ENERGY PSYCHOLOGY

Theory, Indications, Evidence

Joaqun Andrade, M.D. David Feinstein, Ph.D. 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 as well as other conditions, and 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 Im 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. NOTE: This paper was written for and appears in Energy Psychology Interactive: An Integrated Book and CD Program for Learning the Fundamentals of Energy Psychology (Ashland, OR: Innersource, in press). Phil Friedman, Ph.D., and Gary Craig provided astute critiques of an earlier version of this paper, and their contributions are gratefully acknowledged. Permission to copy for personal and educational purposes, with this note included, is freely granted.

For further information, visit: www.innersource.net 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 therapists 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

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diagnosing the energy pathways involved in each patients 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).

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Treating Anxiety During any six-month period, nine percent of Americans are afflicted with an anxiety disorderpanic disorder, post-traumatic stress disorder (PTSD), specific phobias, social phobias, obsessive-compulsive disorder, or generalized anxiety disorder (background information for this section was drawn from the website of the American Psychiatric Association, www.psych.org). While anxiety is an emotion designed to cause us to either flee from danger or to be fully focused and motivated in situations that demand effective action, if the mechanisms that control this process become impaired and anxiety will not turn off or goes into overdrive for no detectable reason, the experience is hard to bear. In addition to psychic distress that can be overwhelming, anxiety disorders often interfere with a persons ability to function. They not only occupy the mind with panic, consuming fears, excessive worry, terrifying flashbacks, or horrific scenarios, they can permeate the body with shakes, nausea, a racing heart, stomach upset, aching muscles, fatigue, numbness, restlessness, or insomnia. In the circular grip of chronic anxiety, fear of the next episode becomes yet another source of anxiety. People cannot usually just will themselves out of this condition, however strong their desire. Helping people suffering with anxiety disorders has been one of psychotherapys partial success stories. Exposure therapy, stress inoculation therapy, and EMDR (eye-movement desensitization and reprocessing therapy) are on a list, generated by the American Psychological Association, of empirically validated treatments for PTSD. Phobic patients who can cooperate with a cognitive behavioral treatment approach and conscientiously comply with back-home assignments are helped in 65 percent of the cases.5 A 22 to 18-month course of medication will help panic patients well over half the time, though relapse rates are estimated to be between 55

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percent and 70 percent after the medication is discontinued.6 Combining medication and cognitive behavior therapy (CBT) increases the durability of treatment gains.7 A cognitive behavioral approach includes methods such as shifting breathing patterns at the first sign of panic, cognitive restructuring to correct for catastrophic misinterpretations of bodily sensations or events, detailed recording of ones thoughts and behaviors along with attempts to shift them, and exposure to fearinducing cues while maintaining a state of relaxation in the body. Many of these interventions require invasive measures such as medication or aversion techniques. Others require persistent back-home application. Even in successful cases, it often requires eight to twelve weeks of compliance before significant gains are enjoyed. This was the state of the art when well-publicized claims about five-minute phobia cures with patients who had not responded to other treatments began to appear in the media. While making dramatic public claims in lieu of controlled research was not the most auspicious entry for getting the psychotherapeutic establishment to take an impartial look, this approachwhich has come to be known as energy psychology or energy-based psychotherapy or simply energy therapyis nonetheless rapidly gaining acceptance among growing numbers of seasoned clinicians.8

Clinical Trials The clinical trials in the South American treatment centers were conducted for the purpose of internal validation of the procedures as protocols were being developed. When energy psychology 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.

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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,9 control groups,10 and double blind assessment.11 The findings were so striking that they are worth reporting 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.12 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.13 The study was conducted over a 5year period. Patients were followed by telephone or office interviews at 1 month after treatment, 3 months, 6 months, and 12 months. 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.14 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 results15 were obtained with 69 percent of the patients treated

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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.16 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

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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 Psychology17 and their full text, along with that of related studies, can be downloaded from www.tftrx.com/5ref.html. For an overview of current research in energy psychology, maintained by the Association for Comprehensive Energy Psychology, visit www.EnergyPsychResearch.org.

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.18 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.

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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.19 Rating of 1Much 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 2Better results than with other methods. Obsessive compulsive disorders, generalized anxiety disorders, anxiety disorders due to general medical conditions,

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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 3Similar 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 Tourettes 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 4Lesser results than expected with other methods. The clinicians posttreatment ratings suggest that for major endogenous depression, personality disorders, and dissociative disorders, other therapies are superior as the primary treatment approach. Energy interventions may still be useful when used in an adjunctive manner. Rating of 5No 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

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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 will influence 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 serious conditions or symptoms that might prove to be the first evidence of a serious condition. Among the hazards: tapping acupoints may bring about subjective improvement that ultimately wastes life-saving time.

Joseph Wolpes 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 bodys 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

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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 modalities 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 bodys 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 bodys 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 system 20 that tapping interventions have a greater power and applicability than systematic desensitization.

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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.21

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 information22 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.23 In energy psychology, this two-part formulation,

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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.24 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.25 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

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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
Energy psychology," "energy-based psychotherapy," and "energy therapy" all refer to the therapeutic modality represented, for instance, by the Association for Comprehensive Energy Psychology. 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.
1

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.
2 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). Anxiety disorders were defined as including panic disorders, post-traumatic stress disorders, specific phobias, social phobias, obsessive-compulsive disorders, and generalized anxiety disorders.
4 5

From the website of the American Psychiatric Association, www.psych.org, specifically http://www.psych.org/public_info/anxiety_day.cfm#1#1.
6

http://www.psych.org/clin_res/pg_panic_1.cfm

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http://www.psych.org/public_info/anxiety_day.cfm#1#1.

While we do not know of formal studies supporting this claim, it is a widely held impression among practitioners, and it is backed by an emerging clinical literature typified, for instance, by the Energy Psychology Series launched by Norton Professional Books.
8

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.
9

Because the conventional treatment for anxietycognitive behavior therapy (CBT) plus medicationwas 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).
10

The raters assessing the patients progress at the close of therapy and in the follow-up interviews were clinicians who were not involved in the patients 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 patients clinician nor rater.
11

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.
12

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.
13

Clinical outcomes were assessed based upon interviews conducted by raters who were not involved in the therapy, as described in footnote 10. These assessments were then compared with the pre- and post-treatment test scores and the pre- and post-treatment digitized brain mappings. Brain mapping was done in approximately 95% of the patients. 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
14

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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. Interestingly, on 12-month follow-up, these beta frequency improvements not only persisted, they became more pronounced. Results in this sub-study were assessed as above. The number of sessions was determined by mutual agreement between the therapist and the patient that further treatment was not indicated.
15

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.
16

While 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).
17

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.
18 19

Hartung & Galvin, op. cit. 16, pp. 31 - 33.

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.
20

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 meridians 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

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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 meridians 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 Edens Energy Medicine (New York: Tarcher/Penguin Putnam, 1999). This statement is based on informal interviews with over 30 practitioners of energy psychology, including many of the fields recognized pioneers and leaders, conducted by the second author while developing the Energy Psychology Interactive program.
21 22

Feinstein, D. Energy: Psychologys Missing Link. Paper submitted for publication.

References can be found in David Feinsteins 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.
23

See, for instance, Kerry H. Levin and Hans O. Luders Comprehensive Clinical Neurophysiology (London: W B Saunders, 2000).
24

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 comparison studies conducted in South America. 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.
25

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

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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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