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Etude efficacité EFT (1) .pdf



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Titre: Clinical EFT as an Evidence-Based Practice for the Treatment of Psychological and Physiological Conditions
Auteur: Dawson Church

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Psychology
2013. Vol.4, No.8, 645-654
Published Online August 2013 in SciRes (http://www.scirp.org/journal/psych)

http://dx.doi.org/10.4236/psych.2013.48092

Clinical EFT as an Evidence-Based Practice for the
Treatment of Psychological and
Physiological Conditions
Dawson Church
National Institute for Integrative Healthcare, Fulton, USA
Email: dawsonchurch@gmail.com
Received May 24th, 2013; revised July 5th, 2013; accepted July 15th, 2013
Copyright © 2013 Dawson Church. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.

Emotional Freedom Techniques (EFT) has moved in the past two decades from a fringe therapy to widespread professional acceptance. This paper defines Clinical EFT, the method validated in many research
studies, and shows it to be an “evidence-based” practice. It describes standards by which therapies may be
evaluated, such as those of the American Psychological Association (APA) Division 12 Task Force, and
reviews the studies showing that Clinical EFT meets these criteria. Several research domains are discussed, summarizing studies of: 1) psychological conditions such as anxiety, depression, phobias, and
posttraumatic stress disorder (PTSD); 2) physiological problems such as pain and autoimmune conditions; 3) professional and sports performance; and 4) the physiological mechanisms of action of Clinical
EFT. The paper lists the conclusions that may be drawn from this body of evidence, which includes 23
randomized controlled trials and 17 within-subjects studies. The three essential ingredients of Clinical
EFT are described: exposure, cognitive shift, and acupressure. The latter is shown to be an essential ingredient in EFT’s efficacy, and not merely a placebo. New evidence from emerging fields such as epigenetics, neural plasticity, psychoneuroimmunology, and evolutionary biology confirms the central link
between emotion and physiology, and points to somatic stimulation as the element common to emerging
psychotherapeutic methods. The paper outlines the next steps in EFT research, such as smartphone-based
data gathering, large-scale group therapy, and the use of biomarkers. It concludes that Clinical EFT is a
stable and mature method with an extensive evidence base. These characteristics have led to growing acceptance in primary care settings as a safe, rapid, reliable, and effective treatment for both psychological
and medical diagnoses.
Keywords: Research; Evidence-Based; Emotional Freedom Techniques; EFT; Exposure; Cognitive
Therapy; Acupressure; Placebo

Introduction

The Need for a Definition of Clinical EFT

Emotional Freedom Techniques (EFT; Craig, 2010) has
moved in the past two decades from a novel intervention derived from Thought Field Therapy (TFT; Callahan, 2001) to an
“evidence-based” practice in its own right. Evidence-based
practices are methods that meet formally established criteria for
efficacy (Melnyk & Fineout-Overholt, 2005; Beautler, Norcross,
& Beutler, 2005). There are several organizations that define
and publish such standards. One of these is the US government’s Food and Drug Administration (FDA; Food and Drug
Administration, 1998). Another is the UK government’s National Institute for Clinical Excellence (NICE; National Institute for Clinical Excellence, 2009). The most influential set of
standards in the field of psychology is the one published by the
Task Force on Empirically Validated Treatments set up by
Division 12 (Clinical Psychology) of the American Psychological Association (APA; Chambless et al., 1996, 1998; Chambless & Hollon, 1998). For convenience these are referred to as
“APA” standards.

Millions of people worldwide are engaged with EFT. A
Google Analytics search showed that in June 2013, 9,143,300
individuals searched for “tapping,” “EFT,” and related terms
such as “EFT therapy” (Google Trends, 2013). Analysis of visitors to the five most-visited EFT web sites shows 6,965,000
unique visitors in that same month (Traffic Estimate, 2013). As
of 2013 over 2 million individuals had downloaded from the
Internet The EFT Manual (Craig & Fowlie, 1995) or The EFT
Mini-Manual (Church, 2013). Thousands of videos made by
hundreds of different individuals appear on YouTube, social
networking sites, and individual websites, attesting to the popularity of the method as well as practitioners’ conviction of its
efficacy.
This proliferation of sources offering EFT presents both challenges and opportunities. Many of these sources offer variants
of EFT. A few sources present the original EFT method as detailed in the manual (Craig, 2010; Church, 2013a). Others present methods that share only a name with EFT while being

Copyright © 2013 SciRes.

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D. CHURCH

devoid of an accurate description of any of its methods. The
remainder are found somewhere on a spectrum between the two
extremes. Tangentially, many variants of EFT have been developed by others, and there are even variants on the variants
(Feinstein, 2009).
This crowded field of candidates has led to the question of
what, exactly, is EFT? This paper seeks to answer that question.
To facilitate review, this paper uses the term “Clinical EFT”
defined as follows: “Clinical EFT is the ‘evidence-based’ method that has been validated in research studies that meet APA
standards.” These studies typically use a manual, The EFT
Manual (Craig, 2010; Church, 2013a), which ensures that the
method as tested in one study is the same method being tested
in another study. The studies typically apply EFT with fidelity
to the method described in the manual, and many studies describe methods of testing therapist fidelity to the method.
Training of practitioners is expected to adhere to the method as
described in the manual, and as demonstrated in research.
Clinical EFT identifies 48 distinct techniques described in the
manual and supplementary materials (www.ClinicalEFT.com).

APA Standards, Fidelity, and Implementation
The APA standards were developed in a series of papers
(Chambless et al., 1996; Chambless et al., 1998, Chambless &
Hollon, 1998). Methods demonstrating efficacy according to
certain criteria, such as two high-quality studies performed by
independent investigators finding the method statistically superior to a placebo or another method, are said to be “efficacious.” Methods that meet lesser standards are classified as
“probably efficacious.”
The APA standards may be summarized as comprising seven
essential criteria (Energy Psychology Journal, 2012). Studies
cannot be measured in order to determine if the method under
investigation is “empirically validated” unless they meet all
seven. Chambless & Hollon (1998) also list additional criteria
that may be divided into two further gradations: “highly desirable” and “desirable” (Energy Psychology Journal, 2012). The
seven essential criteria are:
1) Randomized controlled trials (RCTs)—subjects were
randomly assigned to the treatment of interest condition or to
one or more comparison conditions.
2) Adequate sample size to detect statistically significant (p
< .05 or better) differences between the treatment of interest
and the comparison condition(s) were used.
3) The population for which the treatment was designed
and tested must be clearly defined through the use of diagnosis by qualified clinicians, through cutoff scores on questionnaires that are reliable and valid, through interviews identifying
the focus of the study’s interest, or through some combination
of these.
4) Assessment tools must have demonstrated reliability and
validity in previous research.
5) Any interview assessments were made by interviewers
who were blind to group assignment.
6) Treatment manuals that make clear the nature of the
treatment being tested were used. If the treatment was relatively simple, it could be described in the procedure section of
the journal article presenting the experiment, in lieu of a treatment manual.
7) The paper reporting the study provided enough data that
the study’s conclusions can be reviewed for appropriateness,

646

including sample sizes, use of instruments that detect changes
targeted by the study’s design, and magnitude of statistical
significance.
Studies of efficacious or probably efficacious therapies are
required to demonstrate “statistically significant” results, meaning that there is less than 1 possibility in 20 that the results are
due to chance (Criterion #2). This meaning of the word “significance” as in “demonstrating statistically significant results”
is expressed in research statistics as p < .05, or a probability of
20% (i.e., .05) that the results are due to chance. The term
“highly significant” is often used to refer to studies with outcomes showing that there is less than 1 possibility in 1000 that
the results are due to chance, or p < .001.
These APA criteria then are a stable, defined, published set
of standards by which the efficacy of a therapeutic technique
may be judged. When that technique is then translated into
training, certification, and clinical practice, these criteria provide reasonable assurance that the method as practiced in the
field is the method that has been validated in research.

EFT as an Empirically Validated Treatment
Having defined Clinical EFT and identified the set of standards upon which measurement of efficacy is based, we can
now examine the evidence base that supports the efficacy of
EFT. For this report, a literature search for English-language
papers was performed using MEDLINE/PubMed, PsycINFO,
Google Scholar, and references from the retrieved papers. Papers “in press” were obtained from professional organizations
in the field. The search is current through May of 2013. Chronologically, the earliest group of EFT studies performed were
outcome studies that asked the question, “Are participants better off after treatment?” Outcome studies of Clinical EFT can
be grouped into three primary categories. These examine efficacy for:
 Psychological conditions such as PTSD, phobias, depression, and anxiety;
 Physiological problems such as pain and autoimmune conditions;
 Performance in sports, business, and academic pursuits.
This paper also summarizes the key research on the physiological mechanisms of action of Clinical EFT, showing how
EFT works in the body to effect change. These studies, rather
than measuring whether treatment benefits patients, ask the
questions characteristic of basic science, such as “How does
this treatment work?” and “What is going on in the body as a
result of this treatment?” The final group of studies reviewed
investigate EFT’s application to performance issues such as
public speaking anxiety as well as sports performance. We will
also investigate whether EFT’s somatic component, tapping
with the fingertips on acupressure points, is an inert placebo or
an active ingredient in the results obtained. Finally, we will
derive the meaning of this whole body of work and extend it to
show the next steps in EFT research, such as data gathering via
smartphone apps, patient tolerance trials, large group studies,
and EFTs application in primary care settings.

Psychological Health Outcome Studies
Clinical EFT has met APA standards as an “efficacious” or
“probably efficacious” treatment for a number of conditions,
including anxiety, depression, phobias, and PTSD (Feinstein,
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D. CHURCH

2012). Since RCTs are regarded as the Gold Standard of research, and are the type of experimental design usually used to
evaluate a therapy against APA standards, only RCTs are listed
in this section on mental health outcomes. There have been
many other studies of EFT for these mental health conditions
that were not RCTs, and some of these are referenced outside of
this section on psychological health.
Anxiety. EFT has shown efficacy in several RCTs of anxiety.
In one study, students with fear of public speaking received a
45-minute EFT session and improved significantly (Jones,
Thornton, & Andrews, 2011). In another, high school students
with test anxiety were evaluated before their university entrance
exams (Sezgin & Özcan, 2009). Those who learned EFT improved significantly. A control group was taught progressive
muscular relaxation. The improvement in the EFT group was
significantly greater than that of the control group.
Other studies have also shown statistically significant reductions in anxiety in a variety of populations. A study of fibromyalgia sufferers found significant improvements in anxiety
(Brattberg, 2008), as have studies of veterans and hospital patients with PTSD (Church, 2013b; Karatzias et al., 2011). An
RCT of university students with test anxiety found significant
improvements after both EFT and diaphragmatic breathing (DB)
following EFT treatments (Jain & Rubino, 2012). EFT was
compared to cognitive behavioral therapy (CBT) in an RCT
with female trauma survivors in the Congo (Nemiro, 2013).
EFT was found to be as efficacious as CBT in reducing symptoms of anxiety, depression, and PTSD.
Three studies of anxiety fail to meet one or more APA standards. An RCT of psychological conditions in participants in a
weight loss program found reductions in anxiety that closely
approached significance (p < .053) but did not meet the required p < .05 threshold (APA criterion #2; Stapleton, Church,
Sheldon, Porter, & Carlopio, 2013). Benor, Ledger, Toussaint,
Hett, and Zaccaro (2010) found significant reductions in anxiety in university students, but class scheduling conflicts among
participants prevented true randomization (APA criterion #1).
Waite and Holder (2003) compared EFT to two sham tapping
interventions and a non-tapping control group. However, the
RCT failed to use valid and reliable assessments (APA Criterion #4), failed to apply EFT with fidelity to the manual (APA
criterion #6), and failed to recognize that the “sham” points
selected by the investigators were in fact actual acupressure
points (APA criterion #6). These errors resulted in all three
tapping groups improving relative to the non-tapping group.
Depression. RCTs in which depression was measured before
and after EFT have demonstrated large drops in depressive
symptoms. A study examining college students with high levels
of depression (“clinical” depression as measured by the Beck
Depression Inventory) found that they were in the “normal”
range after EFT (Church, De Asis, & Brooks, 2012). The fibromyalgia study also found significant improvements in depression (Brattberg, 2008), as did the studies of hospital patients and veterans with PTSD (Karatzias et al., 2011; Church,
2013b). An RCT of weight loss program participants also found
significant reductions in depressive symptoms (Stapleton,
Church, Sheldon, Porter, & Carlopio, 2013). The study of Congolese female trauma survivors also found EFT to be efficacious for depression when compared to CBT (Nemiro, 2013).
Phobias. Three RCTs have examined the effects of EFT on
phobias and found that a single session is usually enough to
resolve a phobia (Wells, Polglase, Andrews, & Carrington,
Copyright © 2013 SciRes.

2003; Baker & Siegel, 2010; Salas, Brooks, & Rowe, 2011).
All three studies included a follow-up period and found that the
phobic responses of participants remained significantly lower
than before treatment.
PTSD. EFT has been studied as a treatment for clinical
PTSD in three RCTs. One, in a population of 59 war veterans,
found that PTSD symptoms dropped into the “normal” range
after six sessions of EFT and remained that way on follow-up
(Church et al., 2013). A hospital in Britain’s National Health
Service (NHS) compared EFT to another efficacious treatment,
Eye Movement Desensitization and Reprocessing (EMDR), and
found that both treatments normalized PTSD in an average of
four sessions (Karatzias et al., 2011). An RCT of abused male
teenagers found, on follow-up, that their PTSD symptoms had
been resolved in a single EFT session (Church, Piña, Reategui,
& Brooks, 2011). When EFT was taught to groups of Congolese women with PTSD, EFT’s efficacy was found to be comparable to that of CBT (Nemiro, 2013). As with most PTSD
studies, Nemiro (2013) used the PTSD Checklist or PCL to
evaluate symptoms (Ruggiero, Del Ben, Scotti, & Rabalais,
2003). Studies with veterans usually use the military version of
the same instrument, the PCL-M (Weathers, Huska, & Keane,
1991).
Data from Church et al. (2013) were analyzed to determine if
telephone sessions produced the same symptom reductions as
office visits (Hartung & Stein, 2012). While 67% of veterans
were subclinical after phone sessions, a significantly larger
percentage of the sample recovered after office sessions. A
further substudy based on Church et al. (2013) examined the
performance of life coaches compared to licensed mental health
professionals (Stein & Brooks, 2011). It found larger reductions
in symptoms in veterans treated by licensed practitioners,
though the difference did not rise to the level of statistical significance. These analyses indicate the utility of EFT when delivered over the telephone, and by practitioners with very basic
levels of training.

Physiological Issues: Pain, Weight Loss, Cravings,
and Physical Symptoms
The studies of EFT for physical symptoms include a range of
experimental designs, with both RCTs and studies without a
control group (“uncontrolled” studies). The latter “within-subjects” studies use subjects as their own controls, comparing
their symptom levels before and after EFT.
Pain and physical symptoms. Veterans were found to experience significant drops in physical pain after EFT (Church,
2013b), as were fibromyalgia sufferers (Brattberg, 2008). When
PTSD symptoms were remediated in veterans, symptoms of
traumatic brain injury (TBI) were reduced by 41% (p < .0021;
Church & Palmer-Hoffman, 2013). An RCT of patients with
tension headaches performed at the Red Cross Hospital in Athens found that the frequency and intensity of their headaches
dropped by more than half after EFT, and other physical symptoms improved (p < .001; Bougea et al., 2013). Uncontrolled
studies and case reports showed improvement in a variety of
conditions.
One study examined symptoms in 216 health care workers
such as doctors, nurses, chiropractors, psychotherapists, and
alternative medicine practitioners who attended a one-day EFT
workshop at one of five professional conferences (Church &
Brooks, 2010). They experienced a 68% drop in physical pain
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D. CHURCH

(p < .001). Though this was an uncontrolled study, it examined
the five different groups separately, making it, in effect, five
small studies. In addition, EFT was delivered by two different
practitioners. Despite these disparities, all five groups showed
similar results.
EFT was adopted by a clinic in Britain’s NHS, which performed a “service evaluation” in order to determine the acceptance of EFT by patients and its success in reducing symptoms.
This study found a significant improvement in anxiety, with a
mean treatment time frame of eight sessions. It also found a
significant improvement in overall psychological health and
physical functioning (Stewart et al., 2013).
A pilot study of psoriasis symptoms also showed improvement in skin problems (Hodge & Jurgens, 2011). Other authors
report success with victims of motor accidents (Burk, 2010),
dyslexia (McCallion, 2012), seizure disorders (Swingle, 2010),
and TBI (Craig, Bach, Groesbeck, & Benor, 2009).
Three studies have examined the effect on insomnia after
EFT. The veterans PTSD study referenced above (Church et al.,
2013) found a significant improvement in insomnia scores, with
mean values dropping from the clinical range to the subclinical
range (p < .001). A pilot study of 10 geriatric patients with
insomnia noted a similar reduction in insomnia, along with
decreases in anxiety and depression, and an increase in life
satisfaction (Lee, Suh, Chung, & Kim, 2011). This led to an
RCT conducted with 20 participants that compared EFT to an
active control, Sleep Hygiene Education (Lee & Kim, 2013). It
demonstrated significant reductions in depression and insomnia.
Insomnia is related to stress and to the regulation of the autonomic nervous system; the improvements found in these studies
demonstrate the association between a reduction in stress symptoms and decreases in insomnia.
Weight loss and cravings. Studies have examined the use of
EFT for weight loss and food cravings. An RCT found that
EFT improved restraint (Stapleton, Sheldon, Porter, & Whitty,
2011) and that, in the year following an EFT weight loss program, participants lost an average of 11.1 pounds (Stapleton,
Sheldon, & Porter, 2012). An uncontrolled study of clients in a
6-week online weight loss program found a 12-pound weight
reduction during the 6 weeks of the program, followed by a
further 3-pound drop in the ensuing 6 months (p < .001; Church
& Wilde, 2013). In the health care workers study (Church &
Brooks, 2010) summarized previously, cravings for substances
such as chocolate, sweets, and alcohol were reduced by 83% (p
< .001). Group application of EFT was also found to reduce
psychological symptoms such as anxiety in a group self-identified with addiction issues (Church & Brooks, 2013b). A review
found that EFT could also be useful as an adjunctive therapy
for weight loss (Sojcher, Perlman, & Fogerite, 2012).

Sports and Professional Performance
Mental health studies usually measure reductions in conditions such as anxiety, depression, and PTSD. They typically use
reliable and valid assessments, such as the Beck Depression
Inventory (BDI; Beck, Steer, & Carbin, 1988), the Beck Anxiety Inventory (BAI; Fydrich, Dowdall, & Chambless, 1992),
the Fear Questionnaire (FQ; Mavissakalian, 1986), or the Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith,
1983), as called for in APA standards, to measure symptom
levels before and after treatment, to determine if they decrease.
The focus of performance studies is different. They take indi648

viduals who are already performing at a certain level, and seek
to determine if their level of performance can be increased.
Rather than a decrease in, for example, anxiety, they seek to
measure an increase in, for example, confidence.
Two RCTs have examined EFT’s efficacy for sports performance. One measured the difference in basketball free throw
percentages between an EFT and a placebo control group and
found a performance difference of 38% after a brief session
(Church, 2009; Baker, 2010). Another found similar benefits
for soccer free kicks (Llewellyn-Edwards & Llewellyn-Edwards, 2012). A case study of golf performance found stressrelated errors decreasing after EFT (Rotherham, Maynard, Thomas, Bawden, & Francis, 2012). A 20-minute EFT session was
found to increase confidence and decrease anxiety in an uncontrolled study of female college-aged athletes (Church & Downs,
2012).
Several studies summarized in the previous paragraphs examined the application of EFT to professional performance
issues such as public speaking anxiety and test anxiety, and
found improvements (Jones, Thornton, & Andrews, 2011; Sezgin & Özcan, 2009; Benor et al., 2009). Fox and Malinowski
(2013) examined positive and negative emotions relating to
academic study in a population of undergraduates, and found
significant increases in enjoyment and hope, and decreases in
anger and shame. The NHS service evaluation performed by
Stewart et al. (2013) examined patient self-esteem using the
Rosenberg Self-Esteem Scale (Rosenberg, 1989) and mental
well-being using the Warwick-Edinburgh Mental Wellbeing
Scale (University of Warwick and University of Edinburgh,
2012). It found that both mental well-being and self-esteem
improved significantly (p < .001). A study of university students preparing for exams found that EFT reduced their anxiety,
and improved their test scores (Boath, Stewart, & Carryer,
2013). Nursing students had reduced stress 4 weeks after learning EFT (p < .005), and also exhibited decreases in both the
state of anxiety, and the character trait of anxiety (p < .05; Patterson, 2013). Taken as a whole, this body of research indicates EFT’s robust ability to reduce anxiety, whether it is occasioned by athletic, public speaking, or academic performance
stress.

Physiological Mechanisms of Action
Outcome studies, which compare patient results before and
after treatment, are clearly the most clinically important type of
research. However, while showing that a treatment works allows it to be designated as an “evidence-based” practice, showing how and why it works allows us to understand the physiological changes that underlie its clinical benefits.
Three studies have used electroencephalogram (EEG) to
examine the brain wave frequencies of participants before and
after EFT. These studies provide us with objective physiological evidence, as opposed to the type of subjective self-report
characteristic of mental health studies that use pen-and-paper
assessments. Swingle, Pulos, and Swingle (2004) compared the
EEG readings of auto accident victims before and after they
learned EEG, and found a reduction in the frequencies associated with PTSD. Lambrou, Pratt, and Chevalier (2003) used
acupressure tapping with claustrophobics, comparing them with
a non-claustrophobic group, and found an increase in theta EEG
frequencies associated with relaxation after treatment. Using
electromyography (EMG), they also found significant relaxaCopyright © 2013 SciRes.

D. CHURCH

tion of the trapezius muscle. Claustrophobic subjects declined
significantly in anxiety as well, with gains maintained on
2-week follow-up. Swingle (2010) found EFT to be beneficial
in the treatment of seizure disorders. These three studies all
reinforce the body of work in acupuncture that uses fMRI to
demonstrate regulation of the fear centers of the brain (reviewed by Feinstein, 2010).
If EFT is regulating the body’s stress response and the hypothalamus-pituitary-adrenal (HPA) axis, then it is also logical to
look for changes in stress hormones such as norepinephrine
(adrenaline) and cortisol. A triple-blind study examined the cortisol levels of 83 normal subjects before and after an hour of
EFT (Church, Yount, & Brooks, 2012). A control group received talk therapy while a second control group simply rested.
Comparison of the three groups revealed significant reductions
in cortisol in the EFT group compared to the other two groups
(p < .03). The overall severity of psychological symptoms
dropped by 50.5% in the EFT group (p < .001). This study
demonstrated a significant relationship between the reduction in
psychological conditions such as anxiety and depression, and
cortisol. Improvements in mental health after therapy can be
reflected in reduced levels of cortisol and regulation of the
genes that code for such hormones (Feinstein & Church, 2010).
Scientists studying epigenetics emphasize the role stress and
emotion plays in gene expression (Jirtle & Skinner, 2007;
Church, 2010b; Fraga et al., 2005; Eley & Plomin, 1997).

Is Acupoint Tapping an Active Ingredient
in EFT?
EFT’s “Setup Statement” is an essential part of the “Basic
Recipe.” The Setup Statement has two parts. One is a statement
of the client’s presenting problem, and clients are instructed to
focus on the problem by saying something like, “Even though I
have this problem…” while tapping on a specified acupressure
point. They repeat the name of the problem while tapping on
the other points. This focus on the problem is reminiscent of the
exposure techniques practiced in Prolonged Exposure (PE) and
other exposure therapies. The second half of the Setup Statement directs the client toward acceptance of conditions as they
are: “… I deeply and completely accept myself.” This cognitive
reframe is akin to the techniques used in cognitive therapies,
which seek to modify dysfunctional client cognitions and emotional responses to events. In a review of therapies for PTSD,
the US government’s Institute of Medicine found that therapies that use exposure and cognitive shift were efficacious (Institute of Medicine, 2007). EFT’s Setup Statement draws from
elements of these two established therapies.
The third ingredient used by EFT is tapping on points used in
acupuncture and acupressure (acupoints). Is this component of
EFT an active ingredient, or is EFT’s efficacy dependent solely
on the exposure and cognitive components it shares with other
therapies?
Fox and Malinowski (2013) sought to answer the question of
whether tapping is an active ingredient or an inert placebo.
Their study examined mindfulness, and study-related positive
and negative emotions in an RCT of 20 undergraduates using
the Achievement Emotions Questionnaire (Pekrun, Goetz, Frenzel, Barchfeld, & Perry, 2011). The EFT group received the
Basic Recipe as described in The EFT Manual. The control
group received the cognitive and exposure elements of the Basic Recipe but without acupoint tapping. Instead, they received
Copyright © 2013 SciRes.

an active control of diaphragmatic breathing (DB) in its place.
The intervention lasted 40 minutes, and participants were reassessed 7 days later. Significant improvement in study-related
positive emotions such as enjoyment and hope was found,
along with decreases in negative emotions such as anger and
shame. No change in mindfulness was detected.
This indicates that EFT’s acupoint stimulation is an active
ingredient. This finding supports studies that use fMRI to
measure the effects of acupuncture on the areas of the brain
associated with fear (Hui et al., 2005; Fang et al., 2009; Napadow et al., 2007). These studies uniformly report acupuncture
to produce rapid regulation of these brain regions. They are also
consistent with the studies that use EEG (electroencephalogram)
to evaluate EFT. They find that EFT reduces the brain wave
frequencies associated with stress or amplifies those associated
with relaxation, as well as producing other beneficial physiological changes (Swingle, Pulos, & Swingle, 2004; Lambrou,
Pratt, & Chevalier, 2003; Swingle, 2010). When the established
protocols drawn from exposure and cognitive therapies are
paired with acupressure, their effects appear to be enhanced. It
is probable that the amygdala and other fear-processing centers
of the nervous system are being regulated, as stress-laden emotions are calmed (Phelps & LeDoux, 2005).

EFT as Group Therapy
During the early development of EFT, practitioners reported
lower levels of stress and burnout than they had experienced
previously, while administering therapies other than EFT to
clients. This led to the hypothesis that tapping on oneself while
demonstrating tapping to others, or witnessing tapping on others while tapping on oneself, diminished distress. This phenomenon is known as “Borrowing Benefits” (Craig, 2010). A
series of studies has measured the efficacy of Borrowing Benefits for psychological and physical symptoms.
The first such study was performed by Rowe (2005). Rowe
examined the psychological symptom levels of participants in a
weekend EFT workshop using a valid and reliable assessment,
the Symptom Assessment 45 (SA-45). The SA-45 has two general scales for the breadth and depth of psychological distress,
as well as measuring levels of nine common conditions such as
anxiety and depression. Rowe found a reduction in both general
and specific scales, with participant gains maintained on follow-up.
The health care workers study cited previously (Church &
Brooks, 2010) also utilized the SA-45, with similar results.
Most participant gains were maintained at 3-month follow-up
(p < .0001). The physical pain of subjects was reduced by 68%,
and their cravings were reduced by 83% (both p < .0001). At
follow-up, this study also compared the relative symptom levels
of participants who had used EFT frequently with those who
had not. It found greater improvements in more frequent users.
Another study also found that EFT was effective in groups
taught by a variety of trained practitioners (Palmer-Hoffman &
Brooks, 2011), suggesting that the improvements were due to
the EFT method itself, rather than the unique gifts of any one
practitioner. The addiction study summarized previously found
similar improvements from Borrowing Benefits, with durable
gains (Church & Brooks, 2013b).
PTSD symptoms were examined in a study of 218 veterans
and spouses who attended 7-day group retreats (Church &
Brooks, 2013a). On pretest, 82% of veterans and 29% of
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spouses met the criteria for clinical levels of PTSD symptoms.
After the retreat, at 6-week follow-up, only 28% of veterans
and 4% of spouses were PTSD-positive (p < .001). The study
compared the results of five such retreats, reporting in effect the
results of five individual substudies. Similar symptom declines
were noted in all five groups. This study points to EFT’s ability
to reduce PTSD symptoms in large groups of people simultaneously.
Though these were uncontrolled studies, several RCTs also
utilized a group therapy design. The study of college students
with depression (Church, De Asis, & Brooks, 2012) offered the
EFT intervention in four group counseling sessions. The study
of depression in weight loss subjects also taught participants
EFT in group classes (Stapleton, Church, Sheldon, Porter, &
Carlopio, 2013). Two of the studies of depression (Jones,
Thornton, & Andrews, 2011; Sezgin & Özcan, 2009) also provided EFT instruction to participants as a group. In two of the
studies of sports performance, Church (2009) and LlewellynEdwards & Llewellyn-Edwards (2012), the EFT cohort received at least part of the intervention as a group. EFT was also
provided in groups of 10 in the Congo RCT of traumatized
females, and found to be as effective as CBT in reducing PTSD,
anxiety, and depression (Nemiro, 2013). The insomnia RCT
also administered both EFT and the active control in group
format (Lee & Kim, 2013).
These studies are notable in that significant reductions in
symptoms occurred when EFT was delivered as group therapy,
as opposed to individual counseling. If EFT is able to consistently reduce psychological symptoms by 45%, as the five
groups treated in Church and Brooks (2010) demonstrate, EFT
may be unusually effective when delivered to groups. The
number of recent Middle East war veterans with PTSD is estimated at a minimum of 500,000; according to a September
2012 report from the Department of Veterans Affairs, almost
30% of the 834,463 Iraq and Afghanistan War veterans treated
at VA hospitals and clinics over the course of the previous
decade have been diagnosed with PTSD (Veterans Health Administration, 2012). This is in addition to the estimated 479,000
Vietnam veterans with PTSD (Dohrenwend et al., 2006). Each
veteran with PTSD is estimated to cost society $1,400,000
(Kanter, 2007), implying a social cost of about a trillion dollars
to treat these two cohorts. Therapies such as Clinical EFT,
which produce symptom reductions without the need for
lengthy individual courses of psychotherapy or chronic use of
prescription drugs, are simultaneously efficient and cost effective.

Simultaneous Symptom Reduction
Most psychological research seeks to isolate a single condition and excludes multiple diagnoses (Seligman, 1995). For
instance, a study of PTSD might exclude clients with comorbid
major depression or generalized anxiety. EFT’s client-centered
approach focuses on the distress as experienced by the client,
rather than the primacy of diagnosis by the therapist. EFT is
often successful at treating several diagnoses simultaneously.
An RCT found that EFT was efficacious for PTSD in six sessions, with 86% of veterans subclinical after six sessions
(Church et al., 2013). Data from the same study were later analyzed to reveal that EFT simultaneously reduced anxiety and
depression (Church, 2013b). Furthermore, EFT’s pervasive
treatment effects encompass both psychological and physio650

logical symptoms. Analysis showed that TBI symptoms diminished significantly and continued to decline throughout the
follow-up period, cumulatively reducing 41% from pretest
baseline (p < .0021; Church & Palmer-Hoffman, 2013). Physical pain was reduced by 41% (p < .0001; Church, 2013b). Two
early pilot studies of EFT for PTSD found that not only did
PTSD symptoms drop significantly, but anxiety and depression
symptoms also declined in parallel (Church, 2010a; Church,
Geronilla, & Dinter, 2009). EFT is thus extraordinarily efficient,
addressing multiple symptom domains simultaneously. Scholars have noted that most clients present with a complex of disorders, rather than a single one (Gorman, 1998).

Safety
EFT also appears to be safe when administered by a therapist
or life coach, or self-administered. Therapists treating victims
of childhood sexual abuse preferred energy psychology treatments such as EFT over talk therapy because they found the
risk of abreaction low with the former (Schulz, 2009). Mollon
(2007) reports a general reduction of client distress during acupoint tapping, while Flint, Lammers, and Mitnick (2005) remark on the absence of abreactions during energy psychology
treatments. Most studies of EFT have been performed after
Institutional Review Board (IRB) review. IRB procedures require that studies be designed and conducted in a manner that
protects human subjects, including a requirement that participants be monitored for adverse events. Cumulatively, over 1000
subjects have participated in trials of EFT without a single adverse event being reported, indicating a high degree of safety.

Research Reviews
Many review articles about EFT have been written. Reviews
systematically gather the evidence for a method and ask, “What
does this mean?” and “What does this body of research, taken
as a whole, suggest?” Notable reviews include those of Feinstein (2012) on the evidence for the efficacy of acupoint tapping, Lane (2009) on the physiological mechanism of action of
energy therapies, Feinstein (2010) for energy psychology as
applied to PTSD, Feinstein and Church (2010) showing how
successful psychotherapy can be measured physiologically,
Church and Feinstein (2012) emphasizing that EFT in clinical
practice is fast and effective, and Feinstein (2008) for the effects of acupoint tapping for survivors in disaster zones. The
body of primary research summarized and evaluated in these
review articles, as well as the studies reviewed previously, allow us to draw several conclusions about Clinical EFT:
1) It reduces symptoms for a variety of psychological conditions including phobias, PTSD, anxiety, and depression.
2) It improves physical symptoms such as pain, and autoimmune conditions such as psoriasis and fibromyalgia.
3) It aids in reducing cravings and promoting weight loss.
4) It produces physiological regulation of the autonomic
nervous system and the HPA axis.
5) It can simultaneously reduce a range of psychological
conditions, e.g., diminishing anxiety and depression along with
PTSD.
6) It can simultaneously reduce both psychological and
physiological problems, e.g., fibromyalgia or TBI concurrent
with PTSD, anxiety, and depression.
7) It is safe, both when self-administered and when adminisCopyright © 2013 SciRes.

D. CHURCH

tered by others.
8) It is efficient and cost effective, showing efficacy when
delivered to both groups and individuals.
9) It works quickly. Treatment time frames range from one
session for phobias to six sessions for PTSD.
10) Early evidence points to its efficacy when it is delivered
online.
11) It can play a useful part in early intervention following
human-caused and natural disasters.

Future Research Directions
Having met APA criteria as an “efficacious” or “probably efficacious” treatment for several conditions, such as phobias,
PTSD, anxiety, and depression, what are the next steps for EFT
research?
Larger trials. Most of the RCTs conducted have had a small
number of participants. Because of EFT’s robust treatment
effects, studies are able to achieve statistical significance with a
small number of participants. However, confirmation with trials
involving 100 or more participants per group will provide strata
of information not possible with smaller groups, such as whether EFT is more effective with certain demographics.
Institutional trials. Most studies have been conducted in
outpatient settings by private foundations. Studies within institutions such as large hospitals will provide a framework for
institution-wide implementation of EFT.
Online application. There are only two studies to date in
which EFT has been delivered online (Brattberg, 2008; Church
& Wilde, 2013). The results of these studies were encouraging,
showing improvements in depression and anxiety in both fibromyalgia sufferers and weight loss program participants. Yet
this early research only hints at the possibilities. Much more
work is needed to determine how EFT can be applied effectively in online programs. Emerging technologies like smartphones allow EFT to be used portably during times of heightened stress. There are several EFT iPhone apps, but none has
been subject to experimental testing. Given the low cost of
delivery and ease of automated data gathering, online trials of
EFT are a logical next step.
Medical applications. Only one of the trials of EFT for
physiological functioning, the cortisol study, had a large number of participants (Church, Yount, & Brooks, 2012). The three
EEG studies (Swingle, Pulos, & Swingle, 2004; Lambrou, Pratt,
& Chevalier, 2003; Swingle, 2010) all had a small number of
participants, yet all four studies taken together point to EFT’s
potential as a medical intervention. Cortisol is known to correlate with HPA arousal, heart rate variability (HRV), and other
stress-regulation systems in the body. Depression and anxiety
are associated with many diseases. Yet the existing studies of
EFT only hint at EFT’s potential to affect the course of such
diseases. Medical trials could explicitly identify EFT’s utility as
a medical intervention for conditions such as hypertension,
diabetes, cancer, and cardiac events, all of which are stressrelated. Such studies could ask research questions like: Does
EFT:
Speed wound healing?
Reduce cardiac events markers like C-reactive protein?
Increase circulatory cytokines?
Reduce hypertension?
Reduce chronic pain?
Slow aging by decreasing telomere loss?
Copyright © 2013 SciRes.

Downregulate oncogenes?
Raise levels of cell repair hormones like dehydroepiandrosterone (DHEA)?
Promote healthy balances of neurotransmitters such as serotonin and dopamine?
If EFT is able to demonstrate any of these effects, it can be
introduced into primary care as an auxiliary behavioral treatment that is safe and free of side effects.
Patient tolerance studies. Behavioral interventions such as
meditation, yoga, diaphragmatic breathing, and EFT are rarely
integrated into regular patient care. Research can determine
how to effectively introduce patients to EFT and encourage
compliance with a health-promoting stress-reduction regimen.
Might outpatients benefit from using an EFT app loaded into
their smartphones before an appointment? Might patients preparing for surgery benefit by being taught EFT as a stressmanagement tool to use before and after a procedure? These
and other questions could be answered by research aimed at
improving patient care.
Group scale studies. EFT is notable in its ability to improve
symptoms when delivered to groups. However, the optimal
group size has not yet been tested. The group evaluated by
Rowe (2005) comprised 259 participants, with 102 providing
complete data, while some of the groups in other studies have
been as small as 10 (Church & Brooks, 2010). What is the
minimum size to produce a group effect? What is the optimum
size for each condition? Is there a group size at which the effects diminish? Research that answers these questions of scale
will assist institutions using group therapy to optimize their use
of Clinical EFT.
Pervasive symptom focus. While research has tended to isolate conditions such as chronic pain or depression, EFT’s ability to reduce both psychological and physiological symptoms in
tandem might push research toward measuring client-centered
reports of symptom clusters, and away from reliance solely on
observer-rated clinical diagnoses.
Biomarkers for psychological change. Feinstein and Church
(2010) advocate salivary cortisol testing as an objective measure for the efficacy of psychotherapy. A holistic approach
means that physiological markers might become a standard
measure of efficacy. As cheaper and simpler gene assays become available, the effect of EFT and other therapies on gene
expression might be measured by these objective biomarkers.
Healthcare cost reductions. If symptoms of psychological
conditions such as anxiety and depression reduce after EFT
treatment, what is the impact on healthcare costs? Presumably
they decline, but by how much? The symptom reductions noted
in the research literature suggest that widespread implementation of EFT will have a substantial impact on healthcare costs,
but this has not yet been quantified. Studies examining the costs
before and after EFT implementation in settings such as hospitals and organizations will yield quantifiable measures of the
effects of treatment.

The Maturing Field of Clinical EFT
Clinical EFT, as validated in many RCTs and outcome studies, has established itself as an efficacious treatment for both
psychological and physical conditions. Clinical EFT enjoys a
large and growing body of research that has validated it as an
“evidence-based” practice that is safe, fast, reliable, and costeffective. Clinical EFT is supported by professional training
651

D. CHURCH

programs that teach practitioners to deliver the method as validated by research based on The EFT Manual (Craig, 2010;
Church, 2013a). Clinical EFT is elucidated in depth in The Clinical EFT Handbook: A Definitive Resource for Practitioners,
Scholars, Clinicians and Researchers (Church & Marohn, 2013).
The literature demonstrates sufficient clinical benefit from EFT
to argue for its adoption as a front-line primary care intervention within a wide variety of settings and populations.

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