Single-Session Reduction of the Intensity of Traumatic Memories in Abused Adolescents After EFT: A Randomized Controlled Pilot Study

Abstract

The population for this study was drawn from an institution to which juveniles are sent by court order if they are found by a judge to be physically or psychologically abused at home. Sixteen males, aged 12 – 17, were randomized into two groups. They were assessed using subjective distress (SUD), and the Impact of Events scale (IES), which measures two components of PTSD: intrusive memories and avoidance symptoms. The experimental group was treated with a single session of EFT (Emotional Freedom Techniques), a brief and novel exposure therapy that has been found efficacious in reducing PTSD and co-occurring psychological symptoms in adults, but has not been subject to empirical assessment in juveniles. The wait list control group received no treatment. Thirty days later subjects were reassessed. No improvement occurred in the wait list (IES total mean pre=32 SD ±4.82, post=31 SD ±3.84). Posttest scores for all experimental group subjects improved to the point where all were non-clinical on the total score (IES total mean pre=36 SD ±4.74, post=3 SD ±2.60, p<0.001), as well as the intrusive and avoidant symptom subscales, and SUD. These results are consistent with those found in adults, and indicates the utility of single-session EFT as a fast and effective intervention for reducing psychological trauma in juveniles.

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Traumatology
18(3) 73 –79
© The Author(s) 2012
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DOI: 10.1177/1534765611426788
http://tmt.sagepub.com
EFT (emotional freedom techniques) is one of a group of
therapies collectively referred to as energy psychology (EP).
EP has been used to treat traumatic stress in various groups,
and is establishing itself as an evidence-based treatment for
posttraumatic stress disorder (PTSD), depression, anxiety,
phobias, and other psychological disorders (Feinstein,
2008a). EFT has been shown to normalize EEG patterns in
traumatized participants (Lambrou, Pratt, & Chevalier,
2003), and to successfully treat accident victims with PTSD
(Swingle, Pulos, & Swingle, 2004). EFT lowers PTSD
symptoms in war veterans, with participants typically going
from clinical to subclinical levels (Church, 2010; Church
et al. 2010; Church, Geronilla, & Dinter, 2009). A review of
published EP research, outlining its physiological mecha-
nisms of action in PTSD, especially its effect on the brain’s
limbic system, suggests that EP “quickly and permanently
reduces maladaptive fear responses to traumatic memories
and related cues” (Feinstein, 2010).
One characteristic of clinical reports of EP therapies in
highly traumatized populations is the parsimony of applica-
tion required to obtain reductions in symptoms. Studies of
veterans with traumatic stress typically use six sessions
(Church et al., 2009, 2010). Reports of refuges, and adults in
disaster zones, also typically employ a single-session proto-
col (Folkes, 2002; Green, 2002; Johnson, 2000). A study of
children successfully treated with EP also used a single ses-
sion (Sakai, 2007). Carbonell and Figley (1999) reviewed
recently developed therapies for trauma, and found EP inter-
ventions efficacious in attenuated time frames. A review of
the use of EP in natural and human-caused disasters
(Feinstein, 2008b) noted the frequency of success with sin-
gle-session protocols.
Several institutions, including the American Psychiatric
Association, Britain’s National Institute for Clinical Excellence
(NICE), and the U.S. Veterans Administration, have investi-
gated the efficacy of various therapies for PTSD. Meta-
analyses have found EMDR (eye movement desensitization
and reprocessing), CBT (cognitive behavior therapy), and
426788TMTXXX10.1177/153476
5611426788Church et al.Traumatology
1Foundation for Epigenetic Medicine, Santa Rosa, CA, USA
2Cesar Vallejo University, Trujillo, Peru
3University of Arizona, Tucson, AZ, USA
Corresponding Author:
Dawson Church, Foundation for Epigenetic Medicine, 1490 Mark West
Springs Rd, Santa Rosa CA 95404
Email: dawsonchurch@gmail.com.
Single-Session Reduction of the Intensity of
Traumatic Memories in Abused Adolescents
After EFT: A Randomized Controlled Pilot
Study
Dawson Church1, Oscar Piña2, Carla Reategui2, and Audrey Brooks3
Abstract
The population for this study was drawn from an institution to which juveniles are sent by court order if they are found by
a judge to be physically or psychologically abused at home. Sixteen males, aged 12-17, were randomized into two groups.
They were assessed using subjective distress (SUD), and the Impact of Events Scale (IES), which measures two components
of PTSD: intrusive memories and avoidance symptoms. The experimental group was treated with a single session of EFT
(emotional freedom techniques), a brief and novel exposure therapy that has been found efficacious in reducing PTSD and
co-occurring psychological symptoms in adults, but has not been subject to empirical assessment in juveniles. The wait list
control group received no treatment. Thirty days later, participants were reassessed. No improvement occurred in the wait
list (IES total mean pre = 32 SD ±4.82, post = 31 SD ±3.84). Posttest scores for all experimental-group participants improved
to the point where all were nonclinical on the total score, as well as the intrusive and avoidant symptom subscales, and SUD
(IES total mean pre = 36 SD ±4.74, post = 3 SD ±2.60, p < .001). These results are consistent with those found in adults, and
indicates the utility of single-session EFT as a fast and effective intervention for reducing psychological trauma in juveniles.
Keywords
adolescents, PTSD, memories, affect, trauma, EFT (emotional freedom techniques).

74 Traumatology 18(3)
exposure therapy to be effective (Benedek, Friedman, Zatzick,
& Ursano, 2009; Bradley, Greene, Russ, Dutra, & Western,
2005; Institute of Medicine, 2006, 2007; NICE, 2005; Seidler
& Wagner, 2006; van Etten & Taylor, 1998). EFT employs
brief forms of certain components of these therapies that have
demonstrated efficacy, such as cognitive restructuring and
exposure, which have also been shown to reduce PTSD symp-
toms by as much as 60% in a single session (Salcıoglu &
Basoglu, 2010). To these established interventions, EFT adds a
somatic component, having therapists or participants tap with
their fingers on prescribed acupuncture points while cognitive
statements are made. The somatic stimulation of acupuncture
points during exposure to traumatic memories is observed to
have a calming effect, and to reinforce cognitive change
(Feinstein, 2009). The stimulation of acupuncture points by
pressure alone, without using needles, has been shown to be as
efficacious as needling in a randomized controlled trial
(Cherkin et al., 2009). Acupuncture stimulation has been
shown to reduce fear and pain in the limbic system of the brain
as measured by MRI screening (Dhond, Kettner, & Napadow,
2007). Hui et al. (2000) found acupuncture to send fear-
dampening signals directly to the amygdala.
Other hypothesized mechanisms of action of EFT include
boosting the production of serotonin (Ruden, 2009), and
activation of stress-dampening genes in the hippocampus
and hypothalamus (Church, 2009), especially regulatory
genes such as EGR-1 and C-fos which are activated during
stressful experiences (Davis, Bozon, & Laroche, 2003;
Sabban & Kvetnansky, 2001). A review of the epigenetic
potential of EFT and similar therapies finds that they may
regulate physiology in a systemic manner. These include “(a)
exaggerated limbic system responses to innocuous stimuli,
(b) distortions in learning and memory, (c) imbalances
between sympathetic and parasympathetic nervous system
activity, (d) elevated levels of cortisol and other stress hor-
mones, and (e) impaired immune functioning” (Feinstein &
Church, 2010, p. 283). LeDoux (2006) describes these lim-
bic responses to traumatic memories as the “hostile takeover
of consciousness by emotion.” When stressfully treated,
these memories are not reinstated in their existing form.
Instead, they are reconsolidated to include cues from the
proximate environment (Davis et al., 2003; LeDoux, 2002).
If the environment contains therapeutic cues from EP treat-
ment, memories may be reconsolidated without their past
ability to trigger hyperarousal of the amygdala (Lane, 2009).
EFT is a simple method that has participants pair the mem-
ory of a highly traumatic event (exposure) with a statement of
self-acceptance. A typical example might be, “Even though
my father hit me when he got drunk after my seventh birthday
party . . .” (exposure) . . . “I deeply and completely accept
myself” (cognitive shift). After describing the traumatic inci-
dent, and formulating the statement, the participant repeats
the statement while tapping prescribed acupuncture points.
Emotional distress is self-assessed using a Likert-type scale
from 0 to 10, called subjective units of distress or SUD
(Wolpe, 1973). EFT sometimes brings SUD down to 0 with a
single application, but several “rounds” of EFT may be
required. Progress is client-rated using SUD scores. When
SUD is 0, this indicates no client distress associated with the
traumatic memory.
EFT was developed by Gary Craig in the early 1990s as a
brief form of an earlier EP method called thought field ther-
apy or TFT (Callaghan, 2000). It is administered in a uni-
form manner though a free downloadable manual, also
available in print (Craig, 2011). EFT has been shown to
reduce a range of psychological disorders including phobias,
anxiety, and depression (Church & Brooks, 2010; Rowe,
2005; Wells, Polglase, Andrews, Carrington, & Baker,
2003). In EFT for PTSD, Craig (2009) summarizes clinical
procedures and research findings for using EFT as a treat-
ment for traumatic stress. A study performed by Britain’s
National Health Service compared the efficacy of EFT to
EMDR in adult patients, and found that both were effective
for clinical PTSD in four treatment sessions (Karatzias et al.,
2011) These characteristics make EFT a suitable candidate
for empirical investigation with populations of traumatized
adolescents and children.
Va n d e r K o lk ( 2 0 0 7 ) h a s e mp h a s i z ed t h a t r e c a l l o f t r a u-
matic memories may retraumatize a client. This danger is
moderated with EFT and other EP methods (Mollon, 2008);
clients typically report a steady reduction of distress. However,
given the potentially retraumatizing effect of recalling recent
traumas on a vulnerable population, the current pilot study
sought to minimize risk by using only two brief assessments,
SUD and IES, and only two data points.
Method
Subjects were confined to the St. Joseph’s House (“Hogar
San Jose”) residential treatment facility in Trujillo, Peru. The
institution is one to which children are sent by a judge if their
parents or guardians have a history of sexual, physical, or
psychological abuse, or abandonment or negligence of their
children. At the time of the study, there were 51 children in
residence. Inclusion criteria were as follows: Male; ability to
understand IES instructions, age 12 to 17, and a history of
physical, psychological, or sexual abuse, or parental aban-
donment or negligence. Exclusion criteria were as follows:
Organic or neurological conditions; prior clinical psychiatric
diagnoses, and concurrent pharmacological treatment. Ethical
review was performed at Cesar Vallejo University, and
approval was granted by the departmental head of the
Psychological Training Center. Informed consent and permis-
sion to conduct the study was obtained from the director of
St. Joseph’s House, who was also the legal guardian of the
participants. Thirty-five participants were assessed and did
not meet these criteria; the 16 who did were enrolled.
The investigators assigned participants into two groups of
eight each using random allocation. The experimental group
received a 1-h single session of EFT from either the second

Church et al. 75
or the third author. Data were collected by a supervisor for
these two authors. The control group did not receive any
intervention. Control participants completed the baseline
assessments and returned in one month for the follow-up
assessment. Given the novelty of the intervention and the
possibility of retraumatization during the recall by the par-
ticipants of emotionally triggering memories, a minimally
invasive experimental design was used, with only two data
points: pretest, and 30-day posttest. Assessments and treat-
ments took place in the same location at the institution for
both groups. Data was scored subsequently, offsite and blind,
by a biostatistician (the fourth author). EFT was adminis-
tered with fidelity to the Spanish translation of the EFT man-
ual (www.eftuniverse.com), and included a supplemental
EFT procedure outlined in the manual, called the nine gamut
technique, which is intended for bilateral stimulation of the
brain. The investigators trained with other psychologists in
EFT, clinical supervisors monitored fidelity to the method
during training sessions, and the first author has both an EFT
Cert-1 certification from EFT and is licensed by ACEP, the
Association for Comprehensive Energy Psychology.
The investigator providing the intervention asked the
child to recall the most troubling specific incident of abuse.
An EFT method called the movie technique was used. The
participant imagines the traumatic incident as though it were
a movie with a start, finish, and end. The participant then
gives the movie a title. The participant associates the movie
with a SUD level. EFT is then performed, and the participant-
rated SUD level is reassessed while recalling the movie. If
the SUD has not gone down, EFT is repeated till SUD is at
or near zero. The purpose of the movie technique is to focus
the client on a specific event, and avoid generalization of
distress to other times and incidents. The purpose of the
movie title is to provide the participant with a brief reminder
phrase to keep the distressful incident in memory while the
acupressure points are being tapped.
Participants were assessed using the IES or Impact of
Events Scale, the Spanish-language version of which has
been validated (Báguena et al., 1998; Horowitz, Wilner, &
Alvarez, 1979). The IES is subdivided into an Intrusive
Symptoms Scale (items 1, 4, 5, 6, 10, 11, 14) and an
Avoidance Symptoms Scale (Items 2, 3, 7, 8, 12, 13, 15),
and also yields a total score. A score of 26-42 (moderate)
indicates that an event has had a powerful impact, and
scores 43 or higher indicate an impact so severe that the
ability to function may be affected. A score of 27 or more
indicates a 75% likelihood of a PTSD diagnosis, with a
number of PTSD symptoms (Coffee & Berglind, 2006). A
score of 35 indicates a probable diagnosis of clinical PTSD
(Neal et al., 1994). The results of the participants’ IES tests
are reported below.
The second assessment used in the present study, SUD,
is associated with autonomic arousal (Thyer, Papsdorf,
Davis, & Vallecorsa, 1984). Participants are asked to recall a
traumatic incident, and rate its intensity from 0 (no intensity)
to 10 (highest possible intensity). When a participant pro-
vides a high SUD, physiological symptoms of stress
increase. These include heart rate, vasoconstriction, respi-
ration, and galvanic skin response (Sheeringa, Zeanah,
Myers, & Putnam, 2004). Physiological signs reverse when
therapy is successful at producing a lowering of SUD
(Wilson, Silver, Covi, & Foster, 1996). The failure of a
traumatic memory to elicit a stress response in the body is
an indication of recovery (Horowitz, 1986). Although self-
rated, SUD is therefore a useful indicator of the efficacy of
treatment.
Results
Data were received for 16 male participants, eight in the
control group and eight in the experimental. Ages ranged
from 12 to 17 with an average age of 13.9 years. There was
no significant difference in age between the two groups. All
participants scored in the “moderate clinical” range on the
IES total. Participant IES scores ranged between 27 and 42,
with an average score of 34.2 (SD ±5.4). There was no sta-
tistically significant difference between the groups at base-
line on the IES total, t(14) = 1.71, p < .11, intrusive
memories subscale, t(14) = 0.35, p < .73, and avoidance
subscale, t(14) = 1.93, p < .07, demonstrating similar prog-
nostic indicators at baseline. Posttest administration of the
IES occurred 1 month after pretest. In the experimental
group, the initial SUD level ranged from 7 to 9 with an aver-
age SUD level of 8.25 (SD ±0.71). The number of applica-
tions of EFT ranged from 2 to 4, with an average of 2.87
applications (SD ±0.41), with the final SUDS level ranging
between 0 and 1 with an average of 0.25 (SD ±0.46).
To examine change-over time in the IES total and sub-
scale scores between the two groups, a repeated measures
general linear model was conducted. Post-hoc Tukey tests
were conducted on significant findings. The time by group
interaction was statistically significant (p < .001) for the IES
total and both subscales. Statistically significant differences
were found in the post-hoc analyses for all three IES vari-
ables. The experimental group demonstrated a statistically
significant decrease in distress on the IES total and both sub-
scales following the intervention as seen in the decrease
between the pretest and posttest scores. In addition, the
experimental group’s posttest was significantly lower than
the posttest for the control group on each of the IES vari-
ables. There was no difference between the pretest and post-
test for the control group. All participants in the control
group were still in the “moderate clinical” range on the IES
at posttest, with scores ranging from 27 to 40, whereas none
of the participants in the experimental group scored in the
clinical range at posttest, with scores ranging between 0 and
7. Thus the observed results were both statistically and clini-
cally significant. The IES total and subscale scores for exper-
imental and control groups are presented in Table 1 and
Figure 1 below.

76 Traumatology 18(3)
Table 1. IES Total Score, Memories, and Avoidance Subscales Pre and Posttest Means and Standard Deviations by Treatment Group
IES scale
Control Experimental
F(1,14) Sig.Pretest Posttest Pretest Posttest
IES total 32.00 ±4.82 31.38 ±3.84a36.38 ±4.74a3.38 ±2.60b240.68 p < .001
Memories 10.75 ±3.70 11.13 ±2.93a11.50 ±4.24a0.50 ±0.50b36.25 P < .001
Avoidance 21.25 ±3.83 20.25 ±2.38a25.00 ±3.43a2.88 ±2.62b159.30 p < .001
a > b.
Note: Sig. = significance; “F” = probability density function.
p < .001.
0
5
10
15
20
25
30
35
40
IES pre IES post Memories
pre
Memories
post
Avoidance
pre
Avoidance
post
Control
EFT
Figure 1. IES total score, memories, and avoidance subscales pre
and posttest means by treatment group
highly with diseases in adults, including cardiac events,
hypertension, cancer, diabetes, smoking, and depression
(Felliti, Koss, & Marks, 1998). Childhood sexual abuse cor-
relates highly with adult PTSD (Shakespeare-Finch & de
Dassel, 2009). The benefits of early treatment of childhood
trauma thus extend over time, and encompass both the psy-
chological and physical health of the individuals and com-
munities affected.
There were two cases in the current study in which the
child’s SUD level was not reduced to 0. In one of these, the
child stated that he would need to meet the stepmother who
had neglected him, face-to-face, to test whether or not the
memory still affects him (at the time, the stepmother was not
visiting him). In the second case, the child stated that he
would need to receive an apology from his father, who had
physically abused him, to put the memory behind him.
The investigators delivering the intervention noted a
phenomenon called the apex effect (Craig, 2011). The apex
effect, described for three decades in clinical reports of EP
interventions, is that after EP treatment, the participant
typically forgets how intense the emotionally triggering
event was before treatment. Clinical observation of the
apex effect is one reason that SUD levels are noted before
and after treatment. A concurrent cognitive shift by partici-
pants, from a victim point of view, to an observer’s point of
view, is also typical.
The current pilot study had a number of limitations. It did
not test EFT against a placebo intervention such as a support-
ive interview, to determine the effect of nonspecific factors
such as the sympathetic attention found in a therapeutic alli-
ance, and expectancy effects. It also did not test EFT against
efficacious methods such as exposure and cognitive thera-
pies. Further limitations are that the brevity of the design did
not permit the evaluation of treatment fidelity; also, the
unblinded nature of data collection makes participant gains
participant to demand characteristics. The lack of a follow-up
data point makes it impossible to determine if the results hold
over time. Feinstein (2008a) notes in a review of EP research
that in every study employing a long-term follow-up, for
periods of up to 1 year, participant gains are maintained to a
statistically significant degree, and an extension of this study
should include a long-term follow-up.
Another limitation of the present study that it used self-report
rather than observer-rated measures such as the CAPS-CA.
There were no dropouts. No adverse events, or increase in
participant distress, were reported. After data analysis, the
investigators recommended to the director of St. Joseph’s
House that the control group also receive EFT.
Discussion
The literature airs different opinions as to whether PTSD can
be remediated. Some reviews state that PTSD should be
regarded as an intractable condition such as dissociative
identity disorder (Johnson, Fontana, Lubin, Corn, & Rosenheck,
2004). Vasterling and Brewin (2005) found that PTSD pro-
duces neurological changes that make it treatment resistant.
Others hold out hope for a cure (Foa, Keane, & Friedman,
2000). A review by the Institute of Medicine cited a study by
Monson et al. (2006) as a hopeful sign that PTSD can be
remediated. Studies of highly traumatized war veterans have
also found them to test PTSD negative on average after EFT
sessions (Church, 2010; Church et al., 2009). The current
study supports the position that elements of PTSD such as
avoidance, and intrusive memories, may be successfully
treated. The benefits of successful trauma treatment do not
benefit just the individual; they radiate outward to produce
positive effects on family and communities (McFarlane &
van der Kolk, 1996/2007). Epidemiological research has
shown untreated childhood emotional trauma to correlate

Church et al. 77
However, children’s self-report of PTSD symptoms on the IES
has convergent validity with observer-rated diagnoses of PTSD
(Horowitz & Sundin, 2002; Shemesh et al., 2005). To encourage
client-centered approaches, self-rating methodologies are
encouraged (Glasgow, Magid, Beck, Ritzwoller, & Estabrooks,
2005). An extension of this study would use observer-rated
assessments in addition to client-rated evaluations, to determine
whether the correlations found in other published literature are
maintained.
Because of the affect-reduction properties of EP, thera-
pists report preferring it over other methods when dealing
with emotionally charged memories (Flint, Lammers &
Mitnick, 2005; Mollon, 2007). A survey of therapists found
that they preferred EP when treating adult survivors of child-
hood sexual abuse (Schulz, 2009). Reduced affect is noted
with EFT even when highly traumatized clients recall mem-
ories so emotionally evocative that they have been reluctant
to access them before (Church, 2010; Mollon, 2007). The
authors of this article would therefore argue that participant
safety will not be unduly compromised by the use of addi-
tional assessments immediately postintervention, as well as
3 and 6 months postintervention.
Conclusions
In the current study, 16 institutionalized male children with
intrusive memories and avoidant symptoms were evaluated
using the Impact of Events Scale (IES). After randomiza-
tion, the experimental group of eight participants was
treated with a single session of EFT. The control group did
not receive treatment. After 1 month, the two groups were
reassessed. All members of the EFT group no longer
reported intrusive or avoidant symptoms and their total
scores on the IES had normalized. There was no change in
the group that received no treatment. All results were statis-
tically significant, indicating that EFT may be an effective
treatment for trauma in juveniles. Further research is
needed to determine if these effects hold over greater peri-
ods of time, how they compare to a placebo or active com-
parator, and whether client-rated assessments agree with
observer-rated instruments.
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest
with respect to the research, authorship, and/or publication of this
article: Author Dawson Church derives income from publications
and presentations on EFT. There is no other conflict.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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