By Dawson Church, PhD
Energy Psychology (EP) works spectacularly well at treating certain conditions. It works less well with others, and with still others it is largely ineffective. What general principles can we derive from examining the distinctions between these three groups?
When we hold the conditions for which EP is particularly effective next to the physiological knowledge emerging from neuroscience, what light does it shed on EP’s mechanisms of action, the practical treatment of clients, and the future direction of psychological and neurological research.
Such a dialog between physiology, outcome studies, and clinical observation can accelerate the advancement of knowledge in all three endeavors.
First, what is Energy Psychology (EP) best at treating, and why? Studies show that EP is a reliable one-session treatment for phobias. Three randomized controlled trials of Emotional Freedom Techniques (EFT) for phobias have now been published.
The American Psychological Association (APA) has published standards for “empirically validated treatments” drawn up by the Division 12 (Clinical Psychology) Task Force.
These standards state that to qualify as an efficacious treatment, a therapy must have demonstrated efficacy greater than no treatment, or an active control, in at least two randomized controlled trials (RCTs), conducted by independent research teams, and published in peer-reviewed journals. For a treatment to be considered “probably efficacious,” it must be better than a wait list in two studies that meet these criteria or are conducted by the same research team.
The first RCT showing that EFT can successfully treat phobias in a single session, and that participants maintain their gains over time, was published in the Journal of Clinical Psychology in 2003 (Wells, Polglase, Andrews, Carrington, & Baker, 2003). A replication was published in the journal Explore in 2011, and an extension, carefully controlled for experimental artifacts that might have influenced the results, was published in Energy Psychology in 2010.
This extension controlled for expectancy effects, regression to the mean, and other effects nonspecific to treatment. With three RCTs in place, EFT thus meets and exceeds APA Task Force standards as an “efficacious” treatment for phobias.
EFT is equally effective for clinical posttraumatic stress disorder (PTSD) symptoms in between four and 15 sessions of treatment. An RCT performed by a hospital in Britain’s National Health Service comparing EFT to eye movement desensitization and reprocessing (EMDR) and published in the oldest peer-reviewed psychology journal, showed EFT and EMDR to be equally effective in four sessions (Karatzias et al., 2011).
Another RCT comparing EFT to a wait list showed that after six sessions, 86% of veterans with clinical levels of PTSD symptoms were subclinical and that they maintained their gains on 3- and 6-month follow-up (Stein & Brooks, 2011). Other outcome studies of EFT for PTSD demonstrated similar results. EFT has therefore also been shown to be “efficacious” for PTSD by APA standards.
All of the above studies gathered data on anxiety and depression in addition to the targeted mental health condition such as phobias or PTSD. Without exception, they found statistically significant reductions, not only in anxiety and depression but also in the depth and breadth of psychological conditions.
Research into the application of EP for physical health has yielded further clues about the extent of EP’s efficacy.
A large hospital chain, Kaiser Permanente, has now performed two studies of Tapas Acupressure Technique (TAT) for weight loss and found that TAT can help patients who lose a great deal of weight maintain their gains over time if they use EP (Elder et al., 2007). An RCT of EFT for weight loss found that EFT reduced physical cravings, which leads over time to weight loss, and maintained that improvement at 6- and 12-month follow-up (Stapleton, Sheldon, Porter, & Whitty, 2011).
EFT’s efficacy for autoimmune diseases and pain has been investigated in several studies.
An RCT of EFT for fibromyalgia found significant improvement in symptoms (Brattberg, 2007), as did an open pilot study of EFT for psoriasis (Hodge, 2011). The RCT of EFT for PTSD found significant drops in pain, as did a large-scale open trial (Church & Brooks, 2010).
Researchers in one RCT compared cortisol levels in subjects receiving either psychotherapy, EFT, or no treatment (Church, Yount, & Brooks, 2011). They found that in addition to very large improvements in psychological symptoms such as anxiety and depression, EFT produced statistically significant reductions in cortisol levels compared with the other two groups.
This study ties together psychological and physical symptoms. It is part of a growing body of literature showing that as psychological stress is remediated, physiological stress biochemistry is positively affected.
Several review papers have described the possible physiological mechanisms of action of EP interventions. They have surveyed the scientific literature showing the link between emotion, memory, and physiology. They have reviewed studies showing that the expression of the genes that code for stress hormones like cortisol are upregulated by emotional trauma and downregulated by successful psychotherapy and EFT (Feinstein & Church, 2010).
Lane (2009) tracked the way EP counterconditions old conditioned responses, breaking the neurological feedback loops previously held in place by repetitive traumatic thoughts. Hoss (2010) examined many brain imaging studies to identify how the brain’s threat-assessment machinery is regulated by EP.
When a traumatic event occurs, it is vividly encoded in the brain.
When that event is subsequently recalled, however, it may be modified. The old model portrayed memory retrieval as similar to pulling photographs out of an album, looking at them, and putting them back unchanged. More recent research has shown that memories are more labile than previously believed. When recalled, memories may be “put back in the album” tagged with proximate cues from the present (LeDoux, 2002).
EFT studies have shown that after treatment, when subjects recall the events that used to trigger big emotional reactions, they are now calm. The memory appears to have been reconsolidated with the self-soothing emotional tags generated by tapping. War veterans receiving EFT treatments bring lists of old memories to each treatment session and tap on the list systematically until the intensity of each one is gone (www.StressProject.org).
These studies tell us what EP is good at treating. Where does it fail?
Although there is, unfortunately, no research that delineates these conditions, clinicians have reported limited success with a number of common medical and psychological problems. One of these is tinnitus, a medical condition characterized by a distracting constant ringing tone in a patient’s ears. Although there have been a few anecdotal reports of success using EFT for tinnitus on the EFT case history archive (www.EFTuniverse.com), there are many more accounts of failure by even the best practitioners.
Although EFT is certainly successful for pain, with a mean drop of 68% in 20 min in self-reported pain (Church & Brooks, 2010), the last 30% often stubbornly resists remediation. One hypothesis is that the two thirds of pain that typically vanishes after EFT is the psychological portion of the pain, whereas the other third represents organic pain.
Pain can be compounded by psychological factors such as negative self-talk: “I was so stupid to fall and twist my ankle” or “I should never have been driving that day” or “I was so angry with Harry when I was cutting those vegetables and the knife slipped” or “I have two left feet” and similar messages.
EFT might successfully remove the emotional charge from such subjective statements, but the sting of the objective physical pain remains. Such pain, like tinnitus, might be a purely organic problem, not compounded by an overlay of psychological aspects or susceptible to remediation by psychological means.
The limitation of EFT for certain physical symptoms should not be construed as a reason against trying it. Published studies have noted an absence of adverse events and rapid reduction of client distress; EFT is notable for the rarity of reports of abreactions (Flint, Lammers, & Mitnick, 2005; Mollon, 2007).
So even if futile, it is unlikely that it can harm. Further, although EFT produces only a mean 68% reduction rather than a 100% reduction in pain, few pain patients will quibble when offered a self-applied, drug-free behavioral intervention that removes two thirds of their pain in 20 min. Also, reducing the physical symptoms even slightly might undercut the patterns driving a patient out of a state of health.
This can nudge the body back toward recreating homeostasis in the way removing a few logs from a logjam enables the river to dislodge the remaining logs. Many of the case histories on the EFT website are of precisely this nature. In one case, a visibly depressed 22-year-old woman with a 20-year history of rheumatoid arthritis in three sites in her body was pain free in two of the sites after an EFT session. She said she associated the remaining pain with “safety” and was unable to let it go.
The following day, however, she appeared radiant and reported that she was pain free. Just because EFT is not always able to remove all symptoms does not mean that limited symptom reduction cannot be worthwhile. Yet EFT’s success with some symptoms should not lead to it being considered a panacea; its limitations should be admitted and respected by practitioners.
Beyond physical ailments, there are psychological arenas in which EP appears to have limited success.
One such area is early childhood traumas. EFT is strongly dependent on the client’s ability to recall specific events, and much EFT training is focused on recalling and treating emotionally traumatic specific events.
What happens when the events occurred during a client’s infancy before conscious memories formed? How can you find specific events when the trauma was laid down in the womb when adverse experiences affected the mother and were passed to the fetus?
It is now understood that many neurotransmitters and hormones pass through the placenta from the mother’s body to that of the child. When an adverse event triggers an adrenaline and cortisol spike in the mother, the fetus experiences this wave of stress biochemistry within the womb.
We can speculate that the fetus might, in some sense, “feel bad” and report unease in later life; however, it is virtually impossible for a client to capture a specific memory in such cases. The EFT protocol in the above PTSD studies involved the clients listing traumatic memories and tapping on them one by one. This approach cannot be successful with traumas that occur in early childhood or in utero.
Clinicians practicing EFT have also reported difficulty dealing with cases of dissociation. Dissociation is useful and adaptive for a young child in a violent household. Dependent for his or her survival on troubled caregivers, such a child may dissociate as a way of surviving to a later age. Emotions are stuffed into shadow to enable the child to function for the time being.
Although such dissociation might serve an adaptive function at that particular life stage, by the time the child becomes an adult the same behavior become a liability, cutting the person off from his or her feelings and rendering the adult tasks of assimilating and processing emotional events difficult. The EFT practitioner delving for specific events is blocked by the client’s long-standing habit of dissociation.
The clinical outcome can be frustrating for both client and practitioner, with both sincerely seeking events to treat but unable to find any. EFT has suggestions for such cases, such as “just guess” or “make it up” (Craig, 2011), and these are sometimes successful, but the dissociative client is rarely able to make the same progress as one with a lifelong habit of contact with his or her affective states.
Therapists working with clients suffering from dissociative identity disorder have reported success with the anxiety clients feel at the anticipation of personality shift but not with the underlying psychopathology itself.
Some clinicians have argued that borderline personality disorder (BPD) might in fact be early childhood PTSD (van der Kolk, 1989). BPD is also reported by many clinicians to be resistant to treatment with EFT, which reinforces the suspicion that a different approach may be required when emotional distress was experienced early.
Some progressive psychologists have reported success with attachment disorders using a novel EFT protocol. Rather than digging for childhood events emblematic of poor attachment, they use the safety of the office setting to evoke and process client distress.
The client is encouraged to project his or her emotions onto the therapist while tapping.
As EFT produces a reduction of distress, the client then projects a new emotion onto the therapist, over and over again, until a whole group of troubling emotions has been processed. The process looks similar to the way a nondissociative client works through his or her list of specific events, tapping on each one till the emotional intensity is gone, then moving on to the next. Novel protocols such as projection onto the therapist while tapping require proper mental health training and experience.
For this reason, an RCT that compared the PTSD outcomes of veterans receiving coaching is instructive.
Veterans received EFT from either a licensed mental health practitioner or a life coach (Stein & Brooks, 2011). Large drops in symptoms were noted in both groups of clients. However, the symptom reduction was larger in the group treated by licensed professionals than in those treated by life coaches.
Though the difference was not statistically significant (p = .48), it was clinically significant (90% vs. 83% symptom reduction). This suggests that the higher level of mental health training, and larger assortment of clinical techniques possessed by the licensed practitioners, produced a better outcome than did EFT when applied by unlicensed coaches.
Experienced licensed providers may have experience working with preconscious childhood traumas, whereas life coaches usually do not. Psychopathology is best left to the practitioners within whose scope of practice it lies.
EP research is in its infancy and many questions remain to be answered, but the outline emerging from these early studies suggests that EP is very effective for psychological problems that involve episodic memory. PTSD clients tap through memory after memory, report a reduction in emotional distress, and are stable on follow-up, indicating that the triggering aspect of the memory has been permanently extinguished.
Phobic clients recall each detail of a phobia and tap on them till their distress is gone. EP may be less effective for psychological problems not linked to specific memories and for physical problems that are organically based. Existing studies have focused on outcomes, measured against the APA Task Force criteria.
This data is now enabling researchers to ask more sophisticated questions, facilitating the design of a new group of studies that will examine the biological changes occurring during EP treatments, investigate why EP is better at treating some conditions than others, and discover which elements of EP are responsible for its efficacy.
From these, robust clinical practice guidelines may emerge to make a contribution to both the mental health field and the treatment of autoimmune diseases that test the limits of the conventional biomedical model.
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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, 10(4), 40-44.
Church, D., Yount, G., & Brooks, A. J. (2011). The effect of Emotional Freedom Techniques (EFT) on stress biochemistry: A randomized controlled trial. Manuscript submitted for publication.
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