The first large-scale preliminary clinical trial of energy psychology [EFT] is reported in some detail in Energy Psychology Interactive and summarized here. Full paper below.

Approximately 5,000 patients diagnosed at intake with an anxiety disorder were randomly assigned to an experimental group (EFT) or a control group (Cognitive Behavior Therapy (CBT) with medication, which is traditionally considered the therapy of choice).  Here are the results:

By Joaquin Andrade, MD and David Feinstein, PhD

SUMMARY
(complete paper follows)

In preliminary clinical trials involving more than 29,000 patients from 11 allied treatment centers in South America during a 14-year period, a variety of randomized, double-blind pilot studies were conducted. In one of these, approximately 5,000 patients diagnosed at intake with an anxiety disorder were randomly assigned to an experimental group (tapping) or a control group (Cognitive Behavior Therapy/medication) using standard randomization tables and, later, computerized software. Ratings were given by independent clinicians who interviewed each patient at the close of therapy, at 1 month, at 3 months, at 6 months, and at 12 months. The raters made a determination of complete remission of symptoms, partial remission of symptoms, or no clinical response. The raters did not know if the patient received CBT/medication or tapping. They knew only the initial diagnosis, the symptoms, and the severity, as judged by the intake staff. At the close of therapy:

63% of the control group were judged as having improved.

90% of the experimental group were judged as having improved.

51% of the control group were judged as being symptom free.

76% of the experimental group were judged as symptom free.

At one-year follow-up, the patients receiving tapping treatments were less prone to relapse or partial relapse than those receiving CBT/medication, as indicated by the independent raters assessments and corroborated by brain imaging and neurotransmitter profiles. In a related pilot study by the same team, the length of treatment was substantially shorter with energy therapy and related methods than with CBT/medication (mean = 3 sessions vs. mean = 15 sessions).

If subsequent research corroborates these early findings, it will be a notable development since CBT/medication is currently the established standard of care for anxiety disorders and the greater effectiveness of the energy approach suggested by this study would be highly significant. The preliminary nature of these findings must, however, be emphasized. The study was initially envisioned as an in-house assessment of a new method and was not designed with publication in mind. Not all the variables that need to be controlled in robust research were tracked, not all criteria were defined with rigorous precision, the record-keeping was relatively informal, and source data were not always maintained. Nonetheless, the studies all used randomized samples, control groups, and double blind assessment. The findings were so striking that the team decided to report them.

The principal investigator was Joaqumn Andrade, M.D. The report was written by Dr. Andrade and David Feinstein, Ph.D. The paper will appear in Energy Psychology Interactive: An Integrated Book and CD Program for Learning the Fundamentals of Energy Psychology (Ashland, OR: Innersource, in press, distributed by Norton Professional Books) by David Feinstein in consultation with Fred P. Gallo, Donna Eden, and the Energy Psychology Interactive Advisory Board.

ENERGY PSYCHOLOGY

Theory, Indications, Evidence

Joaqumn Andrade, M.D.
David Feinstein, Ph.D.

In preliminary clinical trials involving more than 29,000 patients from 11 allied treatment centers in South America during a 14-year period, a variety of randomized, double-blind pilot studies were conducted. In one of these, approximately 5,000 patients diagnosed at intake with an anxiety disorder were randomly assigned to an experimental group (tapping) or a control group (cognitive behavior therapy /medication). Ratings were given by independent clinicians who interviewed each patient at the close of therapy, at 1 month, at 3 months, at 6 months, and at 12 months. The raters made a determination of complete remission of symptoms, partial remission of symptoms, or no clinical response. The raters did not know if the patient received CBT/medication or tapping. They knew only the initial diagnosis, the symptoms, and the severity, as judged by the intake staff. At the close of therapy: 63% of the control group were judged as having improved; 90% of the experimental group were judged as having improved. 51% of the control group were judged as being symptom free; 76% of the experimental group were judged as symptom free.

At one-year follow-up, the patients receiving the tapping treatments were substantially less prone to relapse or partial relapse than those with CBT/medication, as indicated by the independent raters assessments and corroborated by brain imaging and neurotransmitter profiles. In a related pilot study by the same team, the length of treatment was substantially shorter with energy therapy and associated methods than with CBT/medication (mean = 3 sessions vs. mean = 15 sessions). If subsequent research corroborates these early findings, it will be a notable development since CBT/medication is currently the established standard of care for anxiety disorders and the greater effectiveness of the energy approach suggested by this study would be highly significant.

Despite its odd-seeming procedures and eye-raising claims, evidence is accumulating that energy-based psychotherapy, which involves stimulating acupuncture points or other energy systems while bringing troubling emotions or situations to mind,1 is more effective in the treatment of anxiety disorders than the current standard of care, which utilizes a combination of medication and cognitive behavior therapy. This paper:

1. Presents preliminary data supporting this assertion.

2. Discusses indications and contraindications for the use of energy therapy with anxiety as well as other conditions.

NOTE: This paper was written for and appears in Energy Psychology Interactive: An Integrated Book and CD Program for Learning the Fundamentals of Energy Psychology (Ashland, OR: Innersource, in press).Phil Friedman, Ph.D., and Gary Craig provided astute critiques of an earlier version of this paper, and their contributions are gratefully acknowledged. Permission to copy for personal and educational purposes, with this note included, is freely granted.

3. Speculates on the mechanisms by which

a) tapping specific areas of the skin while

b) a stimulus that triggers a disturbed emotional response is mentally accessed

apparently alleviates certain psychological disorders.

A Winding Road to Effective Anxiety Treatment

The first author describes his initial encounter with panic disorder, in a crowded urban hospital emergency room, some 30 years ago: The patient was trembling, dizzy, and terrified, pleading, Help me, Doc, I feel like Im gonna die! My medical training had not prepared me for this moment, and I emerged from it determined that I would have a better response the next time I was faced with a patient in acute panic.

This was the first step on a long and winding road. I studied with acknowledged experts on anxiety disorders, attended relevant professional meetings, talked with famous international specialists, read the books they recommended, did my own literature searches, prescribed medications, applied various forms of psychotherapy (from psychodynamic to Gestalt to NLP), learned acupuncture in China, made referrals to alternative practitioners (including those specializing in homeopathy, cranial sacral therapy, chiropractic, flower remedies, applied kinesiology, ozone therapy, and Ayurvedic), sent people on spiritual retreats, used all forms of machines from biofeedback to electric acupuncture, even resorted to sensory deprivation (confining a panic patient in a sensory deprivation tank is a distinguishing sign of a therapists desperation).

The consistent finding: disappointing results. My colleagues and I were making a difference for perhaps 40 to 50 percent of these people, albeit with multiple relapses, partial cures, and many who never completed treatment. Later, we combined alprazolam and fluoxetine with cognitive behavior therapy, obtaining slightly better outcomes. But never were we able to reach the 70 percent in 20 sessions we had read about. Then came Eye Movement Desensitization and Reprocessing (EMDR), which we learned as an almost secret practice some friends were doing in an East Coast hospital. We began toget more satisfactory responses, yet along with them, disturbing abreactions.

We then learned about tapping selected acupuncture points while having the patient imagine anxiety-producing situations. It was a huge leap forward! We began to obtain unequivocal positive results with the majority of panic patients we treated. At first we used generic tapping sequences. Then tapping sequences tailored for panic. Then tapping sequences based on diagnosing the energy pathways involved in each patients unique condition. All of these strategies yielded good results, slightly better with diagnosis-based sequences, averaging about a 70 percent success rate.

We found we could further enhance these encouraging outcomes by limiting sugar, coffee, and alcohol intake and prescribing a physical exercise program. We emphasized the cultivation of enjoyment. We showed our patients how Norman Cousins used laughter in his own healing and encouraged them to engage in sincere laughter for five minutes twice each day. We introduced natural metabolic substances, such as L-tryptophan, L-arginine, and glutamic acid. For rapid symptom relief in severe cases, we found we could combine a brief initial course of medication with the tapping.

With this regime, we have been able to surpass the 70 percent mark. And we have gathered substantial experience indicating that stimulating selected acupoints is at the heart of the treatment and is often sufficient as the sole intervention. Over a 14-year period, our multidisciplinary team, including 36 therapists,2 has applied tapping techniques (we also use the term brief sensory emotional interventions) with some 31,400 patients in eleven treatment centers in Uruguay and Argentina. The most prevalent diagnosis3 was anxiety disorder.4 For 29,000 of these patients, our documentation included an intake history, a record of the procedures administered, clinical responses, and follow-up interviews (by phone or in person) at one month, three months, six months, and twelve months. We have also systematically conducted numerous clinical trials. Our conclusion, in brief: No reasonable clinician, regardless of school of practice, can disregard the clinical responses that tapping elicits in anxiety disorders (over 70% improvement in a large sample in 11 centers involving 36 therapists over 14 years).

Clinical Trials

The clinical trials were conducted for the purpose of internal validation of the procedures as protocols were being developed. When acupoint stimulation methods were introduced to the clinical team, many questions were raised, and a decision was made to conduct clinical trials comparing the new methods with the CBT/medication approach that was already in place for the treatment of anxiety. These were pilot studies, viewed as possible precursors for future research, but were not themselves designed with publication in mind. Specifically, not all the variables that need to be controlled in robust research were tracked, not all criteria were defined with rigorous precision, the record-keeping was relatively informal, and source data were not always maintained. Nonetheless, the studies all used randomized samples,5 control groups,6 and double blind assessment.7 The findings were so striking that the research team decided to make them more widely available.

Over two dozen separate studies were conducted. In the largest of these (and some of the other studies were sub-sets of this study), approximately 5,000 patients were randomly assigned to receive CBT and medication or tapping treatments.8Approximately 2,500 patients were in each group, with diagnoses including panic, agoraphobia, social phobias, specific phobias, obsessive compulsive disorders, generalized anxiety disorders, PTSD, acute stress disorders, somatoform disorders, eating disorders, ADHD, and addictive disorders.9 The study was conducted over a 5=-year period. Patients were followed by telephone or office interviews at 1 month after treatment, 3 months, 6 months, and 12 months. At the close of therapy, positive clinical responses (ranging from complete relief to partial relief to short relief with relapses) were found in 63 percent of those treated with CBT and medication and in 90 percent of those treated with tapping techniques. Complete freedom from symptoms was found in 51 percent and 76 percent, respectively.10At one-year follow-up, the gains observed with the tapping treatments were less prone to relapse or partial relapse than those with CBT/medication, as indicated by the independent raters assessments and corroborated by brain imaging and neurotransmitter profiles.11

The number of sessions required to attain the positive outcomes also varied between the two approaches. In one of the studies, 96 patients with specific phobias were treated with a conventional CBT/medication approach and 94 patients with the same diagnosis were treated using a combination of tapping techniques and an NLP method calledvisual-kinesthetic dissociation (the patient mentally plays a short film of the phobic reaction while watching it from a distance, and then rapidly rewinds and replays it, gradually entering the film, until a dis-sociation from the triggering event is effected). Positive results12were obtained with 69 percent of the patients treated with CBT/medication within 9 to 20 sessions, with a mean of 15 sessions. Positive results were obtained with 78 percent of the patients treated with the tapping and dissociation techniques within 1 to 7 sessions, with a mean of 3 sessions.13The course of treatment for tapping throughout all trials was generally between 2 and 4 sessions; the course of treatment for CBT/medication was generally between 12 and 18 sessions. Tapping patients were also taught simple sequences to apply at home.

Standard medications for anxiety (benzodiazepines, including diazepam, alprazolam, and clonazepan) were given to 30 patients with generalized anxiety disorder (the three drugs were randomly assigned to subgroups of 10 patients each). Outcomes were compared with 34 generalized anxiety disorder patients who received tapping treatment. The medication group had 70 percent positive responses compared with 78.5 percent for the tapping group. About half the medication patients suffered from side effects and rebounds upon discontinuing the medication. There were no side effects in the tapping group, though one patient had a paradoxical response (increase of anxiety).

Specific elements of the treatment were also investigated. The order that the points must be stimulated, for instance, was investigated by treating 60 phobic patients with a standard 5-point protocol while varying the order in which the points were stimulated with a second group of 60 phobic patients. Positive clinical responses for the two groups were 76.6 percent and 71.6 percent, respectively, showing no significant difference for the order in which the points were stimulated. In other studies, varying the number of points that were stimulated, the specific points, and the inclusion of typical auxiliary interventions such as the 9 Gamut Procedure did not result in significant differences between groups, although diagnosis of which energy points were involved in the problem led to treatments that had slightly more favorable outcomes. The working hypothesis of the treatment team at the time of this writing is that for many disorders, such as specific phobias, wide variations can be employed in terms of the points that are stimulated and the specifics of the protocol. For a smaller number of disorders, such as OCD and generalized social anxiety, precise protocols must be formulated and adhered to for a favorable clinical response.

In a study comparing tapping with acupuncture needles, 40 panic patients received tapping treatments on pre-selected acupuncture points. A group of 38 panic patients received acupuncture stimulation using needles on the same points. Positive responses were found for 78.5 percent from the tapping group, 50 percent from the needle group.

While it must again be emphasized that these were pilot studies, they lend corroboration to other clinical trials that have yielded promising results regarding the efficacy of energy-based psychotherapy, such as those conducted by Sakai et al. (n=714, representing a wide range of clinical conditions) and Johnson et al. (n=105, all PTSD victims of ethnic violence in Albania, Kosovo). Both of these studies were published in the October 2001 issue of the Journal of Clinical Psychology.

Indications and Contraindications

The follow-up data on the 29,000 patients coming from the 11 centers in South America included subjective scores after the termination of treatment by independent raters. The ratings, based on a scale of 1 to 5, estimated the effectiveness of the energy interventions as contrasted with other methods that might have been used.15The numbers indicate that the rater believed that the energy interventions produced:

1. Much better results than expected with other methods.

2. Better results than expected with other methods.

3. Similar results to those expected with other methods.

4. Lesser results than expected with other methods (only use in conjunction with other therapies).

5. No clinical improvement at all or contraindicated.

It must be emphasized that the following indications and contraindications for energy therapy are tentative guidelines based largely on the initial exploratory research and these informal assessments. In addition, the outcome studies have not been precisely replicated in other settings, and the degree to which the findings can be generalized is uncertain. Nonetheless, based upon the use of tapping techniques with a large and varied clinical population in 11 settings in two countries over a 14-year period, the following impressions can serve as a preliminary guide for selecting which clients are good candidates for acupoint tapping. There is also considerable overlap between these tentative guidelines and other published reports.16

Rating of 1Much better results than with other methods.Many of the categories of anxiety disorder were rated as responding to energy interventions much better than to other modalities. Among these are panic disorders with and without agoraphobia, agoraphobia without history of panic disorder, specific phobias, separation anxiety disorders, post-traumatic stress disorders, acute stress disorders, and mixed anxiety-depressive disorders. Also in this category were a variety of other emotional problems, including fear, grief, guilt, anger, shame, jealousy, rejection, painful memories, loneliness, frustration, love pain, and procrastination. Tapping techniques also seemed particularly effective with adjustment disorders, attention deficit disorders, elimination disorders, impulse control disorders, and problems related to abuse or neglect.

Rating of 2Better results than with other methods.Obsessive compulsive disorders, generalized anxiety disorders, anxiety disorders due to general medical conditions, social phobias and certain other specific phobias, such as a phobia of loud noises, were judged as not responding quite as well to energy interventions as did other anxiety disorders, but they were still rated as being more responsive to an energy approach than they are to other methods. Also in this category were learning disorders, communication disorders, feeding and eating disorders of early childhood, tic disorders, selective mutism, reactive detachment disorders of infancy or early childhood, somatoform disorders, factitious disorders, sexual dysfunction, sleep disorders, and relational problems.

Rating of 3Similar to the results expected with other methods.Energy interventions seemed to fare about equally well as other therapies commonly used for mild to moderate reactive depression, learning skills disorders, motor skills disorders, and Tourettes syndrome. Also in this category were substance abuse-related disorders, substance-induced anxiety disorders, and eating disorders. For these conditions, a number of treatment approaches can be effectively combined to draw upon the strengths of each.

Rating of 4Lesser results than expected with other methods.The clinicians post-treatment ratings suggest that for major endogenous depression, personality disorders, and dissociative disorders, other therapies are superior as the primary treatment approach. Energy interventions might still be useful when used in an adjunctive manner.

Rating of 5No clinical improvement or contraindicated. The clinicians ratings of energy therapy with psychotic disorders, bipolar disorders, delirium, dementia, mental retardation, and chronic fatigue indicated no improvement. While anecdotal reports that people within these diagnostic categories have been helped with a range of life problems are numerous, and seasoned healers might find ways of adapting energy methods to treat the conditions themselves, the typical psychotherapist trained only in the rudimentary use of acupoint stimulation should have special training or understanding for working with these populations before applying energy methods.

Other Guidelines. Even though the above guidelines are preliminary and heuristic, diagnosis is clearly a key indicator of how and when to bring energy-based psychotherapy into the treatment setting. As part of the diagnostic work-up, co-morbidities should also be carefully identified. Their presence of course influences the treatment strategy. Even in cases where energy interventions are not the treatment of choice, they can be used as a complement to other psychotherapies, drugs, and medical procedures. In these cases, it is useful to orient them around well-defined emotional issues and it is critical to keep other treatment team members informed about the energy treatment and its purpose. While interventions that tap acupuncture points appear to be effective in alleviating a wide range of physical disorders, much as acupuncture with needles can be applied to illnesses ranging from allergies to cancer, strong caution must be used when addressing physical diseases or undiagnosed pain. Medical examinations and the participation of medical personnel is indicated when addressing any serious medical conditions or symptoms that might prove to be the first evidence of a serious condition. One the potential hazards is that tapping acupoints may bring about subjective improvement that ultimately wastes life-saving time.

Joseph Wolpes Seminal Contribution to Energy Psychology

When Joseph Wolpe developed systematic desensitization in the 1950s, he provided the next several generations of clinicians their most potent single non-pharmacological tool for countering severe anxiety conditions. Patients were taught how to relax each of the bodys major muscle groups. With the muscle groups relaxed, they would bring to mind a thought or image that evoked an item from the bottom of a hierarchy of anxiety-provoking situations they had prepared earlier. They would learn to shift the focus between holding the thought or image and relaxing the muscle groups until the thought or image was progressively associated with a relaxed response. They would then systematically move up the hierarchy, reconditioning the response to each thought or image by replacing the anxious or fearful response with a relaxed response.

This process is the closest cousin energy therapy has among traditional psychotherapeutic modalities. Both approaches bring a problematic emotion to mind and introduce a physical procedure that neutralizes the emotion. But energy therapy also has a much older relative, whose lineage substantially expands the range of problems that may be addressed and the precision with which they may be targeted. That progenitor is the practice of acupuncture.

Rather than to relax the muscle tension associated with anxiety or fear, energy therapy corrects for a disturbed pattern in the specificenergy pathways or meridians that are affected when the client is mentally engaged with a problematic situation. For this reason, one of the strengths of energy-based psychotherapy is the range of emotional conditions with which it is effective. Each of the bodys major energy pathways is believed to be associated with specific emotions and themes. A stimulus that brings a meridian out of harmony or balance (while this is a complex concept, terms such as underenergy, overenergy, and stagnant energy might each apply) also activates the emotion associated with that meridian. The treatment pairs the stimulus with an energy intervention that rebalances the meridian, bringing it back into coherence and harmony with the bodys overall energy system. A disturbed meridian response is replaced by an undisturbed response. Just as deep muscle relaxation can neutralize a specific fear in systematic desensitization, calming a disturbed meridian can disengage the emotional reaction associated with that meridian.

It is because of the wide spectrum of emotions that are governed by the meridian system17 that tapping interventions have a greater power and applicability than systematic desensitization. Systematic desensitization can neutralize anxiety-based responses by countering them with deep muscle relaxation, but that is the only key on its keyboard. Interventions capable of restoring balance to any of the major meridians can address the entire scale of human emotions, from anxiety and fear to anger, grief, guilt, jealousy, over-attachment, self-judgment, worry, sadness, and shame. Note the spectrum of problematic emotions for which the raters in the South American studies found energy interventions to produce much