This document summarizes a review of studies examining the effectiveness of Energy Psychology techniques like Emotional Freedom Techniques (EFT) and Thought Field Therapy (TFT) for reducing anxiety. The review included 14 studies with a total of 1358 participants. The studies examined EFT/TFT for reducing test anxiety, public speaking anxiety, dental anxiety, and general psychological distress. The review found that EFT/TFT significantly reduced symptoms of anxiety in the areas studied with moderate effect sizes. However, it noted limitations like varied methodological quality and the need for more research comparing active tapping to no-tapping controls. Overall, EFT/TFT appear to effectively reduce anxiety, but more high-quality research is still needed

2. A narrative what…!?
A ‘systematic review’ is a robust and detailed
review of literature within a particular area of
interest.
Why not just do a literature review?
A literature review may be open to bias in only
identifying sources of information that are
either easily available or in highlighting only
certain aspects of that information, e.g.,
positive findings.

3. Key components
• Focused on question.
• Planned.
• Exhaustive.
– Searches.
– Reviewing studies.
• Impartial in presenting
evidence.
• Synthesis of
data/combining findings.

4. Let’s talk anxiety!
State of psychological
uneasiness and
physiological tension
focused on
apprehension (Colman,
2006).

5. Energy psychology for
anxiety
We know that EFT (and TFT) is helpful (Feinstein, 2008,
2012) for conditions such as:
• Post-traumatic stress disorder (PTSD).
• Various phobias, and psychiatric diagnoses.
• Anxiety.
Of the above, most people would likely identify with anxiety
on some level.
People might be unable to remove themselves from the
anxiety provoking situation/stimulus and so a self-
management technique might appeal!

6. The challenge of reviewing
anxiety systematically
• Anxiety is complicated!
• Studies examining EFT/TFT often include outcome
measures such as Subjective Units of Distress Scale
(SUDS).
– Such measures might constitute a focus on components of
psychological anxiety, given the measure of
disturbance/distress.
– Does one include studies with SUDS in the review?!
• Focus given to studies where there was a clear focus on a
particular type of anxiety, which might have included
SUDS.

7. My original plan
• Focus on academic anxiety:
– Taking tests/examinations.
• 3 papers: Benor et al. (2009); Jain and Rubino (2012);
Sezgin and Özcan (2009).
• Further research/consideration:
– Academic anxiety may comprise ‘public speaking’:
• 4 papers: Boath et al. (2012, 2013); Jones et al. (2011);
Schoninger and Hartung (2010).
• Only 7 papers!? More research:
– 3 papers with anxiety measure at EFT conferences.
• Church and Brooks (2010); Palmer-Hoffman and Brooks
(2011); Rowe (2005).

8. Story so far…
• 10 papers:
– Test anxiety (3).
– Public speaking anxiety (4).
– ‘General anxiety’ (psychological distress) (3).
• More research revealed a further 4 papers also with
outcome measures of anxiety:
– WHEE (hybrid of EFT: EMDR + EFT) (Bair, 2008).
– EFT on stress biochemistry (Church et al., 2012).
– TFT for psychiatric disorders (Sakai et al., 2001).
– EFT for dental anxiety (Temple & Mollon, 2011).

9. Challenges
The initial approach to systematic review was, at
times, not as systematic as I would have hoped,
compounded by:
• The lack of papers using EFT/TFT for a specific
form of anxiety (not best use of time to
systematically review only 3 papers).
• My own lack of experience in systematic
reviewing.
– I did pass the work at doctorate level, however 

10. ANXIETY
General
Anxiety
Public
Speaking
Anxiety
Academic
Anxiety
Challenge of being
systematic

11. Methodology
• Inclusion criteria:
– In English.
– Aiming to investigate effect of EFT or TFT in
attenuating anxiety.
– With both baseline and outcome measures of
anxiety (or psychological distress, e.g., SA-45).
• Exclusion criteria:
– Commentaries, interviews, editorials, case studies,
general information on EFT or TFT.

12. Methodology
• Search strategy:
– All accessible (and relevant) online databases:
• Web of knowledge, ProQuest, ScienceDirect,
SPORTDiscus, Swetswise, Cochrane, CINAHL,
PsycARTICLES/INFO, Innovative Practice in Higher
Education (IPiHE), Energy Psychology Journal,
www.eftuniverse.com, www.tftfoundation.org.
– Consulted local experts in EFT (Liz Boath, Tony
Stewart, and colleagues).

13. Initial Search
(n = 381)
Duplicates (n = 97)
Non-applicable
papers (n = 92)
Reviews (n = 40)
Everything else
(n = 71) Other than
anxiety (n =
65)
Remaining papers (n = 16)
(unable to obtain 2 papers)
Commentaries (n = 14)
Interviews (n = 2)
Editorials (n = 9)
General information (n = 35)
Case studies (n = 6)
Other than EFT or TFT (n = 5)
Methodology

15. 3
RCTs
1
NRCT
2
CBAs
1
HCT
7
BAs
Jadad
2
Jadad
1
Jadad
1, 2
Jadad
1
Jadad
1
Medium Low
Low &
Medium
Low Low
Research designs
Based on Reeves et al. (2008) – Cochrane Collaboration

16. Analysis
Narrative review
What’s that?
Reviewing the studies and summarising the
findings in words, rather than statistically
combining the findings (average differences) and
reporting a statistical effect/result.

17. Analysis
No meta-analysis? Tut-tut 
• Studies had not only different measures of
anxiety but also different types of anxiety.
• Too much variation in the study
design/method.
• Questionable results?
– Danger of statistically pooling results from diverse
non-randomised studies (Sterne, Egger, & Moher,
2008).

18. Synthesis
• 1358 participants.
– 1112 non-clinical sample volunteers.
• 525 attendees at EFT conferences.
• 216 patients receiving mental
health/behavioural care.
• 30 participants receiving dental treatment
presenting with dental anxiety.

19. Synthesis
• Remaining 587 participants.
– Test anxiety:
• High school students (n = 70).
• College and university students (n = 183).
– Public speaking anxiety:
• Third year university students (n = 67).
• University students and staff (n = 36).
• General public (n = 48).
– Graduate research:
• General public (n = 100).
– Free cortisol test:
• General public (n = 83).

20. Results
Test anxiety (TA)
• Significant decrease in TA for WHEE and EFT
(more so than CBT).
• TA significantly decreased for EFT and
progressive muscular relaxation but more so
for EFT.
• TA significantly decreased for both EFT and
diaphragmatic breathing compared to no
treatment.
(p < 0.05, i.e., less than 5% chance of the result
occurring by chance)

21. Results
Dental anxiety
• Significant decrease in subjective distress
(reduction of ≥ 4 points [moderate distress] on
scale).
• Were not allowed to tap on face!

22. Results
Public speaking anxiety (PSA)
• Significant decrease in PSA for groups using
EFT or TFT.
• EFT significantly more effective than control
(wait-list).
• EFT improves speaker confidence but does not
affect communication apprehension (nerves
still remain).
• TFT increases ‘positive anticipation’ prior to public
speaking.

23. Results
Other studies
• EFT conferences:
– Significant effects of EFT in reducing psychological
distress.
• Heart rate synchronisation (similar heart rates
of participants to the therapist):
– Possible indications of energy work.
• Salivary cortisol:
– Significant reductions in salivary cortisol for EFT
use.

24. Discussion
• Both EFT and TFT appear effective in
attenuating anxiety.
• EFT has given rise to other modalities (e.g.,
matrix reimprinting [MR]).
– Stewart et al., (2013a) conducted a service
evaluation for MR on the NHS, finding significant
decreases in psychological anxiety and increases in
well-being and self-esteem.

25. Discussion
• Cost-effectiveness:
– The reduced clinical time required to help people with
anxiety is beneficial. EFT on the NHS requires ~5
sessions to be effective (Stewart et al., 2013b),
compared to the average of 6-20 sessions of CBT,
depending on condition/severity (NICE, 2008).

26. Final thoughts and
reservations
• Energy flow throughout the body is a hotly debated
topic between both academics and clinicians!
– McCaslin (2009) states the basis of energy flow is
unsubstantiated.
– Pignotti (2005) highlights, from using TFT-VT (Voice
Technology) no significant differences between two groups
subjective distress even when ‘true’ and sham TFT points
were used.
• Issues of “proprietary trade secrets” (Pignotti, 2005, p. 72)
leaving any researcher sceptical of extraordinary claims.
– Issue of small sample sizes and poor research designs.

27. Final thoughts and
reservations
• 39% (525 of 1358) participants were attendees at
EFT conferences.
– If a person has an interest in a therapy and has committed
their working life to that therapy, one may not be
surprised if that therapy is of benefit to that person.
• Could the positive effects of energy psychology
techniques be due to:
– Contact with another human in one’s time of distress?
– Reassurance?
– Psychological affirmation.
– Affecting the flow of energy?

28. The future…
Establishing mechanisms of action.
To adhere to evidence-based practice, not really
ethical to offer a treatment purported to be effective,
and not addressing the mechanics of that treatment.

29. The future…
• Gilomen and Lee (2015) meta-analysis:
– 18 RCTs: psychological distress | EFT, TFT, or acupoint
tapping.
– Quality: Used Gold Standard (GS) Scale (7 quality
categories).
– Hedge’s g (standardised mean difference): difference
in average score (post-test) between intervention and
control group, then dividing this into the standard
deviation (the spread of scores).
• Similar to Cohen’s d, but better estimate in smaller
samples.

30. The future…
• Gilomen and Lee (2015) meta-analysis:
– Results:
• Moderate effect size (difference in average score between
treatment and control): Hedge’s g = -0.66.
• No significant relationship between treatment time and
effect size.
– Discussion:
• Issues with randomisation methods and assessors being
blind to treatment conditions (bias).
• EFT appears to have some moderate effect.
• Future studies need to compare tapping vs. no tapping!
• Test mechanisms of action – do not just offer in the hope of
it being effective to service more people.

31. Conclusions and
future directions
• EFT/TFT appear effective for anxiety.
– If a person finds a technique effective, does it really
matter how that technique works?
Yes! No!
Who’s going
to pay?  Great 
Not
me
Further
research/cr
edibility
Discovery of
action

32. References
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Body Medicine, 23, 10-21.
• Benor, D. J., Ledger, K., Toussaint, L., Hett, G., & Zaccaro, D. (2009). Pilot study of Emotional Freedom Techniques, wholistic
hybrid derived from eye movement desensitization and reprocessing and Emotional Freedom Technique, and cognitive
behavioral therapy for treatment of test anxiety in university students. Explore: The Journal of Science and Healing, 5, 338-
340. doi:10.1016/j.explore.2009.08.001
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presentation expression anxiety syndrome (PEAS) in university students.Innovative Practice in Higher Education, 1(2), 1-11.
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33. References
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34. References
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