Claim: Tapping therapy’s effectiveness “was proved”

On 15 – 16 January 2014 the Daily Mail reported: “Experts are calling on the NHS to start using a new self-help technique, called tapping, after its effectiveness in treating a number of conditions was proved (emphasis added). The BBC ran a more cautious headline: “Tapping therapy helps patients with depression”, calling the treatment very effective (emphasis added). Many people criticised the claims including Dr Ben Goldacre. Alex Langford, a junior Psychiatrist, called Emotional Freedom Technique (EFT) “dangerous nonsense”.

True or False?

The claim is largely false as the findings of one small-scale study have been overstated.

Largely FalseAnalysis

Emotional Freedom Technique (EFT) was founded in the 1990s by Gary Craig. EFT involves tapping with the fingertips on acupunture pressure points while saying positive statements. For EFT all negative emotions are caused by “a disruption in the body’s energy system”. By tapping near the end points of your energy circuits or “meridians”, you can change your emotional and physical health as EFT “[balances] disturbances in the meridian system”. It claims to treat a range of conditions from phobias to post-traumatic stress disorder.

Most of the BBC’s and the Daily Mail’s reporting appears to be taken from a Staffordshire University press release, which says:

“Health researchers from Staffordshire University have called on NHS Trusts across the UK to adopt a new emerging self-help method known as tapping – or emotional freedom technique (EFT) – after its effectiveness for treating a number of conditions was proven (emphasis added).”

Two studies are mentioned to support this claim but one is unpublished, so we cannot verify its findings. We examined the main study, conducted in 2013 by Antony Stewart, Professor of Public Health, and his team. They wanted to find out whether EFT was effective in treating various emotional conditions. 39 people were given EFT therapy over 13 months, mainly for anxiety, depression and anger. The results showed that most people improved with the treatment.

However, the research says, “the limitations of the study design … precludes the ability to infer its results to the wider population”, which means that the study does not prove EFT’s effectiveness. It then concludes, “despite the limitations … , the results of this evaluation highlight the successful role of EFT in reducing a wide range of physical and psychological disorders”. This seems inconsistent with the results as we cannot say if EFT was the cause of the improvement.

André Tomlin, Chief Blogger at The Mental Elf and MD of Minervation Ltd, an evidence-based healthcare consultancy told us, “unfortunately their chosen study design cannot support [their] conclusions and they have overstated the findings of this small-scale service evaluation”. The study mentions many reasons why it is not compelling evidence including no control group comparing EFT to another treatment, and a small sample size.

Peter Kinderman, Professor of Clinical Psychology at the University of Liverpool said natural recovery and regression to the mean could explain the change – that is following an extreme measurement, further measurements tend to be closer to the average. A study into major depression shows half of people recover completely within a year if you do nothing. The placebo effect can also explain the improvement: when a patient expects their condition will improve, it often does.

Two researchers conducted a study comparing EFT to a placebo treatment, showing that ‘tapping on meridians’ was no more effective than a placebo. While not conclusive, the findings suggest that the benefits of EFT are not uniquely caused by tapping your meridians, contrary to what Gary Craig, EFT’s founder, claims. The effectiveness of EFT could be explained by practices it shares with more established therapies such as desensitization and distraction or the breathing technique used in EFT.

Professor Kinderman said the best way to confirm EFT’s effectiveness would be to compare it against an established therapy. This view is echoed by André Tomlin, who suggests, “The safety and efficacy of mental health treatments are usually best evaluated in a large-scale randomised controlled trial. The authors themselves recognise this and state that they are planning such a trial, which they hope will provide an unbiased answer to their research question”. The British Association for Counselling and Psychotherapy (BACP) agree, adding “Even a fully powered trial on its own could not [prove effectiveness]; there needs to be a body of research all pointing in the same direction. … In short, considerably more research into this intervention would be required”.

Commentary

Our investigation shows that the claim made about EFT is largely false and more clinical trials are needed before its effectiveness is proven. This has quite serious implications:

In the press release, Professor Stewart is quoted as saying:

“A growing number of studies suggest EFT is an effective and safe treatment, and with the predicted sharp increase in the demand for mental health services – and a corresponding decrease in NHS resources – we feel that the use of EFT should now be extended to other NHS Trusts.”

Dr Ian Walton, mental health lead for Sandwell and West Birmingham Clinical Commissioning Group appeared convinced enough and another 20 therapists are going to be trained in EFT:

“The effective use of EFT demonstrated in this study has not only influenced counsellors and therapists in Sandwell to be trained to use this method …, but also local mental health charities are seeing the value in being trained to use EFT”.

This highlights the need for Clinical Commissioning Groups and other organisations to use treatments supported by compelling evidence. Professor Edzard Ernst, an expert on alternative and complementary medicine, says:

“I have researched the evidence for EFT for some time. The currently available trials are by no means compelling. As the treatment lacks plausibility, and as we have no independent replications of the existing studies, it is in my view irresponsible to advocate EFT as a routine treatment for any condition (emphasis added)”.

The Daily Mail and the BBC appear to have recycled the press release, exaggerating the findings of a small study, although the BBC made some effort to check the facts. This example of what has been called churnalism means we need to raise awareness and increase public understanding of how science works and how it is reported. Ben Goldacre’s talk, Battling bad science and Sense about Science’s resources are good places to start, as well as the NHS’s guide on How to read health news.

Staffordshire University responded to our article, saying “We stand by the content of the full press release.”

The Daily Mail has not replied to requests for comment.

Comments

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