Print

[YanTing]

The Journal of Nervous and Mental Disease
Volume 206(10), October 2018, p 783–793

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

Church, Dawson PhD*; Stapleton, Peta PhD†; Yang, Amy PhD‡; Gallo, Fred PhD§

*National Institute for Integrative Healthcare, Fulton, CA;
†School of Psychology, Bond University, Queensland, Australia;
‡Department of Educational Psychology, Purdue University, West Lafayette, IN; and
§University of Pittsburgh Medical Center, Farrell, PA.
 .
Abstract

Abstract: 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.

https://journals.lww.com/jonmd/Abstract/2018/10000/Is_Tapping_on_Acupuncture_Points_an_Active.6.aspx


Excerpts:

Emotional Freedom Techniques (EFTs) and other energy psychology” protocols combine elements of established therapies, such as cognitive restructuring and exposure techniques, with the novel ingredient of acupuncture point (acupoint) stimulation (Gallo, 2004). Acupoint stimulation is delivered in the form of percussion with the fingertips (“acupoint tapping”), a type of acupressure...Although the term “acupressure” evokes an image of continual pressure, tapping on acupoints is another established way of stimulating them and has been used in methods such as qigong and shiatsu for centuries (Jahnke et al., 2010). For a small proportion of individuals who might find tapping on their skin unsettling, such as those who have been physically abused, an alternative way of stimulating the acupoints within an energy psychology framework is to apply light pressure with the fingertips (Diepold, 2000).

While stimulating these acupoints, clients maintain mental focus on a traumatic event. This is facilitated by EFT's “setup statement,” which combines exposure with cognitive reframing. The client uses the words “even though” before the triggering phrase, and “I deeply and completely accept myself” after it. A typical setup statement might be, “Even though I was so badly hurt in that terrible car crash, I deeply and completely accept myself.” Although tapping on seven prescribed acupoints, the client then uses a “reminder phrase” to facilitate exposure. An example of a reminder phrase is “that terrible car crash.” The purpose of this study is to investigate whether the acupressure component is an active ingredient in the effects measured in studies of EFT.

Since the publication of a preliminary review of efficacy evidence for acupoint tapping protocols that target psychological concerns (Feinstein, 2008a), more than 50 peer-reviewed randomized controlled trials (RCTs) have shown favorable clinical outcomes...Three meta-analyses have found large effect sizes for EFT in the treatment of anxiety (Clond, 2016), depression (Nelms and Castel, 2016), and posttraumatic stress disorder (PTSD) (Sebastian and Nelms, 2017), respectively. A fourth, combining a range of conditions, showed a medium effect size (Gilomen and Lee, 2015). EFT treatment outcomes with PTSD have been particularly encouraging (Church and Feinstein, 2017; Church et al., 2009, 2013, 2016a; Feinstein, 2008b, 2010; Gallo, 2007; Geronilla et al., 2016; Karatzias et al., 2011). Additional studies show rapid improvements for a variety of other psychological challenges such as performance blocks, excessive food cravings, and stress management (see summaries in Church, 2013b; Gallo, 2002, 2004; Mollon, 2007; Schulz, 2009).

A range of medical diagnoses have also responded favorably to EFT treatment, including fibromyalgia (Brattberg, 2008; Church, 2013c), hypertension (Bach et al., 2016), frozen shoulder (Church and Nelms, 2016), psoriasis (Hodge and Jurgens, 2011), tension headaches (Bougea et al., 2013), pain (Church, 2014; Church and Brooks, 2010; Ortner, 2015), obesity (Stapleton et al., 2012, 2016), traumatic brain injury (Church and Brooks, 2014), and seizure disorders (Swingle, 2010). The demonstrated ability of EFT to treat this disparate range of psychological and physiological conditions has been attributed to the technique's capacity to rapidly reduce stress levels (Church et al., 2012; Lane, 2009) combined with its postulated strengths for facilitating the adaptive processing of emotional information (Feinstein, 2015).

Functional magnetic resonance imaging (fMRI) and positron emission tomography scans have investigated neurological shifts after acupoint stimulation...Clinically favorable shifts after acupoint tapping sessions have also been reported for a number of biomarkers, including stress hormones (Church et al., 2012), gene expression (Church et al., 2016b; Feinstein and Church, 2010; Maharaj, 2016), electroencephalogram activity (Lambrou et al., 2003; Swingle et al., 2004), and fMRI-detected brain activation patterns (Gaesser and Karan, 2017)...A wide range of physiological mechanisms, including epigenetic, endocrinal, and neurological components, have thus been found to be associated with EFT treatment.

Because EFT protocols include elements of psychotherapies that have proven to be efficacious (e.g., cognitive reframing and imaginal exposure), what is the evidence that the strong treatment effects found in EFT clinical trials is not due solely to these ingredients, and not to acupressure (Bakker, 2013; McCaslin, 2009)? Is the acupressure component of EFT an instance of the “purple hat fallacy” (Rosen and Davison, 2003), in which a therapist might apply an efficacious therapeutic method while wearing a purple hat and then attribute the treatment success to the hat?

Six studies of varying quality were retrieved in a literature search, which compared the full EFT protocol with a similar protocol that substituted acupoint tapping with either a breathing technique or tapping on sham points. One of the studies (Waite and Holder, 2003), which was designed to have participants tap on sham points, inadvertently used traditional acupuncture points as the comparison condition. The other five studies found that the protocol that used acupoint tapping produced outcomes that were superior to those of the comparison treatment.

These findings are consistent with evidence from the broader acupressure field. A systematic review of 66 studies (n = 7265) comparing traditional point acupressure with sham point acupressure found both to have a clinical effect, but the traditional points had a significantly stronger effect than the sham points (Tan et al., 2015).

The studies examined in this meta-analysis were comparative studies; they included a substitute activity that was either an active control or a sham treatment...The studies examined, therefore, controlled for the placebo effect.

Each of the EFT comparison studies found the protocols that included acupoint tapping to produce significantly stronger outcomes than those that did not, unlike the very small differences found by Wampold and Imel (2015). One possible explanation for the effects of acupoint tapping being so strong goes beyond EFT. Advantages of somatic interventions, particularly in the treatment of trauma-based conditions, have been gaining increasing recognition since the publication of Van der Kolk (1994, 2015). Somatic interventions are qualitatively different from other components of psychotherapy (Church, 2016; May, 2005; Rothschild, 2000), and acupoint tapping is a body-based approach that is easily learned and integrated into psychological frameworks.

Although the introduction of acupoint tapping into modern clinical practice is relatively recent (Gallo, 2004), the use of acupressure for emotional disorders extends back at least 5000 years (Gach and Henning, 2004). 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 (p < 0.0001) treatment effects (Chen et al., 2013; Helmreich et al., 2006). If acupoint tapping done simultaneously with established mental health interventions appreciably increases therapeutic impact, the implications for clinical practice could be substantial.

In the six studies that have examined the active ingredients of EFT, investigators have come to divergent conclusions. The authors of five of the articles reported that their findings lend support to the premise that acupoint tapping is an active ingredient; the authors of the remaining study (Waite and Holder, 2003) speculated that other factors, such as “systematic desensitization and distraction,” may be “mediators of EFT's apparent effectiveness” (p 24)...Although EFT borrows components from other treatment methods, especially 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 large treatment effects measured are not due solely to the components EFT shares with other methods.



Comment: a recent post by Edzard Ernst discussed this and another paper.  The title was "Emotional Freedom Technique, a combination of two types of BS."
https://edzardernst.com/2018/10/emotional-freedom-technique-a-combination-of-two-types-of-bs/

His summary was: "These reviews conveniently forget to mention that the primary studies tend to be of poor or even very poor quality. The most common flaws include tiny sample sizes, wrong statistical approach, lack of blinding, lack of control of placebo and other nonspecific effects. Reviews of such studies thus turn out to be a confirmation of the ‘rubbish in, rubbish out’ principle: any summary of flawed studies are likely to produce a flawed result.  Until I have good quality trials to convince me otherwise, EFT is in my view:1. implausible and 2. not of proven effectiveness for any condition.