This document provides information about a workshop on using EMDR techniques and Acceptance and Commitment Therapy (ACT) in treating chronic pain. The workshop objectives are to explain the principles of EMDR, tapping techniques, and ACT as they apply to chronic pain. It will also cover EMDR visualization modalities and the use of tapping. Participants will learn how to screen for mental health components of pain using an Adverse Childhood Experiences survey. The document discusses the scope of the chronic pain problem, drivers of chronic pain in the nervous system, and the status and history of pain treatment approaches in the US.

1. March 22nd 2019
Acceptance is not Surrender
EMDR techniques & Acceptance and
Commitment Therapy (ACT) in the
Treatment of Chronic Pain
Michael G Bricker MS, CADC-II, NCAC-2, LPC

2. Workshop Presenter
Michael G Bricker MS, CADC-2, NCAC-2, LPC
Behavioral Health Clinician
Trainer & Consultant
mbricker6421@gmail.com

3. Workshop Learning Objectives - Participants will be able to:
Explain the basic
principles of EMDR
Resource Tapping, EFT
Tapping & Acceptance
and Commitment
Therapy as they apply
to chronic pain
Explain the four EMDR
visualization modalities
or “resources” useful in
treating chronic pain,
and the use of EFT
Tapping
Become familiar with
the Adverse Childhood
Experiences (ACE)
survey to screen for
the MH components
of pain syndromes
1 3
2 4
Participate in a brief
experiential exercise
they can utilize for
clients with the
handouts provided

4. Scope of the Pain Problem
• Acute pain is a symptom. Chronic pain is a disorder of the central
nervous system. Chronic pain resides in the brain stem and limbic
system. Roughly 1/3 of US population has chronic pain.
• Brain is made up of: 15% neurons, and 85% glial cells
Glial cells provide power to intensify activity of neurons
However, chronic pain patients have overactivity of glial cells which
causes fatigue, followed by problems with anxiety/depression,
memory/cognitive impairment, and sleep. BEST way to down
regulate hyperactive glial cells is through deep breathing!
• Pain catastrophizing is a major concern for pain patients, and within
40 minutes of this process, chemicals are released into the blood
stream and the catastrophizing will not stop unless the patient
engages in some sort of behavioral/psychological treatment
• One of those chemicals is called Interleukin 10, which
blocks anti-inflammatory cytokines in the blood stream
after Scott Pengally, PhD

5. Status of the “solution”
From 1999 to 2008, overdose death rates, sales and
substance use disorder treatment admissions related to
prescription pain relievers increased in parallel. The overdose
death rate in 2008 was nearly four times the 1999 rate; sales
of prescription pain relievers in 2010 were four times those in
1999, and the SUD admission rate was 6 times higher
Drug overdose is the leading cause of accidental death in the
US, with 47,055 lethal drug overdoses in 2014. Opioid addiction
is driving this epidemic, with 18,893 overdose deaths related to
prescription pain relievers, and 10,574 overdose deaths related
to heroin in 2014
Fastest-growing demographic: 12 – 24 year olds!

8. Opiate Reward
Reinforcement
Reward/Reinforcement
is in part controlled by
mu receptors in the
Reward Pathway:
VentralTegmental
Area (VTA)
Nucleus Accumbens
with projections to
Prefrontal Cortex
Dopaminergic system

9. 46 opioid overdose deaths every day
The Scope of the Problem
Fastest-growing demographic: 12 – 24 year olds!

10. Source: Prescription Nation 2016 – Addressing America’s Drug Epidemic

11. • 1990 – Dr George Fox, head of
the Pain Management Society,
wrote an article presenting the
concept that chronic pain is
under-reported and therefore
under-treated
• Promotion of pain as the “5th Vital
Sign”
• Very little research into long-term
effects of pain medications BUT
• “absence of proof is not proof”
• 2000 – the Joint Commission
publishes non-binding guide-
lines for addressing pain
• Mid-2000’s – “5th Vital Sign”
concept takes hold as a
measure of patient satisfaction,
Physician performance, and
healthcare accreditation
standards
• Pharmaceutical industry takes
note – “cherry-picks” research
to suggest opioids are safe and
non-addictive
A Brief History of the Challenge

12. Chronic Pain Drivers in the PNS and CNS
How the solution became the problem
https://www.chronicpaindrivers.com/chronic-pain-in-action-video

13. Managing pain is partially a matter of medication, and largely a matter of
taking on a more nuanced, holistic, and multimodal approach. Modern-day
pain specialists recognize that to effectively tackle chronic pain, a patient’s
life, circumstances, and options have to be identified and considered. More
than just medication, modern-day pain management makes use of therapies
and medical interventions to help reduce and eliminate pain and help patients
without the use of opioids. Options include:
Heat therapy
Cryotherapy
Stretching and exercise
Meditation and mindfulness
Nerve blocks
Epidural injection
Corticosteroid injection
And more
Pain Management Outside of Pharmacology
And what do all of them have in common?
Even when they work,
THEY DON’T
EMPOWER the
PATIENT!

14. Scope of the Problem
Clearly, we need to
shift the paradigm for
chronic pain… “When
what you’re doing
isn’t working, the
answer is never to do
it HARDER!”

15. The new CDC guidelines severely limit the prescribing of long-term opioid
analgesics for the treatment of chronic pain:
• Non-pharmacological interventions (eg. physical therapy, Behavioral Health)
and non-opioid medications (eg. NSAIDS) are strongly preferred
• Opioid pain medications should be used short-term (2-3 days) for acute pain
only, not initially for chronic pain
• Providers should prescribe immediate-release opioids instead of extended-
release/long-acting opioids.
• Prescribers need to weight risk/benefit ratios throughout the episode of care,
and be prepared to manage symptoms of withdrawal
• Prescribers must always monitor medication compliance (UA testing)
and potential for abuse or diversion
CDC issues draft opioid prescribing
guidelines for chronic pain
December 21, 2015

16. © Carol Vivyan 2009, permission to use for therapy purposes.

17. This cycle
becomes a
negative
feedback
loop …
and a self-
fulfilling
prophecy!
Feeding the “pain monster…”
© Carol Vivyan 2009, permission to use for therapy purposes.

18. 0
10
20
30
40
50
60
70
80
90
100
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Percent
of
Activity
Level
Without
Moderation
With Moderation
Patient "pushes through" the
pain
The pain gets so severe
that it results in extended
rest ("crash and burn")
Patient pushes again to
make up for lost time
Patient again
“crashes and
burns”
With pacing, the patient keeps
a steady pace to avoid pain
flares
Push-Burn-Crash Cycle
Kelly Lamb, MS, LPC, LCDC

19. The Chronic Pain
Cycle –
Ronald Siegel PhD
The cycle of option
reduction – both
mental and physical
– is the hallmark of
the Chronic Pain
Syndrome, and is
independent of the
measured severity
of pain.

20. ACT
EMDR
The Pain
Recovery Cycle –
Ronald Siegel PhD
rev. M Bricker 2015
The combination of
EMDR,
visualization and
EFT reduces
physical pain while
ACT redefines the
experience of pain

21. The American Association of Physicists in Medicine,
through their research has stated the following about
physical pain:
You see, when you’re FIGHTING with physical pain
it limits your ability to live a full life.

22. 1. GET RID OF THE PAIN SCALE! First, it’s a medical metric that’s
beyond our scope! Some medical chronic pain management
programs are moving toward “is it easy, medium or hard?”
2. Shift the focus from “eliminating pain” to “increasing functionality
and satisfaction” – get rid of the “donut hole” effect
3. Consider using the EMDR Subjective Units of Distress scale to
include emotional, cognitive, relational and functional parameters
for a fuller picture. (0 = “plain vanilla everything’s OK” 
10 “worst life distress you can imagine”)
4. I use a “confidence scale” similar to the EMDR “positive cognition”
1 – 7 scale to help patients shift focus and reclaim their power
Sooo… What’s a Counselor s’posed ta DO?

23. 1. The first wave – Cognitive Behavioral Therapy
2. A different perspective – Acceptance &
Commitment Therapy
3. The third wave: Mind-Body interventions -
EMDR, EFT Tapping, aromatherapy, etc.
Behavioral Health Interventions for Chronic Pain

24. Meridians are the “backbone” of
traditional Chinese Medicine
In traditional Chinese
medicine meridians are
invisible energy pathways
or channels that run
through the body. Our
vital life energy, or "qi", is
thought to flow along
these meridians, and
anything that disrupts the
smooth flow of chi is said
to cause illness. The
Chinese term for meridian
is "jing luo"
Most acupuncture and
acupressure points lie
on a meridian and
stimulating these
points using acupres-
sure, is thought to
help correct and
rebalance the flow of
energy. There are over
300 acupuncture
points on the meridian
system.

25. Acupressure - Benefits
Release pain
Regulate the internal organs
Unblocking, makes things flow better
Easy to do
No side effects

26. Acupressure FAQs
 Points (xue) are often tender to the touch
 Points can be stimulated by pressure with
thumb, finger, or knuckle
 Press the point lightly and shallowly,
progressing deeper until you feel distending
sensation , pressure, or dull ache. It may
spread or travels outwardly from the point.
 Hold the point until the pain subsides and you
feel the muscles relax.

27. Conditions Treated
 Pain – Chronic and Acute
 Back pain, neck pain, shoulder pain, knee
pain…
 Carpal Tunnel, tennis elbow, golfers elbow,
tendonitis, neuropathy
 Fibromyalgia, autoimmune conditions

28. Symptoms of Chronic Pain Syndrome
Chronic pain syndrome takes a toll on both your physical and mental health.
While the pain can be near-constant, there may be flares of more intense pain
due to increases in stress or activity. Symptoms include:
• Joint pain
• muscle aches
• burning pain
• fatigue
• sleep problems
• loss of stamina and flexibility, due to decreased activity
• mood problems, including depression, anxiety, and irritability
In one study published in the journal Pain, 60.8 percent of the subjects who
reported chronic pain also had depression, most of them with
“severe” level symptoms.

29. Causes of chronic pain syndrome
Conditions that cause widespread and long-lasting pain are, not surprisingly,
often linked to chronic pain syndrome. Some of these conditions include:
• Osteoarthritis. This type of arthritis is generally the result of wear and tear
on the body and occurs when the protective cartilage between bones wears
away.
• Rheumatoid arthritis. This is an autoimmune disease that causes painful
inflammation in the joints.
• Back pain. This pain may stem from muscle strains, nerve compression, or
arthritis of the spine (called spinal stenosis).
• Fibromyalgia. This is a neurological condition that causes pain and
tenderness in various parts of the body (known as trigger points).
• Inflammatory bowel disease. This condition causes chronic inflammation
of the digestive tract and can produce intestinal pain and cramping.
• Surgical trauma.

31. Cognitive Behavioral Therapy (CBT) is an evidence-based treatment model
focused on the premise that an individual’s thoughts, feelings and behaviors are
intertwined and can ultimately be re-structured to support more productive
actions. Historically routed in the treatment of depression and anxiety, CBT is the
“gold standard” for treating Chronic Pain.
CBT focuses on three phases of treatment – the behavioral phase, cognitive
phase and maintenance and relapse phase. Below is an overview of each
stage, with critical treatment components specific to chronic pain:
Cognitive-Behavioral Therapy for Chronic Pain

32. Behavioral Phase: In this phase, the patient and the clinician/therapist build
rapport. The patient identifies negative emotions and behaviors, and with the
support of the clinician/therapist, a plan for addressing pain is developed:
1. Addressing & minimizing negative behaviors associated with pain such as
the “push – crash –burn” cycle.
2. Providing education and awareness about the pain cycle and mind-body
healing
3. Developing coping strategies for managing negative emotions that
exacerbate the experience of pain - thought stopping
Cognitive-Behavioral Therapy for Chronic Pain

33. Cognitive Phase: In this phase, “cognitive restructuring” techniques are
introduced. Patients are encouraged to challenge their thought process and
learn to identify unhealthy, treatment-interfering thoughts. They are supported
in reshaping their thoughts by developing new perspectives.
4. Conquering concrete & distorted thoughts about “being pain-free” or self-
worth as it applies to an unrealistic level of perfectionism.
5. Improving interpersonal relationships begins here. Patients identify
unhealthy thought patterns, looking introspectively into the impact of their
thoughts on relationships and patterns of communication with others.
6. Providing increased hopefulness, as patients gain insight into how their
thoughts affect their behavior and begin to embrace positive change.
Cognitive-Behavioral Therapy for Chronic Pain

34. Cognitive-Behavioral Therapy for Chronic Pain
Maintenance & Relapse Prevention Phase: This final phase focuses on
maintaining the skills learned in the previous stages of treatment. A
comprehensive relapse and recovery plan is developed by the patient, with
the clinician/therapist’s support, to assist the patient in managing the negative
thoughts and behaviors associated with the experience of pain.
7. Improving self-confidence as patients become more comfortable using the
acquired skills and can identify triggers before they manifest into negative
thoughts and behaviors. Patients should be positively reinforced by the
noticeable progress that is visible to themselves and others.
8. Achieving holistic healing as the pain symptoms are improved and
stabilized. Patients should be able to focus on the root cause and
subsequent areas of mental and physical health that will assist in
transitioning them into a life of recovery.

36. • Confronting the agenda of control --- creating
an initial openness to acceptance
• Psycho-education about the need to “control
the pain as being part of the problem”
• Practicing and intentionally developing
“affirmative willingness” as the alternative
ACT clinical strategies for acceptance

37. ACT can be defined:
“ACT uses acceptance and
mindfulness techniques, along
with commitment and behavior
change processes, to produce
greater psychological flexibility.”
Steven C. Hayes, PhD

38. ACT History
• Part of the ‘Third Wave’ of Behavior Therapy
• Started by Steven Hayes PhD late 1980s
• ACT is grounded in 25 years of clinical practice
• ACT emerges from Relational Frame Theory, supported by over 400
published papers
• Thoroughly researched - “practice-based evidence”
• Promising evidence – dozens of Randomized Clinical Trials in past
several years
• ACT increasingly applied to a wide range of complicated psychological
disorders
• Flexible interventions [not a “cookbook”]

39. Cognitive Behavioral Therapy (CBT)
for Treatment of Chronic Pain
Considered “strong research support” for CBT
for treatment of chronic pain by the American
Psychological Association – highest grade
possible
Includes strong research support for…
fibromyalgia
low back pain
rheumatologic pain
headaches

40. Originally designed and used as a treatment for depression- now research supports use
for a variety of reasons and conditions
Utilizes psychoeducational approach
All CBT approaches view-
People as “active processors of information”
People are able to gain control over their thoughts, feelings and
behaviors, and even sometimes their physiology
Interrelationships exist between thoughts, feeling and behaviors
(Jensen M., et al. 2014)
The premise of CBT- cognitive triangle- thoughts, feelings and behaviors are all
connected

41. Some “bumper stickers” inspired by ACT
Fears are not FACTS
Emotions are not EVENTS
Ridicule is not REALITY
PAIN is not suffering

42. “I’m having
pain”
“My pain is
awful – I can’t
stand it”
“I have to
get rid of
my pain”
Rx pain
medications
This is how the pain cycle works…

43. The solution is to ACT:
Accept those unwanted private experiences and
internal events for what they are, not what they
appear to be,
Commit to a set of valued life directions that could
reinvigorate a sense of purpose and meaning, and
Take action to build larger patterns of committed
action consistent with those valued ends

44. With respect to chronic pain, the expressed goal of ACT is not to reduce
symptoms or pain, but to improve functioning by increasing psychological
flexibility, or the ability to act effectively according to personal values, even in the
presence of negative experiences such as pain.
There is substantial basic research supporting ACT's fundamental processes, and
preliminary evidence regarding their mediational role in ACT outcomes. As of late
2011, there are at least 11 clinical trials, including several that are randomized and
controlled, demonstrating that ACT improves some outcomes in heterogeneous
chronic pain samples, particularly functioning and mood, although pain severity
may be less affected. ACT is superior to wait-list or no treatment, and thus far
demonstrates outcomes for chronic pain that are comparable to cognitive
behavioral therapy.
Research Support: Acceptance and Commitment Therapy for Chronic Pain

45. Evidence for an ACT Approach to Chronic Pain:
Attempt to suppress pain tends to increase it (Cioffi & Holloway, 1993)
ACT interventions improve tolerance of pain in normal populations
more so than CBT interventions (Gutierrez, Luciano, Rodriguez, & Fink, in
press; Hayes, Bissett, Korn, Zettle, Rosenfarb, Cooper, & Grundt, 1999)
Acceptance accounts for more of variance in outcome on pain,
depression, anxiety, disability, vocational functioning, and physical
functioning than existing measures of coping with pain (McCracken &
Eccleston, 2003)
Physical damage bears little relation to amount of pain and
relationship between functioning and pain is weak; willingness to
experience pain and ability to act in a valued direction while
experiencing pain predicts functioning (McCracken, Vowles,
& Eccleston, 2004)

46. Kevin E. Vowles, Ph.D and John T. Sorrell,
Ph.D
Life with Chronic Pain: An Acceptance-
based Approach.
Association for Contextual Behavioral
Science (ACBS)
https://contextualscience.org/
Chronic Pain Group Protocol

47. ACT Restores Balance
Spiritual Being
(meditation; moving
toward my valued ends)
Emotional Being
(relaxation and self-
regulation)
Social Being
(distress tolerance)
Physical Being
(I have pain…
it doesn’t have ME)
Cognitive Being
(re-structuring my
experience without
judgment)
Psychological
flexibility!

48. • Adverse Childhood Experiences* (ACEs) are very common
• ACEs are strong predictors of later health risks behaviors,
chronic disease and early mortality
• This combination makes ACEs ‘the leading determinant of
the health and social well-being of our nation’
(Felitti)
The Adverse Childhood Experiences
(ACE) Study (www.acestudy.org)
• 1995 – 1997 N = 17,337 adults
• Kaiser Permanente and the Centers
for Disease Control (Felitti & Anda)
Findings

49. Adverse Childhood Experiences Survey After Anders & Felitti (rev. 2010, 2015, 2017 mgb)

50. Adverse Childhood Experiences
Adverse Childhood Experiences
Social, Emotional, Physical &
Cognitive Impairment
Adoption of
Health-risk Behaviors
Chronic
Disease, Pain
& Disability
Early
Early
Death
Death
The
Influence
of Adverse
Childhood
Experiences
Throughout
Life
A reproducible
copy of the
ACEs Survey
for medical
settings is
available here
as a handout

51. • Patients with low back pain and ACEs had
higher levels of pain, and more comorbid
conditions, than patients who reported no
ACEs
• Back pain patients with ACEs had significantly
poorer general health and emotional role
functioning…

52. Counselors who treat patients with chronic pain –
especially low back pain – should include a history
of ACEs to improve their understanding of the
patient’s life, and guide their methods of helping
the patient to improve overall health, including pain
severity, emotional- functional- and general health.

53. Cycle of the Breath
Greater
psychological
flexibility
“I accept my
experience
of physical
discomfort”
“My experience
of physical
discomfort
doesn’t keep
me from what’s
important to
me”

54. “Resource Tapping” is
an EMDR-related
technique to activate
your healing resources
through bilateral
stimulation
Tapping In – Dr. Laurel Parnell, PhD

55. • Widely researched and accepted as an Evidence-
Based Practice for a wide variety of conditions,
including chronic pain. However…
• EMDR requires extensive training by certified
Trainers, and is beyond the scope of practice for
counselors without a MH license. Also, it is not
amenable to patient-guided interventions.
EMDR (Eye Movement Desensitization and
Reprocessing) was developed by Francine
Shapiro in the 1980’s

56. • Resource Tapping utilizes
the bilateral stimulation
basic to all EMDR
interventions, combined
with visualization and
breathwork
• The “resources” are the
deep well of healing energy
we all have within us
• As such, “Tapping In” lends
itself to self-directed
interventions and client
empowerment
The “Tapping In” can take a
number of forms, easily taught
in session and practiced
anywhere:
• Tapping right/left, right/left on the
knees
• Tapping with the feet, or just the toes
within your shoes
• The “butterfly hug” with arms folded
across the chest and tapping on the
shoulders
• (Can also be done by walking using Qi
Gong or “movement meditation” mgb)
“Tapping In” was further developed by Laurel Parnell PhD,
an EMDRIA Trainer with wide clinical experience

57. Resource Tapping – an EMDR-related Intervention for Physical Healing
[based on the work of Ronald Siegel PhD on chronic pain and Laurel Parnell PhD on EMDR]
Vertical Integration:
mindfulness, imagery & relaxation
Bilateral stimulation:
Left hemisphere – logic, language
Right hemisphere – imagery, creativity

58. 1. We are essentially whole. This wholeness is our true nature, and is
expressed as health, wisdom, compassion, equanimity, power and joy.
2. We each have within us the capacity to release this wholeness. Indeed,
this healthy wholeness wants to be realized, and impels us to realize it.
3. We have within us a stored reservoir of positive experiences of this
wholeness. We have a felt sense of loving and being loved, comforting and
being comforted, knowing we are competent, healthy, peaceful, happy, joyful
and calm.
4. We become unhappy and unhealthy when we are out of balance and not
able to access this experience of wholeness or reservoir of positive
experience
5. We have a natural healing system that can be accessed, activated and
strengthened by using bilateral stimulation to restore us to balance.
6. We can access, strengthen and integrate this reservoir of health
and wholeness experiences by tapping them in
Dr. Parnell’s approach to Resource Tapping is based on 6 principles:
Laurel Parnell, PhD: Tapping In – an EMDR-Related Technique(2008)

59. 1. Relax and center yourself in the breath. Bring your attention to the part of
your body that is experiencing pain or dis-ease. WITHOUT JUDGING*,
notice what it feels like. Is there a color, shape or temperature associated
with it? * NOTE: this is an ACT intervention
2. Now bring your awareness to a part of your body that feels healthy. Notice
what it feels like. Is there a color, shape or temperature associated with it?
3. If you have difficulty locating a healthy feeling in your body, remember a time
when you were healthy. What were you doing? What did it feel like?
4. When you have a strong sense of that healthiness, begin to tap –right/left,
right/left – in a rhythm that feels comfortable to you. If the good feeling is
getting stronger and feels positive, tap longer if you wish.
5. Now invite the healthy image, sensations or temperature to transfer over to
the unhealthy part of your body. You might imagine the healthy transposing
onto the unhealthy part, mixing with it, or suffusing it with vitality. You can use
the image of white light to represent the feeling of health and allow it to fill the
unhealthy part. As you imagine this, tap 6 – 12 times, or as long
as it continues to feel positive.
Tapping In to an injured or unhealthy part of the body
after Laurel Parnell, PhD: Tapping In (2008)

60. 6. You can go back and forth between the sense of the healthy and unhealthy
part, repeating the steps as much as you like.
7. Imagine yourself healthy and whole in the future. Tap as you imagine this.
• You can also tap in memories of times when you healed in the past.
• To inspire hope, you can tap in the image of someone you know or have
heard about who recovered from a similar illness or injury.
• You can tap in healing imagery. What images do you associate with healing,
and would help your body to heal? What does your body need?
Laurel Parnell, PhD: Tapping In – A Step-by-Step Guide to Activating Your Healing Resources
Through Bilateral Stimulation. Sounds True Press, 2008 (pp. 119 – 121)
Tapping In to an injured or unhealthy part of the body (con’t)

61. Strupp (2001), showed that the outcome of a psychotherapeutic process is often
influenced by so-called non-specific factors, namely, the personal characteristics
of the therapist and the positive feelings that arise in the patient – feelings which
can lead to the creation of a positive therapeutic climate from an emotional and
interpersonal perspective.

62. April 25, 2017
The Placebo Effect in Psychotherapy
JAMA. 2017;317(16):1695. doi:10.1001/jama.2017.0645
A major conclusion from these studies was not only
that placebos are indispensable as controls in
scientific drug evaluation, but also that placebos are
powerful therapeutic tools in themselves.

63. The expectations of the patient play a significant role in the placebo effect; the
more a person expects the treatment to work, the more likely they are to exhibit a
placebo response.
A treating Clinician’s enthusiasm for a treatment can even impact how a patient
will respond. If a therapist seems very positive that a treatment will have a
desirable effect, a patient may be more likely to see benefits from engzging in the
intervention. This demonstrates that the placebo effect can even take place when
a patient is taking real medications to treat an illness.
How the Placebo Effect Works in Psychology
By Kendra Cherry VeryWellMind November 14, 2018
The Placebo Effect in Psychotherapy
JAMA. 2017;317(16):1695. doi:10.1001/jama.2017.0645
A major conclusion from these studies was not only that placebos are
indispensable as controls in scientific drug evaluation, but also that
placebos are powerful therapeutic tools in themselves.

64. stimulation of selected acupoints simultaneous with the mental activation of targeted
psychological issues is a major clinical breakthrough while skeptics counter that the
reported outcomes are improbable and certainly have not been substantiated with
adequate data
Joaquín Andrade, a physician trained in acupuncture and TFT, brought acupoint
tapping for psychiatric conditions to a group practice running 11 clinics in Argentina and
Uruguay. Improvement was found in 90% of the acupoint tapping group and 63% of the
CBT group, with complete relief of symptoms at 76% for acupoint tapping and 51% for
CBT. (N= 5,000)
Stimulating selected acupoints, according to the Harvard studies, simultaneously sends
deactivating signals to the amygdala. Repetition of the physical intervention resolves
these opposing signals by reducing the arousal while the trigger is still mentally active.
The hippocampus records that the memory or trigger is being safely engaged without a
stress response, and the neural pathways that initiate the associated stress response
are permanently altered. Being able to encounter the memory or trigger without limbic
arousal becomes the new normal.
ACUPOINT STIMULATION IN TREATING PSYCHOLOGICAL
DISORDERS: EVIDENCE OF EFFICACY
David Feinstein, Ph.D. Ashland, Oregon R e v i e w of G e n e r a l P s y c h o l o g y (2012)

65. • Developed by Dr Roger Callahan
PhD and researched as “Thought-
Field Therapy”
• Derived from the energy meridians
or “chi” which are the basis of
traditional Chinese medicine,
including acupuncture
• Callahan and his colleagues used
these same meridians and
acupressure points in developing
Thought Field Therapy
• Expanding research base, but
considered outside the mainstream
of psychology until recently
• Recently adapted and popularized
by Gary Craig, Gwenn Bonnell
and many others
• Many resources available on the
internet, but the techniques are
free, easily understandable, and
can be easily taught to patients
• It requires no special training or
certification, and is within the
scope of practice for SUD
Counselors
• EFT has been applied
successfully to many physical and
psychological problems, and
enjoys growing acceptance as an
“adjunctive therapy”
Emotional Freedom Technique or “EFT” Tapping

68. AMT
Welcome to. . .
An amazing
healing technique
that’s easy to learn
and has profound
effects
E m otional
F
T
reedom
echniques T M
F
E
T

69. 1) Focus on your pain. Intentionally think about
the physical symptoms, location, and how intense
the pain is right now as you are experiencing it.
Rate the intensity on the 0-10 scale, with 10 being
the most intense pain you can imagine possible.
2) Stay focused in the pain, and tap 50 times on
the Gamut Point on the back of one hand, using
two fingers of the opposite hand.
3) Tap 5 times on both collarbone points while
keeping your mind focused on the physical pain.
That’s it!
Now you want to re-rate the physical symptoms
you were focused on in Step #1.
HAS YOUR 0-10 RATING CHANGED?

70. If there is no change, or your rating only dropped a
point or two, you’ll want to correct for energy
reversals that might be impeding the tapping progress.
1. Here you’ll use the “Karate Chop” points on the
side of the hands under the baby (little) finger.
These are the spots you would hit doing a karate
chop on the edge of a table.
2. You can either tap on the Karate Chop point of one
hand with two fingers of the opposite hand, or you
can supercharge your results by tapping both
Karate Chop points together.
3. Focus again on the pain and tap on the Karate
Chop point while saying aloud, “Even though I still
have this pain, I accept myself and my body and I
allow the wisdom of my body to heal and release
whatever is causing this pain quickly, easily, and in
a healthy manner.”
Then repeat the QUICK TAPPING SEQUENCE FOR
PHYSICAL PAIN.
Tap Away Pain with EFT Emotional Freedom Techniques - Free EFT ...

71. Experiential Exercise:
EFT meridian tapping and affirmations for pain
The “basic recipe”: using one
finger of each hand, tap lightly
but firmly 5-6 times –
1. Over the eyebrows
2. The side of the eye
3. Cheekbone under the eye
4. Under the nose
5. Point of the chin
6. Collarbone
7. Ribs directly under the armpit
8. Finally, the top of the head
Repeat the cycle as often as you wish!

72. Experiential Exercise:
EFT meridian tapping and affirmations for pain
“Even though I have this
experience of pain, I
completely love and
accept myself”
“My experience of
physical discomfort
doesn’t keep me from
what’s important to me”

73. Effects of EFT Tapping on the Pain Cycle
In a double-blind study
conducted by Dawson Church,
PhD, Tapping was shown to
produce, on average, a 24
percent drop in cortisol after
just one hour of Tapping.
During that same hour of talk
therapy without Tapping,
participants showed a much
smaller drop in cortisol levels.

74. The demonstrable results that tapping has on
alleviating chronic pain may be explained, at least in
part, by its ability to access what are called meridian
channels.
While knowledge of these channels dates back to
ancient Chinese medicine, it wasn't until the 1960s that
these threadlike microscopic anatomical structures were
first seen on stereomicroscope and electron microscope
images. These scans showed tubular structures
measuring 30 to 100 micro-meters wide running up and
down the body. Described in a published paper by a
researcher named Kim Bonghan, they are also referred
to as "Bonghan channels." As a reference point, one red
blood cell is 6 to 8 micrometers wide, so
these structures are tiny!

75. You can think of meridian channels as a fiber-optic
network in the body. They carry a large amount of
information, often electrical and often beyond what the
nervous system or chemical systems of the body can
carry. By accessing these channels while processing
emotions, thoughts as well as physical conditions like
pain, tapping is able to get to the root cause of
chronic pain more quickly than other
approaches can.
Meridian Channels

76. Because tapping sends calming, relaxing signals
directly to the amygdala, it may also help us to
override the brain's negativity bias more rapidly.
By using tapping to neutralize what it thought
were threats to its survival, we're able to
reprogram the brain to support more positive
experiences, such as pain relief, pleasure, and
relaxation.
Meridian Channels

77. Putting it all together…
Questions
?
Comments
?

78. Thank You for your interest and attention!
Your
Michael G Bricker MS, CADC-II,NCAC-2 LPC
Behavioral Health Clinician
Trainer & Consultant
mbricker6421@gmail.com

79. Thank You for your interest and attention!
Your
Michael G Bricker MS, CADC-II, NCAC-2 LPC
Behavioral Health Clinician
LifestanceBehavioral Health Eugene, OR
mike.bricker@lifestance.com
Promoting Dual Recovery since 1984
Mike.bricker@STEMSSinstitute.org

80. Michael G. Bricker MS, CADC-II, LPC
Consultation in
recovery from
substance use and
mental disorders
The STEMSS® Institute
Support Together for Emotional & Mental Serenity and Sobriety
3459Timberline Drive
Eugene, Oregon 97405
Phone: (541) 880 - 8886
Email: mbricker6421@gmail.com
Promoting dual recovery since 1984