The Effect of Emotional Freedom Technique on Psychological Health and Well-being in People With Type 2 Diabetes.

Worldwide, 589 million adults (aged 20-79) live with diabetes (IDF, 2025). This number is projected to rise to 853 million by 2050. The latest International Diabetes Federation Diabetes Atlas (2025) reports that 11.1% (or 1 in 9) of the adult population (aged 20-79) live with diabetes, and 4 in 10 are unaware that they have the condition. More than 90% of people with diabetes have type 2 diabetes (T2DM) due to socioeconomic, demographic, environmental, and genetic factors. The main factors contributing to the increase in T2DM are: urbanization, aging population, decreasing physical activity levels, and increasing prevalence of overweight and obesity. T2DM is associated with microvascular and macrovascular complications. T2DM can cause complications due to a two- to four-fold increase in impaired macrovascular circulation and a 10- to 20-fold impairment in microvascular circulation compared to people without diabetes (Gregg, 2019; Mbanya and Sobngwi, 2003). Microvascular complications, namely peripheral neuropathy, retinopathy and nephropathy, result from damage to small blood vessels in the nerves, retina and kidneys, respectively. Macrovascular complications result from damage to large vessels of the heart, brain and legs, causing heart disease (ischemic heart disease), cerebrovascular disease and peripheral vascular disease, respectively (IDF, 2022). Approximately one in three people with diabetes already has microvascular complications when diagnosed with T2DM, and the risk of developing cardiovascular complications is 2-2.5 times higher in people with diabetes compared to people without diabetes (Dal Canto, 2019). In addition, diabetes is a chronic metabolic disease that affects social and mental states, including the psychological well-being of people living with it. For example, a large-scale, cross-sectional study of the Diabetes Attitudes, Wants and Needs (DAWN) study results from around the world showed that 13.8% of 8596 DM patients in 17 countries may have depression, and approximately 50% of patients may have depression (Burns et al. 2013). Diabetes-related distress is a unique emotional problem that is directly related to the burden and anxiety felt by T2DM patients. Diabetes-related distress was found in 60.5% of T2DM patients. With this in mind, it is important to identify and support patients with physical and psychosocial problems early in the course of diabetes, as this may affect their ability to adapt or take adequate responsibility for self-care.

Diabetic distress is associated with psychological states such as anxiety, lower levels of self-care, and higher hemoglobin A1c (HbA1c) levels. Previous studies have shown that depression and anxiety are associated with an increased risk of diabetes complications (Park et al. 2024). The management of T2DM involves complex components aimed at reducing the numerous, wide-ranging complications associated with the condition. In particular, previous studies have found that psychological interventions have a significant effect on diabetic stress and anxiety levels. One of the psychological interventions in T2DM individuals is the Emotional Freedom Technique. This technique is a method derived from energy psychotherapy. The Emotional Freedom Technique consists of cognitive and somatic components and is used to improve the individual's negative emotions and manage associated emotional and physical disorders. The basic principle of this technique is to regulate the energy flow by stimulating the meridian system and to relax the individual while focusing on the emotional reactions that lead to disability. Previous meta-analyses report that this technique is one of the most recognized and widely used types of energy therapy and is effective in the management of stress as well as anxiety, depression, burnout and phobias. A systematic review and meta-analysis of randomized and non-randomized trials of the clinically applied Emotional Freedom Technique for the treatment of depression found that this technique is as effective as cognitive behavioral therapy (Nelms et al. 2016). However, although the prevalence of psychological problems associated with T2DM and diabetes is increasing, there are not enough studies showing the effect of Emotional Freedom Technique on the psychological well-being of T2DM individuals. Therefore, it is thought that this study will lead to future studies.