Money Attitudes After Clinical Emotional Freedom Techniques: Psychological Change in a Virtual vs In-Person Group.

Context: Emotional Freedom Techniques (EFTs) can reduce anxiety, depression, PTSD, and phobias. Research has found correlations between attitudes toward money and anxiety and depressive symptomatology. No research has yet examined the effectiveness of EFT in changing money attitudes. Objective: The study intended to measure the effectiveness of EFT in changing money attitudes and to contrast EFT's effects delivered virtually or in-person by evaluating multiple markers of stress, including anxiety, depression, pain, happiness, and PTSD. Design: The research team performed a retrospective controlled study. Participants: Participants were a convenience sample of 54 nonclinical individuals. Intervention: The study included participants into an in-person group and a virtual group. The 24 participants in the in-person group met prior to the COVID-19 pandemic, and the 35 participants in the virtual group participated in the workshop toward the end of 2020. Both used EFT to address money-related issues during a two-day workshop. Outcome Measures: The research team used: (1) the brief version of the Generalized Anxiety Disorder-7 (GAD-7), GAD-2, to assess participants' anxiety; (2) the Patient Health Questionnaire-2 (PHQ-2) to assess symptoms of depression over the two weeks prior to the testing; (3) the PTSD Checklist (PCL-2) to assess symptoms of PTSD over the month prior to the test; (4) the Happiness Scale, an 11-point Likert scale that indicates whether respondents feel happy in general; (5) the Numeric Pain Rating Scale, a self-rated average of pain that participants had experienced in the 24 hours prior to the test; and (6) the Money Attitudes Scale (MAS) to measure change in attitudes. Results: Postintervention, the in-person group has significant reductions in anxiety (P = .023), PTSD (P = .013), and pain (P = .029) as well as significant improvements in happiness (P < .001). The group's MAS scores for Power-Prestige (P = .008), Distrust (P < .001) and Money Anxiety (P < .01) also decreased significantly. At the six-month followup, the group's mean scores showed significant decreases for PTSD (P < .001) and pain (P < .001) as well as significant improvements in happiness (P < .05). Postintervention, the virtual group had a significant increase in happiness (P < .001), but while anxiety, depression, and pain decreased, the changes weren't statistically significant. The group's money attitudes also showed a significant increase in Retention-Time (P < .001) as well as significantly decreased scores for Distrust (P < .001), Money Anxiety (P < .01) and Power-Prestige (P < .01). At the six-month followup, the virtual group's mean differences from baseline were greater than that of the in-person group. Conclusions: The current study's findings point toward EFT's potential to improve money attitudes as well as psychological symptoms and indicated that EFT can be effective when delivered virtually. The study demonstrated improvements in anxiety, depression, pain, and happiness. The current research team recommends delivering EFT and other evidence-based therapies virtually, through apps, on-demand therapy sessions, virtual reality (VR), and artificial intelligence (AI).

Clinical EFT as an evidence-based practice for the treatment of psychological and physiological conditions: A systematic review.

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.

Skinny Genes' Six-week, Online, Clinical Emotional Freedom Techniques Program: Durable Weight Loss and Improved Psychological Symptoms.

Context: With obesity a mounting global issue, efficacious treatments can make a contribution to both personal and public health. Prior clinical trials have demonstrated that an evidence-based method, Clinical Emotional Freedom Techniques (EFT), can produce a durable weight reduction. Objective: The study evaluated whether Skinny Genes, a six-week online program applying EFT to emotional eating, was associated with behavioral change and reductions in weight. Design: A pre-post outcome study design evaluated the results of a convenience sample of participants enrolled in an online weight loss course. Participants: Participant were recruited through EFT websites. Pre, post and follow-up measures were available for 72 participants and all analysis was performed on this sample. Intervention: Participants used EFT to address cognitions, behaviors, and adverse experiences that could contribute to binge eating, intermittent dieting, and resistance to exercise. Outcome Measures: Behaviors to restrain eating were measured using the Revised Restraint Scale (RRS); the association of food with reward using the Power of Food Scale (PFS); anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Weight was measured pre and postintervention and at six-month follow-up. Results: Postintervention, a 36.8% reduction in anxiety (P < .001) and a 48.5% reduction in depression (P < .001) were found. The perceived power of food decreased significantly as did restraint behaviors. Participants lost an average of 12.9 lbs during the six weeks of the program (P < .001), and at follow-up, a further 2.6 lbs. All psychological gains were maintained (P < .001). Conclusions: The findings are consistent with those of other clinical trials studying the benefits of EFT for weight loss, demonstrating simultaneous reductions in both weight and psychological distress. The continued weight reduction found on follow-up was consistent with other EFT studies but counter to the pattern of weight regain noted in the literature. Addressing emotional issues using an online delivery format was associated with durable weight-loss maintenance as well as improved mental health. App-based and virtual programs such as Skinny Genes have the potential to bring effective therapies to underserved populations.

Corrigendum Supports Therapeutic Contribution of Acupoint Tapping to EFTs' Observed Effects: Response to Spielmans (2021).

ABSTRACT: We published a meta-analysis of studies that examined the various components of an evidence-based therapy called emotional freedom techniques (EFTs). EFT uses elements of conventional therapies such as exposure and cognitive processing but includes the unique ingredient of acupoint stimulation using fingertip tapping. Six studies were identified, and three of these met the quality control criteria of the American Psychological Association's Division 12 Task Force for Empirically Validated Therapies. Meta-analysis found that the acupoint component of EFT was not an inert ingredient or inactive placebo but made an active contribution to the therapeutic effects noted in a research literature that now numbers over 100 clinical trials of EFT. Subsequent to publication, errors in the original analysis were identified, primarily incorrect standard deviations. A new analysis was performed by an independent statistician and found slightly greater effects than the original investigation. The results were published as a corrigendum, which was subsequently challenged by Spielmans. Here we examine the critiques of the corrigendum and original article. We find that although they may be of academic interest, they are irrelevant to the central research question of whether the acupoint component of EFT is inert or active. We reaffirm that the evidence clearly validates the contribution made by acupoint tapping to EFT's observed clinical effects.

Corrigendum to: Is Tapping on Acupuncture Points an Active Ingredient in Emotional Freedom Techniques: A Systematic Review and Meta-Analysis of Comparative Studies.

We published a meta-analysis of component trials of emotional freedom techniques (EFT) in this journal. EFT is an evidence-based method, validated in over 100 clinical trials, that uses fingertip tapping on acupressure points in conjunction with techniques from exposure and cognitive therapy. The meta-analysis examined six studies in which an active control, such as diaphragmatic breathing or sham acupoints, was used in place of tapping on actual acupoints. The purpose of the meta-analysis was to determine whether tapping was an inert or an active ingredient in EFTs observed treatment effects. Subsequent to publication, errors in the statistical analysis were identified, primarily incorrect standard deviation values, and our methodological approach was questioned by others. We therefore had the meta-analysis rerun by an independent senior statistician who compared pre- to follow-up results to determine the sustained effects of treatment. The cumulative fixed effects Hedge's g-value was found to be 0.73 (95% confidence interval = 0.42-1.04, p < 0.0001). The corresponding random effects Hedge's g-value is 0.74 (95% confidence interval = 0.34-1.13, p < 0.0001). We also reviewed and clarified our methodology. In conclusion, despite computational errors in our original publication, the present revised analysis supports the original conclusion that the acupressure component of the EFT protocol is an active ingredient that contributes to the method's favorable health effects.

Is Online Treatment as Effective as In-Person Treatment?: Psychological Change in Two Relationship Skills Groups.

Psychotherapy has undergone a widespread change recently, with many interventions now available as wireless device apps or online courses. The current study compared the efficacy of an online program with a personal group treatment intervention. The in-person group (n = 37) attended a 6-day workshop called Tapping Deep Intimacy that focused on the development of interpersonal skills. The online group (n = 37) consumed to the same information in the form of a 12-week online course. The content of both courses was drawn from the curriculum for Whole Energy Lifestyle, which trains participants in 12 evidence-based interpersonal and stress-reduction skills designed to reduce emotional triggering and promote health. These include mindfulness, breathwork, meditation (EcoMeditation), heart coherence, Clinical Emotional Freedom Techniques, active listening, and qigong. In both groups, depression, anxiety, and relationship satisfaction were assessed pre, post, and at 1-year follow-up. Anxiety reduced in the in-person but not the online group. Significant improvements in depression (p < 0.001) were found in both groups, although sharper symptom declines were found in the in-person group. A 29% improvement in relationship satisfaction was found in both groups (p < 0.003), and both maintained their gains over time. Anxiety and depression symptoms were much higher in the in-person group pretest despite similar demographic characteristics, suggesting differences in the population that uses online courses. These preliminary findings suggest that while online programs may play a role in the development of stress-reduction and interpersonal skills, it cannot be assumed that they mirror the therapeutic efficacy of in-person treatment in every dimension.

Guidelines for the Treatment of PTSD Using Clinical EFT (Emotional Freedom Techniques).

Clinical EFT (Emotional Freedom Techniques) is an evidence-based method that combines acupressure with elements drawn from cognitive and exposure therapies. The approach has been validated in more than 100 clinical trials. Its efficacy for post-traumatic stress disorder (PTSD) has been investigated in a variety of demographic groups including war veterans, victims of sexual violence, the spouses of PTSD sufferers, motor accident survivors, prisoners, hospital patients, adolescents, and survivors of natural and human-caused disasters. Meta-analyses of EFT for anxiety, depression, and PTSD indicate treatment effects that exceed those of both psychopharmacology and conventional psychotherapy. Studies of EFT in the treatment of PTSD show that (a) time frames for successful treatment generally range from four to 10 sessions; (b) group therapy sessions are effective; (c) comorbid conditions such as anxiety and depression improve simultaneously; (d) the risk of adverse events is low; (e) treatment produces physiological as well as psychological improvements; (f) patient gains persist over time; (g) the approach is cost-effective; (h) biomarkers such as stress hormones and genes are regulated; and (i) the method can be adapted to online and telemedicine applications. This paper recommends guidelines for the use of EFT in treating PTSD derived from the literature and a detailed practitioner survey. It has been reviewed by the major institutions providing training or supporting research in the method. The guidelines recommend a stepped-care model, with five treatment sessions for subclinical PTSD, 10 sessions for PTSD, and escalation to intensive psychotherapy or psychopharmacology or both for nonresponsive patients and those with developmental trauma. Group therapy, social support, apps, and online and telemedicine methods also contribute to a successful treatment plan.

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

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.

The Interrelated Physiological and Psychological Effects of EcoMeditation.

This study investigated changes in psychological and physiological markers during a weekend meditation workshop (N = 34). Psychological symptoms of anxiety, depression, posttraumatic stress disorder (PTSD) and happiness were assessed. Physiological markers included cortisol, salivary immunoglobulin A (SigA), heart rate variability (HRV), blood pressure (BP), and resting heart rate (RHR). On posttest, significant reductions were found in cortisol (-29%, P < .0001), RHR (-5%, P = .0281), and pain (-43%, P = .0022). Happiness increased significantly (+11%, P = .0159) while the increase in SigA was nonsignificant (+27%, P = .6964). Anxiety, depression, and PTSD all declined (-26%, P = .0159; -32%, P = .0197; -18%, P = .1533), though changes in PTSD did not reach statistical significance. No changes were found in BP, HRV, and heart coherence. Participants were assessed for psychological symptoms at 3-month follow-up, but the results were nonsignificant due to inadequate sample size (n = 17). EcoMeditation shows promise as a stress-reduction method.

The Manual Stimulation of Acupuncture Points in the Treatment of Post-Traumatic Stress Disorder: A Review of Clinical Emotional Freedom Techniques.

Background: The manual stimulation of acupuncture points has been combined with components of cognitive and exposure therapies into a clinical and self-help approach known as Emotional Freedom Techniques (EFT). More than 40 clinical trials and four meta-analytic reviews of EFT treatments have demonstrated large effect sizes with a range of conditions, including pain, PTSD (in both civilian and military veteran populations), phobias, anxiety, and depression. Objective: This review describes the approach, with a focus on PTSD in veterans and service members, provides an overview of how EFT is most commonly applied, and outlines obstacles and cautions related to its implementation. Methods: Peer-reviewed clinical trials and meta-analyses of EFT in the treatment of PTSD are assessed to identify the characteristics of the approach that render it suitable for the treatment of PTSD. Results: The literature demonstrates that remediation of PTSD and comorbid conditions is typically accomplished within brief time frames, ranging from one session for phobias to between four and ten sessions for PTSD. Clinical EFT has been shown to regulate stress hormones and limbic function and to improve various neurologic markers of general health. The epigenetic effects of EFT include upregulation of immunity genes and downregulation of inflammation genes. Six dismantling studies have indicated that the acupressure component of EFT is an active ingredient and not placebo. Conclusions: Seven empirically supported strengths of the approach were identified that make it especially suitable for use with veterans and active military: (1) the depth and breadth of treatment effects; (2) the relatively brief timeframes required for successful treatment; (3) the low risk of adverse events; (4) the minimal training time required for the approach to be applied effectively; (5) the simultaneous reduction of physical and psychologic symptoms; (6) the utility and cost-effectiveness of clinical EFT in a large group format; and (7) the method's adaptability to online and telemedicine applications.

EFT (Emotional Freedom Techniques) and Resiliency in Veterans at Risk for PTSD: A Randomized Controlled Trial.

Prior research indicates elevated but subclinical posttraumatic stress disorder (PTSD) symptoms as a risk factor for a later diagnosis of PTSD. This study examined the progression of symptoms in 21 subclinical veterans. Participants were randomized into a treatment as usual (TAU) wait-list group and an experimental group, which received TAU plus six sessions of clinical emotional freedom techniques (EFT). Symptoms were assessed using the PCL-M (Posttraumatic Checklist-Military) on which a score of 35 or higher indicates increased risk for PTSD. The mean pretreatment score of participants was 39 ± 8.7, with no significant difference between groups. No change was found in the TAU group during the wait period. Afterward, the TAU group received an identical clinical EFT protocol. Posttreatment groups were combined for analysis. Scores declined to a mean of 25 (-64%, P < .0001). Participants maintained their gains, with mean three-month and six-month follow-up PCL-M scores of 27 (P < .0001). Similar reductions were noted in the depth and breadth of psychological conditions such as anxiety. A Cohen's d = 1.99 indicates a large treatment effect. Reductions in traumatic brain injury symptoms (P = .045) and insomnia (P = .004) were also noted. Symptom improvements were similar to those assessed in studies of PTSD-positive veterans. EFT may thus be protective against an increase in symptoms and a later PTSD diagnosis. As a simple and quickly learned self-help method, EFT may be a clinically useful element of a resiliency program for veterans and active-duty warriors.

Empirically supported psychological treatments: the challenge of evaluating clinical innovations.

Clear and transparent standards are required to establish whether a therapeutic method is "evidence based." Even when research demonstrates a method to be efficacious, it may not become available to patients who could benefit from it, a phenomenon known as the "translational gap." Only 30% of therapies cross the gap, and the lag between empirical validation and clinical implementation averages 17 years. To address these problems, Division 12 of the American Psychological Association published a set of standards for "empirically supported treatments" in the mid-1990s that allows the assessment of clinical modalities. This article reviews these criteria, identifies their strengths, and discusses their impact on the translational gap, using the development of a clinical innovation called Emotional Freedom Techniques (EFT) as a case study. Twelve specific recommendations for updates of the Division 12 criteria are made based on lessons garnered from the adoption of EFT within the clinical community. These recommendations would shorten the cycle from the research setting to clinical practice, increase transparency, incorporate recent scientific advances, and enhance the capacity for succinct comparisons among treatments.

CAM and energy psychology techniques remediate PTSD symptoms in veterans and spouses.

Male veterans and their spouses (N = 218) attending one of six-week-long retreats were assessed for posttraumatic stress disorder (PTSD) symptoms pre- and postintervention. Participants were evaluated using the PTSD checklist (PCL), on which, a score of >49 indicates clinical symptom levels. The mean pretest score was 61.1 (SD ± 12.5) for veterans and 42.6 (SD ± 16.5) for spouses; 83% of veterans and 29% of spouses met clinical criteria. The multimodal intervention used Emotional Freedom Techniques and other energy psychology (EP) methods to address PTSD symptoms and a variety of complementary and alternative medicine (CAM) modalities for stress reduction and resource building. Interventions were delivered in group format as well as individual counseling sessions. Data were analyzed for each retreat, as well as for the six retreats as a whole. Mean post-test PCL scores decreased to 41.8 (SE ± 1.2; p < .001) for veterans, with 28% still clinical. Spouses demonstrated substantial symptom reductions (M = 28.7, SE ± 1.0; p < .001), with 4% still clinical. A follow-up assessment (n = 63) found PTSD symptom levels dropping even further for spouses (p < .003), whereas gains were maintained for veterans. The significant reduction in PTSD symptoms is consistent with other published reports of EP treatment, though counter to the usual long-term course of the condition. The results indicate that a multimodal CAM intervention incorporating EP may offer benefits to family members as well as veterans suffering from PTSD symptoms. Recommendations are made for further research to answer the questions posed by this study.