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A Systematic Review and Meta Analysis of Randomized and Non-Randomized Trials of Clinical Emotional Freedom Techniques (EFT) for the Treatment of Depression

Citation: Nelms, J., Castel, L., A systematic Review and Meta-Analysis of Randomized and Non-Randomized Trials of Clinical Emotional Freedom Techniques (EFT) for the Treatment of Depression. Explore-The Journal of Science and Healing, Nov. 2016, Vol. 12 Issue 6. Link to Explore Journal Abstract.


Background: Among a group of therapies collectively known as Energy Psychology (EP), Emotional Freedom Techniques (EFT) is the most widely practiced. Clinical EFT is an evidence- based practice combining elements of cognitive and exposure therapies with the manual stimulation of acupuncture points (acupoints). Lacking is a recent quantitative meta-analysis that enhances understanding of the variability and clinical significance of depression reduction outcomes after Clinical EFT treatment.

Methods: All studies (2005–2015) evaluating EFT for sufferers of depression were identified by electronic search; these included both outcome studies and randomized controlled trials (RCTs). Our focus was depressive symptoms as measured by a variety of psychometric questionnaires and scales. We used meta-analysis to calculate effect sizes at three time points including posttest, follow-ups less than 90 days, and follow-ups greater than 90 days.

Results: Twenty studies qualified for inclusion, 12 RCTs and 8 outcome studies. The number of participants treated with EFT included N = 461 in outcome studies and N = 398 in RCTs. Clinical EFT showed a large effect size in the treatment of depression in RCTs. At post-test Cohen’s d for RCTs was 1.85 and for outcome studies was 0.70. Effect sizes for follow-ups less than 90 days was 1.21, and for >= 90 days was 1.11. EFT was more efficacious than DB (Diaphragmatic Breathing) and SI (Supportive Interview) in posttest measurements (p = 0.06 vs DB; p < 0.001 vs SI), and SHE (Sleep Hygiene Education) at follow-up (p = 0.036). No significant treatment effect difference between EFT and EMDR (Eye Movement Desensitization and Reprocessing) was found. EFT was superior to TAU (treatment as usual), and efficacious in treatment time frames ranging from one to 10 sessions. The mean of symptom reductions across all studies was -41%.

Conclusion: The results show that Clinical EFT is highly effective in reducing depressive symptoms in a variety of populations and settings. EFT was equal or superior to TAU and other active treatment controls. The posttest effect size for EFT (d =1.31) was larger than that measured in meta-analyses of antidepressant drug trials and psychotherapy studies. EFT produced large treatment effects whether delivered in group or individual format, and participants maintained their gains over time. This meta-analysis extends the existing literature through facilitation of a better understanding of the variability and clinical significance of depression improvement subsequent to EFT treatment.

Craig’s Notes

This report, called a ‘meta-analysis’ analyzed the results of 20 different studies that examined the effects of Clinical EFT on depression. The authors note that clinical depression affects 6.7% of the population, and that it is more than just a psychological problem since it has been shown that depression can accelerate aging.

The authors collected information and results from recent clinical trials, both randomized and observational, that examined the efficacy of EFT for relieving depression in different segments of the population. The meta-analysis proposed to identify whether or not there is an empirical basis for the widespread and popular use of EFT for depression. All the studies in this analysis were published in the last 10 years, were required to be published in peer-reviewed journals, and to have examined depression symptom levels before and after EFT treatment. Another criteria was that two independent research teams must have demonstrated in a peer-reviewed report that EFT was either more effective than a placebo, or equivalent to another treatment whose efficacy has been established. Additionally, all studies must have been done using EFT treatments that adhered to the EFT Manual. The included studies must have used valid and reliable psychometric questionnaires, along with other criteria that is standard for well-conducted studies.

The study data was examined and coded by both authors according to a pre-designed data collection form. Depression was the dependent variable, and all psychometric data was extracted by the authors of this report. This information came from a variety of questionnaires including Symptom Assessment-45, Beck Depression Inventory 2, Depression Anxiety Stress Scales, and others.

So, what were the results?

Overall, the meta-analysis found that EFT was efficacious in mitigating depression in a variety of demographic groups. Twelve of the studies examined were Randomized Controlled Trials (461 subjects) and eight were outcome studies (398 subjects). In all of the randomized studies Clinical EFT was shown to be significantly effective in the treatment of depressive symptoms. The meta-analysis found that the positive effects of EFT exceeded those found in other studies using psychopharmacology and psychotherapy to treat depression. Additionally this meta-analysis revealed that the impact of EFT endures for at least 90 days and even up to six months after treatment. This was especially true for subjects that received multiple sessions of EFT.

The authors also found that in all cases EFT was found to be equally or more effective than other treatments for depression, including Diaphragmatic Breathing, Supportive Interview, and Sleep Hygiene Education (SHE). EFT was found to have no significant difference in beneficial effects from EMDR (Eye Movement Desensitization and Reprocessing). Additionally, EFT was found to be more effective than TAU (Treatment as Usual) or the simple passage of time.

This meta-analysis also confirmed dismantling studies that have shown that tapping specific acupoints is an active ingredient in EFT and not an inert placebo.

This report extends the existing literature on this subject by facilitating a better understanding of the clinical significance of depression improvement after EFT treatment in a variety of populations. It, along with the studies it examines and others, demonstrates that EFT is a low cost, non-drug, easy, and extremely effective therapy for depression.

Acknowledgment: I would like to express my gratitude for the invaluable assistance of Sarah Grace Powers in the creation of this post.