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How Does EFT Work? Exploring the Mechanisms of Emotional Freedom Techniques

Every practitioner employing Emotional Freedom Techniques (EFT) inevitably faces two fundamental questions: What is EFT, and how does it work? Over time, various explanations have emerged, ranging from it being a therapeutic and self help stress reduction technique to theories involving neurobiological mechanisms and even subtle energy systems of the body. In this article, we’ll delve into some of these theories, mechanisms and considerations, while incorporating published research and insights to provide a comprehensive understanding of how EFT appears to be operating with such safety and effectiveness.

In the November 2018 issue of the Explore Journal (1), author David Feinstein, PhD proposes several hypotheses for how EFT mechanisms of action may explain the speed and efficacy of EFT.

  1. EFT/acupoint tapping sends regulating signals to brain areas aroused by the imaginal exposure component of the protocol.
  2. EFT/acupoint tapping protocols can, with unusual efficiency, modify maladaptive emotional learnings at their neural foundations.

Each of these notions require a deeper look as to how these processes might be occurring and here are several considerations for underlying mechanisms. I wish to specifically thank David for the extensive work he has published exploring our understanding based upon the clinical research by many other researchers worldwide.

 

Stimulation of the Primo-Vascular System affecting the Limbic System and Beyond:

EFT utilizes the percussion/tapping stimulation of specific acupuncture points in the upper body within the primo vascular system, a newly discovered microcirculatory system embedded within fascial structures. There is some evidence that such EFT tapping protocols seem to result in limbic system down regulation similar to the needling of specific acupuncture points. Stimulation of these points has been found to bring about “extensive deactivation of the limbic-paralimbic-neocortical system” according to Fang et al. (2) Studies by Hui (3) and colleagues found that specific point stimulation with needles sends deactivating signals to the amygdala, hippocampus and other brain regions associated with fear and pain. “Functional MRI and PET studies on acupuncture at commonly used acupuncture points have demonstrated significant modulatory effects on the limbic system, paralimbic, and subcortical gray structures” Hui et al. (4). Needle stimulation of such points has also been shown to modulate pain, reduce cortisol and have other beneficial neuroendocrine effects.

Tapping on these acupoints creates electrical signals via mechanosensory transduction where  cells convert a mechanical stimulus into electrical activity.Some of these points demonstrate less electrical resistance hence increased electrical conductivity, more than adjacent points (4). The question of the importance of utilizing the specific EFT tapping points, as opposed to using “sham points” was discussed in the 2018 meta-analysis by Church et al (5) that indicated “that the acupressure component was an active ingredient and outcomes were not due solely to placebo, nonspecific effects of any therapy, or non acupressure components.”

 

Psychological Exposure in combination with the Limbic System Deactivation via Tapping Stimulation:

During an EFT session, typically a client brings to mind an upsetting feeling or recalls an adverse memory or imagines a stress producing scenario as a form of mild psychological exposure. This results in activating signals of arousal to the brain Inducing a negative emotional state along with any associated physical sensations that may be co-occurring. Simultaneously, opposing deactivating signals are sent repeatedly to the limbic system structures. This can result in the individual then revisiting the previous state without experiencing a heightened emotional response.

 

Alterations in Neural Arousal

Studies continue to explore the potential neural mechanisms by which deactivation of arousal states occur with EFT. Functional MRI testing has offered some insight to this idea. In 2019 Stapleton et al (6)  compared pre and post fMRI images prior to and following a course of EFT treatments designed to reduce food cravings in obese individuals, lending support to the premise that acupoint tapping can send signals that directly influence brain activity in targeted ways. Significant decreases between the first and second scans were found in the activation of the lateral orbitofrontal cortex, and decreases were also found in the superior temporal gyrus.

While states of arousal may well utilize EFT tapping to down-regulate overactive regions, there is also the need in various situations to activate and increase neural activity. Magnetoencephalography brain mapping images have shown in a case of fear of flying utilizing EFT in a single session that the treatment down regulated activity in limbic and cerebellar regions implicated in the fear response while increasing activity in executive regions that mediate limbic responses to stressful stimuli.(7)

According to Feinstein (1), these imaging studies showing that acupoint tapping changes arousal levels in areas of the brain related to targeted problems also correspond with clinical experience. In energy psychology protocols, the client brings to mind situations that evoke unwanted psychological responses (such as anger or anxiety) or desired responses (such as increased confidence). The acupoint tapping appears to send regulating signals to brain regions that have been aroused by this brief exposure. By the selection of scenes for the client’s attention during the acupoint tapping, energy psychology practitioners are able to “aim” the regulating signals at targeted issues with considerable precision. This is consistent with the hypothesis: acupoint tapping sends regulating signals to brain areas aroused by the imaginal exposure component of the protocol. Imaging studies using energy psychology with additional conditions are underway and will lend confirming or disconfirming evidence to this premise.

 

Neuroplasticity and the Revising of Deep Emotional Learning:

The question for many years has been whether deeply entrenched emotional learnings could be updated or altered. Studies utilizing techniques such as functional magnetic resonance imaging (fMRI) suggest that EFT may modulate activity in brain regions associated with emotional processing and regulation and as a result, support the hypothesis that EFT facilitates neuroplastic changes, rewiring neural pathways related to emotional responses and stress regulation. Nader’s work on neuroplastic capacity in the brain, defined as the ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience, laid the groundwork of understanding that the brain can be “rewired” and learn new responses. According to Feinstein’s paper (1) “Subsequent studies with human subjects found that the affective component of the fear memory was able to be neutralized “without changing the actual recollection of the threatening event”. Of particular relevance for psychotherapy were experiments that induced experiences which vividly contradicted what the old learning expected or predicted.

 

Memory Reconsolidation

According to the theory of memory reconsolidation, when individuals are in an environment in which they can safely recall emotionally charged or traumatic memories, such as during an EFT session, these memories and the associated learning or beliefs created as a result, they enter a state of instability, making them susceptible to modification and being “updated.” The emotional learning is the information gleaned from the actual memory, ie the felt sense and decisions or beliefs created from the event memory details.l By pairing the recall of distressing memories along with tapping on acupoints along with specific verbalized phrases, EFT may disrupt the reconsolidation process, leading to the reorganization of “maladaptive memory networks” and form new neural pathways that can then be integrated into the memory system and influence an individual’s responses and outlook for their future.

According to Bruce Ecker in his book Unlocking the Emotional the Emotional Brain, “Memory research has established that learnings accompanied by strong emotion form neural circuits in subcortical implicit memory that are exceptionally durable, normally lasting a lifetime.” These adverse emotional memories “convert the past into an expectation of the future, without our awareness.”

This process by which an outdated learning can be transformed while activated, thus forming new updated neural pathways that are then integrated into the memory system and replacing earlier more limiting views of self and the world around them, this is called memory reconsolidation. If the concept that memory reconsolidation is occurring as has been proposed by Feinstein and others, then “how memories are formed, stored, retrieved, modified, updated and used” (Alberini and LeDoux) may be altered with EFT. Memory reconsolidation has also been shown to be more durable than the extinction training that is the basis of exposure therapies.

 

Amygdala Desensitization and Counterconditioning Theory:

Another theory behind ETfs effectiveness suggests that it works by desensitizing the amygdala and then counter-conditions stress responses.  High levels of stress can initially increase amygdala volume, but chronic stress can lead to smaller volumes. The amygdala is involved in emotional regulation, facial recognition, and processing emotions. Studies have shown that larger amygdala volumes are associated with behavioral disorders, such as fearfulness, depression, and anxiety. Desensitization of the amygdala can occur when the amygdala learns that something is not dangerous through experience. Multiple studies have demonstrated statistical significance in a decreased fear response, for example with phobias such as fear of insects and fear of flying that suggests this mechanism might be occurring.

Counterconditioning works to replace an unwanted response or behavior with desired ones. This is often a hallmark result of EFT. This process therapeutically pairs the unwanted behavior or reaction with a neutral or positive stimulus to create a new association, as a way of therapeutically rewiring of your brain. In EFT language consider a cognitive shift that occurs when a client achieves a new updated perspective on why they felt unloved as a child, that results in adult attitudes and behaviors in which they cannot ask for support as they feel undeserving. The goal of counterconditioning is to change how a person feels or reacts when faced with certain things in their current life. Counterconditioning, when used in cognitive behavioral therapy, is commonly used for the treatment of phobias, anxiety disorders, obsessive-compulsive disorder (OCD), and addiction to help create new positive associations.

 

The Placebo Effect, Therapeutic Relationships anbd EFT:

While often overlooked, the placebo effect may contribute significantly to the effectiveness of EFT interventions. The placebo effect is the impact of belief on the body. This can include a reduction in pain perception and an increase in a sense of well-being. Research shows that an expectation of improvment can activate the release of endorphins, dopamine, and other neurotransmitters associated with pleasure, reward, and pain relief. Recent research has highlighted the potency of placebos in promoting healing outcomes, even when participants are aware of receiving a placebo. While the role of placebo in EFT efficacy remains unknown, ongoing dismantling studies have shown that alternate point stimulation does not achieve the same efficacious results as those used in standard EFT protocols.

While EFT can be self applied as neuroregulating activity it is commonly utilized in a therapeutic context with and individual and a practitioner. In the latter case, the therapeutic relationship can offer a compassionate skillful practitioner which of course can create a sense of safety which may well influence the results obtained. According to pubmed.ncbi.nlm.nih.gov, several studies have shown that the relationship between a patient and clinician is a vital component of psychological and physical treatments, and it contributes to the placebo effect, the extent of which has not been measured in clinical research involving EFT.

 

Polyvagal Theory and Autonomic Nervous System Regulation:

Polyvagal Theory as developed by Stephen Porges, PhD, as described in his book, The Polyvagal Theory Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation, offers insights into the physiological effects of EFT on the autonomic nervous system (ANS). It describes a brain-body neural system which governs the fight-flight-freeze responses of the autonomic nervous system (as well affecting other systems including the neuroendocrine, cardiovascular and digestive systems) which can dramatically impact a person’s ability to choose action and thoughts freely. EFT may promote regulation of the ANS, shifting individuals from a state of sympathetic arousal towards parasympathetic “ventral vagal” dominance. By engaging the vagus nerve and promoting physiological relaxation, EFT may facilitate emotional regulation and resilience. Autonomic responses to triggering situations, often associated with previous traumatic experiences, can cause an automatic fight or flight sympathetic response or in other perceived threatening experiences a dorsal vagus shutdown or freeze response. Through gentle trauma informed practices, an individual can learn an updated response to formerly fear inducing stimuli and have easier access to a more neuroregulated response to various life stressful situations.

A healthy parasympathetic nervous system with strong vagus nerve responses in stressful situations supports greater emotional and physical health. One way to measure this capacity is via elevated levels of heart rate variability (HRV and heart coherence (HC). Studies have also demonstrated positive results of EFT for HRV and HC. Increased heart rate variability is usually evidence that your body can adapt to many kinds of changes. People with high heart rate variability are usually less stressed and happier.

In a 2019 study by Bach, Groesbeck et al. (10) “positive trends were observed for HRV and HC and gains were maintained on follow-up, indicating EFT results in positive health effects as well as increased mental well-being.”

 

Other Considerations that may be co occurring during EFT sessions with a practitioner may also include:

Interpersonal Neurobiology, Co-Regulation and Social Engagement Systems (SES):

EFT, particularly when practiced in a therapeutic context, may activate social engagement systems, as described by Porges. According to polyvagal theory, the SES works with the sympathetic and parasympathetic systems to regulate physiological functions and offers an individual a blend of neurophysiological states including both activation and calming that helps people socially engage. The social engagement system is activated when people feel safe, and it facilitates connection with others. This in turn promotes co-regulation between individuals. This can be described as when two individuals in the presence of each other create a supportive compassionate environment and as a result are better able to manage their emotions and behaviors. Co-regulation, can help people soothe and manage internal sensory input or external situations This emphasis on interpersonal connection and attunement may enhance the effectiveness of EFT in promoting emotional healing and interpersonal relationships.

 

Epigenetics and Gene Expression:

Studies have shown that mind-body interventions, including EFT, can modulate the expression of genes involved in inflammation, immune function, and stress response pathways. This research highlights the potential role of EFT in promoting cellular resilience and health through epigenetic mechanisms.

Emerging published evidence suggests that EFT may influence gene expression and epigenetic regulation, providing a molecular basis for some of its physiological therapeutic effects. Clinical trials have noted a wide variety of physical alterations including decreased cortisol measures, increased immune system markers (IgA), decreased blood pressure etc. (11)

In 2016 Church et al (12) found 10 sessions of EFT with veterans suffering from PTSD found “significant differential expression of 6 genes was found (P < .05) when comparing the expression levels before and after the intervention period in participants receiving EFT.”

In addition, in 2016 a study by Maharaj (13) measuring epigenetic changes in salivary MRNA reported that “Differential expression between EFT and control was found in numerous genes implicated in overall health (p < 0.05). Further, the differentially expressed genes in this study were shown to be linked to immunity, pro or anti-inflammatory, as well as neuronal processes in the brain. Ten of the 72 differentially expressed genes are identified as promising targets for downstream research.”

 

Summary:

In exploring the diverse theories and perspectives surrounding EFT, it becomes evident that its effectiveness potentially stems from a combination of neurobiological, psychological, and social factors. By integrating these insights into practice and continuing to engage in interdisciplinary collaboration and research, we can further refine our understanding of how EFT works and optimize its therapeutic efficacy for the benefit of individuals and communities worldwide.

 

Resources

  1. Feinstein, D, Energy psychology: Efficacy, speed, mechanisms, EXPLORE: The Journal of Science and Healing, Elsevier, Nov. 15, 2018
  2. Fang J, Jin Z, Wang Y, et al.. The salient characteristics of the central effects of acupuncture needling: Limbic–paralimbic–neocortical network modulation. Hum Brain Mapp.
  3. Hui KK, Liu J, Makris N, et al.. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: Evidence from fMRI studies in normal subjects. Hum Brain Mapp. 2000;9(1):13–25
  4. Hui KK, Liu J, Marina O, et al.. The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage. 2005;27(3):479–496 
  5. Church, D., Stapleton, P., Yang, A, Gallo, F., Is Tapping on Acupuncture Points an Active Ingredient in Emotional Freedom Techniques? A Systematic Review and Meta-analysis of Comparative Studies. The Journal of Nervous and Mental Disease, Vol. 206, No. 10, October 2018
  6. Stapleton, P. B., Trude, R., Mackintosh, G., Sparenburg, E., Sabot, D., & Carter, B. (2019). Online delivery of emotional freedom techniques in the treatment of food cravings and weight management: a randomised controlled trial. OBM Integrative and Complementary Medicine, 4(4).
  7. Di Rienzo, F., Saruco, E., Church, D., Daligault, S., Delpuech, C., Gurret, J. M., … & Guillot, A. (2019). Neuropsychological correlates of an energy psychology intervention on flight phobia: a MEG single-case study.
  8. Pedreira, M. E., Pérez-Cuesta, L. M., & Maldonado, H. (2004). Mismatch between what is expected and what actually occurs triggers memory reconsolidation or extinction. Learning & memory, 11(5), 579-585.
  9. Unlocking the Emotional Brain, by Bruce Ecker, Robin Ticic, Laurel Hulley, Routledge Publishing, 2012.
  10. Bach D, Groesbeck G, Stapleton P, Sims R, Blickheuser K, Church D. Clinical EFT (Emotional Freedom Techniques) Improves Multiple Physiological Markers of Health. J Evid Based Integr Med. 2019 Jan-Dec;24:2515690X18823691. doi: 10.1177/2515690X18823691. PMID: 30777453; PMCID: PMC6381429.
  11. Bach, D., Groesbeck, G., Stapleton, P., Sims, R., Blickheuser, K., & Church, D. (2019). Clinical EFT (Emotional Freedom Techniques) Improves Multiple Physiological Markers of Health. Journal of evidence-based integrative medicine, 24, 2515690X18823691. https://doi.org/10.1177/2515690X18823691
  12. Church, D., Yount, G., Rachlin, K., Fox, L., & Nelms, J. (2016). Epigenetic effects of PTSD remediation in veterans using Clinical EFT (Emotional Freedom Techniques): A randomized controlled pilot study. American Journal of Health Promotion, 1-11. doi:10.1177/0890117116661154
  13. Maharaj, M. E. (2016). Differential gene expression after Emotional Freedom Techniques (EFT) treatment: A novel pilot protocol for salivary mRNA assessment. Energy Psychology: Theory, Research, and Treatment, 8(1), 17–32. doi:10.9769/EPJ.2016.8.1.MM