual Sun

Hidden by a disk of golden light

That we may know the truth

And do our whole duty

As we journey to Thy sacred feet.

The dual emphasis on knowing the truth and doing our duty are significant. It seems to me that to have knowledge without applying it is useless; and work without knowledge is fruitless. I think that the spiritual path encompasses both.

Yoga students and kirtan enthusiasts may be familiar with the Gayatri, which has been beautifully recorded by Wah! and Deva Premal. Next time you hear one of their beautiful recordings, you will have some meaning to attach to it!

 


therapy in bryn mawr

Past Life Regression Story

Past-life regression therapy with healing can be very powerful tools, helping to accelerate our personal growth and spiritual expansion.  We are able to re-pattern old habits of thinking and feeling that have their root in the distant past, becoming free and effective people in the present. I am passionate about the benefits of this healing technique and have often used regression with healing with clients in my therapy practice in Bryn Mawr. It has been an important part of my own journey as well.

A personal tale

One of my most interesting past-life regression and healing experiences happened about a decade ago. During the session, I retrieved a lifetime in which I was a young sailor, a boy not more than 15 years of age. I was climbing the mast of a tall ship and my foot got caught in the rigging; I lost my footing and fell. I was badly injured with a broken hip.

As the regression proceeded, I saw that I went on to live as a disabled person. In those days, that meant that I became a "beggar". I was left with deep self-esteem issues that continued to plague me in this lifetime. And, interestingly, I have a huge bruise-like birthmark on my hip.

Healing

Since the regression and healing session, I have changed in important ways. The birthmark is still on my hip; I still get dizzy when I look up at tall buildings. But my self-confidence began to improve almost immediately. I remember having two important and conflicting thoughts after the session: One, I was very skeptical that this had really happened! And secondly, I felt more comfortable in my own skin. Years later, I find myself looking back on this session as one of the most significant experiences of my journey.


energy psychology research

Energy Psychology Research

Transformative Therapy is a private therapy practice in Bryn Mawr, PA. We specialize in working with clients who have cancer and other serious illnesses. We offer a holistic approach to therapy including hypnosis and energy psychology. This article summarizes energy psychology research. This is a set of mind-body techniques that combine Western psychology with Eastern energy-based principles.

Energy Psychology

Energy psychology (EP) is a collection of methods that improve emotional and psychological functioning by combining cognitive techniques, such as imagery-based therapy and mindfulness, with physical methods derived from acupuncture and other Eastern systems (Feinstein, 2012; energypsych.org, 12/27/2012).

Research has shown that EP techniques are effective for treating psychological issues such as depression, anxiety, phobia, and posttraumatic stress disorder (PTSD). It is also effective for some physical problems such as chronic pain.

Research on EP has been conducted around the world and supporting evidence has been published in more than 20 independent, peer-reviewed scholarly journals.

Types of energy psychology techniques

There are various forms of energy psychology. The most well known forms focus on tapping or otherwise stimulating acupuncture meridian points (acupoints) while focusing on emotion-evoking stimuli. These meridian-based EP techniques include Emotional Freedom Techniques (EFT), Thought Field Therapy (TFT), Energy Diagnostic and Treatment Methods (EDxTM) and Tapas Acupressure Technique (TAT).

Energy psychology and the broader system of energy medicine have become increasingly popular with consumers and providers of mental health services (Lumadue, Munk and Woodten, 2005). This follows the broader trend of complementary therapies’ popularity among health care consumers (Eisenberg, 1998). The 2007 National Health Interview Survey found that 38% of American adults use some form of complementary/alternative medicine. Global rates are sometimes higher, with the World Health Organization reporting rates as high as 48% in Australia, 70% in Canada, and 75% in France.

Over a million people have downloaded The EFT Manual and The EFT Mini-Manual (Feinstein, 2009). In the U.S., many accredited continuing education programs for counselors include EP and other complementary and alternative practices (Lumadue, Munk and Wooten, 2005). In late 2012, the American Psychological Association approved the Association for Comprehensive Energy Psychology (ACEP) as a provider of continuing education credits for psychologists.

Consumers of mental health services should be aware that, because energy psychology is a relatively new field within psychology, we do not yet fully understand how it works. Critics claim that any treatment effects from EP modalities may result from placebo or other nonspecific therapeutic factors. However, current research suggests that well understood mechanisms of action are responsible for the observed effects (see below).

History

During the 1960s in the U.S., chiropractor George Goodheart developed applied kinesiology, an alternative field that involves the manual testing of muscles (Rosner and Cuthbert, 2012). He began teaching it to other chiropractors in the mid-1970s. John Diamond used applied kinesiology techniques for psychological purposes. Roger Callahan became interested in Goodheart’s techniques, which inspired the creation of Callahan Techniques ® Thought Field Therapy, the original meridian tapping therapy. Several of Callahan’s students went on to develop other forms of meridian-based EP techniques. Gary Craig created the Emotional Freedom Techniques after training with Callahan in the early 1990s, and various other clinicians added to the field with the creation of a dozen techniques that have in common the tapping on acupressure points (Gallo 2002). Meridian-based EP draws on traditional Chinese medicine, which identifies acupuncture meridians and acupoints. Traditional Chinese medicine  has been practiced for thousands of years, and has become increasingly popular in the West within the last few decades. A growing body of research points to the efficacy of acupressure and acupuncture, and the World Health Organization lists it as an effective and often proven treatment for a variety of physical and mental health concerns (WHO, 2013).

Research

Research on EP has followed American Psychological Association (APA) Division 12 Criteria (Feinstein, 2012). These criteria stipulate that for a treatment to be considered empirically effective it must be demonstrated to be superior to an established treatment in two randomized controlled trials. If a treatment is found to be superior to a control group, it is considered “probably efficacious”. The difference must reach the level of statistical significance, or p <.05. This means that there is less than a 5% chance that the results are due to chance. In his comprehensive review of the literature on energy psychology, Feinstein (2012) describes 18 randomized controlled studies. All of them reported statistically significant changes from pre- to post-treatment. All of these studies used self-report inventories, and half also included objective measures such as structured clinical interviews, physiological markers such as salivary cortisol levels, and observable measures such as body weight.

By treatment condition

Emotional Distress

Energy psychology techniques have been found to be effective in treating emotional distress. A study of workshop participants who received EFT showed very significant improvement on all scales of distress, and the changes held at six-week follow-up (Rowe, 2005). Church and Brooks (2010) tested healthcare workers attending EFT workshops, and found significant improvement on all scales; the gains held at three-month follow-up. Palmer and Hoffman (2011) also found significant improvement on a range of emotional symptoms after EFT workshops, and the results held on follow-up.

Anxiety

Energy psychology has shown efficacy in several studies of anxiety. In the largest study of EP, Andrade (Andrade & Feinstein, 2004) studied approximately 5,000 patients with anxiety disorder and found that EFT yielded significant decreases in anxiety; 90% of EFT patients had a reduction in symptoms and 76% were symptom-free, and the results held at follow-up. A randomized control trial by Irgens et al (2012) found significant relief of anxiety symptoms following TFT treatment. Other studies found significant results with public- speaking anxiety (Schoninger & Hartung, 2010; Jones et al, 2010). Rubino (2012) and Benor et al (2009) found significant improvement using EP techniques to treat test-taking anxiety.

Depression

Randomized control trials that measure depression before and after treatment find that EP methods yield significant drops in depressive symptoms. Church, DeAsis & Brooks (2012) studied moderately to severely depressed college students and found mood in the normal range after four EFT sessions. Other studies have found significant improvements in depression among healthcare workers (Church & Brooks, 2010), veterans (Church, 2013), and fibromyalgia sufferers (Brattberg, 2008).

Phobia

EP has found statistical significance in treating phobias. Three randomized control trials using EFT (Salas et al, 2011; Baker & Segal, 2010; Wells et al, 2003) and one using TFT (Darby & Hartung, 2012) found that a single session can resolve a phobia, and that the results last.

PTSD

Several studies, including three randomized control trials, have found that energy psychology methods produce significant relief for people with PTSD. Church et al (2013) studied 59 veterans with PTSD. After treatment, 90% of the EFT group no longer met diagnostic criteria for PTSD, compared to just 4% in the wait list group. Several studies have found EP (TFT) leads to highly significant reduction in trauma among survivors of the Rwandan genocide (Sakai et al, 2010; Stpme et a;. 2009; Stone et al, 2010). A study conducted in Britain compared EFT to Eye Movement Desensitization and Reprocessing (EMDR), and found both treatments to produce significant therapeutic gains at post-treatment and follow-up (Karatzias et al, 2011).

Theory

All energy psychology methods include three core components: exposure to the psychological or emotional issue, generally achieved by calling it to mind; cognitive interventions, such as affirmations; and some type of energy intervention, whether meridian-based, energy-center-based, or biofield-based.

Meridians

The exact mechanisms for the effectiveness of EP are not well understood. One underpinning of the meridian-based EP techniques is the theory of the energy meridian system of traditional Chinese medicine. According to this theory, energy known as qi or chi flows through the body in pathways called meridians. A block in the flow causes distress or disease, and a release of the blockage brings relief (Baker, 2009). This theory, however, is yet unproven.

There have been studies supporting the existence of acupoints and meridians through electrical conductance in the skin (Prokhorov et al, 2006); however, there are no known studies demonstrating the correlation between alterations in the acupoints or meridians and changes in disease conditions (Baker, 2009). While the concept of acupoints and meridians is somewhat foreign to many Westerners, and has not been proven by Western scientific method, it is a cornerstone of traditional Chinese medicine, and has been widely practiced for thousands of years and researched over the past several decades.

The World Health Organization recognized acupuncture as “proved - through clinical trials - to be effective” in treating more than two dozen medical and mental health issues including depression, and shown to be effective but needing further proof for more than five dozen medical and mental health issues.

Acupressure

Much research has focused on acupuncture, and acupressure, its non-needle counterpart, is said to work in much the same way. A comparison of acupuncture to non-needle stimulation of acupoints found non-needle stimulation to be as effective as standard acupuncture (Cherkin et al, 2009). Acupressure has been shown to reduce stress hormone levels (Cabyoglu, Ergene, and Tan, 2006; Eshkevari, 2003).

Memory

Another key to understanding the efficacy of energy psychology may lie in memory reconsolidation, the process in which the retrieval of a memory returns the memory to a labile state, which is then subject to restabilization (Forcato et al, 2009). When recalled, memories become temporarily unstable and changeable (Besnard, Caboche, Laroche, 2012). Memory retrieval therefore provides an opportunity for memory plasticity, or changeability; reconsolidation after recall provides an opportunity to update memories.

Ecker et al (2012) identify three steps for memory reconsolidation: vividly access emotional memory, juxtapose that memory with a contradictory experience, and verify that change has occurred. Most EP interventions incorporate activating a psychologically arousing thought or memory while juxtaposing the arousal with the calming effect that comes from stimulating acupressure points.

According to Lane (2009), the stimulation of acupressure points activates the parasympathetic nervous system by regulating stress hormones and activating the parasympathetic nervous system. The mechanism for meridian-based EP techniques may be conceptualized as counterconditioning of a traumatizing thought or emotional trigger with a feeling of calm, activated by acupressure point stimulation.

Learn more

If you are interested in learning more about energy psychology research, visit the Association for Comprehensive Energy Psychology research section.


References

Andrade, J., & Feinstein, D. (2004). Energy psychology: theory, indications, evidence. In D. Feinstein, Energy psychology interactive (Appendix, pp. 199-214). Ashland, OR: Innersource.

Baker, A. H., & Siegel, M. A. (2010). Emotional Freedom Techniques (EFT) reduces intense fears: A partial replication and extension of Wells et al. Energy Psychology: Theory, Research, & Treatment, 2(2), p 13-30.

Baker, H., Carrington, P., Putilin, D. (2009). Theoretical and methodological problems in research on Emotional Freedom Techniques (EFT) and other meridian-based therapies. Psychology Journal, 6 (2), 34-46

Besnard, A., Caboche, J., and Laroche, S. (2012). Reconsolidation of memory: a decade of debate. Progress in Neurobiology, 99 (1), 61-80.

Brattberg, G. (2008). Self-administered EFT (Emotional Freedom Techniques) in individuals with fibromyalgia: A randomized trial. Integrative Medicine: A Clinician's Journal,Aug/Sep, 30-35.

Cabýoglu, Mehmet Tugrul; Ergene, Neyhan; Tan, Uner (2006). The mechanism of

acupuncture and clinical applications. International Journal of Neuroscience, 116 (2), 115-125. DOI: 10.1080/00207450500341472. Chambless, D., Baker, M., Baucom, D., Beutler, L., Calhoun,K., Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler, J., Haaga,D., Bennett Johnson, S., McCurry, S., Mueser, K., Pope,K., Sanderson, W., Shoham, V., Stickle, T., Williams, D., & Woo, S. (1998). Update on Empirically Validated Therapies, II. The Clinical Psychologist, 51 (1), 3-17

Cherkin, D., Sherman, K., Avins, A., Erro, J., Ichikawa, L., Barlow, W., Delaney, K., Hawkes, R., Hamilton, L., Pressman, A., Khalsa, P., Deyo, R. (2009). An RTC comparing acupuncture, simulated acupuncture, and usual care for lower back pain. Archives of Internal Medicine, 169 (9), 858-866.

Church, D., DeAsis, M., & Brooks, A. (2012). Brief group intervention using Emotional Freedom Techniques for depression in college students: A randomized controlled trial. Depression Research and Treatment, 2012 (2012), DOI 10.1155/2012/257172

Church, D., Hawk, C., Brooks, A., Toukolehto, O., Wren, M., Dinter, I., Stein, P. (2013). Psychological Trauma Symptom Improvement in Veterans Using Emotional Freedom Techniques: A Randomized Controlled Trial. Journal of Nervous and Mental Disease, 201 (2), 153-160

Church, D. Geronilla L. & Dinter, I. (2009). Psychological Symptoms Change In Veterans After Six Sessions of Emotional Freedom Techniques (EFT): An Observational Study. International Journal of Healing & Caring, 9(1), 1-13.

Church, D., Pin˜a, O., Reategui, C., & Brooks, A. (2012). Single session reduction of the intensity of traumatic memories in abused adolescents after EFT: A randomized controlled pilot study.  Traumatology, 18 (3). doi:10.1177/1534765611426788

Church, D., & Brooks, A. J. (2010). 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, 9, 40–44

Ecker, B., Ticic, R. & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York: Routledge.

Eisenberg, D., Kessler, R., Roster, C., Norlock, F., Calkins, D., Delbanco, T. (1993). Unconventional medicine in the United Staes: Prevalence, costs, and patterns of use. New England Journal of Medicine, 328 (4), 246-252

Eshkevari, L. (2003). Acupuncture and pain: a review of the literature. AANA Journal, 71 (5), 361-371.

Feinstein, D. (2012). What does energy have to do with energy psychology? Energy Psychology, 4 (2), 59-80.

Feinstein, D. (2012). Acupoint stimulation in treating psychological disorders: evidence of efficacy. Review of General Psychology, 16 (4),364-380. doi: 10.1037/a0028602

Feinstein, D. (2008). Energy Psychology: A Review of the Preliminary Evidence. Psychotherapy: Theory, Research, Practice, Training. 45(2), 199-213.

Forcato, C., Argibay, P., Pedriera, M., Maldonado, H. (2009). Human reconsolidation does not always occur when a memory is retrieved: the relevance of the reminder structure.  Neurobiology of Learning and Memory, 91 (1), 50-57. Gallo, F. (1999). Energy psychology: Explorations at the interface of energy, cognition, behavior, and health.  Boca Raton, FL: CRC Press.

Gallo, F. (Ed.) (2002).  Energy psychology in psychotherapy: A comprehensive source book.  New York: Norton.

Hui, K. K. S., Liu, J., Makris, N., Gollub, R. W., Chen, A. J. W., Moore, C. I.,  Kwong, K. K. (2000). Acupuncture modulates the limbic system and subcortical gray structures of the human brain: Evidence from fMRI studies in normal subjects. Human Brain Mapping, 9, 13–25. doi:10.1002/(SICI)1097-0193(2000)9:1_13::AID-HBM2_3.0.CO;2-F

Irgens, A., Uldal, M., & Hoffart, A. (2012). Thought Field Therapy (TFT) as a treatment for anxiety symptoms: A randomized controlled trial. Explore: The Journal of Science and Healing.8 (6), 331-338 doi: 10.1016/j.explore.2012.08.002.

Jones, S., Thornton, J., & Andrews, H. (2011). Efficacy of EFT in reducing public speaking anxiety: A randomized controlled trial. Energy Psychology: Theory, Research, Treatment, 3(1), 19-32.

Karatzias, T., Power, K., Brown, K., McGoldrick, T., Begum, M., Young, J., Adams, S. (2011). A controlled comparison of the effectiveness and efficiency of two psychological therapies for posttraumatic stress disorder: Eye Movement Desensitization and Reprocessing vs. Emotional Freedom Techniques. Journal of Nervous and Mental Disease, 199,(6), 372–378. doi:10.1097/NMD.0b013e31821cd262

Lane, J. (2009). The neurochemistry of counterconditioning. Energy Psychology, 1(1), 1-14.

Lilienfeld, S., Loher, J., Morier, D. (2001). The teaching of courses in the science and pseudoscience of psychology: useful resources. Teaching of Psychology, 28 (3), 181-191.

Lumadue, C., Munk, M., Wooten, H. (2005). Inclusion of Alternative and Complementary Therapies in CACREP Training Programs: A Survey. Journal of Creativity in Mental Health, 1 (1), 7-19.

Mason, E. (2012). Energy psychology and psychotherapy: A study of the use of energy psychology in psychotherapy practice. Counseling and Psychotherapy Research, 12 (3), 224-232.

NIH NCCAM http://nccam.nih.gov/health/whatiscam

Palmer–Hoffman, J., & Brooks, A. J. (2011). Psychological symptom change after group application of Emotional Freedom Techniques (EFT). Energy Psychology: Theory, Research, & Treatment, 3, 33–38.

Prokhorov,  E., Prokhorova ,T., González-Hernández, J., Kovalenko, Y., Llamas, F., Moctezuma, S., Romero, H. (2006). In vivo dc and ac measurements at acupuncture points in healthy and unhealthy people. Complementary  Therapies in Medicine, 14(1), 31-8.

Rowe, J. (2005). The Effects of EFT on Long-Term Psychological Symptoms. Counseling and Clinical Psychology Journal, 2 (3), 104-111.

Rubino, A. (2012). The effectiveness of Emotional Freedom Techniques (EFT) for optimal test performance: A randomized, controlled trial. Energy Psychology: Theory, Research, & Treatment, 4(2), 13-24. doi:10.9769.EPJ.2012.4.2.SJ

Salas, M., Brooks, A., & Rowe, J. (2011). The immediate effect of a brief energy psychology intervention (Emotional Freedom Techniques) on specific phobias: A pilot study. Explore: The Journal of Science and Healing, 7, (3), 155–161. doi:10.1016/j.explore.2011.02.005

Schoninger, B; Hartung, J. (2010). Changes on self-report measures of public speaking anxiety following treatment with thought field therapy.  Energy Psychology Journal. doi: 10.9769.EPJ.2010.2.1.BS

Swingle, P., Pulos, L., & Swingle, M. K. (2005). Neurophysiological Indicators of EFT

Treatment Of Post-Traumatic Stress. Journal of Subtle Energies & Energy Medicine. 15, 75-86.

Waite, L., Holder, M. (2003). Assessment of the emotional freedom technique: an alternative treatment for fear. The Scientific Review of Mental Health Practice, 2(1), 20-26.

Wells, S., Polglase, K., Andrews, H., Carrington, P., Baker, A. (2003) Evaluation of a meridian-based intervention, Emotional Freedom Techniques (EFT) for reducing specific phobias of small animals. Journal of Clinical Psychology, 59 (9), 943-966

World Health Organization (2013), retrieved from http://apps.who.int/medicinedocs/en/d/Js4926e/5.html, 3/13/13


hypnotherapy for cancer patients

Hypnotherapy for Cancer Patients

Transformative Therapy is a private therapy practice in Bryn Mawr, PA. We specialize in working with clients who have cancer and other serious illnesses. We offer a holistic approach to therapy including hypnosis and energy psychology. This article summarizes research demonstrating the benefit of hypnotherapy for cancer patients.

The benefits of hypnotherapy for cancer patients

There is a growing interest in the mind-body-spirit approach to health. According to the NIH, 38% of American adults used some form of complementary or alternative therapy in 2007, the most recent year for which statistics are available.

Hypnosis is an evidence-based form of complementary therapy that is growing in popularity. Researchers have documented the effectiveness of hypnosis for people with cancer across all phases of treatment, from detection/diagnosis, through various types of treatment, and into survivorship.

Hypnosis is a relatively low-cost and certainly low-risk intervention that has been shown to improve quality of life, decrease pain and other symptoms and treatment side-effects, decrease depression and anxiety, and improve well-being. Two studies have shown that hypnosis may even have an impact on longevity.

What is hypnosis?

Hypnosis is a relaxed state of mind. When we are hypnotized our brains are using alpha and theta brainwaves, just as we do in meditation and some stages of sleep. These relaxed brainwave patterns allow us to more open to suggestion, or "suggestible": we are more likely to believe what we are told, and we are able to change how we think and feel about things. We can use this suggestibility to our great benefit in many areas of life, from emotional wellbeing to health. Indeed, there is a growing body of clinical data supporting the use of hypnosis for health in general, and for supporting cancer care in particular. Here are some highlights from the literature:

Cancer Detection/Diagnosis:

Hypnosis has been shown to decrease anxiety, distress, and pain for people undergoing biopsy. The studies published have focused on breast cancer screening.

  • Lange et al (2006) studied 236 women undergoing core image-guided breast biopsy. Women who had hypnosis experienced significantly less anxiety (p<0.001) and pain (p=0.024)
  • Montgomery et al (2002) studied 20 excisional breast biopsy patients and found that women who had hypnosis before the procedure had less pre- and post-biopsy distress and less post-biopsy pain (p's<0.001).
  • Schnur et al (2008) compared the effect of hypnosis versus attention control for 90 women undergoing breast biopsy. They found less pre-biopsy upset (p<0.0001), depression (p0.02), and anxiety (p<0.0001), and the hypnosis group were more relaxed (p<0.001).

Cancer treatment

Hypnosis can support every mainstream form of cancer treatment. It has been helpful for surgical patients, has reduced side-effects of chemotherapy, and has helped with the effects of radiation. Here are some ways that researchers have found hypnosis for cancer patients to be helpful:

Surgery

Surgical patients who received hypnosis pre-operatively had less anxiety, pain, pain medication, emotional upset, and fatigue, and had shorter treatment time:

  • A meta-analysis conducted by Montgomery, David, Winkel and Silverstein (2002) investigated the use of hypnosis for surgical patients. Results revealed a large and significant effect size (d=1.20) for hypnosis. Patients in hypnosis treatment groups had better outcomes than 89% of patients in control groups (effect size, D=1.20). Hypnosis affected a wide range of clinical outcomes including pain, pain medication, negative affect, blood pressure, nausea, fatigue, and treatment time.
  • Montgomery et al (2007) conducted a randomized, controlled trial of 200 breast cancer patients undergoing excisional biopsy or lumpectomy found that those who were given 15 minutes of hypnosis before the procedures required pain medication, reported less pain intensity, pain unpleasantness, nausea, fatigue, discomfort, and emotional upset.
  • Lang et al (2008) Studied 201 patients receiving tumor embolization or radiofrequency ablation were randomized to standard care, attention, or hypnosis groups. Patients in the hypnosis group had significantly less pain and anxiety and received significantly less medication (midazolam or fentanyl) than patients in the standard care (33% less medication) or empathic attention (43% less medication) groups.

Chemotherapy

Anti-nausea medications have improved quality of life for patients receiving chemotherapy. However, some patients still experience chemotherapy-related nausea and vomiting.  Hypnosis has been shown to help alleviate these treatment effects:

  • Richardson et alconducted a meta-analysis of randomized controlled trials (RCTs) (n=6) of hypnosis for controlling nausea and vomiting associated with cancer chemotherapy. All studies reported positive results including statistically significant reductions in nausea and vomiting with a moderate effect size for hypnosis compared to attention control and a large effect size of hypnotic treatment compared to treatment as usual.
  • A second review of the literature by Redd, Montgomery, and DuHamel (2001) also supports the use of hypnosis to treat chemotherapy-related nausea and vomiting. This review included both randomized and non-randomized studies.

Radiology

Patients undergoing radiation treatment are often affected by fatigue and emotional distress. Hypnosis helps:

  • Montgomery et al (2009) studied 42 breast cancer radiation patients to test whether CBT with hypnosis could affect fatigue. They found that hypnosis had a significant impact on fatigue: fatigue increased in the control group, whereas fatigue in the CBT-hypnosis group did not increase (p<0.05).
  • Schnur et al (2009) studied 40 women undergoing radiation for breast cancer to see if CBT with hypnosis could impact positive and negative affect. They found that CBTH significantly reduced negative affect and increased positive affect.

Survivorship

According to the American Cancer Society, in January 2014 there were 14.5 million cancer survivors in the United States. Many experience impaired quality of life after treatment, including neuropathy and pain, cognitive problems, fatigue, fear of cancer recurrence, hot flashes and sexual dysfunction (American Cancer Society). Hypnosis may help with the after-effects of cancer treatment:

  • Elkins et al (2008) studied 60 women who had been treated for breast cancer to investigate the efficacy of hypnosis to treat hot flashes and other treatment after-effects. They found hypnosis significantly improved hot flashes, anxiety, sleep, and depression, compared to the non-treatment control group.

Advanced/metastatic disease

Metastatic and recurrent diagnoses can be very distressing for cancer patients. Metastatic patients often experience pain and suffering, as well as emotional distress. Hypnosis has had a measurable impact on quality and even quantity of life for these patients:

  • Two studies ― one by Spiegel and Bloom in 1983, and a more recent replication by Butler et al in 2009 ― found that women with metastatic breast cancer who had been randomly assigned to weekly group therapy with hypnosis experienced significantly less pain and suffering and improved mood than no-treatment controls.
  • In 1989, Spiegel et al studied 86 metastatic breast-cancer patients and found hat survival time was significantly longer in the women who were randomly assigned to supportive group therapy with hypnosis (mean of 36.6 months) compared to no-treatment controls (mean of 18.9 months).
  • A replication by Spiegel et al in 2007 found that survival time for metastatic breast cancer patients with ER-positive cancers was not significantly affected by the hypnosis intervention (mean of 32.8 months). However, for ER negative patients, the hypnosis group had a significant longer survival time (mean of 29.8 months) than the non-treatment controls (mean of 9.3 months).

Hypnosis by any other name….

Many people hear the word "hypnosis" and think of people at comedy shows walking like a chicken. There is also often a general unease, as many believe that hypnosis will somehow make them do things they otherwise would not do. Because of this, many practitioners are inclined to use words like "guided imagery" or "relaxation". However, there is some benefit to using the word "hypnosis".

  • Gandhi and Oakley compared the hypnotic suggestibility of patients in two groups receiving the same intervention, but with one group calling it "hypnosis" and the other "relaxation". They found that those in the "hypnosis" group were significantly more suggestible than those in the "relaxation" group. In their meta-analysis of hypnosis to treat distress related to medical procedures, Schnur et al similarly found greater effect sizes for interventions labeled "hypnosis" compared to "relaxation".

Hypnosis delivery: live or recorded?

There is a plethora of guided meditations, guided imagery, and hypnosis on the market, for free or offered at a low cost. While these recordings can be helpful, live hypnosis is better:

  • According to results of a meta-analysis by Montgomery et al (2002), live hypnosis had a large effect size (d=1.40) whereas recorded hypnosis had a moderate effect size (d=.55).
  • In their meta-analysis of hypnosis for distress related to medical procedures, Schnur et al (2008) found that live hypnosis had a large effect size (g=1.22), while recorded hypnosis had a moderate effect size (g=0.19).

Conclusions

Did you make it this far? Congratulations! Treat yourself to a guided meditation. :-) For those who are living with cancer and undergoing cancer treatment, hypnosis can be tremendously helpful to address a wide range of symptoms, from emotional distress to physical pain. Relaxing and opening ourselves up to the mind-body-spirit connection improves quality of life and overall wellbeing. If you want to explore hypnotherapy for cancer patients, contact me.


 

References

Butler LD, Koopman C, Neri E, Giese-Davis J, Palesh O, Thorne-Yocam KA, Dimiceli S, Chen XH, Fobair P, Kraemer HC, Spiegel D (2009). Effects of supportive-expressive group therapy on pain in women with metastatic breast cancer. Health Psychologl.28(5):579-87.

Elkins G, Marcus J, Stearns V, Perfect M, Rajab MH, Ruud C, Palamara L, Keith T (2008). Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors. Journal of Clinical Oncoogyl. 26(31):5022-6.

Gandhi B, Oakley DA (2005). Does 'hypnosis' by any other name smell as sweet? The efficacy of 'hypnotic' inductions depends on the label 'hypnosis'. Consciousness and Cognition. 14(2):304-15.

Lang EV, Berbaum KS, Faintuch S, Hatsiopoulou O, Halsey N, Li X, Berbaum ML, Laser E, Baum J (2006). Adjunctive self-hypnotic relaxation for outpatient medical procedures: a prospective randomized trial with women undergoing large core breast biopsy. Pain. 126(1-3):155-64.

Lang EV, Berbaum KS, Pauker SG, Faintuch S, Salazar GM, Lutgendorf S, Laser E, Logan H, Spiegel D. (2008) Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice. Journal of Vascular Interventional Radiology. 19(6):897-905.

Montgomery GH, David D, Winkel G, Silverstein JH, Bovbjerg DH (2002). The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. Anesthesia and Analgesia. 94(6):1639-45

Montgomery GH, Weltz CR, Seltz M, Bovbjerg DH, (2002). Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients. International Journal of Clinical Exp Hypnosis. 50(1):17-32.

 Montgomery GH, Bovbjerg DH, Schnur JB, David D, Goldfarb A, Weltz CR, Schechter C, Graff-Zivin J, Tatrow K, Price DD, Silverstein JH (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. Journal of the National Cancer Institute. 99(17):1304-12.

Montgomery GH, Kangas M, David D, Hallquist MN, Green S, Bovbjerg DH, Schnur JB (2009) Fatigue during breast cancer radiotherapy: an initial randomized study of cognitive-behavioral therapy plus hypnosis.Health Psychology. 28(3):317-22.

Reid WH, Montgomery GH, DuHamel KN (2001) Behavioral intervention for cancer treatment side effects. Journal of the National Cancer Institute. 93(11):810-23.

Richardson J, Smith JE, McCall G, Richardson A, Pilkington K, Kirsch I. (2007). Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence. European Journal of Cancer Care (Engl). 16(5):402-12.

Schnur JB, Bovbjerg DH, David D, Tatrow K, Goldfarb AB, Silverstein JH, Weltz CR, Montgomery GH, (2008). Hypnosis decreases presurgical distress in excisional breast biopsy patients. Anesthsia and Analgesoa; 106(2):440-4

Schnur JB, Kafer I, Marcus C, Montgomery GH (2008). Hypnosis to manage distress related to medical procedures: a meta-analysis. Contemporary Hypnotherapy. 25(3-4):114-128.

Schnur JB, David D, Kangas M, Green S, Bovbjerg DH, Montgomery GH (2009) A randomized trial of a cognitive-behavioral therapy and hypnosis intervention on positive and negative affect during breast cancer radiotherapy. Journal of Clinical Psychology. 65(4):443-55.

Spiegel D, Bloom JR (1983) Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosomatic Medicine. 45(4):333-9.

Spiegel D, Bloom JR, Kraemer HC, Gottheil E (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet. 2(8668):888-91.

 


Dealing with Death

Poetry from the Other Side, Dealing with Death.

In the summer of 2015, a client of mine―I'll call her Beth―made her transition out of the body. I had worked with her for a year and a half as she battled a particularly aggressive form of cancer. She and I became close as regular clients and their therapists do. I was sad, but even more so, I was honored to help. It is powerful, coming to terms with and dealing with death. It was an experience I will never forget.

Blocked

A few weeks before she died, I visited Beth in the hospital to do some Reiki healing. (I am a Reiki Master in addition to a regular mental health counselor). A couple of days later, I went back to do another healing session, but this time there were endless interruptions and the healing never got done. When I left her that afternoon, I told her that I would check in and do some distant healing.

I went home with every intention to do distant Reiki, but when I tried to connect, I was "told" that I wasn't allowed to. When we do distant healing, we telepathically or mentally ask for permission. For the first time in my experience,  it was not granted.

Beth and I emailed each other later that week, and she wrote that she was in hospice. I offered to come and visit her and do some more Reiki. In a message on Tuesday, she suggested that maybe I could come on Friday. In the days that followed she was in and out of consciousness. Her husband took over answering her text messages. We never got the visit scheduled for that Friday, so I tried again to do some distant communication and healing. This time, permission granted.

The Healing

When I connected with Beth, the first thing that I saw was an image of her body lifted over itself. And then she and I began to have a conversation. I found myself reassuring her that it was OK for her to go. I was guided to say things that I'd never thought of before, and the words flowed through me.

Beth's biggest problem was her anguish at leaving her teenage daughter. However, I saw and shared that this early death had been known since before her daughter was born. In fact, though not consciously, all of the decisions that they had made as a family were leading to this point and preparing the daughter for success.

When I finished talking I saw my client-friend standing before me, with a blazing sun behind her. She looked radiant and reassured, confident, happy, and powerful. Three days later, she died.

Dealing with Death

I attended her funeral, which was an amazing service filled with reverence and love. Many of the women in attendance were wearing head scarves, and some of them were printed with Beth's poetry. The day was beautiful. Her spirit was surely there, proud to witness the love and devotion of her community.

On the day following her death, another friend of mine was giving a talk on metaphysics and channeling. At the end of her talk, she led our group through a guided meditation in which we connected with a loved one on the other side.

In the exercise, we went up a flight of stairs and down a hallway into a room and sat on a bench. Next to us was a box. We were to open the box and see if it had any contents. Mine contained a scarf printed with Beth's poetry, but I couldn't read the words.

And then Beth was there. I started hurriedly talking to her but then decided to stop and pay attention! Immediately I saw an image of two women walking arm-in-arm down a ballroom floor, dressed in Victorian style clothing. After that I saw an image of a white horse's head with its mane blowing back in the wind. Both images gave me the impression that Beth and I have been friends before – that was the reason we had such an easy rapport and felt so close.

And then Beth read the poem that she had written for me.

True friendship transcends all bounds of time and place.
The seeds of friendship once planted blossom over many lifetimes.
Thank you for being my true friend.

Thank you, my friend. It is an honor to have crossed paths again.


therapy in Bryn Mawr

You Get What You (Think You) Deserve

In my therapy practice in Bryn Mawr, I often help clients resolve issues they have been dealing with for years. The issue may present in different forms, but at its core, it is the same thing, again and again. You get what you (think you) deserve.

Intractable issues?

Typically these intractable issues come in the areas of finance, relationship problems, or weight and other health issues. Even when we know, intellectually, that we should be able to keep our weight in check, or have healthy relationships, or freedom from financial struggle, we often let ourselves down, re-living the same problem again and again. We think we have it mastered, only to see it show up again.

Why? Why, after so much growth and effort, do we face the same stuff again and again? The problem lies deep in the subconscious mind, which is running programming from an earlier time in our lives (or lifetimes). On some level, the problem has become part of our identity; and on a deep level, we think that we deserve it. Consciously we know we deserve to be clear of it, but that doesn’t change the subconscious belief that we do not.

And it isn't simply that the problem is familiar. Usually, on a deep level, we believe that we deserve to have the problem. That's right: If you are struggling with some issue that seems to crop up again and again, chances are good that somewhere deep inside you believe you deserve it. On a deep level, you've bought the lie. The good news is that it is actually simple to find out what this reversal is and then to clear it. When we root out the mistruth we've been subconsciously repeating, the whole system collapses in on itself and we are free. I've seen clients laugh and cry when they release the lie. The world looks different and things fall into place.

And then, it shifts

Once an issue is cleared, it is cleared for good. However, sometimes there are layers upon layers that need to be addressed. Luckily, if a new facet of the issue is presented, it can be cleared in the same way the last one was. My approach combines energy psychology, hypnotherapy, and some neurolinguistic programming to efficiently resolve the issues, in a safe and peaceful way. It is always an honor to do this kind of work and so inspiring to see people make positive changes in their lives. Because they deserve  to!


EFT tapping points

Is tapping really necessary? Here's the deal with EFT tapping.

I have used EFT and other meridian tapping therapies both for myself and with many clients in my therapy practice in Bryn Mawr. I have seen issues―even really tough ones―clear up quickly, almost magically. These results intrigued me, and prompted me to do some research about the field of Energy Psychology; you can read some of it here. People sometimes wonder if tapping meridian points is really a necessary ingredient to EFT's success. One particularly bright and educated client of mine said that he believed it was exposure (the repeated statement of the problem) coupled with a self-soothing technique (tapping) that helped people get clear of their issues. He is a psychologist, so he thinks about these things. The topic has been widely debated, and he is not alone in his suspicions. And the research shows that―he's wrong. Here's the deal with EFT tapping.

EFT researchers have begun conducting "dismantling studies" to separate tapping from the cognitive and exposure portions of the protocol. The first study that attempted to parse out the components of EFT's success were (EFT skeptics) Waite and Holder. In 2003, they conducted a study comparing three tapping conditions (EFT, sham points, and a doll) to a non-tapping condition. However, they mistakenly used EFT points, because they asked participants to with their fingertips, which contain meridian points. Participants in all three tapping groups showed significant improvements; the non-tapping group did not. Waite and Holder concluded that EFT owed its success to distraction and desensitization. But they failed to take the fingertip meridian points into consideration when they reached this conclusion. Perhaps because of this, their study is an outlier when compared to other EFT studies.

In 2013, Louis Fox conducted a study to parse out the components of EFT's success.  He compared EFT to a control group that used the cognitive and exposure portions of EFT with mindful breathing instead of tapping. The group that used EFT tapping points did significantly better than the control group. In 2014, Rachel Rogers and Sharon Sears conducted a similar study but in this case the control group used sham tapping points. Again, the group that used the actual EFT tapping points had significantly better results. The most recent dismantling study was conducted in 2015 by Reynolds, who also compared EFT to a group using sham tapping. And again, the EFT group had better results than the control group. (See this study in the Energy Psychology Journal)

The research bears out again and again what EFT practitioners and enthusiasts have intuited for more than a decade. Tapping meridian points and focusing on the problem is the recipe for success. EFT has helped thousands of people overcome a variety of emotional issues. If you would like to learn more about it, I highly recommend EFT creator Gary Craig's website, along with the Association of Comprehensive Energy Psychology's.


meditation and the maharishi effect

Peace, Love, and Crime: Transcendental Meditation and the Maharishi Effect

For quite a long time now, I've been interested in the effects of distant healing and the ability of people to impact consciousness for the greater good. In my therapy practice in Bryn Mawr, I often can feel the energy shift as clients are making changes. But can we make changes beyond the therapy room? Is what I'm feeling real? I think it is, and that we can, based on what I have read about meditation and the Maharishi effect.

The 1% effect. (No, not that 1%)

One of the most fascinating studies of the impact of group consciousness on the greater whole is the Maharishi Effect. Back in the 1970s, Maharishi Mahesh Yogi, developer of Transcendental Yoga and guru to the stars, predicted that if 1% of a population performed Transcendental Meditation (TM), they would produce measurable improvements in the overall quality of life for the entire population. His students began to track the data, and in 1976 published a paper that found a 16% reduction in crime when 1% of the population participated in TM.

If isolated TM practitioners could have such an effect, they wondered, what would be the impact of a group meditating together? Researchers predicted that the coherence generated by a group of TM practitioners working together could impact a group the size of the square of the number of meditators. In other words, two people meditating together could impact a group of four; 100 meditators could impact 10,000; and 1,600 could impact 256 million people― the population of the US at that time.

And so they set out to test their hypothesis, collecting FBI crime data in the US, and other data from around the world, when large TM groups met. Statisticians carefully controlled for other variables, and the findings are remarkable.

Here are some of the highlights (and here's a link to my primary source):

  • 1980-1981, crime in Delhi decreased by 11% during a TM convention
  • 1984-1985, crime in Manila decreased by 12.5% during a TM convention
  • 1981-1983, Maharishi University opened a campus in DC; violent crime decreased.
  • 1983, a group of meditators met in Jerusalem; crime in Jerusalem decreased 7.4%; crime in Israel decreased 4.1%.
  • The war in Lebanon was also affected, with a decrease in war death and war intensity.
  • 1993, violent crimes decreased during a TM convention in DC and politics functioned better―enough to make a reporter remark, "such a swift reversal of political fortunes is not easy to account for".
  • 1979-1985, when the group of meditators at Maharishi University in Iowa numbered more than square root of 1% of US population, there was a decrease in violent deaths in the US.
  • TM group participation in Iowa also affected quality of life in Canada, with a marked decrease in violent deaths, cigarette consumption and worker strikes.

Can we start to take advantage of this? Please?

The data are impactful, and I was left wondering ―why did it take me 20 years to hear about it? Why haven't we capitalized on this effect? And―can we start now? Last summer I held a group meditation on 8/8, the "Lion's Gate", as part of the worldwide synchronized meditation for peace.  I think that when enough people tune in, we will make a difference in the world. I'm already marking my calendar for this year's International Day of Peace, 9/21/2015―and I hope you do, too.

I suspect that it is not TM alone, but any practice that brings people to a calm, heart-centered, spiritual state that can have such an impact. And I intend to find out!


Oops

I goofed ―and it turns out, I grew

In addition to my work as a therapist and healer, I am a yoga teacher --and I love it. Being a part of the yoga community is rewarding, being a teacher is an honor. Finding the right time-slot for a class is both art and science, as we try to figure out when people can, and want to, come to class. Two weeks ago I spoke with the owner of the studio where I teach, and we decided to start my class 15 minutes earlier. I think this is a fantastic idea: it will bring more students to the class; it will make my day end a little earlier. The new time was to begin yesterday. The problem is, I forgot. En route to the studio, I realized my mistake. Instead of being ten minutes early, I was going to be five minutes late.

And then, a miracle happened: I didn't beat myself up.

I spoke with the studio owner, who was on site as she had just finished teaching. She was gracious and handled the situation with a problem-solver's good humor. She said she'd start the class, and I could take over when I got there. Her grace made it easier for me to hold mine. That is huge. That is HUGE. That is something we can all learn from. We can make the world a safer, happier place by choosing to panic less and to be calm and kind.

According to the Dalai Lama, the purpose of life is to be happy. It is difficult to be happy when we are caught in a constant barrage of criticism, especially that sneaky and pervasive self-criticism. Giving others grace is profound. Giving ourselves the same grace that we would grant another is life-changing. We are going to make mistakes; we are human. How we respond to those mistakes can determine our overall happiness. It can take us closer to, or move us away from, the very purpose of our lives.

I have a history of deep, pervasive, acerbic self-criticism. But I have been really working on this stuff since 2002. I have an arsenal of effective and well-honed techniques that have helped me: hypnotherapy; EFT and other Energy Psychology techniques; Reiki and other energy healing; an almost-daily meditation practice. (Note this is a meditation practice, not a perfect. I have yet to achieve samadhi. I barely find pratyahara. It's all good.)

I've also grown older, and at 46, I'm not the same gal I was at 33. My dad, known for his character and wisdom, once assured me that "these [crises] have a way of working themselves out". Crises do pass, and while they are with us, they teach us a lot. Sometimes I think of my Higher Self speaking to me like a light-hearted Mafioso, saying "We can do this the easy way, or we can do it the hard way…." Let's do the easy way, please.

Yesterday's mistake showed me how far I have come. I would like to take this opportunity to congratulate Sarah. Good job yesterday! Congratulations on not freaking out or beating yourself up. And please, keep up the good work―life is much happier that way.

:)