Dr. Lynne Zimmerman
+ EnergyWorks +
Research

 

 

Accupoint tapping, or EFT,  has been researched in more than 10 countries, by more than 60 investigators, whose results have been published in more than 20 different peer-reviewed journals.  These include distinguished journals such as Journal of Clinical Psychology, the APA journals Psychotherapy: Theory, Research, Practice, Training and Review of General Psychology, and the oldest psychiatric journal in North America, the Journal of Nervous and Mental Disease.

EFT research includes investigators affiliated with many different institutions.  In the US, these range from Harvard Medical School, to the University of California at Berkeley, to City University of New York, to Walter Reed Military Medical Center, to Texas A&M University, to JFK University.  Institutions in other countries whose faculty have contributed to EFT research include Lund University (Sweden), Ankara University (Turkey), Santo Tomas University (Philippines), Lister Hospital (England), Cesar Vallejo University (Peru), and Griffith University (Australia).

Outcome studies measure changes in, for instance, pain, depression, or PTSD symptoms.  These studies compare the medical or psychological outcomes of two groups of people with similar symptoms, or the same sample before EFT was administered.   Mechanism research papers describe the neurological, epigenetic, psychoneuroimmunological, and hormonal pathways that are believed to be active during EFT sessions.  Both types of studies are included below.

The effect of a brief EFT (Emotional Freedom Techniques) self-intervention on anxiety, depression, pain and cravings in healthcare workers  Church, D., & Brooks, A. J. (2010). The effect of a brief EFT (Emotional Freedom Techniques) self-intervention on anxiety, depression, pain and cravings in healthcare workers. Integrative Medicine: A Clinician's Journal, Oct/Nov, 40-44 

Abstract

This study examined whether self-intervention with Emotional Freedom Techniques (EFT), a brief exposure therapy that combines a cognitive and a somatic element, had an effect on healthcare workers’ psychological distress symptoms. Participants were 216 attendees at 5 professional conferences. Psychological distress, as measured by the SA-45, and self-rated pain, emotional distress, and craving were assessed before and after 2-hours of self-applied EFT, utilizing a within-subjects design. A 90-day follow-up was completed by 53% of the sample with 61% reporting using EFT subsequent to the workshop. Significant improvements were found on all distress subscales and ratings of pain, emotional distress, and cravings at posttest (all p<.001). Gains were maintained at follow-up for most SA-45 scales. The severity of psychological symptoms was reduced (-45%, p<.001) as well as the breadth (-40%, p<.001), with significant gains maintained at follow-up. Greater subsequent EFT use correlated with a greater decrease in symptom severity at follow-up (p<.034, r=.199), but not in breadth of symptoms (p<.0117, r=.148). EFT provided an immediate effect on psychological distress, pain, and cravings that was replicated across multiple conferences and healthcare provider samples.  Keywords: Healthcare professionals, burnout, depression, anxiety, pain, craving, EFT

The effect of Emotional Freedom Techniques (EFT) on stress biochemistry: A randomized controlled trial  Church, D., Yount, G., & Brooks, A. J. (2012). The effect of Emotional Freedom Techniques (EFT) on stress biochemistry: A randomized controlled trial.   Journal of Nervous and Mental Disease, 200(10):891-6. doi: 10.1097/NMD.0b013e31826b9fc1.

Abstract This study examined the changes in cortisol levels and psychological distress symptoms of 83 non-clinical subjects receiving a single hour long intervention. Subjects were randomly assigned to either an EFT group, a psychotherapy group receiving a supportive interview (SI), or a no treatment (NT) group. Salivary cortisol assays were performed immediately before, and thirty minutes after the intervention. Psychological distress symptoms were assessed using the SA-45. The EFT group showed statistically significant improvements in anxiety (-58.34%, p<0.05), depression (-49.33%, p<0.002), the overall severity of symptoms, (-50.5%, p<0.001), and symptom breadth (-41.93%, p<0.001). The EFT group experienced a significant decrease in cortisol (-24.39%, SE 2.62) compared to the decrease observed in the SI (-14.25%, SE 2.61) and NT (-14.44%, SE 2.67) groups (p<0.03).  The decrease in cortisol levels in the EFT group mirrored the observed improvement in psychological distress.  Keywords: Cortisol, stress, depression, anxiety, physiology, EFT (Emotional Freedom Techniques).

A randomized clinical trial of a meridian-based intervention for food cravings with six month follow-up   Bougea, A. M., Spandideas, N., Alexopoulos, E. C., Thomaides, T., Chrousos, G. P., & Darviri, C. (2013). Effect of the Emotional Freedom Technique on Perceived Stress, Quality of Life, and Cortisol Salivary Levels in Tension-Type Headache Sufferers: A Randomized Controlled Trial. EXPLORE: The Journal of Science and Healing, 9(2), 91-99. doi:10.1016/j.explore.2012.12.005.

Abstract  This randomised, clinical trial tested whether The Emotional Freedom Techniques (EFT) reduced food cravings. This study involved 96 overweight or obese adults who were allocated to the EFT treatment or 4-week waitlist condition. Degree of food craving, perceived power of food, restraint capabilities and psychological symptoms were assessed pre- and post- a 4-week treatment program (mixed method ANOVA comparative analysis), and at 6-month follow-up (repeated measure ANOVA with group data collapsed). EFT was associated with a significantly greater improvement in food cravings, the subjective power of food and craving restraint than waitlist from pre- to immediately post-test (p < .05).  Across collapsed groups, an improvement in food cravings and the subjective power of food after active EFT treatment was maintained at 6 months, and a delayed effect was seen for craving restraint. Although there was a significant reduction in measures of psychological distress immediately after treatment (p < .05), there was no between-group difference. These findings are consistent with the hypothesis that EFT can have an immediate effect on reducing food cravings and can result in maintaining reduced cravings over time.  Keywords: Emotional Freedom Techniques (EFT), food cravings, weight, energy psychology, subjective power of food.

Clinical benefits of Emotional Freedom Techniques on food cravings at 12-months follow-up: A randomized controlled trial Stapleton, P., Sheldon, T., & Porter, B. (2012). Clinical benefits of Emotional Freedom Techniques on food cravings at 12-months follow-up: A randomized controlled trial.   Energy Psychology: Theory, Research, & Treatment, 4(1), 13-24.

Abstract  This randomized, single-blind, crossover trial tested whether participants who used Emotional Freedom Techniques (EFT) maintained reduced food cravings after 12-months and updates previously reported 6-month findings. Ninety-six overweight/obese adults were allocated to a 4-week EFT treatment or waitlist condition. Degree of food craving, perceived power of food, restraint capabilities, and psychological symptoms were assessed pre- and posttest and at 12-month follow-up for collapsed groups.  Significant improvements occurred in weight, body mass index, food cravings, subjective power of food, craving restraint, and psychological coping for EFT participants from pretest to 12 months (p < .05).  It appears EFT can result in participants maintaining reduced cravings over time and affect weight and BMI in overweight and obese individuals. 

Keywords: EFT, Emotional Freedom Techniques, cravings, psychological symptoms, food, obesity.


Note:

Clinical psychologist Steve Wells,  PhD. has now replicated the Stapleton study above.  He writes: "We've successfully replicated Peta Stapleton’s study on EFT group treatment for food cravings. Both EFT and SET produced significant improvements in reducing cravings AND significant shifts in w-eight and waist measurements for the participants! These results were equivalent to that of a group who were treated using Cognitive Behavior Therapy (CBT). Since CBT is considered the "gold standard" in terms of evidence based treatments, these results are excellent, particularly given the short time-frame of the treatments (4 x weekly 2-hour group sessions).

Pain, depression, and anxiety after PTSD symptom remediation in veterans  Church, D., & Brooks, A. J. (2014). Pain, depression, and anxiety after PTSD symptom remediation in veterans.  Explore: The Journal of Science and Healing (in press).

Abstract A randomized controlled trial of veterans with clinical levels of PTSD symptoms found significant improvements after EFT (Emotional Freedom Techniques). While pain, depression, and anxiety were not the targets of treatment, significant improvements in these conditions were found. Subjects (N = 59) received six sessions of EFT coaching supplementary to primary care. They were assessed using the SA-45, which measures 9 mental health symptom domains, and also has 2 general scales measuring the breadth and depth of psychological distress. Anxiety and depression both reduced significantly, as did the breadth and depth of psychological symptoms. Pain decreased significantly during the intervention period (– 41%, p < .0001). Subjects were followed at 3 and 6 months, revealing significant relationships between PTSD, depression, and anxiety at several assessment points. At follow-up, pain remained significantly lower than pretest. The results of this study are consistent with other reports showing that, as PTSD symptoms are reduced, general mental health improves, and that EFT produces long-term gains for veterans after relatively brief interventions.  Keywords: Anxiety, depression, pain, EFT (Emotional Freedom Techniques), veterans.

Psychological symptom change in veterans after six sessions of Emotional Freedom
Techniques (EFT): An observational study 
Church, D., Geronilla, L., & Dinter, I. (2009). Psychological symptom change in veterans after six sessions of Emotional Freedom Techniques (EFT): An observational study. International Journal of Healing and Caring, 9(1).
 

Abstract  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<.001), anxiety decreased 46% (p<.001), depression 49% (p<.001), and PTSD 50% (p<.016). These gains were maintained at the 90-day follow-up.

Integrating Energy Psychology into Treatment for Adult Survivors of Childhood Sexual Abuse  Kirsten Schulz, PsyD Energy Psychology: Theory, Research, & Treatment, (2009), 1(1), 15-22.

Abstract  This study evaluated the experiences of 12 therapists who integrated energy psychology (EP) into their treatments for adult survivors of childhood sexual abuse. Participants completed an online survey and the qualitative data was analyzed using the Constant Comparative method. Seven categories containing 16 themes emerged as a result of this analysis. The categories included: (1) Learning about EP; (2) diagnosis and treatment of adult CSA using EP; (3) treatment effectiveness of EP; (4) relating to clients from an EP perspective; (5) resistance to EP; (6) the evolution of EP; and (7) therapists’ experiences and attitudes about EP.  These themes are compared and contrasted with existing literature. Clinical implications are discussed, as well as suggestions for future research. The results provide guidelines for therapists considering incorporating these techniques into their practices.  Keywords: psychotherapy, energy psychology, sexual abuse, TFT (Thought Field Therapy), EFT (Emotional Freedom Techniques).

Neurophysiological indicators of EFT treatment of post-traumatic stress

Swingle, P., Pulos, L., & Swingle, M. K. (2005). Neurophysiological indicators of EFT treatment of post-traumatic stress.  Journal of Subtle Energies & Energy Medicine, (2005),15, 75-86.

Abstract  Clients previously involved in a motor vehicle accident who reported traumatic stress associated with the accident received two sessions of Emotional Freedom Techniques (EFT) treatments. All clients reported improvement immediately following treatment. Brainwave assessments before and after EFT treatment indicated that clients who sustained the benefit of the EFT treatments had increased 13-15 Hz amplitude over the sensory motor cortex, decreased right frontal cortex arousal and an increased 3-7 Hz / 16-25 Hz ratio in the occiput.  The benefits of psychoneurological research to reveal the processes of subtle energy healing are discussed. 
Description of Study:  This research study, conducted by Dr. Paul Swingle and his colleagues (Swingle, Pulos & Swingle, 2005), studied the effects of EFT on auto accident victims suffering from post traumatic stress disorder - an extremely disabling conditioning that involves unreasonable fears and often panic attacks, physiological symptoms of stress, nightmares, flashbacks, and other disabling symptoms. These researchers found that three months after they had learned EFT (in two sessions) those auto accident victims who reported continued significant symptom relief also showed significant positive changes in their brain waves. It was assumed that the clients showing the continued positive benefits were those who continued with home practice of self-administered EFT. 
Keywords: Emotional freedom techniques (EFT), traumatic stress, EEG

Literature Reviews

ACUPOINT STIMULATION IN TREATING PSYCHOLOGICAL DISORDERS:

EVIDENCE OF EFFICACY  David Feinstein, Ph.D. Ashland, Oregon


Abstract

Energy psychology is a clinical and self-help modality that combines verbal and physical

procedures for effecting therapeutic change. While utilizing established clinical methods such as

exposure and cognitive restructuring, the approach also incorporates concepts and techniques

from non-Western healing systems. Its most frequently utilized protocols combine the

stimulation of acupuncture points (by tapping on, holding, or massaging them) with the mental

activation of a targeted psychological issue. Energy psychology has been controversial, in part

due to its reliance on explanatory mechanisms that are outside of conventional clinical

frameworks and in part because of claims by its early proponents—without adequate research

support—of extraordinary speed and power in attaining positive clinical outcomes. This paper

revisits some of the field’s early claims, as well as current practices, and assesses them in the

context of existing evidence. A literature search identified 51 peer-reviewed papers that report or

investigate clinical outcomes following the tapping of acupuncture points to address

psychological issues. The 18 randomized controlled trials in this sample were critically evaluated

for design quality, leading to the conclusion that they consistently demonstrated strong effect

sizes and other positive statistical results that far exceed chance after relatively few treatment

sessions. Criteria for evidence-based treatments proposed by Division 12 of the American

Psychological Association were also applied and found to be met for a number of conditions,

including PTSD and depression. Neurological mechanisms that may be involved in these

surprisingly strong findings are also considered.  Keywords: acupoints, efficacy, Emotional Freedom Techniques (EFT), exposure, Thought Field Therapy (TFT)


ACUPOINT STIMULATION IN TREATING PSYCHOLOGICAL DISORDERS:

EVIDENCE OF EFFICACY  David Feinstein, Ph.D.

The stimulation of acupuncture points (acupoints) as a component of psychotherapy traces to psychologist Roger Callahan’s formulation of Thought Field Therapy (TFT) in the 1970s (Callahan & Callahan, 1996). Variations of Callahan’s original protocols have subsequently been introduced under the umbrella term “energy psychology,” with the most popular and widely practiced of these being “EFT” or Emotional Freedom Techniques (Craig, 2011). Most psychotherapists utilizing acupoint stimulation integrate the procedure into their own psychological framework and methods (Mayer, 2009). Acupoint stimulation can also be applied on a self-help basis, and practitioners routinely recommend to their clients that the technique be used as homework as well as in the treatment setting.

Reports of unusual speed, range, and durability of clinical outcomes by practitioners utilizing an energy psychology approach have been provocative (Feinstein, 2009a). Proponents assert that the stimulation of selected acupoints simultaneous with the mental activation of targeted psychological issues is a major clinical breakthrough while skeptics counter that the reported outcomes are improbable and certainly have not been substantiated with adequate data or established mechanisms of action. This paper will review the claims leading to this controversy and consider current empirical evidence bearing upon them.

The early advocates of energy psychology reported rapid results with a wide range of psychiatric disorders (e.g., Callahan, 1985; Johnson et al., 2001; Sakai et al., 2001). These assertions, publicly stated prior to corresponding research support or persuasive explanatory models—combined with odd-looking procedures such as tapping on the skin—led to emphatic skepticism in the clinical community (e.g., Devilly, 2005; Herbert & Gaudiano, 2001; Lohr, 2001; McNally, 2001). Three early large-scale pilot studies were particularly provocative because their purported speed and success rates surpassed any treatment in the clinical literature for the conditions being addressed.

In one of these, a group of clinicians at Kaiser Permanente in Honolulu followed the progress of 714 patients being treated with TFT (Sakai et al., 2001). Sessions were of 30 to 50 minutes in length and patients received an average of 2.2 treatments. Paired pre- and post treatment t-tests of patient reports of subjective distress, the primary outcome measure utilized, showed statistically significant improvement at the .001 level of confidence for 28 presenting problems or diagnostic categories (including, for example, anxiety, bereavement, chronic pain, depression, food cravings, obsessive traits, obsessive compulsive personality disorder, panic disorder, phobias, and post-traumatic stress disorder) and at .01 for three other conditions (alcohol cravings, major depressive disorder, and tremors). While the investigators were careful to emphasize that their findings constituted only “preliminary data that call for controlled studies to examine validity, reliability, and maintenance of effects over time” (p. 1229), their report was met with strong criticism or outright incredulity from the professional community (e.g., Lohr, 2001).

A second preliminary study emerged after Joaquín Andrade, a physician trained in acupuncture and TFT, brought acupoint tapping for psychiatric conditions to a group practice running 11 clinics in Argentina and Uruguay. In an ongoing in-house investigation, his team tracked the progress of 5,000 anxiety patients over a 5-1/2 year period. Half were assigned to the clinics’ standard protocol for anxiety disorders, cognitive behavior therapy (CBT) with antianxiety medication as needed. The other half received acupoint tapping with mental activation but no anti-anxiety medication. Raters did not know which treatment a patient received.

Improvement was found in 90% of the acupoint tapping group and 63% of the CBT group, with

complete relief of symptoms at 76% for acupoint tapping and 51% for CBT. One-year follow-up

samplings predicted that 78% sustained the benefits from acupoint tapping and 69% from CBT.

Perhaps the most striking finding is that in a sub-study of 190 of the patients who were treated

successfully, an average of three acupoint tapping sessions were required before the anxious

condition was no longer present while an average of 15 CBT sessions were required (reported in

Feinstein, 2004).

Even more provocative was a third large-scale investigation by Carl Johnson—a retired Veterans Administration psychologist and a diplomate of the American Board of Professional Psychology—based on his post-retirement work with people who had been severely traumatized.

Johnson learned of acupoint tapping toward the end of his career with the V.A. After retiring, he

began bringing the approach to parts of the world that had sustained widespread disasters such as

genocide or warfare impacting civilian populations. Using TFT, the treatment focused on reducing severe emotional reactions evoked by specific traumatic memories, which often involved torture, rape, and witnessing loved ones being murdered. Johnson’s initial report described his work with 105 people during his first five visits to Kosovo following the genocide, claiming strong improvement with 103 of them (Johnson et al., 2001).

Johnson went on to claim that 334 of 337 traumatized individuals—following treatment provided by him and his colleagues traveling to Kosovo, Rwanda, the Congo, and South Africa—were able to bring to mind their most traumatic memories from the disaster and experience no physiological/affective arousal. A marker in the successful treatment of PTSD is

that the client is able to recall the precipitating event without being reactivated (van der Kolk, McFarlane, & Weisaeth, 1996/2007). The 337 individuals worked with 1016 traumatic memories, successfully resolving 1013 of them according to Johnson’s calculations. Johnson also reported that decreasing arousal to the horrific memories carried by civilian survivors of warfare and genocide produced global improvements in the person’s ability to function. Most of Johnson’s treatments were done within a single session that lasted less than an hour. An 18- month follow-up in which approximately three-fourths of the 105 individuals initially treated in Kosovo who were able to be tracked revealed no relapses.

One of Johnson’s colleagues, psychologist Caroline Sakai, was the principal investigator in a study involving 188 adolescents who had been traumatized and orphaned twelve years earlier by the genocide in Rwanda (Sakai, Connolly, & Oas, 2010). Most of them still exhibited symptoms of PTSD. The 50 who were given the highest scores on a standardized PTSD inventory completed by their caretakers met the study’s selection criteria and were administered a single session of TFT. All 50 exceeded the PTSD cutoff score on the caregiver inventory. The inventory was structured around DSM IV-R (American Psychiatric Association, 2000) criteria for PTSD, designed for parents or other caregivers and translated into Kinyarwandan in a manner that was approved by the test designers. The inventory scores were corroborated by staff observations that these children suffered with enduring PTSD symptoms such as intrusive flashbacks, nightmares, difficulty concentrating, aggressiveness, bedwetting, and withdrawal during the 12-year period following the genocide. After a single treatment session of 20 to 60 minutes and brief relaxation training, only 6% of the adolescents still scored within the PTSD range (p < .0001), and the staff reported dramatic observed decreases in PTSD symptoms. On one-year follow-up, 8% scored within the PTSD range on the caregiver inventory. On a companion inventory administered directly to the adolescents, 72% scored within the PTSD range prior to treatment, 18% scored within this range immediately after treatment (p < .0001), and 16% scored within the PTSD range on one-year follow-up.

The strong outcomes treating traumatic stress in a single-session (the Rwanda orphanage study and the Johnson study) and the low number of sessions required to successfully treat anxiety in the South America study (average of 3) are cause for skepticism in any therapist who has worked with these conditions. Further support for the reported outcomes has, however, been lent by two RCTs using single-session treatments. Connolly and Sakai (2011) followed their orphanage study with an investigation involving 145 adults who had survived the Rwanda genocide. Participants were randomly assigned to a single-session TFT treatment or a wait-list control condition. Pre/post-treatment scores on two standardized PTSD self-inventories were significant beyond the .001 level on all scales (e.g., anxious arousal, depression, irritability, intrusive experiences, defensive avoidance, dissociation, et cetera), and the improvements held on 2-year follow-up.

The other RCT using a singe-session treatment protocol was conducted with 16 abused male adolescents in Peru (Church, Piña, Reategui, & Brooks, 2011). The participants, who all scored above the PTSD threshold on a standardized self-inventory, were randomly assigned to an EFT treatment group or a wait-list group. Each of the eight participants in the treatment group no longer met the PTSD criteria thirty days after the treatment session. None in the wait list control group showed significant change.

Informal interviews by this author with investigators in the Rwanda and Peru studies revealed that they were not intending to prove that single-session treatment protocols would be adequate, only that they could produce a positive effect. In both cases, practical considerations necessitated the brief treatment, and the investigators reported being surprised by the strength of the outcomes. Each acknowledged that additional sessions might have benefitted at least some of the participants. For comparison, a study investigating the use of EFT with PTSD that allowed subjects to receive up to eight treatment sessions reported strong positive outcomes and voluntary termination of treatment after an average of 3.8 sessions (Karatzias et al., 2011).

To provide a sense of how a single acupoint tapping session appeared to be effective in treating chronically traumatized adolescents, the following account is from the principal investigator of the Rwanda orphanage study (Sakai, 2010). She describes the treatment of one of the 47 (of 50) participants whose scores went from above to below the PTSD cutoff, a 15-year old girl who was three at the time of the 1994 genocide: She’d been hiding with her family and other villagers inside the local church. The church was stormed by men with machetes, who started a massacre. The girl’s father told her and other children to run and to not look back for any reason. She obeyed and was

running as fast as she could, but then she heard her father “screaming like a crazy man.” She remembered what her father had said, but his screams were so compelling that she did turn back and, in horror, watched as a group of men with machetes murdered him.

A day didn’t pass in the ensuing 12 years without her experiencing flashbacks to that scene. Her sleep was plagued by nightmares tracing to the memory. In her treatment session, I asked her to bring the flashbacks to mind and to imitate me as I tapped on a selected set of acupuncture points while she told the story of the flashbacks. After a few minutes, her heart-wrenching sobbing and depressed affect suddenly transformed into smiles. When I asked her what happened, she reported having accessed fond memories. 

For the first time, she could remember her father and family playing together. She said that until then, she had no memories from before the genocide.  We might have stopped there, but I instead directed her back to what happened in the church. The interpreter shot me a look, as if to ask, “Why are you bringing it back up again when she was doing fine?” But I was going for a complete treatment. The girl started crying again. She told of seeing other people being killed. She reflected that she was alive because of her father’s quick thinking, distracting the men’s attention while

telling the children to run.

The girl cried again when she reexperienced the horrors she witnessed while hiding outside with another young child—the two of them were to be the only survivors from their entire village. Again, the tapping allowed her to have the memory without having to relive the terror of the experience.

After about 15 or 20 minutes addressing one scene after another, the girl smiled and began to talk about her family. Her mother didn’t allow the children to eat sweet fruits because they weren’t good for their teeth. But her father would sneak them home in his pockets and, when her mother wasn’t looking, he’d give them to the children. She was laughing wholeheartedly as she relayed this, and the translator and I were laughing with her.

We then went on to work through a number of additional scenes. Finally, when she was asked, ‘What comes up now as you remember what happened at the church,’ she reflected, without tears, that she could still remember what happened, but that it was no longer vivid like it was still happening. It had now faded into the distance, like something from long ago. Then she started to talk about other fond memories. Her depressed countenance and posture were no longer evident.


Over the following days, she described how, for the first time, she had no flashbacks or
nightmares and was able to sleep well. She looked cheerful and told me how elated she was about having happy memories about her family. Her test scores had gone from well above the PTSD cutoff to well below it after this single treatment session and remained there on the follow-up assessment a year later. (pp. 50 - 51).

In an RCT using acupoint tapping with military veterans, 59 veterans suffering with symptoms of PTSD were randomly assigned to a treatment group or a wait-list control group (Church, Hawk et al., in press). Fifty-four of the initial participants completed the study, including 29 in the treatment group and 25 in the control group. Six hour-long EFT sessions were administered to each participant in the treatment group. The initial mean score on the military version of a standardized PTSD checklist was 61.4 for the treatment group and 66.6 for the wait-list group. The PTSD cutoff is 50. The mean score after six treatment sessions had decreased to 34.6 (p < .0001), substantially below the PTSD cutoff. The mean score for the waitlist group a month after the initial testing was essentially unchanged (65.3). The control group was then offered treatment. A total of 49 participants, all of whom had initially scored above the PTSD cut-off, ultimately received six hour-long EFT sessions. Eighty-six percent no longer scored in the PTSD range following the treatment.

Four additional peer-reviewed studies of acupoint tapping with post-traumatic stress compared pre- and post-treatment scores on standardized self-inventories but did not use control groups. Each found significant reductions of PTSD symptoms. The statistical significance of the reduced post-treatment PTSD symptom scores were, respectively, at the .01 level (Church, 2010, based on treatments over a five-day period with combat veterans), the .001 level (Church, Geronilla, & Dinter, 2009, 6 treatment sessions with combat veterans), the .001 level (Stone, Leyden, & Fellows, 2009, 3 consecutive group treatment days with genocide survivors, also introducing rapport-building exercises and other techniques), and the .009 level (Stone, Leyden, & Fellows, 2010, using a similar treatment format as in the 2009 study with a different group of genocide survivors).

The first study comparing acupoint tapping with a treatment whose efficacy with PTSD had already been established was conducted by Scotland’s National Health Service (Karatzias et al., 2011). In addition to using an evidence-based comparison group, Eye Movement Desensitization and Reprocessing (EMDR), the study was also more rigorous in other ways, including its use of baseline assessments eight weeks prior to treatment as well as stronger pre-post-, and follow-up assessments, such as a clinician-administered PTSD diagnostic interview along with the self-inventories. Both treatments showed large effect sizes, with the pre/post treatment differences attaining the .001 level of significance on all clinical measures.

Additional comparison studies are required to answer the important question of whether acupoint stimulation is equal to or superior to other treatments for PTSD. Particularly lacking in the literature are comparisons of acupoint stimulation with CBT, which is still considered the treatment of choice for PTSD in many clinical settings (Bryant et al., 2008). In the only comparison study involving acupoint stimulation and CBT, 91 subjects with PTSD following an earthquake in China were randomly assigned to CBT treatment alone or CBT with acupoint stimulation. Participants in both groups improved, but the improvement for those whose treatment included acupoint stimulation was significantly stronger (p < .01) than the improvement for those who received CBT alone (Zhang, Feng, Xie, Xu, & Chen, 2011). While the study did not meet this review’s inclusion criteria because it used an electronic acupoint stimulator instead of tapping, it is mentioned here because it suggests that acupoint stimulation might improve outcomes when used in combination with established modalities.

Specific Phobias. The first published RCT demonstrating the efficacy of acupoint tapping with an established DSM-IV-R (American Psychiatric Association, 2000) diagnosis investigated the treatment of specific phobias, focusing on insects and small animals (Wells, Polglase, Andrews, Carrington, & Baker, 2003). The study compared EFT with diaphragmatic breathing, a physical intervention that is widely used in the treatment of anxiety disorders. The investigation was a “dismantling study” in that the protocols for both groups of subjects were identical except for the physical intervention: acupoint stimulation (n = 18) or diaphragmatic breathing (n = 17). While both groups showed symptomatic improvement after a single 30-minute session, the acupoint group was statistically superior on four of five measures. A partial replication by Baker and Siegel (2010) with 31 subjects supported these findings while carefully controlling for methodological artifacts such as expectancy, regression to the mean, fatigue, and the passage of time. Another partial replication with 22 subjects (Salas, Brooks, & Rowe, 2011) also lent support for the Wells et al. findings.

Public Speaking Anxiety. Preliminary reports have shown acupoint tapping to be effective in treating a variety of specific anxiety disorders (e.g., Darby & Hartung, 2012; Temple & Mollon, 2011). Two RCTs have shown acupoint tapping to produce statistically significant improvement with public speaking anxiety. Schoninger and Hartung (2010) tracked outcomes after a single TFT session of up to 30 minutes was administered to 48 individuals reporting a fear of public speaking. Participants were randomly assigned to a treatment group or a delayed treatment group. Global scores on both a standardized public speaking anxiety self-inventory and a standardized trait and state anxiety self-inventory improved at the .0005 level both pre/post treatment and between groups. Test scores for the treatment group showed significantly less shyness, confusion, physiological activity, and post-speech anxiety, as well as increased sense of poise, positive anticipation, and interest in giving a future speech. On follow-up interviews four months later, the treatment outcomes appeared to have held, according to participant accounts, with more effective self-expression in varying contexts frequently being reported, though standardized instruments were not administered. A subsequent investigation randomly assigned 36 subjects who reported anxiety when speaking in front of a group to a wait-list condition or a 45-minute EFT session (Jones, Thornton, & Andrews, 2011). The treatment group showed statistically significant decreases on standardized checklists for public speaking anxiety, communication apprehension, and trait and state anxiety as well as a significant decrease in indicators of anxiety on an observer behavioral checklist.

Test-Taking Anxiety. The academic performance and self-esteem of approximately one college student in three is negatively impacted by test-taking anxiety (Rubino, in press). Two RCTs have examined the effects of EFT on test-taking anxiety. Sezgin and Özcan (2009) compared two self-applied treatments for test-taking anxiety with high school students preparing for a university entrance exam in Turkey. Seventy of 312 students, whose scores on a standardized test-taking anxiety inventory met the selection criteria, were randomly assigned to an EFT group or a progressive relaxation group and taught how to self-apply the procedure at home. The students were asked to use EFT or progressive muscle relaxation three times per week for the following two months, particularly at times when feeling anxiety about the test. The test taking anxiety inventory was then re-administered (still prior to taking the entrance exam). Both groups showed a significant improvement in scores on the inventory, but the improvement for the EFT group (mean pre-treatment score of 53.9 decreased to 33.9) was significantly greater than the decrease (56.3 to 44.9) for the relaxation group (p < .05). Rubino (in press) randomly assigned 150 college students to an EFT group, a diaphragmatic breathing with imaginal exposure group, or a wait-list group. Both treatment groups significantly improved on standardized pre/post test-taking anxiety inventories in comparison to the control group. Another investigation of test-taking anxiety, a small pilot study using two standardized pre/post treatment inventories, showed acupoint tapping to attain in two sessions benefits that required five sessions of CBT (Benor, Ledger, Toussaint, Hett, & Zaccaro, 2009).

Depression, Generalized Anxiety, and other Psychological Symptoms. Brattberg (2008), investigating EFT outcomes with fibromyalgia, and Karatzias et al. (2011), investigating EFT outcomes with PTSD, both used the Hospital Anxiety and Depression Scale and found highly significant pre/post-treatment improvement on both anxiety and depression. An RCT investigating the use of EFT in treating depressed college students (Church, De Asis, & Brooks, in press) showed that after four 90-minute group sessions, average scores on the Beck Depression Inventory went from well into the range of moderate depression (23.4) down to well below the depression cutoff (6.1). The strong statistical significance and large effect size in this study corroborate a series of uncontrolled studies tracking reductions in depression and other measures following group EFT treatments. surprising finding reported by Rowe (2005), for instance, was that attending an EFT workshop produced significant, lasting reductions in the severity of participants’ psychological symptoms as measured on a standardized self-report.


Rowe used the Derogatis Symptom Checklist (short form, the SA-45) to measure global changes

in psychological functioning after participation in an 18-hour weekend EFT workshop where participants self-applied the method as a way of learning it. The SA-45 was administered to 102 participants one month prior to the workshop, at the start of the workshop, at the end of the workshop, one month after the workshop, and six months after the workshop. A highly significant decrease (p < .0005) was found from pre-workshop to post-workshop on all the SA-45 measures of psychological distress (depression, anxiety, obsessive-compulsive, somatization, hostility, paranoia, interpersonal sensitivity, phobic anxiety, and psychoticism). The lowered distress scores persisted at the six-month follow-up. Subsequent studies by Church and Brooks (2010) and Palmer-Hoffman and Brooks (2011) that built on this design supported and expanded Rowe’s findings. Church and Brooks (2010) administered the SA-45 to 216 health care workers at five separate conferences. Each participated, as part of the conference, in a four-hour EFT workshop that included two hours of training and two hours of self-application. As with Rowe, the pre/post test differences were highly significant (p < .001) for all nine SA-45 symptom scales as well as on a global severity index. Also, as with Rowe, most of the improvements held on follow-up. Palmer-Hoffman and Brooks (2011) administered the SA-45 to the participants in four additional EFT workshops (n = 207), each led by a different practitioner, and also found strong pre/post differences immediately after the workshop (p < .001) and on follow-up. A feature of their study was that, unlike Rowe (2005) and Church and Brooks (2010), the founder of EFT, Gary Craig, did not conduct any of the workshops, so the effects were independent of the founder’s direct influence.

Pain and Physical Illness. Given increasing recognition of the role of emotional factors in pain and illness (Porcelli & Sonino, 2007), acupoint stimulation has been applied with a wide range of 
physical conditions. For instance, some 270 case reports of EFT successfully reducing
physical pain are described on http://www.EFTUniverse.com (retrieved December 12, 2011). Five peer-reviewed studies of acupoint stimulation with pain or illness are briefly described here. Twenty-six women diagnosed with fibromyalgia who had been on sick leave for at least three months were taught EFT using an internet-based training program (Brattberg, 2008). They were also provided personal e-mail support but no face-to-face interaction. At the end of the eight  week treatment program, they showed significant improvement, as compared to a wait-list group, in measures including pain, anxiety, depression, vitality, social function, activity level, and performance problems with work due to physical limitations. In a second study, twelve individuals with psoriasis, the most prevalent autoimmune disorder in the United States, participated in a six-hour EFT workshop (Hodge & Jurgens, 2011). Statistically significant improvements were found on pre/post assessments of psoriasis symptoms as well as other health issues and emotional difficulties, including reduced anger, worry, stress, and self-consciousness.

Better sleep, improved relationships, and fewer medical treatments were also reported on three-month follow-up. The Church and Brooks (2010) study of 216 health care workers included a 20-minute sequence using EFT to focus on physical pain. A 68% reduction in self-reported physical pain on an 11-point Likert-type scale was found immediately following the self-applied tapping. Kober et al. (2002) taught paramedics to hold acupoints following minor injuries that nonetheless required that the patient be transported to the hospital. While their investigations did not meet this review’s inclusion criteria because the acupoints were held instead of tapped and did not include other elements of TFT/EFT protocols, they are still instructive. The research team compared treatment outcomes with two randomly assigned control conditions: no-intervention or holding points that are not acupuncture points. Acupoint stimulation resulted in a significantly greater reduction of anxiety (p < .001), pain (p < .001), and elevated heart rate (p < .001) than the other two conditions, and a related team replicated the findings (Lang et al., 2007).

Weight Control. One of three Americans is obese, a condition which leads to heart disease, stroke, type 2 diabetes, and certain types of cancer (Centers for Disease Control and Prevention, 2011). Investigating acupoint tapping to reduce food craving, Stapleton, Sheldon, and Porter (2012) randomized 96 participants into a treatment group that participated in four 2-hour group EFT sessions and a wait-list group. Following treatment, reductions were found in food craving and ability to restrain from cravings (p < .05), which persisted on one-year follow-up along with statistically significant reductions in weight and body mass. Church and Brooks (2010) also included a component on food cravings in their treatment design and reported a surprising 83% pre/post reduction. Elder et al. (2007) investigated the effects of holding selected acupoints in addressing weight regain after successful weight loss in programs at Kaiser Permanente. Again, while holding rather than tapping acupoints did not meet this review’s inclusion criteria, the study is still pertinent. Maintaining weight loss is one of the largest challenges in weight management. Ten hours of treatment were provided over a 12-week period.

The acupoint treatment was followed by minimal weight gain (average of .1 kg) at 24 weeks. This outcome was strongly superior to one of the two comparison treatments (p < .001) and also outperformed the other, though not quite reaching statistical significance (p < .09).

Athletic Performance.
While professional athletes and others concerned with peak
performance are increasingly utilizing acupoint stimulation (46 cases of improved athletic or artistic performance are described on http://ww.EFTUniverse.com, retrieved December 12, 2011), only two controlled trials have been published. In an RCT by Church (2009), 26 high performance (PAC-10) male and female college basketball players were randomly assigned to an experimental group that received a 15-minute EFT session or a control group that received a coaching session of similar duration. Pre- and post-intervention performance was measured on 12 free throws and vertical jump height. The timeframe of treatment and data collection simulated an actual basketball game. On the post-test, vertical jump height had not significantly changed, but players who received the EFT intervention improved an average of 20.8% on free throws while the control group decreased an average of 16.6%, a difference that was significant at the .03 level. In another RCT with athletes, 15 female soccer players in the U.K. were randomly assigned a group EFT session or group coaching with their trainers. The focus for each group was on improving percentages on penalty kicks (“dead-ball” kicks at distance of 13.5 meters from the goal). Improvement in the scores of the players receiving EFT was significantly higher than changes in the scores of the players receiving standard coaching (Llewellyn-Edwards & Llewellyn-Edwards, 2012).