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Acupressure Enhanced
Psychotherapy
Theory,
Indications, Evidence
Joaquín
Andrade, M.D.
David
Feinstein, Ph.D.
In
preliminary clinical trials involving more than 29,000
patients from 11 allied treatment centers in South America
during a 14-year period, a variety of randomized,
double-blind pilot studies were conducted.
In one of these, approximately 5,000 patients
diagnosed at intake with an anxiety disorder were randomly
assigned to an experimental group (tapping) or a control
group (cognitive behavior therapy /medication). Ratings
were given by independent clinicians who interviewed each
patient at the close of therapy, at 1 month, at 3 months,
at 6 months, and at 12 months.
The raters made a determination of complete
remission of symptoms, partial remission of symptoms, or
no clinical response.
The raters did not know if the patient received CBT/medication
or tapping. They
knew only the initial diagnosis, the symptoms, and the
severity, as judged by the intake staff.
At the close of therapy:
63% of the control group were judged as having
improved; 90% of the experimental group were judged as
having improved. 51%
of the control group were judged as being symptom free;
76% of the experimental group were judged as symptom free.
At
one-year follow-up, the patients receiving the tapping
treatments were substantially less prone to relapse or
partial relapse than those with CBT/medication, as
indicated by the independent raters’ assessments and
corroborated by brain imaging and neurotransmitter
profiles. In a related pilot study by the same team, the
length of treatment was substantially shorter with energy
therapy and associated methods than with CBT/medication
(mean = 3 sessions vs. mean = 15 sessions). If subsequent
research corroborates these early findings, it will be a
notable development since CBT/medication is currently the
established standard of care for anxiety disorders and the
greater effectiveness of the energy approach suggested by
this study would be highly significant.
Despite
its odd-seeming procedures and eye-raising claims,
evidence is accumulating that energy-based psychotherapy,
which involves stimulating acupuncture points or other
energy systems while bringing troubling emotions or
situations to mind,1
is more effective in the treatment of anxiety disorders
than the current standard of care, which utilizes a
combination of medication and cognitive behavior therapy.
This paper:
1.
Presents preliminary data supporting this assertion.
2.
Discusses indications and contraindications for the use of
energy therapy with anxiety
For further information, visit:
http://www.innersource.net/
As well as other conditions:
3.
Speculates on the mechanisms by which:
a)
tapping specific areas of the skin while
b)
a stimulus that triggers a disturbed emotional response is
mentally accessed
apparently alleviates certain psychological
disorders.
A
Winding Road to Effective Anxiety Treatment
The
first author describes his initial encounter with panic
disorder, in a crowded urban hospital emergency room, some
30 years ago: The patient was trembling, dizzy, and
terrified, pleading, “Help me, Doc, I feel like I’m
gonna die!” My medical training had not prepared me for
this moment, and I emerged from it determined that I would
have a better response the next time I was faced with a
patient in acute panic.
This
was the first step on a long and winding road. I studied
with acknowledged experts on anxiety disorders, attended
relevant professional meetings, talked with famous
international specialists, read the books they
recommended, did my own literature searches, prescribed
medications, applied various forms of psychotherapy (from
psychodynamic to Gestalt to NLP), learned acupuncture in
China, made referrals to alternative practitioners
(including those specializing in homeopathy, cranial
sacral therapy, chiropractic, flower remedies, applied
kinesiology, ozone therapy, and Ayurvedic), sent people on
spiritual retreats, used all forms of machines from
biofeedback to electric acupuncture, even resorted to
sensory deprivation (confining a panic patient in a
sensory deprivation tank is a distinguishing sign of a
therapist’s desperation).
The
consistent finding: disappointing results. My colleagues
and I were making a difference for perhaps 40 to 50
percent of these people, albeit with multiple relapses,
partial cures, and many who never completed treatment.
Later, we combined alprazolam and fluoxetine with
cognitive behavior therapy, obtaining slightly better
outcomes. But never were we able to reach the 70 percent
in 20 sessions we had read about. Then came Eye Movement
Desensitization and Reprocessing (EMDR), which we learned
as an almost secret practice some friends were doing in an
East Coast hospital. We began to get more
satisfactory responses, yet along with them, disturbing
abreactions.
We
then learned about tapping selected acupuncture points
while having the patient imagine anxiety-producing
situations. It was a huge leap forward! We began to obtain
unequivocal positive results with the majority of panic
patients we treated. At first we used generic tapping
sequences. Then tapping sequences tailored for panic. Then
tapping sequences based on diagnosing the energy pathways
involved in each patient’s unique condition. All of
these strategies yielded good results, slightly better
with diagnosis-based sequences, averaging about a 70
percent success rate.
We
found we could further enhance these encouraging outcomes
by limiting sugar, coffee, and alcohol intake and
prescribing a physical exercise program. We emphasized the
cultivation of enjoyment. We showed our patients how
Norman Cousins used laughter in his own healing and
encouraged them to engage in sincere laughter for five
minutes twice each day. We introduced natural metabolic
substances, such as L-tryptophan, L-arginine, and glutamic
acid. For rapid symptom relief in severe cases, we found
we could combine a brief initial course of medication with
the tapping.
With
this regime, we have been able to surpass the 70 percent
mark. And we have gathered substantial experience
indicating that stimulating selected acupoints is at the
heart of the treatment and is often sufficient as the sole
intervention. Over a 14-year period, our multidisciplinary
team, including 36 therapists,2
has applied tapping techniques (we also use the term
“brief sensory emotional interventions”) with some
31,400 patients in eleven treatment centers in Uruguay and
Argentina. The most prevalent diagnosis3
was anxiety disorder.4
For 29,000 of these patients, our documentation included
an intake history, a record of the procedures
administered, clinical responses, and follow-up interviews
(by phone or in person) at one month, three months, six
months, and twelve months. We have also systematically
conducted numerous clinical trials. Our conclusion, in
brief: No reasonable clinician, regardless of school of
practice, can disregard the clinical responses that
tapping elicits in anxiety disorders (over 70% improvement
in a large sample in 11 centers involving 36 therapists
over 14 years).
Clinical
Trials
The
clinical trials were conducted for the purpose of internal
validation of the procedures as protocols were being
developed. When acupoint stimulation methods were introduced to the clinical team, many
questions were raised, and a decision was made to conduct
clinical trials comparing the new methods with the CBT/medication
approach that was already in place for the treatment of
anxiety. These were pilot studies, viewed as possible
precursors for future research, but were not themselves
designed with publication in mind. Specifically, not all
the variables that need to be controlled in robust
research were tracked, not all criteria were defined with
rigorous precision, the record-keeping was relatively
informal, and source data were not always maintained.
Nonetheless, the studies all used randomized samples,5
control groups,6
and double blind assessment.7 The findings were so striking that the research
team decided to make them more widely available.
Over
two dozen separate studies were conducted. In the largest
of these (and some of the other studies were sub-sets of
this study), approximately 5,000 patients were randomly
assigned to receive CBT and medication or tapping
treatments.8
Approximately 2,500 patients were in each group, with
diagnoses including panic, agoraphobia, social phobias,
specific phobias, obsessive compulsive disorders,
generalized anxiety disorders, PTSD, acute stress
disorders, somatoform disorders, eating disorders, ADHD,
and addictive disorders.9
The study was conducted over a 5½-year period. Patients
were followed by telephone or office interviews at 1 month
after treatment, 3 months, 6 months, and 12 months. At the
close of therapy, “positive clinical responses”
(ranging from complete relief to partial relief to short
relief with relapses) were found in 63 percent of those
treated with CBT and medication and in 90 percent of those
treated with tapping techniques. Complete freedom from
symptoms was found in 51 percent and 76 percent,
respectively.10 At
one-year follow-up, the gains observed with the tapping
treatments were less prone to relapse or partial relapse
than those with CBT/medication, as indicated by the
independent raters’ assessments and corroborated by
brain imaging and neurotransmitter profiles.11
The
number of sessions required to attain the positive
outcomes also varied between the two approaches. In one of
the studies, 96 patients with specific phobias were
treated with a conventional CBT/medication approach and 94
patients with the same diagnosis were treated using a
combination of tapping techniques and an NLP method called visual-kinesthetic
dissociation (the patient mentally plays a
short “film” of the phobic reaction while watching it
from a distance, and then rapidly rewinds and replays it,
gradually entering the film, until a “dis-sociation”
from the triggering event is effected). Positive results12 were
obtained with 69 percent of the patients treated with CBT/medication
within 9 to 20 sessions, with a mean of 15 sessions.
Positive results were obtained with 78 percent of the
patients treated with the tapping and dissociation
techniques within 1 to 7 sessions, with a mean of 3
sessions.13
The course of treatment for tapping throughout all trials
was generally between 2 and 4 sessions; the course of
treatment for CBT/medication was generally between 12 and
18 sessions. Tapping
patients were also taught simple sequences to apply at
home.
Standard
medications for anxiety (benzodiazepines, including
diazepam, alprazolam, and clonazepan) were given to 30
patients with generalized anxiety disorder (the three
drugs were randomly assigned to subgroups of 10 patients
each). Outcomes were compared with 34 generalized anxiety
disorder patients who received tapping treatment. The
medication group had 70 percent positive responses
compared with 78.5 percent for the tapping group. About
half the medication patients suffered from side effects
and rebounds upon discontinuing the medication. There were
no side effects in the tapping group, though one patient
had a paradoxical response (increase of anxiety).
Specific
elements of the treatment were also investigated. The
order that the points must be stimulated, for instance,
was investigated by treating 60 phobic patients with a
standard 5-point protocol while varying the order in which
the points were stimulated with a second group of 60
phobic patients. Positive clinical responses for the two
groups were 76.6 percent and 71.6 percent, respectively,
showing no significant difference for the order in which
the points were stimulated. In other studies, varying the
number of points that were stimulated, the specific
points, and the inclusion of typical auxiliary
interventions such as the “9 Gamut Procedure” did not
result in significant differences between groups, although
diagnosis of which energy points were involved in the
problem led to treatments that had slightly more favorable
outcomes. The working hypothesis of the treatment team at
the time of this writing is that for many disorders, such
as specific phobias, wide variations can be employed in
terms of the points that are stimulated and the specifics
of the protocol. For a smaller number of disorders, such
as OCD and generalized social anxiety, precise protocols
must be formulated and adhered to for a favorable clinical
response.
In
a study comparing tapping with acupuncture needles, 40
panic patients received tapping treatments on pre-selected
acupuncture points. A group of 38 panic patients received
acupuncture stimulation using needles on the same points.
Positive responses were found for 78.5 percent from the
tapping group, 50 percent from the needle group.
While
it must again be emphasized that these were pilot studies,
they lend corroboration to other clinical trials that have
yielded promising results regarding the efficacy of
energy-based psychotherapy, such as those conducted by
Sakai et al. (n=714, representing a wide range of clinical
conditions) and Johnson et al. (n=105, all PTSD victims of
ethnic violence in Albania, Kosovo). Both of these studies
were published in the October 2001 issue of the Journal
of Clinical Psychology.14
Indications
and Contraindications
The
follow-up data on the 29,000 patients coming from the 11
centers in South America included subjective scores after
the termination of treatment by independent raters. The
ratings, based on a scale of 1 to 5, estimated the
effectiveness of the energy interventions as contrasted
with other methods that might have been used.15
The numbers indicate that the rater believed that the
energy interventions produced:
1.
Much better results than expected with other methods.
2.
Better results than expected with other methods.
3.
Similar results to those expected with other methods.
4.
Lesser results than expected with other methods (only use
in conjunction with other therapies).
5.
No clinical improvement at all or contraindicated.
It
must be emphasized that the following indications and
contraindications for energy therapy are tentative
guidelines based largely on the initial exploratory
research and these informal assessments. In addition, the
outcome studies have not been precisely replicated in
other settings, and the degree to which the findings can
be generalized is uncertain. Nonetheless, based upon the
use of tapping techniques with a large and varied clinical
population in 11 settings in two countries over a 14-year
period, the following impressions can serve as a
preliminary guide for selecting which clients are good
candidates for acupoint tapping. There is also
considerable overlap between these tentative guidelines
and other published reports.16
Rating
of 1—“Much better results than with other methods.”
Many of the categories of anxiety disorder were rated as
responding to energy interventions much better than to
other modalities. Among these are panic disorders with and
without agoraphobia, agoraphobia without history of panic
disorder, specific phobias, separation anxiety disorders,
post-traumatic stress disorders, acute stress disorders,
and mixed anxiety-depressive disorders. Also in this
category were a variety of other emotional problems,
including fear, grief, guilt, anger, shame, jealousy,
rejection, painful memories, loneliness, frustration, love
pain, and procrastination. Tapping techniques also seemed
particularly effective with adjustment disorders,
attention deficit disorders, elimination disorders,
impulse control disorders, and problems related to abuse
or neglect.
Rating
of 2—“Better results than with other methods.” Obsessive
compulsive disorders, generalized anxiety disorders,
anxiety disorders due to general medical conditions,
social phobias and certain other specific phobias, such as
a phobia of loud noises, were judged as not responding
quite as well to energy interventions as did other anxiety
disorders, but they were still rated as being more
responsive to an energy approach than they are to other
methods. Also in this category were learning disorders,
communication disorders, feeding and eating disorders of
early childhood, tic disorders, selective mutism, reactive
detachment disorders of infancy or early childhood,
somatoform disorders, factitious disorders, sexual
dysfunction, sleep disorders, and relational problems.
Rating
of 3—“Similar to the results expected with other
methods.”
Energy interventions seemed to fare about equally well as
other therapies commonly used for mild to moderate
reactive depression, learning skills disorders, motor
skills disorders, and Tourette’s syndrome. Also in this
category were substance abuse-related disorders,
substance-induced anxiety disorders, and eating disorders.
For these conditions, a number of treatment approaches can
be effectively combined to draw upon the strengths of
each.
Rating
of 4—“Lesser results than expected with other methods.”
The clinicians’ post-treatment ratings suggest that for
major endogenous depression, personality disorders, and
dissociative disorders, other therapies are superior as
the primary treatment approach. Energy interventions might
still be useful when used in an adjunctive manner.
Rating of
5—“No clinical improvement or contraindicated.” The clinicians’ ratings of energy therapy
with psychotic disorders, bipolar disorders, delirium,
dementia, mental retardation, and chronic fatigue
indicated no improvement. While anecdotal reports that
people within these diagnostic categories have been helped
with a range of life problems are numerous, and seasoned
healers might find ways of adapting energy methods to
treat the conditions themselves, the typical
psychotherapist trained only in the rudimentary use of
acupoint stimulation should have special training or
understanding for working with these populations before
applying energy methods.
Other
Guidelines. Even
though the above guidelines are preliminary and heuristic,
diagnosis is clearly a key indicator of how and when to
bring energy-based psychotherapy into the treatment
setting. As part of the diagnostic work-up, co-morbidities
should also be carefully identified. Their presence of
course influences the treatment strategy. Even in cases
where energy interventions are not the treatment of
choice, they can be used as a complement to other
psychotherapies, drugs, and medical procedures. In these
cases, it is useful to orient them around well-defined
emotional issues and it is critical to keep other
treatment team members informed about the energy treatment
and its purpose. While interventions that tap acupuncture
points appear to be effective in alleviating a wide range
of physical disorders, much as acupuncture with needles
can be applied to illnesses ranging from allergies to
cancer, strong caution must be used when addressing
physical diseases or undiagnosed pain. Medical
examinations and the participation of medical personnel is
indicated when addressing any serious medical conditions
or symptoms that might prove to be the first evidence of a
serious condition. One the potential hazards is that
tapping acupoints may bring about subjective improvement
that ultimately wastes life-saving time.
Joseph
Wolpe’s Seminal Contribution to Energy Psychology
When
Joseph Wolpe developed systematic desensitization in the
1950s, he provided the next several generations of
clinicians their most potent single non-pharmacological
tool for countering severe anxiety conditions. Patients
were taught how to relax each of the body’s major muscle
groups. With the muscle groups relaxed, they would bring
to mind a thought or image that evoked an item from the
bottom of a hierarchy of anxiety-provoking situations they
had prepared earlier. They would learn to shift the focus
between holding the
thought or image and relaxing the muscle groups until the thought or image
was progressively associated with a relaxed response. They
would then systematically move up the hierarchy,
reconditioning the response to each thought or image by
replacing the anxious or fearful response with a relaxed
response.
This
process is the closest cousin energy therapy has among
traditional psychotherapeutic modalities. Both approaches
bring a problematic emotion to mind and introduce a
physical procedure that neutralizes the emotion. But
energy therapy also has a much older relative, whose
lineage substantially expands the range of problems that
may be addressed and the precision with which they may be
targeted. That progenitor is the practice of acupuncture.
Rather
than to relax the
muscle tension associated with anxiety or fear,
energy therapy corrects for a disturbed pattern in the
specific energy
pathways or meridians that are affected when the client is mentally
engaged with a problematic situation. For this reason, one
of the strengths of energy-based psychotherapy is the
range of emotional conditions with which it is effective.
Each of the body’s major energy pathways is believed to
be associated with specific emotions and themes. A
stimulus that brings a meridian out of harmony or balance
(while this is a complex concept, terms such as
underenergy, overenergy, and stagnant energy might each
apply) also activates the emotion associated with that
meridian. The treatment pairs the stimulus with an energy
intervention that rebalances the meridian, bringing it
back into coherence and harmony with the body’s overall
energy system. A disturbed meridian response is replaced
by an undisturbed response. Just as deep muscle relaxation
can neutralize a specific fear in systematic
desensitization, calming a disturbed meridian can
disengage the emotional reaction associated with that
meridian.
It
is because of the wide spectrum of emotions that are
governed by the meridian system17
that tapping interventions have a greater power and
applicability than systematic desensitization. Systematic
desensitization can neutralize anxiety-based responses by
countering them with deep muscle relaxation, but that is
the only key on its keyboard. Interventions capable of
restoring balance to any of the major meridians can
address the entire scale of human emotions, from anxiety
and fear to anger, grief, guilt, jealousy,
over-attachment, self-judgment, worry, sadness, and shame.
Note the spectrum of problematic emotions for which the
raters in the South American studies found energy
interventions to produce “much better results than other
methods.” These
impressions are corroborated by reports from practitioners
in numerous other settings who have been impressed by the
speed with which a wide range of problematic emotions can
be overcome by using energy interventions.18
Possible
Mechanisms
While
a framework that links specific emotions with specific
energy pathways requires a paradigm-leap for most Western
psychotherapists, the hypothesis is central to traditional
Chinese medicine, a 5,000-year-old method that is
currently the most widely practiced medical approach on
the planet. Its venerable though sometimes quaint concepts
are now being blended with modern scientific understanding
and empirical validation, and an approach is developing
that holds great promise for Western medicine as well as
for psychotherapy.
The
most controversial idea that emerges for psychotherapy is
that the body is surrounded and permeated by an energy
field which carries information19
Disturbances in this energy field are said to be reflected
in emotional disturbances. The concept of energy fields
carrying information that impacts biological and
psychological functioning is appearing independently in
the writings of scientists from numerous disciplines,
ranging from neurology to anesthesiology, from physics to
engineering, and from physiology to medicine.20 In energy psychology, this two-part formulation, in
which biochemistry and invisible physical fields are
believed to be working in tandem, has been used to explain
the rapid changes that are often witnessed in
long-standing emotional patterns. Changes in the energy
field are understood as having the power to shift the organization of electrochemical processes.
Many
of the electrochemical processes that are probably
involved have been mapped.21
When a person thinks about an emotional problem,
activation signals can be registered by various
brain-imaging techniques at the amygdala, hippocampus,
orbital frontal cortex, and several other central nervous
system structures. When tapping is simultaneously
introduced, the receptors that are sensitive to pressure
on the skin send an afferent signal, regulated by the
calcium ion, through the medial lemniscus, that reaches
the parietal cortex and from there is directed to other
cortical and limbic regions. The interaction of these
signals appears to cause a shift in the biochemical
foundations of the problem.22 One hypothesis is that the signal sent by
tapping “collides” with the signal produced by
thinking about the problem, introducing “noise” into
the emotional process, which alters its nature and its
capacity to produce symptoms. Enhanced serotonin secretion
also correlates with tapping specific points.
Whether
serotonin, the calcium ion, or the energy field (or some
combination) is the primary player in the sequence by
which tapping reconditions disturbed emotional responses
to thoughts, memories, and events, early clinical trials
suggest that easily replicated procedures seem to yield
results that are more favorable than other therapies for a
range of clinical conditions. Based on the preliminary
findings in the South American treatment centers, new and
more rigorous studies by the same team are planned or
underway. Many are designed to corroborate the informal
findings reported in this paper. Others will investigate
new protocols for patients who have not responded well to
more standardized energy interventions. Others will focus
on the neurological correlates of energy interventions,
using LORETA tomography and other brain imaging devices.
While much more investigation is still needed to
understand and validate an energy approach, early
indications are quite promising.
Notes
1
“Energy psychology," "energy-based
psychotherapy," and "energy therapy" all
refer to the therapeutic modality represented, for
instance, by the Association for Comprehensive Energy
Psychology (www.energypsych.org). Earlier therapeutic modalities within psychology
and psychiatry that focus on the body's energy systems
extend back at least to Wilhelm Reich and are seen in
contemporary practices such as bioenergetics and Gestalt
therapy.
2 The
initial group included 22 therapists. Of the 36 clinicians
to eventually participate in the studies over the 14-year
period, 23 were physicians (anxiety is typically treated
by the primary care physician in Argentina and Uruguay; 5
of the 23 physicians were psychiatrists), 8 were
“clinical psychologists” (in both countries, the use
of this title requires the equivalent of a masters degree,
substantial supervised clinical experience, and
specialized credentials as a clinical psychologist), 3
were mental health counselors, and 2 were RNs. All of them
had extended experience treating or assisting in the
treatment of anxiety disorders. Their experience with
energy psychology methods ranged from six months in the
initial phases of the clinical trials to some who by the
end had been using energy techniques for 14 years. Most
were initially trained in Thought Field Therapy and later
incorporated related techniques, generally customizing
their approach as they gained experience. During the
fourteen years, some of the 36 therapists were on staff
the entire period, some on the initial team left, others
came onto the team while the clinical trials were
underway.
3
Various assessment instruments were used over the course
of the 14 years. However,
in each clinical trial, the assessment methods were
standardized. Careful
clinical interviews were always taken, physical exams were
given when indicated, and interview data were supplemented
by scores from assessment instruments such as the Beck
Anxiety Inventory, the Spielberger State-Trait Anxiety
Index, SPIN for social phobias, and the Yale-Brown
Obsessive-Compulsive Scale for OCD. The most objective assessment tool that was used
involved pre- and post-treatment functional brain imaging
(computerized EEG, evoked potentials, and topographic
mapping).
4 Anxiety
disorders were defined as including panic disorders,
post-traumatic stress disorders, specific phobias, social
phobias, obsessive-compulsive disorders, and generalized
anxiety disorders.
5
Over the 14 years, a series of randomization methods were
used for assigning patients to a treatment group or a
control group. Simple randomization tables were used
initially; increasingly sophisticated randomization
software was subsequently introduced.
6 Because
the conventional treatment for anxiety—cognitive
behavior therapy (CBT) plus medication—was already being
used at the point the energy interventions were introduced
to the clinical staffs, patients were randomly assigned
for conventional CBT/medication treatment (which
constituted the control group) or for energy-based
treatment (which constituted the experimental group).
7
The raters assessing the patient’s progress at the close
of therapy and in the follow-up interviews were clinicians
who were not involved in the patient’s treatment and
were not aware of which treatment protocol had been
administered. Both
the patients and the raters were instructed not to discuss
with one another the therapy procedures that had been
used. The raters were given a close variant of the
following instructions: “This patient was diagnosed with [detailed
diagnosis, symptoms, and severity of the disorder as
judged at intake] and a course of a given treatment was
applied. Please assess if the patient is now asymptomatic,
shows partial remission, or had no clinical response.” Psychological testing and brain mapping were
administered by still other individuals who were neither
the patient’s clinician nor rater.
8 The
clinicians were generally proficient in both CBT and
energy methods. A
team approach was used in which non-medical therapists
worked with physicians who prescribed medications for the
CBT patients. Patients receiving energy treatments did not
receive medication. There was advance agreement among the
clinical staff about the nature of CBT and about the kinds
of tapping protocols that would be used with any specific
subset of patients. The same clinician might provide CBT
for one patient and an energy approach for another, but
the two approaches were not mixed.
9 In
addition to clinical interviews and physical exams where
indicated, the clinician would order specific assessment
instruments that were judged as being most appropriate for
measuring subsequent treatment gains based on the initial
diagnosis. The
Beck Anxiety Inventory was given to approximately 60% of
these patients, but other scales, such as SPIN for social
phobias or the Yale-Brown Scale for OCD were administered
instead when these diagnoses were suspected based on the
intake interview.
10 Clinical
outcomes were assessed based upon interviews conducted by
raters who were not involved in the therapy. These
assessments were then compared with the pre- and
post-treatment test scores and the pre- and post-treatment
digitized brain mappings. Functional brain imaging was
done with approximately 95% of the patients and can
identify, for instance, excessive beta frequencies in the
prefrontal and temporal regions, which is a typical
profile of anxiety. Most
recently, LORETA tomographies were introduced, allowing
the identification of dysfunction in deeper structures,
such as the amygdala and locus ceruleus.
While
this aspect of the study could and will be the basis of
future reports, in brief, the brain mapping correlated
with other measures of improvement, specifically the
psychological test data and the conclusions reached by the
raters. The
patients assessed as showing the greatest improvement also
showed the largest reduction of beta frequencies.
The
differences revealed by neuroimaging between the control
group and the tapping group are perhaps the study’s most
provocative heuristic finding, and the research team is
conducting further investigation into these differences.
In brief, even when symptoms improved, the
neurological profiles for the control group were only
slightly modified from the initial pathological indicies.
In the tapping group, however, the amelioration of
symptoms ran parallel with
modifications in the neurological profiles toward the
normal reference range. The hypothesis now being
investigated is that the tapping procedures somehow
facilitate a deep, systemic homeostasis, as if the effect
is not “suppression-augmentation” but rather a
homeodynamic adaptation.
11
Approximately
90% of the patients participated in follow-up interviews
at one year. This
high proportion is attributed to the relatively low
mobility of the populations served, the intimate quality
of the doctor-patient relationship in Uruguay and
Argentina, and the persistence of the research team. Also,
the follow-up interviews were most frequently conducted
over the phone, with patients encouraged to come in for a
more in-depth interview when relapses were reported.
Relapse
or partial relapse was found more frequently in the
control group than in the tapping group at each
post-therapy assessment (3, 6, and 12 months).
Partial relapses at one-year follow-up were 29% for
the control group and 14% for the tapping group. Total
relapses were 9% for the control group and 4% for the
tapping group. This
data is contaminated, however, by the administrative
policy of inviting participants back for further treatment
if the 3-month or 6-month follow-up interviews indicated
relapse. Because
both groups were given the opportunity for further
treatment, the differences between the groups may,
however, still be significant.
The relapse data also varied depending on
diagnosis. Disorders such as OCD and severe agoraphobia,
for instance, were far more prone to relapse under either
treatment condition than specific phobias, social phobias,
learning disorders, or general anxiety disorder.
Differences
in the stability of treatment gains between the groups
were corroborated by electrical and biochemical measures.
Brain mapping revealed that the tapping cases tended to be
distinguished by a general pattern of wave normalization
throughout the brain which, interestingly, not only
persisted at 12-month follow-up but became more
pronounced. An
associated pattern was found in neurotransmitter profiles.
With generalized anxiety disorder, for example,
norepinephrine came down to normal reference values and
low serotonin went up. Parallel electrical and biochemical
patterns were not found in the control group.
12
Results
in this sub-study were assessed as in footnote 10.
The number of sessions was determined by mutual
agreement between the therapist and the patient that
further treatment was not indicated.
13
While
in this particular sub-study the addition of the NLP
technique may have skewed the results in favor of the
tapping techniques, the overall findings with the 29,000
patients suggest that similar results are gained without
the inclusion of the NLP technique.
14
Although
these articles were published along with scathing
editorial critiques of the assessment techniques, case
selection, data analysis, and overall design, others have
found that despite these flaws, they are “fascinating
preliminary reports from a clinical standpoint” (Hartung,
J., and Galvin, M. Energy
Psychology and EMDR: Combining Forces to Optimize
Treatment. New York: Norton, 2003, p. 59).
15
While
subjective ratings of this nature certainly fall short of
being established assessment instruments, the purpose of
the ratings was to help the South American clinics
generate guidelines for the use of energy interventions.
The staff reports that these guidelines have proven
administratively useful and clinically trustworthy,
although the degree that they might generalize to other
settings is unknown.
16
Hartung
& Galvin, op. cit.
16, pp. 31 - 33.
17
In
the time-honored and strikingly sophisticated “five
element theory” of traditional Chinese medicine (known
as wu zing and probably conceived around 400 B.C.), each
of five basic “elements” is associated with a primary
impulse or rhythm found in nature (represented by the
metaphors of water, wood, fire, earth, and metal).
These impulses (a more precise translation than
elements is “phases in dynamic motion”) have two
distinct varieties, one being more active and outwardly
focused (yang), the other being more passive and inwardly
focused (yin). Each
of twelve major energy pathways or meridians is associated
with one of these primary impulses in its more active or
more passive state.
The
characteristics of each meridian and its functions reflect
the characteristics of its element.
When an imbalance arises in the energies of a
meridian, this may be a precursor to physical illness
related to the meridian’s element and function, but it
is also often expressed more immediately through the
activation of a specific emotion.
For instance, the “water element” meridians,
not surprisingly, are kidney and bladder.
The emotions that are associated with water element
fall along the continuum from fear to intelligent caution.
Imbalances in the kidney meridian, which is the yin
aspect of water element, lead to an internal fearful
state. Imbalances
in the bladder meridian, which is the yang aspect of water
element, lead more to reactive fears as events unfold.
Each
meridian governs a specific emotion derived from its
element and energetic (active or passive). While the form
and expression of that emotional impulse may vary
considerably as it interacts with the many other factors
making up a human personality, the basic relationship that
is of concern within energy psychology is that a
disturbance in a meridian’s energies tends to evoke a
specific emotion. Treating
the energy disturbance deactivates the emotion.
For
a list of the emotions associated with each meridian, in
both its balanced and reactive states, see the “Meridian
Emotions and Affirmations” table on the CD. For further
discussion of “five element” theory, see Chapter 7 of
Donna Eden’s Energy
Medicine (New York: Tarcher/Penguin Putnam,
1999).
18
This
statement is based on informal interviews with over 30
practitioners of energy psychology, including many of the
field’s recognized pioneers and leaders, conducted by
the second author while developing the Energy
Psychology Interactive program.
19
Feinstein, D. Subtle
Energy: Psychology’s
Missing Link. Paper
submitted for publication.
20
References can be found in David Feinstein’s At Play in
the Fields of the Mind, Journal
of Humanistic Psychology, 1988,
38(3): 71-109.
The entire text of this article is on the CD.
21
See,
for instance, Kerry H. Levin and Hans O. Luder’s Comprehensive
Clinical Neurophysiology (London:
W B Saunders, 2000).
22
One of the unsolved puzzles within energy psychology is
the observation that different tapping practitioners,
using different
techniques, points, and methodologies, get similarly
strong results with most anxiety disorders. This
impression was corroborated in the South America studies.
What is the underlying mechanism that accounts for the
positive outcomes being witnessed regardless of how the
components of the approach were mixed and matched? The
proponents of the various approaches tend to claim that
the strong results they report are a function of the
specifics of their particular technique. The common
element for all of them, however, is that they stimulate mechanoreceptors
in different parts of the body.
Mechanoreceptors
are specialized receptors that respond to mechanical
forces such as tapping, massaging, or holding.
Among their types:
Meissner corpuscles, Pacini corpuscles, Merkel
discs, and Ruffini corpuscles. They are sensitive to
stimulation on the surface of the skin anywhere on the
body. The
acupuncture points, called hsue
in traditional Chinese medicine (“hollow” rather than
“point” is actually the correct translation from the
Mandarin), are loci that have a particularly high
concentration of mechanoreceptors, free nerve endings, and
neurovascular density.
The signals that are initiated when tapping hsue
travel as afferent stimuli that are capable of reaching
the cortex, the amygdala, and the hippocampus.
So
a possible explanation for the puzzle of why stimulating
different points yields the same results involves the
simple fact that mechanoreceptors are distributed all over
the skin surface. Regardless of where you tap, you are
likely to stimulate mechanoreceptors.
The signal that is generated travels via large
myelinated fibers, ascends ipsilaterally through the
medial lemniscus, and triggers the somato-sensory cortex
at the parietal lobes and the prefrontal cortex. >From
there, the signal reaches the amygdala, hippocampus, and
other structures where the emotional problem has
neurological entity, and the signal apparently disrupts
established patterns. In theory, you can tap anywhere and
impact emotional problems.
Non-hsue
skin areas, or "sham points," also have
mechanoreceptors. But
because they are not as dense as in hsue,
the effect of tapping them is not as intense. Also, since
different hsue
send convergent signals that can release one or more
neurotransmitters, the same effects may be obtained from
stimulating different points.
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