Major depression is a global experience which can be difficult to pin down. While minor depressions have been reported to yield to EFT (see listings under heading Depression on website www.emofree.com), true psychotic depressions are another story. These are so all pervasive and overwhelming that tapping on "depression" alone is often meaningless to a patient suffering acutely from these disorders.

In actuality, the word "depression" lumps many different symptoms under one heading. It is therefore not surprising that when Hank Krol, a therapist at Stairways Behavioral Health in Erie, PA -- a mental health clinic working with severely mentally ill clients -- began to explore using EFT for major depression, he was initially somewhat discouraged.

Although the patients would tap away diligently on their "depression," because a major depression can be overwhelming to them and often the beginning and the end of their perspective on life, tapping on "Even though I feel depressed..." yielded mainly disappointing results with these patients.

Accordingly, Hank came up with a new approach to dealing with the depressed population he treats, one which I think holds considerable promise. He reasoned that while "depression" itself was too general a concept for these people to handle, if he broke up the entity, "depression," into its component parts, he might obtain very different results.

To accomplish this he used a symptom checklist found in the book "Mind Over Mood", written by two leading cognitive behavior therapists, Drs. Dennis Greenberger and Christine Pedasky (published by Guilford Press). The book gives practical advice and useful forms for therapists, and when Hank applied some of these forms to working with a depressed population using EFT, he hit on something quite exciting.

Among its other features, the book has an inventory (page 155) which lists 19 symptoms of depression, such as "feeling guilty", "Irritable mood", "less interest or pleasure in usual activities", "withdraw from or avoid people," "find it harder than usual to do things," etc. The inventory asks the respondent to rate each symptom on a 4-point scale according to the frequency with which he or she experiences that symptom in their everyday life.

These responses are then totaled to obtain a general measure of the persons current level of depression in their life, a useful tool if one wants to assess improvement in depression or other undesirable mood states over a period of time. The inventory is usually administered at stated intervals during the course of psychotherapy to find out if a depressed patient is recovering from symptoms of depression, and in his group therapy work Hank does use it in this fashion to track changes in his patients. However, when using it as part of individual psychotherapy with EFT, he does something quite different.

This is it.

He first has the patient check off all the symptoms on the list of 19 that apply to him or her and rate the frequency with which they experienced each over the past week, including the day of the session, using the 0 to 4 point scale that the inventory outlines. He then has the person work on each symptom separately using EFT. Usually they are able to address only one, or at the most two, of these symptoms in a single treatment session.

Hank starts by asking the person to recall a recent situation (if they are not currently feeling/sensing/seeing the symptom in question) where they experienced that symptom at a very high intensity. If, for example, they had checked the symptom "irritable mood" as applying to themselves, he would say something like, "When were you so irritable that on a scale of 0 to 10 you were an 8 or above?"

If the patient cant think of a time when they felt that distressed, he then asks them to go backwards in time a couple of days, and to keep going back until they reach a time when their intensity rating (on a 0 to 10 scale of distress) was at least a 5 or above. When they have located such a scene in their mind, he asks them whether they want to go lower on that rating with respect to this issue. Is it really important to them? If they indicate that it is, then they begin working with EFT.

Hank asks the patient to close their eyes and visualize this scene as vividly as possible, and to rate the severity of the symptom as they experienced it AT THAT TIME. (Note that Hank does not follow the usual rule for rating distress in EFT, which is to rate ones distress level according to the feeling at the present moment -- he is working toward a different goal.).

These patients are, however, in the present as they 'recall' this moment in time. The key is to bring the intensity level down WITHIN THE SESSION, while they visualize the past. This allows them to 'let go' of the recent past incident that was used to typify the identified symptom. The goal is achieved when they see how effective EFT can be in reducing the intensity of the symptom -- as they NOW feel or experience it.

He then helps them to use EFT to bring their SUDS (Subjective Units of Distress) level down as close to zero as possible, after which he assigns them EFT "homework" to do on a daily basis.

Obviously not every patient will do the homework, but those who do often show excellent progress. Hank estimates that about 50% of the patients he sees are committed enough to do this homework, but that those who do not, tend to lose momentum.

It is important in the context of the clinic where he works to achieve as much progress outside of the actual therapy sessions as possible since case-load size and conflicting program responsibilities often permit the counselors to see clients only once every two weeks. It is difficult to keep momentum going under those circumstances unless there is interim homework.

When the patient returns for their next therapy session, Hank has them recall a new scene depicting this same issue, this time one which has occurred within the past two weeks SINCE their last therapy session -- and apply EFT to that.

He has them stick with each symptom until it is no longer one of their primary symptoms, even if this takes several therapy sessions. When that symptom has been reduced to manageable proportions (he doesn’t ask for perfection) they then go on to address another symptom on the list, and so on.

When commencing EFT work, Hank tries to have his patients select a symptom to work on first that is likely to be one in which they can most readily see reduced in their lives. He does this so that they can experience an initial success which will encourage them to continue with EFT.

Persistence is important here. The number of sessions is up to the therapist and the patient, but usually the latter has been authorized by the County to have only 12 sessions in a four-month period before re-authorization. This puts pressure on both therapist and patient to use the most time-efficient methods possible, and here is where EFT can be extremely useful. It is a major resource for short-term psychotherapy.

Although Hank gets a number of referrals involving patients suffering from major depression, he reports that many of them, particularly those that do their homework, are showing excellent progress using this method of treatment.

It may also be of interest that the book Mind Over Mood includes other inventories as well which can be of use to a therapist or counselor using EFT. For example, the worksheet on page 159 lists negative beliefs associated with depression which can easily be used as a basis for Set-Up and Reminder phrases in EFT. For example, the list includes beliefs such as: "I’m no good," "I'm a failure," "No one can help me," and so on. Putting the words "even though" in front of them converts them readily to work with EFT and Hank often uses them in this fashion.

The book also contains an anxiety inventory which he has also used that divides anxiety into 24 component symptoms that can be used to break up the global concept of "anxiety" so that highly anxious patients can be treated more effectively with EFT.