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

  • Awakened Mind Foundation for Research and Education

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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
, Gary Groesbeck, BCIA
, Peta Stapleton, PhD
Rebecca Sims, MCP
, Katharina Blickheuser, PhD
and Dawson Church, PhD
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.
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.
A meta-
analysis of 244 studies found an association between psycho-
logical symptoms and somatic syndromes.
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.
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
A current research bibliography lists more than
100 studies published in peer-reviewed journals (Research.- Its efficacy extends across a wide sample
of populations, including college students,
overweight individuals,
hospital patients,
health care workers,
gifted students,
apy patients,
and phobia sufferers.
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).
National Institute for Integrative Healthcare, Fulton, CA, USA
Bond University, Robina, Queensland, Australia
Corresponding Author:
Peta Stapleton, PhD School of Psychology, Bond University, Gold Coast,
Queensland, 4229, Australia.
Journal of Evidence-Based Integrative Medicine
Volume 24: 1-12
ªThe Author(s) 2019
Article reuse guidelines:
DOI: 10.1177/2515690X18823691
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License
( which permits non-commercial use, reproduction and distribution of the work without further
permission provided the original work is attributed as specified on the SAGE and Open Access pages (
Emotional Freedom Techniques
Since its inception in 1995, EFT has been a manualized
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
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).
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.
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.
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.
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.
A meta-analysis of EFT for depression examined 20 studies.
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
The health care workers study also found a significant
reduction in depression after EFT.
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.
Church et al
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.
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.
Other studies of physical conditions responding to EFT have
included fibromyalgia,
tension headaches,
zen shoulder,
pulmonary injuries,
chronic pain,
motherapy side effects,
traumatic brain injury,
and seizure disorders.
Some studies of psycho-
logical symptoms have included a physiological measure.
2Journal of Evidence-Based Integrative Medicine
Church and Downs
examined psychological trauma in ath-
letes and also measured heart rate. Wells et al
included pulse
rate as a measure for phobia sufferers. Church et al
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.
Two clinical case
histories also report cortisol reductions.
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.
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.
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,
confirming the association of EFT
with the downregulation of inflammation and stress markers
and the upregulation of immune markers.
The question of whether EFTs psychological effects are gen-
eralizable has been addressed in a number of studies. Wells
et al
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
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
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
A study explicitly designed to determine EFTs gen-
eralizability compared effects in 2 heterogeneous groups.
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
) and self-administered EFT for fibromyalgia (Brattberg
et al),
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.
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.
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.
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
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.
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.
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.
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.
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.
Subjects were assessed for depression and anxiety using the Hospital
Anxiety and Depression Scale (HADS; Zigmond et al).
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,
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).
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
Demographic and Baseline
Characteristics Subjects Male Female
N 203 30
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
Mean 2.54 2.57 2.51
Standard deviation 1.24 1.50 1.17
Min-Max 1-5 1-5 1-5
Mean 4.09 3.54 4.16
Standard deviation 2.49 2.40 2.49
Min-Max 0-10 0-8 0-10
Mean 7.28 7.39 7.30
Standard deviation 2.10 2.41 2.03
Min-Max 0-10 0-10 1-10
Mean 8.35 7.31 8.54
Standard deviation 3.85 3.95 3.82
Min-Max 0-20 1-18 0-20
Mean 4.04 4.14 3.96
Standard deviation 3.18 3.29 3.07
Min-Max 0-14 0-13 0-13
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.
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
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.
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
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
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.
The 74%reduction in cravings (P < .000) is typical of that
found in other EFT research.
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.
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%.
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],
depression [Nelms &
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,
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.
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
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
.595* .282* .364* .155 .125 .007 1 .492* .523* .348* .354* .051 .038
.417* .652* .318* .250* .201* .097 .492* 1 .559* .501* .364* .022 .113
.499* .320* .646* .239* .037 .027 .523* .559* 1 .399* .246* .012 .057
.289* 0.398* .321* .482* .220* .125 .348* .501* .399* 1 .377* .002 .137
.091 .249* .055 .133 .396* .019 .354* .364* .246* .377* 1 .054 .036
.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.
*P¼.01. **P¼.05.
Table 7. Subset of Participants Correlation Between Outcome Measures Pre- Versus Postintervention (N ¼31).
Happiness Anxiety Depression PTSD Pain Cravings SigA Cortisol Happiness
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
.296 .422** .089 .244 .034 .249 .047 .057 1 .626* .533* .416** .704* .246 .034 .059 .156
.183 .595* .227 .287 .075 .296 .143 .072 .626* 1 .596* .564* .596* .073 .035 .085 .067
.061 .199 .204 .073 .368** .039 .095 .178 .533* .596* 1 .417** .228 .228 .083 .021 .288
.174 .427** .288 .304 .109 .302 .038 .177 .416** .564* .417* 1 .350 .033 .120 .090 .011
.489* .527* .100 .298 .227 .213 .179 .000 .704* .596* .228 .350 1 .007 .036 .007 .308
.169 .084 .197 .037 .041 .031 .163 .015 .246 .073 .228 .033 .007 1 .223 .050 .211
.116 .062 .022 .073 .155 .469** .289 .018 .034 .035 .083 .120 .036 .223 1 .237 .221
.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.
*P¼.01. **P¼.05.
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
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.
Reviews and meta-analyses of EFT demonstrate that it is an
evidence-based practice
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
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
The authors received no financial support for the research, authorship,
and/or publication of this article.
Peta Stapleton
Dawson Church
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
... Emotional freedom technique (EFT) is an emotional therapy of acupuncture without using needles, just tapping with two fingers to energize the body's meridian points which aims to balance the blocked energy system of the body which can lead to changes in thoughts, behaviours, and emotions by tapping at specific points on the body. This therapy has been developed since 1995 and has been carried out in more than 100 studies [12] which proves EFT therapy is effective such as people suffering from anxiety, depression [13], post-traumatic stress disorder (PTSD) [14], post-stroke patient [15], and cancer patients [16]. However, it has never been applied to COVID-19 patients. ...
... The results of this study are urgent as an alternative therapeutic intervention innovation in overcoming mental health problems in the community, especially during the ongoing pandemic. It has been proven that the efficacy of EFT is arguable as an evidencebased therapeutic method in many different contexts of studies [14]; the therapy contributes an effective impact to reduce depressive symptoms in a range of settings [17]. The efficacy of tapping-based EFT can reduce anxiety symptoms and impact neural emotion regulation [18]. ...
Full-text available
The COVID-19 pandemic has had a massive impact on various aspects, including mental health, especially for people confirmed positive for COVID-19. People who are positively confirmed for COVID-19 tend to experience decreased immunity caused by feelings of anxiety, depression, and insomnia. emotional freedom technology (EFT) therapy has been proven to reduce mental health disorders but has never been applied to people who are positively confirmed for COVID-19. This study aimed to examine the effect of EFT therapy on mental health disorders (anxiety, depression, and insomnia) in COVID-19 patients in Pontianak City. This research method is quantitative with a quasi-experimental design in the COVID-19 isolation area provided by the Pontianak City government, namely Upelkes and Rusunawa in June 2021. The total sampling was employed consisting of 42 people. A validated questionnaire on anxiety, depression, and insomnia was employed as a research instrument. A repeated ANOVA test was used to analyze research data. The results showed that EFT therapy was effective in reducing anxiety, depression, and insomnia scores in positively confirmed people for COVID-19 (p-value <0.05). EFT therapy can overcome mental health disorders experienced by people who are positively confirmed for COVID-19 and as an alternative therapy to speed up the healing process.
... A review of the literature revealed that few studies investigated the effect of EFT on family caregivers of patients. However, some studies reported the positive effect of this new technique on anxiety and stress [31], cancer-related cognitive disorders [32], menstrual-related symptoms [33], depression [34], fatigue [35], and physiological indicators, such as blood pressure, heart rate, and cortisol [36]. Nevertheless, a review of the literature yielded that most of the interventions used to reduce the physical and psychological stress of family caregivers of patients with cardiovascular diseases, especially HF, resorted to psychological education and few studies addressed the effect of these techniques on family caregivers [37]. ...
Purpose: The aim of this study was to evaluate the effect of emotional freedom techniques (EFT) on anxiety and caregiver burden of family caregivers of patients with heart failure.
... Although research exists on the physiological changes following individual PTSD therapy [68][69][70][71], no studies exist on the physiological changes in couple therapy for PTSD. The aim of the proposed study is to be the first to achieve a better understanding of the physiological processes that individuals with PTSD and their spouses undergo during and after CBCT. ...
Posttraumatic stress disorder (PTSD) sequelae often have ripple effects on victims' families and spouses. Yet there has been a lag in the development and study of couple therapy for PTSD. To fill this gap, we present here a protocol for a study examining the efficacy of Cognitive Behavioral Conjoint Therapy (CBCT), a 15- session couple therapy protocol meant to alleviate PTSD and improve relationship satisfaction, in the Israeli context. The study will be a randomized controlled trial examining outcomes and processes of change via self-report questionnaires, qualitative interviews, and physiological measures (e.g., both partners' heart rate variability and electrodermal activity). We will employ a modified remote treatment protocol via video conferencing. The study will examine whether there is a reduction in couples' levels of symptomatic, emotional, and behavioral difficulties following CBCT and whether relationship satisfaction and couples' physiological synchrony increases. The study will also examine physiological and psychological change mechanisms in CBCT. Sixty Israeli couples (n = 120) will be randomly assigned to either a CBCT group or a wait-list control group. Outcomes will be assessed at four timepoints: before treatment, during treatment, post-treatment, and four months after treatment. The proposed study has the potential to shed light on the unique psychological and physiological mechanisms underlying CBCT and will be the first RCT study to employ this unique methodology in CBCT research, particularly in a video conferencing setting. This study may increase our ability to offer effective, cost-efficient, and attainable treatments for patients with PTSD and their spouses.
... This therapy emphasizes spirituality and the energy system in the body using the tapping method on specific points along the body. Besides, relaxation techniques that involve a factor of belief can reduce anxiety (Zainuddin, 2012;Puspitaningrum, 2012;Bach et al., 2019). This finding is in line with the research of (Mardjan et al., 2018) and (Nelms & Castel, 2016), the Emotional freedom technique, which shows a significant decrease in anxiety scores. ...
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A hydatidiform mole is an abnormal form of pregnancy. Women diagnosed with might face anxiety and lose hope of getting pregnant and having a child. Hydatidiform mole is potentially life-threatening and has the potential to be malignant. One of the treatments for this abnormality is curettage. This study aimed to determine the effect of the Spiritual Emotional Freedom Technique (SEFT) therapy on anxiety reduction in patients with hydatidiform mole. This study reported the intervention trials of SEF therapy to five post-curettage women in a private hospital. The researchers collected the data through observation and questionnaire using Hamilton Anxiety Rating Scale (HARS). The results showed changes in anxiety scores in patients with hydatidiform mole. In conclusion, SEFT therapy was effective in reducing women’s anxiety. Therefore, it is expected that nurses apply SEFT treatment as an alternative nursing intervention to reduce patients’ anxiety.
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Introduction Clinical Emotional Freedom Techniques (EFT) is a psychophysiological intervention that includes cognitive and somatic elements, utilizing techniques from both Cognitive Behavioral Therapy (CBT) and Prolonged Exposure therapy (PE). Because only a single meta-analysis existed examining EFT for PTSD, this systematic review and meta-analysis represents an update. Method Ten databases were searched for quantitative reviews and randomised clinical trials, and six met inclusion criteria. Results Study quality and effect size were evaluated and the results demonstrated that treatment with Clinical EFT, when compared to wait list, usual care, or no treatment controls, resulted in significant and large effect sizes, ranging from 1.38 to 2.51. When compared to active controls, effect sizes ranged from −0.15 to 0.79, producing treatment results similar to other evidence-based therapies. Discussion Limitations are presented and considerations for further research are proposed.
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Understanding integrative approaches to mental health care can improve the responsiveness of the mental health system. Complementary and alternative medicine (CAM) use is on the rise. Research documents that many mental health consumers use CAM. This exploratory study attempts to advance awareness of CAM in mental health by examining mental health consumers’ usage of CAM, their experiences in discussing CAM use with providers, and how CAM use relates to mental health recovery. Results show that 72% of the sample uses such methods, and CAM use is associated with recovery. About 54% of respondents feel CAM combined with medication is more effective than medication alone, and many endorse positive beliefs about CAM. Most consumers shared CAM use with their providers, but when they did not, the main reasons were fear of provider judgment and provider attitudes being a deterrent.
This chapter introduces the Heart-Centered Connections (HCC) Facilitator Training, which was developed as a non-degree certificate training offered through the LaFetra College of Education at the University of La Verne. In partnership with Peace4Kids, a local nonprofit, 15 adults who experienced ACEs and toxic stress or had lived experience in foster care participated in an intensive 6-month process. They learned to use mind-body awareness practices to explore how their work as helping professionals has been influenced by their own personal history of trauma or toxic stress. Through participating in the training, these trauma-resilient advocates were prepared to return to their communities to support educators and other child-serving professionals to embody heart-centered practices in their work with children from marginalized populations. The author outlines the core components of the training model and uses qualitative data to offer recommendations for offering similar polyvagal-informed training to all adults who work with children whose lives have been impacted by trauma.
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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).
The present study reports on the first ever controlled comparison between eye movement desensitization and reprocessing (EMDR) and emotional freedom techniques (EFT) for posttraumatic stress disorder. A total of 46 participants were randomized to either EMDR (n = 23) or EFT (n = 23). The participants were assessed at baseline and then reassessed after an 8-week waiting period. Two further blind assessments were conducted at posttreatment and 3-months follow-up. Overall, the results indicated that both interventions produced significant therapeutic gains at posttreatment and follow-up in an equal number of sessions. Similar treatment effect sizes were observed in both treatment groups. Regarding clinical significant changes, a slightly higher proportion of patients in the EMDR group produced substantial clinical changes compared with the EFT group. Given the speculative nature of the theoretical basis of EFT, a dismantling study on the active ingredients of EFT should be subject to future research.
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.