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Energy psychology in the treatment of PTSD: Psychobiology and clinical principles

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Abstract

Energy Psychology (EP) protocols use elements of established therapies such as exposure and cognitive processing and combine them with the stimulation of acupuncture points. EP methods such as EFT (Emotional Freedom Techniques) and TFT (Thought Field Therapy) have been extensively tested in the treatment of post-traumatic stress disorder (PTSD). Randomized controlled trials (RCTs) and outcome studies assessing PTSD and co-morbid conditions have demonstrated the efficacy of EP in populations ranging from war veterans to disaster survivors to institutionalized orphans. Studies investigating the neurobiological mechanisms of action of EP suggest that it quickly and permanently mediates the brain's fear response to traumatic memories and environmental cues. This review examines the published trials of EP for PTSD and the physiological underpinnings of the method. It concludes by describing seven clinical implications for the professional community. These are: (1) the limited number of treatment sessions usually required to remediate PTSD; (2) the depth, breadth, and longevity of treatment effects; (3) the low risk of adverse events; (4) the limited commitment to training required for basic application of the method; (5) its efficacy when delivered in group format; (6) its simultaneous effect on a wide range of psychological and physiological symptoms, and (7) its suitability for non-traditional delivery methods such as online and telephone sessions.
In: Psychology of Trauma ISBN: 978-1-62257-782-8
Editors: Thijs Van Leeuwen and Marieke Brouwer © 2013 Nova Science Publishers, Inc.
Chapter 11
ENERGY PSYCHOLOGY IN THE TREATMENT OF
PTSD: PSYCHOBIOLOGY AND CLINICAL PRINCIPLES
Dawson Church1* and David Feinstein2
1Foundation for Epigenetic Medicine, Santa Rosa, CA, US
2Innersource, Ashland, OR, US
ABSTRACT
Energy Psychology (EP) protocols use elements of established therapies such as
exposure and cognitive processing and combine them with the stimulation of acupuncture
points. EP methods such as EFT (Emotional Freedom Techniques) and TFT (Thought
Field Therapy) have been extensively tested in the treatment of post-traumatic stress
disorder (PTSD). Randomized controlled trials (RCTs) and outcome studies assessing
PTSD and co-morbid conditions have demonstrated the efficacy of EP in populations
ranging from war veterans to disaster survivors to institutionalized orphans. Studies
investigating the neurobiological mechanisms of action of EP suggest that it quickly and
permanently mediates the brain’sfearresponse to traumatic memories and environmental
cues. This review examines the published trials of EP for PTSD and the physiological
underpinnings of the method. It concludes by describing seven clinical implications for
the professional community. These are: (1) the limited number of treatment sessions
usually required to remediate PTSD; (2) the depth, breadth, and longevity of treatment
effects; (3) the low risk of adverse events; (4) the limited commitment to training
required for basic application of the method; (5) its efficacy when delivered in group
format; (6) its simultaneous effect on a wide range of psychological and physiological
symptoms, and (7) its suitability for non-traditional delivery methods such as online and
telephone sessions.
Keywords: PTSD, EFT, Emotional Freedom Techniques, TFT, Thought Field Therapy,
telemedicine, anxiety, depression, pain, training, group therapy
* Correspondence concerning this article should be addressed to Dawson Church, Foundation for Epigenetic
Medicine, 3340 Fulton Rd., Fulton, CA 95439. Email: dawsonchurch@gmail.com.
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Dawson Church and David Feinstein
212
INTRODUCTION
Posttraumatic stress disorder (PTSD) was first conferred legitimacy as a clinical
condition more than three decades ago with its adoption by the Diagnostic and Statistical
Manual of Mental Disorders (3rd ed.; American Psychiatric Association, 1980), Yet despite
considerable research evaluating outcomes for treatment approaches that run the gamut from
psychological to the pharmaceutical protocols, recent reviews find that the research has yet to
fully conceptualize the disorder [Zoellner, Eftekhari, and Bedard-Gilligan, 2008] or to form
a cohesive body of evidence about what works and what does not [Institute of Medicine,
2008, p. 10]. Collectively the existing studies on PTSD treatment fail to conclude
satisfactorily in favor of any one intervention over another. The consequence has been that
PTSD is often perceived of as a treatment-resistant and refractory condition [Gallo, 2009, p.
65]. Others have argued that it is actually an incurable condition which, in the best-case
scenario, one can hope merely to manage [Johnson, Fontana, Lubin, Corn, and Rosenheck,
2004].
A comprehensive assessment of the evidence on psychological and pharmaceutical
treatment outcomes by the Institute of Medicine (IOM) of the National Academy of Sciences
found that a single treatment element, psychological exposure, was present across the most
successful studies [IOM, 2008, p. 10]. The IOM’s conclusions regarding the singular
effectiveness of exposure in the psychological treatment of PTSD were corroborated in a
follow-up review conducted for the American Psychiatric Association [Benedek, Friedman,
Zatzick, and Ursano, 2009], and the use of exposure has become a standard component in
practice guidelines for treating PTSD [Benedek, Friedman, Zatzick, and Ursano, 2009].
Exposure techniques vary, but the principle underlying all exposure therapies is that
by exposing the individual to anxiety-producing memories or cues in a controlled setting,
the therapy can mitigate or even extinguish the effects of those cues. Therapies
may incorporate imaginal exposure, where images and narratives are used to elicit the feared
memory or stressor in the individual; in vivo exposure, where the individual is placed in
the actual anxiety-inducing environment; or virtual reality, where the patient is exposed to
the stressor through computer simulation [Feinstein, 2010]. Gradation of exposure also varies
by approach. Implosion places the patient in a highly stressful imagined situation. Flooding
also utilizes highly stressful circumstances, but in actual, in vivo, settings. Both aim to expose
the individual to the stressor in a controlled environment until the individual’s anxiety
decreases. Graduated exposure, in contrast, exposes the patient to increasing degrees of
stressors.Oncethepatient’sfearor anxiety has been attenuated in response to one stressor, he
or she is exposed to an intensified stressor until that stressor, too, no longer elicits the
patient’s anxiety—continuing until the patient progresses up the ladder of exposure to
increasingly stressful cues, which eventually cease to provoke an adverse response. Santini,
Muller, and Quirk [2001] described the process whereby temporary cessation of that response
will lead to consolidation in long-term memory, which will eventually extinguish the negative
response altogether.
Some exposure therapies pair exposure to the stressor with mechanisms designed to
target theindividual’sphysiologicalresponse. Wolpe [1973], for example, used deep muscle
relaxation concurrently with graduated imaginal exposure to help inhibit patients’ anxiety.
Diaphragmatic breathing, bilateral stimulation, relaxation techniques, biofeedback, and
interoceptive exposure (a type of mindfulness meditation that shifts the patient’s attention
Energy Psychology in the Treatment of PTSD
213
from the stressor to the physiological responses to the stressor; Barlow, 2007) have all been
used in tandem with exposure therapy. They share as a premise the idea that incompatible
physiological states cannot occur simultaneously, and so patients learn to replace their anxiety
responses with calm when exposed to the stressor [Feinstein, 2010; Lane, 2009].
A relative newcomer to the field of exposure therapies, notable for its often very rapid
reductions in PTSD induced in diverse populations, is energy psychology (EP). EP techniques
pair psychological exposure with the physical stimulation of designated pressure points on
the body, generally the same as those targeted in acupuncture. Though premised on the
same combination of exposure and physiological counterconditioning mechanisms as
described above, EP presents an enormously simplified version of this model. The exposure is
briefer, the physiological inhibition produced by the stimulation of acupuncture points
(acupoints) is faster, the intervention can be self-administered or delivered in diverse
environmentsincluding in groups or electronically—and reductions in patients’ anxiety
often occur quickly and, moreover, are sustained. All these trends have considerable
implications for the treatment of PTSD.
This chapter considers the physiological mechanisms underpinning EP therapies, reviews
the research on EP efficacy in PTSD, and argues that characteristics unique to EP recommend
its adoption and application in diverse clinical settingsparticularly in the treatment
of PTSD.
PRINCIPLES OF EP: EAST MEETS WEST
Energy psychology draws on techniques long associated with the healing traditions of
Eastern cultures, in particular, Chinese medicine’s practice of acupuncture. In use for
thousands of years in Asian countries, acupuncture is increasingly being taught in Western
medical schools with evidence of efficacy accumulating in scientific journals [World Health
Organization, 2003]. Acupuncture is designed to activate any of the 2,000 points on the
human body that connect with 12 main and 8 secondary pathways, or meridians [Wilkinson
and Faleiro, 2007]. By targeting these meridians through the insertion and manipulation of
needles, acupuncturists believe that they can resolve imbalances intherecipient’schi energy,
imbalances that can manifest as illness and other physical maladies. Practitioners further
believe that specific meridians correspond with specific organs and ailments. Pressure placed
on an acupoint located on the inner wrist, for example, has been shown to be effective in
treating various forms of nausea [McMillan, 1998].
In place of acupuncture’s needles, EP uses manual stimulation of the acupoints by
tapping, holding, or massaging specific acupoints in a specific sequence, which will vary
depending on the particular method, practitioner, and clinical context [Feinstein, 2010]. EP
protocols pair psychological exposure with acupoint stimulation: first the participant is
exposed to the anxiety-inducing stressor and then the acupressure is applied. For treatments
involving participants with PTSD, exposure typically involves using words or imagery
to trigger a traumatic memory. Participants repeat a self-acceptance statement as they activate
the prescribed acupoints, based on cognitive restructuring principles [Lane, 2009]. Before and
after each round, they self-rate their level of distress. The process is repeated until
participants’ ratings of distress havedecreased, ideally to zero [Craig, 2009; Craig, 2011].
Karatzias et al. [2011] conducted a randomized controlled trial (RCT) comparing EFT to
Dawson Church and David Feinstein
214
EMDR and found that both effectively remediated PTSD within an average of less than five
sessions.
How does EP work? While the mechanisms in EP are still being investigated, the effects
reported in systematic investigations are often striking [reviewed in Feinstein, in press]. The
power of the approach likely derives from its two-pronged nature: a) its incorporation of
elements of exposure therapy, which, as noted earlier, has been found to be the most
efficacious of approaches in the treatment of PTSD, and b) its use of acupoint stimulation.
Explanations of the efficacy of adding the stimulation of acupoints to exposure
techniques began with an extrapolation from acupuncture research [Feinstein, 2010]. In a
study using functional MRI, Hui et al. [2000, 2005] reported that the activation, via
acupuncture needling, of what is known as the Large Intestine 4 acupoint on the hand, led
to significant decreases in signals in the amygdala, hippocampus, and other areas of the brain
associated with fear and pain. Fang et al. [2009] reported additional evidence that
acupuncture produces extensive deactivation of the limbic-paralimbic-neocortical system.
In other words, the areas of the brain responsible for heightened affect, anxiety, and the
fight/flight/freeze response are attenuated by the activation of specific acupuncture points
[reviewed by Lane, 2009, p. 31]. Other researchers have found that acupuncture can produce
endogenous opioids, increase production of serotonin and other neurotransmitters, and reduce
the stress hormone cortisol [Akimoto et al., 2003; Lee, Yin, Lee, Tsai, and Sim, 1982; Ulett,
1992], all of which have implications for the regulation of mood, anxiety, and pain.
The method by which EP therapies activate acupoints is different from that of
acupuncture’suseofneedles,but the effectishypothesizedtobethesame[Feinstein,2010
Lane, 2009]. One double blind study comparing penetration by acupuncture needling with
non-penetrating pressure that simulated the sensation of penetration found equivalent clinical
improvements for each intervention [Takakura and Yajima, 2009]. Informal studies have
suggested that tapping may even be superior to needling in the treatment of anxiety disorders
[reported in Feinstein, 2004].
EFFICACY OF COMBINING ACUPOINT STIMULATION WITH
IMAGINAL EXPOSURE
The effectiveness of tapping on acupuncture points during brief imaginal exposure has
been validated in 36 outcome studies, including 18 RCTs [Feinstein, in press]. For instance,
Church, Yount, and Brooks [2011] compared cortisol levels pre- and posttreatment in groups
receiving either an hour-long psychotherapy intervention with supportive interview, no
therapy, or Emotional Freedom Techniques (EFT), one of the more widely practiced EP
methods, which stimulates the acupoints through tapping. Only those in the EFT group were
found to show significant reductions on a salivary cortisol test. Moreover, reductions in
cortisol were significantly correlated with the attenuation of depression, anxiety, and
symptoms of other psychological conditions.
The effects of EP have also been mapped using electroencephalograms. Diepold and
Goldstein [2009] reported that a patient exposed to a traumatic memory showed brain wave
patterns consistent with a fear response prior to EP application and normalized patterns
following treatment. Lambrou, Pratt, and Chevalier [2003] showed an analogous pattern of
change in the theta waves in patients being treated with EP for claustrophobia. Swingle,
Energy Psychology in the Treatment of PTSD
215
Pulos, and Swingle [2004] found that EP could reduce arousal in the right frontal cortex of
participants being treated for traumatic memories related to motor vehicle accidents. All of
these changes in brain function have likely ramifications for individuals’fearresponses.EP
researchers, like their counterparts in acupuncture research, hypothesize that EP can effect
changes not only at the neurological level but also at the chemical and genetic: boosting
serotonin production [Ruden, 2010], reducing cortisol [Church et al., 2011], and activating
stress-reducing genes, including EGR-1 and C-fos [Davis, Bozon, and Laroche, 2003; Sabban
and Kvetnansky, 2001] in the hippocampus and hypothalamus. This and other evidence for
energy psychology as an epigenetic physiological intervention is reviewed by Church
[2009a].
As a body, the research into the physiological underpinnings of EP suggests that the
intervention has the potential to mitigate the following maladaptations: (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 hormones, and (e) impaired immune functioning [Feinstein
and Church, 2010, p. 283]. By pairing acupoint stimulation with the mental activation of
stress-producing cues, the cue can be counterconditioned. When that cue triggers a traumatic
memory, as in the case of PTSD, EP reconsolidates the memory in a manner that eliminates
its ability to trigger limbic hyperarousal [Feinstein, 2010; Lane, 2009].
APPLICATIONS OF EP
EP techniques have broad application. Published studies have found evidence for the
efficacy of EFT in the long-term reduction of psychological distress [Church and Brooks,
2010; Palmer-Hoffman and Brooks, 2011; Rowe, 2005], phobias [Baker and Siegel, 2010;
Salas, Brooks, and Rowe, 2011; Wells, Polglase, Andrews, Carrington, and Baker, 2003], test
anxiety [Benor, Ledger, Touissant, Hett, and Zaccaro, 2009; Rubino, in press; Sezgin and
Özcan, 2009], and physical conditions such fibromyalgia [Brattberg, 2008] and psoriasis
[Hodge and Jurgens, 2011]. Furthermore, EFT can be used not only to reduce negative
symptoms and responses, such as stress, anxiety, and pain, but also to accentuate positive
affect. Church and Downs [2012] used EFT to simultaneously reduce distress associated with
traumatic memories related to sports performance and improve confidence in college athletes.
Significantly, evidence is accumulating that EP techniques can also be effective in
reducing symptoms of PTSD, which is notable in itself given PTSD’s reputation as a
treatment-resistant condition. Even more surprising, progress is often rapid and reductions
long-lasting. A review of the research shows the diversity of populations and settings in
which EP has been used to treat PTSD.
Thought Field Therapy (TFT) was the the first psychotherapeutic approach to introduce
acupoint tapping [Callahan, 2000], and the earliest reports of EP with PTSD examined the use
of TFT following disasters [Feinstein, 2008]. Johnson, Mustafe, Sejdijaj, Odell, and
Dabishevc [2001] reported strong improvement in 103 of 105 survivors of the Kosovo
genocide based on subjects’ verbal reports. Gains were sustained on 18-month follow-up.
Folkes [2002] explored the effect of TFT in a sample of low-income immigrants and refugees
who were exhibiting symptoms of clinical PTSD. Following the use of one to three
Dawson Church and David Feinstein
216
therapeutic sessions, participants’ avoidance behaviors, intrusive thoughts, and
hypervigilance were all significantly reduced on a standardized self-report inventory.
In four studies conducted by two independent teams applying TFT with genocide
survivors in Rwanda, strong symptom relief was found using standardized self-report or care-
giver inventories [Connolly and Sakai, 2011; Sakai, Connolly, and Oas, 2010; Stone, Leyden,
and Fellows, 2009, 2010]. In the two studies in which follow-up was conducted, gains held at
one year [Sakai et al, 2010] and two years [Connolly and Sakai, 2011]. Church, Piña,
Reategui, and Brooks [2011] tested EFT in a sample of abused boys, ages 12 to 17, living in a
group home setting. They observed similar reductions to the experimental group’s PTSD
symptoms and foundthattheboys’traumaticstress remained at normal levels at a 1-month
follow-up.
EFT has also been found to dramatically reduce the PTSD levels of war veterans. Church
[2009b] investigated the use of EFT in an intensive 5-day format with 11 veterans and their
family members., Church, Geronilla, and Dinter [2009] examined outcomes with seven
veterans who each received six EFT sessions. In both studies, participants’PTSD symptoms
dropped from clinical to subclinical levels following the intervention, as did their other
psychological symptoms, including phobias, anxiety, depression, psychoticism, and hostility.
Follow-ups at 3, 6, and 12 months showed that these gains had been maintained at highly
significant levels. Church, Hawk, et al. [in press] built upon these findings in their RCT of 59
military veterans. As in Church et al. [2009], participants in the experimental group of
received six hour-long sessions of EFT. Again, both breadth and severity of participants’
psychological distress were diminished significantly when measured at the end of treatment
and at 3 and 6-month follow-ups.
CLINICAL IMPLICATIONS FOR PTSD TREATMENT
From this summary of findings of the effects of EP on PTSD, a number of distinguishing
features start to emerge. Each holds salient implications for the treatment of PTSD.
EP Requires Few Treatment Sessions to Reduce PTSD
Clinical reports of EP therapies in highly traumatized populations reveal the parsimony of
application required to obtain reductions in symptoms. Church and colleagues’ studies of
veterans yielded significant reductions in traumatic stress following just six 1-hour sessions
of EFT [Church et al., 2009; Church, Hawk, et al., in press]. Surprising and strikingly strong
outcomes following single-session interventions were found in three studies [Connolly and
Sakai, 2011; Sakai et al., 2010, Church, Piña, et al., 2011]. Connolly and Sakai, for instance,
randomly assigned 145 adults who had survived the 1994 Rwanda genocide to a single-
session TFT treatment or a wait-list control condition. Pre/post-treatment scores on two
standardized PTSD self-inventories were significant beyond the .001 level on all scales (e.g.,
anxious arousal, depression, irritability, intrusive experiences, defensive avoidance,
dissociation, et cetera), and the improvements held on 2-year follow-up. When EP is used to
treat refugees and adults in disaster zones it often, by necessity, employs a single-session
protocol [e.g., Connolly and Sakai, 2011; Folkes, 2002; Green, 2002; Johnson et al., 2001;
Energy Psychology in the Treatment of PTSD
217
Sakai et al., 2010]. Feinstein’s [2008]review of the use of EP in survivors of natural and
human-caused disasters confirmed the frequency of success with single-session protocols.
More generally, Carbonell and Figley [1999] reviewed recently developed therapies for
trauma and found EP interventions efficacious in attenuated time frames.
EP Effects Have Depth, Breadth, and Longevity
Studies reporting treatment effects for the use of EP in PTSD typically observe highly
significant reductions in symptoms, impact on an array of symptoms, and improvements
that last. A more detailed examination of studies introduced earlier supports these assertions.
Sakai et al. [2010] drew their sample from a pool of 188 orphaned survivors of the Rwandan
ethnic cleansing. Caretakers completed a standardized PTSD inventory structured around
DSMIV [American Psychiatric Association, 1994] criteria for PTSD, and the 50 children
scoring highest on the inventory were selected for the TFT intervention. Inventory scores
were corroborated by staff observations of enduring PTSD symptoms in the sample.
The children’s PTSD was characterized by intrusive flashbacks, nightmares, difficulty
concentrating, aggressiveness, bed-wetting, and withdrawal during the 12-year period
following the ethnic cleansing. After a single TFT session and brief relaxation training,
only 6% of the adolescents scored within the PTSD range (p < .0001), and staff reported
dramatic observed decreases in PTSD symptoms. Moreover, these decreases
were maintained, by and large, at the 1-year follow-up. Only 8% scored within the
PTSD range on the caregiver inventory. A companion inventory administered directly to
the orphans found that 72% scored within the PTSD range prior to treatment; only
18% scored within this range immediately after treatment (p < .0001); and the number
had diminished even further, to 16% within the PTSD range, at the 1-year follow-up.
Stone et al. [2009] corroborated these findings using a standardized self-inventory to assess
PTSD symptoms in the same population. Decreases in symptoms were significant at the
p <. 0001 level.
The Rwanda outcomes are supported by RCTs testing EFT with both traumatized combat
veterans and adolescent boys. In Church, Hawk, et al. [in press], for instance, all
49 veterans in the treatment group exceeded the PTSD cutoff on the military version of
the Post-Traumatic Stress Checklist prior to treatment, while only 7 (14%) exceeded
the cutoff after six 1-hoursessions.InChurch etal.’s(inpress)intervention with 16 abused
boys living in a group home in Peru, which like the Rwanda studies used only a single
treatment session, 100% in the treatment group (n = 8) went from above to below PTSD
thresholds 30 days after treatment while none in the wait-list control group (n = 8) showed
significant change.
EP Has a Low Incidence of Adverse Events
Because of the affect-reduction properties of EP, therapists report preferring it over other
methods when dealing with emotionally charged memories [Flint, Lammers and Mitnick,
2005; Mollon, 2007]. A survey of therapists found that they also preferred EP when treating
adult survivors of childhood sexual abuse (Schulz, 2009). Reduced affect is noted with EFT
Dawson Church and David Feinstein
218
even when highly traumatized clients recall memories so emotionally evocative that they have
been reluctant to access them before [Church, 2009b; Mollon, 2007]. An examination of the
published literature on EP finds that, in the studies in which adverse events are discussed,
none have been found. Existing evidence suggests that EP can be safely used for PTSD.
EP Requires Only Minimal Training for Basic Application
In contrast to many of the clinical interventions tested in populations with PTSD, EP
practitioners applied the protocols effectively following relatively brief training periods. EP
training and certification courses can typically be completed in a few weeks, and several of
the above studies used life coaches rather than licensed mental health professionals to deliver
the intervention. Connolly and Sakai (2011) provided a two-day TFT training program and
supervision to the 28 volunteers (none were mental health professionals) who provided the
single-session treatments that produced dramatic symptom reduction. Another study
compared the PTSD symptom levels of veterans who received EFT life coaching with those
receiving EFT from a licensed mental health provider [Stein and Brooks, 2011]. It found that,
at 6 month follow-up, 76% of participants receiving EFT from a life coach exhibited sub-
clinical symptom levels, compared to 83% treated by a licensed provider. Though the
symptom reductions were greater in the group treated by a licensed practitioner, the
difference was not statistically significant.
This is not to claim or advocate that this minimal level of training is sufficient for the
treatment of mental health disorders, since in these studies the life coaches provided EP as a
supplementto,andexplicitlysupportiveof,thetherapeuticalliancewiththepatient’sprimary
care provider. However, it does suggest that EP can be used successfully as a frontline mental
health intervention by occupational categories with a limited amount of training, such as
medics and physician’s assistants. Such training would increase the resources available to
stressed emergency response teams following a natural or human-caused disaster. For
instance, a relatively brief TFT training program allowed volunteers to provide effective care,
according to anecdotal reports, following the 2010 Haiti earthquake [Robson and Robson,
2012], corroborating outcomes of interventions in other areas.
Use of paraprofessionals, allied life coaches, and allied health care providers would also
increase the treatment capacity of over-stretched agencies responsible for mental health. The
Veterans Administration alone is now attempting to deal with the estimated 500,000 new
PTSD cases following the Iraq and Afghanistan wars (Operation Warrior Wellness, 2012).
EP Is Effective in Group Format
In several studies, EP treatment has been found to successfully remediate psychological
symptoms when delivered in large group formats [Church and Brooks, 2010; Rowe, 2005;
Palmer-Hoffman and Brooks, 2011]. Unlike psychotherapy methods that require one-on-one
sessions, EP can be efficacious when delivered to groups of participants. This makes it
suitable for application, for instance, to combat battalions returning from deployment, to
refugees assembled in camps, to children in classrooms, to caregivers returning from
humanitarian missions, and other settings in which individual counseling might be beyond the
Energy Psychology in the Treatment of PTSD
219
resources of the supporting organizations. By having teams of practitioners available for
individuals needing special attention, group treatment is proving to be an efficient and
responsible means of delivering EP.
EP Can Impact Both Psychological and Physiological Symptoms
EP simultaneously reduces a wide range of symptoms, both psychological and
physiological. The link between psychological trauma and organic disease has been
extensively documented [Felliti, Koss, and Marks, 1998]. If PTSD is not successfully treated,
it produces changes in the brain over time [Felmingham, Kemp, and Williams, 2006]. If
PTSD symptoms persist, the published evidence indicates sequelae such as increased lifetime
hospitalization, disease burden, and medical costs [Tanielian and Jaycox, 2008]. The impact
extends beyond the patient and his or her family, affecting the surrounding community
[McFarlane and van der Kolk, 1996/2007]. By rehabilitating patients with PTSD, EP
treatment has a positive impact on both patient quality of life and society’smedical costs.
EP Can Be Delivered Effectively via Electronic Communication Media
Finally,EP’sutilityissuchthatitisalsoadaptabletotheburgeoningtelemedicinefield.
In a study of EFT delivered by phone versus in-office sessions, six phone treatment sessions
were able to effectively remediate clinical PTSD symptoms in 67% of patients [Hartung and
Stein, 2012]. Twenty-six women diagnosed with fibromyalgia showed significant
improvement in measures including pain, anxiety, depression, vitality, social function,
activity level, and performance problems following participation in an internet-based EFT
treatment program (Brattberg, 2008). Reports by practitioners indicate increased utilization of
low-cost audio and video conferencing services such as Google Voice and Skype
(www.EFTuniverse.com). This makes EP treatment feasible in settings beyond the reach of
conventional therapy. Examples include forward bases in combat zones and veterans living in
rural areas.
CONCLUSION
PTSD presents significant treatment challenges to individuals and to society.
Interventions that are capable of reaching large numbers of patients quickly, that are
efficacious in abridged time frames, and that produce large symptom reductions, are urgently
required. EP brings special strengths to meeting these challenges and, if widely utilized, could
make a large contribution to the remediation of this condition.
Dawson Church and David Feinstein
220
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... Emotional Freedom Technique (EFT)) are effective in reducing symptoms of PTSD [22,32,36]. In a study in veterans with PTSD [37], only ten percent of the treatment group met the criteria for PTSD after six single EFT sessions, compared to 96 percent in the waitlist group. Only 14 percent of veterans in the waitlist group that still met the criteria for PTSD still did so after participating in six single EFT sessions. ...
... Only 14 percent of veterans in the waitlist group that still met the criteria for PTSD still did so after participating in six single EFT sessions. Additionally, EFT was shown to reduce sleep problems [37], pain [28], as well as symptoms of anxiety and depression [37]. These improvements remained stable in 3 months and 6 months followup [28,37], and were replicated in two separate samples of veterans with PTSD [38] and subclinical PTSD [23]. ...
... Only 14 percent of veterans in the waitlist group that still met the criteria for PTSD still did so after participating in six single EFT sessions. Additionally, EFT was shown to reduce sleep problems [37], pain [28], as well as symptoms of anxiety and depression [37]. These improvements remained stable in 3 months and 6 months followup [28,37], and were replicated in two separate samples of veterans with PTSD [38] and subclinical PTSD [23]. ...
Article
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Background We present first-time evidence for the immediate neural and behavioral effects of bifocal emotional processing via visualized tapping for two different types of negative emotions (fear and disgust) in a sample of healthy participants. Results Independent of stimulus type, neural activation in the amygdala is increased during regulation, while activation in the ventral anterior cingulate cortex is decreased. Behavioral responses, as well as lateral and medial occipital regions and the dorsolateral prefrontal cortex show differential regulatory effects with respect to stimulus type. Conclusions Our findings suggest that emotion regulation through bifocal processing has a neural and behavioral signature that is distinct from previously investigated emotion regulation strategies. They support theoretical models of facilitated access to and processing of emotions during bifocal processing and suggest differential neural and behavioral effects for various types of negative emotions.
... Furthermore, the increase in limbic activation and decrease in prefrontal activation following bifocal multisensory emotion regulation seems counterintuitive at first, particularly regarding clinical populations with dysfunctional emotional processing (Álvarez-Pérez et al., 2021;Paquette et al., 2003;Straube et al., 2006;Viña et al., 2020). Given the effectiveness of bifocal multisensory interventions in reducing negative affect and symptom severity in various clinical settings ranging from specific phobia (Baker and Siegel, 2010;Feinstein, 2012;Irgens et al., 2017;Salas et al., 2011;Wells et al., 2003b) to PTSD (Church, 2014;Church et al., 2018Church et al., , 2016Church and Feinstein, 2013;Gilomen and Lee, 2015;Karatzias et al., 2011), one would hypothesize to find a decrease in neural activation in regions underlying emotional processing, along with an increase in regions underlying cognitive control (Braunstein et al., 2017;Buhle et al., 2014;Denny et al., 2015;Morawetz et al., 2017;Ochsner et al., 2012). Theoretical models of bifocal emotion regulation however posit that a split of attentional focus between emotional stimulation and physiological stimulation can facilitate working through unwanted negative emotions in a way that is more conducive to one's wellbeing. ...
... Our observations are supported by studies reporting an amelioration of symptoms of e.g. anxiety (Clond, 2016;König et al., 2019) or PTSD (Church et al., 2018;Church and Feinstein, 2013;Karatzias et al., 2011;Sebastian and Nelms, 2017), suggesting that tapping in combination with cognitive restructuring can be used successfully to induce immediate and long-lasting emotion regulatory effects in response to distressing emotional situations. ...
Article
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Despite their well-documented efficacy, very few studies have investigated the neural underpinnings of bifocal-multisensory interventions such as acupoint tapping (tapping). The present study aims to investigate the neural and behavioral responses to tapping during the perception of phobic and generally fear-inducing stimulation in a group of participants with fear of flying. We studied 29 flight-phobic participants who were exposed to phobia-related, fear-inducing and neutral stimulation while undergoing fMRI and a bifocal-multisensory intervention session consisting of tapping plus cognitive restructuring in a within-subject design. During tapping we found an up-regulation of neural activation in the amygdala, and a down-regulation in the hippocampus and temporal pole. These effects were different from automatic emotion regulatory processes which entailed down-regulation in the amygdala, hippocampus, and temporal pole. Mean scores (±SD) on the Fear of Flying scale dropped from 2.51(±.65) before the intervention to 1.27(±.68) after the intervention (p<.001). The proportion of participants meeting the criteria for fear of flying also dropped from 89.7 percent before the intervention to 24.0 percent after the intervention (p<.001). Taken together, our results lend support to the effectiveness of tapping as a means of emotion regulation across multiple contexts and add to previous findings of increased amygdala activation during tapping, as opposed to amygdala down-regulation found in other emotion regulation techniques. They expand on previous knowledge by suggesting that tapping might modulate the processing of complex visual scene representations and their binding with visceral emotional reponses, reflected by the down-regulation of activation in the hippocampus and temporal pole. Bifocal emotion regulation was useful in ameliorating aversive reactions to phobic stimuli in people with fear of flying.
... Church and Feinstein reported that having examined the studies on TFT and EFT in which adverse events had been discussed no adverse effects were found, and related that to the affect-reducing properties of these therapies (Church & Feinstein, 2013). ...
... In contrast to Callahan's theory, Andrade and Feinstein emphasized that the stimulation of mechanoreceptors may lead to disrupt anxiety patterns in the amygdala and other brain structures linked to emotional problems (Andrade & Feinstein, 2004). The theory of how brain structures and processes may be influenced by the tapping procedure in TFT and EFT has been further elaborated by Feinstein (Feinstein, 2010) and Church and Feinstein (Church & Feinstein, 2013;Feinstein & Church, 2010), and is supported by findings of Hui et al who presented preliminary results indicating that acupuncture may influence activity in parts of the brain (Hui et al., 2000;Hui et al., 2005). This view is also supported by findings of Diepold and Goldstein who presented a case study showing persistent changes in brain wave patterns following 20 minutes of TFT, corresponding to a beneficial clinical effect, involving a reflection in brain activity of the thought field as described by Callahan (Diepold & Goldstein, 2009). ...
Thesis
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Anxiety disorders are common, disabling and a source of a great deal of suffering for many patients. The number of therapists delivering effective treatment is limited. One should therefore test other therapies aimed at reducing the symptoms of anxiety disorders, particularly therapies that practitioners can learn quickly and easily. Thought field therapy (TFT) is used for many psychiatric conditions, but its efficacy has not been sufficiently documented. We therefore first studied TFT for anxiety disorders, and found better effect from TFT compared to being on a 10-week wait-list. The beneficial effects continued at 3 and 12 months follow-up. In the next study, we compared TFT to Cognitive therapy (CT) for patients having agoraphobia with large scores on avoidance. We found no difference between the therapies pre-post and at 12-month follow-up, although it was a trend towards better effect from CT than TFT, except on the primary variable on agoraphobic avoidance. The number of patients was too small to say for sure that CT was not better for these patients than TFT. Further, we found that cohabiting patients got better results from CT than did patients living alone, but that cohabiting did not affect the results from TFT. Having a comorbid disorder did not affect the results from CT, but the TFT patients having a comorbid depressive disorder showed small beneficial results from TFT. Only few patients reported side effects from therapy, and none of them was serious. Overall, we found positive effects from Thought field therapy both compared to Cognitive therapy and to a wait-list condition, for patients having agoraphobia or another anxiety disorder, but the number of patients was too small to make any firm conclusions.
... The term Energy Psychology is used to cover TFT and associated variations. TFT can be used alongside other psychological, or indeed medical therapies, although has often been found to be effective when used alone (Callahan and Callahan, 2011). At the start of treatment for Post-Traumatic Stress Disorder (PTSD) the client briefly describes their traumatic event and whilst thinking about the problem and describing how they feel, gives a score of 0 to 10 for the severity of the emotion, 0 being no concerns, 10 being the worst ever. ...
... Uncertainty remains over the mechanism of action of TFT, which is cheap, simple, rapid and may have long-term benefit. This has been discussed by Feinstein (2012) and Church and Feinstein (2013). Acupuncture has been shown to decrease activity in the amygdala and hippocampus using functional Magnetic Resonance Imaging (fMRI) (Hui et al., 2000) and the same authors have produced further evidence of deactivation of the amygdala and suppression of the stress response when a traumatic memory is re-activated at the same time, an effect which can be long-lasting (Fang et al., 2009). ...
Article
Thought Field Therapy (TFT) is a promising treatment for posttraumatic stress in a resource poor environment. This study further explores the benefits of this treatment in a rural population in Uganda, which had suffered from the psychological consequences of previous violent conflict. Thirty-six local community workers received a two-day training in TFT trauma intervention and treated 256 volunteers with symptoms suggestive of Posttraumatic Stress Disorder (PTSD) who had been randomly allocated to a treatment or waitlist (control) group. Assessment was by the Posttraumatic Checklist for Civilians (PCL-C). One week after treatment, the treated group scores had improved significantly from 58 to 26.1. The waitlist group scores did improve without treatment, from 61.2 to 47, although significantly less than the treatment group, but improved markedly to 26.4 following treatment. There was some evidence of persisting benefit 19 months later. This study supports the value of TFT as a rapid, efficient and effective therapy, empowering traumatized communities to treat themselves, although repeated treatment may still be needed.
... Though the number of well-designed studies is small, randomized, double-blind, placebo-controlled acupressure studies have shown some such protocols to be more effective than sham treatments (Church, Stapleton, Yang, & Gallo, 2018;Lang et al., 2007;Werntoft & Dykes, 2001). Proponents of EP claim that their techniques are faster and just as effective as traditional psychoanalytic techniques (Feinstein, Eden, & Craig, 2005;Feinstein, 2012) and recent research has offered promising findings for conditions such as anxiety, depression, and PTSD (Church, Piña, Reategui, & Brooks, 2012;Church & Brooks, 2014;Church & Feinstein, 2013;Mollon, 2018). ...
Article
Reducing communication apprehension (CA) in university public speaking classes has been traditionally achieved by strategies such as skills training, rehearsal, preparation, and repeated performance. Yet, some highly anxious speakers require more intensive interventions. Recently, Energy Psychology (EP) protocols such as Emotional Freedom Techniques (EFT) and Primordial Energy Activation and Transcendence (PEAT) have significantly reduced CA after brief interventions. Other studies have investigated the therapeutic effects of the various components of selected EP protocols through dismantling studies. This study contributes to existing EP dismantling and CA studies by exploring the efficacy of two modified PEAT protocols. Participants (N = 51) were randomly placed into one of three groups: a modified PEAT acupressure group, a modified PEAT non-acupressure group, and a no-treatment control group. Mixed method analyses did not find a significant difference in CA scores (p < .05) or reported subjective experiences between groups at posttest, and highly anxious speakers benefitted more from the public speaking course than less anxious ones. The authors suggest that dismantling the original PEAT technique may have limited its efficacy and further study on PEAT for CA is required.
... K. Kivinen, ссылаясь на J. Kuhl, отмечает, что воля направляет и контролирует интеллектуальную, эмоциональную и поведенческую энергию, направленную на достижение академических и других целей [49, p. 32]. Интересно, что зарубежные исследователи и психотерапевты исследуют особую сферу психологии -энергетическую психологию, различные ее подходы и методы, которые находят широкое практическое применение в психотерапии, в частности, в случаях посттравматического стрессового расстройства и предоперационного cтрессового состояния [50][51][52]. ...
Article
Full-text available
The article features a historical, philosophical, and psychological analysis of the concept of volition in the framework of the energetic approach. While acknowledging the existence of different approaches to volition, the authors justify the necessity to investigate this phenomenon from a new angle taking into consideration its energy component. The paper describes the history of the development of the concept of energy and gives a comparative analysis of its definitions in philosophical and psychological literature, which makes it possible to state that philosophers treat energy as a physical phenomenon, whereas psychologists focus on the psychic component of this concept. The authors offer a detailed review of the literature (domestic and foreign) in which volition and volitional qualities are defined through energy costs, energy efforts, and the concept of energy is used when studying behaviour, motivation, self-regulation, etc. In conclusion, the authors give their own interpretation of volition within the energetic approach based on the synthesis of the points of view described. The authors also make an assumption that the energy of volition changes the state of consciousness, which, in the long run, leads to some purposeful actions. The research results will make it possible to disclose, to some extent, one of the aspects of the complicated concept of energy in psychology. It will also help to investigate and define the intricate and contradictory concept of volition.
... Both TFT and EFT apply imaginal exposure combined with tapping on acupoints (Church and Feinstein, 2013). They have their offspring in the clinical contributions of the American psychologist Roger Callahan (Callahan and Trubo, 2001), who sought to enhance the effect of CBT by tapping on specific points on the body, called acupoints, known from ancient Chinese medicine (Hui et al., 2000). ...
Article
Full-text available
Background: Thought field therapy (TFT) is used for many psychiatric conditions, but its efficacy has not been sufficiently documented. Hence, there is a need for studies comparing TFT to well-established treatments. This study compares the efficacy of TFT and cognitive behavioral therapy (CBT) for patients with agoraphobia. Methods: Seventy-two patients were randomized to CBT (N = 24), TFT (N = 24) or a wait-list condition (WLC) (N = 24) after a diagnostic procedure including the MINI PLUS that was performed before treatment or WLC. Following a 3 months waiting period, the WL patients were randomized to CBT (n = 12) or TFT (n = 12), and all patients were reassessed after treatment or waiting period and at 12 months follow-up. At first we compared the three groups CBT, TFT, and WL. After the post WL randomization, we compared CBT (N = 12 + 24 = 36) to TFT (N = 12 + 24 = 36), applying the pre-treatment scores as baseline for all patients. The primary outcome measure was a symptom score from the Anxiety Disorders Interview Scale that was performed by an interviewer blinded to the treatment condition. For statistical comparisons, we used the independent sample’s t-test, the Fisher’s exact test and the ANOVA and ANCOVA tests. Results: Both CBT and TFT showed better results than the WLC (p < 0.001) at post-treatment. Post-treatment and at the 12-month follow-up, there were not significant differences between CBT and TFT (p = 0.33 and p = 0.90, respectively). Conclusion: This paper reports the first study comparing TFT to CBT for any disorder. The study indicated that TFT may be an efficient treatment for patients with agoraphobia. Trial Registration:https://clinicaltrials.gov/, identifier NCT00932919.
... EFT has been found to be safe; no adverse events have been reported in the studies described in review articles of the method (Church, 2013a;Feinstein & Church, 2010). Clinicians usually report a rapid diminution of client emotional distress during tapping sessions (Church & Feinstein, 2013). As such, the self-administration of EFT fits the criteria for the WHO health determinant entitled "genetics," supporting healthy personal behaviors, adaptive coping mechanisms, health-promoting lifestyle habits, and general ability to deal with life's stressors and challenges. ...
Article
Purpose: The objective of the present study was to explore Emotional Freedom Techniques (EFT) practitioners' experiences of using EFT to support chronic disease patients. This was part of a larger study exploring chronic disease patients' and EFT practitioners' experiences of using EFT to support chronic disease healthcare. Methods: A qualitative approach was deemed suitable for this study. Eight practitioners were interviewed using semi-structured interviews via telephone or Zoom (an online video-conferencing platform). Interviews were transcribed verbatim and data was analyzed using Interpretative Phenomenological Analysis methodology. Results and conclusion: This article presents two super-ordinate themes which explore application of EFT for addressing emotional issues faced by chronic disease patients, and for management of physical symptoms, respectively. Chronic disease patients may benefit from a holistic biopsychosocial, patient-centered healthcare approach. EFT offers potential as a technique that may be used by health practitioners to support the psychosocial aspect of chronic disease healthcare. Implications for Rehabilitation Rehabilitation professionals should incorporate suitable psychological interventions (e.g., EFT) to improve coping and acceptance in physical chronic disease patients and alleviate their fears about the future. Rehabilitation professionals are also recommended to address in chronic disease patients, long-standing or unresolved emotional issues, including past traumas from early life, using EFT or another suitable intervention. Rehabilitation professionals should help improve patients' emotional states using EFT to enhance physical symptom management.
... This is done while holding in mind a troubling memory or emotion in an accepting, mindful way (Church, 2013b). EFT works experientially with key past events or with present-day symptoms, which, in the course of the work, are often traced back to earlier experiences (Church, 2013b;Church & Feinstein, 2013). Experiential therapies have evolved from the person-centered approach and have the following features: they track internal and somatic change; they are contextual, holistic, and embodied; they favor bottom-up processing; they emphasize safety and acceptance; and they enhance capacity for modulating emotions and articulating felt meanings (Bohart, 1993;Bohart & Greenberg, 2002;Gleiser, Ford, & Fosha, 2008). ...
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