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An Initial Investigation of Neural Changes in Overweight Adults with Food Cravings after Emotional Freedom Techniques

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OBM Integrative and
Complementary Medicine
Technical Note
An Initial Investigation of Neural Changes in Overweight Adults with
Food Cravings after Emotional Freedom Techniques
Peta Stapleton 1, *, Craig Buchan 2, Ian Mitchell 3, Yasmin McGrath 2, Paul Gorton 2, Brett Carter 1
1. School of Psychology, Bond University, Gold Coast, Queensland, 4229, Australia; E-Mails:
pstaplet@bond.edu.au, bcarter@bond.edu.au
2. Queensland Diagnostic Imaging, Gold Coast, Queensland, Australia; E-Mails:
cbuchan@med.usyd.edu.au, yasmin.mcgrath@qdi.com.au, pjgorton@gmail.com
3. Siemens Healthcare Pty Ltd, Healthcare Sector, Brisbane, Australia; E-Mail:
ianmitchell@siemens-healthineers.com
* Correspondence: Peta Stapleton; E-Mail: pstaplet@bond.edu.au
Academic Editor: Gerhard Litscher
OBM Integrative and Complementary Medicine
2019, volume 4, issue 1
doi:10.21926/obm.icm.1901010
Received: December 11, 2018
Accepted: February 12, 2019
Published: February 15, 2019
Abstract:
Background: This pilot randomised clinical trial investigated the effect of Clinical Emotional
Freedom Techniques (EFT) on brain activation in response to food craving stimuli using
functional magnetic resonance imaging. EFT is a brief stress reduction technique which
involves stating a cognitive statement with stimulation of acupressure points with a tapping
technique.
Method: Fifteen overweight/obese adults were allocated to a four-week group EFT
treatment or control condition and completed a measure of food craving. Random repeating
images of high-calorie food designed to engage parts of the brain were presented during the
pre and post fMRI scans.
Results: The Group x Time interaction for food cravings were significant for the EFT group
when compared to the controls. Participant mean scores decreased by 18% for the EFT
group and 5% for the control group. Brain activity was mapped using fMRI measures, and
there was relative deactivation in the Superior Temporal Gyrus and lateral orbito-frontal
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cortex for the EFT treatment group only. The control group however, showed continued
activation in these areas.
Conclusion: The findings indicated EFT may decrease limbic region brain activity and reduce
food related symptoms in overweight/obese individuals. This study also illuminates the
neurological mechanisms at work behind the many successful outcome studies of EFT for
weight loss. Recommendations for more comprehensive trials are discussed.
Keywords
Food cravings; overweight; obesity; emotional freedom technique; fMRI; brain
1. Introduction
Obesity is a chronic disease, with an aetiology typically purported to result from a range of
causes including metabolic [1], excessive consumption of obesogenic foods [2], genetics [3],
environmental contributions that have resulted in more sedentary behaviour such as increased
use of transport (e.g. cars), and obesogenic foods being more easily accessible to lower
socioeconomic groups because of decreased costs [2]. The likely explanation may well be a
combination of these complex, and often interacting processes. What is known is that a five to 10%
decrease in body weight for obese adults is associated with significant improvements in blood
pressure, serum lipid levels, glucose tolerance [4], and reductions in diabetes [5] and hypertension
[6, 7]. Existing approaches to addressing the obesity epidemic have included combined dietary and
physical activity approaches [8, 9] and of late, behavioural or motivation strategies to influence
the weight loss process [10-12]. Weight loss and weight maintenance, however, are complex
issues.
Research suggests dieting regularly results in weight loss in the short term [13] yet, meta-
analyses indicate the more time that elapses between the end of a diet and the follow-up period,
the more weight is regained [14]. Weight instability has been related to lower health satisfaction
and self-esteem and higher body dissatisfaction, dieting, and binge eating [15]. Unfortunately, it is
clear that dieting alone does not lead to sustained weight loss and individuals who diet are more
likely to gain back more weight than they lost [14].
Adults who are overweight or obese do experience enhanced weight reductions from
psychological interventions as well as behavioural approaches [16]. A Cochrane review [16]
suggested Cognitive Behaviour Therapy (CBT) and Behaviour Therapy (BT) significantly improved
the success of weight loss for overweight and obese adults, but cognitive therapy alone was not
found to be effective as a weight loss treatment. The evidence available for other strategies such
as relaxation therapy and hypnotherapy also indicated that these might be beneficial in improving
weight loss [16].
Energy Psychology (EP) strategies are emerging as techniques which can change emotional,
behavioural, and cognitive concerns by combining physical somatic interventions with a cognitive
element [17]. Emotional Freedom Techniques (EFT) [18] is one such EP strategy; a type of
exposure therapy that includes a somatic and cognitive component for altering the cognitive,
behavioural, and neurochemical foundations of psychological problems. Likened to a version of
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psychological acupuncture, but without the use of fine needles, EFT combines components of
traditional approaches (including cognitive and exposure therapy) with acupoint stimulation [18].
Research has found EFT for to be extremely successful and durable over time for treatment of
food cravings in overweight and obese adults [19-21]. A randomised clinical trial which originally
offered a 4-week EFT treatment program to 96 overweight and obese participants with severe
food cravings, and then assessed their progress six- and 12-months after treatment ended [19, 20]
found Body Mass Index (BMI), degree of food craving, individual’s perceived power of food,
restraint capabilities and psychological symptoms significantly improved. Weight loss over the 12
months was significant from the start of treatment (mean difference, -5.05 kilograms or 11.1
pounds, p<.05) and the decrease in BMI was also significant (mean difference, -2.28, p<.05;
(Stapleton, Sheldon, & Porter, 2012b).
EFT has also been compared to a gold standard therapy. In an overweight/obese sample of
adults, EFT and CBT demonstrated comparable efficacy in reducing food cravings, individuals’
responsiveness to food in the environment (power of food), and dietary restraint, with Cohen’s
effect size values suggesting moderate to high practical significance for both interventions [22].
Significant decreases in anxiety and depression scores were also reported for subjects in both the
EFT and CBT treatment groups, and these benefits were maintained at 12-month follow-up.
These results revealed that EFT was capable of producing treatment effects that were clinically
meaningful and comparable to a gold standard approach. Notably, EFT lasted longer over time
than CBT for improvements in food cravings and anxious symptomology and subjects’ food
cravings, power over food choices, and dieting mentality at the 12-month follow-up [21, 22].
For general psychological conditions outside food cravings, several meta analyses have found a
very large treatment effect for anxiety (d = 1.23 95% CI: 0.82-1.64, p < 0.001), a very large effect
size in the treatment of depression (Cohen's d across all studies was 1.31) [23], and a large
treatment effect (weighted Cohen’s d = 2.96, 95% CI 1.96-3.97; p < 0.001) for post-traumatic stress
disorder [24]. Research has also indicated treatment gains persist over time [25-29].
Performing the EFT technique while vocalising aspects of a targeted problem (the cognitive
element) has been hypothesized to decrease hyperarousal in the amygdala (the stress response
area of the brain) and hippocampus (the memory area) [30], alter dopamine and serotonin ratios
[17], produce connective tissue transmission of piezoelectric signals [31], and increase HPA axis
regulation, which among other benefits reduces stress-related cortisol secretion [32]. Recent
research in a sample of veterans with PTSD indicated regulation of six genes associated with
inflammation and immunity after 10 EFT sessions, with downregulation of inflammation and stress
markers and upregulation of immune markers found [33]. However, despite these studies, it has
not been unambiguously established how brain activation and neural mechanisms might be
affected by EFT.
1.1 Functional Magnetic Resonance Imaging (fMRI)
Functional Magnetic Resonance Imaging (fMRI) is widely used to map brain activity. fMRI
exploits the local increase in blood flow and hence blood volume and blood oxygenation that
occur to support the resulting increase in metabolic demand, instead of detecting neuronal
activity directly [34]. Brain imaging is a powerful technique that is enhancing neuroscience
research. Most conventional fMRI studies are based on the BOLD effect, which is the term used to
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describe the increase in fMRI signal due to the change in blood oxygenation and blood volume
secondary to the increase in blood flow.
Therefore, tracking brain activity with fMRI does not involve direct measurement of neuronal
activity. With fMRI, attention is paid to changes in blood flow, blood volume, and blood
oxygenation, features of metabolic demand affected by changes in brain activity. Measuring brain
activity indirectly is the basic for the BOLD system where changes in brain activity are defined as
increases or decreases in blood oxygenation and blood volume secondary to changes in blood flow.
Changes in fMRI signal, then, are presumed to be evidence of changes in neural activity.
BOLD fMRI has been used to map the primary cortical representation of taste and odour in
humans and to study responses to pleasant and aversive stimuli. Previous neuroimaging studies
have shown that emotional distress increases the reward value of palatable food in the brain of
restrained eaters [35-37]. Studies have also indicated individuals with, versus without substance
dependence, show greater activation in brain areas related to reward [38, 39] and obese, versus
lean adults, show similar activation in response to food cues [40, 41].
Due to the emerging evidence indicating EFT can have an immediate and lasting effect on food
cravings in obese adults, and given food cravings frequently lead to consumption of the craved
food [42], are positively correlated with body mass index (BMI) [39, 43] and obese adults report
preferences for high fat foods [44], this feasibility study focussed on extending this research
further. Subsequently, the study had two objectives:
1. To determine brain activation (using fMRI) in response to high calorie food image stimuli in
overweight/obese adults, and 2. To investigate neural mechanisms of symptom improvements in
overweight/obese adults following EFT treatment, compared to controls, in order to conduct a
larger trial.
2. Materials and Methods
Ethical Approval was provided by the Bond University Human Research Ethics Committee and
the trial was registered under the Australia New Zealand Clinical Trials Registry.
2.1 Participants
Ethical Approval was provided by the Bond University Human Research Ethics Committee and
the trial was registered under the Australia New Zealand Clinical Trials Registry. The inclusion
criteria were: at least 18 years of age, both genders, overweight (i.e. Body Mass Index; BMI;
between 25-29) or obese (BMI greater than 30), and not currently receiving treatment
(psychological or medical) for their food cravings. Participants who were pregnant, and known
sufferers of diabetes (Type I and II) and hypoglycaemia were excluded due to possible craving
confound. Because of the fMRI aspect of the study, participants could not have any metal implants
(e.g. pace maker) and completed a MRI head safety questionnaire prior to the scan.
After screening, eligible overweight/obese adults were randomly assigned to either the fMRI
treatment (N=10) or control group (N=5). All participants completed a pre-survey battery of
measures via an electronic link (data not presented here), and underwent a brain scan (fMRI) at a
local radiology facility; once for the control group and twice (pre-and post) for the EFT treatment
group.
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The majority of participants were female (86%), and chocolate was the most commonly chosen
food craving to address in the EFT treatment group. The mean age of the EFT group was 48 years
and 39 years for the controls; and the average BMI was 37 for the EFT group and 39 for the
controls. Results of chi-square analyses revealed there were no significant differences between
the EFT and control conditions in baseline sociodemographic characteristics (p>0.05).
2.2 Measures
Anthropometric Measures. Height and weight measurements were obtained to calculate BMI,
which is defined as weight in kilograms divided by height in meters squared (kg/m²). BMI
categories utilised for the present study included: underweight (< 18.5), healthy weight (18.5 to
24.9), overweight (25.0 to 29.9), or obese ( 30.0).
The Food Craving Inventory is a reliable and valid measure for the assessment of cravings for
specific types of foods (White et al., 2002). The FCI measures cravings for specific types of foods,
namely: High Fats, Sweets, Carbohydrates/Starches, and Fast Food Fats, all of which comprise the
higher order construct of “food craving” or the FCI Total score (White & Grilo, 2005). Higher
numbers for each of the subscales reflect greater cravings for that food type with the highest
score being 185.
2.3 fMRI Paradigm
All participants had an initial (pre) brain scanning session and 5-weeks later at the end of the 4-
week EFT intervention. Participants were asked to refrain from eating or drinking prior to the scan
(water excepted) and were asked to consume a caffeinated beverage 30-minutes prior (e.g. coffee)
to capture the hunger state that most individuals feel prior to their next meal. All scans were
completed between 8:00 a.m. and 11:00 a.m., with all participants changed into a gown and
presented with safety questions prior to the scan.
The fMRI scans were examined for intracranial structural abnormalities by the Radiologist
partner in the study (second author) and the third author interpreted pre-and post-effect
differences due to the EFT intervention. During the fMRI scanning the participants were presented
with six random repeating images of high-calorie food designed to engage parts of the brain which
respond to food stimuli. They were passive during the procedure, except for paying attention to
the food images, and this was to minimise engagement of other cognitive systems.
Participants were scanned on a Skyra 3T system on NUMARIS/4 Version Syngo MR E11A, using a
20ch head neck coil combination. A 6:35 mins ep2d_pace_moco sequence was used. This is a
single shot Echo planar sequence that has prospective motion correction built within the sequence
to correct in real time for motion. In addition, real time monitoring of the amount of motion is
possible via the 3D neuro card utilizing the inline features. Block design was used for paradigm
creation, and the total number of measurements was 120, with paradigm size being 20 Threshold
or T-score was set at 3 for the sequence acquisition. The TR 3200 TE 30 total scan time for
sequence was 6:29 minutes, however the use of dummy scans and IPAT calibration accounted for
the 6 second disparity. No other filtering was used; synchronization with the scanner ensured that
baseline did present until after this period. The Voxel size was 2 x 2 x 3 slices 36 dist factor 0
GRAPPA 2. Block design resulted in baseline, activation, baseline for the duration of test BABA.
The paradigm was designed to examine activation in response and anticipated consumption of six
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food items (see Figure 2). Images were presented via digital projector located outside of the scan
room but able to project to a MRI compatible screen. Test subjects were then able to see images
via a head mounted mirror.
Activation and baseline periods for the test were 30 seconds. This meant the randomized
images were visible for 5.4 seconds each time they were viewed by the subject. When participants
saw images, they were advised to imagine tasting and eating each food item as it was presented to
them. The duration of each block was designed to be short enough to prevent habituation in the
amygdala [45]. In the rest or baseline section a ‘checker board’ image was shown and participates
were asked to relax.
Post processing was completed on the scanner using the Neuro 3D platform. Whilst the
threshold had been applied on the creation of the paradigm. Final processing of threshold was
applied to patient for both data sets to ensure clear visualization of activation area (this gave a
threshold of 3.2-4 for all volunteers in cohort). This ensured clarity of data sets for comparison on
completion of data collection.
2.4 EFT Treatment
The intervention used in the current trial was ‘Clinical EFT’; the approach has been validated in
more than 100 clinical trials. The research supporting Clinical EFT has utilized a protocol which has
remained stable through three editions of the EFT Manual [18].
The EFT treatment was offered for two hours per week, for the 4-week period, to the treatment
group, while the control group did not engage in any treatment. A trained EFT practitioner
counsellor skilled in delivery clinical trials delivered the intervention and all sessions were based
on standardised protocols and adhered to the EFT manual [18]. Acupressure points on the
eyebrow, side of eye, under eye, under nose, chin, collarbone, under arm, and the top of the head
were used.
The procedure of EFT begins by the individual stating a difficulty they are experiencing,
followed by an opposing, but positive affirming statement. For example, an individual may state
“Even though I am nervous right now, I accept myself and this problem”. Researchers have long
found that when positive and negative thoughts are combined, the individual reports a decrease
of the negative experience [46]. This combination of positive affirmation and negative thoughts is
typically used in Systematic Desensitization, a behaviour modification therapy [46].
Stimulation of specific acupoints then involves tapping on them with two fingers while saying a
shorter reminder phrase e.g. “nervous”. The subject rates their level of the problem (nervousness)
out of 10 (0 = completely calm, 10 = highest level possible of the issue) before beginning, and re -
rates this every time they complete the eight tapping points. The process is repeated until the
discomfort score is zero. The EFT treatment sessions involved direct exposure to craved foods with
full adherence to protocols and safeguards occurring [18, 47]. The group spent two hours using
EFT on their food cravings, and were encouraged to self-administer EFT outside of treatment
sessions in response to cravings e.g. in the moment of in anticipation). Weekly short message
reminders were sent in between sessions to encourage adherence.
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3. Results
3.1 Food Craving Analyses
The self-report data was analysed using SPSS (Version 23). An alpha level of .05 was utilised to
determine the statistical significance of all results. Inspection of boxplots revealed no extreme
outliers.
The test of within subjects effects revealed there was a significant main effect of time for
participant total FCI scores, Wilk’s = .485, F (1, 13) = 13.778, p = .003, partial = .515.
Participant mean scores decreased by 18% for the EFT group (M = 101.1) to post (M = 67.3) and 5%
for the control group (M = 83.75 pre; M = 73.25 post). The main effect of group revealed FCI total
scores were not significantly different between the EFT (M = 84.300; SE = 3.512) and control (M =
76.400; SE = 4.967) groups, p > .05. The Group x Time interaction for FCI was however significant,
revealing the food craving difference scores over time decreased significantly for the EFT group
when compared to the controls, Wilk’s = .690, F (1, 13) = 5.830, p = .031, partial = .310 (see
Table 1).
Table 1 Associated means, standard deviations, and mean differences for the food
craving inventory.
EFT
Control
Pre (SD)
Post (SD)
Diff
Pre (SD)
Post (SD)
Diff
101.10
(17.62)
67.30
(12.52)
33.80
(22.69)
83.75
(19.94)
73.25
(8.50)
10.50
(14.20)
3.2 fMRI Analysis
The fMRI scans were analysed as a between-groups whole-brain contrast analysis to identify
brain regions activated by anticipation of food. A ‘threshold’ was set to reduce the ‘noisy’ or areas
showing activation that were not of interest. Typically with emotive responses the BOLD response
is very small so the threshold was set at a level to ensure the areas in question were able to be
analysed. The threshold or T-score was set at approximately 2-2.6 (patient dependent). This was
then used for all their scans so that comparison could be made with all the tests.
The areas of emotive responses to food and other stimuli have been documented in previous
papers and it is noted that there does not appear to be one single area that is definitively
identified as the primary response to food. However, in the present study for all the pre-scans,
there was relative activation in the superior temporal gyrus (associated with cognition) and lateral
orbito-frontal cortex (associated with reward). The post scans for the treatment group only were
relatively deactivated in both these areas; there was marked reduction in the BOLD response (see
Figure 1 as an example). Post scanning of a control group who did not receive the EFT treatment
showed continued activation in these areas (see Figure 2).
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Figure 1 Pre and post fMRI for subject in EFT treatment condition.
Note: the yellow, orange and red areas active on the pre scan are relatively deactivated in the post
scan of the EFT group.
Figure 2 Control group example fMRI scan.
Note: the yellow, orange and red areas active on the pre scan that are still relatively activated in the
control group.
4. Discussion
This study represents the first to initially explore neural changes after EFT treatment in
overweight/obese adults and was designed to develop a fMRI protocol for future investigations.
Our fMRI results were also consistent with those obtained by previous studies and met the first
objective. As expected, food images presentation increased activation in the brain and were
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largest in the superior temporal gyrus and orbitofrontal cortex (left cortical regions). Research
suggests even if someone is not hungry, seeing food or thinking about food can stimulate eating
[48, 49], and cortical regions responsive to food images in previous studies have included the
limbic and paralimbic areas [50] and the prefrontal cortex [51].
It has also been noted that while the orbitofrontal cortex is typically associated with reward, it
is also activated when non-reward, or loss occurs, and this may be relevant if a subject is imagining
being deprived of a food (e.g., a diet or treatment program to target this). The orbitofrontal cortex
is the first place where olfactory information and taste information converge [52], therefore, given
participants in the present study were explicitly told to imagine eating the food they were viewing,
this was not unexpected. Other functional imaging studies have found similar high-calorie items
result in more activation than low-calorie control items in the same orbitofrontal cortex region [53,
54]. Further, obese participants characteristically show greater neural activation in these brain
regions implicated in reward, when compared to lean participants [41, 55].
The activation in the superior temporal gyrus in the present study has been noted in other
studies. The superior temporal gyrus is significantly activated to a greater extent during the
presentation of food items compared to non-food items [56]. Television viewing studies also
highlight that food and non-food commercials result in greater activation in neural regions
associated with similar attention, focus and language areas [57]. Food images significantly increase
activation in healthy controls in this brain area too [58].
The second objective of this study was to compare the EFT treatment group to the controls and
ascertain any differences in neural activity after therapy. There were differences between the EFT
group on their pre-and post fMRI scans, as well as differences to the control group. The EFT group
achieved a marked reduction in activation post their EFT treatment in both the superior temporal
gyrus and orbitofrontal cortex, whereas the control group remained the same.
While speculatively, the neural changes indicated in this pilot study appear to compare to the
self-reported food craving decreases in the current trial as well as previous EFT and food craving
trials [19-22]. The lack of engagement in homework activities reported by participants (addressed
next) and the relative deactivation of the brain activity during the post scans while viewing high
caloric food images, suggests a correlation worth examining in larger future trials.
Finally and worthy of note is that while the EFT participants were encouraged to engage in the
technique outside sessions, and reminder messages were sent by the lead therapist between
sessions every week. However, they typically did not do so via self-report and this was also
indicated in previous trials [19-22]. A recent two year follow-up of an 8-week online intervention
program for overweight or obese adults found participants’ food craving, perceived power of food,
dietary restraint capabilities and all psychological distress symptoms (i.e. anxiety, depression and
somatic) remained significantly reduced from the end of treatment to two-year follow-up [59]
with no further treatment and a distinct lack of in-between session homework. This study
suggested that using EFT in the sessions alone resulted in a reduction of cravings that did not
require any further intervention from the end of the 8-week program.
It is true a common strategy in the gold standard cognitive and behaviour therapies is utilizing
homework assignments as a mechanism to produce and strengthen beneficial treatment
outcomes. Practicing skills outside the therapy session for permanent and long-term change is
essential. Indeed, engaging in homework activities to produce positive therapy outcomes has been
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examined in meta-analyses and results indicate that greater compliance with homework is
associated with more beneficial treatment outcomes [60, 61].
However, one of the top cited reasons for therapy failure in CBT is homework noncompliance
[62]. In adult clients, the rates of nonadherence range from 20 to 50 percent [63]. As mentioned,
EFT’s physical component is more than tapping on the skin (indeed meta-analysis indicates that
the acupressure component is an active ingredient and outcomes are not due solely to placebo,
nonspecific effects of any therapy, or nonacupressure components [64]). EFT results in changes in
the brain, DNA expression, hormone production, brain waves, and blood flow; and is it remarkably
swift. This stimulation of acupressure points is indeed a “health promoting activity” that occurs in
session, and does not necessarily rely on homework tasks being completed outside this.
It has been suggested that there are three factors common to all successful psychotherapies:
the therapist and the client have a strong bond and effective working relationship; the therapist
and client both have an expectation that therapy will be successful; and the therapy approach
includes the client engaging in health-promoting, beneficial actions [65]. The stimulation of
specific acupoints in EFT has been suggested to be this “health promoting activity” and thus does
not necessarily rely on homework tasks being completed outside the session [66]. This may
answer why the treatment effects last over time, although further research is warranted
4.1 Limitations
This research served as a pilot study for further explorations of brain activation after EFT
treatment. Clearly participant numbers were relatively low and restrictive on the inferences that
can be drawn. In order to draw direct conclusions future studies should be larger and longer in
follow-up periods and individuals perhaps be able to pick the most appropriate food images that
they would like to consume at the specific moment of the scan. Subjects in the current study were
scanned while fasting; thus, they were hungry during the protocol, which may have enhanced the
appeal of high calorie food items. This study examined findings at an individual level because of
sample size and to retain individualities in brain structure, however it is recommended that future
studies include group brain analyses. Further research may also benefit from investigating the
issue of engaging in homework (e.g. further tapping) to ascertain the impact of compliance and
longevity of the technique.
4.2 Implications and Future Recommendations
Despite the limitations, this initial study did demonstrate that the viewing of high calorie
food items by fasting overweight adults activated brain areas associated with focus and
attention (superior temporal gyrus) and reward (orbitofrontal cortex). Furthermore, eight hours
of EFT treatment resulted in a relative deactivation of neural activity for those adults and may
be a useful adjunct for adults in weight loss and maintenance programs.
Author Contributions
The first author designed and oversaw the clinical trial and wrote the publication with the
research assistant sixth author. The second author investigated the fMRI scans for intracranial
structural abnormalities and was the Radiologist partner in the study. The third author interpreted
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pre-and post-effect fMRI scan differences due to the EFT intervention, while the fourth and fifth
authors were technical staff present during all scans.
Acknowledgements
This study wishes to acknowledge the EFT practitioner Brett Porter who delivered the
intervention for the trial.
Funding
This study acknowledges the private donations of several benefactors (Mrs Pamela Thomas and
Alina Frank/Craig Weiner) and Faculty funding from Bond University, as well as the Association of
Comprehensive Energy Psychology, USA.
Competing Interests
The first author may derive income from delivering presentations or trainings using the
technique investigated in this paper. The remaining authors have declared that no competing
interests exist.
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... As might be expected from a therapy that includes a strong somatic component, measurable changes in biological markers have been found following EFT treatments. Hormonal shifts have been identified, including reductions in cortisol production that were statistically greater than cortisol reductions following a supportive counselling session [37]. Changes in blood flow patterns within the brain have been identified in pre-and post-treatment fMRI readings [38]. ...
... Changes in blood flow patterns within the brain have been identified in pre-and post-treatment fMRI readings [38]. Studies examining the epigenetic effects of EFT treatment have found regulation of a range of genes related to health and mental health [37,39,40]. For instance, a one-hour EFT psychotherapy session found that EFT was associated with the regulation of 72 genes, including those involved in learning and memory, regeneration of neural white matter, enhanced synaptic connectivity, neuronal survival after DNA damage, tumor suppression, insulin regulation, heightened immunity, inflammation, and antiviral activity [39]. ...
... Existing RCTs and meta-analyses show that the treatment of PTSD with Clinical EFT is associated with extensive health and mental health benefits [37,40,[43][44][45]61,[63][64][65]. These include: (a) the remediation of clinical PTSD symptom levels in between 84% and 90% of veterans; (b) durable long-term treatment results; (c) generalizability across a variety of populations; (d) relatively short timeframes, generally ranging between 4 and 10 sessions; (e) positive clinical outcomes in group as well as individual treatment settings; (f) efficacy when administered by telephone or online webcams; (g) effectiveness whether offered by life coaches or licensed mental health professionals; (h) improvement in comorbid conditions such as anxiety and depression; (i) cost-effectiveness when compared to conventional treatments; and (j) a minimal risk of adverse events. ...
Article
Full-text available
Clinical EFT (Emotional Freedom Techniques) is an evidence-based method that combines acupressure with elements drawn from cognitive and exposure therapies. The approach has been validated in more than 100 clinical trials. Its efficacy for post-traumatic stress disorder (PTSD) has been investigated in a variety of demographic groups including war veterans, victims of sexual violence, the spouses of PTSD sufferers, motor accident survivors, prisoners, hospital patients, adolescents, and survivors of natural and human-caused disasters. Meta-analyses of EFT for anxiety, depression, and PTSD indicate treatment effects that exceed those of both psychopharmacology and conventional psychotherapy. Studies of EFT in the treatment of PTSD show that (a) time frames for successful treatment generally range from four to 10 sessions; (b) group therapy sessions are effective; (c) comorbid conditions such as anxiety and depression improve simultaneously; (d) the risk of adverse events is low; (e) treatment produces physiological as well as psychological improvements; (f) patient gains persist over time; (g) the approach is cost-effective; (h) biomarkers such as stress hormones and genes are regulated; and (i) the method can be adapted to online and telemedicine applications. This paper recommends guidelines for the use of EFT in treating PTSD derived from the literature and a detailed practitioner survey. It has been reviewed by the major institutions providing training or supporting research in the method. The guidelines recommend a stepped-care model, with five treatment sessions for subclinical PTSD, 10 sessions for PTSD, and escalation to intensive psychotherapy or psychopharmacology or both for nonresponsive patients and those with developmental trauma. Group therapy, social support, apps, and online and telemedicine methods also contribute to a successful treatment plan.
... A recent comparison of fMRI images prior to and following a course of energy psychology treatments lends support to the premise that acupoint tapping can send signals that directly influence brain activity in targeted ways. Stapleton et al. 114 compared pretreatment with posttreatment brain scans of 10 obese participants from a four-week (two hours per week) EFT program designed to reduce food cravings. Photos of high-calorie foods such as pizza, hamburgers with fries, chocolate chip cookies, and ice cream sundaes were shown while participants were in the fMRI scanner and asked to "think" about eating the food. ...
... The two hypothesized neurological processes by which energy psychology protocols bring about rapid and lasting clinical change are built upon existing empirical knowledge, but they have not been tested as such. While two recent brain imaging studies of acupoint tapping treatments 34,114 have produced findings that are consistent with these hypotheses, additional imaging studies are needed. In addition, any theoretical model is constrained by the limitations of the empirical knowledge at its foundation, current understanding about the mechanisms involved in modifying emotional learnings leaves many fundamental questions unanswered. ...
... Specifically, EFT involves the application of fingertip pressure on acupoints on the face and upper body with a concurrent cognitive reframing of target issues. Research has assessed the efficacy of EFT treatment for a range of psychological and physiological conditions (Bach et al., 2019), including psychological trauma, fibromyalgia, and food cravings (Brattberg, 2008;Church, Yount, Rachlin, Fox, & Nelms, 2018;Salas, Brooks, & Rowe, 2011;Stapleton et al., 2017Stapleton et al., , 2019. ...
... While some speculation continues regarding the mechanisms that underlie EFT intervention effects (Feinstein, 2018), research suggests that EFT targets specific areas of the brain involved in hyperarousal, such as the amygdala and hippocampus. Functional MRI studies indicate that EFT provides similar effects to acupuncture in the downregulation of the amygdala and anterior cingulate areas of the brain, which are activated by exposure to stress and trauma (Dhond, Kettner, & Napadow, 2007;Fang et al., 2009;Feinstein, 2008;Felmingham et al., 2007;Stapleton et al., 2019). Similarly, electroencephalographic recordings of participants performing EFT have demonstrated decreased arousal in the right frontal cortex, a pattern observed in other forms of neurotherapy (Swingle, Pulos, & Swingle, 2004). ...
Article
Objective: In a direct replication of Church, Yount, and Brooks (2012), this study examined changes in stress biochemistry and psychological distress symptoms in 53 participants randomly allocated to one of three 60-min group interventions: Emotional Freedom Techniques (EFT), psychoeducation (PE), and no treatment (NT). The Symptom Assessment-45 (SA-45) was used to assess psychological distress symptoms. Method: Salivary cortisol assays were administered 30 min pre- and postintervention to test cortisol levels. The original study by Church et al. indicated the EFT group showed statistically significant improvements in anxiety (-58.34%, p < .05), depression (-49.33%, p < .002), overall severity of symptoms (-50.5%, p < .001), and symptom breadth (-41.93%, p < .001). The group also experienced a significant decrease in cortisol (-24.39%) compared to the PE group (-14.25%) and NT group (-14.44%). Results: The present results indicated the EFT group experienced a significant decrease in cortisol greater than the original study (-43.24%, p < .05), but these results were not mirrored by subjective reports of psychological distress. The EFT group reduction in cortisol was significantly different from that of the PE group (-19.67%), and as expected, the posttreatment cortisol level detected among the EFT group was lower than that of the NT group (2.02%); however, there was not a statistically significant difference between the 2 groups. Additionally, there were no significant improvements in cortisol reduction among the NT and PE groups. Conclusions: Findings support the original study indicating EFT to be an efficient and effective brief treatment for reducing biological markers of stress. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
... The evidence for its clinical effects was stated with discussions about the mechanism of action and mechanistic reframing 23,26) . The self-care technique of EFT is reported to increase the secretion of opioids, serotonin, and gamma-aminobutyric acid, and to decreases the stress hormone of cortisol [26][27][28][29] , thus leading to epigenetic 30) and neurochemical changes 31) . ...
Article
Full-text available
Objectives: Academic stress poses a significant risk for the mental health of medical students, and a feasible group intervention program for managing academic stress is required. The purpose of this study was to examine the clinical effectiveness of emotional freedom techniques (EFT) on the mental health of Korean medical students. Methods: The class of first-year medical school students (n=36) participated in an after-school EFT group intervention program comprising six sessions (15 minutes/session, three weeks) to analyze its clinical effectiveness as a single-group test-retest clinical study. The changes in the Perceived Stress Scale (PSS), Test Anxiety Inventory (TAI), Positive and Negative Affect Schedule (PANAS), and State-Trait Anxiety Inventory (STAI) scores were examined using a paired t-test and Cohen's D at post-EFT and two-week follow-up. Results: There were significant curtailments at post-EFT and follow-up measures in TAI-Total (t=2.704 and t=3.289), TAI-Worry (t=2.297 and t=2.454), TAI-Emotionality (t=2.763 and t=3.654), PSS-Negative Perspective (t=2.659 and t=3.877), and PANAS-Negative Affect (t=2.885 and t=3.259) subscales, however not in PSS-Positive Perspective (t=-1.279 and t=-1.101) and PANAS-Positive Affect (t=0.194 and t=-0.122) subscales. The trait anxiety (t=2.227) was significantly mitigated in the post-EFT measure and the state anxiety (t=2.30) in the follow-up measure. Conclusions: The EFT group intervention alleviated test stress, negative affect, and anxiety in the Korean medical students. This study contributes to an understanding of academic stress and EFT intervention in the competitive environment of medical education.
... More recently, in an Australian study, fMRI assessments of patients with food cravings showed increased activation in the left cortical regions of the brain when patients were exposed to food images. After a 4-week EFT treatment of 2 hours per week, the left cortical brain activity was reduced in the EFT treatment group, whereas the no-treatment control group remained the same (Stapleton et al., 2019). ...
Thesis
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The Tapping Project was designed in response to the increasing rates of childhood anxiety. Using a mixed methods methodology, the study assessed the effectiveness of Emotional Freedom Techniques (EFT), or tapping, when used as a class intervention for student wellbeing in four Northern Territory schools. Quantitative and qualitative measures found that EFT supports the national educational social and emotional wellbeing curriculum, and presents as a valuable inclusion in school programs. The study’s analyses found that tapping is a mechanism for change, and tapping skills were transferable to other contexts. In addition to calming effects, students felt the benefits of tapping extended to focus and concentration and a reduction in physical discomfort. Both students and teachers agreed that tapping should be introduced to all primary school students. Students were more likely to develop intrinsic motivation for tapping when the psychological needs of competence, autonomy, and relatedness were met.
... Another study found that EFT regulates stress hormones and lymphatic function and improves various neurological indicators in the field of general health. The epigenetic effects of EFT include the regulation of immune genes and the degeneration of inflammatory genes (18). In a study conducted by Sebastian, the effectiveness of EFT on the treatment of post-traumatic stress disorder (PTSD) and related symptoms was proven. ...
Article
Full-text available
Corona virus is a family of viruses that can cause a wide range of diseases. Nurses are among those who have to attend hospital settings due to their job nature and are exposed to suspected patients with Corona. so they experience high level of stress and anxiety. The "Emotional Freedom Technique" (EFT) is an alternative treatment for removing physical pain and emotional distress.This study was conducted to investigate the effect of using EFT on anxiety of nurses during Corona outbreak.The present study was a clinical trial. The statistical population of the present study included all nurses working in hospitals. The data collection tool consisted of two sections: demographic information and the Nursing Stress Scale NSS developed by Gray-Toft James Anderson. After entering the data into computer, they were analyzed through SPSS24 software and by paired T-tests and analysis of variance with repeated observations. It should be noted that the significance level of the study was considered at P <0.05.The independent T-test showed that the mean work stress score in the case and control groups did not differ significantly before the intervention (p =0.14). Analysis of variance with repeated observations showed that the mean work stress scores in the EFT training group were not the same in three times and there was a significant statistical difference among them (P <0.001). Teaching EFT technique is very effective for nurses to reduce work stress by considering practical skills when exposed to stressful conditions.
... Penelitian Vural (2019) menyimpulkan bahwa EFT sangat membantu dalam menurunkan kecemasan melahirkan. Penelitian Stapleton et al., (2018) didapatkan hasil EFT dapat menurunkan aktivitas otak daerah limbik dan mengurangi gejala terkait makanan pada individu yang kelebihan berat badan / obesitas. Studi ini juga menjelaskan mekanisme neurologis yang bekerja di balik banyak hasil studi EFT yang berhasil untuk menurunkan berat badan. ...
Article
This study aimed to determine the effectiveness of SEFT interventions in improving the quality of life of HIV / AIDS patients in Padang City. The design of this study was a Quasi-experimental design with one group pretest and posttest. This study found that the average quality of life of HIV patients before SEFT administration was 97.07, and the average rate of life of HIV patients after SEFT administration was 102.6. It can be seen that the mean difference between before and after SEFT action is 5.57 with a standard deviation of 6.98. The statistical test results obtained p-value = 0.011. In conclusion, there is a significant difference between the quality of life of HIV patients before and after SEFT treatment. Keywords: HIV, Quality of Life, SEFT
... Research has also highlighted the neurological mechanisms that underlie successful weight loss through EFT. A pilot RCT investigated the effect of EFT on brain activation in response to food craving using fMRI [46]. Fifteen overweight or obese adults were allocated to a four-week group EFT treatment or control condition. ...
Article
This clinical trial investigated the effect of an Emotional Freedom Techniques (EFT) intervention on brain activation in chronic pain sufferers using functional magnetic resonance imaging (fMRI). EFT is a brief stress reduction technique which combines stating a cognitive statement with somatic tapping on acupressure points. Twenty-four adults were allocated to a six-week online group EFT treatment and underwent resting-state fMRI pre and post the intervention. A repeated measures MANOVA indicated significant differences in the levels of pain severity (−21%), pain interference (−26%), quality of life (+7%), somatic symptoms (−28%), depression (−13.5%), anxiety (−37.1%), happiness (+17%), and satisfaction with life (+8.8%) from pre-to post-test. Cohen's effect sizes ranged from small (0.2) to large (0.75) values suggesting significance for the intervention. fMRI analysis showed post-EFT treatment significantly decreased connectivity between the medial prefrontal cortex (a pain modulating area) and bilateral grey matter areas in the posterior cingulate cortex and thalamus, both areas being related to the modulating and catastrophizing of pain. There were no brain areas that showed significantly increased connectivity post-EFT treatment. Coupled with the psychological measures the findings support the effects of the EFT intervention in reducing chronic pain and its impacts. Recommendations for future research are discussed.
Article
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Energy psychology, as most widely practiced, integrates the manual stimulation of acupuncture points with imaginal exposure, cognitive restructuring, and other evidence-based psychotherapeutic procedures. Efficacy for energy psychology protocols has been established in more than 120 clinical trials, with meta-analyses showing strong effect sizes for PTSD, anxiety, and depression. The approach has been applied in the wake of natural and human-made disasters in more than 30 countries. Four tiers of energy psychology interventions following the establishment of safety, trust, and rapport are described, including (1) immediate relief/stabilization, (2) reducing limbic arousal to trauma-based triggers, (3) overcoming complex psychological difficulties, and (4) promoting optimal functioning. The first tier is most pertinent in psychological first aid immediately following a disaster, with the subsequent tiers progressively being introduced over time with complex stress reactions and chronic disorders. Advantages of adding the stimulation of acupuncture points to a conventional exposure approach are identified, and challenges around cultural sensitivities and unintended effects are discussed. After establishing a framework for introducing energy psychology in disaster relief efforts, reports from a sampling of settings are presented, based on interviews with this paper’s author. These include accounts of relief work with survivors of mass shootings, genocide, ethnic warfare, earthquakes, hurricanes, tornadoes, floods, wildfires, and the COVID-19 pandemic. Hundreds of other reports from the field show a pattern of strong outcomes following the use of energy psychology in the days or weeks after a disaster and in the subsequent treatment of trauma-based psychological problems. Many of these accounts corroborate one another in terms of rapid relief and long-term benefits. Finally, examples of more efficient delivery methods utilizing large groups, lay counselors, digital technology, and cultivating community resilience are presented.
Article
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Emotional Freedom Techniques (EFTs) combine elements of cognitive restructuring and exposure techniques with acupoint stimulation. Meta-analyses indicate large effect sizes for posttraumatic stress disorder, depression, and anxiety; however, treatment effects may be due to components EFT shares with other therapies. This analysis reviewed whether EFTs acupressure component was an active ingredient. Six studies of adults with diagnosed or self-identified psychological or physical symptoms were compared (n = 403), and three (n = 102) were identified. Pretest vs. posttest EFT treatment showed a large effect size, Cohen's d = 1.28 (95% confidence interval [CI], 0.56 to 2.00) and Hedges' g = 1.25 (95% CI, 0.54 to 1.96). Acupressure groups demonstrated moderately stronger outcomes than controls, with weighted posttreatment effect sizes of d = -0.47 (95% CI, -0.94 to 0.0) and g = -0.45 (95% CI, -0.91 to 0.0). Meta-analysis indicated that the acupressure component was an active ingredient and outcomes were not due solely to placebo, nonspecific effects of any therapy, or nonacupressure components.
Article
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The obesity epidemic is attributable to dietary and behavioral trends acting on a person’s genetic makeup to determine body mass and susceptibility to obesity-related disease. Common forms of obesity have a strong hereditary component, yet genetic pathways that contribute to obesity have not yet been elucidated. Many genetic association studies have been reported, but few have been successfully replicated. New research tools and large studies will lead to an understanding of genes and their interaction to cause obesity, which may help guide successful interventions and treatments.
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Objective This functional magnetic resonance imaging study was designed to observe how physiological brain states can alter food preferences. A primary goal was to observe food‐sensitive regions and moreover examine whether 5‐HTP intake would activate areas which have been associated with appetite suppression, anorexia, satiety, and weight loss. Methods and Procedure Fourteen healthy male and female participants took part in the study, of which half of them received the supplement 5‐HTP and the rest vitamin C (control) on an empty stomach. During the scanning session, they passively observed food (high calories, proteins, carbohydrates) and nonfood movie stimuli. Results Within the 5‐HTP group, a comparison of food and nonfood stimuli showed significant responses that included the limbic system, the basal ganglia, and the prefrontal, temporal, and parietal cortices. For the vitamin C group, activity was mainly located in temporal and occipital regions. Compared to the vitamin C group, the 5‐HTP group in response to food showed increased activation on the VMPFC, the DLPFC, limbic, and temporal regions. For the 5‐HTP group, activity in response to food high in protein content compared to food high in calories and carbohydrates was located in the limbic system and the right caudomedial OFC, whereas for the vitamin C group, activity was mainly located at the inferior parietal lobes, the anterior cingulate gyri, and the left ventrolateral OFC. Greater responses to carbohydrates and high calorie stimuli in the vitamin C group were located at the right temporal gyrus, the occipital gyrus, the right VLPFC, whereas for the 5‐HTP group, activity was observed at the left VMPFC, the parahippocampal gyrus bilaterally, the occipital lobe, and middle temporal gyri. Discussion In line with the hypotheses, 5‐HTP triggered cortical responses associated with healthy body weight as well as cerebral preferences for protein‐rich stimuli. The brain's activity is altered by macronutrients rich or deprived in the body. By reading the organisms physiological states and combining them with memory experiences, it constructs behavioral strategies steering an individual toward or in opposition to a particular food.
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Background: Among a group of therapies collectively known as energy psychology (EP), emotional freedom techniques (EFT) is the most widely practiced. Clinical EFT is an evidence-based practice combining elements of cognitive and exposure therapies with the manual stimulation of acupuncture points (acupoints). Lacking is a recent quantitative meta-analysis that enhances understanding of the variability and clinical significance of outcomes after clinical EFT treatment in reducing depression. Methods: All studies (2005-2015) evaluating EFT for sufferers of depression were identified by electronic search; these included both outcome studies and randomized controlled trials (RCTs). Our focus was depressive symptoms as measured by a variety of psychometric questionnaires and scales. We used meta-analysis to calculate effect sizes at three time points including posttest, follow-ups less than 90 days, and follow-ups more than 90 days. Results: In total, 20 studies were qualified for inclusion, 12 RCTs and 8 outcome studies. The number of participants treated with EFT included N = 461 in outcome studies and N = 398 in RCTs. Clinical EFT showed a large effect size in the treatment of depression in RCTs. At posttest, Cohen׳s d for RCTs was 1.85 and for outcome studies was 0.70. Effect sizes for follow-ups less than 90 days were 1.21, and for ≥ 90 days were 1.11. EFT were more efficacious than diaphragmatic breathing (DB) and supportive interview (SI) in posttest measurements (P = .06 versus DB, P < .001 versus SI), and sleep hygiene education (SHE) at follow-up (P = .036). No significant treatment effect difference between EFT and eye movement desensitization and reprocessing (EMDR) was found. EFT were superior to treatment as usual (TAU), and efficacious in treatment time frames ranging from 1 to 10 sessions. The mean of symptom reductions across all studies was -41%. Conclusions: The results show that Clinical EFT were highly effective in reducing depressive symptoms in a variety of populations and settings. EFT were equal or superior to TAU and other active treatment controls. The posttest effect size for EFT (d = 1.31) was larger than that measured in meta-analyses of antidepressant drug trials and psychotherapy studies. EFT produced large treatment effects whether delivered in group or individual format, and participants maintained their gains over time. This meta-analysis extends the existing literature through facilitation of a better understanding of the variability and clinical significance of depression improvement subsequent to EFT treatment.
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Purpose: To assess the feasibility of measuring changes in gene expression associated with post-traumatic stress disorder (PTSD) treatment using emotional freedom techniques (EFT). Design: Participants were randomized into an EFT group receiving EFT and treatment as usual (TAU) throughout a 10-week intervention period and a group receiving only TAU during the intervention period and then receiving EFT. Setting: A community clinic and a research institute in California. Participants: Sixteen veterans with clinical levels of PTSD symptoms. Intervention: Ten-hour long sessions of EFT. Measures: Messenger RNA levels for a focused panel of 93 genes related to PTSD. The Symptom Assessment 45 questionnaire, Hospital Anxiety and Depression Scale, Insomnia Severity Scale, SF-12v2 for physical impairments, and Rivermead Postconcussion Symptoms Questionnaire. Analysis: Pre-, posttreatment, and follow-up mean scores on questionnaires were assessed using repeated measures 1-way analysis of variance. A Student t test and post hoc analyses were performed on gene expression data. Results: Post-traumatic stress disorder symptoms declined significantly in the EFT group (-53%, P < .0001). Participants maintained their gains on follow-up. Significant differential expression of 6 genes was found (P < .05) when comparing the expression levels before and after the intervention period in participants receiving EFT. Conclusion: Study results identify candidate gene expression correlates of successful PTSD treatment, providing guidelines for the design of further studies aimed at exploring the epigenetic effects of EFT.
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Objective Examining the effectiveness of psychological interventions in treating secondary psychological outcomes of obesity has become prioritized in recent times. The objective of the present study was to compare an eight-week Cognitive-Behavioural Therapy (CBT) and Emotional Freedom Techniques (EFT) intervention program, in the treatment of food cravings and secondary psychological outcomes among overweight or obese adults (N = 83). Method A controlled non-inferiority trial was performed comparing group-delivered CBT to group-delivered EFT. Participants completed the Patient Health Questionnaire at pre- and post-intervention, and at six and 12-months follow-up. Results The CBT group did not report any significant changes in anxiety scores over time, but the decrease in depression symptoms pre-to post-intervention was significant and this was maintained at 6-and 12-months. Anxiety and depression scores significantly decreased from pre-to post-intervention for the EFT group, and was maintained at 6- and 12-month follow-up. Somatoform scores significantly decreased from pre-intervention to all follow-up points for the CBT group, while the EFT group did not report any significant changes in somatoform symptoms. Results also revealed that EFT is capable of producing reductions in anxiety and depression symptoms, and may be comparable to gold standard approaches such as CBT. Conclusion The current study supports the hypothesis that psychological intervention is beneficial for treating psychological comorbidities of obesity and points to the role mental health issues may play in this area.
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Background: Over the past two decades, growing numbers of clinicians have been utilizing emotional freedom techniques (EFT) in the treatment of posttraumatic stress disorder (PTSD), anxiety, and depression. Randomized controlled trials (RCTs) have shown encouraging outcomes for all three conditions. Objective: To assess the efficacy of EFT in treating PTSD by conducting a meta-analysis of existing RCTs. Methods: A systematic review of databases was undertaken to identify RCTs investigating EFT in the treatment of PTSD. The RCTs were evaluated for quality using evidence-based standards published by the American Psychological Association Division 12 Task Force on Empirically Validated Therapies. Those meeting the criteria were assessed using a meta-analysis that synthesized the data to determine effect sizes. While uncontrolled outcome studies were excluded, they were examined for clinical implications of treatment that can extend knowledge of this condition. Results: Seven randomized controlled trials were found to meet the criteria and were included in the meta-analysis. A large treatment effect was found, with a weighted Cohen׳s d = 2.96 (95% CI: 1.96-3.97, P < .001) for the studies that compared EFT to usual care or a waitlist. No treatment effect differences were found in studies comparing EFT to other evidence-based therapies such as eye movement desensitization and reprocessing (EMDR; 1 study) and cognitive behavior therapy (CBT; 1 study). Conclusions: The analysis of existing studies showed that a series of 4-10 EFT sessions is an efficacious treatment for PTSD with a variety of populations. The studies examined reported no adverse effects from EFT interventions and showed that it can be used both on a self-help basis and as a primary evidence-based treatment for PTSD.
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