PsychologyJournal,2009ISSN:1931‐5694Vol.6,No.2www.psychologicalpublishing.compp.34‐46©2009PsychologicalPublishingTheoreticalandMethodologicalProblemsinResearchonEmotionalFreedomTechniques(EFT)andOtherMeridianBasedTherapiesA.HarveyBaker*QueensCollegeoftheCityUniversityofNewYorkPatriciaCarringtonUniversityofMedicineandDentistryofNewJerseyDimitriPutilinQueensCollegeoftheCityUniversityofNewYork*A.HarveyBaker;DepartmentofPsychology;QueensCollegeoftheCityUniversityofNewYork;harvey.baker@qc.cuny.edu(email).ABSTRACT‐ControlledresearchintoEmotionalFreedomTechniques(EFT)andothermeridian‐basedtherapiesisatitsbeginnings.WeexaminedseveralissuesfacingEFTresearchers,including:thenumberandtypeofdependentmeasures;expectancyeffects;theneedforfollow‐upassessment;anewlyproposedprocedureforkeepingparticipantsblind;thedurationoftheintervention;thevalueoftreatingthehypothesizedEnergyMeridianSystemandEFTísoperationsasseparateconstructs;andthepossibilitythatEFTísefficacyismediatedbyprocesseslongknowntobeassociatedwithpsychotherapy.SuchissuesareconsideredinthecontextofthreerecentEFTstudies:WaiteandHolder(2003);Wellsetal.(2003);andBakerandSiegel(2005).SomelimitationsofthesestudiesaredelineatedandguidelinesonEFTresearcharesuggested.EEmotionalFreedomTechniques(EFT)(Craig,1995,1999,2002,2006)andits

precursor,ThoughtFieldTherapy(TFT)(Callahan,1985)arerelativelynewapproachestotreatingpsychologicalproblems.Eachfeaturesthetappingofvariousacupuncturemeridianendpointswhilerepeatingcertainverbalphrases.Althoughtheseapproachesareattractingattentioninthefieldsofmentalhealthandtraumatology(e.g.Oschman,2006;Ruden,2005),thereisadearthofcontrolledresearchinthefield.Toourknowledge,nostudieshavebeenpublishedinpeer‐reviewedjournalsassessingtheeffectivenessofTFTbyusinganappropriatecomparison/controlcondition,andonlytwopublishedstudiesinpeer‐reviewedjournalshaveinvestigatedEFTinthismanner.ThispaperreferstocontrolledstudiesonEFT,althoughourcommentsshouldapplytoanymeridianbasedtherapy.AsitisrelativelyearlyinthedevelopmentofEFTresearch,itwouldseemthatnowisthetimetoidentifytheoreticalandproceduralquestionsfrequentlyencounteredbythoseengagedinsuchinvestigationsandtoclarifytheconceptstobeexplored.

PsychologyJournal,2009,Vol.6,No.2,pp.34‐46TheoreticalUnderpinningsoftheMeridianBasedTherapiesThetheorythatinspiredbothEFTandTFTisbasedontheEnergyMeridianSystem(EMS)postulatedbyancientChinesemedicine‐‐thesametheorythatshapedthepracticeofacupuncture.Accordingtothistheory,avitalenergyknownasQiflowsthroughpathwaysinthebodydesignatedasenergyìmeridians.îIfthisflowisblocked,itissaidtocausedysfunction,disease,or,intheeventofmassiveblockage,death.WewillrefertothispostulatedflowofQithroughenergymeridianpathwaysastheEMS.ThefoundersofbothEFTandTFTclaimthatallemotionalproblemsreflectanimbalanceintheEMS,andthatstimulatingtheendpointsofvariousacupuncturemeridianpointsservestoredressthisimbalance(Callahan,1985;Craig,1995;Gallo,1999).Itshouldbenoted,however,thatthetheorybehindbothEFTandTFTisstillonlyatheory.Althoughthereissomescientificevidenceindicatingthatacupunctureisaneffectiveanalgesic(e.g.Levine,Gormley,&Fields,1976)andanti‐anxietyagent(e.g.,Lo&Chung,1979;Roccia&Rogora,1976),weknowofnoacceptedbodyofscientificstudieswhichhasasyetdemonstratedtheexistenceoftheputativeEMSandQi.AstumblingblocktoconductingresearchonEFT(andbyimplicationonanyothermeridianbasedtherapy)isthatitisalltooeasytoassumethatEFT'seffectiveness,ifdemonstrated,wouldconstituteinandofitselfproofoftheexistenceoftheEMS;orconversely,thatifEFTíseffectivenesswasdisconfirmed,thatthiswoulddisprovetheexistenceoftheEMS.Inordertoavoidconfusioninthisareaofresearch,werecommendthatthesetwoquestionsbeconceptualizedseparatelywheneverstudiesinthisfieldareundertaken.Wewillelaborateonthispointlater.EFTOperationsandProceduresAsingleroundofthestandardEFTprocedureinvolveseightsteps(Craig,1995,1999):Step1‐Theparticipantisaskedtoimaginehimselforherselfexperiencingthedisturbingaffectorsituationtobeaddressed.Step2‐Thepersonisaskedtoratehisorhernegativeaffect,ìÖasitexistsNOWÖ.asyouthinkaboutitÖî(Craig,1995,p.28)

ona0to10pointSubjectiveUnitsofDiscomfortScale(SUDS),wherezerodenotesìnoneîand10denotesìmaximumintensity.îStep3‐Theparticipantusesastandardsetupphrase(e.g.,ìEventhoughIhavethisfearofrats,Ideeplyandcompletelyacceptmyselfî)whichisrepeatedthreetimesoutloudwhilesheorhetapsonaspecificlocationatthesideofthehand,orsimultaneouslyrubstwospecificlocationsonthechest.Step4‐Theparticipantthentapsfivetoseventimesoneachofsevendifferentacupuncturepointsonthefaceandupperbodywhilerepeatingashortreminderphraseateachlocation(e.g.,ìfearofratsî)tomaintainfocusontheissuebeingaddressed.Step5‐Thesamethingisdoneonfivelocationsononehand,whileagainrepeatingthereminderphraseonceateachlocation.Step6‐Thepersonthenperformsnineactivities(calledìtheninegamutprocedureî)consistingoftappingonalocationonthebackofonehandwhileengaginginaseriesofeyemovementsandvocalizations.Steps7and8consistofrepeatingSteps4and5.Theentireproceduretakesanaverageoftwotothreeminutes.WhenusingEFTwithclinicalpatients,atypicaltreatmentsessionconsistsofmultipleroundsoftreatment,lastingusuallyabout45minutes.Itshouldbenotedthattheshort

PsychologyJournal,2009,Vol.6,No.2,pp.34‐46formofEFT,whichomitsStep6ineachround,ismostoftenusedtodayforclinicalpurposes.ControlledStudiesonEFTInthefirstcontrolledandpublishedstudyofEFT,WaiteandHolder(2003)exploredwhetherEFTisefficaciousindecreasingasinglespecificfear,andwhethertheefficacyofEFT,ifany,isìattributabletothemanipulationofmeridianpointsî(Waite&Holder,2003,p.21).Inthefirstphaseoftheirstudy,WaiteandHolder(2003)employedfourconditions:1.ìEFTî‐aparticipantunderwentoneroundofthefullEFTproceduredescribedabove,tappingwiththetipsofhis/herindexandmiddlefingers(personalcommunicationfromM.Holder,June21,2004)onlocationsonhis/herbody.2.ìPlaceboî‐aparticipantusedthetipsofher/hisindexandmiddlefingerstotapon12pointsonthearmthatarenotusedinEFT.Exceptforthelocations,thefullEFTprocedurewasfollowed.3.ìModelingî‐insteadoftappingon12locationsonhis/herownbodyduringSteps4and5,aparticipanttappedon12correspondinglocationsonthebodyofadoll,usingthesametwofingertips.DuringStep3(seeEFTdescriptionabove),participanttappedonthedollíschestratherthanonhis/herownchest.DuringStep6,participanttappedonthedollíshandratherthanonhis/herownhandwhileperformingthe9‐gamutprocedure.4.AìControlîconditionwhereparticipantconstructedanorigamitoyoutofpaper.OnlyStep2oftheEFTprocedure(fearlevelassessmentusingSUDS)wasincluded.NoothercomponentsofEFTwerepresentinthiscondition.Exceptforthelocationsuponwhichtheparticipanttapped,eachofthefirstthreeconditionsincludedalltheotheraspectsofEFT:focusingonthefearedobjectorsituation,theuseofstandardizedEFTverbalizations,the9‐gamutprocedure,andfearlevelassessments.ThecontrolgroupdidnotemployanyaspectsofEFT,butreceivedthesamefearlevelassessmentsastheotherconditions.

FearlevelwasassessedusingSUDS,onceatbaseline,andagainaftertheintervention(post‐treatment1).Noobjective(i.e.behavioralorphysiological)measuresoffearwereused.Thisstudyalsoincludedasecondphaseinvolvingabreathingandtappingtechniquewhichwasadministeredequallytoparticipantsinallconditions.Therewerenosignificantfindingsforthissecondphaseandtheauthorsalmostcompletelyignoreitindiscussingtheirstudy.Weemulatethemhereandfocusallourattentiononthefirstphaseofthestudy.WaiteandHolderís(2003)findingsshowedsignificantdecreasesinfearfrombaselinetopost‐treatment1foreachofthethreetreatmentconditions(EFT,PlaceboandModeling),andnosignificantdecreaseinfearforthecontrol(toy‐construction)condition(seeFig.1inWaite&Holder,p.23).ItisimportanttonotethattheirEFT,Placebo,andModelingconditionsincludedallcomponentsoftheEFTprocedureanddifferedonlyinthelocationthatwastapped.WaiteandHolderconcludedthattheefficacyobservedfortheEFT,Placebo,andModelingconditions(a)"appearsunrelatedtotheuniquefeaturesofEFTandinsteadderivesfromcomponentssharedwithmoretraditionaltherapiesalreadyestablishedaseffectivetreatmentsforspecificphobiaîsuchassystematicdesensitizationordistraction(p.24),and(b)"[does]notsupporttheideathatthe

PsychologyJournal,2009,Vol.6,No.2,pp.34‐46purportedbenefitsofEFTareuniquelydependentonthe'tappingofmeridiansí"(p.20).Wells,Polglase,Andrews,Carrington,andBaker(2003)exploredwhetherEFTcanreducespecificphobiasofsmallanimalsunderlaboratory‐controlledconditions.Randomlyassignedparticipantsweretreatedindividuallyfor30minuteswithEFT(n=18)orwithDiaphragmaticBreathing(DB)(n=17).TheDBconditionwasdevisedtoserveasacomparisontreatmentconditionrelativetotheEFTcondition.Durationoftreatment,numberofroundsoftreatment,demandcharacteristics,attentionpaidbytheexperimentertotheparticipant,timespentfocusingonandimaginingthefearedobject,etc.,wereverysimilarinbothconditions.ThenumberofassessmentsofSUDSlevelwasalsoequalforEFTandDB,sincemorefrequentassessmentofSUDSforoneconditionmightproducedifferentdemandcharacteristicsforthatcondition.TheresultswerepositiveforEFT:ANOVASrevealedthatEFTproducedsignificantlygreaterimprovementthandidDBbehaviorallyandonthreeself‐reportmeasures,althoughnotonpulserate.ThegreaterimprovementforEFTwasmaintained,andpossiblyenhanced,at6‐9monthsfollow‐uponthebehavioralmeasure.ThesefindingssuggestthatasingletreatmentsessionusingEFTtoreducespecificphobiascanproducevalidbehavioralandsubjectiveeffects.Wewillnowlookatthemethodologicalandpracticalproblemsillustratedbytheabovetwopublishedstudiesandoneadditionalstudy(Baker&Siegel,2005).MethodologicalandPracticalProblemsMeasuringDependentVariablesIntheWaiteandHolder(2003)study,onlyasingleself‐reportdependentmeasure(SUDS)wasemployedatpre‐interventionandpost‐intervention,whereasinWellsetal.(2003)andinanunpublishedreplicationandextensionofWellsetal.,BakerandSiegel(2005),multipleself‐reportmeasures,abehavioralmeasureandaphysiologicalmeasure

wereused.Whenonlyasingleself‐reportdependentmeasureisemployed‐‐especiallyonethatrepeatedlyanddirectlyassessesthetargetbehavior,asSUDSdoes‐‐wesuspectthatthereisgreaterpossibilitythatdemandcharacteristicswillaffecttheoutcome.WhenusingSUDS,itismucheasierfortheparticipanttobecomeawarethattheexperimenterdesiresadecreaseinself‐reportedfear.Amorerobustarrayofdependentmeasureswouldbeadvisable,preferablytoincludepsychometricallyvalidself‐reportmeasuresofthetargetedsymptom,generalmeasuresofpsychologicalhealth,andobjectiveorbehavioralmeasuresthatassessthetargetedsymptom(s).Twoexamplesofthisarefoundin(a)BakerandSiegelísuseoftheFearofSpecificAnimalQuestionnaire(Baker,Quiatchon,&Putilin,inpreparation)aswellasabehavioraltaskinvolvingagraduatedapproachtothefearedanimal,withassessmentsofdiscomfortateachstep,and(b)Roweís(2005)findingofdecreaseinlong‐termpsychologicalsymptomsassessedbytheshortformoftheSCL‐90‐R(SA‐45)inagroupofparticipantsatanEFTtrainingworkshop.ThereisanadditionallimitationintheuseofSUDSasadependentmeasureofoutcome.AsPignotti(2005)pointsout,mainstreampsychologyregardsandusesSUDSasaìprocessmeasureîandnotasanìoutcomemeasureî.InbothoftheTFTandEFTprocedures,SUDSisusedasbothaprocessmeasure(tomonitorthepersonísprogressthroughoutthesession),aswellasanoutcomemeasure(treatmentonaspecificaspectof

PsychologyJournal,2009,Vol.6,No.2,pp.34‐46theclientísissueisconcludedwhenSUDSreaches0).AlthoughthislatterusageofSUDSiscommonandconvenientinaclinicalsetting,itisinadequateasevidenceoftreatmentefficacywhenEFTorTFTarestudiedinthelaboratory.NomatterhowhighlysignificanttheoutcomesareasassessedbySUDS,thesefindingsneedtobecorroboratedbycreditableself‐reportandbehavioraloutcomemeasurestobeacceptabletothepsychologicalscientificcommunity.Inadditiontorecommendingmultiplemeasuresatthetimeoftheoriginalintervention,thereisgreatvalueinassessingthelong‐termeffectsoftheinterventionbybringinginparticipantsforafollow‐upsessionconsistingofonlyassessmentwithoutprecedingtreatmentorothermanipulation.Inthisway,onecandistinguishbetweentransientandlong‐termeffects.ControlforExpectancyEffectsExpectancyeffectshavebeenknowntoaffectpsychotherapyoutcomes(e.g.,Weinberger&Eig,1999)aswellasavarietyofotherpsychologicalphenomena(e.g.,Kirsch,1985;Kirsch&Lynn,1999).IntheWaiteandHolder(2003)study,participantsineachinterventionconditionweretold,priortotheintervention,thattheparticularinterventionmightpossiblyhelpthemtodecreasetheirfear.However,nomeasureswereusedtoassessand/orcontrolforexpectancy.IntheWellsetal.(2003)study,expectancyeffectwasassessedbyaskingparticipantsduringthepre‐treatmentphasehowconfidenttheywerethattheiras‐yet‐unidentifiedtreatmentwouldwork.Theseratingsconstitutedaglobalratingofconfidencethatanytreatmentwouldhelptheircondition.Sincethetwotreatmentconditions(EFTandDB)hadnotyetbeendescribedtoparticipants,itisnotpossibletodeterminewhetherthetwogroupsdifferedinexpectationofhelponcetheybecamefamiliarwithadescriptionofthetreatmentproceduretowhichtheyweretobeexposed.Therefore,althoughthetwo

groupsdidnotdifferintermsoftheirgeneralratingsofconfidencethatanytreatmentwouldhelp,expectationregardingtheparticulartreatmenttowhichtheywereexposedwasnotassessed.ItisonlyintheBakerandSiegelstudy(2005)thattherewas(a)ademonstrationofthetreatmentproceduretowhichtheparticipanthadjustbeenrandomlyassigned,(b)asystematicassessmentofpre‐treatmentexpectancyregardingthatparticipantístreatmentprocedure,and(c)statisticalcontrolforanypossibleeffectofexpectationonoutcome.WerecommendthatmeasuresofexpectancyforEFTbestandardizedtothedegreepossible,andthatthesemeasuresbeadministeredbeforetheexperimentalintervention,tocontrolforexpectancyeffects.ResearcherswouldbewelladvisedtoconsiderthemeasuresoftherapeuticexpectancyproposedbyBorkovecandNau(1972)orDevillyandBorkovec(2000).ASuggestedProcedureforKeepingParticipantsBlindtoConditionChristoff(2004)hasdescribedaprocedurethatcanbeusedtokeepaparticipantblindregardingwhetherornotshe/heisreceivingarealtreatmentoraplacebo/controlcondition.Forexample,iffearisbeingstudied,anaiveparticipantcanbeinformedthathe/shewillbereceivingeitheranestablishedtreatmentforfear,anewexperimentaltreatmentforfear,anestablishedpsychologicaltreatmentthatisnotforfear,aplacebo

PsychologyJournal,2009,Vol.6,No.2,pp.34‐46treatment(appropriatelydefinedfortheparticipant),ornotreatment.Inthisblindprocedure,nosubjectiseverinformedregardingwhattypeofconditionhe/sheisinatleastuntilthestudyiscompleted.Ifthereisapossibilitythatparticipantsmaycommunicatewitheachotherregardingtheconditionthattheparticipanthasexperienced,then(a)thenatureoftheconditionisneverrevealedtotheparticipant(andtheConsentFormforewarnstheparticipantthatthiswillbethecase),and(b)experimenter(s)aretrainedtoneverrevealconditiontypetotheparticipant.Christoff(2004)suggestedthatonecancouplethisprocedurewithabriefquestionnaireafterward,listingeachoneofthepossibleconditiontypeslistedabove,todeterminetowhatdegreetheparticipantbelieveshe/shewasexposedtothattypeofcondition.Ifthisprocedureisrigorouslyexecuted,aparticipantcanbekeptblindregardingwhattypeofconditionhe/shehasbeenexposedto.Additionally,thisprocedurecreatesthepossibilityofbothassessingandcontrollingforparticipantísperceptionsoftheintervention.LengthofExposuretoInterventionInthethreecontrolledstudiesofEFTdescribedabove,markedlydifferentexposuretimestoEFTwereused.WaiteandHolder(2003)presentedparticipantswithasingleround(about2to3minutesinlength)ofEFT,whiletheparticipantsintheWellsetal.(2003)studyweresubjectedtoa30‐minuteEFTsession,andBakerandSiegel(2005)useda45minutesession.Thus,WaiteandHolderwereputtingEFTtoamuchmorestringenttestbyposingthequestion:doesverybriefandatypicalparticipantexposuretoEFT(ascomparedtothemuchlongersessionsroutinelyusedinclinicalpractice)showanyeffects?Itislikelythattheveryshortdurationoftheirinterventioncoupledwiththeuseofonlyasingle‐itemself‐reportdependentmeasuresubstantiallyincreasedthepossibilitythattheiroutcomeswereinfluencedbydemandcharacteristics.WewouldrecommendthatanEFTsessionof30‐45minutes,attheminimum,beemployed.

ìEnergyMeridiansîandìOperationsîasSeparateConstructsThecreatorsofbothTFTandEFT(e.g.,Callahan,1985,Craig,1995)regardstimulationoftheenergymeridiansystemasthecentralfeatureoftheirmethods.Thus,mostoftheoperationsofEFThavethestatedaimofaffectingtheEMSsoastoreleaseblockedenergies.WaiteandHolder(2003)sharedthisperspective,asevidencedbytheircommentthatìthepresentresearchwasbasedprimarilyonthecontentionthatmeridianpointsarethefundamentalfactorinEFTíseffectivenessÖî(p.24).Fromthisperspective,ifonecouldproduceevidencethatdirectphysicalstimulationoftheputativeenergymeridiansystemisnotanecessaryconditionforproducingtheefficacyobservedforEFT,thentherewouldbereasonablegroundsforcontendingthatEFTdoesnoteitherentailorimplicateuniqueprocesses,butinsteadproducesefficacythroughprocesseslongknowntooccurinvariousformsofpsychotherapysuchasdesensitizationordistraction(assuggestedbyWaite&Holder,2003).BelievingthattheyhadruledoutalldirectphysicalstimulationoftheEMSintheirmodelingcondition,WaiteandHolderthusconcludedthatalthoughEFTwasclearlyefficacious,itsbeneficialeffectswerenotduetostimulationoftheEMS,andthereforeEFTdidnotrepresentanewtherapeuticprocess.Fromthisperspective,WaiteandHolderísreferencetotheir

PsychologyJournal,2009,Vol.6,No.2,pp.34‐46conditionwhichinvolvedtappingontwelvenon‐meridianpointsononeísarmasaìplaceboconditionîisreasonable,despitethefactthatalltheothercomponentsoftheEFTprocedurewereincludedinthiscondition.However,onecanconstrueEFTísoperationsandthetheoryregardingtheenergymeridiansystemasseparateentities,andthusgeneratetwodifferenthypotheticalquestions:First,aretheoperationsinvolvedinEFT(i.e.handmovements,verbalizations,etc.)efficacious,regardlessoftheunderlyingmechanismofaction?Second,dotheeffectsofEFTdependoninfluencinganenergymeridiansystem?WeofferthesedualhypothesesbecausepriorresearchhasshownthatEFTisefficacious(Waite&Holder,2003;Wellsetal.,2003;Baker&Siegelís[2005]replicationofWellsetal.,2003),andthusfar,thereisnoacceptablescientificevidenceestablishingtheexistenceoftheEMS.Thisraisesthepossibilitythatthecreatorsofmeridian‐basedpsychotherapiesserendipitouslycameuponasetofoperationsallorpartofwhichareefficaciouswhetherornottheEMSexists.Fromthisperspective,afailuretofindanysupportfortheexistenceoftheEMSwouldsimplyprovideabasisforrejectingaparticulartheoryofwhyEFTworksbutwouldnot,byitself,provideabasisforrejectingEFT‐as‐a‐set‐ofoperationsorforconcludingthatEFT‐as‐a‐set‐of‐operationsdoesnotconstituteaneffectiveornoveltherapeuticapproach.AsappliedtotheWaiteandHolder(2003)study,thisperspectivedoesnotjustifyreferringtothearm‐tappingconditionasìplacebo,îi.e.,apsychologicallyinerttreatment,sincethemechanismofactionresponsiblefortheobservedefficacyofEFThasnotyetbeenidentified.Westronglyrecommendthatthesetwoissues,theoperationsinvolvedinEFTandthetheoryofEMS,betreatedasseparateentities,andthatresearchonEFTandothermeridianbasedtherapiesbeconductedandinterpretedwithacleardifferentiationbetweenthetwo.Ifthisisdone,unwarrantedconclusionsaremuchlesslikelytobedrawnandresultscanbemoreclearlydelineated.AppropriateControlConditions

TherearetwopitfallsthatmayfaceinvestigatorsattemptingtoclarifytheroleofEMSinproducingtheobservedefficacyofmeridianbasedtherapies.ThefirstdealswithanoverlyrestrictiveconceptualizationofwhatisinvolvedinstimulationoftheEMS.ìPhysicalstimulationoftheEMSîandìtappingonmeridianendpointsîarenotsynonymous,althoughCraig(e.g.1995)oftenwritesasiftheyare.Ifoneadoptsthisperspective,onemightconcludethatbyeliminatingtapping,onehaseliminatedallstimulationoftheEMS.Yet,tappingisonlyonewaytophysicallystimulatetheEMS.Forexample,notappingwhatsoeverwouldoccurifacupunctureneedleswereusedinsteadoftapping,andyetsimilarresultsshouldbeproducediftheEMShypothesisisvalid.Thesecondpitfallinvolvesfailingtorecognizethattheactofìtappingîisbidirectional:intapping,thefingertipsstimulatethesurfacebeingtappedandthesurfacebeingtappedsimultaneouslystimulatesthefingertips.Itiseasytofailtonoticethis,ashappenedwithWaiteandHolder(2003).TheybelievedtheyhadeliminatedalldirectphysicalstimulationoftheEMSintheirìmodelingîcondition,inwhichparticipantstappedonvariouslocationsofadoll.Theyfailedtorecognize,howeverthatthereareacupuncturepointsinthefingersthatwere,infact,beingstimulatedrepeatedlyastheir

PsychologyJournal,2009,Vol.6,No.2,pp.34‐46participantstappedonthedollusingthetipsoftheirindexandmiddlefingers(M.Holder,personalcommunication,June21,2004).TraditionalChineseacupunctureidentifiesanimportantmeridianpointatthetipofthemiddlefinger(Pericardium9)(Worsley,1975;O'Conner&Bensky,1981).Theindexfingeralsohastwomeridianpointsonit:onelocatedontheradialsideofthefingeratthecornerofthenail,andtheotherontheradialsideoftheindexfingerdistaltothejointofthefinger(O'Conner&Bensky,1981).ThemodelingconditionoftheWaiteandHolderstudythuscontainedtheexactsamefrequencyofEMSstimulationasdidEFT(thatis,thenumberoftappingswereidentical),butthetotalquantityofphysicalactivationoftheEMSwassubstantiallylessinthismodelingcondition(onlythefingertipswerestimulatedbutnotthe12meridianendpointsusedinEFT).FutureresearchcanclarifytheroleoftheEMSinproducingtheeffectsofEFTbyemployingacontrolconditioninwhichmeridianstimulationiscompletelyeliminated,whileretainingalltheotherfeaturesofEFT.IfsuchaconditionproducedresultscomparabletothoseofEFT,itwouldpresentconclusiveevidencethatdirectphysicalstimulationoftheEMSdoesnotconstituteanecessaryconditionfortheeffectsobservedwithEFT.Furthermore,whenattemptingtoeliminatestimulationoftheEMSinacomparisoncondition,researchersmustensurethatallmeansofstimulationñwhetherbytapping,acupuncture,orothermeansñareeliminated.RelationshipBetweenProcessesLongKnowntoOccurwithPsychotherapyandProcesseswhichmayMediateEFTísEfficacyBasedontheirerroneousbeliefthattheyhadeliminatedallstimulationtotheputativeEMSintheirmodelingcondition,whileobtainingthesameefficacyasintheirEFTcondition,WaiteandHolder(2003)dismissedEFTasreflectingonlynonspecificeffects.EveniftheyhadeliminatedallEMSstimulationasintended,andobtainedthesameresults,theirconclusionwouldstillbelogicallyunwarranted.ItisimportanttoconsiderthepossibilitythatevenifitisempiricallydemonstratedthatstimulationoftheEMSis

notanecessaryconditionforobservingefficacywithEFT,itisstillpossiblethatoneormoreaspectsofEFTofferstherapeuticvaluethatisequivalentto,oranimprovementupon,well‐establishedpsychotherapies.Forexample,EFTmayactivatemorereadily,morequicklyand/ormoreintenselyoneormoreoftheprocesseslongknowntooccurinpsychotherapy.Eventhoughtheprocess(es)activatedmaybeinherentintraditionaltherapies,aneasier,morerapidormoreintenseactivationwouldbetherapeuticallyvaluableandspecifictoEFT.ConsiderWaiteandHolderís(2003)conclusionthattheprocessthatmediatestheefficacyofEFTmaybedesensitization.Infact,desensitizationorcounter‐conditioningmaywellbeoneoftheprocesseselicitedbyEFT(seecommentsbyWellsetal.[2003]totheeffectthatthecombinationofrelaxation,whichmanyparticipantsandpatientsreportafteranEFTsession,withfrequentfocusingonthefearedobjectmightbeclassifiedasìanovelformofdesensitizationî[p.959]).ThisconclusionneednotresultindismissingEFTashavingcertainpropertiesofitsownthatcouldbetherapeuticintheirownright.Thefactthatdesensitizationisaprocesslongknowntooccurinpsychotherapydoesnotbearonthisissuedirectly,formorethanoneprocessmaybeinvolved.Forexample,ifEFTinducesdesensitizationmorerapidly,moreintensely,orboth,thatcouldconstitute

PsychologyJournal,2009,Vol.6,No.2,pp.34‐46somethingnewandusefulñeventhoughtheprocessitself(desensitization)isonelongknowntopsychologists.InordertoidentifyanypotentiallyuniquetherapeuticcharacteristicsofEFT,wesuggestatwo‐prongedapproach.First,bycomparingcharacteristicssuchasefficacyandrateoftherapeuticchangeinEFTwiththoseofwell‐establishedtherapies,futureresearchmayfindindicationsthatEFToffersadvantagesthatcannotbeattributedtosharedaspectsbetweenEFTandtheestablishedtherapies.Second,futureresearchcanbedirectlyaimedatidentifyingthemechanismofactioninEFT.TheRapidityoftheEffectsofEFTNeedstobeDeterminedItisessentialtoinvestigatetherapidityoftheoccurrenceoftheeffectsofEFTandofothermeridianbasedtherapiesascomparedtothatoftraditionaltherapies,becausethismightbeoneofitsmostvaluablefeatures.Forexample,astrikingfindingoftheWaiteandHolder(2003)studywasthatsignificantdecreasesinfearoccurredafteronlyoneroundofeachoftheirthreeinterventionconditions.AsingleroundofEFTwasadministeredin"justafewminutes"intheirstudy(M.Holder,Personalcommunication,June21,2004).Weknowofnolaboratorycontrolledstudyintheliteratureusingatraditionalpsychotherapeuticmodalitythathasproducedsucharapidstatisticallysignificanteffect.TheWaiteandHolderstudyindicatesthatintheEFTcondition,meanSUDSleveldecreasedbyapproximately18%(ourestimate:seeFig1oftheirstudy)inonlyafewminutes,withsimilardecreasesobservedfortheothertwoexperimentalconditions,butnotforthenotreatmentcondition.Thisisanimpressivedecreaseforsoshortadurationoftreatment.Iffutureresearchconfirmsthatthisisarealeffectintrinsictooneormoreoperationsinvolvedintheseinterventions,anddoesnotsimplyreflectdemandcharacteristics,responsetendencies,expectations,orothermethodologicalartifacts,thenthisrapiditywouldbenoteworthywhetherornotenergymeridiansareresponsible.

WesuggestthatexperimentallycomparingEFTwithtraditionalpsychotherapies,givingspecialattentiontotherapidityoftheeffectsofeachandtheirdurationovertime,isthebestwaytoanswerthisquestion.TherapistAllegianceEffectsInpsychotherapyresearch,astrongcorrelationhasbeenobservedbetweenthetherapist/researcherísallegianceandtheoutcomeofthestudy(Luborskyetal.,1999).Thissuggeststhatifthepersonwhointeractswiththeparticipanthasanallegiancetotheparticularformofpsychotherapyunderstudy,he/shemayinfluencetheparticipanttoproduceresultsthatsupporttheefficacyofthatparticularformoftreatmentParsimonyandlogicsuggesttousthatthetherapistallegianceeffect,ifany,wouldmostclearlybeevidentintheobservedefficacyofthespecificconditiontowhichpositiveornegativeallegianceisdirected.EFTwasfoundtodecreasefearfrompre‐topost‐interventionassessmentsinboththeWellsetal.(2003)studyandtheBakerandSiegel(2005)study.ThepossibleroleoftherapistallegianceinproducingthisobservedefficacycouldnotberuledoutsinceeachoftheseresearchteamshadapositiveallegiancetoEFT.

PsychologyJournal,2009,Vol.6,No.2,pp.34‐46ItwouldthereforebeofgreatinteresttofindastudywhichdemonstratedefficacyforanEFTconditionconductedbysomeonewithnopriorallegiancetoEFT.WebelieveWaiteandHolder(2003)haveproducedsuchastudy.Theywere"...relativelyneutralaboutwhetherEFTwouldworkornotattheoutsetofthestudy...î(Holder,M.,Personalcommunication,June21,2004).WhenattentionisrestrictedtotheirEFTconditiononly,WaiteandHolder(2003)reportadecrease(p=.003)infearlevelfrombaselinetoposttreatment1(afterasingleroundoftreatment,lastingafewminutesonly).Inthisrestrictedsense,theirfindingfortheirEFTconditionisparalleltothoseofWellsetal.(2003)andBakerandSiegel(2005)whoalsofoundasignificantdecreaseinfearfortheirEFTconditionsfrompretesttoposttest.Forthefirsttimeinalaboratorycontrolledstudy,therefore,thereisevidencethatthereisasignificantdecreaseinfearforanEFTconditioninastudywhereitisquiteunlikelythatthepossibleroleoftherapistallegiancehascontributedtothisoutcome.WerecommendthatfuturestudiesofEFTbeconducted,whenatallpossible,byresearcherswhohavelittleformalallegiancetoEFT,orwheretheexperimenter(s)administeringconditionstoparticipantsassumeequalefficacyofEFTandthecomparisoncondition(s)beingused.Whilethisrequirementisadmittedlynoteasytomeet,effortsshouldbemadetoatleastapproximateit.LegitimateIssuesRaisedbyTFTandEFTCriticsGiventhatthepresentauthorsarefavorablydisposedtothepossibilitythatEFTpossessestrueefficacy,itisimportantthatwetakecognizanceofcertainlimitationsofstudiesthatwehavehereconstruedassupportiveofEFT(viz.,Wellsetal.,2003;andBaker&Siegel,2005).CriticsofTFTandEFT(e.g.,Herbert&Gaudiano,2001;Lohr,Lilienfeld,Tolin,&Herbert,1999)makeapersuasivecasethatbeforeacceptinganyformofpsychotherapy

asconstitutinganewandefficaciousformoftreatment,onemustruleoutthepossibilitythattheobservedefficacysimplyreflectsnon‐specificfactorsknowntobecommontomanyformsofpsychotherapy.AlthoughWellsetal.(2003)andBakerandSiegel(2005)eachmadeanattempttoruleoutsuchfactors,noclaimcanbemadethatallsuchfactorsweresuccessfullyruledout.Indeed,itisdifficulttodesignasinglestudythatcansuccessfullydothat.However,theWellsetal.andtheBakerandSiegelstudieseachoffersomeevidencethattheefficacyobservedwithEFTdoesnotreflectonlynon‐specificfactors.InWellsetal.(2003),bothconditions(EFTandDeepBreathing)entailedapproximatelyequalamountsofimaginedexposuretothefearedanimalandassessmentsofSUDS.ThefindingthatEFTshowedsignificantlygreaterdecreaseinfearcanthusnotbeexplainedasreflectingeithergreaterimaginedexposuretothefearedanimalorgreaterexposuretoassessmentofSUDS.TothedegreethatbothEFTanddeepbreathingshowedsomeshareddegreeofdecreaseinfear,thisshareddecreasemaywellreflecttheoperationofnon‐specificfactors.ButtothedegreethatEFTshowedsignificantlygreaterdecreaseinfearthandeepbreathing,thisdifferenceindecreaseinfearcannotreflectageneralnon‐specificfactorcommontobothconditions.InBakerandSiegel(2005),EFTwascomparedtoasupportiveinterview.Therewasnosignificantdifferenceinexpectationofhelpbeforetreatmentbetweenthesetwo

PsychologyJournal,2009,Vol.6,No.2,pp.34‐46conditionsandthefindingthatEFTproducedsignificantlygreaterdecreaseinfearwhereastheinterviewdidnothelpatallheldupevenafterstatisticallycontrollingforexpectations.Thus,anygeneralnon‐specificfactorwhichholdstrueforbothEFTandthesupportiveinterviewcannotaccountforEFTísefficacyhere.However,withoutprovidingdirectempiricalevidenceastowhatspecificmechanismorprocessthatisatleastrelativelyuniquetoEFTleadstoitsefficacy,onecannotlogicallyruleoutthepossibilityoftheoperationofoneormorenon‐specificfactors.ThisisalimitationofboththeWellsetal.(2003)andtheBakerandSiegelstudies.SummaryandConclusionsInsummary,wehavefocusedonsomeproblemsinvolvedinresearchintoEFT.Wehavearguedforaneedtoassessandcontrolforparticipantexpectancyeffects,theneedforafollow‐upassessment,andthevalueofkeepingparticipantblindtothenatureoftheconditionhe/sheisin.Wehavecontendedthatinplanningstudiesandinterpretingresultsfromstudies,theconstructsofìenergymeridiansîandìoperationsinvolvedinEFTîshouldbetreatedquiteseparately.InadditionwehavearguedthatitisquitepossiblethatEFTinvolvesprocessesthataretherapeuticallyvaluableandrelativelyuniquetoEFT,andthatsimultaneouslyitsefficacymaybemediatedbyprocesseslongknowntooccurwithpsychotherapy.WehavealsotakencognizanceoftheimportantissueraisedbyTFTandEFTcriticsthatbeforeacceptinganyformofpsychotherapyasconstitutinganewandefficaciousformoftreatment,onemustruleoutthepossibilitythattheobservedefficacysimplyreflectsnon‐specificfactorsknowntobecommontomanyformsofpsychotherapy.ResearchintoEFTisstillinitsinfancy,andthemethodologicalproblemsinthestudiespublishedthusfarhavesometimesofferedcontradictorypossibilitiesforinterpretation.Forexample,inWaiteandHolder(2003),itisnotcleartowhatextentthe

observedeffectsreflectartifact(i.e.demandcharacteristics)orrealeffectsoftreatment.Inthispaper,wehaveconsideredtheimplicationsthateachofthesepossibilitiesraise.However,onlyfutureresearchusingmorerobustmethodologywillbeabletodefinitivelyresolvetheseambiguities.Inourview,boththecriticsandsupportersofmeridian‐basedtherapytendtodrawconclusionsthatgobeyondwhattheavailableresearchdatawillsupport.InthethreeEFTstudiesreviewedhere,thereisagreementthatEFTisefficacious.WhilesupportersofEFTmayprefertoarguethatthisefficacyreflectsarelativelyuniqueand/orsuperiortherapeuticprocess,intheabsenceofstudiesdelineatingthemechanismofactionofEFT,thisconclusioncannotbereached.Ontheotherhand,criticshavearguedthat,sinceEFTísefficacydoesnotappeartodependonmeridianstimulation,itsefficacymustthereforereflectonlynon‐specificfactorscommontomostpsychotherapies(e.g.Waite&Holder,2003).Thisconclusionissimilarlypremature,whetherornottheEMSexists,especiallygiventherapiditywithwhichWaiteandHolderíseffectswereobtained.IfEFTandothermeridian‐basedtherapiesaretogainacceptanceinthemainstreampsychologicalcommunity,controlledresearchmustdemonstratethattheirefficacyisatleastcomparabletothatofwell‐establishedtherapiesforagivenpsychologicalcondition.WhetherornotthemechanismresponsiblefortheefficacyobservedwithEFTthusfarisfoundtoimplicateenergymeridians,acceptanceofEFTwouldbefacilitatedby

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