In preliminary clinical trials involving some 31,400 patients from 11 allied treatment centers in South America during a 14-year period, a variety of randomized, double-blind pilot studies were conducted. In one of these, approximately 5,000 patients diagnosed at intake with an anxiety disorder were randomly assigned to an experimental group (imagery and self-statements paired with the manual stimulation of selected acupuncture points) or a control group (cognitive behavior therapy /medication). Ratings were given by independent clinicians who interviewed each patient at the close of therapy, at 1 month, at 3 months, at 6 months, and at 12 months. The raters made a determination of complete remission of symptoms, partial remission of symptoms, or no clinical response. The raters did not know if the patient received CBT/medication or tapping. They knew only the initial diagnosis, the symptoms, and the severity, as judged by the intake staff. At the close of therapy: 63% of the control group were judged as having improved; 90% of the experimental group were judged as having improved. 51% of the control group were judged as being symptom free; 76% of the experimental group were judged as symptom free.

At one-year follow-up, the patients receiving the tapping treatments were substantially less prone to relapse or partial relapse than those with CBT/medication, as indicated by the independent raters’ assessments and corroborated by brain imaging and neurotransmitter profiles. In a related pilot study by the same team, the length of treatment was substantially shorter with energy therapy and associated methods than with CBT/medication (mean = 3 sessions vs. mean = 15 sessions). If subsequent research corroborates these early findings, it will be a notable development since CBT/medication is currently the established standard of care for anxiety disorders and the greater effectiveness of the energy approach suggested by this study would be highly significant.
 

1. Presents preliminary data supporting this assertion.
    

2. Discusses indications and contraindications for the use of energy therapy with anxiety

as well as other conditions.

3. Speculates on the mechanisms by which

1. tapping specific areas of the skin while
    

2. a stimulus that triggers a disturbed emotional response is mentally accessed

apparently alleviates certain psychological disorders.

The first author describes his initial encounter with panic disorder, in a crowded urban hospital emergency room, some 30 years ago: The patient was trembling, dizzy, and terrified, pleading, "Help me, Doc, I feel like I’m gonna die!" My medical training had not prepared me for this moment, and I emerged from it determined that I would have a better response the next time I was faced with a patient in acute panic.

This was the first step on a long and winding road. I studied with acknowledged experts on anxiety disorders, attended relevant professional meetings, talked with famous international specialists, read the books they recommended, did my own literature searches, prescribed medications, applied various forms of psychotherapy (from psychodynamic to Gestalt to NLP), learned acupuncture in China, made referrals to alternative practitioners (including those specializing in homeopathy, cranial sacral therapy, chiropractic, flower remedies, applied kinesiology, ozone therapy, and Ayurvedic), sent people on spiritual retreats, used all forms of machines from biofeedback to electric acupuncture, even resorted to sensory deprivation (confining a panic patient in a sensory deprivation tank is a distinguishing sign of a therapist’s desperation).

The consistent finding: disappointing results. My colleagues and I were making a difference for perhaps 40 to 50 percent of these people, albeit with multiple relapses, partial cures, and many who never completed treatment. Later, we combined alprazolam and fluoxetine with cognitive behavior therapy, obtaining slightly better outcomes. But never were we able to reach the 70 percent in 20 sessions we had read about. Then came Eye Movement Desensitization and Reprocessing (EMDR), which we learned as an almost secret practice some friends were doing in an East Coast hospital. We began to get more satisfactory responses, yet along with them, disturbing abreactions.

We then learned about tapping selected acupuncture points while having the patient imagine anxiety-producing situations. It was a huge leap forward! We began to obtain unequivocal positive results with the majority of panic patients we treated. At first we used generic tapping sequences. Then tapping sequences tailored for panic. Then tapping sequences based on diagnosing the energy pathways involved in each patient’s unique condition. All of these strategies yielded good results, slightly better with diagnosis-based sequences, averaging about a 70 percent success rate.

We found we could further enhance these encouraging outcomes by limiting sugar, coffee, and alcohol intake and prescribing a physical exercise program. We emphasized the cultivation of enjoyment. We showed our patients how Norman Cousins used laughter in his own healing and encouraged them to engage in hearty laughter for five minutes twice each day. We introduced natural metabolic substances, such as L-tryptophan, L-arginine, and glutamic acid. For rapid symptom relief in severe cases, we found we could combine a brief initial course of medication with the tapping.

Standard medications for anxiety (benzodiazepines, including diazepam, alprazolam, and clonazepan) were given to 30 patients with generalized anxiety disorder (the three drugs were randomly assigned to subgroups of 10 patients each). Outcomes were compared with 34 generalized anxiety disorder patients who received tapping treatment. The medication group had 70 percent positive responses compared with 78.5 percent for the tapping group. About half the medication patients suffered from side effects and rebounds upon discontinuing the medication. There were no side effects in the tapping group, though one patient had a paradoxical response (increase of anxiety).

Specific elements of the treatment were also investigated. The order that the points must be stimulated, for instance, was investigated by treating 60 phobic patients with a standard 5-point protocol while varying the order in which the points were stimulated with a second group of 60 phobic patients. Positive clinical responses for the two groups were 76.6 percent and 71.6 percent, respectively, showing no significant difference for the order in which the points were stimulated. In other studies, varying the number of points that were stimulated, the specific points, and the inclusion of typical auxiliary interventions such as the "9 Gamut Procedure" did not result in significant differences between groups, although diagnosis of which energy points were involved in the problem led to treatments that had slightly more favorable outcomes. The working hypothesis of the treatment team at the time of this writing is that for many disorders, such as specific phobias, wide variations can be employed in terms of the points that are stimulated and the specifics of the protocol. For a smaller number of disorders, such as OCD and generalized social anxiety, precise protocols must be formulated and adhered to for a favorable clinical response.

In a study comparing tapping with acupuncture needles, 40 panic patients received tapping treatments on pre-selected acupuncture points. A group of 38 panic patients received acupuncture stimulation using needles on the same points. Positive responses were found for 78.5 percent from the tapping group, 50 percent from the needle group.

1. Much better results than expected with other methods.
    

2. Better results than expected with other methods.
    

3. Similar results to those expected with other methods.
    

4. Lesser results than expected with other methods (only use in conjunction with other therapies).
    

5. No clinical improvement at all or contraindicated.

Rating of 2—"Better results than with other methods." Obsessive compulsive disorders, generalized anxiety disorders, anxiety disorders due to general medical conditions, social phobias and certain other specific phobias, such as a phobia of loud noises, were judged as not responding quite as well to energy interventions as did other anxiety disorders, but they were still rated as being more responsive to an energy approach than they are to other methods. Also in this category were learning disorders, communication disorders, feeding and eating disorders of early childhood, tic disorders, selective mutism, reactive detachment disorders of infancy or early childhood, somatoform disorders, factitious disorders, sexual dysfunction, sleep disorders, and relational problems.

Rating of 4—"Lesser results than expected with other methods." The clinicians’ post-treatment ratings suggest that for major endogenous depression, personality disorders, and dissociative disorders, other therapies are superior as the primary treatment approach. Energy interventions might still be useful when used in an adjunctive manner.

When Joseph Wolpe developed systematic desensitization in the 1950s, he provided the next several generations of clinicians their most potent single non-pharmacological tool for countering severe anxiety conditions. Patients were taught how to relax each of the body’s major muscle groups. With the muscle groups relaxed, they would bring to mind a thought or image that evoked an item from the bottom of a hierarchy of anxiety-provoking situations they had prepared earlier. They would learn to shift the focus between holding the thought or image and relaxing the muscle groups until the thought or image was progressively associated with a relaxed response. They would then systematically move up the hierarchy, reconditioning the response to each thought or image by replacing the anxious or fearful response with a relaxed response.

This process is the closest cousin energy therapy has among traditional psychotherapeutic modalities. Both approaches bring a problematic emotion to mind and introduce a physical procedure that neutralizes the emotion. But energy therapy also has a much older relative, whose lineage substantially expands the range of problems that may be addressed and the precision with which they may be targeted. That progenitor is the practice of acupuncture.

Rather than to relax the muscle tension associated with anxiety or fear, energy therapy corrects for a disturbed pattern in the specific energy pathways or meridians that are affected when the client is mentally engaged with a problematic situation. For this reason, one of the strengths of energy-based psychotherapy is the range of emotional conditions with which it is effective. Each of the body’s major energy pathways is believed to be associated with specific emotions and themes. A stimulus that brings a meridian out of harmony or balance (while this is a complex concept, terms such as underenergy, overenergy, and stagnant energy might each apply) also activates the emotion associated with that meridian. The treatment pairs the stimulus with an energy intervention that rebalances the meridian, bringing it back into coherence and harmony with the body’s overall energy system. A disturbed meridian response is replaced by an undisturbed response. Just as deep muscle relaxation can neutralize a specific fear in systematic desensitization, calming a disturbed meridian can disengage the emotional reaction associated with that meridian.

While a framework that links specific emotions with specific energy pathways requires a paradigm-leap for most Western psychotherapists, the hypothesis is central to traditional Chinese medicine, a 5,000-year-old method that is currently the most widely practiced medical approach on the planet. Its venerable though sometimes quaint concepts are now being blended with modern scientific understanding and empirical validation, and an approach is developing that holds great promise for Western medicine as well as for psychotherapy.

¹ "Energy psychology," "energy-based psychotherapy," and "energy therapy" all refer to the therapeutic modality represented, for instance, by the Association for Comprehensive Energy Psychology (www.energypsych.org). Earlier therapeutic modalities within psychology and psychiatry that focus on the body's energy systems extend back at least to Wilhelm Reich and are seen in contemporary practices such as bioenergetics and Gestalt therapy.

² The initial group included 22 therapists. Of the 36 clinicians to eventually participate in the studies over the 14-year period, 23 were physicians (anxiety is typically treated by the primary care physician in Argentina and Uruguay; 5 of the 23 physicians were psychiatrists), 8 were "clinical psychologists" (in both countries, the use of this title requires the equivalent of a masters degree, substantial supervised clinical experience, and specialized credentials as a clinical psychologist), 3 were mental health counselors, and 2 were RNs. All of them had extended experience treating or assisting in the treatment of anxiety disorders. Their experience with energy psychology methods ranged from six months in the initial phases of the clinical trials to some who by the end had been using energy techniques for 14 years. Most were initially trained in Thought Field Therapy and later incorporated related techniques, generally customizing their approach as they gained experience. During the fourteen years, some of the 36 therapists were on staff the entire period, some on the initial team left, others came onto the team while the clinical trials were underway.

³ Various assessment instruments were used over the course of the 14 years. However, in each clinical trial, the assessment methods were standardized. Careful clinical interviews were always taken, physical exams were given when indicated, and interview data were supplemented by scores from assessment instruments such as the Beck Anxiety Inventory, the Spielberger State-Trait Anxiety Index, SPIN for social phobias, and the Yale-Brown Obsessive-Compulsive Scale for OCD. The most objective assessment tool that was used involved pre- and post-treatment functional brain imaging (computerized EEG, evoked potentials, and topographic mapping).

⁴ Anxiety disorders were defined as including panic disorders, post-traumatic stress disorders, specific phobias, social phobias, obsessive-compulsive disorders, and generalized anxiety disorders.

⁵ Over the 14 years, a series of randomization methods were used for assigning patients to a treatment group or a control group. Simple randomization tables were used initially; increasingly sophisticated randomization software was subsequently introduced.

⁶ Because the conventional treatment for anxiety—cognitive behavior therapy (CBT) plus medication—was already being used at the point the energy interventions were introduced to the clinical staffs, patients were randomly assigned for conventional CBT/medication treatment (which constituted the control group) or for energy-based treatment (which constituted the experimental group).

⁷ The raters assessing the patient’s progress at the close of therapy and in the follow-up interviews were clinicians who were not involved in the patient’s treatment and were not aware of which treatment protocol had been administered. Both the patients and the raters were instructed not to discuss with one another the therapy procedures that had been used. The raters were given a close variant of the following instructions: "This patient was diagnosed with [detailed diagnosis, symptoms, and severity of the disorder as judged at intake] and a course of a given treatment was applied. Please assess if the patient is now asymptomatic, shows partial remission, or had no clinical response." Psychological testing and brain mapping were administered by still other individuals who were neither the patient’s clinician nor rater.

⁸ The clinicians were generally proficient in both CBT and energy methods. A team approach was used in which non-medical therapists worked with physicians who prescribed medications for the CBT patients. Patients receiving energy treatments did not receive medication. There was advance agreement among the clinical staff about the nature of CBT and about the kinds of tapping protocols that would be used with any specific subset of patients. The same clinician might provide CBT for one patient and an energy approach for another, but the two approaches were not mixed.

⁹ In addition to clinical interviews and physical exams where indicated, the clinician would order specific assessment instruments that were judged as being most appropriate for measuring subsequent treatment gains based on the initial diagnosis. The Beck Anxiety Inventory was given to approximately 60% of these patients, but other scales, such as SPIN for social phobias or the Yale-Brown Scale for OCD were administered instead when these diagnoses were suspected based on the intake interview.

¹⁰ Clinical outcomes were assessed based upon interviews conducted by raters who were not involved in the therapy. These assessments were then compared with the pre- and post-treatment test scores and the pre- and post-treatment digitized brain mappings. Functional brain imaging was done with approximately 95% of the patients and can identify, for instance, excessive beta frequencies in the prefrontal and temporal regions, which is a typical profile of anxiety. Most recently, LORETA tomographies were introduced, allowing the identification of dysfunction in deeper structures, such as the amygdala and locus ceruleus.

While this aspect of the study could and will be the basis of future reports, in brief, the brain mapping correlated with other measures of improvement, specifically the psychological test data and the conclusions reached by the raters. The patients assessed as showing the greatest improvement also showed the largest reduction of beta frequencies.

The differences revealed by neuroimaging between the control group and the tapping group are perhaps the study’s most provocative heuristic finding, and the research team is conducting further investigation into these differences. In brief, even when symptoms improved, the neurological profiles for the control group were only slightly modified from the initial pathological indicies. In the tapping group, however, the amelioration of symptoms ran parallel with modifications in the neurological profiles toward the normal reference range. The hypothesis now being investigated is that the tapping procedures somehow facilitate a deep, systemic homeostasis, as if the effect is not "suppression-augmentation" but rather a homeodynamic adaptation.

¹¹ Approximately 90% of the patients participated in follow-up interviews at one year. This high proportion is attributed to the relatively low mobility of the populations served, the intimate quality of the doctor-patient relationship in Uruguay and Argentina, and the persistence of the research team. Also, the follow-up interviews were most frequently conducted over the phone, with patients encouraged to come in for a more in-depth interview when relapses were reported.

Relapse or partial relapse was found more frequently in the control group than in the tapping group at each post-therapy assessment (3, 6, and 12 months). Partial relapses at one-year follow-up were 29% for the control group and 14% for the tapping group. Total relapses were 9% for the control group and 4% for the tapping group. This data is contaminated, however, by the administrative policy of inviting participants back for further treatment if the 3-month or 6-month follow-up interviews indicated relapse. Because both groups were given the opportunity for further treatment, the differences between the groups may, however, still be significant. The relapse data also varied depending on diagnosis. Disorders such as OCD and severe agoraphobia, for instance, were far more prone to relapse under either treatment condition than specific phobias, social phobias, learning disorders, or general anxiety disorder.

Differences in the stability of treatment gains between the groups were corroborated by electrical and biochemical measures. Brain mapping revealed that the tapping cases tended to be distinguished by a general pattern of wave normalization throughout the brain which, interestingly, not only persisted at 12-month follow-up but became more pronounced. An associated pattern was found in neurotransmitter profiles. With generalized anxiety disorder, for example, norepinephrine came down to normal reference values and low serotonin went up. Parallel electrical and biochemical patterns were not found in the control group.

¹² Results in this sub-study were assessed as in footnote 10. The number of sessions was determined by mutual agreement between the therapist and the patient that further treatment was not indicated.

¹³ While in this particular sub-study the addition of the NLP technique may have skewed the results in favor of the tapping techniques, the overall findings with the 29,000 patients suggest that similar results are gained without the inclusion of the NLP technique.

¹⁴ Although these articles were published along with scathing editorial critiques of the assessment techniques, case selection, data analysis, and overall design, others have found that despite these flaws, they are "fascinating preliminary reports from a clinical standpoint" (Hartung, J., and Galvin, M. Energy Psychology and EMDR: Combining Forces to  Optimize Treatment. New York: Norton, 2003, p. 59).

¹⁵ While subjective ratings of this nature certainly fall short of being established assessment instruments, the purpose of the ratings was to help the South American clinics generate guidelines for the use of energy interventions. The staff reports that these guidelines have proven administratively useful and clinically trustworthy, although the degree that they might generalize to other settings is unknown.

¹⁶ Hartung & Galvin, op. cit. 16, pp. 31 - 33.

¹⁷ In the time-honored and strikingly sophisticated "five element theory" of traditional Chinese medicine (known as wu zing and probably conceived around 400 B.C.), each of five basic "elements" is associated with a primary impulse or rhythm found in nature (represented by the metaphors of water, wood, fire, earth, and metal). These impulses (a more precise translation than elements is "phases in dynamic motion") have two distinct varieties, one being more active and outwardly focused (yang), the other being more passive and inwardly focused (yin). Each of twelve major energy pathways or meridians is associated with one of these primary impulses in its more active or more passive state.

The characteristics of each meridian and its functions reflect the characteristics of its element. When an imbalance arises in the energies of a meridian, this may be a precursor to physical illness related to the meridian’s element and function, but it is also often expressed more immediately through the activation of a specific emotion. For instance, the "water element" meridians, not surprisingly, are kidney and bladder. The emotions that are associated with water element fall along the continuum from fear to intelligent caution. Imbalances in the kidney meridian, which is the yin aspect of water element, lead to an internal fearful state. Imbalances in the bladder meridian, which is the yang aspect of water element, lead more to reactive fears as events unfold.

Each meridian governs a specific emotion derived from its element and energetic (active or passive). While the form and expression of that emotional impulse may vary considerably as it interacts with the many other factors making up a human personality, the basic relationship that is of concern within energy psychology is that a disturbance in a meridian’s energies tends to evoke a specific emotion. Treating the energy disturbance deactivates the emotion.

For a list of the emotions associated with each meridian, in both its balanced and reactive states, see the "Meridian Emotions and Affirmations" table on the CD. For further discussion of "five element" theory, see Chapter 7 of Donna Eden’s Energy Medicine (New York: Tarcher/Penguin Putnam, 1999).

¹⁸ This statement is based on informal interviews with over 30 practitioners of energy psychology, including many of the field’s recognized pioneers and leaders, conducted by the second author while developing the Energy Psychology Interactive program.

¹⁹ Feinstein, D. (2003, Summer). Subtle Energy: Psychology’s Missing Link. Noetic Sciences Review, 64,18-23.

²⁰  References can be found in David Feinstein’s At Play in the Fields of the Mind, Journal of   Humanistic  Psychology, 1988, 38(3): 71-109. The entire text of this article is on the CD.

²¹ See, for instance, Kerry H. Levin and Hans O. Luder’s Comprehensive Clinical   Neurophysiology  (London: W B Saunders, 2000).

²² One of the unsolved puzzles within energy psychology is the observation that different tapping practitioners, using different techniques, points, and methodologies, get similarly strong results with most anxiety disorders. This impression was corroborated in the South America studies. What is the underlying mechanism that accounts for the positive outcomes being witnessed regardless of how the components of the approach were mixed and matched? The proponents of the various approaches tend to claim that the strong results they report are a function of the specifics of their particular technique. The common element for all of them, however, is that they stimulate mechanoreceptors in different parts of the body.

Mechanoreceptors are specialized receptors that respond to mechanical forces such as tapping, massaging, or holding. Among their types: Meissner corpuscles, Pacini corpuscles, Merkel discs, and Ruffini corpuscles. They are sensitive to stimulation on the surface of the skin anywhere on the body. The acupuncture points, called hsue in traditional Chinese medicine ("hollow" rather than "point" is actually the correct translation from the Mandarin), are loci that have a particularly high concentration of mechanoreceptors, free nerve endings, and neurovascular density. The signals that are initiated when tapping hsue travel as afferent stimuli that are capable of reaching the cortex, the amygdala, and the hippocampus.