ENERGY PSYCHOLOGY-PRACTICES AND THEORIES OF NEW COMBINATIONS OF PSYCHOTHERAPY

Energy Psychology (EP) includes a spectrum of pract ices in which people tap on their bodies while focu sing their minds on problems they want to change. EP the rapi s often are very rapidly effective. This artic le examines varieties of explanations for how EP works , including: Cognitive changes, psychological conditioning, expectation effects, distraction tech niques, tapping on acupuncture points, shifts in ot her biological energies, wholistic healing, alternating stimulation of right and left sides of the body (p resumably producing alternating stimulation of left and right brain hemispheres) and nerve conduction speeds.


INTRODUCTION
Energy Psychology (EP) encompasses a wide variety of practices in which people tap on their bodies while focusing their minds on issues they want to address. EP therapies often bring about very rapid changes. Varieties of theories will be considered to explain EP: • Cognitive changes brought about through wellrecognized conventional psychological mechanisms, as well as through newly developed mechanisms • Shifting the balances and interactions of brain hemispheric activities through alternate tapping on right and left sides of the body • Activating bioenergies, as in tapping on various acupressure points (acupoints) and in other bioenergy interventions • Body-mind mechanisms, such as conduction speeds of nerves; and • Wholistic Healing-addressing every level of a person's being: Body, emotions, mind, relationships and spirit Three tapping techniques will be the primary focus of this exploration: Emotional Freedom Techniques (EFT), Eye Movement Desensitization and Reprocessing (EMDR) and the Wholistic Hybrid derived from EMDR and EFT (WHEE). While there appear to be significant differences in their methodologies, broadly similar benefits are observed with each of these techniques. There are several dozens of other variations of EP therapies, some of which will be cited but not discussed in detail. (Feinstein, 2012). EP is proving particularly helpful to soldiers and civilians with PTSD (Church et al., 2009;2013). Biochemical stress markers confirm effects of EP (Church et al., 2012a).

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Many EP clients are very pleased that they are able to work on their problems and achieve substantial symptom relief through self-treatment, rather than having to wait for their next therapy session if their symptoms are triggered. They are also pleased to need fewer psychoactive medications, per the clinical experience of the author and of other EP practitioners.

Emotional Freedom Techniques (EFT)
EFT is by far the most widely used EP method (Craig, 2011), with therapists available in North America, Europe and many other parts of the world. With EFT, clients will tap on a series of acupoints, while focusing on the negative issues they wish to release. A standardized affirmation is used to neutralize the negatives (See EFT procedure details in Appendix A).
EFT practitioners may be licensed healthcare providers or may be trained solely in EP. There is certification training for EFT in the US, Canada, England, France and Australia; and TFT in the US and Japan. EFT as yet is not a licensed modality. A growing body of EFT research confirms benefits in treatment of Post Traumatic Stress Disorders (Feinstein, 2008;, with modest evidence for efficacy in obsessivecompulsive disorders, a variety of other anxiety disorders, fears, phobias, depression, alcohol cravings, nicotine cravings, adjustment disorder, bereavement, tremors and chronic pain (Feinstein, 2008).
EFT is often used as a self-treatment. It is safe to use and does not produce heavy abreactions (heavy emotional releases, which are common with EMDR-per discussion below) and EFT is widely used when and as people need it. For example, EFT may be of great immediate help when a person is anxious about speaking in public, afraid of flying, is getting over the trauma of an auto accident, or stressed in any other ways.
Limitations of EFT may include inability to remember the long series of acupuncture points for tapping when people are experiencing stress or panic reactions. They may also find it embarrassing to be seen tapping on their bodies in public. The author has found that children in particular report they hesitate to use EFT in public because they get teased or bullied.
There are other varieties of EP techniques. Among these are Thought Field Therapy (TFT), the original EP approach, which has a substantial research database (Callahan and Callahan, 1996) and Tapas Acupressure Technique (TAT), with a modest research database (Fleming, 2002) and WHEE (discussed below) and several dozen other applications of self-treatment or therapist treatments involving acupuncture meridians and chakras (biological energy centers in the body) combined with affirmations (See further details in Appendix D).
In all of these methods, progress is tracked with the person's Subjective Units of Distress Scale (SUDS). The initial intensity of the issue being addressed is rated on a scale of 0-10. With every repetition of the tapping and affirmation, the subjective intensity of the issue being addressed is assessed and the procedures are repeated until the SUDS is reduced to zero. This is generally the endpoint of the intervention in EFT, TFT and many other EP methods.
There are several professional EP organizations: The Association for Comprehensive Energy Psychology (ACEP) in the US, The Canadian Association for Integrative and Energy Therapies (CAIET) in Canada, The Association for the Advancement of Meridian Therapy Techniques (AAMET) in the UK and several other organizations in Europe and Japan.

Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is an approach in which the patient is guided in alternately stimulating the left and right sides of the body by moving their eyes from right to left and back, while focusing their mind on their problems (Christman et al., 2003;Shapiro, 2001). At the same time, the mind is focused on issues the person wants to feel better about. No counteracting affirmation is used. When the intensities of negative issues are reduced to or near zero, positive cognitions and feelings are installed that replace the negative ones, with the accompaniment of the same methods for stimulating the left and right sides of the body. The EMDR protocol is very carefully defined and practitioners are strongly encouraged to precisely follow this protocol (See more details in Appendix B).
EMDR can help people address the same spectrum of problems as EFT and other EP. While many EP practitioners are also trained in EMDR and consider it very closely related to EP, the EMDR International Association (EMDRIA) and Francine Shapiro, the originator of EMDR, do not acknowledge any such relationship. It is the opinion of this author that there are indeed considerable overlaps between EP and EMDR.
You must be a licensed healthcare therapist to have training in EMDR. EMDR may produce intense emotional releases that can frighten people or even retraumatize them. For this reason it is recommended Science Publications CRP that EMDR should be used only in the therapist's office. A portion of the EMDR protocol teaches patients ways to calm themselves when such emotional abreactions occur. While many EMDR practitioners continue to have patients use eye movements, others use alternating auditory stimulation or alternating tapping on the left and right sides of the body, particularly for people who have nausea or vertigo when doing eye movements. Children may also prefer tapping on their bodies rather than eye movements, often practiced as the "butterfly hug" in which the arms are held across the chest and each hand taps on the opposite bicep muscle.
EMDR has a robust body of research confirming its benefits in treatment of PTSD, with further studies confirming its efficacy in treating other stress disorders, anxieties, depression, pain, insomnia and more EMDRIA. Meta-analyses have confirmed the efficacy of EMDR (Shapiro, 2000). Meta-analyses are facilitated because EMDR has a very strict protocol for its interventions. It is now broadly acknowledged (by the American Psychiatric Association, the World Health Organization and other such professional bodies) as an effective treatment for severe stress disorders (Shapiro, 2001).

Wholistic Hybrid Derived from EMDR and EFT (WHEE)
WHEE is an EP combining elements from EFT and EMDR (Benor, 2008) and wholistic healing (Benor, 2005). WHEE is an acronym for the Wholistic Hybrid derived from EMDR and EFT. WHEE procedures involve alternately tapping on the right and left sides of the body, while focusing the mind on the negative emotions and the issues being addressed and reciting affirmations to counteract the intensity of those issues. When the intensity of the issue are reduced to zero, replacement positive statements are installed, as in EMDR.
The wholistic components of WHEE include clearing of early childhood memories related to current problematic emotions and issues; dialoguing with body symptoms; two-chair dialogues (similar to Gestalt therapy); encouraging intuitive awarenesses; addressing problematic family relationships; and accessing spiritual awarenesses and resources. WHEE is extremely simple to learn and to use, yet very rapidly and deeply effective. Within minutes it can reduce physical and psychological pains, even when these have been present for a long time. WHEE can also reduce the intensity of fears, phobias, stress reactions and other problems and in many cases can completely eliminate them . WHEE can be used safely anywhere and any time a person feels a need to decrease negativity and increase positivity. The simplicity of WHEE allows it to be used discretely in public, so that no one else knows a person is using it. This can be enormously helpful in dealing with anxiety disorders, phobias, anger, cravings, triggered memories and emotions of PTSD and other issues whenever and wherever they arise. WHEE has only a few studies showing its efficacy (Bair, 2006;Benor et al., 2009), with further research in progress.

Composite Clinical Examples
The following composite examples could have been people who used EFT, EMDR or WHEE. The clinically observed results are very similar, with the exception that with EP people can use the modality on their own, when and as they need to.
School phobia and school avoidance are usually extremely difficult to treat. School phobia is one of the truly urgent psychological problems. It is like falling off a horse. If you do not get back in the saddle or return to school immediately, it becomes increasingly difficult to do so with every day that passes. With conventional psychotherapy it may take weeks and months for a child to overcome a school phobia. It is very common to have prolonged periods of home schooling before the child is able to return to school.
'Tommy" (assumed name) is a fourteen year old boy who developed school phobia after being bullied in the schoolyard. Several counseling attempts had failed and he was unhappily resigned to home schooling, which was delayed due to difficulties in finding an available teacher. He was also at risk of having to repeat the year, as he had been out of school for two months. In desperation, his mother pursued a recommendation for an EP therapist. Tommy responded well to clearing his trauma from the bullying and anticipatory anxieties about going to school-while in the therapist's office and at home-but could not bring himself to get into his father's car to go to school. He agreed he had to go to school and his parents agreed they were willing to be coercive in getting him there. His father physically dragged him to the car and drove him to school, leading him firmly by the arm to the school door. Tommy promptly ran back to the car as soon as his arm was released from his father's grasp. An arrangement was made to have the

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Assistant Principal physically hold him while his father drove off. Despite having practiced the EP procedures on his own, under guidance of the therapist, Tommy was embarrassed to tap on himself in class, being anxious not to invite further teasing or bullying. An arrangement was made with his teacher to allow him to go to the boys' room if he waved his hand (rather than just raising his hand in a static response when asking or answering classroom questions). He would do his tapping in a toilet booth, out of sight from any of his peers. Within a week he was completely over his school avoidance and after another week he was clear of his phobias and bullying trauma. Tommy also reported that the EP enabled him to clear his anxieties about being around bullies and for test anxieties. It was interesting that he had not mentioned the test anxieties to his therapist but was able to clear them on his own.
Tommy's return to school after just a week of EP treatment and his clearing of his bullying trauma is impressive. Test anxieties often clear very quickly, but it is to Tommy's credit that he did this on his own.
Severe emotional trauma may take many months to clear with conventional psychotherapeutic approaches. EP can help people release their trauma memories and post traumatic stress symptoms very quickly.
Betty' a 22 year-old secretary, had been gang raped after being abandoned by her boyfriend, following an angry argument with him in a rough bar. She, too, reported that her medical emergency care had been reasonable but that none of the long series of medications she was given were of any help, starting with the psychiatrist at the emergency room and then by her family doctor and another psychiatrist. She was groggy, couldn't think clearly enough to hold onto any of several jobs and was waking frequently with horrible nightmares of being attacked by people, animals or frightening monsters. Her parents provided enormous support, allowing her to live in the basement of their small home. Her welcome was wearing thin, however, because of her drinking, smoking, depression, irritability and shorttemperedness, on top of her being unable to hold a job for more than a day or two.
Under her parents' urgings, she sought counseling. Cognitive Behavioral Therapy (CBT) helped her see and understand what was happening to her, but did not clear her trauma memories or problematic behaviors and she abandoned this counseling after six frustrating months. Two years later, with no change in her condition, her friend, Donna, recommended an EP therapist who had helped Betty quickly overcome fears of driving following a serious auto accident. Though skeptical, Betty made an appointment. She was pleased and greatly relieved to experience immediate benefits from the first session. She was particularly grateful to be able to use EP on her own whenever she was anxious or triggered. In two months she was clear of her trauma, able to hold down a job and looking forward to finding a place of her own to live. An interesting aspect of her therapy was the unearthing of traumatic memories and emotions from having been molested by an uncle in her early teen years. She had never told anyone about this before and had completely shut it out of her mind. Her earlier memories and feelings also cleared rapidly with the help of EP.
EP is outstanding in helping people clear their post traumatic stress problems. Quite often these people have also suffered earlier traumas that have never been addressed or cleared.
These sorts of very rapid improvements are the expected norm with EP, even with people who were severely traumatized and had not responded to various other therapies over long periods of time.

Explanations for the Efficacy of EP
The mechanisms of action of EP have yet to be clearly and firmly established. A variety of possibilities can be postulated, some with a fair amount of research evidence to support them.
Several aspects of EP have been proposed as possible mechanisms for their effectiveness: • The focusing statements and counteracting affirmations are the necessary and essential aspects of EP interventions • Tapping on acupoints are the primary procedure that produce the beneficial effects

. Paired Negative and Positive Cognitions Used in EP
Extinctions of negative emotions and cognitions and enhancements of positive ones are addressed in EP along with the tapping. The prevalent procedure in the majority of EP interventions is to state the problem that a person wishes to deal with, followed by a positive, counteracting statement (per the formal procedures in Appendix A-C).
Here are some samples of paired EP format cognitions: For a fear of heights: "Even though I'm afraid of heights, I still love and accept myself, wholly and completely." For exam anxiety: "Even though I'm terrified of failing my exams, despite having studied sufficiently to know the materials well outside of the exam room and remember how my father was always critical of me, no matter how well I did as a child, I still remember my grandmother always comforting and reassuring me I'd be ok." For trauma: "Even though I shudder when I think of seeing that child thrown from the car in that crash (adding salient details) and have nightmares about it, I know that God loves and protects me and that the child's angels are there to guide him on his path." The positive, counteracting affirmation neutralizes the negative issues that people want to change. This pairing of positives that counteract and neutralize negatives has been very well studied.

Pairings of Positive and Negative Cognitions in Conventional Psychology
Systematic desensitization (also called reciprocal inhibition) is a well-accepted form of behavior modification therapy, widely practiced by conventional psychotherapists since the 1950's. Extensive research confirms that the pairing of positive and negative thoughts and feelings leads to a decrease in the intensity of the negative issues (Goldfried, 1971;Kazdin and Wilcoxon, 1976;Wolpe, 1969).
For systematic desensitization of focal issues, people with problems such as fears, phobias and trauma residues are guided in therapy sessions to focus on positive imagery, thoughts and feelings. They practice these positives until they fell they can readily bring them to consciousness on demand. They then switch to focusing upon the negativity they want to address until they experience it with some intensity. At the point that they feel the negatives are moderately uncomfortable, they switch to evoking the positive cognitions and feelings. By repeating this process of pairing positives with negatives a number of times, the negativity gradually decreases until it is entirely dissipated.
In more global uses of systematic desensitization, a person writes down a comprehensive list of their anxieties, fears, angers or other negative feelings about a given focus. They rank the intensity of each one from the mildest to the most severe. Then they start eliminating the negativity of the least intense and work their way up to cancelling the intensity of the worst on their list. Systematic desensitization is one of the tools of today's CBT.
The author used this approach in his private psychotherapy practice in the 1970's and 1980's. Although it is rather slow, it is highly effective. It helped people release fears and phobias of animals, flying, confined spaces (claustrophobia), difficulties in relationships and other anxieties. Mild to moderate trauma memories responded fairly well too, but severe trauma memories were very often resistant to such approaches. Exposure therapy, developed by Joseph Wolpe (1969), invites people to practice relaxation while being exposed in graduated steps to whatever they are afraid of. A person who is frightened of dogs would be exposed to a dog who is held securely at the far end of a long hall. He would practice relaxing until he was no longer anxious. The dog would be brought gradually closer and closer, with the person practicing relaxation at each interval until he could have the dog right next to him and even pet the dog without anxiety.
Flooding is a similar approach, in which people are subjected to prolonged exposures to stimuli that resemble as closely as possible the most intense issues in their original trauma. Thomas Stampfl developed a variant of flooding that is called implosion therapy for treating phobias (Leitenberg, 1990). These methods are commonly used today in efforts to aid emergency services personnel, soldiers and civilians who have PTSD. In some cases this can effectively reduce the trauma responses associated with gruesome memories of auto accidents, burns, civilian and battlefield violence and other such horrible experiences. However, flooding techniques may make people feel worse rather than better and may retraumatize them (Pitman et al., 1991).

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Non-specific neutralizations of negatives with systematic desensitization are an integral and important aspect of most therapies. In a general manner, the pairing of negative issues with the calming effects of the therapy situation (quiet room, empathetic therapist, general suggestions and expectations of benefits) may contribute to the neutralization of negative thoughts and feelings by pairing them with non-specific positive cognitions and feelings. These are also labeled 'expectation effects.'

Pairings of Positive and Negative Cognitionss in Complementary/ Alternative Therapies
Neurolinguistic Programming (NLP) employs what is assumed to be a bioenergy approach that works on the same principles of positives cancelling negatives.
People are instructed to press with one finger on a part of their body (e.g., on their thigh, where their hand is resting) while holding in their awareness a memory of a negative experience with negative feelings attached to it. They assess the intensity of the negative cognitions. They hold the pressure for 15-30 sec. Upon releasing the pressure, they carefully leave their hand resting in exactly the same position so that they can again press with the same finger on exactly the same spot. After releasing their finger pressure they deliberately release their focus on their negative cognitions.
Next, they press with one finger of their other hand on another part of their body (commonly on the other thigh), while focusing on positive thoughts and feelings. After releasing their finger pressure they deliberately release their focus on their positive cognitions.
Without holding any mental focus, they simultaneously press each finger again on the same spot as they did earlier, holding the pressure of both fingers for 15-30 sec and then release the pressure.
They again assess the intensity of the negative cognitions.
In most cases, the intensity of the negative cognitions is significantly decreased. This process is called discharging or collapsing anchors.
NLP also demonstrates that the same effect of positives neutralizing negatives can be achieved through an imagery exercise. People can visualize that they are holding an energetic bubble in one hand that contains negative cognitions and a bubble in the other hand with positive cognitions. Bringing the two hands together and visualizing that the bubbles coalesce with each other, the positives neutralize the negatives.
Any or all of the following may explain these results: The anchoring through touch and/or the bubble imagery is simply a mental construct that facilitates visualizations of merging positive and negative cognitions in what is essentially a systematic desensitization exercise.
A psychophysiological conditioned response is established when a portion of the body is touched while the mind is focused on specific cognitions. Pressing simultaneously on two points, one of which has been conditioned to a positive and the other to a negative cognition will lead to the positive cancelling the negative, as in systematic desensitization.
Thoughts and emotions are assumed either to project bioenergetic fields from the body in general and the nervous system in particular, or to represent bioenergetic constructs that manifest into the body and brain from spirit (which is the primary source of consciousness that is tuned in by the nervous system). In either case, a bioenergetic imprint of cognitions may be anchored at the point of finger pressure on the body. When a positive anchor is activated at the same time as a negative anchor is activated, the positive bioenergies neutralize the negative ones.
The efficacy of the bubble imagery procedure may also be explained as an energetic neutralization of the projected positive and negative bioenergies that are created through visualizations of the bubbles. Levine (2010), who developed the psychotherapeutic method of Somatic Experiencing, coined the term 'pendulations,' which is a most helpful concept in understanding one of the aspects of releasing physical and psychological trauma. Levine (2010) observes that repetitive, alternating focus of attention may contribute to healing.

Pendulations: Alternating Body Stimulations and Rhythmic Alternations of Attention
In general, focusing inward and becoming curious about one's inner sensations allows people to experience a subtle inner shift, a slight contraction, vibration, tingling, relaxation and sense of openness. I have named this shift from the feelings of dread, rage or whatever one likes to avoid toward "befriending" one's internal sensations pendulation, the intrinsic rhythm pulsing between the experienced polarities of contraction and expansion/openness (Step 3 in Chapter 5). Once people learn to access this rhythmic flow within, "infinite" emotional pain begins to feel manageable and finite. This allows their attitude to shift from dread and helplessness to Pendulations may, in fact, be a variation on the methods of pairings of positives and negatives. Alternatively, they may also represent a distraction technique.
Levine's observations on pendulations are an interesting parallel with WHEE and EMDR, in which there are repetitive, rapid physical pendulations with stimulation of right and left sides of the body (and brain hemispheres), as well as slower, cognitive pendulations between focus on problematic issues and counteracting affirmations. EFT includes simultaneous R/L physical stimulation and slower, cognitive pendulations between focus on problematic issues and counteracting affirmations. There may be one or more common denominators within these methods.

Giving Oneself Permission to Change
Simply agreeing to allow oneself to change has been developed into a systematic therapy. STA (2014) can be an even faster approach than EP. This involves simply asking people whether they are prepared to let go of their problems and then inviting them to do so. A structured series of questions is used. This method is trademarked by the Sedona Method instructors. The author finds that adults and older children respond better than younger children to this approach. This would be a more focused example of an expectation effect and similar to the acceptance therapies.

Distraction Techniques
CBT may include varieties of distraction techniques. Some CBT therapists have suggested that "pleasant imagery, counting methods and use of a focal point help patients learn to divert attention away from severe pain episodes" (Keefe, 1996). Research confirms distraction can be an effective strategy for dealing with pain (Miller et al., 1992;Vessey et al., 1994); stress (Mills et al., 2008); moodiness (Dombeck and Wells-Moran, 1995); and more.
Distraction through tapping may contribute to the efficacy of EP. Pairing of negative issues with the calming environment of the therapy situation may again be one of the effective factors in distraction therapies.
Any or all of the above helpful pairings of negatives with positives may contribute to the positive effects observed in EP.

Relevance of Cognitive Changes to EP
There are several parts of the protocols common to many EP modalities that fit the model of systematic desensitization: • Affirmations protocols in which the problem is stated, followed by a counteracting affirmation • The process of repeatedly assessing the levels of intensity of the SUDS and observing that the levels of negativity are decreasing provides feedback and reinforcement of confidence in the efficacy of the EP procedures • Users of EP find that confidence is built up in the efficacy of EP when successful eliminations of problems are repeatedly experienced with EP. This reinforces the efficacy of further uses of EP. ('metapositive' effects) Considering the evidence for the efficacy of cognitive changes in bringing about therapeutic changes, it is reasonable to postulate that the affirmations used in many EP modalities, plus other, non-specific positive clinical factors, may be effective in neutralizing the negatives. Similarly, pairing very strong positive cognitions and feelings with replacement positives may strengthen the replacement positives.
Explanations proposed by practitioners for the efficacy of EFT, TFT and related therapies generally have not delved to any great extent into the contributions of the EP procedural cognitive interventions to the observed outcomes. In EMDR there have been discussions on this topic, with various suggestions that are clearly relevant to many of the EP approaches.
EMDR may be a form of exposure therapy (Lee et al., 2006). It could be that the repetitions of focusing statements leads to extinction of the negative focus. Shapiro (2002) suggests that shifting repeatedly from disturbing issues to new cognitions and feelings may build confidence in one's ability to let go of the negatives. In the language of WHEE, this builds a metapositive belief that successful releases of negativity will occur. Such positive beliefs facilitate releases of negativity. It appears from these observations that EMDR may be a variant of systematic desensitization.
It would be difficult, however, to assert that it is only the pairing of the negatives with positives that explains the positive results of EMDR. While the factor of repetitions as exposure therapy might contribute a further modest measure of improvement, the progress made by people using EMDR and WHEE is reliably very much faster and deeper than those therapies using exposure therapy or any of its related variants alone, without some form of tapping. (2002): [This] model (Shapiro, 2001) guides EMDR treatment. This theory posits that many disorders are based, at least in part, on the inadequate processing of information related to distressing experiences. It is proposed that this information is stored, with the emotions and physical sensations, in a state-dependent fashion. Essentially the memory becomes isolated, without adequate integration with semantic knowledge or assimilation into other memory networks. During effective treatment, traumatic material is linked to more adaptive material and new associations are made, resulting in complete information processing and adaptive resolution. What is useful is learned, stored with appropriate emotion and is able to effectively guide one in the future. What is useless (such as high arousal, disturbing emotions, irrational beliefs, sensations) is discarded. In practice, EMDR is a structured integrated approach, synthesizing elements of many other effective psychotherapies such as psychodynamic, cognitive-behavioral, personcentered, body-based and interactional therapies... The integration of these orientations provides a unique set of procedures and protocols.

Acupuncture Point (Acupoint) Stimulation
Many EP practitioners are of the opinion that it is the tapping on acupoints which is the principal effective mechanism in achieving the observed rapid and deep effects. This is by far the most popular theory in the EP community. In some EP circles the term Meridian Based Therapies (MBT) is used to label these modalities. Meridians are bioenergy lines that connect series of acupoints, running from the extremities through the trunk and to the head (Chang, 1976;Manaka and Urquhart, 1980;Mole, 1992;NIHCP, 1997;Pomeranz and Stux, 1989).
There is a wealth of clinical data gathered over several thousands of years from acupuncture practitioners on the effectiveness of using various forms of stimulation on acupoints. Common traditional methods for this stimulation include needles, pressure using sticks or other probes and finger pressure ((acupressure). Newer ones include electrical and laser stimulation.
Awareness about acupuncture was greatly stimulated in the west by the testimonial of James Reston, a well known New York Times reporter, who had an appendectomy while on assignment in China in 1971 (Reston, 1971). The sole anesthesia used was acupuncture and he reported no pain and very rapid postoperative recovery. His rapid recovery was quite remarkable at that time because the anesthetics used in the west in those days often left people groggy for several days.
Very complex and detailed relationships have been described between functions of the acupoints-both individually and in various combinations-and functions of the organs and physiological systems of the body, emotions, mind, environment and spirit. These bear little relationship to modern western understandings and explanations for health and illness.
Western science and medicine have been skeptical about the very existence of acupuncture points and meridians. However, in recent decades electrical resistance at these points has been shown in some studies to differ from the skin resistance where there are no points (Prokhorov et al., 2006). However, critical reviews point out weaknesses in these studies and recommend further explorations (Ahn et al., 2008).
Experienced, sensitive acupuncture practitioners report they are able to identify acupressure points by finger touch.
Western style clinical research confirms that acupuncture may be beneficial for several problems. "General international agreement has emerged that acupuncture appears to be effective for postoperative dental pain, postoperative nausea and vomiting and chemotherapy-related nausea and vomiting. For migraine, low-back pain and Temporomandibular (TMJ) disorders the results are considered positive by some and difficult to interpret by others. For a number of conditions such as fibromyalgia, osteoarthritis of the knee and tennis elbow the evidence is considered promising, but more and better quality research is needed" (Birch et al., 2004). Further studies have shown that acupuncture enhances recovery of neuromuscular functions following strokes (Johansson et al., 1993;Kjendahl et al., 1997;Naeser et al., 1992;Weizian et al., 1987) but others did not confirm this.

Eastern Explanations of the Mechanisms for Efficacy of Acupuncture
Eastern explanations of the mechanisms for efficacy of acupuncture involve totally different understandings Science Publications CRP of physiology, health and illness. Kaptchuk (1984) provides an excellent discussion on aspects of health and illness that allopathic medicine seems helpless to treat, but which respond well to Traditional Chinese Medicine (acupuncture, herbal therapies, qigong, Fung Shui and Chinese cosmology). He also expands on Chinese views of health and illness.
For instance, the Chinese do not ask what causes a particular illness. They ask, "Which patterns within the individual and his environment are in harmony and which are in conflict?" Therapy is not aimed at correcting symptoms so much as at bringing the person to greater harmony with the cosmos. The Chinese description of reality does not penetrate to a truth, it can only be a poetic description of a truth that cannot be grasped. The Heart, Lung and Kidneys… are not a physical heart, lung or kidneys; instead they are personae in a descriptive drama of health and illness. For the Chinese, this description of the eternal process of Yin and Yang is the only way to try to explain either the workings of the universe or the workings of the human body and it is enough, because the process is all there is; no underlying truth is ever within reach. The truth is immanent in everything and is the process itself.
The fact that western research confirms any effects of acupuncture is to some extent remarkable. Putting acupuncture to tests that are not designed to take into consideration the theories and cosmology associated with Chinese medicine is highly unfair and prejudicial, placing acupuncture at a serious disadvantage in demonstrating its efficacy. In Traditional Chinese Medicine (TCM), the uses of acupuncture are only a part of a much more comprehensive approach to health and illness. TCM often includes a rebalancing of bioenergies, adjustments of diet, herbal remedies and all of these within a cosmology that views the individual being treated as a part of the balance of aspects of the world such as yin (feminine) and yang (masculine) and five essential elements that are aspects of every living being (wood, fire, earth, metal and water).

Theories Explaining How Acupressure Works in EP
Eastern theories surrounding acupuncture assume there are bioenergies (called qi, ki, chi) that infuse, activate and guide the functions of the physical body. There are higher concentrations of these energies at acupuncture points. Stimulation of these points by needling or blunt pressure enables therapists to regulate increases or decreases of flows and to release blocks to the flows of these energies. In addressing symptoms and illnesses, the entire biological energy (bioenergy) system is harmonized rather than focusing only on the body parts or organs associated with the presenting symptoms. Thus, regulating the bioenergies of the person enables a harmonizing of their body, emotions, mind, relationships and spirit. Treatments harmonize the person with the rest of the world.
Western science assumes that stimulation of acupuncture points produces bioelectrical responses in various parts of the body, particularly in the brain. Early research suggests possible ways in which acupoint stimulations may bring about beneficial effects observed in EP. In a literature review, Lane (2009)

notes:
Recent research indicates that manual stimulation of acupuncture points produces opioids, serotonin and Gamma-Amino Butyric Acid (GABA) and regulates cortisol. These neurochemical changes reduce pain, slow the heart rate, decrease anxiety, shut off the fight/flight/freeze response, regulate the autonomic nervous system and create a sense of calm. This relaxation response reciprocally inhibits anxiety and creates a rapid desensitization to traumatic stimuli. Feinstein (2012) observes that acupoint stimulation has been shown to alter neurochemicals (Ruden, 2005); brainwaves (Diepold and Goldstein, 2009;Lambrou et al., 2003;Swingle et al., 2004); and blood cortisol levels, which are indicators of stress (Church et al., 2012b). The mechanisms of action and significance of these changes have yet to be fully explored and explained. These changes are suggestive of possible pathways to alterations in brain and body functions that produce healing effects. Feinstein (2012) also suggests that brain imaging findings may explain how tapping on acupoints can reduce the intensity of negativity. Brain scans demonstrate that needle stimulation of acupoints can reduce activity in areas associated with fear, such as the amygdala and hippocampus (Hui et al., 2000) and also in the limbic-paralimbic-neocortical areas (Fang et al., 2009). Feinstein (2012 suggests that in EP the focusing of the mind on an anxiety-producing issue will activate the amygdala. When acupoints are stimulated, they Science Publications CRP deactivate the amygdala. Repeating this process can lead to a learned or conditioned response of lessened reactions to the anxieties that are activated by the mental focus on the problem. The hippocampus stores the new memories of lessened anxieties and clinical improvements in the stress situations that are experienced, creating new habits of responses.

Bioenergy Healing Therapies
In acupuncture there is an overlap with bioenergy healing therapies such as Therapeutic Touch, Healing Touch, Reiki, spiritual healing and related approaches (which I'll refer to as 'healer interventions' in the discussion below). Practitioners' bioenergies are directed through light touch and/or mental intent to bring about healings. Research confirms these healer interventions can reduce anxieties, pains and other problems without affirmations and without engaging the acupuncture meridian system. Research also confirms effects of healer interventions on animals, plants, bacteria, yeasts, cells in laboratory culture enzymes and more (Benor, 2002;2013).
Some EP practitioners are also trained in healer interventions. The consensus among these practitioners is that bioenergy interventions can enhance EP interventions. In fact, it may be that acupoint tapping is just a special case of bioenergy healing, focused on stimulating acupuncture points and meridians rather than on shifting the bioenergies of the person as a whole. Conversely, it may be that introducing bioenergies via acupoints is more potently effective.
In summary, it is held by many EP practitioners that acupoint stimulation is the essential intervention producing the observed benefits. The fact that TAT in general and some TFT practitioners obtain excellent results with stimulation of particular points but without using counteracting affirmations would be the clearest evidence lending support to this theory. The fact that healer interventions appear to enhance EP acupoint treatments further supports a belief that tapping on acupoints may be the effective component in EP. It could be postulated as well that healer interventions act upon the acupuncture meridian system even when no direct intent is held by the healer to do so. However, the opposite may also be the case. The fact that healer interventions may be beneficial when addressed to the person as a whole, without focus on acupressure points, might be an indication that the acupressure points are not crucial to the intervention.

Alternating Stimulation of the Right and Left Sides of the Body as the Mechanism for Change with Tapping Interventions
Alternating right and left stimulation of the body produces releases of negative thoughts, memories and feelings and enhances the installation of positive ones in EMDR (Gunter and Brodner, 2008;Lee and Drummond, 2008). Extensive research (Shapiro, 2000) and clinical reports from EMDR (Shapiro, 2001) and WHEE ) confirm this approach is highly effective.
The R-L stimulation of the body is presumably effective through L-R stimulation of the brain. Various forms of alternating R-L stimulation produce the same effects: • Eye movements • Auditory stimulation • Tactile stimulation of any area of the body, from head to toes In EMDR, alternating Right and Left (R-L) stimulation is used without affirmations. There is no theory with solid research evidence to explain how alternating right and left stimulation of the body produces these releases. The following discussion considers various possibilities.

EMDR-Based Theories Propose it is Effective Through Stimulation of Particular Brain Structures
Clinical observations and research with EMDR demonstrate that alternating R-L stimulation alone (with a focusing statement but without counteracting affirmations) produces emotional releases of trauma. Not only is the intensity of the trauma reduced by the tapping, but memories also surface to consciousness about aspects of the trauma that had been buried previously outside of conscious awareness.
Early research suggests there may be responses in the frontal lobes that account for the effectiveness of Eye Movements (EMs) in EMDR. Per notes on the EMDRIA website: Specifically, the EM manipulation used in the present study, reported previously to facilitate episodic memory, resulted in decreased interhemispheric EEG coherence in anterior prefrontal cortex. Because the gamma band includes the 40 Hz wave that may indicate the active binding of information during the

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consolidation of long-term memory storage (Cahn and Polich, 2011), it is particularly notable that the changes in coherence we found are in this band. With regard to PTSD symptoms, it may be that by changing interhemispheric coherence in frontal areas, the EMs used in EMDR foster consolidation of traumatic memories, thereby decreasing the memory intrusions fund in this disorder" (Propper et al., 2007)

WHEE-Based Theories Propose it is Effective Through Right and Left Hemispheric Stimulation
WHEE practitioners and users regularly report very rapid and deep releases of physical and psychological problems of all sorts. Multiple mechanisms appear to contribute to the observed benefits.
The evidence from conventional psychological research strongly suggests that the neutralization of negatives through pairing them with positives is an essential mechanism explaining how WHEE and other EP. It is quite likely that this mechanism also contributes to the efficacy of EMDR, with non-specific positive aspects of the therapy situation constituting the counteracting positive reinforcement.
In addition, both the alternate right and left stimulation of the body (by whatever method) and the tapping on acupoints enhance these processes.
Right and left stimulation of the body is broadly presumed to be effective through alternating activation of particular portions the left and right hemispheres of the brain. While specific brain areas that are essential for these effects have not as yet been verified, it may also be that global stimulation of the R and L brain hemispheres may be the effective mechanism for change.
The Left Hemisphere (LH) abstracts what is perceived by the senses and by RH into cognitive representations of the external world. LH organizes perceptions into recognized patterns. LH functions tend to be more within conscious awareness. LH modes of conceptualizing the world are very familiar in western society, where they are strongly emphasized in educational institutions and reductionistic research.
The Right Hemisphere (RH) processes external awarenesses of the world that are more general, gestaltic and more closely identical to the outer world. RH mediates internal awarenesses and processing of emotions and empathy with others in the outside world. Much of the awareness people have through their RH involves perceptions and experiences that are unconscious. The degree to which they are outside of conscious awareness varies in different people.
In general, these differences in predominance of RH and LH expressions appear to be broadly correlated with overall personality preferences, as described by Jung (1981). Jung proposed a continuum of polarities from thinking to feeling as personality traits. But even in those who are relatively more consciously aware of their emotions, many aspects of emotions and cognitions remain unconscious.
McGilchrist (2009) provides an excellent summary of research on right and left hemispheric functions. He also emphasizes that LH cognitions are "re-presentations" of the perceived and experienced world. That is, the LH builds models of the world to explain it to the conscious mind. The LH then becomes so used to these models for interpreting its experiences that it takes the models to be accurate perceptions (rather than self-constructed representations) of the world.
People have a strong tendency to adopt the hemispheric modes that are preferred by their families of origin. They also tend to choose friends and colleagues who share similar preferences. Thus, their own hemispheric models of the world appear to them to be validated as 'the way the world is supposed to be.' While RH dominant people tend to be more accepting of differences in people who have strong LH functions, LH dominant people's re-presentations of the world tend to be more exclusive, rejecting the worldviews and approaches of anyone who differs from themselves.
There is a preponderance of LH thinking in the educational, industrial, financial and governmental institutions of the world today. These strongly validate and reinforce the LH thinking individuals in their presumptions about the validity of their re-presentations of the world. Most people broadly ignore the fact that there are countless varieties of LH beliefs that are held by countless other individuals and groups of people other than their own-all of whom also believe their own representations of the world are the only valid descriptions of external, perceived experiences and internal, experienced/ perceived experiences. This contributes to prejudices, tensions and conflicts between individuals, groups and nations on our planet, not to mention between researchers who often hold to exclusive theories about psychological processes and behaviors.
Trauma residues can be cleared very rapidly with L-R alternating stimulation. Consideration of global L and R hemisphere functions may help to explain how this study. Memories of stressful and traumatic experiences,

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CRP along with their associated feelings, are often buried (partially or completely) outside of conscious awareness. This is a helpful survival mechanism in dangerous and frightening situations. It leaves people with more cognitive and emotional resources during the period of danger to deal with whatever is threatening them. The problem is that after the danger has passed, the trauma memories and feelings often remain buried outside of conscious awareness, but they may continue to be experienced as traumatic within the unconscious mind.

The Unconscious is not unconscious. It is only the Conscious that is unconscious of what the Unconscious is conscious of. -Francis Jeffrey
It appears reasonable to postulate that the biological repository or gateway for these buried memories lies in several portions of the right hemisphere. RH protects the more conscious LH by keeping the traumatized person from being re-traumatized from recollections of the original dangerous, traumatic situations and the resulting negative emotions. RH actively promotes avoidance of any experiences that could trigger the recall of these buried feelings and memories.
LH (conscious awareness) feels anxiety when strong negative emotions arise in RH. People who are stronger in LH (thinking, analytic, linear, either/or thinking) generally prefer to avoid experiencing strong emotions in interactions or in memory. LH appears to invite RH to protect it from disturbing memories of negative, traumatic experiences. RH and LH appear to set up alerts, warnings and rules for avoiding new behaviors and situations that might trigger memories of negative experiences.
At the same time, RH is burdened by keeping these materials buried and by constantly having to keep the person alerted and on guard against encountering anything in life that might trigger their recall. This drains a lot of cognitive and emotional energies and also narrows and diminishes many options for positive experiences. So RH will invite interactions that will trigger some portions of these buried memories into conscious awareness, hoping that LH will pick up on the hints and agree to clear them away. This is why people who have been traumatized will often engage in behaviors and enter relationships that recreate the original trauma. People abused in childhood, who have buried many of their trauma memories, will find themselves in abusive relationships; those who have suffered violent trauma will often place themselves in situations that invite triggerings of violent reactions. RH is staging these interactions in the hopes of releasing the buried memories-at times when the person is no longer in the dangerous situations and has more resources to deal with them and clear them.
It appears reasonable to hypothesize that: • Alternating stimulation of RH and LH while focusing the mind on troublesome, traumatic feelings and memories stimulates the release of the blocks to conscious recall of the buried materials • These materials are rapidly and deeply neutralized through the variations of systematic desensitization that occur when the positive cognitions and feelings are paired with the negative memories and feelings. • There are then marked improvements in the presenting problems, which had been caused by combinations of memories and feelings repressed from conscious awareness; enervating vigilance required to avoid triggering these memories and feelings into conscious awareness; and unconscious efforts to recreate life experiences that invite releasing the RH from these burdensome tasks • As we continue to use these methods we shed fears of addressing our repressed feelings and memories and we develop a meta-positive attitude about dealing with our traumas, saying to ourselves, "I can handle this buried trauma too, just like I handled the other ones!" • Installing positive cognitions and feelings to replace the negative ones that have been released brings even stronger healings • As we continue to install replacement positives we gain even greater confidence that we can address any problems and we develop metapositive expectations, saying to ourselves, "I can convert my negative experiences into positive lessons just as I've done with the others!" Emotion and the body are at the irreducible core of experience: They are not there merely to help out with cognition. Feeling is not just an add-on, a flavoured coating for thought: It is at the heart of our being and reason emanates from that central core of the emotions, in an attempt to limit and direct them, rather than the other way about. Feeling came and comes, first and reason emerged from it… Iain McGilchrist

Could EP Acupoint Tapping Effects be
Due to a Simultaneous R-L Tapping?
There is a distinct possibility that some portions of the efficacy of EP tapping on acupoints are due to simultaneous R-L tapping. In some or all of the acupoint tapping people will use their dominant hand to tap on the opposite side of their body. This may or may not be true for tapping on acupoints on the head, but is always true of tapping under the opposite arm and on the opposite hand. While stimulating the acupoints on the opposite side of the body, they are also stimulating the finger that is doing the tapping. Thus they are engaging in simultaneous bilateral tapping.
This raises the possibility that, in addition to the effects of acupoint stimulation, there is a simultaneous (rather than an alternating) R-L tapping that is occurring. As mentioned above, some people using WHEE find that simultaneous, repetitive R-L tapping on the body works better for them than alternating R-L tapping.

Tapping on Oneself in Popular Uses
When people are nervous, some will rhythmically tap their R and L feet alternately or simultaneously on the floor, or tap their fingers in various rhythms on a table or the arm of a chair or on their laps. Often, these are single-sided tapping patterns. These, too, appear to relieve tensions, though not as deeply or thoroughly as R-L tapping.
Music stirs people spontaneously to engage in R-L self-stimulating activities. Lively tunes will elicit rhythmic hand clapping (simultaneous R-L stimulation) and foot tapping, stomping or dancing (alternating R-L stimulation). Waving one's hands and arms rhythmically from right to left and back is another common R-L response to music. It may be that the beneficial effects of R-L stimulation were intuitively recognized by people in various cultures and used for self-healing: This Video May Point to where Right-Left Stimulation for Relief of Tensions Originated http://www.youtube.com/watch?v=5LLbGYbZbes

Combined Tapping and Affirmations
Early observational evidence suggests that tapping combined with mental focus on cognitions and feelings appears to be more effective than either approach alone.
This has yet to be systematically investigated. The contributions of tapping to cognitive interventions have yet to be investigated with neural imaging. Leskowitz (2010) suggests that in EP treatments for pain relief, the nerve conduction times from skin to brain for touch are much faster than from skin or other body parts to brain (NK, 1996) Table 1.

Nerve Conduction Speeds
Repeated tapping on the body may stimulate the skin touch fibers, which could interrupt habitual pain responses because they reach the brain much faster. This could contribute to the some of the beneficial effects of tapping and affirmations detailed above. Leskowitz (2002) also suggests that EP and EMDR could be variations on the theme of hypnotherapy. The use of a pendulum swinging in front of a person as a method of induction certainly suggests an overlap with the direct R-L stimulation of EMDR and WHEE and the covert R-L overlap with other tapping methods.

Wholistic Healing
The part can only be known when the whole is apparent.

Ted Kaptchuk
Wholistic perspectives acknowledge that each of us is composed of body, emotions, mind, relationships (with other people and the environment) and spirit. Wholistic healing extends beyond many of the more conventional boundaries of focus and therapeutic interventions. Many EP modalities include aspects of wholistic healing. WHEE deliberately promotes wholistic healing. More on this topic in Benor (2005).

In summary
The universe is a communion of subjects, not a collection of objects.

-Thomas Berry
There are varieties of clinical paths to healing with EP. Each can lead to psychological and physical improvements. Evidence suggests that it may be combinations of diverse mechanisms that contribute to the rapid changes achieved through each of the various EP approaches. Tapping alternately on any part of the right and left sides of the body. (Eye movements are an option but people very rarely choose this. A few people find that simultaneous, repetitive R-L tapping on the body works better for them than alternating R-L tapping.); 2.
Focusing awareness on feelings and thoughts (in that order) that people want to change.
Feelings are highlighted in this process and addressed as a priority. A typical focusing statement would be: "Even though I feel _____ when I think about _____"; 3.
Reciting a counteracting affirmation to neutralize the intensity of the cognitions in (2). A typical counteracting affirmation could be "I wholly and completely love and accept myself" or any other strongly positive statement; 4.
Adding new feelings and thoughts that arise following a round of (1-3) to the ones identified in (2); 5.
Repeating (1-4) until the intensity of negative feelings and thoughts has been reduced to 0 (on a scale of 0-10); 6.
Installing and strengthening positive feelings and thoughts using a replacement positive affirmation for the troublesome feelings and thoughts of (2) after these have been completely neutralized by (3); 7.
The strength of the positivity is assessed on a Subjective Units of Success Scale; 8.
A wholistic approach is emphasized, addressing every level of a person's being: Body, emotions, mind, relationships (with other people and the environment) and personal spiritual awarenesses and beliefs (Benor, wholistic web reference); and 9.
Individualizing the above protocol to the preferences of each person.
When the intensity of the issue is reduced to zero, a