Why Tapping Works

WHY TAPPING WORKS

Six Evidence-Based Premises That Demonstrate the Power of Tapping

What the Research Tells Us About Tapping

Posted January 27, 2022

When acupoint tapping protocols were, in the 1980s, first formulated with a focus on psychological change, they were met with skepticism – even mockery – by the clinical community. But a lot has changed since then. Today, hundreds of clinical trials, peer-reviewed papers, and anecdotal reports show the positive – often rapid – transformational effects of energy psychology and tapping. Hidden within this growing literature are 6 fundamental evidence-based premises that demonstrate why tapping works and how it can be used as a remarkably powerful and effective technique in treating a myriad of challenging psychological and physiological issues.

6 Powerful Premises About Tapping

A premise is an assumption that is logically consistent with existing evidence and related assumptions. The following 6 premises are based on 245 clinical trials, meta-analyses, systematic evaluations, and theory pieces examining energy psychology protocols that include tapping on acupuncture points or acupoints (acupoint tapping is the most frequently used and investigated intervention in energy psychology).

Enough empirical support has accumulated to make strong claims about the power of acupoint tapping in producing significant and lasting results. The 6 premises demonstrate that tapping:

  1. Is effective in treating a range of clinical conditions
  2. Can produce rapid results compared to conventional treatments
  3. Leads to durable benefits
  4. Creates changes in biological markers as well as in subjective self-reports
  5. Is the critical ingredient that produces results – it’s not just a placebo or suggestion
  6. Sends signals to specific areas of the brain, making it possible to target outcomes with unusual precision

The first 3 premises focus on efficacy, speed, and durability. The other 3 explore the physiological effects of the procedure. Let’s take a closer look at each of these 6 premises.

Premise #1 Tapping Protocols Are Effective in Treating a Range of Clinical Conditions

A wide range of physical and psychological conditions have been shown to respond to EFT (Emotional Freedom Technique) and TFT (Thought Field Therapy), the most popular acupoint tapping variants. Studies referenced in the Association for Comprehensive Energy Psychology (ACEP) database (as of April 2021) showed that tapping can create positive outcomes in treating psychological issues such as anxiety, depression, post-traumatic stress disorder (PTSD), phobias, anger, stress, concentration difficulties, food cravings, insomnia, and performance blocks. Physical conditions that have shown improvement after tapping include fibromyalgia, pain, headaches, frozen shoulder, psoriasis, obesity, immune function, and cardiovascular function.

A suitable method of investigating an emerging therapy such as tapping is to make a head-to-head comparison with a well-known treatment that has strong empirical support. Cognitive Behavioral Therapy (CBT) and its variations are considered the “gold standard” for treating many psychological conditions. A total of 10 head-to-head studies compared CBT to an acupoint tapping protocol. In all 10 studies, acupoint tapping outcomes were approximately equivalent or even better than CBT.

In a large, informal pilot study conducted at 11 allied clinics in Argentina and Uruguay, both CBT and TFT were assessed in the treatment of anxiety and related disorders. Over a 5-1/2 year period, approximately 5000 patients diagnosed with a range of anxiety-related conditions were randomly assigned to either TFT or CBT treatment.

At the end of therapy, interviewers who were blind to the treatment modality placed each former patient into one of 3 categories: no improvement, some improvement, or complete remission. The numbers showing the effectiveness of TFT were nothing short of outstanding. Some improvement was reported by 90% of the patients in the TFT group and 63% in the CBT group; complete remission was reported by 76% of the patients in the TFT group, again substantially superior to the 51% in the CBT group.

Overall, of the 10 head-to-head studies, 9 found not only a general equivalency between acupoint tapping and CBT but also at least 1 superior effect of acupoint tapping, such as greater speed, impact, or durability.

Clinical trials and meta-analytic reviews showed significant pre-treatment to post-treatment improvements in 113 of the 115 studies investigating outcomes of acupoint tapping protocols for a range of conditions. Two studies comparing various trauma treatments for children found tapping to be among the most effective of the approaches examined. This is solid evidence that provides a reasonable base to support Premise #1 – acupoint tapping protocols are effective in treating a range of clinical conditions.

Premise #2 Tapping Protocols Are Rapid Compared to Conventional Treatments

When it comes to the positive effects of tapping, one of the claims the clinical community has had the most difficulty with is the reported speed with which long-standing problems can be overcome. However, clinical trials do lend support to claims of unusually rapid results with tapping protocols compared to traditional treatment methods.

Four studies that involved a single tapping session of 30 to 60 minutes resulted in statistically significant or client-reported improvements. The sessions were focused on overcoming the fear of small animals, claustrophobia, and other specific phobias, insomnia, the symptoms of frozen shoulder, and even PTSD.

In one of these 4 studies, 16 abused male adolescents struggling with PTSD were randomly assigned into 2 groups. One group of 8 boys received an EFT treatment session while the other group of 8 received no treatment. It was found that the 8 boys in the EFT treatment group no longer showed PTSD symptoms 30 days after the single treatment session. Meanwhile, none of the boys in the control group showed significant change.

In a more extensive study conducted 10 years after the Rwanda genocide, 145 traumatized adult survivors were randomly assigned to a single session of TFT or a waitlist control group that received no treatment. Pre-treatment and post-treatment scores on 2 standardized PTSD self-inventories showed significant improvements on all scales, including anxious arousal, depression, irritability, intrusive experiences, defensive avoidance, and dissociation. The improvements held at the 2-year follow-up. Subjects in 2 other studies also experienced significant relief of PTSD symptoms after a single tapping session.

This is not to suggest that a single-session format is adequate for treating PTSD, and certainly not for “complex PTSD,” which might involve a traumatic event as an adult on top of significant childhood trauma. However, the number of sessions that have been required for successfully treating PTSD with acupoint tapping protocols has been relatively low in the research that has been conducted.

The improvements in phobias, insomnia, frozen shoulder discomfort, and PTSD following a single tapping session suggest the power of the approach for facilitating rapid change. This, along with the data from meta-analyses and studies, provides evidence that Premise #2 has good empirical support – tapping protocols are generally faster than conventional treatments.

Premise #3 Tapping Protocols Lead to Durable Benefits

Of the 115 clinical trials of acupoint tapping in the ACEP database, 79 did follow-up investigations. Of the 79 studies, 77 found that “benefits were sustained” during follow-up. This was defined as showing a statistically significant improvement between pre-treatment assessments and assessments at the end of the follow-up period, which ranged from 30 days to a full 2 years.

The most frequent follow-up periods were 1 month (8 studies), 3 months (9 studies), 6 months (22 studies), and 12 months (10 studies), with an average of 7 months. Since 97% of the studies that conducted follow-up found that at least 1 targeted change was sustained, it can be reasonably deduced that the positive effects of acupoint tapping protocols are durable over the long term.


Premise #4 Tapping Protocols Produce Changes in Biological Markers as Well as Through Subjective Self-Reports

Many of the clinical improvements reported in the efficacy studies were based on self-inventories and other subjective measures. A client’s emotions and judgments may, however, be influenced by a complex combination of factors such as:

(a) Discussing personal challenges with a caring professional
(b) The enthusiasm, charisma, and/or status of the practitioner
(c) An expectation that the therapy will be helpful; and/or
(d) A desire to believe that the time, money, and effort that went into the therapy were worthwhile investments

A reliable method of detecting treatment effects that do not rely on personal judgments is to measure the pre-treatment and post-treatment status of “biological markers” that highlight physiological changes.

Tapping treatments have been followed by clinically desirable changes in biological markers such as hormone production, cardiovascular function, immune response, gene expression, brain wave patterns, and blood flow in targeted brain regions.

For instance, in studies of brainwave changes, electroencephalogram (EEG) monitoring found reduced arousal in the right frontal cortex of 9 victims of motor vehicle accidents following tapping treatment for trauma. Tapping with patients who were experiencing seizures led to desirable increases in the amplitude of the sensory motor rhythm of the sensory motor cortex. Four individuals, after receiving a single tapping session for claustrophobia, showed not only reductions in muscular tension but also a normalization of theta waves.

These and other positive biological and psychological changes provide strong evidential support for Premise #4 – tapping protocols produce changes in biological markers as well as through direct personal experience.

Premise #5 Tapping is the Critical Ingredient That Produces Results -- It’s Not Just a Placebo or Suggestion

Even if energy psychology treatments do lead to the benefits reported in the clinical trials, the act of tapping is not the only active component in acupoint tapping protocols. The psychological benefits of interventions that focus on faulty beliefs or that revisit traumatic events, both used during acupoint tapping sessions, are well-established. The relaxation and meditative effects of repetitive physical movements may be involved. Influences such as the attention of a caring professional and the placebo power of hope and positive expectation may add to the positive impact of virtually any psychotherapeutic approach.

Six studies have attempted to isolate the influence of acupoint tapping on treatment results. Each of these studies compared an energy psychology protocol with a nearly identical protocol, except that in the control group, acupoint tapping was replaced with a different method such as diaphragmatic breathing, mindfulness, or tapping on points that are not acupuncture points, referred to as “sham points.”

For instance, the risk of burnout was assessed among 126 public school teachers. These teachers were taught to self-apply tapping treatments designed to reduce burnout. One group tapped on the standard EFT acupoints. The other tapped on sham points. Participants in both groups were given the same list of situations that contribute to burnout and asked to bring them to mind while doing the tapping. Reductions on the 3 indicators of burnout measured (emotional exhaustion, depersonalization, and personal accomplishment) were significantly greater in the group that tapped on the EFT points than in the group that tapped on the sham points.

The 6 studies were evaluated in a review and meta-analysis which concluded that acupoint tapping is an active ingredient in the outcomes reported in the clinical trials, independent of other influences. Since many of the critiques of energy psychology suggest that it is not the acupoint tapping but other components of the protocol that account for any clinical improvements, this is an incredibly significant finding.

An extensive body of evidence, independent of energy psychology, has demonstrated that acupuncture is a potent intervention in healthcare. Needling and tapping produce similar physiological effects, and this mapping of the physiology underlying how acupoint tapping influences neural processes, as well as results from the 6 studies, lends credible support to Premise #5 – tapping is the critical ingredient that produces results, it’s not just a placebo or suggestion.


Premise #6 Tapping Sends Signals to Specific Areas of The Brain Making It Possible to Target Outcomes with Unusual Precision

How can the complex changes seen in psychotherapy involving deeply embedded emotional learning, such as overcoming a spider phobia or the symptoms of PTSD, be brought about by acupoint tapping protocols?

A 10-year-research program conducted at Harvard Medical School used fMRI and other imaging equipment to study the effects of stimulating selected acupuncture points in various brain areas. The researchers found that specific acupoints can send signals to the amygdala that reduce threat activation nearly instantly. Without talking, this somatic intervention can quickly turn off hyperarousal (a state of high alert) in the brain's emotional centers.

Because hyperarousal is the reason behind many challenges faced by psychotherapy clients – such as anger, panic, anxiety, self-destructive behavior, guilt, shame, irritability, sleeping problems, difficulties concentrating – the implication of this finding for therapists is significant. It suggests the possibility of rapid intervention for deactivating unhelpful hyperarousal in various situations, whether real or imagined.

Reducing hyperarousal also allows greater executive functioning (tapping can also activate executive brain regions). Subjects in the PTSD studies frequently reported increased executive functions such as an enhanced ability to concentrate and to manage feelings of distress.

Three laboratory studies go beyond the clinical trials in suggesting that the signals generated by acupoint tapping go to areas of the brain that have been aroused by the words, images, memories, or emotions that are brought to mind during the tapping session. By selecting what their clients focuses on while they are tapping, the therapist can accurately direct the positive results produced by the tapping to targeted brain regions. This line of evidence and reasoning offers preliminary support to Premise #6 – tapping sends signals to specific areas of the brain, making it possible to target outcomes with unusual precision.

Six premises about the efficacy, speed, durability, and physiological effects of tapping, along with evidence-based support for each premise, have been reviewed. They suggest that integrating acupoint tapping protocols into conventional clinical practices could be widely beneficial. While further studies will help to solidify this assertion, current research is trending toward its support.

This article is based on findings presented in a paper entitled Six Empirically-Supported Premises About Energy Psychology: Mounting Evidence for a Controversial Therapy by David Feinstein, Ph.D. The full paper is published in the journal Advances in Mind-Body Medicine. It is now available to you, our reader, as a free download by special arrangements with the journal (which is not generally "open access").

If you have thoughts, ideas, insights, or experiences you'd like to share on this article or the full paper, please comment below. David will regularly review the comments and reply to those that move the discussion forward. Next month’s feature article will focus on the powerful ways energy psychology has been brought to communities that have faced natural or human-made disasters, from earthquakes and hurricanes to school shootings and genocide.

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Eran Laish

Hi Dr. Feinstein, thank you for the elaborate discussion. I would like to ask, based on your experience, how Donna’s tapping protocols, for example the four thumps, compare to EFT or TFT. Do you observe a similar efficacy when used together with exposure therapy in the form of declarations?

David

Hi Eran, yes, when the four thumps is combined with exposure-type statements, it seems to send deactivating signals to the limbic system (inferred by reduced intensity of response to the stressful memory or trigger being evoked.by the words). What is not known is exactly which acupuncture points are the most effective or how many points is the minimum needed. Most practitioners use between eight and a dozen points, and the various combinations that are in use seem to be equally effective, though no one has, to my knowledge, really studied that. The advanced TFT format uses the alarm point system to identify the exact points to use with a particular statement or image. It would be interesting to do a head-to-head study between that approach and the EFT “one size fits all” set of points.

Karen Harris, MD

The evidence for EFT as administered by mental health practitioners to treat various conditions is slowly chipping away at the resistance to it from the traditional side of the field. This is wonderful and needed in today’s world. I do have concerns about whether all of the references to it as a “treatment” helps or actually hinders the practice of EFT by certified EFT practitioners who are (1) licensed in other-than-mental-health healthcare fields or (2) not licensed in any healthcare field. There is ample evidence that these practitioners provide a valuable service for clients who will not or cannot seek the services of a licensed mental health professional. The problem lies in defining that service, since very careful wording is used by those who are even aware of the need to protect themselves to avoid the possibility of the former being accused or guilty of practicing “experimental or substandard care” or “outside of their scope of practice” and the latter being guilty or accused of “practicing psychotherapy or medicine without a license”. In my opinion, no amount of calling their practice of EFT “coaching” detracts from the benefit it can and does frequently have on medical and mental disorders, or at least symptoms of those. It’s a desired effect of EFT, but any intentional or unintentional “cure” or “treatment” has to be essentially hidden by such practitioners for legal reasons.
May I suggest that a review of studies where EFT sessions were conducted by practitioners who are not licensed mental health professionals could possibly begin to mount evidence that would promote more public demand for Healthcare Freedom Legislation in states that do not yet have these laws.

David

Hi Karen, you are raising a very important and thorny issue about the laws and regulations about the practice of tapping. Some studies along the lines you are suggesting do exist. For instance, highly successful tapping programs for communities in the aftermath of genocide have been carried out by local leaders after just a weekend of training. I summarize some of this in a paper about the uses of energy psychology in disaster relief. It will be the subject of our February posting. Stay tuned.

Christopher Semmens

Hi David – Your dedicated and extraordinary scholarship is truely a wonderful gift to the TFT and tapping community – and significantly to humanity. Thank you immensely. Chris Semmens, Perth, Western Australia.

David Feinstein

What an affirming comment, Chris. Thank you!

Kelsy

Hi Dr. Feinstein! Thank you for this encouraging information. The article says, “The researchers found that specific acupoints can send signals to the amygdala that reduce threat activation nearly instantly.” Do you know which specific acupoints can neutralize a flashback? Or are they referring to the usual series of all of the EFT tapping points (approx. 9 different points)?

David Feinstein

Hi Kelsey, Good question.

The Harvard researchers had never heard of EFT when they were doing this research a couple of decades ago, so the points they investigated were not the EFT points. To my knowledge, those points have not been investigated using the imaging methods the Harvard team used.

Rather than try to summarize their findings about the effects of specific points, I will share the three papers that were my sources:

Fang, J. et al. (2009). The salient characteristics of the central effects of acupuncture needling: limbic-paralimbic-neocortical network modulation. Human Brain Mapping, 30:1196-1206.  https://doi.org/10.1002/hbm.20583

Hui, K.K., et al. (2000). Acupuncture modulates the limbic system and subcortical gray structures of the human brain: Evidence from fMRI studies in normal subjects. Human Brain Mapping, 9:13-25. https://doi.org/10.1002/(sici)1097-0193(2000)9:1<13::aid-hbm2>3.0.co;2-f  

Hui, K. K.-S. et al. (2005). The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. NeuroImage, 27, 479–496.
https://doi.org/10.1016/j.neuroimage.2005.04.037

Best regards,
David

Brad

NOTE: The doi.org link for the (2000) paper listed above requires ALL of the characters through “2-f” in the URL address, so be sure to manually highlight and copy the entire line before pasting it into your browser! When done manually (rather than just clicking on the link) it does open the paper correctly!

Kelsy

That is fascinating! I look forward to reading your references to learn more. Thank you for your response!