648456

research-article2016
JHNXXX10.1177/0898010116648456Journal of Holistic NursingEmotional Freedom Technique / Rancour

jhn
Practice

The Emotional Freedom Technique

Finally, a Unifying Theory for the Practice of Journal of Holistic Nursing
American Holistic Nurses Association
Holistic Nursing, or Too Good to Be True? Volume XX Number X
XXXX 201X 1­–7
© The Author(s) 2016
10.1177/0898010116648456
Patrice Rancour, MS, RN, PMHCNS-BC http://jhn.sagepub.com
Integrative Medicine, The Ohio State University Wexner Medical Center

The Emotional Freedom Technique (EFT) is defined and described as a clinical procedure for the relief
of psychological and physical distress that patients often bring to the attention of nurses. Frequently
referred to as “tapping,” this technique combines the cognitive reprocessing benefits of exposure and
acceptance therapy with the energetic disturbance releases associated with acupuncture and other
energy therapies. More than 60 research articles in peer-reviewed journals report a staggering 98%
efficacy rate with the use of this procedure from psychological distress (posttraumatic stress disorder,
phobias, anxiety, depression, etc.) to physical conditions (asthma, fibromyalgia, pain, seizure disorders,
etc.) to performance issues (athletic, academic). Perhaps because of this, this technique has encoun-
tered a fair degree of skepticism within the health care community. Easily taught as a self-help aid that
patients can administer to themselves, EFT becomes an efficacious tool in the hands of nurses who are
seeking whole person approaches for the healing of a wide variety of psychological and physical condi-
tions. A conceptual framework, mechanisms of action, evidence of safety, literature review, and case
studies are also included.

emotional freedom technique (EFT); healing modalities; energy-based therapies; energy

Keywords: 
work; healing modalities

Introduction and Definition Implications for nursing practice, education, and

research will also be identified.
A basic tenet of holistic nursing is the inter- EFT is a branch of comprehensive energy psy-
relatedness between mind, body, and spirit. Since chology that has evolved since the 1970s from a
the field of psychoneuroimmunology has contrib- variety of sciences. These include traditional Chinese
uted a font of knowledge as to how consciousness medicine (acupuncture), Dolores Krieger’s and Doris
affects anatomy and physiology, and vice-versa, Kunz’s energy work, applied and behavioral kinesiol-
this is no longer a contested theory in the life sci- ogy, thought field therapy, meridian-based psychol-
ences. What remains problematic is how to thera- ogy, neurolinguistic programming, and energy
peutically improve health and promote healing on medicine to name but a few. The concepts defined
the emotional, spiritual, mental, and physical lev- as EFT herein have been elucidated by Craig since
els simultaneously. the 1990s and are described in his highly detailed
The purpose of this article is to introduce and online tutorial. Craig (2016) encourages those new
define “The Emotional Freedom Technique” (EFT),
also known as tapping, as a holistic nursing interven-
tion that can be used for a variety of psychological Author’s Note: All material is based on the body of work devel-
and physical conditions. The clinical technique and oped to date by Gary Craig. For more information, see http://
www.emofree.com/. Please address correspondence to Patrice
mechanism of action will be described, and a litera- Rancour, MS, RN, PMHCNS-BC, 1978 Glenn Avenue,
ture review will demonstrate its evidence base. Columbus, OH 43212; e-mail: rancour.1@osu.edu.
2  Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX
to EFT to explore Optimal EFT on his website as a
more evolved spiritual iteration of the EFT process.
EFT is a clinical intervention whereby one
focuses one’s awareness on a specific issue, whether
it be physical or psychological, while simultaneously
stimulating selected acupoints along meridians in the
body, primarily on the head and upper torso, by tap-
ping on them with fingertips. Each acupoint carries
specific releases, such as trauma, fear, overwhelm,
rage, and so on (Montgomery, 2016). Properly done,
EFT appears to release disturbances in the energy
meridian, thereby balancing the system as a whole.
In this way, the body’s stress response can be recon-
ditioned and learn to respond to triggers without
stimulating the sympathetic nervous system.
Frequently, EFT is referred to as “tapping.”
Literature Review
There have been well over 60 studies in peer-
reviewed journals establishing a 98% efficacy rate
for EFT. Many of the studies described below are
listed on the Association for Comprehensive Energy
Psychology’s (2014) website, which provides a com-
prehensive research review. The range of problems
for which EFT can be used is constantly being
tested. Two excellent review articles include
“Acupoint Stimulation in Treating Psychological
Disorders: Evidence of Efficacy” (Feinstein, 2012)
and “Clinical EFT as an Evidence-Based Practice for
the Treatment of Psychological and Physiological
Conditions” (Church, 2013).
The diversity of psychological problems success-
fully treated include, but is not limited to, anxiety
(Gaesser, 2014), addictions (Church & Brooks,
2014), posttraumatic stress disorder (PTSD), both
individual and large-scale trauma events (Boath,
Stewart, & Rolling, 2014; Church & Brooks, 2014;
Church et  al., 2013; Church & Feinstein, 2012;
Church, Pina, Reategui, & Brooks, 2012; Connolly
& Sakai, 2012; Dunnewold, 2014; Gallo, 2013;
Gurret, Caufour, Palmer-Hoffman, & Church, 2012;
Hartung & Stein, 2012; Karatzias et al., 2011; Lake,
2014; Robson & Robson, 2012; Sheldon, 2014;
Stein & Brooks, 2011; Zhang, Feng, Xie, Xu, &
Chen, 2011), dyslexia (McCallion, 2012), academic
performance (Boath, Stewart, & Carrier, 2013; Jain
& Rubino, 2012), weight loss and cravings (Church
& Brooks, 2010; Stapleton, Sheldon, & Porter, 2012;
Stapleton, Sheldon, Porter, & Whitty, 2010), depres-
sion (Church, De Asis, & Brooks, 2012; Stapleton,
Church, Sheldon, Porter, & Carlopio, 2013;
Stapleton, Devine, Chatwin, Porter, & Sheldon,
2014), and phobias (Baker & Siegel, 2010; Salas,
Brooks, & Rowe, 2011; Temple & Mollon, 2011),
including fear of public speaking (Fitch, Schmuldt,
& Rudick, 2011; Jones, Thornton, & Andrews, 2011;
Schoninger & Hartung, 2010). The use of EFT to
intervene with physical conditions is just as wide-
spread and diverse and includes diverse problems
such as psoriasis (Hodge, 2011), seizure disorders
(Swingle, 2010), fibromyalgia (Brattberg, 2008),
headache (Bougea et  al., 2013), and sports perfor-
mance enhancement (Church, 2009; Church &
Downs, 2012; Llewellyn-Edwards & Llewellyn-
Edwards, 2012; Rotheram, Maynard, Thomas,
Bawden, & Francis, 2012) to name but a few.
As one can see from the aforementioned list, the
sheer breadth of conditions for which this approach
has been found to be rapidly effective begs the ques-
tion as to whether it is indeed just “too good to be
true.” Furthermore, this appears to be the case even
when investigators return for retesting months after
the intervention and determine that the effect has
been sustained over time. Western medical practi-
tioners may indeed express skepticism as this tech-
nique does indeed lie so far outside the boundaries
of allopathic paradigms of health and healing. This
skepticism remains despite the proliferation of dou-
ble-blind randomized controlled studies, the gold
standard of research investigation that demonstrates
a high evidence base for EFT.
Mechanisms of Action
EFT is based on the premise that the cause of all
emotional and physical dis-ease is a disruption in the
body’s energy system. This presumes that a distress-
ing memory of an event is not the trigger of the
individual’s pain, but instead, the distressing mem-
ory becomes a disruption in the body’s energy sys-
tem, and it is the disruption that causes the symptom
or condition. This explains why a unitary technique,
EFT, can be applied to such a wide array of problems
since all the problems are the result of an energy
disruption in the system and the intervention is
designed to release those disruptions.
According to allopathic models, the stress
response generates systemic inflammation by acti-
vating the hypothalamus–pituitary–adrenal axis

(Church, 2013). In normal situations, this response
subsides once the survival episode is completed. In
many individuals, however, the stress response con-
tinues to activate, releasing even more stress hor-
mones, such as cortisol, norepinephrine, and
adrenaline, into the system. This repeated stimula-
tion produces increased activation of the amygdala,
hippocampus, and other brain areas associated with
fear and distress (Feinstein, 2012). Unless these
feedback loops are interrupted, the stress response,
with its attendant physical and psychological conse-
quences, can often continue unimpeded, resulting
in chronic inflammatory conditions.
EFT works on cognitive and energetic levels
simultaneously. While holding the troubling symp-
tom or condition in one’s conscious awareness and
concurrently tapping on selected acupoints, a cogni-
tive shift and an energetic release are produced.
Feinstein (2012) elaborates,
Bringing to mind an emotional trigger, problematic
scene, or unresolved traumatic memory activates
the amygdala, arousing a threat response. Stimulating
selected acupoints . . . simultaneously sends deacti-
vating signals by reducing the arousal while the trig-
ger is still mentally active. The hippocampus records
that the memory or trigger is being safely engaged
without a stress response, and the neural pathways
that initiate the associated stress response are per-
manently altered. Being able to encounter the mem-
ory or trigger without limbic arousal becomes the
new normal. (p. 16)
Supporting this proposed mechanism of action,
Church identified the following test results associ-
ated with EFT treatment:
•• EEG confirmed a reduction in the frequen-
cies of brain waves associated with PTSD.
•• EEG increased theta frequencies associ-
ated with relaxation.
•• EMG revealed significant relaxation of the
trapezius muscle.
•• fMRI demonstrated changes in the regula-
tion of the fear centers in the brain. (The
amygdala and other fear-processing cent-
ers of the nervous system are regulated as
stress-laden emotions are calmed.)
•• Cortisol levels significantly dropped post-
treatment.
Emotional Freedom Technique / Rancour   3
•• Release of serotonin, γ-aminobutyric acid,
and beta endorphins posttreatment.
(Regulation of stress response through the
hypo-thalamus-pituitary-adrenal axis.)
•• And evidence even exists for EFT’s effects
on epigenetics and gene expression
(Feinstein & Church, 2010)
Contraindications/Safety
As of 2013, more than 1,000 respondents have
participated in institutional review board–approved
studies without one single adverse event reported, so
the risk of abreaction is very low. EFT is safely
administered by a therapist, coach, grass roots health
educator, or as a self-help tool to one’s self or family
members. It can be safely administered one-on-one,
in group settings, online, or even in the field during
large-scale disasters, such as used by organizations
like Capacitar (http://www.capacitar.org/). EFT is
safely delivered to people of all ages. Mucillo (2016)
prescribes EFT for children who have problems with
test anxiety and performance, fear, phobias, bedwet-
ting, nightmares, sleep problems, stress, school
problems, sports anxiety performance fears, learning
difficulties, and self-esteem. While efficacy rates
can vary from individual to individual, the fact that
so many studies report high rates of efficacy (98%)
with so little contraindication makes it difficult to
not trial it when compared with other interventions,
the risks of which appear so much more problematic
(Church, 2013).
Clinical Procedure
The patient is asked to rate the presenting prob-
lem on a scale of 0 to 10 so that testing of effective-
ness can proceed throughout the administration of
the intervention. The patient is then asked to hold
the troubling symptom or condition in his/her con-
scious awareness while developing a set-up phrase
during the initial tapping at the karate chop acu-
point, as shown in Figure 1. The basic statement
sounds like: “Even though I (name the problem), I
completely and deeply accept myself.” Examples of
such issues might include “Have migraine pain at a
level of 9 on a scale of 0 to 10,” “Am afraid I will
stutter during my presentation today,” or “Can’t
sleep at night because of flashbacks of my uncle
attacking me in my bedroom when I was 7 years
4  Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX
Figure 1  Anatomical Landmarks for EFT
KC: The Karate Chop (KC) point is located at the center of the
fleshy part of the outside of your hand (either hand) between the top
of the wrist and the base of the baby finger or . . . stated differently
. . . the part of your hand you would use to deliver a karate chop.
TOH: On the top of the head. If you were to draw a line from
one ear, over the head, to the other ear, and another line from
your nose to the back of your neck, the TOH point is where
those two lines would intersect.
EB: At the beginning of the eyebrow, just above and to one side
of the nose. This point is abbreviated EB for beginning of the
EyeBrow.
SE: On the bone bordering the outside corner of the eye. This
point is abbreviated SE for Side of the Eye.
UE: On the bone under an eye about 1 inch below your pupil.
This point is abbreviated UE for Under the Eye.
UN: On the small area between the bottom of your nose and the
top of your upper lip. This point is abbreviated UN for Under
the Nose.
Ch: Midway between the point of your chin and the bottom of
your lower lip. Even though it is not directly on the point of the
chin, we call it the chin point because it is descriptive enough for
people to understand easily. This point is abbreviated Ch for Chin.
CB: The junction where the sternum (breastbone), collarbone
and the first rib meet. To locate it, first place your forefinger on
the U-shaped notch at the top of the breastbone (about where a
man would knot his tie). From the bottom of the U, move your
forefinger down toward the navel 1 inch and then go to the left
(or right) 1 inch. This point is abbreviated CB for CollarBone
even though it is not on the collarbone (or clavicle) per se. It is
at the beginning of the collarbone and we call it the collarbone
point because that is a lot easier to say than “the junction where
the sternum (breastbone), collarbone and the first rib meet.”
UA: On the side of the body, at a point even with the nipple (for
men) or in the middle of the bra strap (for women). It is about 4
inches below the armpit. This point is abbreviated UA for Under
the Arm.
Source: Used with permission by Gary Craig, 2015.
old.” As the patient continues to tap through the rest
of the prescribed acupoints (see Figure 1), she/he
repeats brief follow-up statements to continue to
help him/her focus on what she/he is trying to
release. For example, such follow-up statements
might sound like “residual migraine pain of 4,” “fear
of stuttering,” or “can’t sleep at night.” Such mental
activation of the problem issue is a form of exposure
therapy as well as acceptance therapy. The trigger is
identified and accepted—not resisted. There is no
need to remember triggering details, which might
precipitate overwhelm or flashbacks. It is merely the
naming of the problem, thereby exposing one’s self
to it, and accepting it that promotes the cognitive
shift. Often such work results in the elucidation of
the core issues around which such symptoms organ-
ize. The acupoints are described in Figure 1.
Each time the tapping procedure is concluded,
the patient is asked once again to retest the intensity
of the symptom by rating it on the 0 to 10 scale. Very
frequently, the intensity will be substantially reduced.
Retapping until the symptom has disappeared can
continue to the patient’s satisfaction. Other times,
the retest may reveal that the patient scores the prob-
lem even higher than initially tested. Oftentimes this
can be the result of a new aspect of the problem
presenting itself that can be explored with the patient:
perhaps the emergence of a new memory, image, or
story connected to the problem that was not initially
evident to the patient. The more specific the patient
can be regarding these details, the more finely tuned
and successful the tapping process can be as well.
For example, one patient who suffered from a
persistent fear of driving insisted there was no logical
reason why she should be so afraid to do so. She
started tapping: “Even though I don’t know why I am
so afraid of driving, I still completely and deeply
accept myself.” As she tapped through the acupoints,
suppressed memories began to trigger, including a
traumatizing driver’s education film that showed
graphic accident videos, a long-forgotten boyfriend
whose face was mutilated in a car accident, and a
suppressed memory of driving with her father at night
during which time they actually ran over a part of a
dead body in the road. None of these triggers was
consciously available to the patient at the beginning
of the session; however, as they were released, she
could tap down her distress sufficiently enough that,
by the end of the session, she reported absolutely no
fear of driving. This effect was sustained at subse-
quent sessions. The patient was able to heal by releas-
ing the disruption in the energy system, thereby
reconditioning the stress response toward the trigger.
Craig’s (2016) work offers many detailed
instructions as to techniques aimed at producing
more beneficial effects. As this article is merely an

introduction to the uninitiated, the reader is
referred to his online tutorial for further detailed
instructions and numerous embedded web videos
that demonstrate the technique.
Implications for Nursing Practice,
Education, and Research
Clinical implications abound for many physical
and psychological conditions that patients bring to
the attention of nurses. Patients quickly grasp the
effect of stress, its effects on a super-heated sympa-
thetic nervous system, and the effects it has on the
psyche and the body. Inflammatory conditions such
as pain, autoimmune illnesses, and other stress-
related conditions like PTSD, anxiety, and depres-
sion often respond quickly. The empowerment that
comes with learning a self-help tool that patients
can use easily without the need for a prescription or
an appointment with a health care provider cannot
be underestimated. The fact that this technique can
be learned/administered one-to-one or in a group
makes it a very flexible tool. The following case stud-
ies provide examples of clinical applications of EFT.
Margaret is a patient with bipolar disorder whose
anxiety can often escalate into panic attacks despite
being on mood stabilizers. She has been taught mind/
body techniques such as guided imagery, biofeedback,
and mindfulness, but due to attention deficit disorder,
she often neglects her daily practice. She appeared to
have difficulties self-monitoring stress levels whereby
she could intervene earlier and head the panic attacks
off. She was taught EFT and is able to tap her anxiety
attack down from a 10 to a 2 on a scale of 0 to 10
within 4 to 6 minutes. For her to be effective, however,
she has to set the timer on her smartphone to chime
every 2 hours to help her stop, take a stress assessment
reading, and intervene as necessary. She believes this
is a small price to pay for regaining control over a cha-
otic day-to-day life. She is working toward reducing
the dosage of her mood stabilizing medication.
Milo presents with historical anger management
issues that he can trace back to an abusive child-
hood. Currently, his rage results in domestic vio-
lence against his wife, who is currently planning to
end their relationship. In the meantime, despite
initial skepticism from Milo, he learned in one ses-
sion to tap down rage from an 8 to a 2. Unfortunately,
while it is not timely enough to save his marriage, he
is getting relief from a life-long scourge of rabid
Emotional Freedom Technique / Rancour   5
anger that manifests in other relationships as well.
Jan reported she developed gestational hyperten-
sion starting with her first pregnancy, and her blood
pressure never normalized. She learned EFT for
assistance with stress relief, and now reports since
tapping on a daily basis, that she is slowly weaning
off anti-hypertensive medication that she has been
taking for years.
Eleanor has suffered debilitating migraine head-
aches, which have resulted in numerous missed days
at work. She rated her headaches as a 14 on a 0 to
10 scale. As she learned EFT, it was remarkable to
watch as the head pain, often located behind her left
eye, would move to other locations in her body as it
was tapped down: into her right shoulder, her right
hip, and so on, and on into her foot by which time
the pain was often reduced to a 1 to 2. She remarked
that she often received quicker relief without side
effects from EFT than she received from taking
Imitrex, her rescue medication, used to abort
migraines in progress.
The implications for nursing education are no
better illustrated than by using EFT to assist nursing
students with their own anxiety (Patterson, 2013).
Many colleges of nursing devote considerable
resources to help their students pass state boards.
Teaching students EFT can boost academic perfor-
mance substantially without being costly. As they
themselves benefit from using EFT, they become
highly motivated to teach it to their patients.
Nursing research implications abound as EFT can
be studied for a wide variety of its effects on such phe-
nomena as wide and varied as wound healing, reha-
bilitation progress, posttraumatic stress disorder,
nonpharmacological pain management, addictions
including drug and behavioral cravings, and the ability
to wean off medications for such inflammatory condi-
tions as asthma, hypertension, diabetes, and so on.
Summary
The Emotional Freedom Technique, or “tap-
ping,” is defined as a cognitive/energetic therapeutic
technique designed according to the precepts of
energy principles often found in eastern healing
practices. A substantive literature review described a
robust 98% efficacy rate, mechanisms of action were
proposed based on diagnostic testing during and
post-administration, and the clinical procedure was
described. Implications for nursing practice, educa-
tion, and research were identified.
6  Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX
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Patrice Rancour, MS, RN, PMHCNS-BC, is a mental health
clinical nurse specialist in Integrative Medicine, The Ohio State
University Wexner Medical Center and a clinical assistant pro-
fessor in the OSU College of Nursing. She is the author of two
books, Tales from the Pager Chronicles and the Pager Chronicles,
Volume II.