This paper looks at the use of a modified form of emotional freedom techniques (EFT, Craig & Fowlie, 1995) in the treatment of a subject's self-reported compulsive eating behavior. In brief, the method involves a client's attending to a presenting problem while the client gently taps specified acupuncture points on the body. If effective (Seligman, 1995), the approach holds promise as a less-invasive treatment when compared with other therapies currently in use, for example, Wolpe's systematic desensitization (SD, cited in Masters, Burish, Hollon, & Rimm, 1987). As a therapist might choose eye movement desensitization and reprocessing (EMDR, Shapiro, 1995) over SD, EFT may prove as effective and less invasive than EMDR. A number of recently developed therapies are based on the hypothesis that manual stimulation of acupuncture points can affect psychological state, and subsequently, behavior. The premise is that life events (physical, mental, or emotional) affect the human energy system, and conversely, a therapeutic intervention involving that system can effect positive outcomes. Gallo (in press) refers to these techniques as energy psychology. A representative sample of said energy psychologies includes thought field therapy (TFT, Gallo, 1996a; formerly referred to as the Callahan techniques, see Callahan, 1985, 1991), EFT, energy diagnosis (EDx, Gallo, in press), and thought energy synchronization therapies (TEST, private correspondence with Nicosia, February, 1998).

EFT was chosen for this study due to its simplicity and ease of training and use. Other energy psychologies mentioned above utilize either specific acupuncture-point stimulation algorithms for specific complaints--a cookbook approach--or complex diagnostic procedures yielding discrete algorithms for individual cases. In contrast, EFT uses one "basic recipe" in all cases (Craig & Fowlie, p. 46). Psychological practitioners among the internet community have referred to these treatments as a subset of a larger class of power therapies (Gallo, 1996a, 1996b) which includes EMDR, visual/kinesthetic dissociation (VK/D, Bandler & Grinder, 1979) and traumatic incident reduction (TIR, Gallo, 1996a). The narrower term, energy psychology, is used in this paper.

While this approach is not without problems for the psychological practitioner, not the least of which is scope of practice, the latter issue is beyond this exploratory effort. For our purposes, we shall assume that informed consent leaves us on safe ground. Even if effective, other salient issues arise for the researcher, if less so for the clinician, including (a) the existence of the hypothesized energy system, and (b) a consideration of alternate explanations, such as, an orienting response (Armstrong & Vaughan, 1996; Denny, 1995), a conditioning model (Dyck, 1993), or Wolpe's reciprocal inhibition (as cited in Masters et al., 1987). The reader is also referred to Hooke's discussion of TFT (1998).

With those caveats noted, the hypothesis which drives this effort is that EFT is expected to exhibit measurable positive effects on compulsive eating behavior. The research design sought to measure the effect of EFT on body weight and, more importantly, the calculated rate of change.

Figure 1. Diagram of acupuncture points used.

A client is directed to attend to a presenting problem; rate the level of distress on a subjective units of distress scale (SUDS) from 0 to 10; tap on a series of seven acupuncture points (see figure 1, Altaffer, no date) while attending to the problem; and again provide a SUDS rating. The treatment procedure is repeated until a SUDS value of 0 or 1 is obtained. An educational phase prior to treatment includes the hypothetical underpinnings of the method (Becker, 1985; Callahan, 1985, 1991; Craig & Fowlie, 1995), an explanation of the rating system or SUDS (Shapiro, 1995), and a handout explaining the steps (see table 1).
 
 
 
 
 
 

Table 1. Outline of EFT steps.

Rate the distress

In order to measure progress, rate your distress on a SUDS, from 0 to 10 (where 0 is no problem and 10 is the worst it can be).

The setup

Use two fingers (index and middle) of the dominant hand for tapping. You may tap either side of body. Remember it's a tapping (not hitting).

Tap the karate chop point (KC, see below) while repeating three times the affirmation "I accept myself even though I have this ____."

The KC point is located at "...the center of the fleshy part of the outside of your hand between the top of the wrist and the base of the baby finger or... the part of your hand you would use to deliver a karate chop" (Craig & Fowlie, p. 53).

The sequence

While repeating a word or short phrase naming the problem (e.g. this headache), tap the following points about seven times each (see figure 1, above):

1. At the beginning of the eyebrow, just above and to one side of the nose....

2. On the bone bordering the outside corner of the eye....

3. On the bone under an eye about one inch below your pupil....

4. On the small area between the bottom of your nose and the top of your upper lip....

5. Midway between the point of your chin and the bottom of your lower lip....

6. 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 breastone (about where a man would knot his tie). From the bottom of the U, move your forefinger down toward the navel one inch and then go to the left (or right) one inch.

7. 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 four inches below the armpit (Craig & Fowlie, pages 55-56).

Post-procedure rating

Rate any remaining distress on a SUDS. Repeat "The Sequence" if distress remains and SUDS rating went down at least two points. If SUDS scale went down less than two points, repeat from "The Setup."

The case study incorporates an A/B design across multiple baselines (Kazdin, 1982, 1992).

Design across multiple baselines

After a brief explanation of the study, the subject was asked to daily log body weight and food intake. Data was collected for one week in this fashion to establish multiple baselines, and thus, represent a control condition. An appointment was set for the following week to continue the educational phase and train the subject in the treatment procedure. In addition to informed consent, noted above, the researcher's demonstrating the tapping procedure, but having the subject perform the actual tapping on her body, steered clear of the potentially sticky "touch" issue for the psychological, as opposed to medical, practitioner. An additional four appointments were set at two-week intervals, and a final appointment after the conclusion of the reporting period, for a total of five face to face sessions over a nine-week period.

Two-phase treatment procedure

Due to the expected situation-specific nature of the presenting problem, a two-phase treatment procedure was employed to insure its regular application. Specifically, the subject was instructed first to use the tapping procedure four times daily (morning, noon, evening, and bed time), and second, per required need (PRN) in any situation in which compulsive eating surfaced. The logic of this approach becomes clear if one compares the nature of compulsive eating behavior to a condition such as depression. While the latter is in general a more pervasive condition--and presumably treatment four times per day would be applying it to the condition--the former may occur only in the presence of certain stimuli, for example, food or anxiety. If the treatment were applied only when compulsive eating surfaced, perhaps 20 times in one week and five in another, it would be difficult to make generalizations about treatment effect.

The subject was a 48-year-old White female who approached the writer for assistance with a self-reported eating compulsion. Subject stated she had just started a weight-reduction diet, but felt the eating compulsion would be a stumbling block. She reported her best past performance on a weight reduction diet was a mean loss of .5 pounds per week, on diets ranging in duration from four months to one year. The subject gave informed consent to participate in the study after an initial explanation of the method.

Figure 2. Weight loss in pounds over nine weeks.

Subject reported a loss of 7.5 pounds in body weight over the course of the reporting period. (See figure 2.) This represents a mean weekly loss of .83 pounds, a .33 pound improvement over the self-reported past performance of .5 pounds per week. (See figure 3.) A visual inspection of the food intake logs showed adherence to the diet. While the data is in no way conclusive, further discussed below, the subject reported being "pleased" with the weight loss, and remarked that the procedure had "definitely made a difference." The subject also reported no incidents of succumbing to the eating compulsion after initiating treatment.
 

Figure 3. Rate of weight loss: comparison of
best past performance and current study.

While the use of words such as psychosomatic, or diagnostic categories such as posttraumatic stress disorder (APA, 1994) tacitly states the field of psychology recognizes a mind-body connection, the emphasis is on the pathological: the mind causing a problem in the body in the former; the body causing a problem in the mind in the latter. What shifts is the direction of the causal arrow, mind-body or body-mind, respectively. Regardless of the direction of causality, however, the emphasis is first on pathology: how either a mental or physical event causes a problem, and second, how a psychological, and therefore primarily mental, intervention can impact therapeutic change. In contrast, the approach of energy psychology is to assume a role of therapeutic agency for the body, no matter in which sphere--mental or physical--a problem surfaces. More specifically, energy psychology hypothesizes that manual stimulation of acupuncture points will positively affect psychological state. Thus, an initial question surfaced. Is there an empirical basis for acupuncture?*

Becker (1985) hypothesized that measurements of galvanic skin response (GSR) at acupuncture points would differ from the GSR measurements of surrounding skin. His research for the Veterans Administration demonstrated an approximate .5 correlation between hypothesized acupuncture points and points on the skin demonstrating a measurable difference in GSR from readings of surrounding skin. While far from constituting "proof" of acupuncture, Becker concluded the results demonstrated there was a measurable energy difference, namely GSR, and the concept merited further study. Limited support for acupuncture is also evidenced by other events. The National Institute of Health (NIH) recently accepted certain acupuncture procedures (Marwick, 1997). The Food and Drug Administration (FDA) removed acupuncture needles from its list of "experimental" procedures (Podolsky, 1996). For the purposes of this investigation, the writer assumes at least a plausibility to the concept of acupuncture.

While the subject reported being satisfied with the results, as noted above, this is merely anecdotal. Two measures were assumed by the writer to potentially demonstrate success, weight loss itself, and more significantly, rate of loss. Since the subject reported an eating compulsion, and not a reduction diet per se, to be the problem, it was thought that an improvement in compulsive eating would first appear as a weight loss, and second, in an improvement in rate of change. Both a weight loss and a greater mean weekly loss appeared. It may be noted that the reduction diet itself may be considered a treatment. To control for this factor, daily food intake was logged. Adherence to the weight reduction diet remained constant throughout the study. The rate of weight loss changed in comparison with the subject's best past performance, suggesting a positive treatment effect of the EFT procedure.

This case study sought to measure the effect of EFT on compulsive eating behavior. By demonstrating not only a weight loss--which the subject had accomplished in the past--but an improvement in the rate of weight loss, a positive effect of the treatment procedure, EFT, is suggested. The brevity of the reporting period, possible influence on outcome of such nonspecifics as the therapeutic alliance between the researcher and the subject, and the lack of a true control (inherent in any single-subject design) limit the interpretation of results. Treatment effect may have been better demonstrated with the inclusion of measurements comparing frequency and intensity of the compulsive eating desire, pre- and posttreatment, as well as a count of any incidents in which compulsive eating actually occurred. The subject's anecdotal report of no such incidents is not to be discounted, nevertheless, no such measurement was logged. Ideally, a number of similar case studies could be performed, including a control group in which subjects performed an EFT-type procedure on a sham algorithm. As a single-case design, however, this study appears to demonstrate a positive treatment effect of the EFT procedure.

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