The effectiveness of Emotional Freedom Techniques (EFT) as a treatment for Post-Traumatic Stress Disorder (PTSD)

A systematic review

Lisa Cowap

Trainee Health Psychologist & Research Associate Staffordshire University

l.cowap@staffs.ac.uk

What is a systematic review?

“A high level overview of primary research on a particular research question that tries to identify,

select, synthesise and appraise all high quality research evidence relevant to that question in

order to answer it”

(Cochrane, 2014)

What is PTSD?

• A highly prevalent lifetime disorder (1); incidence rates are estimated at 6.8% of the general population (2).

• Commonly patients can remain symptomatic for up to three years or more without treatment (3).

• Associated financial and societal costs are high (4).

The need for effective treatments is a priority; there are many debates surrounding the best protocol

of treatment to provide.

EFT as a treatment for PTSD?

• EFT is particularly suited to treat PTSD.

• Uses a combination of established PTSD treatments (e.g. cognitive & exposure therapies) and also incorporates novel somatic stimulation.

• EFT has been shown to be an effective intervention for a variety of conditions such as presentation anxiety (5), fears and phobias (6) and fibromyalgia (7).

EFT as a treatment for PTSD?

• Gilomen & Lee (2015) found EFT to reduce psychological distress, with moderate effect sizes across a number of conditions.

• Two key reviews focusing on assessing the impact of EFT on PTSD symptomatology by Feinstein (2010) and (2012) also show very positive findings.

• However methodological flaws were evident in these two earlier focused reviews, and since publication there have been numerous additional PTSD studies published.

Additional review is warranted

Review Methodology

Objective: To examine the effectiveness of EFT treatment for PTSD.

•A specific search strategy was utilised; eight databases were searched using identical search keywords in each database.

•An inclusion criteria was developed and articles satisfied all criteria to be included in the review.

•Upon identification for review, data was extracted in a systematic manner and quality was assessed using a validated tool.

Article Selection

Identification

Potentially relevant studies identified through database searching (n = 263)

Identification

Potentially relevant studies identified through other sources e.g. hand searching (n = 7)

Screening

Potentially relevant studies screened after duplicates removed (n = 270)

Studies excluded based on review of title (n = 237)

Eligibility

Potentially relevant studies assessed for eligibility based on

inclusion/exclusion criteria

(n = 33)

Studies excluded if they did not meet the inclusion criteria including: EFT was not used as

a treatment for PTSD

(n = 24)

Included

Studies meeting the inclusion criteria

(n = 9)

Review Results

Nine articles met the inclusion criteria for review.

Study characteristics – Participants

-Total review sample; n=226 (smallest = 7, largest = 77)

-Larger number of males than females (78.2% male)

-Wide age range (12-86 years).

-Most common trauma type was through combat.

Review Results

Study characteristics – Interventions

•All studies involved delivery of EFT using protocols described by Craig (2011).

•Six studies also included EFT homework.

•Length and frequency of treatment varied considerably between studies.

Review Results

Study characteristics – Outcome measures

•All included at minimum baseline and post-treatment measures.

•Common measures included self-report Symptom Checklist-45 and the civilian or military PTSD Checklist.

•Six studies included follow up measures.

Summary of Main Findings

• In all nine studies, the delivery of an EFT treatment intervention had a significant positive effect on psychological distress and PTSD symptomatology.

• Intervention effects appeared to be maintained at follow up time points were measured.

• Positive and significant findings were evident, regardless of differences in samples, and intervention delivery.

Quality Assessment

• The majority of studies (n=7) were classed as ‘weak’ in terms of quality; only two were ‘moderate’.

• There were strengths in terms of study design and using reliable, valid and follow up measures.

• However some considerable flaws must be considered:

- Lack of control comparison conditions. - Self-report measures. - Short follow up time points. - Self-selected samples

Implications of the Findings

• The review findings illustrate some convincing evidence for EFT as an effective treatment for PTSD.

• EFT has many benefits over traditional PTSD treatment methods; it’s cost-effective, can be brief, administered as a group and self-administered.

• However, there is limited research in the area and serious methodological flaws were identified. Findings should be taken with caution and further work is required, yet preliminary findings appear positive.

Future Research

• Methodological flaws of previous research should be addressed in more rigorous studies including direct control comparison groups.

• Longer follow up time points are needed.

• Effects on female PTSD patients need further exploration.

• Optimum intervention delivery needs to be established to facilitate the development of a standardised treatment protocol.

Conclusions

• This review provides a comprehensive and systematic synthesis of the evidence and indicates the potential of EFT as an effective treatment for PTSD.

• The evidence should be taken with caution due to the low methodological quality of included studies.

• Despite limited research in this area, preliminary findings are positive and several avenues for future research are open to explore and strengthen the evidence base.

Thank you

Any questions?

References

1. Kessler, D.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Post traumatic stress disorder in the National Co-Morbidity Survey. Archive of General Psychiatry, 52, 1048-1060.

2. Kessler, D.C., Berglund, P., Demler, O., Jin, R., & Merrikangas, K.R. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archive of General Psychiatry, 62, 593-602.

3. Foa, E.B., & Rothbaum, B.O. (1998). Treating the Trauma of Rape: Cognitive-Behavioural Therapy for PTSD. New York: Guildford Press.

4. Tanielian, T., & RAND. (2009). Assessing combat exposure and post-traumatic stress disorder in troop and estimating the costs to society: Implications from the RAND invisible wounds of war study. Last accessed 25th June 2013 from www.rand.org/pubs/testimonies/2009/RAND_CT321.pdf.

5. Boath, E., Stewart, A. & Carryer, A. (2013). Emotional Freedom Techniques (EFT) for enhancing academic performance in University students. Innovative Practice in Higher Education, 1(3).

6. Salas, M., Brooks, A.J., & Rowe, J.E. (2010). The immediate effect of a brief energy psychology intervention (EFT) on specific phobias: A randomized controlled trial. Explore: The Journal of Science and Healing, 7(3), 255-160.

7. Brattberg, G. (2008). Self-administered EFT (Emotional Freedom Techniques) in individuals with fibromyalgia: A randomized trial. Integrative Medicine: A Clinician's Journal, 7(4), 30-35.