EFT Research Paper
Clinical EFT as an evidence-based practice for the treatment of psychological and physiological conditions: A systematic review
Citation: Church, D., Stapleton, P., Vasudevan, A., O’Keefe, T. (2022). Clinical EFT as an evidence-based practice for the treatment of psychological and physiological conditions: A systematic review. Frontiers in Psychology, vol 13. DOI=10.3389/fpsyg.2022.951451 Available online at https://www.frontiersin.org/articles/10.3389/fpsyg.2022.951451/full
Background: Since the turn of the century, Emotional Freedom Techniques (EFT) has come into widespread use in medical and psychological treatment settings. It is also used as self-help by tens of millions of people each year. Clinical EFT, the manualized form of the method, has been validated as an “evidence-based” practice using criteria published by the American Psychological Association (APA) Division 12 Task Force on Empirically Validated Therapies. Its three essential ingredients are exposure, cognitive framing, and acupressure.
Objectives: In 2013 we published a paper defining Clinical EFT and reviewing published research. It has been viewed or downloaded over 36,000 times, indicating widespread interest in this treatment modality. Here we update our findings based on subsequently published literature and propose directions for future research.
Method: We performed a systematic review of the literature to identify randomized controlled trials (RCTs) and meta-analyses. Retrieval of 4,167 results resulted in the identification of 56 RCTs (n = 2,013), 41 of which were published subsequent to our earlier review, as well as eight meta-analyses.
Results: RCTs have found EFT treatment to be effective for (a) psychological conditions such as anxiety, depression, phobias, and posttraumatic stress disorder (PTSD); (b) physiological issues such as pain, insomnia, and autoimmune conditions; (c) professional and sports performance; and (d) biological markers of stress. Meta-analyses evaluating the effect of EFT treatment have found it to be “moderate” to “large.” Successful independent replication studies have been carried out for anxiety, depression, PTSD, phobias, sports performance, and cortisol levels. We outline the next steps in EFT research. These include determining its impact on cancer, heart disease, diabetes, and cognitive impairment; analysis of the large-scale datasets made possible by mobile apps; and delivery through channels such as virtual practitioner sessions, artificial intelligence agents, online courses, apps, virtual reality platforms, and standardized group therapy.
Conclusions: Subsequent research has confirmed the conclusions of earlier studies. These find Clinical EFT to be efficacious for a range of psychological and physiological conditions. Comparatively few treatment sessions are required, treatment is effective whether delivered in person or virtually, and symptom improvements persist over time. Treatment is associated with measurable biological effects in the dimensions of gene expression, brain synchrony, hormonal synthesis, and a wide range of biomarkers. Clinical EFT is a stable and mature method with an extensive evidence base. Its use in primary care settings as a safe, rapid, reliable, and effective treatment for both psychological and medical diagnoses continues to grow.
This comprehensive and updated Systematic paper by Church, Stapleton et al is an update of the 2013 review paper published by Church. Their investigation resulted in the identification of 56 RCTs, 41 of which were published after the 2003 review, as well as eight meta-analyses. So clearly an updated status was warranted.
The most frequently asked question I hear about EFT is “Is EFT an Evidence Based Technique?” This is an excellent question that requires a nuanced answer. I have spoken with Dr Stapleton (article author) about this and here are some of her responses:
According to a recent conversation with her: “Mostly I say – EFT has previously met the requirements of the American Psychological Association (APA) for being an evidence based practice – and that it is currently under review with the APA against the new Tolin standards. You can say it is accepted by a range of organisations worldwide…
(please note that at this point if you were to say that EFT has been accepted as an Evidence Based modality, there are certainly those in the scientific, academic and profession of psychology that would correctly argue that is has NOT been accepted as such by any of the primary leading/determining authorities)
According to Dr. Stapleton’s website: “EFT has previously been found to be an “evidence-based” practice for anxiety, depression, phobias and PTSD when measured against the standards of the American Psychological Association’s Division 12 Task Force on Empirically Validated Treatments. EFT now currently under review with the APA (2022) for its effectiveness for trauma and Post Traumatic Stress Disorder (under the APA’s current criteria).”
In this paper you will find more details about what the new Tolin Standard’s are that the APA is using to provide their “seal of approval of being put on their list of evidence based practices” for specific conditions. In 2022 a task force led by Stapleton submitted to the APA for a renewed determination of EFT’s status for PTSD.
You will find mention in this paper relevant comments such as the following as per the perspective of the authors:
- Emotional Freedom Techniques (EFT) is an “evidence-based” therapeutic method (Church, 2013a). It combines elements of cognitive and exposure therapy with acupressure.
- Clinical EFT has met APA standards as an “efficacious” treatment for a number of conditions, including anxiety, depression, phobias, and PTSD (Church et al., 2018b).
- Evidence-based practices are methods that meet formally established criteria for efficacy. There are several organizations that define and publish such standards. Two US government’s agencies that perform this function are the Food and Drug Administration (Food and Drug Administration [FDA], 1998) and the Institute of Medicine (Institute of Medicine [IOM], 2008). Another is the UK government’s National Institute for Health and Clinical Excellence (N.I.C.E.).
- Between 1996 and 1998 an influential set of standards in the field of psychology was published by the Task Force on Empirically Validated Treatments set up by Division 12 (Clinical Psychology) of the American Psychological Association.. For convenience these are referred to as “APA standards.”
The point of contention is that researchers argue that while EFT has met the APA criteria listed below but still has not been ACCEPTED by the APA (nor N.I.C.E. in the U.K) as having met these standards.
Emotional Freedom Techniques (EFT) is a psychological treatment that involves tapping on specific acupressure points while focusing on negative emotions and on adverse or traumatic memories in order to change emotional states, behavioral patterns or limiting beliefs about oneself or the world around them. EFT has been demonstrated to be effective in reducing anxiety, depression, phobias, and post-traumatic stress disorder (PTSD). This paper explores the evidence supporting the effectiveness of EFT and why it should be considered an “evidence-based” treatment.
It is noteworthy that EFT has also been approved for use in Australia by the National Insurance Disability Scheme, and has been included in the clinical guidelines for PTSD by the Blue Knot Foundation in Australia. In 2020, the APA journal published a study on the effects of EFT on cortisol levels, and in the same year, a major review of psychological treatments for PTSD found that EFT was the second most effective treatment at reducing PTSD symptoms at the end of treatment, after EMDR.
In addition to the research studies mentioned above, EFT has also been the subject of numerous trials published in non-English journals and has been accepted by a range of organizations worldwide. All of this evidence supports the conclusion that EFT is an effective treatment for a variety of mental health issues.
This paper describes the “APA standards” (not including the newer Tolin criteria standards) as:
The original APA standards were defined in a series of papers (Chambless et al., 1996, 1998; Chambless and Hollon, 1998). Therapies 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, 2017) and studies are deemed “empirically validated” if they meet all seven. Chambless and Hollon (1998) also list additional criteria designated as “highly desirable” or “desirable”. 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 < 0.05 or better) differences between the treatment of interest and the comparison condition(s) was 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, including sample sizes, use of instruments that detect changes targeted by the study’s design, and magnitude of statistical significance.
What Else Does this Paper Offer?
A HUGE wealth of information including:
- Defining Clinical EFT
- Evidence forEFT as an empirically validated treatment
- A review and description of Psychological health outcome studies including a significant review of clinical trials on Anxiety, Depression, Phobias and PTSD
- A review and description of trials related to Physiological issues—Somatization, pain, physical symptoms, weight loss, insomnia, gene expression, autoimmune conditions, hormones, and cravings
- A review and description of trials related to Sports, academic, and professional performance, and positive emotions
- A review and description of papers related to Physiological mechanisms of action including measurable changes of EEGs, cortisol, neurological changes measeured via MRI, epigenetic changes, etc.
- A review and description of studies exploring whether acupoint tapping an active ingredient in EFT? (ie compared to sham points)
- A review of Safety Issues: “Cumulatively, over 2,000 subjects have participated in trials of EFT without a single adverse event being reported, indicating a high degree of safety. EFT also appears to be safe when administered by a therapist or life coach or self-administered”
- A review of Replication of studies (including for PTSD, depression, anxiety, phobias, cortisol, pain, and sports performance)
Another excellent use of this paper as a resource for practitioners includes the final summary points to consider sharing:
Characteristics of clinical EFT: The body of literature summarized in this paper allows us to draw several conclusions about Clinical EFT. These include:
Regulation of stress
The epigenetic, hormonal, and neurological evidence demonstrates that Clinical EFT regulates the body’s hypothalamic-pituitary-adrenal (HPA) axis and attenuates the stress response. Since stress recruits all the body’s major organ systems, the reduction of stress produces pervasive physiological regulation.
When applied with fidelity to the manual, Clinical EFT can be relied upon to produce the magnitude of change identified in the evidence base.
Long-term follow-ups demonstrate that when issues are resolved after tapping, gains are maintained over time.
Clinical EFT, both when self-administered and when administered by trained and certified practitioners, produces a reduction in affect and has not been associated with adverse events.
Clinical EFT works quickly. Treatment time frames range from one session for phobias to 10 sessions for PTSD. For some conditions, it is effective in time frames of 15 min or less.
Simultaneous reduction of multiple psychological conditions
Clinical EFT’s stress-reduction capacity makes it effective at the same time in alleviating multiple psychological conditions, including phobias, PTSD, anxiety, and depression.
Physical symptom reduction
The amelioration of psychological stress has a wide range of physiological benefits. Clinical EFT has been shown to remediate physical symptoms associated with pain, insomnia, immunity, addictions, hypertension, autoimmune conditions, traumatic brain injury, and a variety of other diagnoses. However, the lack of RCTs and replications means that Clinical EFT cannot yet be considered an evidence-based treatment for these conditions.
Clinical trials in which trained and certified practitioners apply the method with fidelity to The EFT Manual produce consistent results.
Clinical EFT has demonstrated efficacy with widely disparate demographic samples, occupational groups, diagnoses, and conditions. It has produced consistent results among independent teams of investigators and in multiple geographic locations, making its measured effects generalizable.
Rather than requiring extraordinary personal healing abilities, the 48 techniques of Clinical EFT can be learned in a structured and supervised training program. Practitioners trained in the form of the method described in the manual are able to produce consistent results.
Clinical EFT is safe and effective when self-applied as well as when it is practiced by trained professionals.
Clinical EFT’s group therapy method, described in the manual as “Borrowing Benefits,” is effective in groups of various sizes and in virtual as well as in-person groups.
When EFT is delivered using virtual delivery platforms such as apps and online courses, initial evidence suggests efficacy comparable to in-person application. Future treatment and research options will extend the options for treatment delivery using artificial intelligence (AI), virtual reality (VR), and immersive reality (IR).
Public health impact
Clinical EFT’s efficacy and ease of use makes it relevant to public health issues such as obesity, PTSD, disaster relief, stress, and addiction treatment. Clinical EFT is increasingly being adopted in primary care settings where it has the potential to produce pervasive improvements in public health.
The brevity of treatment time frames required to produce symptom reduction, as well as Clinical EFT’s efficacy when delivered using groups and virtual platforms, makes it a cost-effective treatment option.