Reprint:

FES Launches a Major Multi-Site Scientific Study on Flower Essences and the Treatment of Depression

by Jeffrey Cram , Ph.D.
(1949-2005)

Jeffrey R. Cram, Ph.D. was a clinical and research psychologist who was also director of the Sierra Health Institute in Nevada City, California. He was the founding president of the Surface EMG Society of North America (SESNA). He is the author of three books and 34 articles on surface Electromyography and applied psychophysiology. He was on the editorial list of 4 journals and is the editor of the California Biofeedback Newsletter. Dr. Cram did double-blind studies on the physiological measures of the effects of prayer. He also designed double-blind tests on flower essences (Five-Flower Formula and Yarrow Special Formula). The Flower Essence Society commissioned Dr. Cram to lead a major clinical outcome study on the application of flower essence therapy for depression.

Why do a scientific study?

If you have been using flower essences in your practice for any length of time, you have certainly seen them work clinically. And depending upon the patient, and your depth of skill in choosing the right essence, you can see doors open to the patient which just otherwise wouldn't be there. So, we know that flower essences work, and sometimes they work remarkably well. Yet, it is often difficult to give precise descriptions of their effects and the exact circumstances under which they are most effective.

Therefore, the Flower Essence Society is developing a systematic clinical study to give more precise information about the effects of flower essences in treating depression. Besides deepening our knowledge of flower essence therapy, the study can also provide scientific evidence of the "clinical efficacy" of flower essences. This will help lend credence to a therapy that we all know works, but which is not yet recognized by many health practitioners as a valuable clinical tool along with homeopathy and other related modalities.

Why study depression?

There are several reasons to choose depression as a focus for our study. First of all, it is quite common. According to the Center for Disease Control and the ICD-9 /DSM IV coding systems, approximately one out of every four individuals have some element of depression operating in them. Secondly, it is a diagnosis which is gaining public acceptance. Thirdly, depression symptoms are easily quantified. There are several psychological instruments which are commonly used to measure depression. They have become the gold standard for identifying not only its presence, but also its magnitude. Fourthly, and probably most importantly, flower essence therapy has been successfully used with many kinds of depression.

The Depression Study Questionnaire

We are currently in the process of refining the clinical protocol we will use. To that end, we are looking for feedback from flower essence practitioners to help guide in the design of the study. We also seek to understand the ways in which flower essences are currently being used for depression. 

Editor's note: We encourage all practitioners working with depression cases to fill out the form as much as possible, whether or not you intend to participate in the clinical study, or if you are unsure if your practice qualifies. Your answers to the questionnaire will help us refine the clinical study design and select participating practitioners.

Participation in the Multi-Site Study

Besides tabulating the information received from the responses to this questionnaire, we are looking for a number of interested clinicians to become active participants in the study. To conduct a study of this magnitude, we will need approximately 500 patients. If each site provided only 5 patient samples, it would take approximately 100 sites to complete the study. If you are a professional health care provider who actively uses flower essences, we invite your participation.

If you decide to join the study, what is the commitment on your part?

You will identify a patient new to your practice who you feel has depression as part of the case, or as the main presenting problem.

You will seek an informed consent from the patients to participate in the study and they sign a form which we will supply.

You will administer the Beck Depression Inventory that we supply to the your patients, and conduct the structured depression interview ( The Hamilton Depression Scale ) during the first appointment. These assessments must be taken before you give them their first flower remedy.

The client must also complete the demographics form which we supply for each person who has agreed to participate in the study. This form will take less than five minutes to complete.

You will administer your usual therapy for one month, and then add flower essence therapy to your other treatment methods for three more months, for a total of four months.

During each visit with the patient you will complete a treatment form which allows us to track your work with the patient. It simply includes a record of the essences prescribed and a 1-6 word description of any additional therapy given. This should take you less than a minute to do.

Monthly, you will ask the patient to complete the Beck Depression Inventory as part of their office visit.

At the end of your therapy with the patient, you will complete a termination form and re-administer the two original depression inventories to the patient. Again, this is a five-minute assessment form.

Participation in this study is an opportunity to provide the Flower Essence Society with valuable clinical information which will deepen our understanding of flower essence therapy, and aid in its wider acceptance by the therapeutic community and the public at large. It is true that you will need to collect information at the correct times, and to do a little more paper work than usual. But, in the end, you will have the satisfaction of knowing that, in return for the benefit that flower essence therapy has given to you and your patients, you will have given something back which can be a lasting contribution to development and acceptance of this remarkable therapy.

Pilot study has begun

Since December, 1999 I have been conducting a small pilot study (4 subjects) using a double-blind placebo protocol. I see the clients for a normal counseling session, and make an individualized flower essence selection. This selection is then passed on the Flower Essence Society. Using a random number table to assign the patient to the flower essence or placebo condition, FES then sends the subject the dropper bottle. Neither I nor the subject know who has received the placebo and who has received the essence combination. The study lasts only two months, and the subjects are tested at the beginning of the study, one month later and then again one month later. I will then get the key from FES to determine which subjects got the placebo and will analyze the difference in responses of the two groups. I will then offer flower essences to the subjects who originally received the placebos and see how they then respond. This is known as a crossover design.

The results of this pilot study will help us in the design of our multi-site clinical study and future double-blind studies. If you think that your setting could handle this "double blind" approach, let me know. I would prefer to add more subjects from other clinics to this tightly controlled experimental approach. We recognize, however, that such an approach will not work in most clinics. So, the clinical outcome approach is truly our best bet at documenting how flower essences are helping patients around the world. Please do give consideration to joining me and the Flower Essence Society in this most exciting study.

If you have questions about the depression study, please feel free to contact Richard Katz at the Flower Essence Society (800-736-9222 or research@flowersociety.org ).