Dawson Church
Editorial
While preparing to submit a new study to a peer-reviewed journal, I had occasion to check a certain fact: The number of papers on Emotional Freedom Techniques (EFT) published in peer-reviewed journals. As I counted up the tally listed on the bibliography at Research.EFTuniverse.com, I was amazed as the number rose higher and higher. There are now over 100 papers listed there. They include randomized controlled trials, outcome studies, review articles and case reports published in peer-reviewed professional journals.
This is a substantial body of research. To perform a single outcome study takes an enormous amount of time, commitment and work. If you’re the first investigator to ask that particular research question, you don’t have history to guide you. Like inventing a weaver’s loom, steam engine, airplane or microscope, you have to work out all the problems inherent in a complex design. Often the first pilot studies performed are as useful in working out research designs as they are at providing preliminary data.
Once designed, your study needs to be reviewed by experts after which you begin recruiting participants. Perhaps your study measures psychological symptoms like anxiety and depression before and after treatment, with at least one follow-up point to determine if any observed effects persisted over time. You then first need to assess your participants, then have them treated, assess them again, and then track them for a period of months. You deal with scheduling conflicts, people who don’t return your phone calls or emails, job promotions and firings, marriages and divorces, relocations, and all the general upheaval that occurs in the lives of your subjects, few of whom realize the importance of the data they’re supplying.
Eventually, after a long hard slog, you have that miraculous result: a pile of data. You then need to analyze it and determine what it means. If you had been treading a well-trodden path, refining a topic with an existing research base, you’d be “standing on the shoulders of giants,” in Thomas Edison’s memorable phrase. At the outset you’d know what you were looking for, and design a study to measure it. If you’re a pioneer, you don’t have much idea what you’ll find. You’re like the ancient Norse mariners who suspected there was a great continent beyond the Atlantic but no maps, instruments or measurements to guide them there.
Once you’ve crunched the numbers, you have to write a paper. Academic papers are written in a jargon baffling to the average reader; an intelligent lay person could read an entire study published in a major journal and be unable to understand its significance or results. In The Structure of Scientific Revolutions, not for nothing does author Thomas Kuhn assert that the entrenchment of a paradigm is marked by the last book that can be read and understood by person who is not an expert in that field (Kuhn, 2012).
After you’ve mastered the jargon, a task as difficult as learning a foreign language fluently, you submit to a journal. There teams of peer reviewers with little knowledge of your specialty will point out every real and imagined flaw in your paper. While it’s relatively easy to get a study of a conventional therapy published, it’s very hard to get one of a novel therapy published.
One of the earliest papers published in Energy Psychology was performed by Harvey Baker PhD of Queens University in New York and his student Linda Siegel. It was a replication of an earlier study, but was carefully designed to account for experimental artifacts, and demonstrate that the excellent results were indeed due to EFT (Baker & Siegel, 2010). After several rejections by conventional journals, Dr Baker gave up, and his important contribution to the literature was not published until after his death.
When I asked one prominent psychiatry professor why she didn’t have her graduate students conduct studies of EFT, she replied with unusual frankness, “Because I want them to be able to get jobs after graduation.” These disincentives mean that endless studies of known efficacious therapies get published, adding to the literature supporting the method, while few studies of novel therapies see the light of day.
I remember how astonished I was when I got the first batch of preliminary results back from Audrey Brooks, PhD, the statistician analyzing the data from one of my first studies. It was a simple pre-post study of healthcare workers who were attending a one-day EFT workshop at a professional conference. They filled out a validated questionnaire measuring psychological symptoms like anxiety and depression before and after the workshop. During the workshop, we also measured their physical pain, and their degree of cravings for foods like chocolate, pastries, candy, alcohol and tobacco.
The preliminary results from the first workshop showed a drop in the breadth and depth of psychological distress of over 40%, p < .05. We went on to collect data from more and more subjects, and when the study was eventually published in the journal Integrative Medicine several years later, we had a total population of 216 participants, and a p of .0001, making it one of the largest studies ever published in the field (Church & Brooks, 2010).
Before obtaining Dr Brooks’s measurements, I could see for myself that participants were benefiting. But the degree by which their symptoms were abating amazed me. We suddenly had numerical measures of the degree of improvement, and statistical estimates of the probability of the results being due to chance. After that study, I began to present EFT with much greater confidence to professional audiences because I had the data to back up my presentations.
The study was relatively easy to conduct because the participants were a “convenience sample” of professionals who’d already signed up for the workshops. Other studies are not so easy. I’ve been involved in several studies that involve recruiting veterans with post traumatic stress disorder (PTSD). One that’s now in peer review took 5 years to accumulate 16 participants. We had to talk to dozens of veterans for every sign-up. Without an institution to fund such work, or a hospital to recruit from, it can take many years to get a simple study completed. Most EFT studies have been performed by the dedicated volunteers of the National Institute for Integrative Healthcare (niih.org), but without the resources of a well-funded institution.
So as I recently added up the total and discovered that in 10 years, we’ve succeeded in conducting and publishing over 100 studies, review articles and case reports, I was pleasantly surprised.
The fact that this body of research now exists has many important implications. It decisively demonstrates that EFT is an “evidence-based” practice. This has allowed us to obtain accreditation as providers of continuing medical education (CME) for doctors (American Medical Association), nurses (American Nurses Credentialing Commission), psychologists (American Psychological Association), and social workers.
This body of research can be shown to a hospital administrator by a therapist who wants to offer EFT to clients within the hospital setting. Several therapists working Veterans Administration clinics and hospitals, for instance, have used it to demonstrate that EFT is an evidence-based practice, and that it’s therefore ethical to offer it to clients.
Existing research can also be used to support a grant application. It is a starting point for new studies being done in institutional settings like universities and hospitals. These are increasingly sophisticated and rigorous, and there are many of them in progress.
Research is also a potent tool to rebut the many vocal critics of EFT and other forms of energy psychology. EFT Universe is home to a large number of case reports written by therapists, coaches, and individuals using EFT for themselves, but these stories are dismissed by critics as “anecdotal” never mind that there are over 5,000 of them. When there were 3 studies of EFT, as was the case a decade ago, critics derided the small number of studies. Even when the number of studies swelled, and study after study replicated the initial results, the critics were unimpressed. The title of one critical paper is “A Larger Swamp is Still a Swamp” (Bakker, 2014).
As the number of papers continues to mount, and then combined into sophisticated meta-analyses and systematic reviews that demonstrate efficacy across a wide range of populations and mental health issues, such arguments become harder to sustain.
The research also allows EFT to be presented to gatekeepers like the editors of the list of validated psychological treatments maintained by Division 12 (Clinical Psychology) of the American Psychological Association. So far, they have successfully excluded therapies they don’t personally favor, like Eye Movement Desensitization and Reprocessing (EMDR).
The Division 12 list was designed to summarize studies that meet the criteria of the Task Force on Empirically Validated Therapies (Chambless & Hollon, 1998). If a study met all seven “essential” criteria, that therapy was considered “probably efficacious” and made the list. A therapy that is validated by an independent replication study is classified as “efficacious.” The initial list was constructed and maintained that way. It provided an impartial set of criteria that were published and stable. It leveled the playing field since proponents of any new therapy could perform the research required to meet these stated criteria.
Unfortunately, that hasn’t happened. The list still excludes the last fifteen years of research into EMDR and EFT. While it gets updated with research into conventional therapies like Prolonged Exposure (PE) and Cognitive Behavior Therapy (CBT) that have been around for decades, new therapies are excluded. EMDR and EFT studies that meet the criteria are excluded; in fact every single EFT study is excluded and EFT appears nowhere on the list. This has precisely the opposite effect of the level playing field envisaged by its original authors.
Yet in time, as evidence continues to mount, the sheer weight of fact will make such elevation of personal preference over scientific merit impossible.
Finally, the large number of EFT studies will make the position of the skeptics increasingly uncomfortable. An informally organized consensus of skeptics controls all the alternative medicine entries on Wikipedia. The first paragraph in the Acupuncture entry, for instance, informs the reader that: “traditional Chinese medicine (TCM)” theory and practice are not based upon scientific knowledge, and acupuncture is described by some as a type of pseudoscience.
You will similarly learn from Wikipedia’s entry for the entire field of energy medicine, including qi gong, healing touch, and Reiki, that these are all branches of pseudoscience. EFT is tarred with the same brush. These Wikipedia editors feature newspaper reports, opinion pieces and review articles attacking the method in the entry for EFT, but censor the posting of any of the more than 100 published studies that support the method. One prominent opponent calls EFT and similar methods possible threats to the science of psychiatry and psychology (Devilly, 2005).
While it’s difficult to conduct and publish research, it’s easy to dismiss it. Skeptics can simply characterize it as “poor quality” or sneer at the journal or author. They need offer no evidence of their own.
This type of opposition can be extraordinarily effective in blocking new treatments. Any new therapy faces an uphill journey to acceptance, since research funding goes to established methods, while a large body of existing professionals are trained in and familiar with these methods. As the old saying goes, “To the man whose only tool is a hammer, every problem looks like a nail.”
This results in a “translational gap,” a very long lag between the discovery of effective new therapies, and their implementation in primary care. According to a US government analysis, the translational gap averages 17 years (Institute of Medicine, 2001). Only 20% of new therapies succeed in crossing what the report calls a “quality chasm”; the benefits of the remaining 80% are forever lost to patients and clients.
However, while skepticism and inertia have been successful in blocking the majority of new treatments, I do not believe that they will succeed in the long run when it comes to energy psychology. The elephant in the room “the body of research evidence” is growing bigger and bigger. It is becoming increasingly difficult to ignore or explain away.
And the people who benefit from these treatments are suffering needlessly in the meantime. When the Vietnam war group is combined with veterans of the recent Middle East Wars, there are over a million veterans suffering from PTSD. Millions of non-veterans also have PTSD triggered by injury or traumatic childhood events. Depression is predicted by the World Health Organization to be the biggest single source of disability within this decade (Moussavi et al., 2007). When effective evidence-based treatments are available, placing barriers between them and suffering people is cruel and unethical.
Energy psychology, with its proven ability to rapidly remediate over 80% of cases of PTSD in six sessions, as well as eliminating phobias and treating anxiety and depression, should be available in primary care. It deserves to be in the front line of treatment. While drugs and conventional therapies have their place in the spectrum of care, therapies that are as effective as EFT should be one of the first remedies offered, rather than an occasional alternative. Safe, effective methods without side effects should be the norm, rather than the exception. As these methods become widespread, they will usher in a revolution in the treatment of mental health.
References
Baker, A. H., & Siegel, L. S. (2010). Emotional Freedom Techniques (EFT) reduces intense fears: A partial replication and extension of Wells, Polglase, Andrews, Carrington, & Baker (2003). Energy Psychology: Theory, Research, and Treatment, 2(2), 13-30. doi:10.9769.EPJ.2010.2.2.AHB
Bakker, G., (2014). A bigger swamp is still a swamp : Comments on Feinstein (2014). Energy Psychology: Theory, Research, and Treatment, 6(1), 44-47.
Chambless, D., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7-18.
Institute of Medicine, Committee on Quality of Health Care in America. (2001) Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. Devilly, G. J. (2005). Power therapies and possible threats to the science of psychology and psychiatry. Australian and New Zealand Journal of Psychiatry, 39, 437-445. doi: 10.1080/j.1440-1614.2005.01601.x
Kuhn, T. S. (2012). The structure of scientific revolutions. University of Chicago press. Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet, 370(9590), 851-858.