Further thoughts on EFT – Tapping as a safety behaviour?

CBT_Anxiety_TreatmentI’ve written before about the Emotional Freedom Technique and Tapping; a pretty ridiculous-looking form of therapy that involves tapping oneself on the face and body in order to stimulate the end-points of ‘energy meridians’. It’s clear that this is essentially bogus, for the blank and uncontroversial reason that such energy meridians in the body simply don’t exist.

However, it’s possible that people derive some benefit from tapping/EFT, even though the mechanism behind it is bunk. The internet is awash with people who claim to have had extremely positive experiences with all kinds of things, including reiki, homeopathy, acupuncture, any of the various kinds of energy healing, and a whole host of other new-age touchy-feely alternative-medicine approaches; all of which have been determined to be basically ineffective in controlled trials. The positive experiences that people have with these things can be fairly safely attributed to some combination of the placebo effect and regression-to-the-mean. Most likely the same is true for those who derive some benefit from EFT/tapping.

So far, so uncontroversial. In this view, tapping is basically harmless and the only people suffering from it are people who willingly pay money for bogus therapies. However, I want to make an alternative suggestion; in people who tap for issues related to anxiety, tapping might actually be harmful, because it might come to be a safety behaviour.

Safety behaviours are well-studied characteristics of anxiety disorders, and the Cognitive Behaviour Therapy (CBT) literature has many examples. This article explains them pretty well, but briefly, a safety behaviour is something that prevents engagement and exposure to the anxiety-provoking stimulus. For example, imagine someone who experiences panic attacks on trains, but  needs to take a train on their daily commute to work. One way of coping with this issue would be to simply get off the train at the next stop when the anxiety started to increase. A good CBT therapist doing exposure-therapy with this patient would instead recommend that they remain on the train and cope with their anxiety in other ways; this exposure to the feared situation, and the experience of being there and not having a panic attack (or having one, but then feeling the anxiety gradually decrease again) is the cornerstone of exposure therapy, and a very powerful weapon in the CBT therapists arsenal. In short then, safety behaviours are unhelpful in that they prevent exposure to the feared situation; they’re seductive, in that they reduce anxiety in the short term (by getting off the train, the situation is resolved and the panic attack doesn’t happen) but maintain, and perhaps even strengthen the association between a feared-situation and anxiety in the long-term. Some patients require many hours of therapy and exercises in order to reduce their safety behaviours, and this is generally a helpful process.

Tapping appears to be used a lot for anxiety relief, as this video (and many other videos/sites) suggests. My thought about tapping for anxiety then is, what if tapping becomes a safety behaviour? Tapping in an anxiety-provoking situation might serve to reduce the anxiety just because of simple distractibility. In fact it may be the spoken or sub-vocalised ‘scripts’ that accompany tapping that are more effective; something recognised by many previous authors. Unfortunately, this might have the effect of preventing the full exposure to a feared situation that is necessary to  learn that the fear will eventually reduce, and that the situation can be coped with. Just as for other safety behaviours, tapping might well be beneficial and highly reinforcing in the short-term (i.e. it reduces the anxiety) but harmful in the longer term. Some safety behaviours can be highly dysfunctional and, once entrenched, very difficult to eliminate.

14 responses to “Further thoughts on EFT – Tapping as a safety behaviour?

  1. You should write up these thoughts and problems, so that they are understandable to (stupid) patients. I have relatives who did this, and not wanting to be the negative guy who always bashed alternative medicine and not wanting them to lose at least the placebo help, I didn’t speak up against it. But the safety behaviour explanation seems highly plausible, and that would indeed be actively harmful. I think a few somewhat-skeptical people google this before therapy, but I remember doing so when I heard about it from my relatives and I couldn’t find any skeptical resources (that was before you started writing about it).

    • Hi there,
      I very much hoped that I was writing things in a (fairly) intelligible way for non-specialists! Hopefully some patients will find my little scribblings and perhaps think twice about spending their money on it…

      I’m honestly not sure about the safety behaviour angle – it seems plausible to me, but it’s just an idea. Thanks for the comment though!

  2. Carey Mann's - The Bridge

    I work with many doctor’s, surgeon’s, and neuroscientist’s and they are all open to learning more about new therapies, and eager to see if the future will hold new research that can explain if, and how they work. I use EFT (pain management) in the NHS for cancer patients and none of them believed in it prior to trying it: come on they would have to be mad as it looks completely mental.

    There is science that can support the concept of meridians http://www.prweb.com/releases/2011/12/prweb9029906.htm. I am just about to start a clinical trial with City University (using brain imaging) using EFT for chronic pain (we have already wired somebody up and seen the changes in the soma cortex when Tapping for whiplash. David Feintstein PhD has carried out many, many trials using EP http://innersource.net/ep/images/stories/downloads/Acupoint_Stimulation_Research_Review.pdf.

    Best xx

    • Hi Carey,

      Many thanks for getting in touch. I have to say, I’m somewhat appalled that EFT is being used in the NHS. I’m sure your intentions are good and you may even attain some good results, but it’s disturbing to me that public money is being used for something which has such a tiny evidence-base.

      I don’t buy that paper which says that C-fibre branching points correspond to acupuncture points either I’m afraid – C-fibres are present throughout the skin, and the branching points are everywhere. Plus, C-fibres are actually pretty well characterised in their functions: http://en.wikipedia.org/wiki/Group_C_nerve_fiber

      Would be very interested in hearing more about your brain imaging work with EFT. You mentioned seeing a change in the somatosensory cortex with EFT – would that not more plausibly be interpreted as simple phasic activation to the tapping itself? From what you said I assume you used EEG, which means that you probably couldn’t source-localise the signal within the somatosensory cortex with enough precision to determine if it was related to the tapping, or the whiplash. Is that correct?

      The Feinstein paper is harder to argue with, I’ll admit, though I do have to note that he is hardly an unbiased examiner of the literature, given that he’s heavily involved in the whole ‘energy psychology’ movement (http://www.innersource.net/ep/). For an alternative very recent, very comprehensive review on acupuncture, I’d suggest this letter by David Colquhon and Steven Novella:
      http://www.dcscience.net/Colquhoun-Novella-A&A-2013.pdf

      Thanks again for the comment – very interesting.

  3. Emotional Freedom Technique and EFT are registered trade marks belonging to Gary Craig. What we have is an MLM scheme of sorts; take a course over a couple days, try it out on friends, family and your own issues pay an exam fee, employ a mentor for a couple of hours, pay a registration fee and hay presto your a certified EFT practitioner.

    To move up the pyramid you can become a mentor yourself and then a trainer with ever increasing licensing fees.

    Simple.

    Why spend all that time studying at university and in the clinic?

    http://www.eftuniverse.com/index.php?option=com_content&view=article&id=8564

    http://www.skepdic.com/eft.html

  4. Speaking of science that can support the concept of meridians, did you hear of the Primo Vascular System, also known as “Bonghan channels”?
    Here you can find a summary of the Bong-Han Kim’s publications. The subjects of articles are the studies on the reality of acupuncture meridian, the Kyungrak system, and the Sanal theory.

    http://link.springer.com/chapter/10.1007%2F978-1-4614-0601-3_2#page-1

    • Half-translations of five papers from Korean, with no methods sections – you find that persuasive? The primo-vascular system seems to be a pretty fringe field of endeavour.

  5. I’d agree that using ‘tapping’ as a safety technique is likely the only plausible execution could yield any genuine effectiveness. As such, this really only reinforces the concept of the safety technique as the tool and the ‘tapping’ is just one possible physical implementation.

    One could also argue that from a CBT toolkit perspective, the ‘tapping’ is only effective insofar as it’s a conscious reminder to change the behaviour, in your example, ameliorating an anxiety attack. From a behaviour changing POV, it’s more likely the timing of the tapping (or safety trigger) is more important than the actual tapping as technique itself. You’d have to ask, is it a way of letting yourself know you’re about to hit danger, so you move away from the anxiety bringing thing (i.e. getting of the crowded train)? Or are you tapping in hopes that you can tap the anxiety away? The former is a conscious change, the latter wishful thinking at best.

    It could also run the risk of becoming a crutch, and end up being more harmful than helpful. If you become too focussed on the ‘tapping’ as the thing changing the behaviour, rather than the implementation of a safety, it’s possible that you lose the element of mindfulness or challenging the behaviour.

    So yeah, I can see how tapping something on one’s person can be a safety technique as a CBT tool, *anything* that challenges the behaviour you’re attempting to rework can do that, but you also have to be ready to throw it away if it stops being helpful.

    At best ‘tapping’ sounds like ‘placebo finger’. Great as a CBT “tool”, perhaps, but utter bullshit as a stand alone panacea to anything.

    • Yes – that’s exactly what I was trying to get at – tapping might very well help to reduce anxiety, but it’s a temporary fix, and might prevent ‘proper’ exposure and the concomitant anxiety reduction. Thanks for the comment!

  6. I think I missed an indirect object/mistaken syntactic category or two in there… sorry!

  7. I have used ‘tapping’ with nearly 200 individuals, mostly to deal with anxiety-related issues (primarily performers suffering from various degrees of stage fright/performance anxiety) and my experience indicates that, with all due respect, the possibility of ‘safety behavior’ is minimal. Those I have worked with are constantly being exposed to the ‘stressor’ — performance situations — and for the most part, were unsuccessful in reducing their performance anxiety before the use of EFT/tapping tools. The results have been lasting in my experience, with little to no recurrence of the original anxiety as much as 3 1/2 years later (I began studying these tools and sharing with colleagues/students/clients in 2010).

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  9. Wow you might wanna check your science before you go off slandering people, the meridians HAVE been discovered by western practitioners, only since the 80s, not like that was decades ago or anything. No matter how bad your arrogance wishes to usurp the truth of practices done for millennia, it can’t be done. 0/10 on this for failing to research your personal projections and using fallacious arguments to form the foundation for your hollow arguments. Thank you, maybe the right brain cell will grow while you’re off guard and you’ll develop a noteworthy theorem.

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