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Thinking Outside the Box:
EFT as Psychological Acupuncture for Adult Obesity
CRICOS CODE 00017B
Peta Stapleton, PhD
School of Psychology, Bond University
Acknowledgements: BreE Porter, Amy Bannatyne, Wendy Mackay, Rebecca Mailli, Elyse McNeil, Timothy McIntyre, Keri-‐Charle Urzi, Terri Sheldon
Food Cravings
• Food cravings frequently lead to consump<on of the craved food, are posi<vely correlated with Body Mass Index (BMI), and obese adults report preferences for high fat foods
• Research combining imaginal exposure and cogni<ve procedures, with the manual s<mula<on of acupuncture points (e.g. Emo<onal Freedom Techniques [EFT]) for food cravings has recently revealed significant improvements in weight, Body Mass Index, food cravings, subjec<ve power of food, craving restraint and psychological coping for par<cipants from pre-‐ to 12-‐months aPer a 4-‐week treatment (Stapleton, Sheldon & Porter, 2012)
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Treatment Op<ons
• The current randomised clinical trial extended Stapleton et al.’s (2012) trial and compared EFT treatment for food cravings, with a gold standard treatment strategy, Cogni<ve Behavioural Therapy (CBT), in addi<on to a community group
• Over 18 years old • No severe psychological
impairment • No treatment (psychological
or medical) for food cravings • Body Mass Index greater
than 25 • Food cravings of a certain
severity (FCI)
Inclusion Exclusion
• Psychotropic medica<on • Known sufferers of diabetes
(Type I and II) • Hypoglycaemia • Pregnancy • Anorexia Nervosa
Craving = A physiological and emo5onally intense urge to eat
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Par<cipants
• 178 overweight/obese adults (BMI) were randomized into an 8-‐week EFT (n = 52) or CBT (n = 34) treatment and were compared to a community sample (n = 92)
• Of the total sample, 155 were female, and 23 were male
• EFT – 46 female, 6 male • CBT – 31 female, 3 male • Community – 78 female, 14 male • Mean age was 36 to 40 years
Food Craving Categories • Chocolate • Salty foods (e.g. chips, crisps, salted nuts) • Sweet carbohydrate foods (cakes, cookies, soP/soda drinks)
• Carbohydrate foods which are neither sweet nor salty such as white refined foods (bread, rice, pasta)
• Caffeinated products
76% of sample idenRfied Chocolate as main food craving concern
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Measures
• The Food Craving Inventory (White et al., 2002) • The Power of Food Scale (Lowe et al., 2009) • The Revised Restraint Scale (Herman & Polivy, 1980) • The Pa<ent Health Ques<onnaire (Spitzer, Kroenke & Williams, 1999) -‐ anxiety, depression, alcohol concerns, ea<ng issues, and somatoform symptoms
• Demographic informa<on • Weekly evalua<on of each treatment
EFT Treatment • Emo<onal Freedom Techniques (EFT) is brief exposure therapy that
combines cogni<ve and soma<c elements (Church, 2009) • Par<cipants state a nega<ve cogni<on associated with a specific
emo<onal event or thought, and then pair this with a self-‐acceptance statement
“Even though I am scared of heights, I accept this about myself”
• Par<cipants rate the discomfort on a scale from 0 to 10 (0 = no distress ,
10 = complete distress) • The soma<c component of EFT involves tapping specific parts of the
body while verbalizing the cogni<ve pairing • The process is repeated un<l the discomfort score is 0 • The EFT program was based on standardized treatment protocols (Craig &
Fowlie, 1995; Craig, 2010)
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EFT Has been described as an
Emotional Version of Acupuncture WITHOUT
the needles
A unique exercise that calms you so that you can think more
clearly about your problem and do something about it
EFT Acupuncture Points • Tapping on each point 7 <mes (approx), while sta<ng the cogni<ve statement
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How Does it Work?
• S<mula<on of acupoints is believed to send a signal to the limbic system, and reduce limbic hyper arousal (Feinstein, 2010)
• This in turn, leads to “rapid reciprocal inhibi<on” and “long-‐term counter-‐condi<oning” (Feinstein, 2010)
• EFT can decrease ac<vity in the amygdala, which is part of the brain’s arousal pathway (Dhond, Kemner, & Napadow, 2007)
• The process of EFT has possible effects on the body’s physiological systems that regulate stress, emo<onal intensity and associated neural transmission frequencies (Diepold Jr & Goldstein, 2009)
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CBT Treatment
• Thoughts, feelings and behaviours combine to influence a person’s quality of life, therefore changing thoughts can result in differences in feeling and behaviour
• The CBT interven<on was based on standard protocols (Fursland, & Watson, 2013)
Group Treatment
• The EFT / CBT treatments in this trial were offered to groups of 15 par<cipants
• 2 hour weekly sessions for 8 weeks, including homework
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Food Cravings • No sig differences -‐ CBT vs EFT at pre-‐interven<on; however, both groups had
sig higher scores than community sample • No sig differences at post-‐interven<on -‐ EFT and CBT groups had comparable
FCI scores to community sample • No sig differences at 6-‐mth follow-‐up -‐ EFT and CBT groups had comparable FCI
scores to community sample • No sig differences at 12-‐mth follow-‐up -‐ EFT and CBT groups had comparable
FCI scores to community sample For the EFT group
– Scores decreased sig from pre to post interven<on (p = .005), with this reduc<on maintained at the 6 and 12 month follow ups (p = .025 and p = .027, respec<vely)
For the CBT group – Scores decreased sig from pre to post interven<on (p = .007), however this
reduc<on was not maintained at the 6 and 12 month follow ups (p = .171 and p = .197, respec<vely)
Power over Food • EFT and CBT had sig higher scores than community sample at pre-‐interven<on • No sig differences between CBT vs EFT at pre-‐interven<on, post, 6-‐month and
12-‐month follow-‐up • EFT and CBT groups had comparable POF scores to community sample by post-‐
interven<on. Maintained at 6 and 12-‐mth follow-‐ups For the EFT group
– Scores decreased sig from pre to post interven<on (p = .002), with this reduc<on maintained at the 6 and 12 month follow ups (p = .003 and p = .004, respec<vely)
For the CBT group – Scores decreased sig from pre to post interven<on (p = < .001), with this reduc<on
maintained at the 6 and 12 month follow ups (p = .001 and p = .001, respec<vely)
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Restraint • EFT and CBT had sig higher Restraint scores than community sample than
Community Sample. No sig differences CBT vs EFT at pre-‐interven<on
• Sig differences at post-‐interven<on and 6 month follow-‐up -‐ EFT and CBT had higher Restraint scores than the community sample BUT no sig differences CBT and EFT
• No sig differences at 12-‐mth follow-‐up -‐ EFT and CBT groups had comparable Restraint scores to community sample
For the EFT group – No sig decreases from pre to post or pre to 6-‐months. Sig decrease in restraint scores
from pre to 12-‐mth follow-‐up (p = .004)
For the CBT group – Scores decreased sig from pre to post interven<on (p = .011), with this
reduc<on maintained at the 6 and 12 month follow ups (p = .003 and p = .001, respec<vely)
BMI • EFT and CBT groups had significantly higher BMI scores than community
sample at pre, post, 6-‐month and 12-‐month BUT no sig differences b/wn CBT vs EFT at any <me point
For the EFT group
– No sig decreases from pre to post; however, significant decrease from pre to 6-‐month follow-‐up (p = .009), though not maintained at 12-‐month follow-‐up
For the CBT group
– No sig decreases from pre to post; however, sig decreases from pre to 6-‐month follow-‐up (p = .009) and pre to 12-‐month follow-‐up (p = .032)
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Weight • EFT group
– Pre to post = 3.15kg weight loss – Pre to 6-‐mth = 4.28kg weight loss – Pre to 12-‐mth = 3.32kg weight loss
• CBT group – Pre to post = 0.90kg weight loss – Pre to 6-‐mth = 2.90kg weight loss – Pre to 12-‐mth = 5.10kg weight loss
• BUT no sig differences -‐ EFT and CBT at any <me point
Soma<c, Dep, Anx
• EFT group – no sig changes in soma<c or depression scores, but sig decrease in Anxiety from post to 6-‐mth (p = .013), pre to 12-‐mth (p = .023), and post to 12-‐mth (p = .002)
• CBT group – no sig changes in soma<c or anxiety scores, but sig decrease in depression pre to post (p = .017), pre to 6 month (p = < .001) and pre to 12 month (p = < .001)
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Conclusions • This is the first <me EFT has been compared to CBT in a treatment for food cravings in an overweight/obese adult sample
Findings of the current study indicated:
• EFT treatment was as effec<ve as the CBT interven<on in increasing one’s power over food and restraint ability
• It appeared more superior than CBT to decrease food cravings and anxiety symptoms and maintain this
Prac<cal Tips for Weight Issues Using EFT
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Prac<cal Tips for Weight Issues Ques<ons that assist in elici<ng underlying emo<onal issues related to being overweight, obese or food cravings include:
1. How do you feel in your stomach when you eat a food that you crave? 2. How do you feel in your stomach when you eat a food you don’t crave? 3. Seeing and smelling the food you crave; what do you feel? 4. Imagine yourself throwing this food away how do you feel? 5. What’s your first memory of ea<ng the food you crave? 6. As a child, were you given food to comfort you? 7. What’s your best memory that involves food? 8. What’s your worst memory that involves food?
Food and Weight Issues Lots of Triggers & Aspects
BELIEFS
EMOTIONS
BODY FEELINGS & AWARENESS
FEELINGS IN THE NOW
PAST FEELINGS OR MEMORIES
FEELINGS ABOUT THE
FUTURE
BELIEFS ABOUT YOUR
GOALS
NUTRITIONAL NEEDS
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Common Topics – EFT can …. • reduce immediate food cravings • eliminate nega<ve or distorted body images • neutralise issues from the past that have led to overea<ng
• target future situa<ons that might trigger a relapse • confront and ‘loosen’ the unconscious and conscious irra<onal beliefs individuals have about food, weight, and hereditary factors that may contribute to them being overweight
Issues to Address and How • Food (usually junk) craving • Examples of Set up Statements -‐ Even though I love sugary foods.... (or insert own food craving here), I completely accept myself. Or, even though I crave something sweet (or whatever it is aPer meals), I completely accept myself
• Feeling – Depriva<on • Examples of Set up Statements -‐ Even though I feel deeply deprived… I deeply and completely accept myself anyway; Even though I can’t eat like others, I deeply and completely accept this about myself; Even though when I restrict my intake, I feel deprived, I truly and sincerely accept myself.
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Common Weight Issues to Address • Feeling – Anxiety/Stress • Feeling – Loneliness • Situa<on – Exercise and Mo<va<on Issues • Situa<on – Given food as a comfort as a child – family issues • Situa<on -‐ I don’t like drinking water • Feeling -‐ Using Food to Change Mood • Situa<on -‐ Nega<ves or Costs to Reaching a Natural (Ideal)
Body Shape • Situa<on – Other nega<ve consequences to reaching goal
weight or body shape • Situa<on – A lack of belief in achieving Weight goals
Food Diary Research
• 89 female overweight and obese adults par<cipa<ng in a treatment trial for food cravings
• For 2 weeks prior to beginning treatment and for the dura<on of a 4-‐week treatment, all par<cipants were required to complete a daily food monitoring sheet or diary in real-‐<me, indica<ng all quan<<es of food/drink eaten throughout a day and whether the item was a craving item for them
Stapleton, P.B., & Doyle, W. (2013). Mood and Food Cravings in Overweight and Obese Australian Adults: Clues
to Treatment in Food Diaries. Current Research in Psychology, 4(1), 6-‐15, doi:10.3844/crpsp.2013.6.15
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Food Diary Research • Physiological -‐ indicated by par<cipants recording they were ea<ng in
response only to “hunger”. • Enjoyment / Celebra<on – indicated by par<cipants recording they were
ea<ng because of a celebra<on • Missing Out or depriva<on – par<cipants indicated they were ea<ng
because of a fear of missing out and feeling deprived • Reward – this common theme was indicated through responses such as “I
didn’t have a chocolate this morning” • Wastage – par<cipants ea<ng because they didn’t want to throw out or
discard of food • Emo<ve – any emo<on which appeared to be the cause of the food eaten
was coded as emo<ve reasons. • External environment – any situa<on which did not appear to be coded
through the previous themes and were related to the external environment were noted here. These were typical of the presence of food in the environment
Results indicated that the most common themes recorded included
Wastage, Emo<ve and Reward
2nd Layer to focus on!!
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Can You Throw it Out? • What feelings come up for a client when they throw/amempt to throw the craved food out?
• Do they have some feelings or thoughts arise about was<ng it?
Even though I was taught that I must not waste food or leave any on my plate and I feel guilty and anxious if I do, I deeply and completely accept
myself
Contact
• Dr Peta Stapleton, Bond University • Email: [email protected] • Facebook: hmps://www.facebook.com/peta.stapleton
• Twimer: hmps://twimer.com/PetaStapleton
• Research: hmp://works.bepress.com/peta_stapleton/ • Food Craving Program: www.foodcraving.com.au • Weight Management Psychology Expert Interven<on Series on EFT -‐
hmp://www.weightmanagementpsychology.com.au/?page_id=1151
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Our Published Research – contact Peta for copies • Stapleton, P., Bannatyne, A., Porter, B., Urzi, K.C., & Sheldon, T. (2015). Food for Thought: A Randomised Controlled Trial of
Emo<onal Freedom Techniques and Cogni<ve Behavioural Therapy in the Treatment of Food Cravings. Applied Psychology: Health and Well-‐Being, under review
• Stapleton, P.B., Chatwin, H., William, M., Humon., A., Pain, A., Porter, B., & Sheldon., T. (2015). A Randomised Clinical Pilot Trial: Do Emo<onal Freedom Techniques Impact Ea<ng Habits in 14 to 15 Year Olds, as well as Self-‐Esteem, Self-‐Compassion, and Psychological Distress? EXPLORE, under review.
• Chatwin, H., Stapleton, P.B., Porter, B., Devine, S., & Sheldon, T. (2015). The Effec<veness of Cogni<ve-‐Behavioural Therapy and Emo<onal Freedom Techniques in Reducing Depression and Anxiety among Adults with Six-‐Month Follow-‐Up. Integra<ve Medicine, under review.
• Stapleton, P.B., Murphy, D., Pidgeon, A.M., Porter, B., Thibault, S., & Sheldon, T. (2015). The Efficacy of Emo<onal Freedom Techniques for Improving Student Wellbeing: A Controlled Clinical Trial. Journal of Clinical Psychology, under review.
• Stapleton, P.B., Porter, B., Devine, S., & Sheldon, T. (2014). A feasibility study: Emo<onal Freedom Techniques for depression in adults. Current Research in Psychology, 5(1), 19-‐33.
• Sheldon, T. (2014). Psychological interven<on including Emo<onal Freedom Techniques for an adult with motor vehicle accident related posmrauma<c stress disorder: A case study. Current Research in Psychology, 5, 40-‐63.
• Stapleton, P.B., Church, D., Sheldon, T., & Porter, B. (2013). Depression Symptoms Improve aPer Successful Weight Loss with Emo<onal Freedom Techniques. ISRN Psychiatry, 1, 1-‐7.
• Stapleton, P.B., Porter, B. & Sheldon, T. (2013). Qui}ng Smoking: How to Use Emo<onal Freedom Techniques. Interna5onal Journal of Healing and Caring, 13(1), 1-‐16.
• Stapleton, P.B. (2013). Long-‐term weight loss. In D. Church & S. Marohn (Eds.), The clinical EFT handbook: A defini<ve resource for prac<<oners, scholars, clinicians, and researchers (pp. to be advised). USA: Energy Psychology Press (Hay House). In press.
• Stapleton, P.B., Sheldon, T., & Porter, B. (2012). Prac<cal Applica<on of Emo<onal Freedom Techniques for Food Cravings. Interna5onal Journal of Healing and Caring, 12(3), 1-‐9.
• Stapleton, P.B., Sheldon, T., & Porter, B. (2012). Clinical Benefits of Emo<onal Freedom Techniques on Food Cravings at 12-‐months follow-‐up: A randomised controlled trial. Energy Psychology: Theory, Research, and Treatment, 4(1), 1-‐12.
• Stapleton, P.B., Sheldon, T., Porter, B., & Whimy, J. (2011). A Randomised Clinical Trial of a Meridian-‐Based Interven<on for Food Cravings with Six Month Follow-‐up. Behaviour Change, 28 (1), 1-‐16.
Questions?
CRICOS CODE 00017B
