The current Wikipedia entry for EFT is deeply flawed. It was written by Wikipedia editors who are members of the Skeptical Inquirer community, and labels EFT as “having characteristics consistent with pseudoscience.”
For most of the past decade, these ideologues (with no subject matter expertise, training, or certification) have controlled the Wikipedia entry on EFT. This same bias against alternative therapies in general is the subject of an article in Natural News, another in ANH, and a blog post in Reality Sandwich.
Whenever a qualified expert tries to amend the Wikipedia entry by, for instance, summarizing a review article published in a peer-reviewed medical journal, the skeptics delete the amendment, in violation of Wikipedia’s NPOV (Neutral Point of View) policy.
If a fact does not conform to the skeptics worldview, they omit mention of that fact. They have no apparent understanding of “evidence-based” standards such as those of the American Psychological Association or the US Government’s National Registry of Evidence-Based Programs and Practices. They encourage skeptics to vandalize articles, and maintain an organized presence on Wikipedia called Wikiproject Skepticism that has been very successful at suppressing opinions at variance with their own.
Because the editors who control the EFT entry have high editorial status on Wikipedia, since around 2004 attempts by subject matter experts to update the EFT entry have been unsuccessful. Below is a proposed entry for Clinical EFT that meets most of Wikipedia’s editorial standards, and that can be used as a draft if Wikipedia ever again returns to enforcing its NPOV policy on the skeptics. Before posting, the article below needs to be reformatted following Wikipedia’s Medical Research rules.
Acupuncture and Stress
Clinical EFT Techniques
Early Development and Controversies
EFT is a clinical and self-help approach that reduces internal distress and shifts problematic patterns of thought, emotion, and behavior. It draws upon established forms of therapy–such as cognitive processing and exposure techniques–while adding physical procedures for stimulating acupuncture points (acupoints).
Research has shown that EFT is effective for psychological conditions such as phobias, anxiety, depression, and posttraumatic stress disorder (PTSD), as well as certain physical symptoms (Gallo, 2009; Lane, 2009; Feinstein, 2012; Church, 2013a). Research on EFT has been conducted in more than 10 countries, by over 60 investigators, whose results have been published in more than 20 peer-reviewed journals (Church, 2013a).
A type of scientific review called a meta-analysis examines a group of studies in order to draw conclusions about the effectiveness of a treatment. An early meta-analysis, of EFT studies published up till 2012, found a “moderate” treatment effect (Gilomen & Lee, 2015). Later meta-analyses examined EFTs efficacy for anxiety (Clond, 2015), depression (Nelms & Castel, 2016) and PTSD (Sebastian & Papworth, 2016). They found that EFT treatment has a “large” effect. The meta-analysis of EFT for depression also found that EFTs effects are greater than those for psychotherapy or pharmacotherapy (Nelms & Castel, 2016).
EFT has spread widely since its inception in the mid 1990s. Over two million people have downloaded The EFT Manual (Craig, 2008; Church, 2013b) and The EFT Mini-Manual (Church, 2009/2013). Some 5,000 case histories in 15 languages have been written and posted by EFT users on the online story archive EFT Universe.
These describe how EFT has been used successfully for a variety of problems, ranging from pain to sports performance. More than 1,000 licensed health providers (such as psychotherapists, physicians, nurses, and clinical social workers) and life coaches have been trained and certified in EFT (Church, 2013a).
Among the primary care settings offering EFT to patients are a number of hospitals in Britain’s NHS (National Health Service) and America’s Veterans Administration (Stewart et al., 2013a; Karatzias et al., 2011; Stewart et al., 2013b; Church & Brooks, 2014).
Over a million survivors of natural and human-caused disasters have been treated using EFT, over 9 million Google searches a month are performed for terms such as “EFT therapy,” and the top 5 EFT web sites receive over 3 million unique visitors a month (Church, 2013a; Traffic Estimate, 2013). EFT is one of a group of therapies collectively known as “energy psychology” or EP.
Professional training in EFT is accredited for Continuing Medical Education (CME) for doctors (American Medical Association), nurses (American Nurses Credentialing Commission), psychologists (American Psychological Association), social workers (NASWB) and many other professional organizations.
Despite EFTs popularity and the research evidence, there are many skeptics and opponents of the method. One prominent critic calls EP a “possible threat to the science of psychiatry and psychology” (Devilly, 2003). A group of skeptics control the Wikipedia entry for EFT. They simultaneously prevent subject matter experts from updating it with new research, and use non-peer-reviewed and biased sources like the Skeptical Enquirer as authorities. Such tactics are often successful at suppressing new therapies for decades (Church, Feinstein, Palmer-Hoffman, Stein, & Tranguch, 2014).
EFT research has been guided by the standards of the American Psychological Association’s (APA) Division 12 (Clinical Psychology) Task Force on Empirically Validated Treatments. The Task Force, convened in the early 1990s, published its standards in a series of papers (Chambless et al., 1996; Chambless et al., 1998; Chambless & Hollon, 1998), and these are often referred to as “APA standards” or “APA criteria” for short.
The APA criteria specify that for a therapy to be regarded as “efficacious,” it is required to demonstrate superiority or equivalence to an established treatment in two randomized controlled trials (RCTs).
The Food and Drug Administration of the US government also requires two studies to demonstrate efficacy (Food and Drug Administration, 1998). If an RCT demonstrates that a therapy is more effective than a wait list, or only one RCT supports it, the APA standards consider it “probably efficacious.” Studies of “efficacious” or “probably efficacious” therapies are required to demonstrate “statistically significant” results, meaning that there is less than one possibility in twenty that the results are due to chance (this meaning of the word “significance” is expressed in research statistics as < .05).
The APA standards identify 7 “essential” criteria, and unless a study meets all 7, the method being studied cannot be evaluated for whether or not it is “evidence-based” (Church, Feinstein, Palmer-Hoffman, Stein, & Tranguch, 2014). Unless otherwise noted, all RCTs referenced in this article are statistically significant and meet all 7 APA criteria.
EFT has met the APA standards for a number of conditions, including anxiety, depression, phobias, and PTSD (Feinstein, 2012; Church, 2013a). There are as many forms of EFT as there are practitioners, so to denote the technique as validated in research studies that meet APA Division 12 criteria, the term “Clinical EFT” is used (Church, 2013a).
EFT is popularly referred to as “tapping” since instead of needling, practitioners stimulate acupuncture points by tapping or pressing them. Pressure on acupoints is called “acupressure” and the practice has been found efficacious for pain in a number of studies (Robinson, Lorenc, & Liau, 2011).
Anxiety. Clinical EFT shows a “large” treatment effect for anxiety, according to a meta-analysis of 14 randomized controlled trials (Clond, 2015). Typical studies analyzed included one of students with fear of public speaking. They received a 45 minute EFT session and improved significantly (Jones, Thornton, & Andrews, 2011). In another, high school students with test anxiety were evaluated before an important test. Those who learned EFT improved significantly (Sezgin & Ozcan, 2009).
Depression. According to a meta-analysis of 12 randomized controlled trials of depression, EFT produces a “large” treatment effect (Nelms & Castel, 2016). A typical study analyzed by the meta-analysis examined college students with high levels of depression (“clinical” depression as measured by the Beck Depression Inventory) found that they were in the “non-depressed” range after EFT (Church, de Asis, & Brooks, 2012). Another, of fibromyalgia sufferers, also found significant improvements in depression (Brattberg, 2008), as have studies of healthcare workers (Church & Brooks, 2010), veterans (Church et al., 2013), and NHS hospital patients (Karatzias et al., 2011).
Phobias. Several review papers examine three RCTs that have examined the effects of Clinical EFT on phobias and found that a single session is usually enough to resolve a phobia (Feinstein, 2012; Church, 2013a). All three studies included a follow-up period and found that the phobic responses of participants remained significantly lower than before treatment (Wells et al, 2003; Baker & Siegel, 2010; Salas et al., 2010).
PTSD. A meta-analysis of 7 RCTs of EFT for PTSD found “large” treatment effects (Sebastian & Papworth, 2016). One of those analyzed examined a population of 59 war veterans, and found that PTSD symptoms dropped into the “normal” range after six sessions of EFT and remained that way on follow-up (Church et al., 2013). Another, conducted in a hospital in Britain’s NHS, compared EFT to another efficacious treatment, Eye Movement Desensitization and Reprocessing (EMDR) (Karatzias et al., 2011). It found that both treatments normalized PTSD in an average of four sessions. An RCT of abused male teenagers found, on follow-up, that their PTSD symptoms had been resolved in a single EFT session (Church et al., 2011).
Physical Symptoms. The veterans PTSD study also found a significant reduction in physical pain and TBI (traumatic brain injury) symptoms, as did Brattberg’s (2008) RCT with fibromyalgia sufferers. An RCT of patients with tension headaches performed at the Red Cross Hospital in Athens found that the frequency and intensity of their headaches dropped by more than half after EFT, and other physical symptoms improved (Bougea et al., 2013).
A pilot study of psoriasis symptoms also showed improvement in skin problems (Hodge, 2011). Other authors report success with victims of motor accidents (Burke, 2010), prisoners (Lubin & Schneider, 2009), dyslexia sufferers (McCallion, 2012), and patients with seizure disorders (Swingle, 2010).
Sports Performance. Two RCTs have examined EFT’s efficacy for sports performance. One measured the difference in basketball free throw percentages between an EFT and a placebo control group and found a performance difference of 38% after a brief session (Church, 2009; Baker 2010). Another found similar benefits for soccer free kicks (Llewllyn-Edwards & Llewllyn-Edwards, 2011).
A case study of golf performance found stress-related errors decreasing after EFT (Rotherham et al., 2012). A twenty-minute EFT session was found to increase confidence and decrease anxiety in female college-aged athletes (Church & Downs, 2012).
Weight Loss. Studies have examined the use of EFT for weight loss and food cravings. A randomized controlled trial found that EFT improved restraint (Stapleton, 2010) and that in the year following the EFT weight loss program, participants lost an average of 11.1 lb (Stapleton, 2011).
In several groups of healthcare workers, cravings for substances such as chocolate, sweets and alcohol were reduced by 68% (Church & Brooks, 2010). A review found that EFT could also be useful as an adjunctive therapy for weight loss (Sojcher et al., 2012).
Studies using fMRI to measure the effects of acupuncture on the areas of the brain associated with fear have found it to produce rapid regulation of these regions (Hui et al., 2005; Fang et al., 2009; Napadow et al., 2007). EFT has been evaluated using EEG (electroencephalogram) technology.
Studies have found that acupoint tapping reduces the brain wave frequencies associated with stress (Swingle, Pulos, & Swingle, 2004; Lambrou, Pratt, & Chevalier, 2003; Swingle, 2010).
The relationship between psychological conditions such as anxiety and depression and the stress hormone cortisol has also been studied. A triple-blind study examined the cortisol levels of 83 normal subjects before and after an hour of Clinical EFT. A control group received talk therapy while a second control group simply rested.
Comparison of the three groups revealed significant reductions in cortisol in the EFT group compared to the other two groups, as well as more than double the drop in symptoms of psychological distress (Church, Yount, & Brooks, 2012). Improvements in mental health after therapy can be reflected in reduced levels of stress hormones such as cortisol and regulation of the genes that code for such hormones (Feinstein & Church, 2010).
In its simplest form, Clinical EFT involves the stimulation of 12 acupressure points (acupoints) while focusing on a problem. EFT uses a “setup statement” which combines a description of the problem with a statement of self-acceptance. Acupoints may be tapped with the fingertips or touched lightly, a variant known as TAB or “touch and breathe.”
EFT also specifies the use of a “reminder phrase” to keep the user highly focused on the specifics of the problem while tapping. This aspect of the technique draws on the established therapeutic benefit of exposure to the problem, as used in EMDR (Bergmann, 2010) and prolonged exposure therapy (Foa, Keane, & Friedman, 2009).
Before starting the tapping sequence, EFT has users score the intensity of their distress about a targeted problem or memory on a scale from 0 to 10. This verbal assessment is drawn from psychiatrist Joseph Wolpe’s (1973) widely used SUD (Subjective Units of Distress) rating approach.
After tapping, the EFT user provides a second SUD rating to measure whether or not the level of distress has changed.
These and some 40 other techniques–focused on evoking vivid exposure to the fear, pain, or other targeted problem–are described in The EFT Manual (Craig & Fowlie, 1995; Church, 2013). The manual has been available in either print or download form since the mid 1990s, ensuring uniform application of the method in research and training. A written manual is one of the 7 “essential” APA criteria.
There are 48 Clinical EFT techniques described in the most recent version of The EFT Manual (Church, 2013b). These include specialized methods of addressing severe psychological trauma, pain and physical symptoms, cravings and addictions, weight loss, and with special populations such as children, veterans, and athletes.
Early Development and Controversies
EFT was developed in the early 1990s as an offshoot of Thought Field Therapy or TFT. TFT also has users tap acupoints, but it uses elaborate diagnostic protocols and specifies that points should be tapped in a certain order depending on the condition being treated.
TFT originated with clinical psychologist Roger Callahan, PhD. One of Callahan’s students, a performance coach named Gary Craig, reasoned that since only 12 acupoints are commonly used, they could all be tapped quickly, dispensing with the rest of the TFT protocol. He named this abbreviated form Emotional Freedom Techniques (EFT).
EFTs development and acceptance by the clinical community was slowed by several factors. One was early and extravagant claims of efficacy by Callahan and Craig before research evidence had accumulated to validate TFT and EFT. These unsupported claims led to understandable skepticism by clinicians (Feinstein, 2009).
While clinicians observed that acupoint tapping rapidly reduced many psychological symptoms, the explanatory mechanisms for these effects proposed by Craig and Callahan fell outside of the boundaries of mainstream science. They posited “subtle energies” as the reason for EFTs effects; Craig went so far as to make his “Discovery Statement” central to his explanation of why EFT works.
The Discovery Statement holds that “The cause of all negative emotion is a disruption in the body’s energy system.”
This statement is inconsistent with research showing that many other factors contribute to negative emotion, such as adverse experiences, pain and physical symptoms, and childhood psychological trauma (Felliti et al., 1996). It is characterized as “magical thinking” by other EFT experts (Church, 2013).
By way of contrast to magical explanations, research has shown that EFTs effects are due to changes in conventional biomedical signs, such as reductions in the stress hormone cortisol, reduced heart rate, and regulation of the brain wave frequencies associated with psychological trauma (Swingle, Pulos, & Swingle, 2004; Lambrou, Pratt, & Chevalier, 2003; Church, Yount, & Brooks, 2012; Wells et al, 2003). In 2009, Craig announced his retirement, and in 2011, he abandoned the manualized form of EFT in favor a revised online variant he trademarked as “Official EFT.”
Hampered by the explanatory mechanisms employed by proponents, it was not until 2012, when ample empirical evidence of EFTs efficacy had been accumulated, in the form of dozens of clinical trials and review papers, that the APA approved the provision of CE (continuing education) credits to psychologists for EFT training.
Organizations offering professional medical education have also now determined that Clinical EFT has met evidence-based standards, thus doctors and nurses can receive CME (continuing medical education) credit for Clinical EFT training.
EFTs public acceptance was further impeded by the actions of a group of skeptics. These individuals control the Wikipedia entry for EFT. Though they had no training, certification, or other expertise in the subject matter, they allowed only disparaging and outdated sources to appear on Wikipedia’s entry, blocking the addition of references to RCTs and clinical trials meeting APA Division 12 standards.
Till 2012 they permitted the mention of only one study on the Wikipedia EFT page (Waite & Holder, 2003), the design of which was so flawed that it can be used to either support or disprove EFT (Baker, Carrington, & Putilin, 2009). This study also failed to meet 3 of the 7 APA criteria (Church, Feinstein, Palmer-Hoffman, Stein, & Tranguch, 2014).
Many review papers have been published on EFT. Those that apply the APA Division 12 criteria to assess the quality and quantity of research find that the method is “empirically validated” for phobias, depression, anxiety, and PTSD (Feinstein, 2012; Church, 2013; Gallo, 2009; Kevin, 2011; Church & Feinstein, 2013; Mollon, 2011; Sojcher, Fogerite & Perlman, 2011; Church, 2014).
Reviewers using a variety of ad hoc standards other than those defined by APA Division 12 have criticized the research base for EFT, the method itself, and a purported lack of explanatory mechanisms for its rapid effects (Devilly, 2003; Pignotti & Thyer, 2011; McCaslin, 2009; Gaudiano & Herbert, 2000).
Despite these obstacles, the use of EFT has grown steadily, mostly by word of mouth, and referrals to the success stories on EFT Universe and other web sites. Clinical EFT is now used in certain hospitals and clinics operated by the US Department of Veterans Affairs as well as Britain’s NHS. EFT is widely used in psychotherapy and coaching.
An assessment critical of EP surveyed licensed psychotherapists recruited from Listservs such as the Association of Behavioral and Cognitive Therapies, Acceptance and Commitment Therapy, and the Society for a Science of Clinical Psychology (Gaudiano, Brown, & Miller, 2012). Of these, 42% reported using EP techniques in their practices. The professional EP society, the Association for Comprehensive Energy Psychology (ACEP) now numbers over 1,000 members.
Research has shown that EFT is effective when delivered by life coaches, though not quite as effective as when offered by licensed mental health professionals (Hartung & Stein, 2012). It is also effective when delivered by telephone, though in-person sessions have been found to be more beneficial (Stein & Brooks, 2011).
A dismantling study sought to determine the effect of the tapping and affirmation component of EFT, separating it from the cognitive and exposure components, and found that tapping was an active ingredient rather than a placebo (Fox, 2013). Another study compared different demographic groups, and found that EFTs effects could be generalized to widely diverse populations (Boath, Stewart, & Carryer, 2013).
In addition to statistical significance, the APA criteria emphasize the evaluation of clinical significance. This is a measure of how beneficial a treatment is to people suffering from the psychological condition being studied. Studies have identified large clinical benefits to using EFT in the form of sharply reduced symptoms (Church, 2011a).
EFT is also effective when used in groups rather than individual therapy.
An outcome study of PTSD symptoms in 218 veterans and spouses who received group EFT found that most normalized after treatment (Church & Brooks, 2014). A study of 216 healthcare workers, including psychotherapists, nurses, doctors, and alternative medicine practitioners, demonstrated a highly significant 45% drop in psychological symptoms after EFT group treatment (Church & Brooks, 2010).
EFT’s efficacy when delivered in groups has also been demonstrated by other investigators (Rowe, 2005; Palmer-Hoffman & Brooks, 2011). Clinician-developed treatment guidelines for using EFT for conditions such as PTSD have also been developed (e.g., Schulz, 2009; Church & Feinstein, 2012; Church, 2014).
EFT has also found a role in helping the victims of human-caused and natural disasters. One study measured PTSD symptoms in 77 male seminarians following the 2010 Haiti earthquake. After two days of EFT instruction, their symptoms had normalized (Gurret, Caufour, Palmer-Hoffman, & Church, 2012). Similar results were found with orphans of the 1994 Rwanda genocide (Stone, Leyden, & Fellows, 2009; Stone, Leyden, & Fellows, 2010). A review paper examining the use of EFT and TFT reported similar results in Kosovo and other disaster zones (Feinstein, 2008).
Though the research on EFT indicates robust treatment effects for many problems, EFT is not always successful and should not be considered a panacea (Church, 2011b). Broadly speaking, given the physiological and psychological evidence, EFT appears to be very useful at reducing stress.
Stress is often a component of problems like pain, anxiety, and depression. There are also problems for which EFT appears to have little or no effect, and it cannot be used as a substitute for proper medical or psychological care (Church, 2011b).
EFT advocates emphasize that while it can be safely used as a self-help method, it is most effective when used in conjunction with a suite of therapeutic techniques such as cognitive behavioral therapy or experiential approaches such as Gestalt therapy (Church, 2011b; Hoss & Hoss, 2010).
A review article on Clinical EFT as a single-session therapy cautions that early and superficial success can lead patients and clinicians to become over-confident, and neglect the fundamental benefits of multi-modal psychotherapy as well as appropriate medication (Church, 2014).
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