Online and App-Based Research on EFT

Abstract

Background: The burgeoning area of mobile health (mHealth) has experienced rapid growth in mobile apps designed to address mental health issues. Although abundant apps offer strategies for managing symptoms of anxiety and stress, information regarding their efficacy is scarce.

Objective: This study aimed to assess the effect of an mHealth app on user self-ratings of psychological distress in a sample of 270,461 app users. The Tapping Solution App guides users through the therapeutic protocols of Clinical Emotional Freedom Techniques (EFT), an evidence-based psychophysiological intervention that combines acupressure with elements of cognitive and exposure therapies.

Methods: App users provided self-ratings of emotional intensity before and after app sessions (termed “tapping meditations”) using an 11-point Subjective Units of Distress scale. App user data for 23 tapping meditations, which addressed psychological symptoms of anxiety and stress, were gathered between October 2018 and October 2019, totaling 380,034 completed app sessions.

Results: Across 12 anxiety-tapping meditations, the difference in emotional intensity ratings from presession (mean 6.66, SD 0.25) to postsession (mean 3.75, SD 0.30) was statistically significant (P<.001; 95% CI −2.92 to −2.91). Across 11 stress-tapping meditations, a statistically significant difference was also found from presession (mean 6.91, SD 0.48) to postsession (mean 3.83, SD 0.54; P<.001; 95% CI −3.08 to −3.07). The results are consistent with the literature on the efficacy of Clinical EFT for anxiety and stress when offered in conventional therapeutic formats.

Conclusions: The findings provide preliminary support for the effectiveness of the mHealth app in the immediate reduction of self-rated psychological distress. As an adjunct to professional mental health care, the app promises accessible and convenient therapeutic benefits.

Citation (APA Style): Church, D., Stapleton, P. B., & Sabot, D. (2020). App-Based Delivery of Clinical Emotional Freedom Techniques: Cross-Sectional Study of App User Self-Ratings. JMIR mHealth and uHealth, 8(10), 1-15. Article e18545. https://doi.org/10.2196/18545

Direct link: https://mhealth.jmir.org/2020/10/e18545/

Abstract

Context: With obesity a mounting global issue, efficacious treatments can make a contribution to both personal and public health. Prior clinical trials have demonstrated that an evidence-based method, Clinical Emotional Freedom Techniques (EFT), can produce a durable weight reduction.

Objective: The study evaluated whether Skinny Genes, a six-week online program applying EFT to emotional eating, was associated with behavioral change and reductions in weight.

Design: A pre-post outcome study design evaluated the results of a convenience sample of participants enrolled in an online weight loss course.

Participants: Participant were recruited through EFT websites. Pre, post and follow-up measures were available for 72 participants and all analysis was performed on this sample.

Intervention: Participants used EFT to address cognitions, behaviors, and adverse experiences that could contribute to binge eating, intermittent dieting, and resistance to exercise.

Outcome Measures: Behaviors to restrain eating were measured using the Revised Restraint Scale (RRS); the association of food with reward using the Power of Food Scale (PFS); anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Weight was measured pre and postintervention and at six-month follow-up.

Results: Postintervention, a 36.8% reduction in anxiety (P < .001) and a 48.5% reduction in depression (P < .001) were found. The perceived power of food decreased significantly as did restraint behaviors. Participants lost an average of 12.9 lbs during the six weeks of the program (P < .001), and at follow-up, a further 2.6 lbs. All psychological gains were maintained (P < .001).

Conclusions: The findings are consistent with those of other clinical trials studying the benefits of EFT for weight loss, demonstrating simultaneous reductions in both weight and psychological distress. The continued weight reduction found on follow-up was consistent with other EFT studies but counter to the pattern of weight regain noted in the literature. Addressing emotional issues using an online delivery format was associated with durable weight-loss maintenance as well as improved mental health. App-based and virtual programs such as Skinny Genes have the potential to bring effective therapies to underserved populations.

Citation (APA Style): Church, D., Stapleton, P., & Raynor, D. (2022). Skinny Genes' Six-week, Online, Clinical Emotional Freedom Techniques Program: Durable Weight Loss and Improved Psychological Symptoms. Advances in Mind-Body Medicine, 36(1), 13-21.

Direct link: https://www.sciencedirect.com/science/article/abs/pii/S1550830717300964?via%3Dihub

Abstract

Recent research has demonstrated the effectiveness of Emotional FreedomTechniques (EFT), to address overeating behaviours in obese and overweightindividuals both in-person (Church & Brooks, 2010; Stapleton et al., 2011,2012, 2016, 2017) and online (Church, Stapleton, Sheppard & Carter, 2018;Church & Wilde, 2013). The aim of the present study was to determinewhether an online EFT program was as efficacious as the in-person treatment.This was achieved by comparing data from a randomised clinical trial (RCT)for an in-person EFT intervention for weight management (Stapleton et al.,2016), with an equivalent online RCT. Each program targeted food cravings,the subjective power of food, dietary restraint, body mass index, weight, somaticsymptomology, anxiety, and depression. Results indicate both modalitieswere comparable in efficacy and both groups experienced significant reductionsfrom pre-intervention to post-intervention, with reductions remainingsignificant at follow ups for food cravings, power of food, depression andweight, with minor differences observed at post-intervention or 6-month followup for dietary restraint, somatic symptoms, anxiety and body mass index.Follow-up analyses revealed a significant effect of depression, anxiety and weight on attrition in the online treatment group.

Citation (APA Style): Stapleton, P. B., & Stewart, M. (2020). Comparison of the Effectiveness of Two Modalities of Group Delivery of Emotional Freedom Technique (EFT) Intervention for Food Cravings: Online versus In-Person. Open Journal of Social Sciences, 8(2), 158-181. https://doi.org/10.4236/jss.2020.82014

Direct link: https://www.scirp.org/journal/paperinformation?paperid=98546

Abstract

Background: The combination of dietary restraint and physical exercise as a recommended treatment for weight loss has had limited long-term success. One factor proposed as limiting weight management techniques efficacy is the failure to target psychological processes linked with overeating. Consistent with prior research that has identified the efficacy of emotional freedom techniques (EFT) in reducing food cravings and aiding weight loss, this pilot randomised controlled trial (RCT) examined the impact of online delivery of EFT intervention on food cravings and weight management.

Methods: Participants were randomly assigned to an eight-week online EFT intervention group or waitlist control group. The sample comprised primarily of women (96%) aged between 41 and 60 years. Of the treatment group, 65% consumed their craved foods daily and had an average Body Mass Index in the obese range (33.3). Outcome measures assessed included food cravings, dietary restraint, subjective power of food, weight, somatic (body sensation), anxiety, and depressive symptoms.

Results: Post-intervention analyses revealed significant reductions on all measures for participants in the EFT condition (n = 314) with Cohen’s effect size values suggesting moderate to high practical significance for the online intervention. However, there were no significant differences for participants in the waitlist control group (n = 137). In this crossover study design, post-test waitlist data was then collapsed into the EFT treatment group data for follow-up analyses, which indicated treatment gains on all measures at 6-month (n = 216) and 12-month (n = 145) follow-up.

Conclusions: Findings constitute preliminary support for the utility of online EFT as an accessible tool to assist the management of food cravings and body weight.

Citation (APA Style): Stapleton, P. B., Trude, R., Mackintosh, G., Sparenburg, E., Sabot, D., & Carter, B. (2019). Online Delivery of Emotional Freedom Techniques in the Treatment of Food Cravings and Weight Management: A Randomised Controlled Trial. OBM Integrative and Complementary Medicine, 4(4). https://doi.org/10.21926/obm.icm.1904065

Direct link: https://www.lidsen.com/journals/icm/icm-04-04-065

Abstract

Background/Objective: Traditional methods of delivering therapeutic interventions have increasingly been supplemented by online courses. The current study investigated the effects of Clinical EFT (Emotional Freedom Techniques) in 76 participants enrolled in a six-week online course called Naturally Thin You. Weight, restraint, the power of food in the external environment, happiness, and posttraumatic stress disorder (PTSD) symptoms were assessed before and after the course and at one-year follow-up.

Method: Participants received six live group teleclasses, access to online course materials and a private social media group, and a year of monthly support teleclasses. No particular diet was recommended; the course focused instead on controlling emotional eating, and using EFT to treat the emotional triggers associated with food. Clinical EFTs Borrowing Benefits protocol, in which the group facilitator works with a single participant while others simultaneously self-apply EFT, was used during the teleclasses.

Results: Repeated measures ANOVA compared scores pre- to 12-month follow-up, and significant improvements were found for body weight (P <.001), depression symptoms (P = 0.010), restraint (P = 0.025), and the subjective power of food in the external environment (P = 0.018). Weight decreased an average of 1 lb/week during the course, and 2 lb/month between pretest and one-year follow-up. On follow-up, no change was observed in PTSD symptoms measured by a brief civilian trauma checklist, or anxiety, and increases in happiness were non-significant. The results indicate Clinical EFTs utility to address the influence of food in the external environment and assist weight loss, and to promote beneficial long-term change when delivered in an online format.

Citation (APA Style): Church, D., Stapleton, P., Sheppard, L., & Carter, B. (2018). Naturally Thin You: Weight Loss and Psychological Symptoms After a Six-Week Online Clinical EFT (Emotional Freedom Techniques) Course. Explore, 14(2), 131-136. https://doi.org/10.1016/j.explore.2017.10.009

Direct link: https://www.sciencedirect.com/science/article/abs/pii/S1550830717300964?via%3Dihub

Abstract

Background: The burgeoning area of mobile health (mHealth) has experienced rapid growth in mobile apps designed to address mental health issues. Although abundant apps offer strategies for managing symptoms of anxiety and stress, information regarding their efficacy is scarce. 
Objective: This study aimed to assess the effect of an mHealth app on user self-ratings of psychological distress in a sample of 270,461 app users. The Tapping Solution App guides users through the therapeutic protocols of Clinical Emotional Freedom Techniques (EFT), an evidence-based psychophysiological intervention that combines acupressure with elements of cognitive and exposure therapies. 
Methods: App users provided self-ratings of emotional intensity before and after app sessions (termed “tapping meditations”)using an 11-point Subjective Units of Distress scale. App user data for 23 tapping meditations, which addressed psychological symptoms of anxiety and stress, were gathered between October 2018 and October 2019, totalling 380,034 completed app sessions. 
Results: Across 12 anxiety-tapping meditations, the difference in emotional intensity ratings from presession (mean 6.66, SD0.25) to postsession (mean 3.75, SD 0.30) was statistically significant (P<.001; 95% CI −2.92 to −2.91). Across 11 stress-tapping meditations, a statistically significant difference was also found from presession (mean 6.91, SD 0.48) to postsession (mean 3.83,SD 0.54; P<.001; 95% CI −3.08 to −3.07). The results are consistent with the literature on the efficacy of Clinical EFT for anxiety and stress when offered in conventional therapeutic formats. 
Conclusions: The findings provide preliminary support for the effectiveness of the mHealth app in the immediate reduction of self-rated psychological distress. As an adjunct to professional mental health care, the app promises accessible and convenient therapeutic benefits.

Citation (APA Style): Church, D., Stapleton, P. B., & Sabot, D. (2020). App-Based Delivery of Clinical Emotional Freedom Techniques: Cross-Sectional Study of App User Self-Ratings. JMIR mHealth and uHealth, 8(10), 1-15. Article e18545. https://doi.org/10.2196/18545

Direct link: https://mhealth.jmir.org/2020/10/e18545/

Abstract

Background: Growing obesity rates are a problem worldwide. Several studies of emotional freedom techniques (EFT), a brief psychophysiologic technique, have indicated that it may be a promising addition to traditional weight loss interventions.

Objective: The current study evaluated food cravings, dietary restraint, subjective power of food, weight changes, and self-reported symptoms (e.g., somatic, anxious, and depressive) 2 years after an 8-week online self-directed EFT intervention with additional online support.

Design: Participants were initially randomly allocated to a treatment or waitlist group. The treatment group was instructed to self-pace through an online EFT treatment program made up of seven modules throughout the 8-week intervention period, and the waitlist was also completed at the end of this period.

Results: Analyses of the online EFT intervention program indicated significantly reduced scores for food cravings (−28.2%), power of food (−26.7%), depression (−12.3%), anxiety (−23.3%), and somatic symptoms (−10.6%) from pre to postintervention and from pre (baseline) until the 2-year follow-up and significantly improved scores for restraint (+13.4%). Further improvements were experienced for carbohydrates and fast food cravings between 6 months and 2 years. Body Mass Index and weight significantly decreased from pre- to 12 months follow-up although there were no differences at the 2-year point.

Conclusions: As an online intervention program, EFT was very effective in reducing food cravings, perceived power of food, psychologic symptomatology, and improving dietary restraint and maintaining those improvements over a 2-year period. The addition of EFT to traditional weight loss interventions is timely and supported by this research.

Citation (APA Style): Stapleton, P. B., Lilley-Hale, E., Mackintosh, G., & Sparenburg, E. (2020). Online Delivery of Emotional Freedom Techniques for Food Cravings and Weight Management: 2-Year Follow-Up. Journal of Alternative and Complementary Medicine, 26(2), 98-106. https://doi.org/10.1089/acm.2019.0309

Direct link: https://www.liebertpub.com/doi/10.1089/acm.2019.0309

Abstract

Background
Chronic pain represents a major global healthcare crisis, and current treatments are limited in effectiveness and safety. Emotional freedom techniques (EFTs) show promise as a potential psychological treatment.

Methods
The current study investigated the effect of a randomized clinical trial of EFT for chronic pain in a sample of 147 adult chronic pain sufferers (89.9% female; mean 54.63 years). Participants engaged in a 6-week EFT programme (either online self-paced or in-person).

Results
The per-protocol analysis indicated pain severity and interference scores were significantly lower at the end of treatment for the EFT group compared to waitlist, and these were sustained at follow-up. There were no differences between the in-person or self-paced programmes at follow-up for pain severity and interference. Somatic symptoms were significantly lower after EFT, although no further differences at follow-up. Quality of life scores were significantly higher after EFT, which were sustained at follow-up, and no differences between two styles of programme. No significant effects were found for anxiety, depression, happiness or satisfaction with life across the 6-week programmes for either style of delivery or at follow-up. These are discussed in terms of clinical score meanings. Intent-to-treat analysis was consistent with the per-protocol analyses. Limitations of the study are identified and future directions are discussed.

Conclusions
Findings offer early promise for EFT as a potentially effective pain management strategy, as well as support for online intervention without compromising treatment outcomes.

Citation (APA Style): Stapleton, P., Wilson, C., Uechtritz, N., Stewart, M., McCosker, M., O’Keefe, T., & Blanchard, M. (2024). A randomized clinical trial of emotional freedom techniques for chronic pain: Live versus self-paced delivery with 6-month follow-up. European Journal of Pain, 00, 1–14. https://doi.org/10.1002/ejp.4740

Direct link: https://onlinelibrary.wiley.com/doi/10.1002/ejp.4740