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EP Studies on Anxiety
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EP Research Studies on Anxiety

The Effect of Emotional Freedom Techniques (EFT) on Stress Biochemistry: A Randomized Controlled Trial


Dawson Church, PhD, Foundation for Epigenetic Medicine

Garret Yount, PhD, California Pacific Medical Center (CPMC) Research Institute
Audrey Brooks, PhD, Psychology Department, University of Arizona at Tucson

Journal of Nervous and Mental Disease, (2011), in press.

Cortisol is a physiological marker for stress. Elevated cortisol levels are associated with accelerated aging, many organic diseases, and psychological conditions such as depression and anxiety. This study examined the changes in cortisol levels and psychological symptoms of 83 non-clinical subjects receiving a single hour-long intervention. Subjects were randomly assigned to either an EFT group, a psychotherapy group receiving a supportive interview (SI), or a no treatment (NT) group. Salivary cortisol assays were performed immediately before, and thirty minutes after the intervention. Psychological conditions were assessed using the SA-45. The EFT group showed clinically and statistically significant improvements in anxiety (-58.34%, p < .05), depression (-49.33%, p < .002), the overall severity of symptoms, (-50.5%, p < .001), and symptom breadth across conditions (-41.93%, p < .001). There were no significant changes in cortisol levels between SI (-14.25%, SE 2.61) and NT (-14.44%, SE 2.67); however cortisol in the EFT group dropped significantly (-24.39%, SE 2.62) compared to SI and NT (p < .01). The reduced cortisol levels in the EFT group correlated with decreased severity in psychological symptoms as measured by the SA-45. These results suggest that salivary cortisol tests may be useful not only for assessing stress physiology, but also as an objective indicator of the impact of mental health treatments in reducing psychological symptoms.  In the current study, EFT was shown to significantly improve both cortisol-related stress levels and self-reported psychological symptoms after a single treatment session.

Keywords: Cortisol, stress, depression, anxiety, physiology, EFT (Emotional Freedom Techniques).

To purchase the full text of this paper, click here to visit the journal's web site.


The Effect of a Brief EFT (Emotional Freedom Techniques) Self-Intervention on Anxiety, Depression, Pain and Cravings in Healthcare Workers

Dawson Church, PhD & Audrey J. Brooks, PhD

Integrative Medicine: A Clinician's Journal, (2010), Oct/Nov.

This study examined whether self-intervention with Emotional Freedom Techniques (EFT), a brief exposure therapy that combines a cognitive and a somatic element, had an effect on healthcare workers’ psychological distress symptoms. Participants were 216 attendees at 5 professional conferences. Psychological distress, as measured by the SA-45, and self-rated pain, emotional distress, and craving were assessed before and after 2-hours of self-applied EFT, utilizing a within-subjects design. A 90-day follow-up was completed by 53% of the sample with 61% reporting using EFT subsequent to the workshop. Significant improvements were found on all distress subscales and ratings of pain, emotional distress, and cravings at posttest (all p<.001). Gains were maintained at follow-up for most SA-45 scales. The severity of psychological symptoms was reduced (-45%, p<.001) as well as the breadth (-40%, p<.001), with significant gains maintained at follow-up. Greater subsequent EFT use correlated with a greater decrease in symptom severity at follow-up (p<.034, r=.199), but not in breadth of symptoms (p<.0117, r=.148). EFT provided an immediate effect on psychological distress, pain, and cravings that was replicated across multiple conferences and healthcare provider samples.

Keywords: Healthcare professionals, burnout, depression, anxiety, pain, craving, EFT (Emotional Freedom Techniques).


Psychological Symptom Change in Veterans After Six Sessions of Emotional Freedom Techniques (EFT); An Observational Study

Dawson Church, PhD, Linda Geronilla, PhD, & Ingrid Dinter

International Journal of Healing and Caring, (2009, January), 9(1).


Protocols to treat veterans with brief courses of therapy are required, in light of the large numbers returning from Iraq and Afghanistan with depression, anxiety, PTSD and other psychological problems. This observational study examined the effects of six sessions of EFT on seven veterans, using a within-subjects, time-series, repeated measures design. Participants were assessed using a well-validated instrument, the SA-45, which has general scales measuring the depth and severity of psychological symptoms. It also contains subscales for anxiety, depression, obsessive-compulsive behavior, phobic anxiety, hostility, interpersonal sensitivity, paranoia, psychosis, and somatization. Participants were assessed before and after treatment, and again after 90 days. Interventions were done by two different practitioners using a standardized form of EFT to address traumatic combat memories. Symptom severity decreased significantly by 40% (p<.001), anxiety decreased 46% (p<.001), depression 49% (p<.001), and PTSD 50% (p<.016). These gains were maintained at the 90-day follow-up.


Pilot Study of EFT, WHEE and CBT for Treatment of Test Anxiety in University Students

Daniel J. Benor, Karen Ledger, Loren Toussaint, Greg Hett, & David Zaccaro.
Explore: The Journal of Science and Healing, (2009, November) 5(6), 338-340.
  • Objective: This study explored test anxiety benefits of Wholistic Hybrid derived from EMDR (WHEE), Emotional Freedom Techniques (EFT), and Cognitive Behavioral Therapy.
  • Participants: Canadian university students with severe or moderate test anxiety participated.
  • Methods: A double-blind, controlled trial of WHEE (n = 5), EFT (n =5), and CBT (n = 5) was conducted. Standardized anxiety measures included: the Test Anxiety Inventory (TAI) and Hopkins Symptom Checklist (HSCL-21).
  • Results: Despite small sample size, significant reductions on the TAI and HSCL-21 were found for WHEE; on the TAI for EFT; and on the HSCL-21 for CBT. There were no significant differences between the scores for the three treatments. In only two sessions WHEE and EFT achieved the equivalent benefits to those achieved by CBT in five sessions. Participants reported high satisfaction with all treatments. EFT and WHEE students successfully transferred their self-treatment skills to other stressful areas of their lives.
  • Conclusions: WHEE and EFT show promise as effective treatments for test anxiety. 



The Effect of Progressive Muscular Relaxation and Emotional Freedom Techniques on Test Anxiety in High School Students: A Randomized Controlled Trial

Nilhan Sezgin, PhD, & Bahar Özcan, MA 
Energy Psychology: Theory, Research & Treatment, (2008), (1)1, 23-30/

This study investigated the effect of Emotional Freedom Techniques (EFT) and Progressive Muscular Relaxation (PMR) on test anxiety. A group of 312 high school students enrolled at a private academy were evaluated using the Test Anxiety Inventory (TAI), which contains Worry and Emotionality subscales. Scores for 70 students demonstrated high levels of test anxiety; these students were randomized into control and experimental groups. During a single treatment session, the control group received instruction in PMR and the experimental group in EFT, which was followed by self-treatment at home. After 2 months, subjects were retested using the TAI. Repeated covariance analysis was performed to determine the effects of EFT and PMR on the mean TAI score, as well as the 2 subscale scores. Each group completed a sample examination at the beginning and end of the study, and their mean scores were computed. Thirty-two of the initial 70 subjects completed all the study’s requirements, and all statistical analyses were done on this group. A statistically significant decrease occurred in the test anxiety scores of both the experimental and control groups. The EFT group had a significantly greater decrease than the PMR group (p < .05). The scores of the EFT group were lower on the Emotionality and Worry subscales (p < .05). Both groups scored higher on the test examinations after treatment. Although the improvement was greater for the EFT group, the difference was not statistically significant.

Keywords: test anxiety, academic performance, high school students, worry, emotionality, Emotional Freedom Techniques (EFT), Progressive Muscular Relaxation (PMR).



Self-administered EFT (Emotional Freedom Techniques) in Individuals with Fibromyalgia: A Randomized Trial

Gunilla Brattberg, MD, School of Medicine, Lund University, Sweden
Integrative Medicine: A Clinician's Journal, (2008), Aug/Sep, 30-35.

The aim of this study was to examine if self-administered EFT (Emotional Freedom Techniques) leads to reduced pain perception, increased acceptance, coping ability and health-related quality of life in individuals with fibromyalgia. 86 women, diagnosed with fibromyalgia and on sick leave for at least 3 months, were randomly assigned to a treatment group or a waiting list group. An eight-week EFT treatment program was administered via the Internet.

Upon completion of the program, statistically significant improvements were observed in the intervention group (n=26) in comparison with the waiting list group (n=36) for variables such as pain, anxiety, depression, vitality, social function, mental health, performance problems involving work or other activities due to physical as well as emotional reasons, and stress symptoms. Pain catastrophizing measures, such as rumination, magnification and helplessness, were significantly reduced, and the activity level was significantly increased. The number needed to treat (NNT) regarding recovering from anxiety was 3. NNT for depression was 4.

Self-administered EFT seems to be a good complement to other treatments and rehabilitation programs. The sample size was small and the dropout rate was high. Therefore the surprisingly good results have to be interpreted with caution. However, it would be of interest to further study this simple and easily accessible self-administered treatment method, which can even be taught over the Internet.


The Effects of EFT on Long-term Psychological Symptoms


Rowe, J.

Counseling and Clinical Psychology Journal, 2(3):104. (2005)


Previous research (Salas, 2000; Wells, et al., 2003), theoretical writings (Arenson, 2001, Callahan, 1985, Durlacher, 1994, Flint, 1999, Gallo, 2002, Hover-Kramer, 2002, Lake & Wells, 2003, Lambrou & Pratt, 2000, and Rowe, 2003), and many case reports have suggested that energy psychology is an effective psychotherapy treatment that improves psychological functioning. The purpose of the present study was to measure any changes in psychological functioning that might result from participation in an experiential Emotional Freedom Techniques (EFT) workshop and to examine the long-term effects. Using a time-series, within-subjects repeated measures design, 102 participants were tested with a short-form of the SCL-90-R (SA-45) 1 month before, at the beginning of the workshop, at the end of the workshop, 1 month after the workshop, and 6 months after the workshop. There was a statistically significant decrease (p < .0005) in all measures of psychological distress as measured by the SA-45 from pre-workshop to post-workshop which held up at the 6 month follow-up.


Assessment of the Emotional Freedom Technique: An Alternative Treatment for Fear

Waite, L. W. & Holder, M. D.
The Scientific Review of Mental Health Practice, (2003), 2(1). 20-26.


The effectiveness of the Emotional Freedom Technique (EFT), a treatment for anxiety and fear, was assessed. One hundred nineteen university students were assigned and tested in an independent four-group design. The groups differed in the treatment each received: applied treatment of EFT (Group EFT); a placebo treatment (Group P); a modeling treatment (Group M); and a control (Group C). Participants' self-reported baseline and post-treatment ratings of fear were measured. Group EFT showed a significant decrease in self-report measures at post-treatment. However, Group P and Group M showed a similar significant decrease. Group C did not show a significant decrease in post-treatment fear ratings. These results do not support the idea that the purported benefits of EFT are uniquely dependent on the "tapping of meridians." Rather, these results suggest that the reported effectiveness of EFT is attributable to characteristics it shares with more traditional therapies.


Rebuttal: An open letter regarding the serious flaws in the Waite & Holder EFT study

This open letter by EFT founder Gary Craig is in response to the 2003 Waite & Holder study in which EFT's effectiveness for phobias was investigated.


To whom it may concern:

This was a study that purported to discredit EFT and was seriously flawed. Even though major mistakes were made in this study, let me at least honor the effort it took to complete it. I admire anyone's dedication to such a task and welcome valid criticism of EFT. It is my hope, however, that more care be taken in future studies on EFT so that conclusions can be more accurate. I present 8 serious flaws below.

Flaw #1: The study was based on a minimal understanding of EFT: It states that "Group EFT followed the treatment procedures outlined in the EFT manual (Craig, 2001a)."

Please note that The EFT Manual is a poor source for conducting a scientific study. This is readily seen in the first paragraph of the EFT Manual. It reads as follows, "This manual is a starting point - an introduction - to EFT. It is a companion to our more extensive video based EFT Course and is NOT intended to be complete training."

There are 140 hours of instructions in our DVD sets that were not reflected in the study. It puzzles me why a 119 subject study would be conducted with only a beginner's knowledge of EFT. This is like trying to evaluate an entire school system having only attended the 1st grade.

Flaw #2: The study included a breathing technique on over 60% of the subjects (instead of less than 5% that was indicated in the protocol). It was supposedly the Collarbone Breathing Exercise mentioned on page 51 of the EFT Manual. However, its description was so different from that given in the manual as to be unrecognizable. This unrecognizable breathing exercise, even had it been accurate, was used 12 times more often than indicated in the manual (60% vs. 5%).

Also, had Waite & Holder gone beyond the EFT Manual for their EFT training they would have seen that, in over 100 hours of filmed sessions, the Collarbone Breathing Exercise was used only once. This is because we found in practice that it was rarely necessary. We teach it in the EFT Manual for limited use (less than 5%) but have basically put it on the shelf. Thus Waite & Holder threw in an unnecessary and unrecognizable breathing exercise for the majority of their subjects. You cannot distort the EFT process like this and still claim a valid EFT study.

Flaw #3: The study included an invalid "Placebo Group": It states, "The placebo group (Group P) received the same procedure as Group EFT, but the tapping points were located along each participant's arm, away from the areas identified as meridian points."

Interestingly, Waite & Holder also referred to these arm points as "nonmeridian points" and thus mistakenly presumed the arm contained no meridians whatsoever. This is wrong. There are at least 5 well known meridians traversing through the arm and thus this "arm tapping" method comes nowhere near qualifying as the intended placebo. Accordingly, since there was no proper placebo control, this part of the study is invalid. Again, I must urge scientists to understand what they are doing before conducting a study of EFT. It would have been a very simple matter to consult a meridian chart and avoid this embarrassment.

Also, it should be noted that tapping these arm points appeared to produce significant results. This points to the possibility that benefits can be obtained by stimulating meridian points other than those indicated within the EFT process. This fact is not new. We have known this in EFT circles for over a decade and a proper study of our materials would have informed Waite & Holder of this well known fact.

Flaw #4: The study included another invalid control group: It states, "As a further control for possible unforeseen benefits of tapping regardless of the location, a third group (Group M) modeled the EFT treatment by tapping a doll instead of themselves."

However, the subjects tapped with their fingertips on the doll (thereby stimulating the acupuncture fingertip points) and, as is well known by any student of the acupuncture meridians, the fingertips contain powerful meridian points. Accordingly, this control group does not meet its purpose and becomes invalid.

Of more importance, however, is the well known fact that EFT can be successfully conducted WITHOUT PHYSICALLY TAPPING ON THE SUBJECT. Thus the doll test tells us nothing new. This has been openly discussed on the EFT website and EFT newsletter for many years. Just go to our in-site search engine and enter the term surrogate (for surrogate tapping). This will bring up a long list of articles wherein people worldwide report remarkable successes tapping for others without tapping on the subject or even being in proximity to the subject. This list includes successfully tapping for animals and infants who have no belief or other understanding about EFT (and thus are not subject to the placebo effect).

Accordingly, the doll experiment added nothing to the basic study and, if anything, served to validate the surrogate feature of EFT.

Flaw #5: The study used only one round of EFT: This unnecessarily minimizes EFT's results. The EFT Manual and other EFT materials emphasize the value of doing several rounds of EFT for each issue. Waite & Holder performed only one round and still reported stastically significant results. Had they performed 5 or more rounds their reported results would have been materially improved. This has been repeatedly demonstrated in clinical practice for over a decade and even a cursory perusal of the case histories on our website would evidence this.

Flaw #6: The study found that EFT was effective in reducing phobias but concluded that, "It is possible that systematic desensitization and distraction are mediators of EFT's apparent effectiveness."

Anyone familiar with systematic desensitization knows that the subjects must be taught a relaxation procedure first and then be intermittently exposed to the feared object or circumstances over hours, weeks or months. In the Waite & Holder study, there was no relaxation procedure taught nor was there intermittent exposure to feared objects or circumstances. Despite this, Waite & Holder mistakenly draw parallels between EFT and systematic desensitization.

Also, Waite & Holder reported statistically valid results that were obtained within a few minutes of doing EFT...not hours weeks or months. Thus the comparison to systematic desensitization is a major stretch and, if there is any correlation at all, EFT should be heralded as a rapid form of systematic desensitization.

Also, EFT is not distraction and anyone with reasonable EFT experience knows this. Sure, the tapping can be distracting but that is the reason why we include the Reminder Phrase in the EFT Process. It is designed to keep the client tuned-into (not distracted from) their issues. As a result, EFT is the exact opposite of distraction.

This was also made clear on page 11 of the EFT Manual wherein I list several reactions to EFT by uninformed newcomers. This includes, "I am told that the tapping techniques were distractions that took people's minds off their problems. This ignores the requirement that people 'tune in' to their problems for EFT to work. It is the exact opposite of distraction."

Thus Waite & Holder failed to understand this clearly stated non-distraction feature of EFT and proceeded to erroneously point to distraction as a cause of EFT's effectiveness.

Again, it is my hope that scientists take the time to properly inform themselves before undertaking an EFT study. If Waite & Holder had done this, the distraction or systematic desensitization speculations would never have come up.

Flaw #7: EFT's results were inaccurately tested and did not adjust for the "fear of the fear": The proper way to assess how well a phobic responds to EFT is to test the result in the real world. This is well known among experienced EFT students. When phobics experience EFT while imagining the feared object or circumstance, they often report a SUDS rating well above what is actually happening within them. This is because they have what we call the "fear of the fear." This means that they aren't convinced of the magnitude of their healing until they get on top of that tall building, see a spider, etc.

Until they do this they fear that they will actually have the fear response under the real circumstances (even though they often will not). Accordingly, they frequently report magnified SUDS ratings in the imaginal phase. This is discussed in detail on our website. Just go to our in-site search engine and enter "fear of the fear" (include the quotes) and you will be presented with numerous articles on this topic.

Flaw #8: Scientific objectivity requires that studies be independently evaluated. Waite & Holder did not do this. Instead, they presented their study to a journal associated with Scott Lilienfeld, Brandon Guadiano and James Herbert who are known adversaries of various forms of Energy Psychology. This throws an unprofessional bias into the mix. It is my hope that future EFT studies will be submitted to objective and prestigious peer reviewed journals and not home-grown, biased ones.

Finally, I realize that EFT is hard to accept for many people, especially when it is associated with such non-western concepts as energy meridians. Accordingly, I expect criticism. But, and let me say it again, I expect that such criticism be based on reasonable experience and proper study of the EFT material. Scientists should understand the process thoroughly before criticizing it. I would ask any future researcher to please learn EFT and learn it well. Then apply it to clients, friends and yourselves to get a solid feel for the process and its results before entering the laboratory. This can avoid publishing erroneous studies.

The more you experience EFT (properly performed) the more impressed you will become with the results. The variety and depth of EFT's benefits far transcend anything else out there and many highly credentialed MDs, PhDs and other healing professionals have discovered this in extensive clinical practice.

Unfortunately, some poorly informed researchers continue to throw stones at what they have yet to understand. However, they will not be able to generate convincing evidence of EFT "ineffectiveness. Nor will they be able to explain it away by insisting that it mirrors conventional technques.

As the reader may know, I am a scientist by academic background (Stanford engineer, '62) and am quite familiar with the scientific method. While properly done studies show the clear efficacy of EFT, I am persuaded that the ultimate proof of the true power of this discovery lies in the findings of quantum physics. In that field, EFT's extraordinary results are to be expected and the astonishing effects of Surrogate EFT are easily explained.

Also, a word for skeptics. Please know that I am not wedded to the meridian theory. Although this theory has not been overturned by anyone since its inception, I am open to the possibility that there may be some other explanation for EFT's effectiveness and thus invite discussions along these lines.

However, please don't contact me about this if you haven't thoroughly understood and practiced the process. You will just be wasting our time as I have been around the block on this countless times with people having only surface knowledge of the process. You must have practical, hands-on EFT experience to understand that EFT's results far exceed those of placebo, distraction, systematic desensitization, CBT and an endless list of other techniques. EFT is unique and represents a paradigm shifting discovery. I am looking for unique explanations here, not rehashes of conventional concepts by those who have yet to be "in the trenches" with this fascinating method.


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