Have you thought about integrating tapping into your clinical toolbox?
Emotional Freedom Techniques (EFT) tapping uses the self-stimulation of acupuncture points through tapping to decrease distress.
EFT tapping is a body-centric therapy that combines elements of cognitive and exposure therapy you may already use, with light pressure on acupoints.
The number of professionals using EFT tapping is estimated in the tens of thousands (Leskowitz, 2016). Tapping is used by psychotherapists, teachers, physicians, athletic trainers, nurses, life coaches, and disaster relief workers (Feinstein, 2023).
The underlying premise of EFT tapping is that stimulating the physical body has psychological effects. But how does it work? What can you use it for? Is it effective? In this blog post, we will describe how to perform clinical EFT, the science of tapping, and how it can be integrated into your practice.
EFT tapping is a somatic intervention to reduce psychological distress through self-stimulation of acupoints on the face and upper body while focusing on sensations in the body, or a distressing thought or feeling (Stapleton, 2020).
The stress response is experienced not only as a constellation of emotions and patterns of thinking, but also as physiological symptoms in our body that result in a dysregulated nervous system. EFT tapping works to regulate our nervous system by stimulating acupoints.
EFT tapping is extremely versatile as a supplement to existing therapeutic interventions and as an effective self-help technique for immediate relief of distressful symptoms outside the clinical setting.
Clinical EFT is the standard method of acupoint tapping used in clinical efficacy trials and is distinguished from other methods of EFT that have been put forth since the early 1990s. It is called Emotional Freedom Techniques (plural) because it consists of 48 different techniques from modern psychology, including Cognitive-Behavioral Therapy and Prolonged Exposure Therapy (Church, 2013).
The “basic recipe” is outlined in five steps below. A more detailed description of the steps, along with the 48 techniques of clinical EFT, can be found in The EFT Manual (Church, 2013). For an explanation and visual demonstration of clinical EFT by researcher Peta Stapleton, check out this video.
What is EFT Tapping, How Does it Work and How Do You Tap?
Step 1. Identify a problem
Be specific. Identify a troublesome thought, feeling, behavior, or physical discomfort experienced in a specific part of the body. The problem can be an experience in the past, present, or future.
I can’t stop myself from eating even though I’m not hungry.
I feel so much tension in my face right now.
I’m so scared to drive after my car accident.
Step 2. Rate the level of distress
On a scale of 1 to 10, with 10 being the most distress, rate the level of discomfort being experienced right now in the present moment. The rating identifies the size of the problem and gives a starting point for measuring change in distress within a tapping session.
Step 3. Setup statement and side-of-hand tapping
The setup statement is a two-part statement. It includes:
An exposure statement that brings the negative experience front and center
An acceptance statement that recognizes the current reality at this moment
The statement should be specific, such as a pain, physical sensation, emotion, image, sound, taste, odor, or belief.
Side-of-hand tapping: Repeat the setup statement aloud two to three times while tapping the fleshy side of the hand connected to the pinkie finger with the fingertips of the opposite hand (see illustration).
“Even though I am craving another slice of pizza, I completely accept myself anyway.”
“Even though this tension I feel in my face won’t go away, I accept that I feel this way.”
“Even though I keep replaying the car accident in my mind, I deeply and completely accept myself.”
*The term “karate chop” is no longer used to describe side-of-hand tapping.
Using two fingertips, manually tap each of the eight acupoints in the illustration in sequence while repeating aloud a reminder phrase. The reminder phrase is a word or short phrase from the exposure statement. Its purpose is to prevent the mind from wandering and sustain attention to the problem. Repeat the tapping sequence along with the reminder phrase two to three times.
Step 5. Re-rate the level of distress
Using the same 1 to 10 scale, re-rate the level of distress. Repeat step four until the distress rating is 0 or 1.
EFT tapping is not a “one and done” treatment. Trauma and anxiety are complex experiences of the body and mind with roots in one’s past and in the subconscious mind. Clinical tapping is used across a series of sessions to get at root causes by “tapping out” distressful feelings and thoughts as they arise in a session.
With a gentle approach, clinical EFT is a safe and effective technique to incorporate into clinical practice to improve self-regulation. Now we turn from technique to the research side of EFT tapping. What is the science behind the effectiveness of EFT in a clinical setting?
6 Emotional Freedom Techniques Studies
Over 300 research studies of clinical EFT have been published in peer-reviewed publications (Church et al., 2022).
EFT therapy is currently under review by the American Psychological Association (APA) for use in trauma and post-traumatic stress disorder. As of the time of writing, it is not yet listed as an evidence-based treatment by the American Psychological Association.
To date, clinical EFT has been validated in numerous clinical trials that comply with the standards for empirically supported treatments (Society of Clinical Psychology, 2022). Clinical EFT research has skyrocketed, and significant progress has been made to meet the APA standards for evidence-based treatment.
1. Clinical EFT reduces biomarkers of stress
Improvement in multiple physiological markers of health is associated with clinical EFT (Bach et al., 2019). In the first clinical EFT study published by the APA, Stapleton et al. (2020) reported that one hour of acupoint tapping reduced the stress hormone cortisol compared to psychoeducation and no-treatment groups.
2. EFT is capable of reducing symptoms comparable to CBT
Is EFT as effective as other evidence-based treatments, such as Cognitive-Behavioral Therapy (CBT), eye movement desensitization, and exposure therapy? Stapleton et al. (2017) reported a reduction in psychological symptoms comorbid to obesity in adults after an eight-week EFT or CBT intervention.
The EFT intervention reduced anxiety and depression at six- and 12-month follow-ups, while the CBT intervention reduced depression and somatoform symptoms at six- and 12-month follow-ups.
3. FMRI shows brain changes after EFT
Data from imaging studies are powerful indicators of the effect of clinical EFT on neural organization. Stapleton et al. (2022) reported decreases in neural connectivity between areas of the brain related to modulating and catastrophizing pain in chronic pain sufferers after a six-week EFT intervention.
4. Integrating EFT into psychotherapy
EFT is a somatic technique with neurological effects and can be easily added to well-established treatments regardless of the theoretical perspective of the clinician. For example, acupoint tapping can reduce the stress response while a client actively processes past trauma (Church et al., 2020).
5. Group EFT reduces psychological symptoms
“Borrowing Benefits” is the phenomenon that simply watching someone else do EFT on their own issue can decrease the intensity of your own issues as you tap along. Church and House (2018) reported a decrease in psychological symptoms of anxiety and depression six months after attending a two-day group EFT workshop.
These results have been replicated (Palmer-Hoffman & Brooks, 2011).
6. What is standing in the way of EFT as an evidence-based treatment?
Feinstein (2021) provides six empirically supported premises of EFT tapping that describe the significant progress made in research in acupoint tapping over the past 20 years.
Acupoint tapping is effective in treating a range of clinical conditions.
Acupoint tapping is rapid compared to conventional treatments.
Acupoint tapping has durable benefits.
Acupoint tapping produces changes in biologic markers that corroborate clients’ subjective assessments.
Acupoint tapping is a critical ingredient for the demonstrated clinical effects.
Stimulation of selected acupoints sends signals that can increase or decrease arousal in specific areas of the brain.
To make progress as an evidence-based treatment, Feinstein (2021) suggests:
Improvement in research rigor and transparency
Improvement in communication of research to the larger treatment community
The exact mechanism that leads to the benefits of clinical EFT remains unclear. However, significant progress has been made to identify testable neural and physiological mechanisms.
Watch this quick animation describing the neural mechanism behind EFT tapping for a weight management program developed by Peta Stapleton and used in clinical trials.
How does tapping work?
1. Acupoint tapping calms the amygdala
Tapping on known acupoints sends deactivating signals to the amygdala. With repeated sessions of EFT tapping, the deactivating signals outweigh the activating signals of the stress response created by exposure to the distressing thought.
Neural imaging shows the effects occur almost instantaneously, which may account for the rapid improvement in symptoms reported with EFT tapping (Feinstein, 2019).
2. Acupoint tapping speeds up memory reconsolidation
As EFT tapping brings about a more regulated nervous system, the exposure statement simultaneously brings the distressing emotion front and center. The distressing mental image of donating blood for a person with a needle phobia is unexpectedly met with less arousal and this “prediction error” prepares the neural network for change.
The hypothesis is that tapping reconstructs the neural circuits that maintain maladaptive mental models (Feinstein 2021).
3. EFT decreases physiological stress
Clinical EFT intervention improves biological markers of stress, including resting heart rate, blood pressure, immune function, and the stress hormone cortisol.
Chronic low-level stress and repeated activation of the stress response can have long-term effects on the body, such as weight gain, high blood pressure, cardiovascular effects, and changes in the brain related to anxiety, depression, and addiction (Bach et al., 2019; Stapleton et al., 2020).
Can You Use Tapping Therapy for Anxiety?
EFT tapping is an effective treatment for reducing symptoms of anxiety experienced with post-traumatic stress disorder (PTSD), trauma, social anxiety, chronic pain, and more.
The overall effect of EFT for treatment of anxiety pretreatment to posttreatment is 1.23, which is a large effect size (Clond, 2016).
When the nervous system is in a state of intense dysregulation, such as fight-or-flight, silent tapping with no setup statement is a gentle place to start to reduce heart rate, respiration, and distressing thoughts. Instruct clients to focus directly on the sensation of the pressure of individual finger taps on each of the eight acupoints.
Start with the body
A gentle beginning setup statement focuses on the physical body. Often, we can detect a change in our physical body more easily than we notice change in our emotions or thinking, and it’s encouraging to feel progress.
Start with a body-focused setup statement that identifies exactly where the emotion, thought, or sensation is being felt in the body. For example, tension in our face, butterflies in our stomach, and grinding our teeth are bodily sensations related to distress in our mind.
Identify root causes
When distress is further reduced, setup statements that go deeper into the emotions or thoughts related to physiological symptoms may be possible.
For two questions you can use to find root causes with EFT tapping, listen to this podcast episode Tapping Q & A with Gene Monterastelli.
EFT tapping is used to assist weight loss, reduce food cravings, and improve binge eating psychopathology.
Tip #1: Replace negative with positive
After a few rounds of successful EFT tapping on a food craving, tap on a positive statement that replaces the space where the craving used to be.
Setup statement for craving: “Even though this craving for something sweet feels like such a burden, I completely accept myself and this feeling.”
When self-reported stress is reduced, replace it with positive tapping statements: “I listen to my body,” “My body is satisfied,” or “I take care of my body.”
Tip #2: Tap on negative comments
To increase body confidence, clear out negative statements said by others by including them in a setup statement. For a more detailed description, read this Healing Story from Roushan Martens.
Negative comment: “Those jeans are too tight on your butt.”
Setup statement: “Even though my mom said my jeans are too tight for me, I completely accept the way I look.”
Reminder phrase: “Too tight”
Self-rate the level of distress. Continue until distress decreases to a 0 or 1.
As a follow-up, ask what the client would like to say to their mom. Tap out these responses on one acupoint each:
“You make me feel bad about myself. Stop doing that.”
“I like the way I look.”
“Keep your opinions to yourself.”
Self-rate the level of distress. Continue until distress decreases to a 0 or 1.
Tip #3: Borrowing Benefits for weight loss
Borrowing Benefits as described earlier are when your distress is relieved as you observe another person use EFT tapping on their own issue.
Use this technique in group settings or as homework. Ask clients to watch an EFT video and tap along. Check out below a live demonstration with instructions as Dawson Church uses tapping to stop using sweets as a reward in an EFT workshop. You can also read these instructions for using Borrowing Benefits.
EFT for Stopping Using Sweets as a Reward for Being Good
Where to Get EFT Tapping Training
High standards of education and training ensure the safety and integrity of EFT tapping. Find the education, training, and certification program to meet your specific goals as a practitioner. Certification does not require licensure, except for training from ACEP, although about half are licensed professionals. All programs are online with virtual or in-person options available.
Not sure if you are ready for certification? Browse through each of the sources below for how-to videos, annual research reports, FAQs, professional conferences, and more.
Association for Comprehensive Energy Psychology (ACEP)
They provide comprehensive training and certification for a wide range of clinical settings and populations. Certifications are only available to licensed practitioners or those with counseling training and includes APA-approved CE/CME credits.
Emotional Freedom Techniques Professional Skills 1 & 2
ACEP Certified Practitioner of EFT
ACEP Certified Advanced EFT Practitioner
Training based on clinical EFT as described in The EFT Manual founded by Dawson Church (2013) is provided by EFT Universe.
Browse their Ultimate EFT Certification Program curriculum.
Evidence-Based EFT is an Australian-based, online, global training platform founded by Peta Stapleton.
Course options include:
Evidence-based EFT Premium Accreditation
Evidence-based EFT Practitioner Training
Evidence-based EFT Training for Trauma
Evidence-based EFT Advanced Training
Tapping in the Classroom Training for Teachers
EFT for Weight Management Certification
EFT HQ monthly subscription to master classes, video instructions, and online workshops
EFT International is a nonprofit organization dedicated to upholding the highest standards of EFT practice developed by Gary Craig. Certification options include:
Accredited Certified EFT Practitioner
Accredited Certified Advanced EFT Practitioner
A Take-Home Message
In modern psychological practice, it’s easy to overlook the physical body as we focus on our clients’ thinking and emotions. Yet, our thoughts and emotions in the moment, our memories of the past, and our imaginings of the future are tethered to our physiology. Our nervous systems are in a constant state of responsiveness to our experiences.
One of my favorite mental health quotes is from neuroscientist and psychologist Lisa Feldman Barrett (2020, para. 35) and what she calls the fundamental dilemma of the human condition:
“The best thing for your nervous system is another human and the worst thing for your nervous system is another human.”
That argument with your partner this morning, the hug from your daughter, that look someone gave you as you walked in the door … they all changed your nervous system. This is powerful stuff. Quite literally, we have the capability to change our own nervous systems and destroy or lift up the nervous systems of those around us, and it happens in an instant.
Manual stimulation of acupressure points with EFT tapping changes our nervous system and gets us to a calmer state. It is consistently reported as a highly effective, durable, and cost-effective treatment option to use in isolation or alongside conventional clinical practices.
The reported benefits of EFT tapping in group settings, online, in an app, in individual therapy, and as a self-administered treatment make it an extremely versatile treatment option.
Bach, D., Groesbeck, G., Stapleton, P., Sims, R., Blickheuser, K., & Church, D. (2019). Clinical EFT (Emotional Freedom Techniques) improves multiple physiological markers of health. Journal of Evidence-Based Integrative Medicine, 24, 1–12.
Church, D. (2013). The EFT manual (3rd ed.). Energy Psychology Press.
Church, D., & House D. (2018). Borrowing Benefits: Group treatment with clinical Emotional Freedom Techniques is associated with simultaneous reductions in posttraumatic stress disorder, anxiety, and depression symptoms. Journal of Evidence-Based Integrative Medicine, 23, 1–15.
Church, D., Stapleton, P., & Sabot, D. (2020). App-based delivery of clinical Emotional Freedom Techniques: Cross-sectional study of app user self-ratings. Journal of Medical Internet Research mHealth and uHealth, 8(10).
Church, D., Stapleton P., Vasudevan A., & O’Keefe T. (2022). Clinical EFT as an evidence-based practice for the treatment of psychological and physiological conditions: A systematic review. Frontiers in Psychology, 13.
Clond, M. (2016). Emotional freedom techniques for anxiety: A systematic review with meta-analysis. The Journal of Nervous and Mental Disease, 204(5), 388–395.
Feinstein, D. (2019). Energy psychology: Efficacy, speed, mechanisms. EXPLORE: The Journal of Science and Healing, 15(5), 340–351.
Feinstein, D. (2021). Six empirically-supported premises about energy psychology: Mounting evidence for a controversial therapy. Advances in Mind-Body Medicine, 35(2), 17–32.
Feinstein, D. (2023). Integrating the manual stimulation of acupuncture points into psychotherapy: A systematic review with clinical recommendations. Journal of Psychotherapy Integration, 33(1), 47–67.
Feldman Barrett, L. (2020, November 17). People’s words and actions can actually change your brain: a neuroscientist explains how. Ideas.TED.com. Retrieved June 10, 2023, from https://ideas.ted.com/peoples-words-and-actions-can-actually-shape-your-brain-a-neuroscientist-explains-how/.
Leskowitz, E. (2016). Integrative medicine for PTSD and TBI: Two innovative approaches. Medical Acupuncture, 28(4), 181–183.
Palmer-Hoffman, J., & Brooks, A. J. (2011). Psychological symptom change after group application of Emotional Freedom Techniques (EFT). Energy Psychology, 3(1), 1–6.
Society of Clinical Psychology. (2022). Psychological treatments. Retrieved June 10, 2023, from https://div12.org/treatments/.
Stapleton, P., Bannatyne, A., Chatwin, H., Urzi, K. C., Porter, B., & Sheldon, T. (2017). Secondary psychological outcomes in a controlled trial of Emotional Freedom Techniques and cognitive behaviour therapy in the treatment of food cravings. Complementary Therapies in Clinical Practice, 28, 136–145.
Stapleton, P., Crighton, G., Sabot, D., & O’Neill, H. M. (2020). Reexamining the effect of emotional freedom techniques on stress biochemistry: A randomized controlled trial. Psychological Trauma: Theory, Research, Practice, and Policy, 12(8), 869–877.
Stapleton, P., Baumann, O., O’Keefe, T., & Bhuta, S. (2022). Neural changes after Emotional Freedom Techniques treatment for chronic pain sufferers. Complementary Therapies in Clinical Practice, 49.
About the author
Jessica is a developmental scientist with a background in neurocognitive research and sociocultural theory. As co-founder of The Urban Chalkboard Play Cafe in Indiana, her applied work focuses on the cognitive, social, and mental health benefits of children's play.