The ACEs

The article begins with the history of the ACEs. In the late 1990’s, researchers Vincent Felitti and Robert Anda of Kaiser Permanente discovered a strong connection between adverse childhood experiences (ACEs) and medical, psychological, and psychosocial problems throughout the lifespan. ACEs are generally divided into three categories: abuse, neglect, and household dysfunction. Higher numbers of ACEs are related to increased risk in health problems, mental health, and lifestyle difficulties.

As serious as the consequences of ACEs are, the research on psychotherapeutic interventions to treat them is meager. Several approaches seem relatively ineffective. In the body of literature, CBT shows the most promising results. Yet, as Bessel van der Kolk memorably pointed out in his book, The Body Keeps the Score – involving the body in healing seems to lead to better outcomes. Other researchers have pointed to mind-body therapies as effective approaches for people suffering from the aftermath of childhood trauma.

The framework

David proposes energy psychology as a mind-body tool that may be particularly helpful in overcoming ACEs. Energy psychology emerged in the 1990’s, when it was largely ridiculed and dismissed by the mainstream establishment. However, early practitioners found it to be quite effective! Today, more than 2 million downloads of the EFT (Emotional Freedom Techniques) phone app testify to its popularity. Moreover, a body of research points to its efficacy.

Research

The paper includes an easy-to-digest review of the research on energy psychology. David summarizes many studies and meta-analyses. Additionally, he cites the amazing results that Sakai et al (2010) found after treating children who had survived the genocide in Rwanda. In that study, 47 out of 50 participants no longer met diagnostic criteria for PTSD after a single session. In treating PTSD, according to Stapleton et al (2023), tapping can get results in four to ten sessions. By comparison, it can take eight to 15 sessions of CBT to treat PTSD, according to Watkins et al (2018).

Mechanisms

Is acupoint tapping a worthwhile exercise? Is it a “purple hat” or an essential component of energy psychology? David points to his 2023 review which found that five of six studies showed that acupoint tapping is an active ingredient in the process.

In his 2021 paper, David outlines five empirically-supported premises that support the validity of acupoint stimulation.

These include:

1. Tapping acupoints generates electrical impulses.
2. These impulses increase or decrease activation in brain regions involved in treatment.
3. The words and images used while tapping activate or deactivate specific brain regions, calling the electrical signals to them.
4. This creates neural changes, which are often durable.
5. Tapping leads to other physiological shifts: It decreases stress hormones, changes gene expression and brainwave patterns, and improves immune and cardiovascular function.

How tapping is a good neurological fit for ACEs

Three neural networks are relevant to ACEs, as they may have become impaired during childhood brain development.

These are:

1. The salience network, which distinguishes the important from the unimportant. An impaired salience network can lead to hyperarousal, numbing, or both. 
2. The central executive network, which involves attention, self-regulation, working memory, and decision-making. This is also involved in coding fear. Problems in this region can cause a mismatch between threat or danger and a safe or unsafe response.
   
3. The default mode network, which is responsible for our relaxed thoughts, reflections, daydreams, and where we reexperience past trauma. ACES can change the default mode network, causing a distorted memory retrieval, more distress upon these retrievals, and a biased view of interpersonal experiences.

David explains that tapping can help reduce activation of the salience network by pairing exposure therapy, which is highly arousing, with tapping, which is calming. This seems to depotentiate the neural network involved in the trauma memory. As the salience network calms down, the central executive network may reprocess data unconsciously. Moreover, tapping can repair the incorrect associations of danger with benign stimuli. Finally, as the salience and central executive networks become calmer, the ruminations of the default mode network may shift as well, becoming less distorted.

Treating adverse childhood experiences with energy psychology

While there are few recommendations for treating adverse childhood experiences, the International Society for the Traumatic Stress Studies has investigated approaches to treating complex PTSD (cPTSD), which often involves childhood trauma. Among the cluster of cPTSD symptoms, David reports, the most important to treat seem to be poor self-concept, poor emotion regulation, and relationship problems.

The literature recommends a three-pronged approach to therapy. Focus first on safety, then on trauma memory processing, and finally on generalizing gains. Within this framework, it is important to be somewhat flexible. Other life events will almost certainly arise and need attention. These clients may need continued follow-up care for tune-ups or as new stressors arise.

Guidelines

There are guidelines for using EFT to treat PTSD, and these can inform work with clients who have experiences ACEs. It is important to remember that the symptoms were initially adaptive responses to adversity. It is essential that therapists instill hope. Goals must be collaboratively created with the client. Finally, clinicians must be extra sensitive to their clients’ trauma histories. They may do well to interface with other treatment providers to help improve understanding.

David recommends introducing tapping “as early as prudent” by using it to address a low-level stressor such as an upcoming task. Energy psychology incorporates distress ratings (SUDs) at every round of tapping. This is a great way to keep clients engaged in the treatment and assessment of progress. Perhaps most importantly, energy psychology is a tool that allows clients to downregulate their arousal during treatment. It also acts as a self-help tool that can be used at any time between sessions.

For these reasons, energy psychology may be a great tool to bring to work with clients who have experienced ACEs or who have cPTSD. Kudos to David Feinstein for another well-researched and well-written paper that helps further the field of energy psychology!

Paying it forward

Do you want to bring energy psychology to children? One way to get started is to sign up for ACEP’s free Mind Body Tools for Children training. Are you a clinician or stakeholder wanting to bring energy psychology to your community? Enroll in ACEP’s free Emotional First Aid training. If you would like to build your energy psychology skills, consider getting trained in TFT or EFT. Finally, you can stay up to date with the research on energy psychology here, or ask Research Committee chair John Freedom to be added to his mailing list at research_committee@energypsych.org.  

Author

Sarah Murphy, LPC, ACP-EFT, is the ACEP board secretary and communications committee chair. She is a counselor in private practice and specializes in working with people who have serious illnesses.

Photo by Nathan Dumlao on Unsplash