The Case for Energy Psychology
Clinical psychologist David Feinstein describes some of the compelling research behind energy psychology, a method based on tapping selected acupuncture points to address psychological problems, including post-traumatic stress disorder.
Drawing from contemporary psychological understanding as well as ancient spiritual practices and healing traditions, Energy Psychology (EP) provides simple methods for shifting the brain’s chemistry, specifically through a variation of Emotional Freedom Techniques (EFT). Using a combination of acupressure points, along with advanced psychological methods, EFT releases traumatic memories and facilitates healing.
The Evidence Accumulates for Energy Healing
Despite continuing professional skepticism, empirical evidence for the effectiveness of Energy Psychology (EP) has been accumulating. Treatment teams have been deployed to more than a dozen countries to provide mental health services following natural and human disasters. Outcome data systematically collected in at least five of these countries, and corroborated by local health-care authorities who had no stake in EP, were encouraging.
The first research using established measures to investigate treatment outcomes with disaster survivors was conducted in 2006 by a team led by psychologist Caroline Sakai, working with an orphanage in Rwanda. Of the 400 orphans living or schooled at the facility, 188 had lost their families during the ethnic cleansing 12 years earlier. Many had witnessed their parents being slaughtered, and they were still having severe symptoms of post-traumatic stress disorder (PTSD), including flashbacks, nightmares, bedwetting, withdrawal, or aggression.
The study focused on the 50 teenagers identified by the caregivers as having the greatest difficulties. All 50 were rated on a standardized symptom inventory for caregivers and scored above the PTSD cutoff. Each then received a single acupoint-tapping session lasting 20 to 60 minutes, combined with approximately six minutes spent learning two simple relaxation techniques.
Not only did the scores of 47 of the 50 adolescents fall below the PTSD range following this brief intervention, these improvements in serious conditions that had persisted for more than a decade held at a one-year follow-up.
Another recent study, a randomized, controlled trial (the scientific "gold standard" for establishing the effectiveness of a treatment) with traumatized male adolescents in Peru also used a single acupoint-tapping session. The findings, currently under peer review, showed that 16 boys who'd been abused all scored above the PTSD cutoff on a standardized self-report inventory before treatment. Of this group, 8 were given a single EP session, after which none scored in the PTSD range, and they were still below the cutoff a month later. Scores for the 8 in the waitlist control group were unchanged at the one-month follow-up.
In the first randomized controlled trial of the use of EP with combat veterans, presented at the Society of Behavioral Medicine Conference in Seattle, 49 vets showed dramatic improvement after six treatment sessions—42 of them no longer scored above the PTSD cutoff.
Conducted under auspices of the Vets Stress Project, participants were recruited from throughout the United States and were treated by volunteer practitioners. The gains persisted at the six-month follow-up. There was only one dropout. In contrast, less than one 1 in 10 of the 49,425 veterans of the Iraq and Afghan wars with newly diagnosed PTSD who sought care from facilities run by the Department of Veterans Affairs actually completed the conventional treatments recommended.
After the Seattle report, I contacted the study's principal investigator and asked whether I could interview some of the therapists involved. One of them, Ingrid Dinter, described to me her work with Keith, an infantry soldier who had served in the Mekong Delta during the Vietnam War. In his initial therapy session in April 2008, he reported that he had seen "many casualties on both sides." More than three decades later, he was still tormented with nightmares and repeated flashbacks.
"Sometimes I think I see Viet Cong soldiers behind bushes and trees," he added. His severe insomnia, complicated by the nightmares, made him fatigued and unable to function during the day. He'd been diagnosed with PTSD and reported that his group and individual therapy through the Department of Veterans Affairs (VA) hadn't helped with his symptoms.
Keith had six hour-long sessions with Dinter, during which she had him tap on acupoints while he focused on traumatic war memories and other psychological stressors. In their first session, he reported that since the war's conclusion, he'd rarely gotten more than one to two hours of sleep at a stretch, and averaged about two nightmares each night.
By the end of the six sessions, he was getting seven to eight hours of uninterrupted sleep and was having no nightmares. He said that other symptoms, such as intrusive memories, startle reactions, and overwhelming obsessive guilt, had abated as well. A six-month follow-up interview and further testing showed that the improvements held.
Can Tapping Change the Brain?
Studies continue to confirm that Energy Psychology works and works quickly, but the fundamental question remains: How does it work? How could tapping on the skin be an ingredient in producing rapid cures for severe psychological disorders? How, in fact, can any intervention reliably overcome PTSD within a few sessions?
The emerging understanding of neuroplasticity—particularly the ways that thought and experience can decisively change the brain—suggests that significant therapeutic shifts can happen far more rapidly than we once believed. It's now at least plausible that therapeutic interventions can be developed that quickly alter the neural pathways maintaining emotional and behavioral patterns that were once protective (like trauma-based hyperarousal), but have become dysfunctional.
A series of studies conducted over the past decade as part of the Neuroimaging Acupuncture Effects on Human Brain Activity project at Harvard Medical School provides clues to why acupoint tapping may be such an approach. According to project leader Kathleen Hui, "functional MRI and PET studies on acupuncture at commonly used acupuncture points have demonstrated significant modulatory effects on the limbic system."
How does that apply to EP? It's always been obvious that psychological exposure is an ingredient in EP. Traumatic memories or other cues that trigger unwanted emotional responses are mentally activated during the acupoint tapping. Since exposure is the single therapeutic component present in virtually all studies of effective PTSD treatments, the success of EP has often been attributed simply to its use of that approach.
But this doesn't address the fact that clinicians utilizing the technique, and numerous studies, have found that by adding acupoint tapping, the exposure can be much briefer, requires fewer repetitions, and leads to positive outcomes with a greater proportion of clients. The new understanding provided by the Harvard neuroimaging studies is that stimulating specific acupoints generates signals that instantly reduce arousal in the amygdala.
So rather than relying on repeated or prolonged exposure to extinguish the threat response, EP introduces acupoint tapping during a brief exposure, which immediately counters the threat response. The process appears to work like this:
The client is asked to bring to mind an anxiety-provoking memory, thought, or related cue, activating an alarm response in the amygdala;
The simultaneous stimulation of acupoints sends deactivating signals to the amygdala, initiating an opposing process, reminiscent of Joseph Wolpe's "reciprocal inhibition";
The signals sent by the acupoint stimulation turn off the alarm response, even though the trigger is still present.
With a few repetitions, the trigger no longer evokes fear, and this innocuous experience, which becomes the defining memory about the trigger, is stored in the hippocampus.
The apparent operating principle, although not yet demonstrated by laboratory research, is that when a traumatic memory or other trigger is paired with an intervention that turns off the alarm response, such as the stimulation of selected acupoints, the neural pathways that were keeping the alarm response in place are altered.
In When the Past Is Always Present: Emotional Traumatization, Causes, and Cures, trauma researcher Ronald Ruden speculates on how interventions such as acupoint tapping during traumatic recall result in the elimination of conditioned fear pathways in the amygdala. Activating the memory makes the glutamate receptors that maintain long-standing signal transmissions between neurons vulnerable to disruption (this is well-established), and in a clinical one-two punch, the acupoint tapping sends new signals that "depotentiate" the vulnerable receptors. In this way, the conditioned fear is permanently eliminated.
When the maladaptive fears that are at the core of PTSD have been eradicated in this manner, associated symptoms also diminish. A marked decrease of flashbacks, nightmares, intrusive thoughts, concentration problems, numbing, and even self-defeating thoughts and behaviors has been reported by clinicians, and is now being corroborated by systematic research. So while EP utilizes psychological exposure, the acupoint tapping allows for a kinder intervention, requiring far fewer and much shorter exposures to traumatic material...
EP is being used in the British and French military services to treat soldiers with PTSD, and Britain's National Health Service, which has been using EFT as a treatment modality for years, is now offering it to the public as part of its Mental Health Improvement Training. In the United States, however, partially as a consequence of the APA's unbending position on EP, many therapists still have to introduce the therapy surreptitiously, or risk censure. Still, EP methods are slowly finding their way into mainstream psychotherapy practice as well as institutions such as hospitals, VA centers, and HMOs, with major studies underway at Kaiser Permanente, the Sutter Health network, and the Walter Reed Army Medical Center.
EP's strongest enthusiasts speak of it as if it were the psychotherapeutic equivalent of penicillin, a clinical breakthrough that will revolutionize therapy, while its critics view it as a pseudoscience whose new ingredients are no more potent than sugar water. Because the basic technique is so easy to learn—the hard part being using it well with challenging cases—I'll sometimes ask a spirited skeptic, "Why not try it and evaluate it yourself? What's to lose?" In fact, that's part of the strategy employed by those bringing EP to disaster areas to gain the cooperation of local health leaders.
While empirical studies to fully demonstrate the speed and power of EP are still needed, it's hard not to be deeply moved seeing emotionally devastated people come back into happier, more effective lives after a few EP sessions. For instance, the video described earlier shows an Army combat veteran who'd suffered from panic attacks, nightmares, hypervigilance, anger, and depression for more than 30 years. His symptoms were getting worse, to the point that he was regularly and convincingly threatening to shoot his family.
In his intake session at a five-day EP program where two to three hour-long sessions per day would be offered, he said, "The dichotomy is so great between what I was when I went in and what I became when I got out that it's a very messy situation inside my head!" In his exit session on day five, he triumphantly announced, "I can't emphasize enough how important it is to actually feel like you're a real person again, and not be afraid, and not have to cover up all of your junk every single day of your life."
His wife also participated in the five-day program. On day three, she said, "He's had all the symptoms! We've been in psych wards for years. And in three days, we're talking! We haven't talked in five years—really talked!" Post-treatment testing confirmed his observable improvements, which persisted on follow-up assessments.
As we deepen our explorations of the complex mysteries of the human nervous system, rapid, noninvasive ways of repairing damage and dysfunction seem not so far away. Energy Psychology holds promise for blazing a trail toward that goal. As bizarre as it may have once sounded, the evidence has moved far beyond the early anecdotes, suggesting that tapping on the skin can reliably facilitate decisive emotional change with a range of conditions. However uncomfortable such findings may make old-time clinicians like me, they may force all of us to rethink our models of psychotherapy.