EFT Research Paper
Adapted emotional freedom techniques (EFT) for managing kinesiophobia in patients with rheumatoid arthritis: a feasibility study
Citation: You, Y.L., Ramoo, V., Yahaya, N. et al. Adapted emotional freedom techniques (EFT) for managing kinesiophobia in patients with rheumatoid arthritis: a feasibility study. BMC Complement Med Ther 25, 407 (2025). https://doi.org/10.1186/s12906-025-05118-z
Link to full PDF: https://rdcu.be/eSiEc
Abstract
Background: Up to 70% of patients with rheumatoid arthritis (RA) experience kinesiophobia, a debilitating fear of
movement that exacerbates physical limitations and psychological stress. However, effective interventions remain
limited, particularly in resource-constrained settings. This study evaluated the feasibility, safety, and acceptability of an
adapted Emotional Freedom Techniques (EFT) intervention for Chinese patients with RA.
Methods: A two-phase design was used. Phase 1 involved protocol validation and adaptation through the Delphi
method. Phase 2 was a single-arm feasibility study involving 20 RA patients with kinesiophobia. The 4-week
intervention included a 2-week supervised inpatient phase and a 2-week self-practice phase supported via WeChat.
Feasibility (adherence, safety, satisfaction) and secondary outcomes (kinesiophobia, pain, pain anxiety, patient
activation, and quality of life) were assessed. Data analysis included paired t-tests and thematic analysis of patient
feedback.
Results: The adapted EFT protocol achieved expert consensus (I-CVI≥0.80). Among participants, 80% met adherence
criteria, no adverse events were reported, and 75–85% expressed satisfaction with the intervention. EFT was perceived
as simple and accessible. Kinesiophobia scores decreased by 6.5 points (a 12.7% reduction; Hedges’ g=1.36), with
moderate to large effects also seen for pain and anxiety.
Conclusions: This adapted EFT intervention proved feasible, safe, and acceptable for Chinese RA patients with
kinesiophobia. These findings support the potential for larger randomized controlled trials to rigorously evaluate
effectiveness and long-term impact.
Clinical trial registration Chinese Clinical Trial Registry, ChiCTR2300076013. Date of registration: 21 September 2023.
Keywords Rheumatoid arthritis, Kinesiophobia,
Craig’s Comments:
This trial was performed in China and explored the use of EFT in 20 Rheumatoid Arthritis patients, the average age was 48 and majority were women. Kinesiophobia is a significantly problem for those people who suffer chronically from the pain of RA. This fear of movement inhibits joint movement which in turn is a critical factor required not only for mobility and joint range but without such motion can increase additional degenerative joint type osteoarthritis.
In this study adapatations were made (though not fully described) in addittion to the standard EFT Manual protocal; a six-step
structured adaptation was developed, including Emotion Focusing, Initial Assessment, Psychological Unblocking, Acupoint Stimulation, Neurolinguistic Relief, and Reassessment as well as adverse reaction management training for the practitioners. (NOTE: this “adaptation” as I just noted is simply the EFT Long Basic EFT Recipe including the 9 Gamut Procedure)
Patients attended two supervised EFT sessions daily (10–15 min each) in a ward classroom with live demonstrations, video tutorials, and guided exercises. In the Post-Discharge Phase (2 weeks), patients practiced EFT independently twice daily, logging activities via a WeChat group with regular feedback and guidance from the research team. Patients maintained their usual diet, social activities, and prescribed antirheumatic medications, with temporary use of nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotics allowed for pain exacerbation. Adherence was defined as completing at least 90% of sessions during the inpatient phase and at least three weekly sessions lasting 15–20 min during the post-discharge phase.
What were the results?
- Of the 20 who completed all assessments, 17 completed it. No adverse events were reported, and all participants tolerated the intervention well without pain, anxiety exacerbation, or other interruptions.
- Notable improvements were observed in several outcomes. Kinesiophobia scores decreased by 12%. These results are consistent with findings from previous studies including the efficacy of other psychological interventions for chronic musculoskeletal pain, and a 2018 trial demonstrating CBT’s effectiveness in reducing kinesiophobia following total knee arthroplasty.
- Pain intensity (BPI-SF) declined from 5.5 to 3.6, pain interference nearly halved, and pain-related anxiety also improved significantly. These findings align with research by Stapleton et al. confirming EFT’s efficacy in managing
chronic pain through both guided and self-applied formats
What else was fascinating about this study?
- The authors worked to adapt the EFT intervention in culturally sensitive ways. “This feasibility study provides preliminary evidence supporting the cultural adaptability, safety, and acceptability. According to the authrors: “A strength of this study is the culturally informed adaptation of the EFT protocol, which retained its core therapeutic elements while enhancing feasibility and perceived trustworthiness in the Chinese healthcare context. By integrating TCM concepts—such as the Bai Hui (DU20) (Top of Head) acupoint, associated with calming the mind, and adapting Hou Xi (SI3) stimulation into a more familiar hammerstyle tapping—the intervention gained greater cultural legitimacy and emotional resonance. These modifications appeared to improve participant engagement, foster psychological safety, and increase trust in the method.
- “Participants consistently described the intervention as easy to learn and practice, particularly appreciating its suitability for self-use at home. The integration of traditional Chinese medicine concepts also enhanced cultural resonance and acceptance. “It’s easy to learn even at my age, and the connection with Chinese medicine makes it more relatable.”