Emotional Freedom Technique (EFT) is a counseling procedure created in the 90s by Gary Craig, an engineer and self-proclaimed “Personal Performance Coach.” Craig reports that early in his life, he came to the realization that the quality of a person’s life and their physical and mental health is directly related to emotional health, and thus sought tools to help maximize it.
Amidst his frustration with the “ineffective” techniques of psychology and psychotherapy, Craig wanted to find something better. After much research and discovery he settled on what he now calls Emotional Freedom Technique.
What Is Emotional Freedom Technique?
Caig writes that the basic essence of EFT begins with “The Discovery Statement,” and understanding its full implications is the key to treatment. According to Craig,
“the cause of all negative emotions is a disruption in the body’s energy system.”
Despite having absolutely no acceptable evidence for this statement, Craig uses it as a starting point. He suggests that we can restore the natural energy flow throughout our bodies by physically tapping the “end points of numerous energy meridians.” Along with tapping these acupressure points, saying personal affirmations about the reason for treatment can ultimately change the energy flow and facilitate healing in a very short amount of time.
A typical treatment involves four steps, and can be facilitated by an EFT practitioner if necessary:
- Say the following affirmation three times: “Even though I have this (reason for treatment), I deeply and completely accept myself,” while touching a location on your chest or hand.
- Tap seven times on a series of “energy points” on your face, upper body, and hands, while saying the affirmation again.
- Tap a point on your hand while performing a series of eye movements and humming.
- Repeat step two again. (10)
Craig suggests this procedure can be effective for literally any problem that anyone could have ever. On the first page of his definitive text on the subject, Craig writes EFT
“applies to all issues...including pain relief, anger, addictions, weight loss, anxiety, trauma, depression, fears & phobias, allergies, respiratory problems, blood pressure, relationship issues, women’s issues, children’s issues, school, sports and sexual performance issues, serious diseases (from migraines to cancer).” (10)
In addition, Craig suggests that EFT has fully overhauled the psychotherapy profession, has reduced “healing time” from months and years to only minutes and hours, and may “radically change your world” (10). This should really be a dead giveaway that something suspicious is going on here, but we’ll indulge Mr. Craig and take a look at the science.
What Is The State Of The Research?
A search on MEDLINE, a popular database of medical research, for “Emotional Freedom Technique” reveals 33 total matches. A search on a similar treatment like cognitive behavioral therapy (CBT) returns over 80,000 matches. EFT universe, a website dedicated to all things EFT, purports to have over 100 peer-reviewed studies that show EFT is an effective treatment.
There are an overwhelming number of case studies on the treatment as well. There is one core group of researchers that have put out the majority of the papers on EFT at this time, and unsurprisingly, they all perform EFT treatments or teach courses on it.
Does The Theory Behind EFT Make Sense?
EFT has many of the classic features of an “alternative” medicine treatment which should raise a few red flags:
- There is no plausible or validated mechanism by which it works.
- The purported mechanism is sufficiently vague and can be superficially connected to any problem.
- Practitioners claim to treat anything and everything.
- They dismiss or criticize “traditional” or “western” medical approaches.
- Marketing materials are saturated with anecdotal and non-verifiable reports of success.
- The basic science behind their claims is weak, distorted, or non-existent.
The theory behind EFT simply does not make sense and there is no logical chain of reasoning between the basic premises and the proposed treatment and effects. There is no evidence for the existence of meridians, acupoints, or chi. There is no evidence that physical or mental health conditions are related in any way to these things.
Even if these things were true, we have no evidence to suggest that tapping at these points can change the flow of chi. And what can be asserted without evidence, can be dismissed without evidence.
However, one study from 2003 published in the journal The Scientific Review of Mental Health Practice, sought to assess these claims and test the importance of the tapping aspect of EFT. The study had 182 students with phobias who were separated into four groups; traditional EFT treatment, EFT treatment with tapping on the “wrong” points, EFT treatment with tapping on the “right” points on a doll, and a control group.
Can you guess what the results were? Every experimental group had a similar reduction in fear, suggesting it does not matter where you tap or if you tap at all. (19). This study demolishes the basic premise of EFT, and it should be clear that whatever is happening during an EFT treatment has nothing to do with tapping, meridians, acupoints, or chi. On the theory behind EFT, one author writes,
“they have assumed or asserted theoretical underpinnings and underlying mechanisms for which no evidentiary support has arisen in the entire history of the sciences of biology, anatomy, physiology, neurology, physics, or psychology, and they have claimed massive, rapid treatment effects for almost all psychological problems” (1)
On the plausibility of EFT treatment, I see two possibilities:
We have to believe some unsubstantiated claims: everything we know about biology, anatomy, psychology, and medicine is wrong; there is some undiscovered force that has some influence on every aspect of health; and we can manipulate it to our benefit by saying a few words and tapping on locations on the body.
Someone with genuine or suspect motives created a pseudoscientific medical treatment and the success people see with it is due to the features it has in common with every other psychological treatment.
I think the answer is clear, but either way, much time and money has been devoted to studying EFT and its supposed effects. What does the research actually say?
Does It Help With Stress, Anxiety, Or Depression?
Stress, anxiety, and depression have been the subject of the majority of EFT research by far. A study of 83 healthy people from 2012 found that the group that underwent a single EFT session had improvements in cortisol levels and psychological distress symptoms, as compared to a supportive interview group and inactive control group. However, the participants weren’t blinded, there was no follow up, and the overall effects were generally small (6).
A small pilot study of people diagnosed with depression found that after eight sessions of EFT or cognitive behavioral therapy, the cognitive behavioral therapy group had improvements in depression symptoms, but the EFT group did not. There were no significant changes in anxiety symptoms for either group (3).
In another study, 63 students that were 10-18 years old with anxiety underwent EFT, CBT, or were inactive controls. The researchers found that both treatments helped to reduce anxiety, but EFT was only slightly more effective than CBT (12).
A study of 37 nursing students found four sessions of EFT helped to reduce anxiety and stress by small amounts, but there were no comparison groups that received a placebo treatment or a similar treatment (15).
Systematic Reviews And Meta-Analyses
Let’s move on to a few systematic reviews and meta-analyses for a broader look at the literature. I was able to find three reviews that looked at EFT on various psychological conditions, but all three suffered from significant issues in the way they were performed.They read as hopeful endorsements of a treatment rather than an in-depth evaluation of the effectiveness of it. The reviews and analyses were performed sloppily:
- the research questions asked were too broad
- they did not look for studies of a particular type of patient
- they didn’t look at a specific comparison to another treatment that works
- the parameters for what studies to include were extremely loose
- the studies they chose to combine were too statistically different, which typically precludes a meta-analysis.
To put it plainly, the researchers found any study that had positive results (regardless of quality or design), combined them when the statistics suggested said they shouldn’t, and reported seemingly impressive results of EFT on these conditions. All three reviews reported that EFT can have beneficial effects, but they did not compare EFT to treatments that already exist or placebo controls (9, 11, 14).
A fourth meta-analysis was sent in to us by a reader and looked at 18 papers on using EFT for various disorders. After statistically combining the studies, they found that EFT has an apparent “moderate” effect size, meaning that those that had EFT had modest improvements in their condition. However, as pointed out by the authors, the quality of the studies, the control/placebo treatments utilized and the way that they assessed each patient group raises major concerns and precludes any discussion of conclusive support. 12 of 18 studies compared EFT to no treatment, which will make it seem as though EFT is effective because getting any treatment will be better than none. Five studies compared EFT to treatments that have not demonstrated efficacy of their own, and only one study compared it to a treatment with an evidence base (20). Thus it is clear that although EFT has moderate effects, the studies that show it are not giving it a fair test up against an established treatment and they don’t assess for the possibility of non-specific effects.
“While it seems clear that EFT produces an effect, it remains unclear as to whether this effect is due to the claimed therapeutic properties of acupoint stimulation, or if in fact the positive effects are attributable to elements of EFT that are common to long standing evidence based therapies such as CBT. Furthermore the improvement could be due to other so-called general factors such as the therapeutic alliance. The efficacy of EFT beyond such general therapy effects has yet to be tested” (20).
Small, biased studies without comparison groups have shown that EFT treatments are associated with improvements in stress, anxiety, and depression. When compared to CBT, there is little or no difference in effectiveness.
Does It Help With PTSD?
Research on the effects of EFT on post traumatic stress disorder has been spearheaded by one researcher, Dawson Church, the head of the National Institute of Integrative Health, and his colleagues. A series of four studies by this group has been purported to show that EFT can help improve symptoms associated with PTSD (8, 7, 4, 13).
However, all four studies suffered from two fatal flaws: they had a small number of participants, and EFT was compared to waitlist controls that did nothing. These studies really tell us nothing about the effectiveness of EFT and they do not validate the theory behind it. EFT needs to be compared to other active treatments in larger-scale trials, and with more rigorous statistical analysis, before we can say it is worth anyone’s time.
One systematic review and meta-analysis looked at these studies and a few others and reinforced the original studies’ conclusions. However, the authors saw one study comparing EFT to CBT, and saw that there were no statistical differences at all (16).
Small, biased studies without comparison groups from one group of researchers with a financial interest in EFT have shown the treatment is associated with improved PTSD symptoms. However, when it has been compared to CBT, there are no differences between the approaches.
Does It Help With Headaches?
A research study from 2013 on 35 patients with tension-type headaches revealed that compared to a control group that received standard care, the group that received EFT treatments had fewer and less intense headaches (2). Despite some positive results, there was no blinding of the patients or the researchers, introducing an element of bias.
Blinding a patient consists of keeping it secret as to whether they receive a real treatment or a placebo treatment. Blinding the researchers refers to not revealing what group a patient was in (real treatment or control/placebo treatment), until the research is finished. Both of these things are necessary to prevent positive or negative expectations of patients and researchers alike from potentially influencing the results.
Most importantly, EFT was only compared to no treatment, instead of an existing treatment that may be more effective like meditation, cognitive behavioral therapy or neck massage.
One small study without an adequate control/placebo group or effective blinding showed EFT can improve headache symptoms.
Does It Help With Food Cravings And Weight Loss?
One pair of studies from 2011 and 2012 looked at the effects of EFT treatments versus waitlist control on food cravings and weight for 96 patients with elevated BMIs. Unsurprisingly, those that had a series of EFT treatments reported improvements in food cravings, psychological stress, and weight (17, 18). However, there was no proper comparison group, and the authors failed to declare a conflict of interest. The lead author sells EFT courses, and just conveniently didn’t mention it.
A pair of biased studies without any comparison group showed EFT techniques are associated with improvements in food cravings and weight loss.
Does It Help With Athletic Performance?
One study of 26 basketball players found that the group that had daily sessions of EFT had improved free throw performance, but no changes in vertical jump height, as compared to a control group that had no intervention (5).
A study without a valid comparison group showed improvements in free throw performance.
Is Emotional Freedom Technique Safe?
An EFT treatment involves saying phrases and tapping different body parts, and is without any significant safety risks. The majority of the studies I read did not report any adverse events or injuries following treatment. However, like many alternative medicine practices, choosing to utilize EFT may delay getting true effective medical care and thus puts yourself at increased risk of injury, disability, or emotional stress.
Major Conflicts Of Interests
Almost all of the studies that we looked at reported positive results in favor of EFT. However, there is an invisible asterisk on these studies that really taints the results and leaves room for reasonable doubt. Many of the researchers have financial interests in promoting EFT, and not everyone disclosed this conflict of interest.
Many studies were funded by the National Institute of Integrative Healthcare, a group that advocates for EFT, or were published in journals that are friendly to alternative medicine like Explore: The Journal Of Science and Healing, or Energy Psychology. Chasing down authors and references of the majority of these studies led me back to the same core group, led by Dawson Church, the head of the NIIH.
Now, either consciously or subconsciously, this introduces an element of bias into these studies that has to be taken into account. While I am not alleging outright misconduct, it remains a possibility and we have to consider that someone selling a course on a treatment will not produce any negative research.
While it is important to dive into these studies on their own merits, we need to keep in mind that the authors and editors have a clear bias and an agenda to bolster their own viewpoints. We need to view this research with extreme caution and skepticism, and not being transparent about conflicts of interest is a major foul.
- The theory behind EFT has no scientific basis and is not plausible.
- Anecdotally and scientifically, EFT treatments have benefits, but they can be explained by other factors instead of the effectiveness of tapping on acupuncture points, like going through a therapeutic ritual, practitioner and patient beliefs, and contextual factors.
- Many studies are clearly biased or published in journals that are insufficiently skeptical and overly friendly to alternative medicine and its practitioners.
- There is no properly designed study to date that suggests EFT has any benefits beyond a placebo treatment or a comparison treatment.
- EFT cannot be recommended, and if you are having a problem, you should seek the help of a licensed mental health professional or other qualified healthcare practitioner.
My piece on Emotional Freedom Technique generated quite a bit of interesting feedback from many EFT practitioners and users. I have been in dialogue with three people in particular, and my emails back and forth have been nothing but cordial, substantive, and informative. Much of the criticism I received focused on a few different themes, of which I will list and address individually below.
- I failed to cite enough research. The majority of the criticism I received has focused on the fact that my article only cited 19 research papers out of potentially hundreds that have been aggregated on various EFT websites. According to my critics, the research I did not cite does in fact show that EFT works, and works well. Unfortunately it would be virtually impossible to cite all the relevant research on EFT as I am up against the limits of time, a word count, and my readers’ attention spans. It is therefore my job to represent the body of research as best as I can within these constraints and I believe I provided a representative sample. There are plenty more articles on EFT that I did not include, but this was because I don’t believe they show anything substantially different than the ones I did include. If you want to see for yourself, you can look at the research catalogued here.
- I am biased against EFT. As a physical therapist, health writer, and user and consumer of scientific research, it is my nature to be skeptical of all treatments. My career as a writer started by me critically analyzing trends in my own profession. All health claims deserve reasonable skepticism until proven otherwise. Before even looking at the research, the claims of EFT and its practitioners warrant strong skepticism; there is no plausible mechanism by which it works and they claim it can treat everything. I would be more than happy to have an easy, simple treatment to help patients with psychological conditions, but I need to be biased in favor of science and skepticism to make sure the claims are true. I am biased against things that are wholly implausible on the face.
- As a physical therapist, I am not sufficiently qualified to make to evaluate EFT research. This is just flatly a non-sequitur. Qualifications matter less than the merits of the arguments I am making. However, if qualifications are important to my readers, I have earned my doctorate in physical therapy, which involves extensive coursework in evidence-based practice and research interpretation. Both my physical therapy job and my work as a health writer involves daily research interpretation and translation. I am highly qualified to analyze and discuss health care research of all types. In my article, I brought up Gary Craig’s credentials because it is relevant to the story; it suggests that EFT was a treatment without a sound scientific basis.
- I am failing to recognize the success that the individual practitioners have had with EFT. It would be silly of me to deny that those that use EFT report seeing beneficial effects. However, this is purely anecdotal evidence that cannot be relied upon heavily when seriously investigating a treatment. Every new treatment will have happy patients and enthusiastic practitioners pushing it.
Two additional studies were provided to me by one EFT practitioner, both designed to determine the underlying mechanism of EFT. One study looked at teacher burnout, and reported that those in the real EFT group did better than those in a sham group on most measures, but the sham group had some improvements as well (1). Another study reported similar results for college students looking to reduce stress, but the researchers said some of the participants knew the lead researcher and may have been familiar with EFT already, and the method of randomization was unclear (2). While I applaud the effort to perform studies on the mechanism of EFT, these studies are not significantly convincing. The design flaws mentioned above, the small number of participants, potential conflicts of interest with the lead authors, and the general lack of any basic science in support of the mechanism make me significantly doubt the results.
In my discussions, I proposed a question to all three of the people responding to me:
What is more likely and allows us to assume the least amount of propositions?
EFT works as advertised, health conditions are somehow influenced my meridians and acupoints, we can stimulate acupoints with tapping, and we can get results.
EFT works not as advertised, the features that it has in common with other therapies (i.e. meeting with a caring therapist, changing your thoughts, getting any treatment, mindfulness etc) are what is responsible for the effects we see, and that's why there is much positive research, even when you compare it to established treatments.
The first possibility seems highly unlikely to me because:
- we have no reason to believe meridians or acupoints exist
- we have no reason to believe meridians or acupoints are related to health conditions
- we have no reason to believe meridians or acupoints can be stimulated by tapping on them
The second possibility just seems more likely to me, and that is what I have to believe. People that undergo EFT report beneficial effects, but by all the available research I have seen, it must be due to the features it has in common with other therapies, and has nothing to do with tapping on acupoints.
In order to believe EFT works as suggested, you have to believe the entirety of science in general, as well as physics, chemistry, biology, medicine, and psychology, has thus far failed to discover a hidden life-force that has a relationship with every aspect of human health, and it can be manipulated to our benefit by learning a seemingly-arbitrary pattern of tapping and saying a few words about what is going on. It is often said that we should be open-minded, but not so open-minded that our brains fall out. I say this with no ill-will, but being sufficiently open-minded to believe in the mechanism behind EFT leaves too large of a hole for anyone’s brain to stay put. I am not willing to do that.
- Reynolds, Ann E. “Is Acupoint Stimulation an Active Ingredient in Emotional Freedom Techniques (EFT)?A Controlled Trial of Teacher Burnout.” Energy Psychology Journal, vol. 7, no. 1, Jan. 2015, doi:10.9769/epj.2015.05.01.ar.
- Rogers, Rachel, and Sharon Sears. “Emotional Freedom Techniques (EFT) for Stress in Students: A Randomized Controlled Dismantling Study.” Energy Psychology Journal, vol. 7, no. 2, Jan. 2015, pp. 26–32., doi:10.9769/epj.2015.11.01.rr.