Citation: Church, D., Stern, S., Boath, E., Stewart, A., Feinstein, D., & Clond, M. (2017). Emotional Freedom Techniques to Treat Posttraumatic Stress Disorder in Veterans: Review of the Evidence, Survey of Practitioners, and Proposed Clinical Guidelines. The Permanente journal, 21, 16-100.
High prevalence rates of posttraumatic stress disorder (PTSD) in active military and veterans present a treatment challenge. Many PTSD studies have demonstrated the efficacy and safety of Emotional Freedom Techniques (EFT).
To develop clinical best practice guidelines for the use of EFT to treat PTSD, on the basis of the published literature, practitioner experience, and typical case histories.
We surveyed 448 EFT practitioners to gather information on their experiences with PTSD treatment. This included their demographic profiles, prior training, professional settings, use of assessments, and PTSD treatment practices. We used their responses, with the research evidence base, to formulate clinical guidelines applying the “stepped care” treatment model used by the United Kingdom’s National Institute for Health and Clinical Excellence.
Most practitioners (63%) reported that even complex PTSD can be remediated in 10 or fewer EFT sessions. Some 65% of practitioners found that more than 60% of PTSD clients are fully rehabilitated, and 89% stated that less than 10% of clients make little or no progress. Practitioners combined EFT with a wide variety of other approaches, especially cognitive therapy. Practitioner responses, evidence from the literature, and the results of a meta-analysis were aggregated into a proposed clinical guideline.
We recommend a stepped care model, with 5 EFT therapy sessions for subclinical PTSD and 10 sessions for clinical PTSD, in addition to group therapy, online self-help resources, and social support. Clients who fail to respond should be referred for appropriate further care.
The authors note the high prevalence of post-traumatic stress disorder (PTSD) among military veterans, along the evidence supporting the efficacy of EFT in reducing the symptoms. This research report is intended to develop clinical best practice guidelines for the use of EFT to treat PTSD. They did this by evaluating practitioner experience and the published literature to arrive at a consensus statement.
They note a meta-analysis of six dismantling studies done to differentiate the acupressure component from the cognitive and exposure elements that EFT shares with other therapies. This meta-analysis found a large treatment difference between the groups that used authentic acupoints vs controls, indicating that acupressure is an active treatment ingredient in EFT’s protocol and not merely an inert component.
They also note that clinicians widely practice EFT and similar techniques. A recent survey of licensed psychotherapists using Listservs such as Acceptance and Commitment Therapy, the Society for a Science of Clinical Psychology, and the Association for Behavioral and Cognitive Therapies found that 42% of therapists were using these modalities.
The authors of this paper undertook a survey of practitioners using EFT to treat PTSD. The goals of the survey were to develop a demographic profile of practitioners, to evaluate how EFT is used in professional settings, and to determine current practices for PTSD treatment. Drawing from those results as well as evidence base and case histories, they formulated clinical guidelines for the use of EFT in the treatment of veterans and military personnel, with the “stepped care” model used by the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom as the framework.
The received responses to the survey from 448 practitioners. Most respondents were either licensed health professionals or alternative medicine practitioners, with 62% holding a master’s degree or higher and 84.5% practicing in a private practice setting. More than a third of the practitioners said that PTSD clients constituted over 20% of their practices. Nearly half reported having worked with more that 50 clients with PTSD, and 40% said they spend more than 5 hours per week treating PTSD. About 25% of respondents estimated that they could treat PTSD in 1-5 sessions, with 37% estimating 6-10 sessions for successful treatment.
Almost half of the practitioners reported using EFT more than 51% of the time during their therapy sessions, with another 27% reporting the use of it 21% to 50% of the time. The three most common non-EFT methods used are cognitive therapy, life coaching, and EMDR. In an open-ended survey question, respondents listed the following non-EFT techniques that respondents as most beneficial for treating PTSD: cognitive therapy, EMDR, and meditation.
The summary of the evaluations of PTSD therapy outcomes is encouraging, Nearly 65% of respondents reported full rehabilitation in more than 60% of their clients, with full rehabilitation in 90% of their clients being reported by 22% of respondents. Most respondents (90%) reported that less than 10% of their clients make little or no progress with EFT.
The authors document some PTSD veteran case studies that are amazingly successful and certainly worth a read.
On the basis of the studies outlined earlier, the results of the survey, and expert consensus, the authors propose treatment guidelines for using EFT for PTSD that follow a framework of a ‘stepped care’ model based on the NICE guidelines. They also suggest that the risk of PTSD should be mitigated using a proactive approach to develop resiliency. In the NICE model, the patient is offered the least intrusive potentially effective intervention first. If the patient does not benefit, or prefers not to continue, s/he is offered the next step. The NICE guidelines emphasize the importance of integrated care, because many mental health conditions share similar neural pathways.
The NICE Step 1 guideline advocates identification, assessment, psychoeducation, active monitoring, and referral for further assessment and interventions. PTSD levels are assessed using accepting testing, and further treatment is based on the scores.
NICE Step 2 guidelines for PTSD recommend treatment using Trauma-Focused Cognitive Behavior Therapy (TFCBT) or EMDR. These recommendations did not include EFT because most of the EFT studies had not been published at the time the guidelines were developed. To make EFT available to a PTSD-positive population, study authors recommend an update of the guidelines based on currently published research. They propose that EFT be added to the recommended treatments and they go on to suggest specific amounts of sessions and group therapy based on the scores of the PTSD testing.
They conclude that: According to published reports, systematic reviews of the published evidence, a meta-analysis of seven RCTs, and practitioner consensus, most cases of PTSD are remediated in ten EFT sessions or less. As a safe, efficacious, and easily learned self-help method, EFT should be offered to clients as an initial treatment option immediately after diagnosis.
Group therapy involving family members may reinforce treatment effects through social support. A structured evidence-based practice protocol should be widely disseminated to clinicians and institutions bearing the burden of PTSD treatment. For those patients who do not respond, appropriate medication and intensive individual psychotherapy is recommended, especially in cases of complex PTSD.
If you work with clients with PTSD, this paper is definitely worth reading and referencing!