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Is Tapping on Acupuncture Points an Active Ingredient in Emotional Freedom Techniques? A Systematic Review and Meta-analysis of Comparative Studies

Citation:  Church, D., Stapleton, P., Yang, A, Gallo, F. The Journal of Nervous and Mental Disease, Vol. 206, No. 10, October 2018


Emotional Freedom Techniques (EFTs) combine elements of cognitive restructuring and exposure techniques with acupoint stimulation. Meta-analyses indicate large effect sizes for posttraumatic stress disorder, depression, and anxiety; however, treatment effects may be due to components EFT shares with other therapies. This analysis reviewed whether EFTs acupressure component was an active ingredient. Six studies of adults with diagnosed or self-identified psychological or physical symptoms were compared (n = 403), and three (n = 102) were identified. Pretest vs. posttest EFT treatment showed a large effect size, Cohen’s d = 1.28 (95% confidence interval [CI], 0.56 to 2.00) and Hedges’ g =1.25 (95% CI, 0.54 to 1.96). Acupressure groups demonstrated moderately stronger outcomes than controls, with weighted posttreatment effect sizes of d = −0.47 (95% CI, −0.94 to 0.0) and g = −0.45 (95% CI, −0.91 to 0.0). Meta-analysis indicated that the acupressure component was an active ingredient and outcomes were not due solely to placebo, nonspecific effects of any therapy, or nonacupressure components.

Craig’s Notes

The authors hypothesized that EFT protocols that used tapping on acupressure points would be shown to produce stronger outcomes than comparable protocols that do not use acupressure points. They started by doing an extensive search for every study they could find on EFT. From these they selected studies that addressed the question of acupoint tapping as an active ingredient in the success of EFT.

The studies were assessed using seven stringent criteria, which included a sufficient samples size, valid and reliable assessment tools, the use of EFT treatment manuals, and more. To be included in the final meta-analysis, all seven of the criteria had to be met. They found six studies, with a combined total of 403 participants that addressed the question of acupoint tapping being an essential component in the results.

All six studies had the experimental group tap on acupoints, three of them had the comparative group also tap on sham points (ones not used in EFT), two used diaphragmatic breathing instead of tapping, and one used a mindfulness breathing technique. Unfortunately, three of the studies did not meet all of the Design Quality standards, for example, in a couple of the studies using sham tapping points the tapping was done with the forefinger which in itself is an acupoint for mental restlessness. And so – there could not be a conclusive result as to whether the actual EFT tapping was more effective.

The final meta-analysis included three studies which met all criteria. However, the authors reported on and discussed all six studies.

So, what were the conclusions? In all instances, the protocols that included acupoint tapping produced significantly stronger effects than the protocols that did not. Although the studies reviewed each had some limitations, each provides solid evidence addressing the question of whether tapping is an essential ingredient in EFT protocols, and each corroborates the essential findings of each of the others.

The authors further note that although the introduction of acupoint tapping into modern clinical practice is relatively recent, the use of acupressure for emotional disorders extends back at least 5000 years. Acupressure, used independent of EFT, has been shown to be effective with a range of physical and psychological conditions, particularly pain. Meta-analyses of acupressure studies for pain and nausea have found highly significant treatment effects.

They postulate that if acupoint tapping done simultaneously with established mental health interventions appreciably increases therapeutic impact, the implications for clinical

practice could be substantial. They further concluded that although EFT borrows components from other treatment methods, like cognitive therapy and imaginal exposure, the evidence analyzed in this report supports the hypothesis that acupoint tapping is an active ingredient in EFTs efficacy and that the proven treatment effects are not due solely to the components EFT shares with other methods.