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The Immediate Effect of a Brief Energy Psychology Intervention (Emotional Freedom Techniques) on Specific Phobias: A Pilot Study


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Specific phobia is one of the most prevalent anxiety disorders. Emotional Freedom Techniques (EFT) has been shown to improve anxiety symptoms; however, their application to specific phobias has received limited attention. This pilot study examined whether EFT, a brief exposure therapy that combines cognitive and somatic elements, had an immediate effect on the reduction of anxiety and behavior associated with specific phobias. The study utilized a crossover design with participants randomly assigned to either diaphragmatic breathing or EFT as the first treatment. The study was conducted at a regional university in the Southwestern United States. Twenty-two students meeting criteria for a phobic response to a specific stimulus (≥8 on an 11-point subjective units of distress scale). Participants completed a total of five two-minute rounds in each treatment intervention. Study measures included a behavioral approach test (BAT), Subjective Units of Distress Scale (SUDS), and Beck Anxiety Inventory (BAI). Emotional Freedom Techniques significantly reduced phobia-related anxiety (BAI P = .042; SUDS P = .002) and ability to approach the feared stimulus (BAT P = .046) whether presented as an initial treatment or following diaphragmatic breathing. When presented as the initial treatment, the effects of EFT remained through the presentation of the comparison intervention. The efficacy of EFT in treating specific phobias demonstrated in several earlier studies is corroborated by the current investigation. Comparison studies between EFT and the most effective established therapies for treating specific phobias are recommended.
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Martha M. Salas, MA,
Audrey J. Brooks, PhD,
and Jack E. Rowe, PhD,
Background: Specific phobia is one of the most prevalent anx-
iety disorders. Emotional Freedom Techniques (EFT) has been
shown to improve anxiety symptoms; however, their application
to specific phobias has received limited attention.
Objective: This pilot study examined whether EFT, a brief ex-
posure therapy that combines cognitive and somatic elements,
had an immediate effect on the reduction of anxiety and behav-
ior associated with specific phobias.
Design: The study utilized a crossover design with participants
randomly assigned to either diaphragmatic breathing or EFT as
the first treatment.
Setting: The study was conducted at a regional university in the
Southwestern United States.
Participants: Twenty-two students meeting criteria for a phobic
response to a specific stimulus (8 on an 11-point subjective
units of distress scale).
Intervention: Participants completed a total of five two-minute
rounds in each treatment intervention.
Outcome Measures: Study measures included a behavioral ap-
proach test (BAT), Subjective Units of Distress Scale (SUDS),
and Beck Anxiety Inventory (BAI).
Results: Emotional Freedom Techniques significantly reduced
phobia-related anxiety (BAI P.042; SUDS P.002) and
ability to approach the feared stimulus (BAT P.046) whether
presented as an initial treatment or following diaphragmatic
breathing. When presented as the initial treatment, the effects of
EFT remained through the presentation of the comparison in-
Conclusions: The efficacy of EFT in treating specific phobias
demonstrated in several earlier studies is corroborated by the
current investigation. Comparison studies between EFT and the
most effective established therapies for treating specific phobias
are recommended.
Key words: specific phobias, energy psychology, Emotional
Freedom Techniques (EFT), anxiety, exposure treatment
(Explore 2011; 7:155-161. © 2011 Elsevier Inc. All rights reserved.)
Specific phobia is the most prevalent anxiety disorder both
within the United States and in other countries.
A specific
phobia is characterized by a persistent and excessive unreason-
able fear in the presence of, or in the anticipated presence of, a
specific object, or situation. The Diagnostic and Statistical Manual
of Mental Disorders-Fourth Edition (DSM-IV) recognizes four pri-
mary subtypes of specific phobias: animals (eg, snakes), natural
environment (eg, heights), situational (eg, flying), blood-injec-
tion-injury (eg, injections, dentist), and an “other” category for
phobias that do not fit in one of the four subtypes.
Despite the widespread prevalence, it is the disorder for which
individuals are least likely to seek treatment
even though it is
an easily treated disorder. Two recent reviews found exposure-
based treatments, especially in vivo exposure (having the patient
come into direct contact with the feared stimulus), were very
However, it is unclear in most of the reviewed stud-
ies how many individuals dropped out or did not enter a study
due to the intense fear of being exposed to the feared stimulus.
In a survey of persons meeting clinical criteria for specific pho-
bias, a greater preference and lower refusal rate for virtual reality
over in vivo exposure was found with fear of confronting the
feared stimulus as the most frequent reason given.
In addition,
the ability to implement therapist-directed exposure treatments,
especially those involving in vivo demonstrations, in a clinical
setting limits its widespread adoption. Although several alternate
treatment approaches, for example, cognitive approaches or vir-
tual exposure, have been tried in treating specific phobias, they
are not as effective as in vivo exposure. A recent review found
positive results for One-Session Treatment (OST) of specific
The OST technique employs hierarchical exposure,
1 Corpus Christi Independent School District, Corpus Christi, TX
2 Department of Psychology and Sociology, Texas A&M University-
Kingsville, Kingsville, TX
3 Department of Psychology, University of Arizona, Tucson, AZ
4 Private practice, Coweta, OK
1, 2, 4 This study was conducted as part of the first author’s Masters’
Thesis at the Department of Psychology and Sociology, Texas A&M
University-Kingsville, TX. Ms Salas is now a school counselor with the
Corpus Christi Independent School District, Corpus Christi, TX. Dr
Rowe is now in private practice in Tulsa, OK.
Portions of this data were presented at Energy Psychology Conference-
International 2001, San Diego, CA, and the Sixth Annual Energy Psy-
chology Conference, 2004, Toronto, Canada.
This study was funded in part by the Foundation for Epigenetic Medi-
cine, Fulton, CA, to A.J.B. The authors thank Dawson Church, PhD, for
comments on drafts of this paper.
#Corresponding Author: Addresss:
Department of Psychology, University of Arizona, P.O. Box 210068,
Tucson, AZ 85721
© 2011 Elsevier Inc. All rights reserved EXPLORE May/June 2011, Vol. 7, No. 3
ISSN 1550-8307/$36.00 doi:10.1016/j.explore.2011.02.005
participant modeling, cognitive intervention, and reinforcement
in a single session of up to three hours. However, due to the
intensity of the intervention, a sufficient degree of participant
motivation is required. Therefore, exploration of new treatments
is still needed.
Energy psychology techniques have been proposed as an al-
ternate treatment for anxiety disorders. The most widely used
form of energy psychology is the Emotional Freedom Tech-
niques (EFT).
EFT was developed by Gary Craig as an ab-
breviation of the methods used in Thought Field Therapy, an
earlier Energy Psychology method that used elaborate diagnostic
and treatment protocols.
EFT can be administered by a thera-
pist or taught to individuals for self-application. The technique
employs brief forms of certain components of other therapies
that have demonstrated efficacy, such as cognitive restructuring
and exposure; however, it also includes a somatic component.
The somatic component involves tapping on prescribed acu-
puncture points during the process. As described in Traditional
Chinese Medicine, the acupuncture points used are situated on
or near the endpoints of specific meridians or energy pathways
in the body. It is this use of “energy meridians” that Gary Craig
and other proponents of EFT attribute as one of the primary
mechanisms underlying the method’s effectiveness.
for this contention was demonstrated in a recent study that
found the stimulation of acupuncture points by pressure alone,
without using needles, was as efficacious as needling in a ran-
domized controlled trial.
Hui and colleagues
found acu-
puncture to send fear-dampening signals directly to the
amygdala, the structure in the limbic system that scans the en-
vironment for threats.
Recent studies examining EFT have found evidence for EFT’s
ability to reduce psychological distress symptoms such as test
anxiety, general anxiety, depression, and trauma.
Wells and
for instance, examined the effect of a single EFT
session on specific phobia of small animals. In this study 35
individuals meeting DSM-IV criteria for specific animal phobia
were randomly assigned to either a 30-minute EFT or diaphrag-
matic breathing session. The EFT treatment produced an imme-
diate improvement in behavioral and subjective distress mea-
sures, but not in pulse rate. Twenty-one (60%) of the sample
completed a follow-up assessment six to nine months after the
intervention. Improvements in the behavioral measure were still
present at follow-up, even showing a slight increase from the
posttest. There was also evidence that the improvements in the
subjective distress measures were maintained at follow-up in
that, although they were lower than the posttest values, they did
not return to baseline levels. However, given the declines in
improvement on the subjective distress measures, the superiority
of EFT over diaphragmatic breathing had dissipated somewhat
at the follow-up point. The authors attribute the lack of statisti-
cal significance between the two treatment conditions in part to
the small sample size.
The purpose of the present study was to compare the imme-
diate effectiveness of a single session of EFT with that of a
comparison condition, diaphragmatic breathing, in the reduc-
tion of anxiety of specific phobias. Diaphragmatic breathing was
chosen as the comparison treatment, as it has been used both as
a stand-alone treatment as well as a component of interventions
designed for stress management and to reduce anxiety.
Breathing therapies are commonly used by healthcare practitio-
ners to reduce tension and arousal, as well as to treat specific
symptoms and disorders.
The present study was designed as a
partial replication of the Wells study.
Participants were 22 volunteers recruited from a mass survey of
students in undergraduate Psychology classes at a regional uni-
versity in south Texas. More than half of the sample was female
(N 15, 68%) with an average age of 20.8 years old. Participants
ethnic backgrounds included Hispanic (N 16, 73%), in addi-
tion to Caucasian (N 5, 23%), and other (N 1, 4%). The
inclusion criterion for this study was a phobic response, equal to
or more than 8 on an 11-point subjective units of distress scale
(SUDS) to a specific stimulus (described below). Phobias in-
cluded fear of heights (n 12), snakes (n 5), cockroaches (n
2), darkness (n 2), and syringes (n 1). Participants with a
phobia that could not be tested directly, for example, fear of
flying, were excluded. Although a formal DSM-IV diagnostic
interview for specific phobias was not conducted; the SUDS
cutoff score was chosen to indicate that the participant had a
noticeable phobic response to one of the subtypes of specific
phobias. All participants received a detailed explanation of the
study and provided informed consent to participate. There were
no dropouts or adverse events in the course of the study.
Subjective Units of Distress Scale.
A list of six potential phobic
situations and objects that could be behaviorally tested was cre-
ated. The situations/objects were elevators, enclosed spaces,
heights, public speaking, small animals/insects, and other anxi-
ety-provoking stimuli that participants self-identified. Partici-
pants responded to each of these stimuli on an 11-point scale
ranging from 0 (no anxiety—would not avoid it) to 10 (extremely
anxious—would avoid it). This widely used scale is commonly
referred to as the SUDS popularized by Joseph Wolpe’s work in
systematic desensitization.
As described above, a score equal
to or greater than 8 on one of the six stimuli qualified the
participant for inclusion in the study.
Beck Anxiety Inventory (BAI).
is a widely used,
well-validated measure of anxiety. The 21-item measure assesses
physiological and cognitive symptoms of anxiety on four-point
Likert scale ranging from 0 (not at all) to 3 (severe). Responses are
summed to create a total anxiety score ranging from 0 to 63.
Total scores distinguish between minimal (0-7), mild (8-15),
moderate (16-25), and severe anxiety (26-63). The instructions
were modified to apply to the identified phobic situation, “how
much are you bothered by each symptom when thinking about
being in the feared situation?”
Behavioral Approach Test (BAT).
The BAT is a commonly
used behavioral assessment for specific phobias and a popular
156 EXPLORE May/June 2011, Vol. 7, No. 3 The Effect of EFT on Specific Phobias
objective measure of clinical progress following treatment
such as exposure therapy.
Participants were assessed on
their ability to approach the feared stimulus without experi-
encing a SUDS level of equal to or more than 5. To assess
approach, the feared stimulus (eg, snake, cockroach) was pre-
sented and the proportion of comfortable distance (eg, feet)
from the stimulus was calculated with 100% representing the
closest distance to the phobic stimulus. In other words, a
higher percentage indicates a less phobic response or ability
to get closer to the feared stimulus. The approach test varied
for each phobic stimulus. In the test for fear of heights par-
ticipants were taken to the university stadium, which contains
38 bleachers. Participants were asked to go up the bleachers
next to the outside guardrail, where they could clearly notice
the height. The approach test for this particular phobia
ranged from 1 bleacher (3%) to 38 bleachers (100%). The
snake phobia approach test was conducted in the university
serpentarium with an observation room containing 20 terrar-
iums with live rattlesnakes. The approach test for snake pho-
bia ranged from being no less than seven feet from the obser-
vation room (14%) to being inside the observation room, two
feet away from the snakes (100%). In testing the darkness
phobia, the approach test was done in an adjacent office with
no light. The approach test ranged from walking toward the
dark room but stopping before standing in front of the closed
door (14%) to being inside the dark room, with the door
completely closed for at least five seconds (100%). The ap-
proach test for the injections phobia ranged from seeing the
researcher (sitting approximately five feet away) hold a syringe
inside the plastic package (14%) to seeing the researcher sim-
ulate an injection (rubbing alcohol on arm and placing the
needle right next to the arm; 100%). The approach test for
phobia of cockroaches was done in an adjacent office where a
live cockroach was kept in a jar. The test ranged from standing
three feet from the jar (20%) to holding the jar and opening
the lid (100%).
The present study utilized a crossover design with participants
randomly assigned to either breathing relaxation or EFT as the
first treatment. Half of the participants received the breathing re-
laxation treatment first followed by EFT, and the other half were
assigned to receive EFT first followed by breathing.
The anxiety intervention focused on the specific phobic stim-
ulus identified by the participant. As described above, the study
measures (SUDS, BAI) and intervention were conducted in a
separate area, adjacent to the location of the approach test. Partici-
pants received the intervention individually or in pairs. The study
self-report measures and approach test were conducted at baseline
and following each intervention.
Treatment Intervention
The treatment intervention was provided by the first author who
was a Master’s level graduate student in counseling psychology
under the supervision of a licensed psychologist (third author).
The interventionist was trained in and utilized both treatments
as part of her supervised clinical practice in the university coun-
seling center. Although the intervention was delivered under the
supervision of a licensed psychologist, no specific treatment
fidelity measures were collected. Participants completed a total
of five rounds (described below) in each treatment intervention.
Each treatment round was approximately 2 minutes, resulting in
a 10-minute treatment for each intervention. In both treatment
conditions participants were instructed to focus on the fear while
practicing either EFT or diaphragmatic breathing. In addition,
the intervention took place in proximity to the feared stimulus.
For example, the intervention for fear of heights was conducted
at the bleachers, while the intervention for the fear of snakes was
conducted in an area adjacent the observation room in the ser-
pentarium. After each round of treatment, participants were
asked to assess their anxiety level with a SUDS reading while
thinking about being in the feared situation. The last SUDS
reading after round 5 was considered the posttest.
Diaphragmatic Breathing. Diaphragmatic breathing, involving
the use of the diaphragm, is a standard procedure that has been
used for many years to reduce anxiety. For the present study, a
round of diaphragmatic breathing consisted of three deep
breaths, inhaling for a count of 4, holding for a count of 2, and
exhaling for a count of 4.
EFT. The EFT technique has both cognitive and somatic ele-
ments. The cognitive component pairs thinking about being in the
feared situation with a self-acceptance statement, while the somatic
component of EFT involves tapping specific points on the body
with the tips of the index and middle fingers. These points corre-
spond to the endpoints of traditional acupuncture meridians. The
present study employed a brief version of EFT
utilizing 8 of the 12
body points. The first point on the body, referred to as the “setup,”
consists of tapping on the side of the hand next to the little finger,
while repeating an affirmation statement three times, for example
“Even though I have this fear of heights, I deeply and completely
accept myself.” After the setup is complete, a “reminder phrase,”
such as “this fear of heights,” is repeated while tapping seven times
at each of the remaining seven body points. These body points
include the beginning of either eyebrow, the outside corner of the
eye, about one inch under either eye, under the nose in the center of
the upper lip, between the lower lip and the chin, just below the end
of the collarbone next to the sternum, and about four inches down
from the center of either armpit. A round of EFT consisted of the
self-acceptance statement and tapping the eight body points.
Statistical Analysis
A General Linear Model repeated-measures analysis of covari-
ance was conducted on each of the dependent variables, SUDS,
Table 1. Baseline t-Test Results by Treatment Order Means and
Standard Deviations
Mean SE
Mean SE t(20) Sig
SUDS 9.45 0.82 8.91 0.94 1.45 0.16
BAI 38.82 13.20 31.64 7.62 1.56 0.13
Approach 39.91 27.86 35.55 14.29 0.46 0.65
The Effect of EFT on Specific Phobias EXPLORE May/June 2011, Vol. 7, No. 3
BAI, and BAT, controlling for the baseline value. The between-
subjects variable was the order of therapy presentation (breath-
ing first/EFT second versus EFT first/breathing second) and the
within-subjects variable was time of measurement (after the first
treatment, and after the second treatment). Post hoc Tukey tests
were conducted on significant findings.
The t-tests were conducted on the baseline SUDS, BAI, and BAT
variables comparing the two treatment order groups and no
significant differences were found (see Table 1). In the models
examining intervention effects over time, the time by treatment
order interactions were significant for each dependent variable.
In the post hoc Tukey analyses the SUDS, BAI, and BAT breath-
ing first posttest was significantly higher than the EFT presented
first posttest, the EFT presented second posttest, and breathing
presented second posttest (Table 2). When presented first,
breathing therapy is significantly less effective in reducing sub-
jective distress, anxiety, and ability to approach the feared stim-
ulus than EFT. In addition, when EFT is presented following the
breathing intervention a statistically significant reduction in sub-
jective distress, anxiety, and ability to approach the feared stim-
ulus occurs above any effect the breathing may have had. No
additional reduction in subjective distress, anxiety, and ability to
approach the feared stimulus occurs when breathing is presented
following EFT (Figures 1,2and 3).
Effect sizes were calculated for the first posttest between
groups for the three dependent variables. Cohen’s dwere ob-
tained for SUDS, BAI, and BAT (1.11, 0.941, and 0.893, respec-
tively). According to Cohen values of dgreater than 0.80 are
considered a large effect
indicating a large treatment effect for
The present study demonstrated the ability of EFT to reduce
anxiety related to a specific phobia in comparison to diaphrag-
matic breathing. EFT significantly reduced phobia-related anxi-
ety and behavior whether presented as an initial treatment or
following the comparison treatment, diaphragmatic breathing.
When presented as the initial treatment, the effects of EFT re-
mained through the presentation of a second comparison inter-
vention. The use of a comparison condition that is often an
element of many exposure, desensitization, and relaxation treat-
ments, suggests that EFT is not merely a placebo, and therefore,
worthy of additional research for the treatment of specific pho-
Figure 1. Subjective Units of Distress Scale treatment pretest and posttests adjusted means by treatment order.
Table 2. First and Second Treatment Adjusted Posttest Means and Standard Errors by Treatment Order
Variable Treatment Order
First Treatment Posttest
Mean SE
Second Treatment Posttest
Mean SE F(1,19) Sig
SUDS Breathing-EFT 5.719 0.77
2.890 0.74
12.30 0.002
SUDS EFT-Breathing 2.872 0.77
2.792 0.74
BAI Breathing-EFT 27.872 3.82
15.278 3.75
4.75 0.042
BAI EFT-Breathing 15.946 3.82
11.995 3.75
Approach Breathing-EFT 51.153 5.88
79.255 6.40
4.58 0.046
Approach EFT-Breathing 68.574 5.88
79.472 6.40
Posthoc Tukey test a b, P.001; a c, P.03.
158 EXPLORE May/June 2011, Vol. 7, No. 3 The Effect of EFT on Specific Phobias
bias. Furthermore, statistically significant effects were found
with a small sample indicating a robust treatment effect.
The results of this study should be interpreted in light of the
following limitations. This study is limited by the lack of a
follow-up. The first author provided the treatments and col-
lected the data. However, although it was hypothesized that EFT
would yield superior results; both treatments were used by the
first author in clinical practice with positive results.
The present study confirmed the immediate effect of EFT
found in the Wells study. In addition, the present study exam-
ined multiple subtypes of specific phobias, not just small animal
phobias as in the Wells study.
Although the Wells study em-
ployed a 30-minute intervention, the present study demon-
strated a reduction in phobia-related anxiety and behavior fol-
lowing a 10-minute intervention. Given the lack of a follow-up
in the present study, it is not possible to determine durability of
the effects with a 10-minute intervention. Further research is
needed to determine the optimal intervention period. Although
the present study only examined the immediate effect of EFT on
phobia-related anxiety, the Wells study on which this study was
based, found some evidence for the long-term benefit of EFT in
treating specific phobias. A study conducted as a partial replica-
tion of the Wells study found EFT to be superior to a supportive
interview treatment and no treatment in treating small animal
Similar to Wells results, evidence supporting the
long-term effect of EFT was found. Effect sizes obtained in these
two studies, as well as the present study, indicate a large effect for
EFT on specific phobias. Furthermore, the effect sizes obtained
Figure 2. Beck Anxiety Inventory treatment posttests—adjusted means by treatment order.
Figure 3. Approach treatment posttests—adjusted means by treatment order.
The Effect of EFT on Specific Phobias EXPLORE May/June 2011, Vol. 7, No. 3
in these studies is consistent with those obtained in a recent
meta-analysis of OST of specific phobias.
Accordingly, these
studies provide support for EFT as a well-established treatment
in that the studies used a between group design comparing EFT
to a psychological treatment;
however, the comparison treat-
ments in these studies were not specifically designed to treat
specific phobias and had relatively small sample sizes. Therefore,
a comparison of EFT with other current treatments of specific
phobias is needed to establish EFT as an efficacious treatment
for specific phobias.
Certain elements of EFT are comparable to other specific
phobia interventions, which may explain the positive results
observed in this study. Namely, imaginal exposure, cognitive
restructuring, and relaxation associated with tapping are all pres-
ent in EFT. However, unlike other techniques, EFT is hypothe-
sized to intervene on the body’s energy system through the
mechanism of tapping specific energy meridian endpoints. The-
ories based on the body’s energy system hypothesize that energy
blockages or imbalances, often due to trauma or psychological
conditioning as in phobias, cause emotions to persist and block
the flow of energy.
Removing the blockage and rectifying
the flow of energy is believed to alleviate symptoms, such
as those experienced in a phobic situation. Preliminary support
for this hypothesis was found in a pilot study of EFT for claus-
trophobia. Changes in electrical conductance between acupunc-
ture points were observed following a single EFT treatment.
Although further studies are needed to determine whether EFT
is as, or more, efficacious as the existing specific phobia treat-
ments, the contribution of tapping to the common treatment
elements warrants further study. Both the present study and the
Wells study utilized diaphragmatic breathing as the comparison
condition as a control for EFT’s ability to reduce anxiety; how-
ever, a control for the cognitive component of EFT was not used
in the diaphragmatic breathing intervention in either study.
Therefore, future dismantling studies of EFT should examine
the contribution of both the cognitive component and tapping.
In addition, verifying the unique contribution of tapping will
provide further support for the principles of not just EFT, but
energy psychology in general.
Clinical Implications. A strength of the present study is that
positive results were observed after a very brief 10-minute EFT
intervention. The single-session intervention (OST) employed
to treat specific phobias can take up to three hours. Furthermore,
EFT is particularly amenable to self-administration as well as
instruction in group settings further enhancing its use in either
the direct treatment of specific phobias or to augment an exist-
ing treatment. For example, significant improvements in psy-
chological distress were found following both brief (four-hour
workshop including two hours of self-application,
two weekly
two-hour sessions
) and intensive (three-day) instruction in
Improvements were maintained at both 90-day
six-month follow-ups.
In contrast to other anxiety disorders,
specific phobias are particularly responsive to self-administered
or minimal therapist contact interventions,
thus enhancing
EFT’s value as an intervention for this type of disorder. The short
intervention time frame required and ability to administer the
treatment in a group format suggests that EFT may be a cost-
effective treatment for specific phobias.
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The Effect of EFT on Specific Phobias EXPLORE May/June 2011, Vol. 7, No. 3
... Results of studies investigating tapping techniques show that especially patients with conditions characterized by high physiological arousal such as specific phobias and post-traumatic stress disorder (PTSD) benefit from this type of intervention (Clond, 2016;Feinstein, 2012). More specifically, tapping techniques including EFT and TFT (Thought Field Therapy) showed lasting (>12 months) and replicable reductions of anxiety and increases in the ability to approach phobic stimuli in participants with agoraphobia (Irgens et al., 2017), small animal phobia (Baker and Siegel, 2010;Salas et al., 2011;Wells et al., 2003a) and other specific phobias (Salas et al., 2011). These effects are unlikely to be due to nonspecific effects such as active factors of established psychotherapeutic interventions, regression to mean, fatigue, passing of time or practice effects: tapping techniques show greater effects than both diaphragmatic breathing (Wells et al., 2003a), supportive interviews or waiting (Baker and Siegel, 2010), and their efficacy is comparable with the effects of Cognitive Behavioral Therapy (CBT; (Irgens et al., 2017)). ...
... Results of studies investigating tapping techniques show that especially patients with conditions characterized by high physiological arousal such as specific phobias and post-traumatic stress disorder (PTSD) benefit from this type of intervention (Clond, 2016;Feinstein, 2012). More specifically, tapping techniques including EFT and TFT (Thought Field Therapy) showed lasting (>12 months) and replicable reductions of anxiety and increases in the ability to approach phobic stimuli in participants with agoraphobia (Irgens et al., 2017), small animal phobia (Baker and Siegel, 2010;Salas et al., 2011;Wells et al., 2003a) and other specific phobias (Salas et al., 2011). These effects are unlikely to be due to nonspecific effects such as active factors of established psychotherapeutic interventions, regression to mean, fatigue, passing of time or practice effects: tapping techniques show greater effects than both diaphragmatic breathing (Wells et al., 2003a), supportive interviews or waiting (Baker and Siegel, 2010), and their efficacy is comparable with the effects of Cognitive Behavioral Therapy (CBT; (Irgens et al., 2017)). ...
... Furthermore, the increase in limbic activation and decrease in prefrontal activation following bifocal multisensory emotion regulation seems counterintuitive at first, particularly regarding clinical populations with dysfunctional emotional processing (Álvarez-Pérez et al., 2021;Paquette et al., 2003;Straube et al., 2006;Viña et al., 2020). Given the effectiveness of bifocal multisensory interventions in reducing negative affect and symptom severity in various clinical settings ranging from specific phobia (Baker and Siegel, 2010;Feinstein, 2012;Irgens et al., 2017;Salas et al., 2011;Wells et al., 2003b) to PTSD (Church, 2014;Church et al., 2018Church et al., , 2016Church and Feinstein, 2013;Gilomen and Lee, 2015;Karatzias et al., 2011), one would hypothesize to find a decrease in neural activation in regions underlying emotional processing, along with an increase in regions underlying cognitive control (Braunstein et al., 2017;Buhle et al., 2014;Denny et al., 2015;Morawetz et al., 2017;Ochsner et al., 2012). Theoretical models of bifocal emotion regulation however posit that a split of attentional focus between emotional stimulation and physiological stimulation can facilitate working through unwanted negative emotions in a way that is more conducive to one's wellbeing. ...
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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.
... A second study designed explicitly as a partial replication of Wells et al. (2003) also used DB as a control intervention (Salas et al., 2011). It found that EFT significantly reduced ...
... See Table 17 for summaries. Two replications (Baker and Siegel, 2010;Salas et al., 2011) corroborated the findings of the Wells et al. (2003) phobia study. Two replications (Geronilla et al., 2016;Church et al., 2018c) found results similar to the first PTSD RCT . ...
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Background Since the turn of the century, Emotional Freedom Techniques (EFT) has come into widespread use in medical and psychological treatment settings. It is also used as self-help by tens of millions of people each year. Clinical EFT, the manualized form of the method, has been validated as an “evidence-based” practice using criteria published by the American Psychological Association (APA) Division 12 Task Force on Empirically Validated Therapies. Its three essential ingredients are exposure, cognitive framing, and acupressure. Objectives In 2013 we published a paper defining Clinical EFT and reviewing published research. It has been viewed or downloaded over 36,000 times, indicating widespread interest in this treatment modality. Here we update our findings based on subsequently published literature and propose directions for future research. Method We performed a systematic review of the literature to identify randomized controlled trials (RCTs) and meta-analyses. Retrieval of 4,167 results resulted in the identification of 56 RCTs ( n = 2,013), 41 of which were published subsequent to our earlier review, as well as eight meta-analyses. Results RCTs have found EFT treatment to be effective for (a) psychological conditions such as anxiety, depression, phobias, and posttraumatic stress disorder (PTSD); (b) physiological issues such as pain, insomnia, and autoimmune conditions; (c) professional and sports performance; and (d) biological markers of stress. Meta-analyses evaluating the effect of EFT treatment have found it to be “moderate” to “large.” Successful independent replication studies have been carried out for anxiety, depression, PTSD, phobias, sports performance, and cortisol levels. We outline the next steps in EFT research. These include determining its impact on cancer, heart disease, diabetes, and cognitive impairment; analysis of the large-scale datasets made possible by mobile apps; and delivery through channels such as virtual practitioner sessions, artificial intelligence agents, online courses, apps, virtual reality platforms, and standardized group therapy. Conclusions Subsequent research has confirmed the conclusions of earlier studies. These find Clinical EFT to be efficacious for a range of psychological and physiological conditions. Comparatively few treatment sessions are required, treatment is effective whether delivered in person or virtually, and symptom improvements persist over time. Treatment is associated with measurable biological effects in the dimensions of gene expression, brain synchrony, hormonal synthesis, and a wide range of biomarkers. Clinical EFT is a stable and mature method with an extensive evidence base. Its use in primary care settings as a safe, rapid, reliable, and effective treatment for both psychological and medical diagnoses continues to grow.
... EFT has been subjected to a systematic review which concluded that the approach meets the criteria detailed by the American Psychological Association's Division 12 Task Force on Empirically Validated Treatments for a number of psychological conditions [35], including depression [35,36] anxiety [37], post-traumatic stress disorder [35], and phobias [38,39]. Other meta-analyses support the efficacy of EFT in the treatment of anxiety, depression, and posttraumatic stress disorder (PTSD) [40][41][42]. ...
... Participants also experienced significant decreases in the severity of somatic, anxiety, and depression symptoms immediately following the EFT program compared to the waitlist control group, who displayed no significant differences in psychological symptoms. This current finding is consistent with previous research on the efficacy of EFT for reducing a variety of psychological and physiological symptoms such as anxiety [37,38], depression [73], pain [36,37], and headaches [30]. ...
... The literature on Energy Psychology and CA has grown in recent years. Emotional Freedom Techniques (EFT), the most widely studied and perhaps most widely practiced EP technique, has been effective at reducing phobias, including public speaking (Boath, Stewart, & Carryer, 2013;Salas, Brooks, & Rowe, 2011). The acupressure point "tapping" protocol has also been effective in reducing fear of delivering public presentations and speeches among college students (Boath, Stewart, & Carryer, 2012;Jones, Thornton, & Andrews, 2011) and one study found that it was more effective at reducing CA than SD (Madoni, Wibowo, & Japar, 2018). ...
... Previously documented successes of the original Basic PEAT protocol may be a result of the specific combination of its techniques. Other research has suggested that optimal benefits of EP systems are achieved when the entire, original protocol is correctly applied (Church & Nelms, 2016;Salas et al., 2011;Church et al., 2018). For example, Fox (2013) stated that "tapping on acupoints" (p. ...
Reducing communication apprehension (CA) in university public speaking classes has been traditionally achieved by strategies such as skills training, rehearsal, preparation, and repeated performance. Yet, some highly anxious speakers require more intensive interventions. Recently, Energy Psychology (EP) protocols such as Emotional Freedom Techniques (EFT) and Primordial Energy Activation and Transcendence (PEAT) have significantly reduced CA after brief interventions. Other studies have investigated the therapeutic effects of the various components of selected EP protocols through dismantling studies. This study contributes to existing EP dismantling and CA studies by exploring the efficacy of two modified PEAT protocols. Participants (N = 51) were randomly placed into one of three groups: a modified PEAT acupressure group, a modified PEAT non-acupressure group, and a no-treatment control group. Mixed method analyses did not find a significant difference in CA scores (p < .05) or reported subjective experiences between groups at posttest, and highly anxious speakers benefitted more from the public speaking course than less anxious ones. The authors suggest that dismantling the original PEAT technique may have limited its efficacy and further study on PEAT for CA is required.
... overweight (Stapleton, Bannatyne , Urzi, Porter , & Sheldon, 2016;Stapleton, Church, Sheldon, Porter, & Carlopio, 2013), hospital patient (Boath, Stewart, & Rolling, 2014), athlete (lewellyn-Edwards & Llewellyn-Edwards, 2012), chemotherapy patient ( Baker & Hoffman, 2015) and people who suffer from phobias (Salas , Brooks, & Rowe, 2011;Bach, et al., 2019). Previous studies have also proven that EFT is statistically significant in dealing with psychological distress based on more than 98% of related studies (Rancour, 2017). ...
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The increasing number of deaths from Covid-19 is in line with anxiety disorders and depression in people who are positive for Covid-19. The emotional Freedom Technique (EFT) is known as an effective therapy to reduce mental health disorders in certain patients but has never been applied to people who are confirmed positive for Covid-19. This study aims to analyze the effectiveness of EFT as an alternative therapy in reducing anxiety and depression in people who are positive for Covid-19. This research design uses a quasi-experimental approach with a one-group pretest and posttest approach. A total of 22 people were isolated in the Health Training Unit (UPELKES) provided by the Pontianak Government in June 2021. The data analysis technique used paired t-test (95% CI). There was a significant decrease in anxiety (t value = 6,738) and depression scores (t value = 2,585) after EFT therapy was given (p-value < 0.05). Thus, EFT can be an alternative therapy in overcoming anxiety and depression disorders in people who are confirmed positive for Covid-19.Meningkatnya angka kematian akibat Covid-19 seiring dengan gangguan kecemasan dan depresi pada orang yang positif Covid-19. Emotional Freedom Technique (EFT) dikenal sebagai terapi yang efektif menurunkan gangguan kesehatan mental pada pasien tertentu, namun belum pernah diaplikasikan pada orang yang terkonfirmasi positif Covid-19. Penelitian ini bertujuan untuk menganalisis efektivitas EFT sebagai terapi alternatif dalam menurunkan gangguan kecemasan dan depresi pada orang yang positif Covid-19. Desain penelitian ini menggunakan quasy experimental dengan pendekatan one group pretest and posttest. Sebanyak 22 orang yang diisolasi di Unit Pelatihan Kesehatan (UPELKES) yang disediakan Pemerintah Pontianak pada bulan Juni 2021. Teknik analisis data menggunakan paired t test (95% CI). Terdapat penurunan skor gangguan kecemasan (nilai t = 6,738) dan depresi (nilai t = 2,585) yang signifikan setelah diberikan terapi EFT (p value < 0,05). Dengan demikian, EFT dapat menjadi terapi alternatif dalam mengatasi gangguan kecemasan dan depresi pada orang yang terkonfirmasi positif Covid-19.
... Several studies have examined symptom levels before and after a single session of EFT (≤60 min in duration). These studies showed that EFT is effective for fear of public speaking [39,40,47], sports performance [48,49], anxiety and depression [50], phobic fear [51][52][53], and traumatic stress [54,55]. ...
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Background: The burgeoning area of mobile health (mHealth) has experienced rapid growth in mobile applications (apps) designed to address mental health issues. While abundant apps offer strategies for managing symptoms of anxiety and stress, information regarding their efficacy is scarce. Objective: This study assessed the effect of a mHealth app on user self-ratings of psychological distress in a sample of 270,461 app users. The Tapping Solution App guided users through the therapeutic protocols of Clinical Emotional Freedom Techniques (EFT), an evidence-based psycho-physiological intervention that combines acupressure with elements of cognitive and exposure therapies. Methods: App users provided self-ratings of emotional intensity pre and post app sessions (termed "tapping meditations") using an 11-point Subjective Units of Distress scale. App user data for 23 tapping meditations, which addressed psychological symptoms of anxiety and stress, were gathered between October 2018 and October 2019, totaling 380,034 completed app sessions. Results: Across 12 anxiety tapping meditations, the difference in emotional intensity ratings from pre-session (M = 6.66, SD = 0.25) to post-session (M = 3.75, SD = 0.30) was statistically significant, P < .001, 95% CI [-2.92, -2.91]. Across 11 stress tapping meditations, a statistically significant difference was also found from pre-session (M = 6.91, SD = 0.48) to post-session (M = 3.83, SD = 0.54), P < .001, 95% CI [-3.08, -3.07]. Results are consistent with the literature on the efficacy of Clinical EFT for anxiety and stress when offered in conventional therapeutic formats. Conclusions: Findings provide preliminary support for the effectiveness of the mHealth app in the immediate reduction of self-rated psychological distress. As an adjunct to professional mental health care, the app promises accessible and convenient therapeutic benefits. Clinicaltrial: Not applicable.
... Specifically, EFT involves the application of fingertip pressure on acupoints on the face and upper body with a concurrent cognitive reframing of target issues. Research has assessed the efficacy of EFT treatment for a range of psychological and physiological conditions (Bach et al., 2019), including psychological trauma, fibromyalgia, and food cravings (Brattberg, 2008;Church, Yount, Rachlin, Fox, & Nelms, 2018;Salas, Brooks, & Rowe, 2011;Stapleton et al., 2017Stapleton et al., , 2019. ...
Objective: In a direct replication of Church, Yount, and Brooks (2012), this study examined changes in stress biochemistry and psychological distress symptoms in 53 participants randomly allocated to one of three 60-min group interventions: Emotional Freedom Techniques (EFT), psychoeducation (PE), and no treatment (NT). The Symptom Assessment-45 (SA-45) was used to assess psychological distress symptoms. Method: Salivary cortisol assays were administered 30 min pre- and postintervention to test cortisol levels. The original study by Church et al. indicated the EFT group showed statistically significant improvements in anxiety (-58.34%, p < .05), depression (-49.33%, p < .002), overall severity of symptoms (-50.5%, p < .001), and symptom breadth (-41.93%, p < .001). The group also experienced a significant decrease in cortisol (-24.39%) compared to the PE group (-14.25%) and NT group (-14.44%). Results: The present results indicated the EFT group experienced a significant decrease in cortisol greater than the original study (-43.24%, p < .05), but these results were not mirrored by subjective reports of psychological distress. The EFT group reduction in cortisol was significantly different from that of the PE group (-19.67%), and as expected, the posttreatment cortisol level detected among the EFT group was lower than that of the NT group (2.02%); however, there was not a statistically significant difference between the 2 groups. Additionally, there were no significant improvements in cortisol reduction among the NT and PE groups. Conclusions: Findings support the original study indicating EFT to be an efficient and effective brief treatment for reducing biological markers of stress. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
... For example, in Psychological Trauma Symptom Disorder (PTSD) patients reduces psychological and physiological PTSD symptoms, psychological distress, depression, anxiety and pain perception. [3][4][5][6][7] It has been shown that EFT can also be an effective part of treatment package in non-veterans for example, in animal phobias, 2,[8][9][10] in tension-type headache sufferers, which reduces frequency and severity of pain and improve quality of life, 11 in students, which reduces depression, anxiety, and test anxiety, [12][13][14] in addict persons, which reduces anxiety, hostility and obsessive-compulsive disorders (OCD) symptoms and improve somatization symptoms and interpersonal sensitivity, 15 in healthcare workers, which reduces psychological distress, pain and cravings, 16 in persons without clinical signs and symptoms, which reduces depression, anxiety and cortisol level. 17 Also EFT increases acceptance, coping and quality of life in individuals with fibromyalgia. ...
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Emotional Freedom Technique (EFT) as a new therapeutic technique in energy psychology has positive effects on psychological and physiological symptoms, and quality of life. In this research we studied the effect of this treatment on immunological factors. This study tested whether 8-week group sessions of EFT (compared to a wait-list control group) with emphasis on patient's respiratory, psychological and immunological problems in chemically pulmonary injured veterans (N=28) can affect on immunological and psychological factors. Mixed effect linear models indicated that EFT improved mental health (F=79.24, p=0) and health-related quality of life (F=13.89, p=0.001), decreased somatic symptoms (F=5.81, p=0.02), anxiety/insomnia (F=24.03, p<0.001), social dysfunction (F=21.59, p<0.001), frequency and severity of respiratory symptoms (F=20.38, p<0.001), and increased lymphocyte proliferation with nonspecific mitogens Concanavalin A (Con A) (F=14.32, p=0.001) and Phytohemagglutinin (PHA) (F=12.35, p=0.002), and peripheral blood IL-17 (F=9.11, p=0.006). This study provides an initial indication that EFT may be a new therapeutic approach for improving psychological and immunological factors.
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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.
Context Thought Field Therapy is an evidence-based method validated by 17 clinical trials, including five Randomized Controlled Trials. This study investigates whether a single Thought Field Therapy session can improve psychological issues such as stress, depression, and performance anxiety in university students. Methods Fifty university students were randomly assigned to an intervention group or a waitlist control group. The intervention group received a single counseling session of Thought Field Therapy and was assessed by Subjective Units of Distress and Heart Rate Verifiability before and after the session. The waitlist group received Thought Field Therapy and was administered the Profile of Mood States Second Edition. All participants completed the latter after a waiting period of 1–3 weeks. Results The 39 students who received Thought Field Therapy showed significantly higher Heart Rate Verifiability post-compared to pre-therapy (p < .001). The 33 students who were assessed for Subjective Units of Distress also reported significant improvements (p < .001) by a 91% reduction in distress for an average duration of 36 minutes. The Profile of Mood States Second Edition score did not show significant improvements in the intervention group (n = 24) as compared to the control group (n = 15). Conclusion A brief intervention of Thought Field Therapy can reduce stress and psychological distress among university students, and increase their physiological resilience in a limited timeframe, after a single session of counseling. However, the single session did not suffice to significantly improve their psychological conditions over the long term.
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Protocols to treat veterans with brief courses of therapy are required, in light of the large numbers returning from Iraq and Afghanistan with depression, anxiety, PTSD and other psychological problems. This observational study examined the effects of six sessions of EFT on seven veterans, using a within-subjects, time-series, repeated measures design. Participants were assessed using a well-validated instrument, the SA-45, which has general scales measuring the depth and severity of psychological symptoms. It also contains subscales for anxiety, depression, obsessive-compulsive behavior, phobic anxiety, hostility, interpersonal sensitivity, paranoia, psychosis, and somatization. Participants were assessed before and after treatment, and again after 90 days. Interventions were done by two different practitioners using a standardized form of EFT to address traumatic combat memories. Symptom severity decreased significantly by 40% (p
Energy psychology utilizes cognitive operations such as imaginal exposure to traumatic memories or visualization of optimal performance scenarios—combined with physical interventions derived from acupuncture, yoga, and related systems—for inducing psychological change. While a controversial approach, this combination purportedly brings about, with unusual speed and precision, therapeutic shifts in affective, cognitive, and behavioral patterns that underlie a range of psychological concerns. Energy psychology has been applied in the wake of natural and human-made disasters in the Congo, Guatemala, Indonesia, Kenya, Kosovo, Kuwait, Mexico, Moldavia, Nairobi, Rwanda, South Africa, Tanzania, Thailand, and the U.S. At least three international humanitarian relief organizations have adapted energy psychology as a treatment in their post-disaster missions. Four tiers of energy psychology interventions include 1) immediate relief/stabilization, 2) extinguishing conditioned responses, 3) overcoming complex psychological problems, and 4) promoting optimal functioning. The first tier is most pertinent in psychological first aid immediately following a disaster, with the subsequent tiers progressively being introduced over time with complex stress reactions and chronic disorders. This paper reviews the approach, considers its viability, and offers a framework for applying energy psychology in treating disaster survivors.
This comprehensive volume provides up-to-date information on the 3 main types of phobic disorder: panic disorder and agoraphobia, social phobia, and specific phobia. The book integrates current research findings with practical recommendations for diagnosis and treatment. For each disorder, clinicians will find guidelines for assessment, including diagnostic interviews, behavioral assessments, symptom diaries, and standardized self-report measures that are highly useful for differential diagnosis and treatment planning. The authors present flexible and detailed treatment protocols for each disorder that include session frequency and duration, sequencing of cognitive and behavioral strategies, bibliotherapy, homework, and monitoring forms for tracking patient progress. Basic principles of exposure-based treatment and social skills training and the most effective cognitive techniques are described, illuminated by sample therapist–patient dialogue and troubleshooting tips. A chapter on the most commonly used medications, side effects, issues related to dosage, and strategies for discontinuing medication is included. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This chapter describes and evaluates the Beck Anxiety Inventory (BAI), a 21-item self-report instrument for measuring the severity of anxiety in adolescents and adults. A summary of the research investigating the reliability, internal consistency, test-retest reliability, content validity, construct and convergent validity, discriminant validity, and factorial validity is offered. Sex, age, ethnic, and diagnostic effects of the BAI are also presented. The chapter concludes with applications, benefits and limitations of the BAI. (PsycINFO Database Record (c) 2012 APA, all rights reserved)