EFT stands for Emotional Freedom Techniques.
What is EFT?
Clinical EFT is a manualised, evidence-based stress reduction technique that utilises elements of cognitive therapy with physical stimulation of acupressure points (Church, 2013a). EFT is often referred to as ‘Tapping’ as it uses a two-finger tapping process on known acupuncture points. (Church, 2013b)
It involves gentle systematic tapping on particular parts of the face and body, sometimes described as psychological acupuncture, as the tapping points are located at the same points which are used in traditional acupuncture.
EFT allows us to release the intensity and transform the way uncomfortable feelings like hurt, guilt, fear, or anger may be affecting our experience. EFT can also be used to help transform the thoughts and beliefs behind our emotional experiences.
After just a few rounds of tapping, people often report feeling lighter and calmer and able to breathe more easily – almost as if they have more space inside now. They also report that their thinking has changed, they have gained new insights or that they are feeling better, overall.
Mechanisms of Work and Research
EFT is a surprisingly simple technique. By stimulating pressure points on the body with these two finger-tapping techniques, Emotional Freedom Techniques result in a calming effect on two important parts of the brain.
The first one is called the amygdala (the stress centre of the brain). This part plays a role in the stress response. When the amygdala sends a distress signal, another part of the brain activates the ‘fight or flight’ response, which may provoke feelings like anger, anxiety or worry and physical symptoms like changes in our breathing and heart rate.
The other part of the brain that EFT tapping has an impact on is the hippocampus (the brain’s memory centre). This part of the brain is responsible for storing memories and can remind us of similar events from the past, which may be linked to us feeling anxious and fearful.
EFT also seems to have a calming effect on cortisol – the stress hormone. When we are under stress, the prefrontal cortex of the brain, our rational thinking brain goes “offline,” and our body’s levels of adrenaline and cortisol increase. The EFT intervention can help calm the amygdala, facilitate the release of calming chemicals, and bring us back to a more resourceful state.
We also know from clinical trials that EFT has the ability to turn off or deregulate up to six genes in our bodies that are involved in stress symptoms.
How can EFT help cancer patients?
Stress, anxiety, and emotional distress are present along the entire cancer care pathway. (Gary et al., 2022)
These factors impact the efficacy of treatments, patient outcomes, recovery time, and cost of care. Most importantly, they present a significant burden to cancer patients, their families and friends, clinicians, and the wider society.
Interest in fostering positive patient outcomes beyond survival is growing among patients, clinicians, and those paying for cancer services. Effective mitigation of these factors requires early identification followed by effective intervention.
A stress reduction technique, EFT is well supported by clinical research (Stapleton, 2022). Benefits include reduced psychological distress, improved quality of life, and a positive impact on various psychological and physical symptoms.
Tapping can be particularly supportive for patients who are experiencing the emotional impact and physical side effects of their cancer diagnosis and treatment.
Clinical EFT’s stress-reduction capacity makes it also effective in alleviating multiple psychological conditions, including phobias, PTSD, anxiety, and depression (Church et al., 2022) that are often associated with a cancer diagnosis (Pitman, et al 2018).
EFT can be used as an adjunct to traditional treatment and is effective in reducing the side effects of Tamoxifen in women with breast cancer (Baker et al, 2015), improving quality of life and reducing fatigue or cancer-related cognitive impairment (Tack, L.,et. al 2021).
EFT can help cancer patients in many ways:
- Coming to terms with the shock of the diagnosis
- Alleviating stress, frustration, anger, grief, fear, and hopelessness
- Clear overwhelm and help make decisions with a calm and clear mind
- Enables patients to take an active role in their healing process
- Managing the emotional and physical side effects of treatments; e.g., Neuropathy, pain, hot flushes, nausea, sleep problems
- Identify and clear negative thinking patterns and behaviours
- Deal with the challenges of daily life
- Foster a positive frame of mind and experience joy in life
- Moving on after treatment or after the “All Clear”
- EFT seems to help patients come to terms with physical changes and body image.
Quote: “I didn’t want the mastectomy. I didn’t want to have the deformity. I believed it would be impossible to start a new relationship… I would never feel confident in my body again… I needed emotional support to understand why I didn’t want to give myself the best chance of living. EFT helped me understand that I wanted to live more than I was worried about the deformity. Now I have a new life and I am really incredibly happy”. CR; Breast Cancer patient.
Quote: “The second chemo on Friday was a different experience. .. I feel that the change in my attitude towards the treatment has played a very significant part – and this has come directly from our meetings and EFT. Welcoming the poison into my body, trusting my body to work with it as it kills the cancer cells floating around my body, all in pursuit of strengthening and revitalising my health and my well-being. The effect of forgiving and accepting my decision to try again has been extraordinary” RW, Breast Cancer patient.
EFT has the potential to be a powerful tool to improve the care of palliative patients who have distressing emotions (Quilty et al, 2017).
What can I expect from the process?
The EFT process involves clients identifying a concern or an issue they wish to address and rating their level of distress on a Likert-type scale out of 10 (10 is the maximum amount of distress and 0 represents the minimum or a neutral state). This is called a Subjective Unit of Distress (SUDS)(Wolpe 1973).
Participants then state their concerns in a “Set-up Statement,” which assists in tuning them into their level of distress. This is typically stated in this format: “Even though I have this problem (e.g., anger), I deeply and completely accept myself.”
The first part of the set-up statement emphasises exposure, while the second half frames the traumatising event in the context of self-acceptance. The participant then engages in the tapping process on acupoints while they repeat a shortened phrase to stay engaged (e.g.; angry). This is called the “Reminder Phrase.” The tapping sequence uses 9 acupoints (see Figure 1) on the face and upper body and is normally repeated until the SUDS rating reduces to one or zero.
Where can patients get EFT?
- Check with your local cancer clinic or cancer support charity whether they offer EFT sessions.
- EFT works very well online, therefore you may be able to access EFT sessions via cancer support charities such as Penny Brohn UK or Fountain Centre remotely.
- Try the EFT offer on the ONCIO App
- Find an experienced Accredited EFT Practitioner specialising in cancer support on the
- EFT International Practitioners Directory or other Accredited trainers directory
- Search Yes To Life > Life Directory for EFT practitioners with experience in cancer
What is EFT not?
EFT helps to deal with the emotional and physical impact of cancer and cancer treatments, it is NOT a cancer treatment. Using EFT will complement and support conventional cancer treatment. EFT can lead to an increased sense of calm and well-being and enable patients to cope with difficult treatments.
The level of stress generated by cancer and the medical process is huge, long-lasting and toxic. The aim of EFT sessions is to reduce the stress substantially, introduce coping strategies and encourage a return to a relaxed and well-resourced state.
Research
As of January 2023 there are:
- Over 300 research studies on Energy Psychology methods (of which the most important and widely used one is EFT) published in peer reviewed scientific journals
- 70 Randomised Controlled Trials
- 55 Outcome Studies
All but one document the efficacy of EFT
- 5 Meta Analyses (looking at a range of scientifically sound studies to combine and evaluate findings)
- 5 systematic reviews of EP modalities
- 12 Comparative reviews EFT and other therapies
All above document EFT efficacy
So far EFT has been approved by the following organisations:
- 2017: US Veterans Administration approved EFT for use with its clients suffering with PTSD, depression, anxiety, pain and other issues
- 2019: Blue Knot Foundation (for trauma) included EFT in PTSD clinical guidelines in Australia
- 2020: EFT was approved under the National Insurance Disability Scheme (NDIS) for therapy in Australia
Some important findings:
- Reduction in salivary Cortisol: This study randomly allocated 83 participants in a stress study to either EFT, “Sympathetic Talking”, or resting. Before and after participants reported their subjective experience of stress and anxiety. After the one hour of individual intervention, participants receiving EFT measured 24% less Cortisol, the talking group measured a reduction of 14%, resting group had no change. The changes in biochemistry corresponded with the self-reported improvement of symptoms. Church, D., Yount, G. & Brooks, A. (2012). The Effect of Emotional Freedom Technique (EFT) on Stress Biochemistry: A Randomized Controlled Trial. Journal of Nervous and Mental Disease, 200(10)
- This study was replicated by Peta Stapleton in 2020. Instead of individual sessions, the participants received 60 minutes of group tapping. The effect was even stronger; the EFT group’s cortisol levels reduced by 43%.
- Clinical EFT (Emotional Freedom Techniques) Improves Multiple Physiological Markers of Health This study suggests that EFT simultaneously improves a broad range of health markers across multiple physiological systems. As hypothesized, participants experienced significant decreases in pain, anxiety, depression, and PTSD. Physiological indicators of health such as Resting Heart Rate, Blood Pressure, and Cortisol also significantly decreased, indicating improvement. Happiness levels increased as did immune system function.
- The Effectiveness of Emotional Freedom Techniques in the Treatment of Posttraumatic Stress Disorder: A Meta-Analysis, 20161 The analysis of existing studies showed that a series of 4–10 EFT sessions is an efficacious treatment for PTSD with a variety of populations. The studies examined reported no adverse effects from EFT interventions and showed that it can be used both on a self-help basis and as a primary evidence-based treatment for PTSD.
- A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Trials of Clinical Emotional Freedom Techniques (EFT) for the Treatment of Depression “The results show that Clinical EFT were highly effective in reducing depressive symptoms in a variety of populations and settings. EFT was equal or superior to TAU and other active treatment controls. ..EFT produced large treatment effects whether delivered in group or individual format, and participants maintained their gains over time.”
Research into EFT for cancer
- Cancer related cognitive impairment This multicentre randomised wait-list controlled trial demonstrated that EFT is an effective strategy for patients suffering from cancer-related cognitive impairment. “EFT is associated with multidimensional improvements in mental well-being and quality of life. This trial highlights EFT as a safe, effective, low cost and low threshold intervention, easy to implement in clinical practice.”
- Anxiety in Breast Cancer patients This study showed that EFT was effective to decrease anxiety in breast cancer patients. “Based on this result, it is recommended that health provider especially nurses to use Emotional Freedom Technique (EFT) therapy as one non-pharmacological therapy to decrease anxiety”.
- Stress, anxiety, and depression in cancer patients EFT can effectively reduce the levels of perceived stress, anxiety and depression in cancer patients.
- Side effects of Tamoxifen and Aromatase Inhibitors in women with Breast cancer This Study showed that Emotional Freedom Techniques (EFT) is effective in reducing side effects associated with Tamoxifen and Aromatase Inhibitor Use in Women with Breast Cancer
- 3 case studies in Palliative care for cancer patients EFT has the potential to be a powerful tool to improve the care of palliative patients who have distressing emotions. Future research on EFT and its effect on distressing emotions in palliative populations and their families is warranted.
For more detailed information on EFT research see Peta Stapleton, The Science behind Tapping or https://www.efttappingtraining.com/eft-research.
The recordings of the 2023 EFT International Scientific Symposium “EFT and Issues around Cancer” can be purchased here.
Research in Cancer
- Liu et al. 2017 – stress, anxiety and depression in cancer patients
- Stapleton et al., 2020 – EFT during usual care Tx
- Tack et al., 2021 – quality of life and cancer-related cognitive impairment in survivors*
- Clinical Baker & Hoffman, 2014 – breast cancer
- EFT Kalroozi et al., 2022 – sleep quality and happiness of women – breast cancer surgery and lived in military and nonmilitary families
The “mechanisms of action” for a technique such as EFT describe what is happening in the body during application of the technique. The following research papers describe the neurological, epigenetic, psychoneuroimmunological and hormonal pathways engaged by EFT.
- Bach, D., Groesbeck, G., Stapleton, P., Sims, R., Blickheuser, K., & Church, D. (2019). Clinical EFT (Emotional Freedom Techniques) improves multiple physiological markers of health. Journal of evidence-based integrative medicine, 24 , 2515690X18823691 https://www.eftuniverse.com/research-studies/clinical-eft-emotional-freedom techniques-improves-multiple-physiological-markers-of-health
- Maharaj, M.(2016). Differential gene expression after Emotional Freedom Techniques (EFT) treatment: A novel pilot protocol for salivary mRNA assessment Energy Psychology: Theory, Research, and Treatment, 8(1), 17-32. doi:10.9769/EPJ.2016.8.1.MM. Church, D., Yount, G., Rachlin, K., Fox, L., & Nelms, J. (2016). https://www.eftuniverse.com/index.php?option=com_content&view=article&id=12092
- Epigenetic effects of PTSD remediation in veterans using Clinical EFT (Emotional Freedom Techniques): A randomized controlled pilot study. American Journal of Health Promotion, 1-11. doi:10.1177/0890117116661154 Treatment, 8(1), 17-32. doi:10.9769/ EPJ.2016.8.1.MM https://www.eftuniverse.com/index.php?option=com_content&view=article&id=11977
- Church, D., Yount, G., & Brooks, A. J. (2012). The effect of Emotional Freedom Techniques (EFT) on stress biochemistry: A randomized controlled trial. Journal of Nervous and Mental Disease, 200(10), 891-896. doi:10.1097/NMD.0b013e31826b9fc1 https://www.eftuniverse.com/index.php?option=com_content&view=article&id=9160
- Stapleton, P., Crighton, G., Sabot, D., & O’Neill, H. M. (2020). Reexamining the effect of emotional freedom techniques on stress biochemistry: A randomized controlled trial. Psychological Trauma: Theory, Research, Practice, and Policy, 12(8), 869-877. https://doi.org/10.1037/tra0000563
https://research.bond.edu.au/en/publications/reexamining-the-effect-of-emotional freedom-techniques-on-stress-
The following scientific references include research and trials done on the efficacy of EFT:
- Tack, Lefebvre et al: A randomised wait-list controlled trial to evaluate Emotional Freedom Techniques for self-reported cancer-related cognitive impairment in cancer survivors
https://www.sciencedirect.com/science/article/pii/S2589537021003618 - Santi Fitria Ningsih et al: Effectiveness of Emotional Freedom Technique (EFT) therapy to anxiety of breast cancer stage II and III patients
https://www.neliti.com/publications/188590/efektivitas-terapi-emotional-freedom-technique-eft-terhadap-kecemasan-pasien-kan - Liu, Yang, Chen: Effect of emotional freedom technique on perceived stress, anxiety and depression in cancer patients: a preliminary experiment / 现代临床护理
https://pesquisa.bvsalud.org/portal/resource/pt/wpr-666270 - Baker, Hoffman: Emotional Freedom Techniques (EFT) to Reduce the Side Effects Associated with Tamoxifen and Aromatase Inhibitor Use in Women with Breast Cancer: A Service Evaluation
https://www.sciencedirect.com/science/article/abs/pii/S1876382014003072 - Maharaj: Differential gene expression after Emotional Freedom Techniques (EFT) treatment: A novel pilot protocol for salivary mRNA assessment.
https://www.researchgate.net/publication/305213169_Differential_Gene_Expression_after_ Emotional_Freedom_Techniques_EFT_Treatment_ A_Novel_Pilot_Protocol_for_Salivary_mRNA_Assessment - Church, Yount, Rachlin, Fox, Nelms: Epigenetic Effects of PTSD Remediation in Veterans Using Clinical Emotional Freedom Techniques: A Randomized Controlled Pilot Study
https://pubmed.ncbi.nlm.nih.gov/27520015/ - Church, Feinstein: The Manual Stimulation of Acupuncture Points in the Treatment of Post-Traumatic Stress Disorder: A Review of Clinical Emotional Freedom Techniques https://www.ncbi.nlm.nih.gov/pubmed/28874920
- Bach, Groesbeck, Stapleton, Sims: Clinical EFT Improves Multiple Physiological Markers of Health
https://www.researchgate.net/publication/331219849_Clinical_EFT_Emotional_Freedom _Techniques_Improves_ Multiple_Physiological_Markers_of_Health - Coyle: A Role for Emotional Freedom Technique in Palliative Patients? Three Case Reports https://www.proquest.com/openview/feb9cf51e5dd7d27ff29724ed424a6ac/1?pq-origsite=gscholar&cbl=2040968
- Sebastian, Nelms: The Effectiveness of Emotional Freedom Techniques in the Treatment of Posttraumatic Stress Disorder: A Meta-Analysis https://www.ncbi.nlm.nih.gov/pubmed/27889444
- Mehdipur et al: The effectiveness of emotional freedom techniques (EFT) on depression of postmenopausal women: a randomized controlled trial
https://pubmed.ncbi.nlm.nih.gov/34013673/ - Thomas et al: Emotional Freedom Techniques (EFT) Reduces Anxiety Among Women Undergoing Surgery
https://energypsychologyjournal.org/eft-reduces-anxiety-among-women-undergoing-surgery/ - NICE, Treatment for PTSD Guidelines, 2018 – recommendations for research
https://www.nice.org.uk/guidance/ng116/chapter/Recommendations-for-research - Stapleton: Efficacy for food cravings, using FMRI: https://bond.edu.au/intl/news/49213/world-first-brain-scan-research-shows-tapping-effective-combating-food-cravings
