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Clinical EFT (Emotional Freedom Techniques) Improves Multiple Physiological Markers of Health

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Emotional Freedom Technique (EFT) is an evidence-based self-help therapeutic method and over 100 studies demonstrate its efficacy. However, information about the physiological effects of EFT is limited. The current study sought to elucidate EFTs mechanisms of action across the central nervous system (CNS) by measuring heart rate variability (HRV) and heart coherence (HC); the circulatory system using resting heart rate (RHR) and blood pressure (BP); the endocrine system using cortisol, and the immune system using salivary immunoglobulin A (SigA). The second aim was to measure psychological symptoms. Participants (N = 203) were enrolled in a 4-day training workshop held in different locations. At one workshop (n = 31), participants also received comprehensive physiological testing. Posttest, significant declines were found in anxiety (−40%), depression (−35%), posttraumatic stress disorder (−32%), pain (−57%), and cravings (−74%), all P < .000. Happiness increased (+31%, P = .000) as did SigA (+113%, P = .017). Significant improvements were found in RHR (−8%, P = .001), cortisol (−37%, P < .000), systolic BP (−6%, P = .001), and diastolic BP (−8%, P < .000). Positive trends were observed for HRV and HC and gains were maintained on follow-up, indicating EFT results in positive health effects as well as increased mental well-being.
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Original Article
Clinical EFT (Emotional Freedom
Techniques) Improves Multiple Physiological
Markers of Health
Donna Bach, ND
1
, Gary Groesbeck, BCIA
1
, Peta Stapleton, PhD
2
,
Rebecca Sims, MCP
2
, Katharina Blickheuser, PhD
1
,
and Dawson Church, PhD
1
Abstract
Emotional Freedom Technique (EFT) is an evidence-based self-help therapeutic method and over 100 studies demonstrate its
efficacy. However, information about the physiological effects of EFT is limited. The current study sought to elucidate EFTs
mechanisms of action across the central nervous system (CNS) by measuring heart rate variability (HRV) and heart coherence
(HC); the circulatory system using resting heart rate (RHR) and blood pressure (BP); the endocrine system using cortisol, and the
immune system using salivary immunoglobulin A (SigA). The second aim was to measure psychological symptoms. Participants (N
¼203) were enrolled in a 4-day training workshop held in different locations. At one workshop (n ¼31), participants also
received comprehensive physiological testing. Posttest, significant declines were found in anxiety (40%), depression (35%),
posttraumatic stress disorder (32%), pain (57%), and cravings (74%), all P< .000. Happiness increased (þ31%, P¼.000) as
did SigA (þ113%, P¼.017). Significant improvements were found in RHR (8%, P¼.001), cortisol (37%, P< .000), systolic BP
(6%, P¼.001), and diastolic BP (8%, P< .000). Positive trends were observed for HRV and HC and gains were maintained on
follow-up, indicating EFT results in positive health effects as well as increased mental well-being.
Keywords
anxiety, cortisol, immunity, heart rate variability, Emotional Freedom Techniques
Received August 8, 2018. Received revised November 5, 2018. Accepted for publication December 17, 2018.
A large body of research identifies associations between phy-
siological and psychological symptoms. A systematic review
of 31 studies, including 16 922 patients, found that objective
physiological measures of health as well as medical diagnoses
were strongly correlated with anxiety and depression.
1
A meta-
analysis of 244 studies found an association between psycho-
logical symptoms and somatic syndromes.
2
A large-scale
international study of 25 916 patients at 15 primary care centers
in 14 countries on 5 continents found a significant association
(P ¼.002) between depression and somatic symptoms in 69%
of patients.
3
Many other studies of specific conditions identify
links between levels of psychological well-being and physio-
logical measures of health.
Emotional Freedom Technique (EFT) is a novel therapy
that combines both cognitive and somatic elements (described
below). Systematic reviews and meta-analyses have demon-
strated its efficacy for both physiological and psychological
symptoms.
4,5
A current research bibliography lists more than
100 studies published in peer-reviewed journals (Research.-
EFTuniverse.com). Its efficacy extends across a wide sample
of populations, including college students,
6
veterans,
7,8
pain
patients,
9,10
overweight individuals,
11-13
hospital patients,
14,15
athletes,
16,17
health care workers,
18
gifted students,
19
chemother-
apy patients,
20
and phobia sufferers.
21-23
When measured against
the standards of the American Psychological Association’s Divi-
sion 12 Task Force on Empirically Validated Treatments, EFT is
found to be an “evidence-based” practice for anxiety, depres-
sion, phobias, and posttraumatic stress disorder (PTSD).
4,5
1
National Institute for Integrative Healthcare, Fulton, CA, USA
2
Bond University, Robina, Queensland, Australia
Corresponding Author:
Peta Stapleton, PhD School of Psychology, Bond University, Gold Coast,
Queensland, 4229, Australia.
Email: pstaplet@bond.edu.au
Journal of Evidence-Based Integrative Medicine
Volume 24: 1-12
ªThe Author(s) 2019
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Emotional Freedom Techniques
Since its inception in 1995, EFT has been a manualized
method,
7,24
leading to uniform application research, training,
and clinical practice. EFT is a brief intervention combining
elements of exposure, cognitive therapy, and somatic stimula-
tion of acupressure points on the face and body. Participants
typically identify a concern or issue they wish to address with
the technique and rate their level of distress on a Likert-type
scale out of 10 (10 is the maximum amount of distress and 0
represents the minimum or a neutral state). This is called a
Subjective Unit of Distress (SUDS) scale and has long been
used as a subjective measure of a participant’s discomfort in
therapy.
25
Participants then state their concern in a “Setup
Statement,” which assists in turning them into their level of
distress. This is typically stated in this format “Even though I
have this problem (eg, anger), I deeply and completely accept
myself.” The first half of the setup statement emphasizes expo-
sure, while the second half frames the traumatizing event in the
context of self-acceptance. The participant then engages in the
somatic tapping process on acupoints on the body while they
repeat a shortened phrase to stay engaged (eg, feel angry). This
is called the “Reminder Phrase.” The tapping sequence uses 8
acupoints on the face and upper body and is normally repeated
until the SUDS rating is very low (1 or 0).
Anxiety
EFT has been extensively investigated for anxiety and depres-
sion. In the first large-scale study of 5000 patients seeking
treatment for anxiety across 11 clinics over a 5.5-year period,
patients received either traditional anxiety treatment in the
form of cognitive behavioral therapy (CBT), with medication
if needed, or acupoint tapping with no medication.
26
An
improvement was found in 90%of patients who received acu-
point tapping therapy compared to 63%of the CBT partici-
pants. Only 3 acupoint tapping sessions were needed before
an individual’s anxiety reduced, while an average of 15 was
needed for CBT to show results. Complete relief of symptoms
was seen in 76%of people in the acupoint taping group com-
pared with 51%of people in the CBT group. One year later, the
improvements seen were maintained by 78%of the acupoint
group compared with 69%of the CBT group. Other studies also
indicate equivalence or superiority to CBT.
27-29
Similarly, a study of self-applied EFT for anxiety, depres-
sion, pain, and cravings in 216 health care workers resulted in
significant improvements on all distress subscales and ratings
of pain, emotional distress, and cravings following 2 hours of
intervention, with gains maintained at follow-up. The severity
and range of psychological symptoms was reduced, and greater
subsequent use of EFT was associated with a steeper decrease
in symptoms, although not in symptom range or breadth.
18
A meta-analysis of 14 randomized controlled trials of EFT
for anxiety disorders (n ¼658) found a very large treatment
effect of d¼1.23 (95%CI 0.82-1.64, P< .001), while the
effect size for combined controls was 0.41 (95%CI 0.17-
0.67, P¼.001). EFT treatment was associated with a signifi-
cant decrease in anxiety scores, even when accounting for the
effect size of control treatment.
30
Depression
A meta-analysis of EFT for depression examined 20 studies.
31
These included 8 outcome studies (n ¼461) as well as 12
randomized controlled trials (n ¼398). EFT demonstrated a
very large effect size in the treatment of depression. Cohen’s d
across all studies was 1.31, with little difference between ran-
domized controlled trials and uncontrolled outcome studies.
Effect sizes at posttest, less than 90 days, and greater than 90
days were 1.31, 1.21, and 1.11, respectively, indicating durable
maintenance of participant gains. EFT was more efficacious
than physical interventions such as diaphragmatic breathing
and as well as psychological interventions such as supportive
interviews.
31
The health care workers study also found a significant
reduction in depression after EFT.
18
A randomized controlled
trial with a population of 59 veterans successfully treated for
PTSD also identified a significant reduction in depressive
symptoms after six 1-hour EFT sessions.
32
Church et al
6
reported that after brief group intervention using EFT for
depression in 18 college students, those who received EFT
were found to have significantly less depression than those who
did not receive it, with an average depression score in the
“nondepressed range” following treatment, compared to the
control group who demonstrated no change in depressive
symptoms. More recent research comparing EFT to CBT for
10 patients diagnosed with major depressive disorder, found
after 8 weeks of group treatment (16 hours), both interventions
produced significant reductions in depressive symptoms. The
CBT group indicated a significant reduction postintervention,
but this was not maintained over time. The EFT group how-
ever, showed a delayed effect of significant reductions in
symptoms at 3- and 6-month follow-ups.
27
Physiological Markers
The effect of EFT on medical diagnoses has been the subject of
several studies. Chronic disease patients may benefit from a
holistic health care and research has begun to consider the
physiological changes that occur after EFT. A recent qualita-
tive study that explored practitioners’ experiences of using EFT
to support chronic disease patients indicated that while EFT
was one technique, “many emotions” emerged and “tapping on
the physical” for pain perception, and negative emotions that
may increase the perceived intensity and limiting impacts of
physical pain were important.
33
Other studies of physical conditions responding to EFT have
included fibromyalgia,
34
psoriasis,
35
tension headaches,
9
fro-
zen shoulder,
10
pulmonary injuries,
36
chronic pain,
37
che-
motherapy side effects,
20
traumatic brain injury,
38
insomnia,
39
and seizure disorders.
40
Some studies of psycho-
logical symptoms have included a physiological measure.
2Journal of Evidence-Based Integrative Medicine
Church and Downs
41
examined psychological trauma in ath-
letes and also measured heart rate. Wells et al
21
included pulse
rate as a measure for phobia sufferers. Church et al
42
performed
a triple-blind randomized controlled trial comparing EFT to
talk therapy and rest in a non-clinical sample of 83 participants.
They found significant declines in the stress hormone cortisol.
However, a trial with a smaller N did not have sufficient power
to identify significant cortisol reductions.
9
Two clinical case
histories also report cortisol reductions.
43,44
The most revealing studies of the physiological aspects of
EFT have examined its epigenetic effects. A population of
veterans with PTSD received 10 EFT sessions.
45
It found reg-
ulation of 6 genes associated with inflammation and immunity.
A pilot study comparing an hour-long EFT session with pla-
cebo in 4 nonclinical participants found differential expression
in 72 genes.
46
These included genes associated with the sup-
pression of cancer tumors, protection against ultraviolet radia-
tion, regulation of type 2 diabetes insulin resistance, immunity
from opportunistic infections, antiviral activity, synaptic con-
nectivity between neurons, synthesis of both red and white
blood cells, enhancement of male fertility, building white mat-
ter in the brain, metabolic regulation, neural plasticity, reinfor-
cement of cell membranes, and the reduction of oxidative
stress. The broad function of this suite of genes is similar to
that found in Church et al,
10
confirming the association of EFT
with the downregulation of inflammation and stress markers
and the upregulation of immune markers.
Generalizability
The question of whether EFTs psychological effects are gen-
eralizable has been addressed in a number of studies. Wells
et al
21
original study of EFT for small animal phobias found
that EFT produced greater decrease in intense fear of small
animals than did a comparison breathing condition. A partial
replication and extension by Baker and Sigel
22
assessed
whether such findings reflected (a) nonspecific factors com-
mon to many forms of psychotherapy, (b) some methodological
artifact (such as regression to the mean, fatigue, or the passage
of time), and/or (c) therapeutic ingredients specific to EFT. For
most dependent variables, the EFT condition showed a signif-
icant decrease in fear of small animals immediately after, and
again 1.38 years after, one 45-minute intervention, whereas a
supportive interview and no-treatment condition did not.
The health care workers study
18
found no significant differ-
ence between five 1-day workshops delivered by 2 different
trainers. A replication of that study with EFT delivered by 5
different trainers in heterogenous settings noted the same
effect.
47
A study explicitly designed to determine EFTs gen-
eralizability compared effects in 2 heterogeneous groups.
48
It
found no significant difference.
EFT has been found efficacious in widely disparate groups,
including hospital patients, war veterans, victims of sexual
violence, school children, college students, teachers, health
care workers, cancer patients, athletes, presurgery patients,
mothers, dental patients, psychotherapists, diabetics, and
survivors of natural disasters. Treatment time frames ranging
from 15 minutes to ten 1-hour sessions have been successful.
Studies have delivered EFT in a variety of formats, including
online courses for weight loss and cravings (eg, Stapleton
et al
49
) and self-administered EFT for fibromyalgia (Brattberg
et al),
34
via telephone sessions, in groups, and in individual
counseling sessions. The breadth of populations, settings and
delivery methods encompassed in these studies provides indi-
cation that EFTs effects can be considered generalizable.
Dismantling Studies
Because of the interest in the mechanism of change and active
ingredient of EFT, several dismantling studies have been con-
ducted. The first dismantling study included 119 university
students and compared EFT points, sham points, and tapping
on a doll, and also included a control group who did nothing.
50
While significant reductions in self-reported fear occurred for
all 3 tapping groups but not the nontapping group, the students
used their forefinger to tap, which inadvertently stimulated an
acupuncture point. The EFT group also included acupoints not
in the typical process and omitted others, and the study did not
use valid assessments nor full randomization to the groups.
A study of university students (EFT or a control group who
received mindful breathing instead of tapping) found the EFT
group reported more significant increases in enjoyment, hope,
and pride and more significant decreases in anger, anxiety, and
shame than did the breathing control group.
51
However, the
mindful breathing control group did not use the EFT setup or
reminder statements, so while the actual tapping was the major
difference to the control group, it was not the only difference.
The next study involved 56 university students who were
assessed for stress symptoms and randomly allocated to an EFT
group or a control group who tapped on sham points.
52
The
students reported a 39.3%reduction in stress symptoms in the
EFT group but the sham tapping group only reported an 8.1%
decrease. This study was, however, limited in that the stress
questionnaire they used had not been validated and one of the
investigators led both the experimental and control groups,
possibly contaminating the results.
A 2015 study involved 126 school teachers (assessed for
burnout risk) and is possibly the best dismantling study to
date.
53
A control group tapped on the left forearm, about an
inch above the wrist, with the underside of the fingers of the
open right hand. This was important because no finger points
were used or unintentionally activated (as in the first study
discussed). Everything else was identical. Results indicated the
EFT group was superior to the sham points group on the 3
indicators of burnout being tracked (Emotional Exhaustion,
Depersonalization, and Personal Accomplishment).
Finally, a recent meta-analysis of 6 dismantling or partial
dismantling studies indicates that the acupuncture component
is an essential ingredient, and not due to placebo, nonspecific
effects of any therapeutic method, or non-acupressure compo-
nents, in the rapid outcomes shown in EFT clinical trials.
54
Bach et al 3
The Present Study
While the foregoing studies of physiological markers typically
examine a cluster of diagnostic systems with EFT treatment,
the current study sought to elucidate EFTs common underlying
physiological mechanisms of action. The systems studied
included the autonomic nervous system (ANS) by measuring
heart rate variability (HRV) and heart coherence (HC); the
circulatory system by assessing resting heart rate (RHR) and
blood pressure (BP); the endocrine system by evaluating corti-
sol, and the immune system by examining levels of salivary
immunoglobulin A (SigA). After successful training in emo-
tional regulation, HC increases and a reduction (improvement)
in HRV is found.
55
The current study also assessed psycholo-
gical symptoms of anxiety, depression, PTSD, pain, cravings,
and happiness, and the relationship of psychological symptoms
to physiological markers.
Based on prior research, it was hypothesized that EFT would
result in significant decreases in the psychological constructs of
anxiety, depression, PTSD, pain and cravings, as well as the
physiological markers of HRV, cortisol, RHR, and BP. It was
further hypothesized that an increase in happiness, immune
response (SigA), HC, and would be identified.
The second hypothesis of the study was that psychological
change would be robust and durable across a range of settings
and instructors. If EFT effects were due to the intervention of a
particularly gifted therapist, they should not be as robust in
groups trained by other therapists. If, on the other hand, psy-
chological improvement is found regardless of the individual
delivering the training, or the setting in which it is delivered, it
can be reasonably concluded that the effects measured are due
to the clinical EFT method itself and not to some unique char-
acteristic of a single individual or the stress-reducing effects of
a unique setting.
Methods
The study included 203 participants at 6 Clinical EFT workshops. The
workshops were taught by a variety of instructors trained and certified
in Clinical EFT, the evidence-based form of the technique.
7
To mea-
sure physiological change, participants at one of these workshops (n ¼
31) also received a comprehensive battery of medical tests. Psycho-
logical testing was similar at all 6 workshops, with pre- and postmea-
sures, and a follow-up during the subsequent year. Physiological
measures were not assessed at follow-up since data collection was
performed via email. Table 1 represents the baseline characteristics
of study participants at recruitment. The majority of participants were
women (65%) older than 50 years.
Measures
Subjects were assessed for depression and anxiety using the Hospital
Anxiety and Depression Scale (HADS; Zigmond et al).
56
HADS
includes 7 questions related to depression and seven questions related
to anxiety. Each item is scored from 0 to 3 and the score is totaled.
Thus, subjects can score from 0 to 21 for either anxiety or depression.
Scores for the HADS were calculated for anxiety and depression
separately. A score of >8 for either is considered clinical. Happiness,
57
pain,
58
and cravings were assessed using an 11-item Likert-type scale
(SUDS rating). PTSD was assessed with the 2-item form of the PTSD
Checklist (PCL; Lang et al).
59
All assessments are reliable and valid.
Blood pressure and heart rate were measured using a standard
blood pressure cuff (Omron 3). HRV and HC were assessed using
HeartMath Pro Plus hardware and software (HeartMath LLC, Boulder
Creek, CA). Cortisol and SigA were assessed using saliva swabs
(Sabre Labs, Capistrano, CA). Cortisol samples were collected at the
same time pre and post (10 AM) to eliminate variability due to circa-
dian rhythms.
Cravings were assessed before and after a 1-hour module on the
use of EFT for this topic. Participants were provided with chocolate
and self-assessed their pretest level of craving (11-point SUDS rating
scale). EFT was then used for several components of the experience of
craving. These included the substance itself, emotions associated with
the substance, early childhood experiences involving the substance,
times at which craving levels increased, and emotional losses associ-
ated with the substance.
Table 1. Baseline Characteristics of Study Participants at
Recruitment.
Demographic and Baseline
Characteristics Subjects Male Female
N 203 30
(14.8)
170
(83.7)
Age, years
Mean 50.45 48.13 50.80
Standard deviation 12.35 14.76 11.96
Min-Max 19-81 22-75 19-81
Education, n (%)
High school/College 14 (6.9) 3 11
University 55 (27.1) 9 46
Postgraduate 86 (42.4) 15 71
Unknown 48 (23.6) 3 42
Posttraumatic stress disorder
feelings
Mean 2.54 2.57 2.51
Standard deviation 1.24 1.50 1.17
Min-Max 1-5 1-5 1-5
Pain
Mean 4.09 3.54 4.16
Standard deviation 2.49 2.40 2.49
Min-Max 0-10 0-8 0-10
Happiness
Mean 7.28 7.39 7.30
Standard deviation 2.10 2.41 2.03
Min-Max 0-10 0-10 1-10
Anxiety
Mean 8.35 7.31 8.54
Standard deviation 3.85 3.95 3.82
Min-Max 0-20 1-18 0-20
Depression
Mean 4.04 4.14 3.96
Standard deviation 3.18 3.29 3.07
Min-Max 0-14 0-13 0-13
Cravings
Mean 6.47 5.71 6.64
Standard deviation 2.53 3.03 2.37
Min-Max 0-10 0-10 0-10
4Journal of Evidence-Based Integrative Medicine
EFT Intervention
All EFT instructors were trained and certified in Clinical EFT (EFT
Universe, Fulton, CA). EFT was applied with fidelity to the third
edition of The EFT Manual.
60
Twelve hours of the workshop was
devoted to clinical demonstrations, practice sessions, and feedback.
EFT was delivered as peer-to-peer coaching, and symptoms assessed
without attempting to diagnose or treat mental health conditions. A
group delivery method known as “Borrowing Benefits” described in
The EFT Manual
60
was used, in which EFT is administered to one
individual while the remainder of the group simultaneously self-
applies EFT. The settings included residential institutes, nonresiden-
tial institutes, hotel meeting rooms, and a university campus. The
identical curriculum was used at all 6 workshops. Most were con-
ducted over 4 days. Two were conducted at residential institutes in
which the curriculum was delivered over the course of 5 days, with 2
half-days off, but the same number of instruction and practice hours.
Results
Participant scores for happiness, anxiety, depression, PTSD,
pain, and cravings were compared before and after treatment
using the Wilcoxon signed rank test for paired samples. In
order to make the least number of assumptions about the data,
it was deemed appropriate to use the nonparametric Wilcoxon
signed rank test rather than ttests. Changes in BP, RHR, corti-
sol, SigA levels, HRV, and HC in a subsample of participants
were also determined using the Wilcoxon signed rank test. All
statistical analyses were performed using the SPSS statistical
package version 24.
Between the pre- and posttest time points, participants expe-
rienced significant decreases in anxiety, depression, PTSD,
pain, and cravings, and a significant increase in happiness (see
Table 2). Not all participants completed all assessments at all
time points, thus the navailable for analysis is shown in the
relevant rows of the appropriate tables.
In the subset of participants in whom physiological indi-
cators of health were assessed (n ¼31), psychological mea-
surements, including anxiety,depression,PTSD,pain,and
cravings all improved. Physiological indicators, including
RHR, BP, and cortisol also significantly decreased indicat-
ing a functional improvement (see Table 3 and Figure 1).
The changes corresponded with an increase in happiness
(P¼.0004) and immune function in the form of SigA
secretion (P¼.017). Though not statistically significant,
a downward trend was observed for HRV and an upward
trend for HC suggesting an improvement in cardiovascular
health and ANS function.
Between the pre and follow-up time points, participants
experienced significant decreases in anxiety, depression,
PTSD, and pain (see Table 4). All changes were statistically
significant with the exception of happiness.
Dissimilar results were found between post and follow-up
time points, with anxiety and pain found to significantly
increase, while happiness decreased significantly (see
Table 5).
The correlations among psychological measures were cal-
culated to determine their interaction (see Table 6). Significant
Table 2. Participant Outcome Measures Pre- Versus Postintervention.
Scale Pretest, Mean +SD Posttest, Mean +SD Change in Mean ZStatistic PPercent Change
Happiness (n ¼170) 7.28 +2.10 8.65 +1.72 1.37 8.389 <.000 18.82
Anxiety (n ¼170) 8.35 +3.85 4.98 +3.43 3.37 9.963 <.000 40.36
Depression (n ¼170) 4.04 +3.18 2.30 +2.28 1.74 8.282 <.000 43.07
Posttraumatic stress disorder (n ¼158) 4.74 +2.16 3.30 +1.49 1.44 7.793 <.000 30.38
Pain (n ¼168) 4.09 +2.49 1.63 +1.89 2.46 9.325 <.000 60.15
Cravings (n ¼164) 6.47 +2.53 1.81 +1.81 4.66 10.766 <.000 72.02
Table 3. Subset of Participants Outcomes Pre- Versus Postintervention (N ¼31).
Scale Pretest, Mean +SD Posttest, Mean +SD Change in Mean ZStatistic PPercent Change
Happiness (n ¼29) 7.9 +1.92 9.03 +1.27 1.13 2.736 .006 14.30
Anxiety (n ¼31) 6.32 +3.89 3.84 +3.17 2.48 3.640 <.000 39.24
Depression (n ¼31) 2.68 +2.29 1.45 +1.61 1.23 2.615 .009 45.89
PTSD (n ¼28) 4.59 +2.01 3.14 +1.46 1.45 2.934 .003 31.59
Pain (n ¼29) 3.9 +2.35 1.34 +1.69 2.56 3.856 <.000 65.64
Cravings (n ¼25) 6.72 +2.73 1.36 +1.25 5.36 4.225 <.000 79.76
Heart rate, beats/min (n ¼29) 80.97 +12.04 74.59 +10.48 6.38 3.430 .001 7.88
Systolic blood pressure, mm Hg (n ¼29) 123.61 +16.8 116.41 +18.46 7.2 3.376 .001 5.82
Diastolic blood pressure, mm Hg (n ¼29)) 80.26 +9.97 73.38 +11.18 6.88 4.124 <.000 8.57
HRV (n ¼25) 16.72 +7.58 14.54 +7.46 2.18 0.888 .374 13.04
Heart coherence (n ¼25) 65.34 +17.55 69.75 +15.24 4.41 1.332 .183 6.75
SigA, mg/mL (n ¼28) 112.58 +119.37 181.73 +155.32 69.15 2.391 .017 61.42
Cortisol, nmol/L (n ¼28) 12.66 +5.84 6.51 +2.81 6.15 4.213 <.000 48.58
Abbreviations: HRV, heart rate variability; PTSD, posttraumatic stress disorder; SigA, salivary immunoglobulin A.
Bach et al 5
positive correlations were found between pre and post inter-
vention measures of happiness, anxiety, depression, pain, and
cravings. Significant negative correlations were found between
happiness and all measures except cravings at both time points.
The correlations among psychological and physiological
measures in the subset of individuals who completed both
assessments (n ¼31) were also calculated to determine their
interaction (see Table 7). Significant positive correlations were
found between pre- and postintervention measures of anxiety
and cortisol. Significant negative correlations were found
between happiness and anxiety, PTSD, pain at preintervention,
and only pain at postintervention.
Figure 1. Score changes following treatment in study participants. Outliers within each group are represented by the black dots. DBP, diastolic
blood pressure; HC, heart coherence; HRV, heart rate variability; PTSD, posttraumatic stress disorder; SBP, systolic blood pressure; SigA,
salivary immunoglobulin A.
6Journal of Evidence-Based Integrative Medicine
Discussion
This study adds to the evidence base for EFT as an effective
mental health intervention, as has been demonstrated in many
previous studies. It also suggests that EFT simultaneously
improves a broad range of health markers across multiple phy-
siological systems. As hypothesized, participants experienced
significant decreases in pain, anxiety, depression, and PTSD.
Physiological indicators of health such as RHR, BP, and corti-
sol also significantly decreased, indicating improvement. Hap-
piness levels increased as did immune system function.
The current research findings of each of the physiological
measures has potential and far-reaching health consequences.
Decreases in cortisol have been associated with a wide spec-
trum of positive health effects, including increased muscle
mass, increased bone density, improved skin elasticity,
enhancement of cognitive function especially learning and
attention, and enhanced cell signaling
61
This was the first study
to assess SigA, HRV, HC, BP, and RHR after EFT treatment.
The results are consistent with previous research demonstrating
improvements in endocrinal and genetic regulation.
10,42,46
The 74%reduction in cravings (P < .000) is typical of that
found in other EFT research.
18,11,13,62
While not statistically
significant, the trends toward improvement in HRV and HC
allude to possible improvements in cardiovascular health and
ANS function. A power analysis was performed, and it was
determined that detection of a medium effect size change for
HC and HRV at a significance level of .05 and 90%power
would require a minimum of 44 participants.
The improvements found in RHR and BP were clinically as
well as statistically significant. If these were available to hos-
pital patients as well as therapy group participants, medical
services utilizations would be reduced. The savings in terms
of financial cost and human suffering would be substantial. For
example, outpatient psychotherapy has been shown to be effec-
tive in terms of symptom reduction and the improvement of
quality of life, and to decrease work disability days,
hospitalization days, and inpatient costs.
63
A meta-analysis of
91 studies, which examined a range of psychological treat-
ments (various forms of psychotherapy, behavioral medicine,
and psychiatric consultation), found the average savings result-
ing from using psychological interventions was estimated to be
about 20%.
64
The review also reported that even when the cost
of providing the psychological intervention was subtracted, it
was still this substantial saving. Clearly, there is something to
be gained from including psychological interventions.
While the psychological improvements produced by EFT
have been extensively studied (eg, large effect sizes for EFT
in the treatment of anxiety [Clond],
30
depression [Nelms &
Castel],
31
and PTSD [Sebastian & Nelms]), the extension of
research into their physiological dimensions is relatively new.
When approaches such as EFT are noninvasive, nonpharma-
ceutical, and free of negative side effects are resulting in such
profound changes for a person, they may demand further con-
sideration as frontline medical interventions. Users report
Clinical EFT can be learned quickly and applied easily, and
is well-tolerated in heterogeneous populations, makes a simple
nondrug therapy available to a large population. Its use in and
outside clinical settings as a safe and reliable method for reduc-
ing distress,
7
and for a wide range of psychological and phys-
ical symptoms, makes it a useful strategy to add to existing
protocols. The profound physiological changes that also occur
with this technique, is establishing EFT as safe and effective
with a variety of populations and conditions.
Limitations
Despite the positive results, the study had a number of limita-
tions. One was the absence of a control or comparison group.
Others included reliance on self-report for psychological mea-
sures, the low number of participants who completed follow-up
assessments (89 out of 203) and the use of relatively brief
assessments. The effects obtained could have been partially
due to nonspecifics present in any therapy, to the supportive
Table 5. Participant Outcome Measures Post Versus Follow-up Intervention
Scale Posttest, Mean +SD Follow-up, Mean +SD Change in Mean ZStatistic PPercent Change
Happiness (n ¼89) 8.65 +1.72 7.70 +2.09 0.95 4.410 <.000 10.98
Anxiety (n ¼84) 4.98 +3.43 5.62 +3.74 0.64 3.294 .001 12.85
Depression (n ¼84) 2.30 +2.28 2.78 +2.93 0.48 1.091 .275 20.87
Posttraumatic stress disorder (n ¼77) 3.30 +1.49 3.64 +1.73 0.34 1.662 .097 10.30
Pain (n ¼87) 1.63 +1.89 2.66 +2.26 1.03 3.790 <.000 63.19
Table 4. Participant Outcome Measures Pre- Versus Follow-up Intervention.
Scale Pretest, Mean +SD Follow-up, Mean +SD Change in Mean ZStatistic PPercent Change
Happiness (n ¼85) 7.28 +2.10 7.70 +2.09 0.42 1.581 .114 5.77
Anxiety (n ¼84) 8.35 +3.85 5.62 +3.74 2.73 5.276 <.000 32.69
Depression (n ¼84) 4.04 +3.18 2.78 +2.93 1.26 3.083 .002 31.18
Posttraumatic stress disorder (n ¼72) 4.74 +2.16 3.64 +1.73 1.10 4.088 <.000 23.21
Pain (n ¼85) 4.09 +2.49 2.66 +2.26 1.43 4.681 <.000 34.96
Bach et al 7
Table 6. Correlation Between Outcome Measures Pre- Versus Postintervention
Happiness Anxiety Depression PTSD Pain Cravings Happiness
a
Anxiety
a
Depression
a
PTSD
a
Pain
a
Cravings
a
Age
Happiness 1 .483* .589* .392* .215* .009 .595* .417* .499* .289* .091 .047 .013
Anxiety .483* 1 .515* .467* .372* .050 .282* .652* .320* .398* .249* .045 .109
Depression .589* .515* 1 .396* .218* .106 .364* .318* .646* .321* .055 .003 .033
PTSD .392* .467* .396* 1 .366* .029 .155 .250* .239* .482* .133 .054 .034
Pain .215* .372* .218* .366* 1 .018 .125 .201* .037 .220* .369* .013 .134
Cravings .009 .050 .106 .029 .018 1 .007 .097 .027 .125 .019 .384* .047
Happiness
a
.595* .282* .364* .155 .125 .007 1 .492* .523* .348* .354* .051 .038
Anxiety
a
.417* .652* .318* .250* .201* .097 .492* 1 .559* .501* .364* .022 .113
Depression
a
.499* .320* .646* .239* .037 .027 .523* .559* 1 .399* .246* .012 .057
PTSD
a
.289* 0.398* .321* .482* .220* .125 .348* .501* .399* 1 .377* .002 .137
Pain
a
.091 .249* .055 .133 .396* .019 .354* .364* .246* .377* 1 .054 .036
Cravings
a
.047 .045 .003 .054 .013 .384* .051 .022 .012 .002 .054 1 .015
Age .013 .109 .033 .034 .134 .047 .038 .113 .057 .137 .036 .015 1
Mean 7.28 8.35 4.04 4.74 4.09 6.47 8.65 4.98 2.30 3.30 1.63 1.81 50.45
SD 2.098 3.853 3.178 2.16 2.489 2.534 1.715 3.427 2.279 1.49 1.889 1.807 12.346
n 182 179 179 170 182 165 178 176 176 165 175 165 187
Abbreviation: PTSD, posttraumatic stress disorder.
a
Postintervention.
*P¼.01. **P¼.05.
8
Table 7. Subset of Participants Correlation Between Outcome Measures Pre- Versus Postintervention (N ¼31).
Happiness Anxiety Depression PTSD Pain Cravings SigA Cortisol Happiness
a
Anxiety
a
Depression
a
PTSD
a
Pain
a
Cravings
a
SigA
a
Cortisol
a
Age
Happiness 1 .516* .259 .708* .476* .220 .151 .291 .296 .183 .061 .174 .489* .169 .116 .025 .069
Anxiety .516* 1 .510* .647* .441** .218 .062 .077 .422** .595* .199 .427* .527* .084 .062 .038 .188
Depression .259 .510* 1 .343 .157 .048 .120 .059 .089 .227 .204 .288 .100 .197 .022 .179 .026
PTSD .708* .647* .343 1 .451** .151 .052 .076 .244 .287 .073 .304 .298 .037 .073 .087 .264
Pain .476* .441** .157 .451** 1 .218 .260 .056 .034 .075 .368** .109 .227 .041 .155 .142 .156
Cravings .220 .218 .048 .151 .218 1 .211 .046 .249 .296 .039 .302 .213 .031 .469** .227 .008
SigA .151 .062 .120 .052 .260 .211 1 .073 .047 .143 .095 .038 .179 .163 .289 .326 .064
Cortisol .291 .077 .059 .076 .056 .046 .073 1 .057 .072 .178 .177 .000 .015 .018 .381** .005
Happiness
a
.296 .422** .089 .244 .034 .249 .047 .057 1 .626* .533* .416** .704* .246 .034 .059 .156
Anxiety
a
.183 .595* .227 .287 .075 .296 .143 .072 .626* 1 .596* .564* .596* .073 .035 .085 .067
Depression
a
.061 .199 .204 .073 .368** .039 .095 .178 .533* .596* 1 .417** .228 .228 .083 .021 .288
PTSD
a
.174 .427** .288 .304 .109 .302 .038 .177 .416** .564* .417* 1 .350 .033 .120 .090 .011
Pain
a
.489* .527* .100 .298 .227 .213 .179 .000 .704* .596* .228 .350 1 .007 .036 .007 .308
Cravings
a
.169 .084 .197 .037 .041 .031 .163 .015 .246 .073 .228 .033 .007 1 .223 .050 .211
SigA
a
.116 .062 .022 .073 .155 .469** .289 .018 .034 .035 .083 .120 .036 .223 1 .237 .221
Cortisol
a
.025 .038 .179 .087 .142 .227 .326 .381** .059 .085 .021 .090 .007 .050 .237 1 .149
Age .069 .188 .026 .264 .156 .008 .064 .005 .156 .067 .288 .011 .308 .211 .221 .149 1
Mean 7.9 6.32 2.68 4.59 3.9 6.72 112.58 12.66 9.03 3.84 1.45 3.14 1.34 1.36 181.73 6.51 52.88
SD 1.92 3.89 2.29 2.01 2.35 2.73 119.37 5.84 1.27 3.17 1.61 1.46 1.69 1.25 155.32 2.81 16.05
n 30313129302528282931 31 282925282826
Abbreviations: PTSD, posttraumatic stress disorder; SigA, salivary immunoglobulin A.
a
Postintervention.
*P¼.01. **P¼.05.
9
nature of the group, to demand characteristics, or to sympa-
thetic attention. Completers of the follow-up assessments
(44%) might not have been representative of the sample as a
whole. Because of the small sample size, statistical significance
was not obtained for HC or HRV. The reliable measurement of
HRV is also in its infancy and requires further validation to be
considered a sound procedure.
Further research should also randomize participants
between EFT and an active control treatment such as CBT and
include at least 44 persons per group in order to identify sta-
tistically significant changes in all physiological markers. EFTs
epigenetic effects could be further explored with use of salivary
gene assays such as were used in Maharaj
46
and similar studies.
A larger battery of psychological assessments could be used,
and a second follow-up data point included to determine trends
over time.
Despite these limitations, this study points to the multidi-
mensional physiological effects of EFT as well as its utility for
improving emotional health when delivered in group format.
Group therapy is efficient and cost-effective, and similar
results were found when different trainers taught Clinical EFT,
showing that the improvements measured were not due to the
unique gifts of a particular therapist.
Conclusions
Reviews and meta-analyses of EFT demonstrate that it is an
evidence-based practice
7,44
and that its efficacy for anxiety,
depression, phobias and PTSD is well-established. The
research investigating physiological improvements after EFT
intervention is limited; however, this study adds to the body of
literature and suggests that EFT is associated with multidimen-
sional improvements across a spectrum of physiological
systems.
Author Contributions
DB and GG collected the data. RS and KB analyzed the data. PS and
DC wrote the article with the assistance of RS.
Declaration of Conflicting Interests
The authors declared the following potential conflicts of interest with
respect to the research, authorship, and/or publication of this article:
All authors except RS may occasionally derive income from trainings,
clinical services, and workshops in the approach examined in this
article.
Funding
The authors received no financial support for the research, authorship,
and/or publication of this article.
ORCID iD
Peta Stapleton https://orcid.org/0000-0001-9916-7481
Dawson Church https://orcid.org/0000-0001-7324-3140
Ethical Approval
All procedures performed in studies involving human participants
were in accordance with the ethical standards of the institutional
and/or national research committee.
Informed Consent
Informed consent was obtained from all individual participants
included in the study.
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12 Journal of Evidence-Based Integrative Medicine
... Like cognitive behavioural therapy and Mindfulness, EFT is based on the premise that acceptance of a particular condition or problem can alleviate suffering rather than resist it. It plays a role in overcoming mood disorders, anxiety and negative thoughts and can increase nurse's self-esteem (13,15). ...
... The distinctions in therapy include acupuncture, which uses tiny needles to stimulate the body's meridians, and acupressure, which uses massage. In contrast, EFT uses tapping to tap the meridian points without the client feeling pain gently (13). ...
... The benefits of EFT can be felt after going through 3 stages, namely preparation (set-up), tapping (tapping), and evaluation which is applied to the meridian energy points that have an emotional relationship with physical discomfort and feelings in the hands, face, and chest. The function of the meridian points is as a liaison between body organs (13). ...
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Introduction: Nurses are imperative people as health providers for helping people in health services, but many have problems with self-esteem. Self-esteem is an essential component in building good mental and health. One of the complementary therapies that can help improve mental health is the Emotional Freedom Technique (EFT). Tapping on certain body spots with words or affirmations is EFT, a safe psychological energy therapy. This study aims to examine the effect of EFT on self-esteem. Methods: : A pre-post test was used in this quasi-experimental investigation. The sampling technique used convenience sampling for 115 participants who joined EFT Training. Self-esteem was measured using the Rosenberg Self Esteem Scale, which was administered to all participants. It was decided to use the paired t-test to determine the mean difference between before and after the intervention. Results: TEFT was effective in increasing self-esteem, with a substantial outcome (P value=0.000). Conclusion: : Emotional Freedom Technique (EFT) can be an alternative to boosting nurses' self-esteem.
... The scores of the items are summed up giving a total score ranging from 5 to 35. For categorical analysis, the total score is dichotomized into dissatisfied (total score [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], and satisfied (total score [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Research demonstrated high tool validity and reliability 24,25 . ...
... During this phase, the researchers prepared the study intervention programs to be implemented in each of the two groups. This was based on a review of pertinent literature [27][28][29] . It also took consideration of the participants' needs identified in the assessment phase. ...
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Abstract Sleep disorders are common among elderly persons, with deleterious effects on their physical and mental health. Many approaches are used to manage such disorders. To compare the Emotional Freedom Techniques–Insomnia (EFT-I) and Sleep Hygiene Education (SHE) group therapy as two treatments for insomnia in a geriatric population when delivered, and their effects on sleep quality, depression, and life satisfaction. This open-label randomized controlled trial study was conducted at El-Abbasia Mental Hospital and Osana family wellness elderly nursing home at Maadi, Cairo. It included 60 elderly patients suffering insomnia sleep problems randomized into two equal groups: one group received a Sleep Hygiene Education (SHE) intervention, the other had a form of Emotional Freedom Techniques (EFT) adapted for use with insomnia (EFT-I). A self-administered questionnaire with tools for sleep quality (Pittsburgh Sleep Quality Index [PSQI]), depression, and life satisfaction was used to collect data. The fieldwork was from January to March 2021. The two groups had equal median age (70 years), and almost similar gender and place of residence distribution. After the intervention, 73.3% of the EFT group had good sleep quality, compared to 100.0% in the SHE group (P = 0.005); the median score of depression (3.00) was higher in the EFT group compared with 0.00 in the SHE group (P
... The acupoint tapping has been shown to stimulate meridian circulation or life energy and to clear emotional problems and painful memories 23,25) . 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) . ...
... 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) . ...
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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.
... Only later were the physiological mechanisms of action elucidated. However, many of these mechanisms now have been measured, including gene expression (Church et al., 2018a(Church et al., , 2018bMaharaj, 2016), stress hormone reduction (Church et al., 2012;Stapleton et al., 2020), and physiological regulation (Bach et al., 2019;Bougea et al., 2013). Among the technologies used to measure EFTs mechanisms are PCR gene sequencing, MRI and EEG scans, hormone assays, heart rate variability monitors, and immune marker tests. ...
... Irrespective of this commentary and underlying meta-analysis, EFT continues to find increased clinical application and acceptance. This is because of the extensive literature base showing efficacy of EFT across a wide range of clinical conditions (e.g., Bach et al., 2019;Baker and Hoffman, 2015;Bougea et al., 2013;Church, 2013;Clond, 2016;Nelms and Castel, 2016;Sebastian and Nelms, 2017;Stapleton et al., 2020). EFT is classified by the Integrative Medicine Office of the Veterans Administration as a "generally safe therapy." ...
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We published a meta-analysis of studies that examined the various components of an evidence-based therapy called emotional freedom techniques (EFTs). EFT uses elements of conventional therapies such as exposure and cognitive processing but includes the unique ingredient of acupoint stimulation using fingertip tapping. Six studies were identified, and three of these met the quality control criteria of the American Psychological Association's Division 12 Task Force for Empirically Validated Therapies. Meta-analysis found that the acupoint component of EFT was not an inert ingredient or inactive placebo but made an active contribution to the therapeutic effects noted in a research literature that now numbers over 100 clinical trials of EFT. Subsequent to publication, errors in the original analysis were identified, primarily incorrect standard deviations. A new analysis was performed by an independent statistician and found slightly greater effects than the original investigation. The results were published as a corrigendum, which was subsequently challenged by Spielmans. Here we examine the critiques of the corrigendum and original article. We find that although they may be of academic interest, they are irrelevant to the central research question of whether the acupoint component of EFT is inert or active. We reaffirm that the evidence clearly validates the contribution made by acupoint tapping to EFT's observed clinical effects.
... that acupoint tapping induces regulatory signals and changes kinds of conflicts psychological learning by triggering mechanisms that integrate memory [10]. EFT may also cause significant changes in biomarkers including saliva immunoglobulin (Ig)A and a significant decline in cortisol levels [11], [12]. ...
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Public Speaking Anxiety is the most frequently feared condition among university student in academic activities. Emotional freedom technique has gained increased popularity and appears as a promising way to reduce emotional distress in different setting and populations. However, limited review has examining EFT treatment on public speaking anxiety. This integrative review was to examine the effectiveness of EFT programs on public speaking anxiety in university students. The review was carried out using the framework for integrated reviews obtained from Google Scholar, PsycINFO, and PubMed. Articles were included when reporting primary studies on the efficacy of EFT programs on public-speaking anxiety for university students in Bahasa Indonesia and English. The total of 5 were evaluated critically and included in the review. Two of the studies were undertaken in the United Kingdom, and one each in Australia, Turkey, and Indonesia. Two of the studies were randomized controlled, two used mixed methods, and one queasy experiment design. A majority of the interventions were able to reduce public speaking anxiety. This review shows that implementation of EFT, even within limited resources, is both achievable and worthwhile. EFT programs should be ­introduced early in the curriculum for university student in their first year of a Bachelor program
... Research by Donna Bach, ND1, Gary Groesbeck, BCIA1, Peta Stapleton, PhD2, Rebecca Sims, MCP2, Katharina Blickheuser, PhD1, and Dawson Church, PhD1 about Clinical EFT (Emotional Freedom Techniques) Improves Multiple Physiological Markers of Health with 31 samples of workshop participants revealed the result after EFT that there were reductions by 40% of stress, 35% of depression, 32% of posttraumatic stress disorder, 57% of pain with P < 0,000 and happiness escalation occurred about 31% with p <0,000 (Bach et al., 2019). ...
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The research aimed to recognize the EFT effect on the stress reduction of diabetes mellitus patients. The Research used a quasi-experimental design non-randomization pre-test – post-test group design. The ‘t’ value for stress level before EFT was performed with a p-value of 0,000 and for stress level after EFT p-value was 0,000. From the statistic, it was concluded that there was a significant EFT effect on stress reduction in patients with diabetes mellitus. The Emotional Freedom Technique (EFT) including the mind-body therapy relaxation technique was an integrated system between energy medicine and EFT therapy using a tapping method on body meridian points. EFT therapy firmly helped the patients to manage their minds from emotional pressure (negative energy) therefore it helped patients with stress. It helped all patients mainly patients with diabetes mellitus.
... Previously, however, differential effects have been observed comparing fear-inducing and disgustinducing stimuli in a healthy sample (Wittfoth et al., 2020). Bifocal emotion regulatory strategies are also known to be effective across different contexts (Bach et al., 2019;Church, 2013;Feinstein, 2018;Stapleton, 2019). This suggests that bifocal regulatory strategies are suitable for regulating various aversive emotions, and that the neural underpinnings of these effects might differ with respect to stimulus type and the presence or absence of psychopathology. ...
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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.
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Historical literature demonstrates that Black women have exhibited a deep commitment to wellness and social change. Black women engage in various forms of mindfulness to sustain themselves as they make changes. There is a dearth of literature on the ways in which Black women in academia who identify as Christians describe Christian mindfulness and their applications of such to promote their own health and wellness in hostile environments. Autoethnography and narrative inquiry were used to describe and analyze the principles and practices a Black academic used to thrive in a historically hostile Christian institution. These findings suggest Christian mindfulness is vast and focused on God’s perspectives and applications of Godly wisdom.
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Introduction: Although hundreds of studies presently demonstrate some forms of Energy Psychology to show efficacy in reducing the negative emotional states associated with traumatic past experiences, the vast majority of the research data focus upon either Thought Field Therapy [TFT], or Emotional Freedom Technique [EFT]. In an attempt to assess potential clinical efficacy for a different model of Energy Psychology intervention, Advanced Integrative Therapy [AIT], the current pilot study aims to assess clinician perceptions of the AIT through a cross-sectional survey. Methods: A 17-item questionnaire consisting of 5 questions related to clinician demographics and 12 questions about the AIT practice and its perceived efficacy was administered using the Qualtrics platform. Therapists (respondents) who had completed at least one training in AIT in any part of the world were recruited through an email invitation to participate in a web-based survey during November, 2021. The Subjective Units Distress (SUD) scale was used to ascertain the reduction in the negative emotions. This project was reviewed and approved by the IRB at UNLV as an exempt category. Results: A total of 76 complete responses were analyzed. The sample was predominately females (81.6%), and non-Hispanic white (68%). Clinician responses were from countries all over the world. Nearly 46% reported practicing AIT in the United States. Over 80% respondents reported using the AIT on their clients within past 6 months and a significant proportion of participants self-assessed their AIT skills as at an expert or proficient level . As reported by the therapists, 77% of the sessions described were used to clear patterns of negative events rather than a single event. Over 75% of events were identified as being either since childhood or were chronic in nature. Negative emotions filled the range of possibilities, and physical location was primarily chest and abdomen. The average pre-AIT intervention SUD score was 8.3±2.7 out of 10, which dropped to either zero or one following a single session among 92% of cases. In the vast majority of cases, if a secondary emotion arose, it cleared within the same session, as did the physical sensation. The average number of rounds of AIT to achieve this improvement was 3 (range 1-6) At follow-up sessions, over 90% of cases reported to have maintained the improvement [from the set of interventions for which follow-up had already occurred]. Discussion: The responses demonstrated a marked improvement within a single session of AIT in terms of removing negative emotion from recall of past traumatic life events. One interesting potential advantage of this model includes the ability to clear emotion from a pattern of events rather than a single event, which was used by most of the clinicians in this survey. As this study referenced clinician observations based upon client experience reported within the session, rather than a direct solicitation of client perceptions, there is a possibility of bias in the direction of treatment effectiveness. The selection of case material for the survey was naturalistic rather than randomized which may limit the generalization of findings. Additionally, since the questions followed the typical Energy Psychology protocol of reaching a zero to one SUD score, it was not possible to assess average response per round of intervention. Conclusion: Although this pilot study was limited to clinician responses in assessment of the ability of AIT to reduce the negative emotions related to past traumatic events, the initial observations were supportive of potential clinical utility with this energy psychology technique. The ability to clear the negative emotional content of decades-old trauma within a single session and maintenance of observed effects at follow-up suggests a robustness potentially comparable to well-studied interventions such as EFT or EMDR. Additional study is needed in the form of a randomized clinical trial to more objectively assess this energy psychology intervention in comparison to those already acknowledged as clinically effective. The promise of effective reduction of trauma induced negative emotion has widespread clinical utility for the relief of suffering. ***this study has been submitted for publication
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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.
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Interventions to Reduce Anxiety for Gifted Children and Adolescents Amy H. Gaesser, PhD University of Connecticut, 2014 This study examined the anxiety levels of gifted students, as well as the effectiveness of two interventions: Cognitive-Behavioral Therapy (CBT) and Emotional Freedom Technique (EFT). Using the Revised Children’s Manifest Anxiety Scale-2 (RCMAS-2), Phase I of this study examined anxiety levels in gifted youth (n = 153) participating in private and public gifted education programs, grades 6-12, in two Northeastern states. ANOVA analyses indicated that gender (F [1, 149] = 13.52, p< .001, h2= .08) and school setting (F [2, 149] = 21.41, p< .001, h2= .23) were significant factors in the anxiety levels of the gifted students. In Phase II, a randomized controlled research design was used to investigate the effectiveness of CBT and EFT interventions. Participants (n = 63) identified with moderate to high levels of anxiety on the pre treatment RCMAS-2 were assigned to one of three treatment groups: a) CBT, b) EFT, or c) a wait-listed control group. Treatment outcomes were measured using the RCMAS-2 post treatment scores and analyzed using ANCOVA with pre treatment RCMAS-2 scores serving as the covariate. EFT participants (n= 20, M = 52.163, SE = 1.42) showed significant reduction in anxiety levels when compared to the control group (n= 21, M = 57.93, SE = 1.39, p = .005). CBT participants (n= 21, M = 54.82, SE = 1.38) did not differ significantly from either the EFT or control groups (p = .12 and p = .18, respectively).
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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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SCIENTIFIC Clinical EFT (emotional freedom techniques) combines acupoint stimulation with elements of cognitive and exposure therapy. Numerous studies have demonstrated the efficacy of EFT for depression, anxiety, phobias, PTSD, and other psychological conditions. The current study assesses whether acupoint stimulation is an active ingredient or whether treatment effects are due to nonspecific factors. Thirty-seven participants with “frozen shoulder” consisting of limited range of motion (ROM) and pain were randomized into a wait list, or 1 of 2 treatment groups. ROM, pain, and the breadth and depth of psychological conditions such as anxiety and depression were assessed before and after a 30-min treatment session, and 30 days later. One treatment group received clinical EFT, while the other received an identical cognitive/exposure protocol but with diaphragmatic breathing (DB) substituted for acupoint stimulation. No significant improvement in any psychological symptom was found in the wait list. Participants in both the EFT and DB groups demonstrated significant posttest improvement in psychological symptoms and pain. Follow-up showed that both groups maintained their gains for pain, with EFT superior to DB, but only the EFT group maintained gains for psychological symptoms (p
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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.