Abstract

Aim: To investigate whether emotional freedom technique (EFT) can improve emotional and psychosomatic health through clinical trials, and to further explore the relationship between emotional freedom technique and traditional Chinese medicine.

Methods: 30 participants with psychosomatic sub-health states and psychosomatic diseases were selected for a randomized controlled study from July to October 2022. A 4-week training regimen based on emotional freedom technique for the treatment group and no intervention for the control group. Both groups filled in the corresponding questionnaires at 3 timepoints. Finally, the score and change of each scale were sorted out and the data were analysed by statistical methods. The relationship and prospect of emotional freedom technique and traditional Chinese medicine were compared and analysed as well.

Results: After the training of the Emotional freedom technique, the Fatigue Assessment Inventory, Self-rating Anxiety Scale, Self-rating Depression Scale and Pittsburgh Sleep Quality Scale all decreased, and the changes were statistically significant. The results showed statistical differences before and after the training, indicating that the clinical trial effect of EFT was considerable.

Conclusions: Emotional freedom technique can improve psychosomatic health. It has an academic correlation with the meridian theory of traditional Chinese medicine, which also proves the correctness of the meridian theory. In today's post-COVID-19 era, the emotional freedom technique, as a convenient, safe and effective method of mental health care, has played a protective role in people's psychological health.

Introduction

The mental state of the global population

Under the ravages of the global COVID-19 epidemic since 2020, people's mental health has suffered a significant impact. According to the World Health Organization (WHO), the global prevalence of anxiety and depression increased by 25% in the first year of the pandemic [1]. Research revealed that the number of people with depression has increased by 60 million, while the number of people with anxiety disorders has increased by 90 million in one year after the pandemic [2]. This shows that the importance of mental and physical health and the restoration of confidence in life is even more critical at this time.

EFT (Emotional Freedom Technique)

Emotional freedom technique (EFT), also named "Emotion Freedom Tapping", was created by Gary Craig, an American psychologist based on Dr. Roger J. Callahan's Thought Field Therapy (TFT) [3]. The brief flow of EFT is to focus first on the emotion to be processed (Tune-in) and assess the intensity of this emotion (Measurement), establish a declarative sentence (Affirmation), and finally dismantle the reactionary mechanism (Psychological reversal), which refers to "Self-harm" or "Self-punishment" in the individual's subconscious (Self Sabotage). The act of disarming the release of emotions caused by the mechanism of counteracting the release of power means the release of these subconscious emotions. In short, EFT's theory is that "the cause of all negative emotions is a disruption in the body's energy system." [4] The so-called "intrusion" refers to the outbreak of hurtful negative emotional energy when something happens, which will be stored in the body's energy system and continue to harm the individual's psychosomatic functioning. The associated pain or emotion will naturally disappear once this energy is expelled or released from the body. EFT operates by talking about the psychological problems that are bothering you; you gently pat several related energy meridians on your body. In the unity of body and mind, slowly release the accumulated negative emotions and finally return to calm [5].

The relationship between EFT and Traditional Chinese Medicine (TCM)

The most direct connection between EFT and TCM is that the energy points in EFT coincide with the acupuncture points in the meridian theory of TCM [6]. For example, one of the energy points Karate Chop (KC) is located between the base of the little finger and the wrist, corresponding to the acupuncture points on the small intestine meridian, namely “Houxi” (SI3), which can clear the heart and calm the nerves, and activating the meridians. Another energy point Under the Nose (UN) is between the lower part of the nose and the upper lip, which belongs to the acupuncture point “Shuigou” (GV26) of the Governor Vessel Meridian. It has the effects of awakening and opening the mind, relieving erratic pulse, and reconciling yin and yang [7]. In addition to the meridian theory, EFT encourages trainers to pronounce proclamations aloud. In TCM theory, a loud voice is a sign of total energy, strength and confidence, and when the trainer raises the volume, they focus more on what is being said. EFT is intended to release negative emotions, which is closely related to the “emotions of the five zang organs” in the TCM theory. As liver qi can be soothed through emotional release therapy, its role in governing the free flow of qi over the entire body could be maintained [8].

Materials and Methods

Study Subject

From July to October 2022, participants were recruited by posters published on social media. 30 qualified participants were recruited for EFT training and final analysis.

Inclusion and exclusion criteria

Inclusion criteria: 1. All participants aged between 18 and 65; 2. Psychosomatic state of the participants was preliminarily judged through the questionnaires (Fatigue Assessment Inventory, Self-rating Anxiety Scale, Self-rating Depression scale and Pittsburgh sleep quality index); 3. Able to speak, read texts, pictures and watch videos; 4. Willing to actively cooperate with EFT training.

Exclusion criteria: People with serious physical illness or psychiatric illness such as cancer or schizophrenia.

Study design

This study is a tentative clinical trial. 30 eligible subjects were preliminarily screened through online recruitment from July to October 2021. Participants were divided into treatment groups and control groups in a 2:1 ratio. The research assistant used an online research randomizer to generate random numbers and concealed them in opaque envelopes. All participants have signed informed consents. The research protocol adhered to the ethical standards and was approved by the Research Ethics Committee (REC) of Hong Kong Baptist University.

Interventions

The treatment group was required to watch instructional videos and relevant pictures and texts published by researchers during the training period to conduct 4-weeks EFT training and fill out relevant questionnaires in November 2022. On the other hand, the control group will not receive any intervention for four weeks, but they will still need to complete a questionnaire on time. During the study period, the researcher will conduct corresponding TCM syndrome differentiation on all participants' samples, which will be associated with the final data analysis.

Statistical analysis

The database is developed by Microsoft Excel 2010 for data entry and score conversion. Data was processed using SPSS 26.0. Descriptive statistics (normally distributed quantitative data) was presented by mean ± standard deviation (x ± s), while the median values M (P25, P75) represented skewed data. The Student's T-test was used for comparing normally distributed quantitative data, while the non-parametric Mann-Whitney U test was used for skewed data. Statistical significance was defined as p< 0.05.

Results

Fatigue

After four weeks of EFT intervention, the treatment group's fatigue severity decreased from 55.88±7.68 to 31.09±8.44 (p=0.000). In addition, the environmental specificity of fatigue and the outcome of fatigue in the treatment group were reduced. The score of the final fatigue response to rest and sleep was also slightly reduced, and the above differences were statistically significant (p<0.05). In the control group, only the environmental specificity of fatigue decreased, which was statistically significant (p<0.05). There were statistically significant differences in both groups. Still, the changes in the treatment group were more critical, which showed that EFT significantly improved fatigue.

Anxiety and Depression

The anxiety level in the treatment group was significantly reduced, and the depression index was also reduced after a 4-week EFT intervention. The SAS score decreased from 58.71±3.55 to 35.61±8.1, and the SDS score decreased from 27.28±4.33 to 20.71±4.81, while there was no significant change in the SAS and SDS scores of the control group. (p>0.05). The decrease in the treatment group intuitively reflected the improved effect of EFT emotion release therapy on anxiety and depression.

Sleep Quality

The PSQI score of the treatment group decreased slightly from 9.72±5.36 before treatment to 9.19±5.22. The PSQI score of the control group increased slightly from 9.65±8.28 to 9.77±4.49. (p>0.05). From the data, it can be seen that EFT emotional release therapy did not significantly improve participants' sleep quality.

Discussions

EFT Mechanisms

The mechanism of EFT is similar to meditation in yoga and mindfulness [9]. EFT attempts to make people more focused on the present moment or problems that must be faced. Through synchronising words and energy point tapping, the trainer can stop thinking about the subsequent results and the anxiety caused by the imagined future. Consequently, they can focus more on facing and solving the current troubles and pressures brought by this problem.

Psychologically, autosuggestion is considered a fundamental concept in treating all emotional problems. Autosuggestion refers to self-stimulation through subjective imagination of a particular person or thing's existence to change behaviour and subjective experience [10]. The principles of autosuggestion are as follows: Always suggest in the present rather than in the future tense, and do it most positively and assertively, such as loudly proclaiming, focusing on the auto-suggestive thing, etc. It is essential to accept and feel all our emotions, including the so-called negative and negative emotions, rather than trying to change or avoid them immediately. EFT is linked to autosuggestion psychotherapy, which is also a manifestation of improving the trainer's self-confidence.

The connection between the TCM meridian acupuncture points and the EFT energy points

Traditional Chinese medicine believes that meridians are the channels that run qi and blood, connect all body parts, and are the regulatory system of human body functions [11]. Acupuncture points, or acupoints, mainly refer to particular points on the meridian line of the human body that are stimulated through acupuncture, massage, and moxibustion for treating diseases under TCM theory. In this study, different energy points correspond to different acupuncture points on the body in EFT, and the following analysis was made after collecting and collating the data in the study:

Cases’ emotional changes confirm the concept of the meridian theory of TCM: some participants reported that after continuously tapping the energy points SE, the current mood of confusion and irritability was alleviated. The energy point SE corresponds to the Tongzhiliao acupoint of traditional Chinese medicine. This acupuncture point belongs to gallbladder meridians. Tapping this acupuncture point mobilizes the liver and gallbladder qi. Since qi can be discharged, so that the irritability can be calmed. The same situation occurred with another energy point, CB, the Shenzang acupoint of Kidney Meridians. Participants reported that the energy point CB could soothe fear and anxiety. Surprisingly, the energy points in EFT have the theoretical basis of TCM meridian theory. At the same time, EFT emotion release therapy also reconfirms the feasibility and correctness of the TCM meridian system.

Conclusions

Based on the above data, it has been found that EFT has a positive effect on psychosomatic health (e.g. stress, anxiety, depression, etc.). As for limitations, due to the influence of the research workforce, time, and funding, this study recruited only 30 qualified volunteers to participate, resulting in a low sample size. Although this study has certain limitations, exploring the effects of EFT on psychosomatic health is innovative. As a low-cost, small-sample exploratory clinical trial, the study shows that EFT has a curative effect on the improvement of psychosomatic diseases, and it is hoped that the research on related topics can be further deepened in the future to promote the development of EFT in the psychosomatic field.

Conflicts of Interest:

The authors declare no conflict of interest.

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