Emotional Freedom Techniques for Anxiety: A Systematic Review With Meta-analysis

Emotional Freedom Technique (EFT) combines elements of exposure and cognitive therapies with acupressure for the treatment of psychological distress. Randomized controlled trials retrieved by literature search were assessed for quality using the criteria developed by the American Psychological Association’s Division 12 Task Force on Empirically Validated Treatments. As of December 2015, 14 studies (n = 658) met inclusion criteria. Results were analyzed using an inverse variance weighted meta-analysis. The pre-post effect size for the EFT treatment group was 1.23 (95% confidence interval, 0.82-1.64; p < 0.001), whereas the effect size for combined controls was 0.41 (95% confidence interval, 0.17-0.67; p = 0.001). Emotional freedom technique treatment demonstrated a significant decrease in anxiety scores, even when accounting for the effect size of control treatment. However, there were too few data available comparing EFT to standard-of-care treatments such as cognitive behavioral therapy, and further research is needed to establish the relative efficacy of EFT to established protocols.

Craig’s Notes:

This meta-analysis review was performed the authors state because no previous published work has offered a quantitative meta-analysis of the effect of EFT (Emotional Freedom Techniques) treatment for anxiety. As per standard protocol in such a meta-analysis the randomized controlled trials retrieved by literature search were assessed for quality using the criteria developed by the American Psychological Association’s Division 12 Task Force on Empirically Validated Treatments.

The authors concluded that EFT is associated with a significant treatment effect when the treated patients are compared with pre-treatment levels and or control conditions. The review did not find sufficient evidence to support equivalence nor superiority of EFT over traditional psychotherapeutic interventions such as CBT. However, the effect size for EFT compared with inactive treatment is higher than those reported in meta-analyses of CBT versus inactive treatment for anxiety.

The study participants were wide ranging, including children, adolescents, university students and adults with demonstrates generalizability while simultaneously making the studies highly heterogenous or dissimilar in both population and with regards to anxiety related issues as the studies evaluated included a variety of issues including test anxiety, specific phobias and post-traumatic stress syndrome. As a result, the authors recommended the need for further studies to explore the effectiveness of EFT for conditions such as generalized anxiety disorder, social phobias and obsessive-compulsive disorder.

The authors highlighted some of the advantages of EFT as it demonstrated a reduced treatment time required with fewer sessions needed to achieve significant results, that EFT and be self-administered effectively as a self-help modality and may not always require a licensed professional and can even be self-administered. As a result they state “Emotional freedom technique may present a very effective, low-risk, and economic adjunct to current practice… Although there are many limitations to this analysis, the large effect sizes of the treatment groups imply that investigation should be continued.”

Of course there are always limitations and here they found small sample sizes, a disparity in diagnostic presentation variations, a lack of head to head comparison of EFT to standardized treatments which were recommended for future study and a variety of potentially impacting considerations from placebo effects, expectancy effects, therapist allegiance and others.