The effectiveness of Emotional Freedom Techniques (EFT) for improving the physical, mental and emotional health of people with chronic diseases and/or mental health conditions: a systematic review protocol

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Review question/objectiveThe purpose of this systematic review is to:Identify, summarize and synthesize evidence on the uses and perceived benefits of a meridian-based energy psychology intervention, Emotional Freedom Techniques (EFT) for enhancing physical, mental and emotional health of people with chronic diseases and/or mental health conditions.Specifically, this systematic review will examine the available Level 1 scientific literature in order to examine the effectiveness of Emotional Freedom Techniques, as a tool to assist with improving people's health. These will include:1. Specific changes occurring in the physical body, as a result of administering EFT to a subject; for example, changes in cortisol levels, reduced clumping in blood cells, or a reduction in somatization.2. Emotional and mental health benefits reported immediately and at a later follow-up time by subjects.BackgroundEmotional Freedom Techniques (EFT), also known as tapping, is an energy psychology technique that combines stimulation of acupressure points on the face and upper body with exposure to a specific traumatic memory or trigger.1 EFT uses the meridian energy system of the body, similar to traditional acupuncture, but it differs in the way it is administered.2 In traditional acupuncture, needles are used to stimulate the end points of meridians. In EFT, the subject gently taps acupressure points with his/her fingertips. While tapping on acupressure points, the subject also focuses on the emotions triggered by a stimulus (e.g. spiders, in the case of phobias), or a particular traumatic event, and voices statements of self-acceptance. EFT combines cognitive strategies with systems such as acupuncture which leads to a shift in the “cognitive, behavioral and neurochemical foundations of the psychological problem”.3(p2)Similar to cognitive behavioral therapy, EFT's aspect of self-acceptance relies on the premise that acceptance, rather than resistance of a particular condition can reduce suffering.4Stimulation of acupoints is believed to send a signal to the limbic system and reduce limbic hyper-arousal.5 This in turn, leads to “rapid reciprocal inhibition” and “long-term counter-conditioning”.5(p3)EFT appears to decrease activity in the amygdala, which is part of the brain's arousal pathway. It is also considered to have effects on the body's physiology in relation to stress regulation, emotional intensity and neural transmission.2A randomized controlled trial (RCT) undertaken by Church et al. showed significant improvements in psychological distress symptoms and cortisol levels in 83 non-clinical subjects, who received one hour long EFT sessions.6 Participants were assigned to EFT, supportive interviews/psychotherapy, or no treatment groups. Salivary cortisol assays, which were undertaken prior to and 30 minutes post intervention, showed a reduction in cortisol level by over 24% in the group that received EFT, compared to a 14.25% decrease in the case of supportive interviews and about 14.44% in the case of no treatment.6 These decreases were in alignment with the perceived improvement in psychological distress symptoms. The EFT group demonstrated improvements in anxiety (58.34%), depression (49.33%) and overall symptom severity (50.5%).6Another clinical study conducted by Church et al. involved 238 first year psychology students who were randomly allocated to either EFT or no treatment groups.7 Four 90-minute long group EFT sessions were administered to the EFT group.7 At the end of the four sessions, the EFT group showed statistically significant improvements in their depression scores, which were assessed using the Beck Depression Inventory (BDI).7 The mean score was in the non-depressed range.7A number of studies have been undertaken to investigate the benefits of EFT for post-traumatic stress disorder (PTSD) patients, in particular veterans. In one RCT, veterans meeting clinical criteria for PTSD were randomly divided into EFT treatment and standard of care/wait list groups.8 Psychological distress and PTSD symptoms were compared after one month for the standard care group and after six EFT sessions for the EFT group. Not only were symptoms significantly improved, but also 90% of the subjects in the EFT group no longer met clinical PTSD criteria.8 At the end of the wait list period, the standard care group subjects received EFT.8 Sixty percent of the subjects became symptom free at the end of three sessions.8 Eighty six percent of the subjects were symptom free at the end of three months and 80% were symptom free at the end of six months.8 There have also been studies demonstrating some level of benefits of EFT for fibromyalgia,4 food cravings,2 and phobias.9EFT in its current form emerged in the early 1990s.10 Whilst there have been a number of studies on various health conditions, as well as reviews of its evidence base, there seems to be only one review done systematically, which was a narrative review by Boath et al.1The proposed systematic review will focus on summarizing and synthesizing evidence related to the perceived benefits of EFT for enhancing physical, mental and emotional health, in order to better understand how EFT can be used to support people suffering from chronic diseases and/or mental health conditions. A variety of scientific literature exists on the subject of EFT, ranging from RCTs to case reports. However, to ensure that studies falling in the higher ranks of evidence hierarchies are included in this review, only RCTs and cohort studies will be included.

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