The Neurochemistry of Counterconditioning: Acupressure

14 Pages·2009·0.34 MB·English

REVIEW ARTICLE
The Neurochemistry of Counterconditioning:
Acupressure Desensitization in Psychotherapy
James R. Lane
Abstract
A growing body of literature indicates that This relaxation response reciprocally inhibits
imaginal exposure, paired with acupressure, anxiety and creates a rapid desensitization to
reduces midbrain hyperarousal and coun- traumatic stimuli. This paper explores the neu-
terconditions anxiety and traumatic memo- rochemistry of the types of acupressure coun-
ries. Recent research indicates that manual terconditioning used in energy psychology
stimulation of acupuncture points produces and provides explanations for the mechanisms
opioids, serotonin, and gamma-aminobutyric of actions of these therapies, based upon cur-
acid (GABA), and regulates cortisol. These rently accepted paradigms of brain function,
neurochemical changes reduce pain, slow the behavioral psychology, and biochemistry.
heart rate, decrease anxiety, shut off the fight/ Keywords: Counterconditioning, acupressure,
flight/freeze response, regulate the autonomic amygdala, exposure therapies, anxiety, desen-
nervous system, and create a sense of calm. sitization.
James R. Lane, PhD, DCEP is an Arizona licensed psycholo- a stimulus from anxiety to calm is called “coun-
gist in clinical practice, with 38 years of counseling experi- terconditioning” or “desensitization.” Feinstein
ence. He has utilized EMDR and EP techniques for 12 years.
(2008a, 2009) has summarized a growing body
He is a member of APA, AzPA, and ACEP. He has supervised
of research studies which demonstrate that ener-
counseling practicum at Arizona State University, and special-
izes in trauma resolution, relationship counseling, and anxiety gy psychology (EP) techniques, which combine
disorders. Contact: Jim Lane PhD, 4015 S. McClintock, Suite exposure to a stress component with self-applied
101, Tempe AZ 85282. [email protected]. Disclosures: The acupoint stimulation, effectively countercondi-
author declares no conflicts of interest.
tion anxiety.
Evidence from acupuncture research indi-
cates that manual stimulation of acupuncture
Clients with anxiety disorders, phobias, points (acupoints) produces endogenous opioids,
and traumatic memories, constitute a increases production of neurotransmitters such as
significant treatment population for men- serotonin and gamma-aminobutyric acid (GABA)
tal health practitioners (Barlow, 2004). What and regulates cortisol, the main stress hormone
these treatment categories have in common is (Napadow et al., 2007; Akimoto et al., 2003; Lee,
the maladaptive hyperarousal of the midbrain’s Yin, Lee, Tsai & Sim, 1982; Ulett, 1992). These
FFF response (Perry, 1999; Barlow, 2004). The biochemical changes effect midbrain structures
midbrain acts in a quick, reflex-like manner to to reduce pain, slow the heart rate, decrease anxi-
stimuli (van der Kolk, 2002), and is conditioned ety, induce calm and shut off the fight/flight/freeze
based upon associative learning (Rothschild, (FFF) response (Dhond, Kettner, & Napadow,
2000). 2007; Fang et al., 2008; Hui et al., 2000; Korber et
To recondition these stimuli, psychiatrist al., 2002). For psychotherapy clients re-experienc-
Joseph Wolpe developed a type of exposure ing fearful memories, panic or anxiety states, or
therapy in which the anxiety reflex is elicited by heightened affect, the calming effects of acupoint
having the client imagine an anxiety-producing stimulation are a valuable supplement to other
stimulus, and then replacing it with a relaxation therapeutic approaches.
response (Corey, 1977; Wolpe & Wolpe, 1981). This paper explores acupressure-assisted EP
He demonstrated that the response of anxiety can psychotherapy and provides explanations for its
be “reciprocally inhibited” by deep muscle relax- mechanisms of action based upon the currently
ation. The process of transforming the response to accepted paradigms of brain function, behavioral
The Neurochemistry of Counterconditioning Energy Psychology 1:1 • Nov 2009 
psychology, and biochemistry. The purpose of this genes involved in the FFF response, and increases
paper is to familiarize mental health practitioners the reuptake of stress hormones such as cortisol.
with the theory and practice of acupressure desen- Several fMRI neuroimaging studies have not-
sitization therapies. It will discuss in more depth ed that acupuncture results in significant decreases
the physiological mechanisms of the FFF response; in the activity of the limbic system, amygdala,
midbrain structure and function; conditioning and brain stem and midbrain structures involved in
counter conditioning; traumatic memories as con- the FFF response (Dhond et al., 2007; Fang et al.,
ditioned stimuli which elicit the FFF response; 2008; Hui et al., 2000; Napadow et al., 2007; Na-
current acupressure desensitization therapies; pro- padow et al., 2009). The activation of the amygda-
cedures common to acupressure countercondition- la is associated with a heightened FFF response,
ing therapies; and acupuncture research defining while the hippocampus, which is responsible for
the neurobiological molecules which produce a re- contextual associations, reduces it (LeDoux, 2002;
laxation response. This paper will also summarize Phelps & LeDoux, 2005; Perry, 1999). Both stud-
the evidence base for the efficacy of acupressure ies by Napadow et al. (2007; 2009) showed sig-
desensitization EP techniques and discuss their in- nificant differences occurring in fMRI images re-
tegration into current psychotherapies. sulting from true versus sham acupuncture points,
indicating that acupoint stimulation has greater ef-
ficacy than other forms of somatic stimulation.
Acupoint Stimulation, Changes in the
Acupoint stimulation is an effective treat-
Brain, and Anxiety Reduction
ment for fear because it terminates the sympathetic
Ulett’s (1992) review of scientific acupunc- nervous system’s (SNS) alarm or FFF response,
ture studies on pain reduction indicates that and replaces it with the parasympathetic nervous
acupoint stimulation produces: internal opioids system’s (PNS) relaxation response (Korber et al.,
(endorphins, enkephalins and dynorphins) which 2002; Napadow et al., 2007; Rudin, 2005). The
reduce pain; serotonin, a mood regulator; and de- SNS alarm response is terminated through a bio-
creases of up to 50% in cortisol, which signals chemical feedback mechanism in the midbrain that
the homeostatic mechanisms in the midbrain to produces calming neurotransmitters such as opioid
reduce the FFF response. Internal opioids, such neuropeptides, serotonin, and GABA, and regulates
as endorphins, both reduce pain and slow down cortisol. These biochemical changes are active in-
the heart rate. A fast heart rate often is an indi- gredients in the counterconditioning process.
cation of anxiety and fear for the person expe- Perry (999) notes that the human midbrain
riencing this proprioceptive stimulus. Ulett cites lies between the brainstem and neocortex and is
acupuncture studies which found a doubling of structured to sense, process, store, perceive and
pain-reducing endorphin levels in the cerebro- mobilize responses to threat. It provides, along
spinal fluid within 30 minutes of acupuncture with the brainstem, regulatory functions affecting
stimulation. the whole body (e.g. activation or relaxation). He
Many neuroimaging studies of acupuncture notes that sensory input is matched against stored
indicate that midbrain structures, particularly the patterns of threat, so that incoming sensory infor-
amygdala, are influenced by acupoint stimula- mation associated with threat sets off a sympathet-
tion (Dhond et al., 2007; Fang et al., 2008; Hui ic nervous system alarm response.
et al., 2000; Napadow et al., 2007; Napadow et The limbic (emotional) brain is part of the mid-
al., 2009). Rudin (2005) indicates that an increase brain structure, and plays a key role in the alarm
in serotonin stimulates the basolateral amygdala to response (Rothschild, 2000). Within the midbrain,
produce GABA, an anxiety-reducing neurotrans- the amygdala is involved in the integration of mul-
mitter that blocks the production of glutamate and tiple sensory modalities and is where associational
delinks the biochemical pathway that produces learning of the alarm response occurs (Phelps &
and maintains the fear response. Regulatory genes, LeDoux, 2005; Perry, 1999). Human brain map-
such as EGR- and c-fos, are triggered by stress- ping of the effects of acupoint stimulation, and
ful experiences (Sabban & Kvetnansky, 2001; neurobiological research, indicates that the proc-
Davis, Bozon, & Laroche, 2003). Church (2009b) ess of counterconditioning occurs in the human
summarizes epigenetic studies demonstrating that midbrain, particularly in the amygdala (Hui et al.
relaxation downregulates the expression of the 2000; Napadow et al., 2009; Rudin, 2005).
2 Energy Psychology 1:1 • Nov 2009 The Neurochemistry of Counterconditioning
Besides the insertion of acupuncture needles, The relaxation state counterconditions the
acupoint stimulation can also be accomplished connection between the stimulus and anxiety
by vacuum suction, tapping, ultrasound, and acu- (Wolpe & Wolpe, 1981), increases blood flow to
pressure (Jones, 2002; Cherkin et al., 2009; Ulett, the neocortex (Amen, 2002; Root et al., 2009) and
1992; Andrade & Feinstein, 2004). Cherkin et al. opens up new neural pathways for processing in-
(2009), using randomized controls, showed that formation and changing behavior (LeDoux, 2002;
somatic stimulation (acupressure) produced the Foa, Keane, & Friedman, 2000; Hartung & Galvin,
same results as acupoint needling. These studies 2002; van der Kolk, 2002). Energy psychology is
indicate that tapping or rubbing provides effective therefore believed to enhance the effects of cogni-
stimulation of the acupoints. This gives credence tive and exposure protocols through its use of the
to the hypothesis that the findings of acupuncture stimulation of acupoints.
research apply equally to acupressure.
The theory and practice of countercondition-
Biophysiology of the Autonomic
ing is a generally accepted paradigm in Behav-
Nervous System’s Fight / Flight /
ior Therapy, with applications for psychotherapy
Freeze Response
(Corey, 1997). Joseph Wolpe successfully dem-
onstrated the counterconditioning of anxiety- The control mechanisms of the autonomic
producing stimuli by using progressive muscle (automatic) nervous system (ANS) include the
relaxation. Several other therapies also appear to thalamus, amygdala, hippocampus, and hypotha-
effect counterconditioning. They include expo- lamus, which are housed in the midbrain (Perry,
sure therapy, cognitive behavior therapy, and Eye 1999; Rothschild, 2000). The ANS is closely
Movement Desensitization and Reprocessing, or linked to the limbic system, which shares many of
EMDR (Bradley, Greene, Russ, Dutra, & Western, the same midbrain structures, and which governs
2005; Institute of Medicine, 2006/2007). emotional responsiveness (van der Kolk, 2002).
Energy psychology builds on the foundation The midbrain is also directly linked to the hind-
of research and clinical experience found in expo- brain, which governs heart rate and respiration,
sure therapies and cognitive restructuring, but adds and to the prefrontal cortex, which can inhibit the
in the stimulus of acupoint stimulation. Energy activation of midbrain responses (Rudin, 2005).
psychology interventions are observed in a number Within the autonomic nervous system are the
of studies to reduce affect, countercondition- sympathetic nervous system (SNS), which pre-
ing emotionally traumatic memories very rapidly pares the body for vigorous physical activity, and
(Church, 2009; Johnson, Shala, Sejdijaj, Odell, the parasympathetic nervous system (PNS), which
& Kadengjika, 2001; Church & Brooks, in press; generates the relaxation response. The purpose of
Wells, Polglase, Andrews, & Carrington, 2003). the SNS alarm response is to increase the ability of
As a result of acupressure desensitization the body to perform vigorous muscular activity in
through EP, the stress-producing thought becomes the event of an emergency.
newly associated with a state of relaxation, resulting This alarm response prepares the body for vig-
in the rapid counterconditioning of stress-producing orous physical activity by increasing respiration,
stimuli, such as thoughts, memories, and external pulse rate, cardiac output, arterial blood pressure,
triggers. Studies measuring brain EEG patterns of blood flow to the large muscles (and away from
subjects before and after EP treatments find a reduc- the skin’s surface), blood sugar, cellular metabolic
tion in the EEG frequencies associated with anxiety rates, muscle strength, blood coagulants and the
(Lambrou, Pratt, & Chevalier, 2003; Swingle, Pulos anti-inflammatory response. The FFF response re-
& Swingle, 2004; Diepold & Goldstein, 2008). sults in limited and highly focused mental activity.
The counterconditioning appears to take place Current SPECT (single positron emission compu-
in the amygdala (Hui et al., 2000; Rothschild, terized tomography) scan research (Amen, 2002)
2000; Rudin, 2005; Napadow et al., 2007; Ulett, indicates that there is more blood flow in the limbic
1992). It is possible that any effective therapy for system and basal ganglia of the midbrain than in the
conditioned states of maladaptive hyperarousal prefrontal cortex and other parts of the neocortex
(disabling anxiety) needs to induce a relaxation (the “analytical brain”) during states of anxiety.
response to “reciprocally inhibit” and countercon- The SNS alarm response is a survival response
dition the response of anxiety. that fires off in fractions of a second, and often pre-
The Neurochemistry of Counterconditioning Energy Psychology 1:1 • Nov 2009 3
cedes awareness of the stimulus by the frontal lobes lamus. The amygdala operates in a rapid but in-
of the brain (Perry, 1999; van der Kolk, 2002). This complete fashion and, although it involves thou-
alarm response can be triggered by physical stress, sands of neurons, it is reflex-like in its operation.
tissue damage that causes pain, prior condition- When at great physical risk, speed and strength are
ing, and/or by strong emotional reactions (Swack, primary (as is skill, but skills have to be learned
2001). Pain stimuli travel up the brainstem and reg- and practiced over time to become solidified into
ister in the thalamus. Other internal (interoceptive) behavior patterns). Certain stimuli, such as pain,
and external (exteroceptive) stimuli also are regis- extreme physical stress, or intense emotional re-
tered in the thalamic region of the brain. action register in the amygdala, and set off the
The amygdala, sometimes called the “smoke FFF response. The amygdala learns to associate
detector of the brain” (van der Kolk, 2002), rap- patterns of stimuli which have been paired with
idly assesses information from the thalamus and, danger to set off the FFF response.
on the basis of prior learning by association (Per- The ability to engage in associative learn-
ry, 1999; Rothschild, 2000; Rudin, 2005), triggers ing is one of the hallmarks of the human brain.
the FFF alarm response via the hypothalamus. The It appears that a kind of reflex-like Pavlovian
hypothalamus sets off the FFF response through (classical) conditioning occurs in the midbrain’s
separate nerve and neuropeptide pathways to the amygdala (Rothschild, 2000; van der Kolk, 2002).
adrenal glands. The hypothalamus directly enner- Rudin (2005) cites animal studies indicating that
vates the adrenal medulla, producing epinepher- associative learning is accomplished in the baso-
ine (adrenaline) and norepinephrine. The adrenal lateral nucleii of the amygdala. When a configura-
cortex is signaled to produce the stress hormone, tion of stimuli associated with danger is perceived
cortisol, an anti-inflammatory, through neuropep- by the amygdala, the result is a firing of the FFF
tide action in the hypothalamic-pituitary-adrenal response. The stimuli are associated with prior
(HPA) axis. Coritsol also signals the liver to re- learning. For instance, if an individual was at-
lease glycogen (blood sugar), so the body can in- tacked from behind, she or he may well develop
crease its energy. The hippocampus, which houses an SNS alarm response any subsequent time he
memory relating to the context of the perceived or she is approached from behind. An individual
threat, can be overridden by a sudden strong amy- with this association will demonstrate an exagger-
gdala activation (van der Kolk, 2002). The left ated startle response, physiological hyperarousal,
prefrontal cortex, which inhibits the expression of and other FFF responses, dependent upon prior
the FFF response, is activated more slowly than learnings (e.g. prior traumas, other environmental
the FFF response, and can be preempted by amy- stimuli, martial arts training).
gdala activation (Perry, 1999; Rothschild, 2000; It has been demonstrated that thinking about a
van der Kolk, 2002). stressful event and/ or stimulus cues in the environ-
The entire purpose of the FFF response is im- ment can bring on distressingly high levels of SNS
mediate activation of physical responsiveness geared activation (Perry, 1999; van Der Kolk, 2002; Wolpe
towards survival. Part of the parasympathetic nerv- & Wolpe, 1981). Intrusive thinking that elicits the
ous system (PNS) and the brain’s gray matter (Rudin, FFF response is one of the indicators of traumatic
2005) may be involved in the freeze response, which stress disorder and posttraumatic stress disorder or
can have survival value in certain situations (Roth- PTSD (van der Kolk, 2002). Panic attacks may also
schild, 2000). After the individual has taken him/her- be triggered by stimuli, perceived by the amygdala,
self out of danger, termination of the FFF response that have been unconsciously associated with prior
is the most adaptive response. Other systems which trauma, or imagined/ anticipated traumas.
have been shut down by the SNS alarm response,
such as digestive processes, can resume and the or-
Classical Conditioning
ganism can utilize its energy for other activities.
Pavlovian, or “classical” conditioning, builds
on the foundation of a connection between an
The Midbrain, the Amygdala and
unconditioned stimulus (UCS) which, without
Associative Learning
prior learning, leads to an unconditioned response
The amygdala evaluates danger associated (UCR). For example, a very loud noise (UCS)
with incoming stimuli funneling through the tha- leads to a startle and orientation response (UCR).
4 Energy Psychology 1:1 • Nov 2009 The Neurochemistry of Counterconditioning
Subsequently, a neutral stimulus is paired with the with a desensitization target. The anxiety levels
unconditioned stimulus (e.g. the visual presenta- are calibrated using the client’s subjective units of
tion of a speeding red pickup truck) and after one discomfort (SUD) on a scale of 0 (no anxiety) to
or more pairings, the once neutral stimulus is able 100 (maximum anxiety). Stimuli associated with
to elicit a startle and orientation response in the low levels of anxiety are counterconditioned first,
absence of the UCR (loud noise). thereby providing a “systematic desensitization” of
The once neutral stimulus, now called the con- anxiety-producing stimuli. This gradual approach
ditioned stimulus (CS), has the ability to elicit a ensured that the patient did not get overwhelmed
startle and orientation response similar to the loud with anxiety and retraumatized. Stimuli associated
noise alone. The startle and orientation response with progressively higher levels of anxiety were
elicited by the CS alone is referred to as the condi- then counterconditioned, resulting in the therapeutic
tioned response (CR). A scenario drawn from clin- desensitization of a particular target. The result was
ical experience follows: A relaxed driver of a car is that the anxiety-producing stimuli no longer elicited
making a left turn and is hit by another car (UCS). anxiety. This process resulted in greater behavioral
As the accident happens, the driver’s sympathetic flexibility, better problem solving (with more blood
nervous system’s “alarm” response fires off a rush flow to the cognitive centers of the brain), and en-
of adrenaline and cortisol, giving the driver an ex- hanced performance for the client.
perience of the FFF response (UCR).
After recovery from the accident, whenever
Therapies That Utilize
the driver begins to make a left turn (CS), the driv-
Acupressure Desensitization and
er feels a rush of adrenaline and its physiological
Shared Procedures of Treatment
effects (CR). Even thinking about making a left
turn results in feelings of anxiety. Making a left There are some 30 different EP methods
turn while driving has become a conditioned stim- (Feinstein, 2003). Among the most widely prac-
ulus for activation of the FFF response. ticed are Thought Field Therapy or TFT (Calla-
han, 2000), Emotional Freedom Techniques or
EFT (Craig, 2008), Touch and Breathe (Diepold,
The Counterconditioning of Anxiety
2000), and Tapas Acupressure Technique or TAT
Counterconditioning is the replacement of (Fleming, 1996). There are many hybrids, varia-
one conditioned response by another conditioned tions, and combinations of these and other thera-
response to the same conditioned stimulus (Corey, pies. These therapies use cognitive and exposure
1971, p.127). In the counterconditioning of anxi- elements, as well as acupressure stimulation. They
ety, a stimulus which has been associated with first evoke an anxiety-producing stimulus (expo-
anxiety is reassociated with a response of relaxa- sure), and then apply the therapeutic technique to
tion. The response of relaxation is physiologically bring about a relaxation state, counterconditioning
incompatible with anxiety, therefore the relaxation client anxiety. During the process, these therapies
response “reciprocally inhibits” the response of also introduce a reframing statement (cognitive
anxiety. In this way, a particular stimulus once as- restructuring), helping the client develop a new
sociated with anxiety can be counterconditioned. cognitive framework. Clients self-rate their level
The counterconditioning of anxiety is also referred of distress on the SUD scale after each application
to as “desensitization,” as the subject becomes less of the procedure.
and less sensitive to the stimulus that triggered the Energy psychology interventions typically
anxiety (Wolpe & Wolpe, 1981, p. 50). begin with a statement of self-acceptance while
Wolpe used deep muscle relaxation to produce stimulating one or more acupoints, which is
a state of relaxation. The state of relaxation was then believed to ameliorate the client’s resistance to
paired with target stimuli which elicited anxiety. The treatment. For example, the client will say: “Even
relaxation response reciprocally inhibited the anxi- though I have this problem, I accept myself and
ety, and a new association was learned to the once- choose to overcome this problem.” The subject’s
anxiety-producing stimuli. In Wolpe’s therapeutic distress level generally decreases by two or more
system of counterconditioning, clients construct a SUD points per round of acupoint stimulation
desensitization hierarchy by enumerating several (Craig, 2008; Gallo, 1999; Feinstein, 2003; Gru-
stimuli having varying levels of anxiety associated dermeyer & Gruedermeyer, 2000). This procedure
The Neurochemistry of Counterconditioning Energy Psychology 1:1 • Nov 2009 5
is then repeated a number of times focusing on the Subjects were drawn from an ad in the news-
same stimuli and/or different distressing aspects paper, and were given an array of psychological
of the traumatizing material (Craig, 2008). Utiliz- tests and physiological measures. Thirty nine sub-
ing this approach, the SUD level is brought to 0 or jects were allotted up to four sessions of one of
stabilizes at a low level, providing the client with a the therapies. The average treatment time by treat-
sense of calm, behavioral flexibility, and increased ment mode was 63 minutes for TFT; 113 minutes
cognitive problem-solving capacity. The result of for V/KD; 172 minutes for EMDR and 254 min-
the therapy is that the client can think of the once- utes for TIR. All subjects started with a SUD level
distressing stimulus without feeling a sense of dis- of between 8 and 9. Four to six months later, the
comfort. Additionally, the mental representation subjects in the study, by treatment group, reported
of the distressing thought (e.g. the remembered a SUD of 3.60 for TFT; 3.30 for V/KD; 2.64 for
visual recollection of an emotional trauma, body EMDR and 5.67 for TIR. This study attested to
sensations, and internal dialogue) often changes. lasting therapeutic effects of TFT along with the
The results hold over time, indicating that reas- effectiveness of the other modalities. Of all the
sociation or counterconditioning of the distressing modalities utilized, TFT had the shortest aver-
material has occurred (Church & Brooks, in press; age time of treatment. One limitation of the study
Church, 2009a; Wells, Polglase, Andrews, & Car- was that varying methods of client selection were
rington, 2003; Baker & Siegel, 2005). A review of used, therefore limiting strict comparisons among
EP research to date notes that in all EP studies that methods.
include a follow-up, participant gains have been Reports of victims of the 9/11 World Trade
maintained over time (Feinstein, 2008a). Center disaster showed relief from persistent
troubling memories after EP (Nicosia, 2008;
Studies Support the Efficacy of Greene, 2002). Several dozen cases are presented
Acupressure Desensitization by Feinstein, Eden, and Craig (2005), reporting
success with a wide range of physical and psy-
The efficacy of acupressure-assisted EP ther-
chological ailments. EP has been used in disaster
apies in promoting counterconditioning, along
areas throughout the world, where case reports
with all the positive biological changes that ac-
are sometimes the only evidence available be-
company it, is attested by several groups of
cause of the difficulty of gathering empirical data
studies, many of them summarized by Feinstein
(Feinstein, 2008b). EP was used to successfully
(2008a). This evidence base is in several forms,
treat traumatic memories experienced by the sur-
from case studies and anecdotal collections, to
vivors of the genocide in Kosovo (Johnson et al.,
uncontrolled outcome studies, to randomized
2001).
controlled trials using stringent experimental
designs. Anecdotal, case report, and preliminary
data studies show a reduction in FFF triggering Within-subjects Studies
in subjects (Arenson, 2001; Craig, 2008; Gallo,
Uncontrolled studies using time-series, re-
1999; Hover-Kramer, 2002; Callahan, 2000; Car-
peated measures designs to measure pre-post
bonell & Figley, 1999).
changes in psychological symptoms have shown
a high degree of statistical significance (Fein-
Prelminary Studies
stein, 2008a). Rowe (2005) demonstrated that an
A small research study using evaluative meas- 18-hour EFT training group, involving 102 par-
ures, and follow-ups, was done by Carbonell and ticipants, reduced both the intensity and breadth
Figley (999). They evaluated the effectiveness of of psychological distress. Rowe took a baseline
the acupressure method, Thought Field Therapy measurement a month before the training, and
(TFT) and a number of other methods deemed found that participant distress levels were the
successful by experienced psychotherapists for same as pretest.
treating Post Traumatic Stress Disorder symptoms. Posttest, participant symptom levels had im-
Other therapies included Eye Movement Desensi- proved to a statistically significant degree, and in
tization and Reprocessing (EMDR), Visual/ Ki- two follow-ups, they were found to have main-
nesthetic Dissociation (V/KD) and Traumatic In- tained their gains. Church & Brooks (in press)
cident Reduction (TIR). performed a similar study with 216 healthcare
6 Energy Psychology 1:1 • Nov 2009 The Neurochemistry of Counterconditioning
workers who received a one-day EFT workshop Goldstein (2008). They used qEEG frequen-
in which they self-applied EFT for two hours. The cies before treatment, after treatment and at 8
participants were workshop attendees at five dif- months.
ferent conferences. One workshop was taught by The results demonstrated that as reported
Gary Craig, founder of EFT, and the other four SUD ratings decreased from the use of acupres-
by Church. No statistically significant difference sure, so did the brainwave frequencies associated
was found when EFT was taught by its founder, with anxiety. Lambrou, Pratt, & Chevalier (2003)
and when it was taught by another presenter. This found that one 30-minute TFT session was effec-
study also tracked EFT use after the conferences, tive in reducing symptoms of claustrophobia for
and found that those who used EFT the most im- the 4 subjects treated, as well as pre/ post normali-
proved more than those that used EFT little or zation of EEG brain function. A study by Swingle,
not at all. Depression, anxiety, and seven other Pulos, & Swingle (2004) with 9 traumatized auto
symptom areas all declined to a highly statistically accident victims, also showed EEG brain normali-
significant degree, as did the breadth and depth of zation. A study, examining heart rate variability
psychological distress. values, found that during the course of EP treat-
A study by Church, Geronilla, & Dinter ment, the HRV of the client entrained with that of
(2009), using a repeated measurement within- the therapist (Bair, 2009).
subjects design, demonstrated the effectiveness
of six sessions of EFT in the reduction of PTSD
Randomized Controlled Trials
and other psychological symptoms experienced
by seven combat veterans. A significant effect in Randomized controlled trials (RCTs) have
a study with only seven participants indicates a also demonstrated the efficacy of EP interven-
very large effect size, i.e. the intervention initiated tions for many psychological and physical condi-
large changes in participant symptoms. In another tions. One of the earliest applications of EP, in the
study, Church (2009a), found a reduction in PTSD 90s, was for the treatment of phobias (Callahan,
and co-occurring conditions among  military 2000). In one of the first RCTs of EP, Wells et.
veterans and their family members as a result of al. (2003) utilized acupressure-based Emotional
a one week EFT intensive, which contained 10 to Freedom Techniques (EFT) in the treatment of
15 sessions of EFT. The average participant PTSD small animal or insect phobias (mouse, rat, spider,
symptom score dropped from well over clinical cockroach) under laboratory conditions. Subjects
levels at pretest, to subclinical levels at posttest. screened had to: have a “specific phobia” as des-
Three follow-ups, the last at one year, indicated ignated by the DSM-IV criteria, be over 18 years
that participants had maintained their subclinical old, have had this phobia for over three years, and
levels of PTSD symptoms over time. EP was also not be receiving current treatment for this phobia.
shown to produce statistically significant improve- This study used a control group and a double blind
ments in PTSD symptoms in genocide orphans in rating procedure. Randomly assigned participants
Rwanda in two pilot studies (Sakai, 2007; Stone, were treated individually for 30 minutes with
Leyden, & Fellows, 2009). either EFT (n = 8) or a comparison condition
A number of EEG neuroimaging studies known to reduce anxiety, Diaphragmatic Breath-
also support the effects of acupressure in calm- ing (DB) (n = ).
ing areas of the midbrain associated with the FFF The structure of both treatments were kept as
response. Andrade & Feinstein (2004) studied similar as possible, with both groups visualizing
a group of patients who were diagnosed with the feared object while applying the treatment
Generalized Anxiety Disorder (GAD). Digitized in individual sessions run by a trained research
EEG scans were done at the start of TFT acupres- psychologist. The dependent variables included:
sure treatment and after four, eight, and 12 ses- the Behavioral Approach Test (BAT), three sub-
sions. GAD symptoms and SUD ratings reduced jective ratings of fearfulness (two using SUD
over the course of treatment. The brain mapping scales) and pulse rate. EFT produced significantly
showed a progressive movement towards EEG greater improvement than did DB in the ability to
normalization as treatment progressed. A single approach the feared objects (p < .02). EFT also ap-
case study on the effects of TFT in normalizing peared more effective when comparing the three
brain waves has been reported by Diepold and self-report measures.
The Neurochemistry of Counterconditioning Energy Psychology 1:1 • Nov 2009 
Reductions in SUD levels using imagination PTSD, a randomized controlled trial was un-
of the feared object were: 3.8 units for EFT and 1.1 dertaken (Church, Hawk, Brooks, Toukolehto,
units for DB (p < .005). Reductions in SUD level Wren, Dinter, & Stein, 2009). Preliminary re-
when actually approaching the feared object were: ports of this study show participants dropping
3. units for EFT and .8 units for DB (p < .02). from high clinical to subclinical levels of PTSD
There was no significant difference between EFT symptoms after EFT, with gains maintained on 3
and DB on pulse rate. The greater improvement and 6 month follow-ups, and highly statistically
for EFT was maintained, and possibly enhanced significant results. Other symptoms such as pho-
at six to nine months follow-up on the behavio- bias, hostility, paranoia, depression and anxiety
ral measures. These findings suggest that a single also decreased.
30-minute treatment session using EFT to reduce A study by Elder et al. (2007) demonstrated
specific phobias can produce valid behavioral and that Tapas Acupressure Technique (TAT) was sig-
subjective effects which last for at least six to nine nificantly more effective at maintaining weight
months after the treatment. loss than a weight maintenance strategy group or a
Baker & Siegel (2005) replicated the effec- qi gong group at the end of ten one hour sessions
tiveness of EFT for treating phobias of small ani- and at a 12 week follow-up.
mal and insects using randomized controls. They Brattberg (2008) administered EFT to a popu-
compared a 45-minute session of EFT (n = ) lation of fibromyalgia sufferers randomized into a
with a 45-minute supportive Rogerian counseling wait list or treatment group. She found a significant
(n = 0) and a no treatment group (n = 0). EFT improvement in the primary fibromyalgia symp-
showed statistically significant results compared toms of pain, fatigue, and muscular soreness. The
to the control groups on pre/post measures of: intervention in this case was administered over the
SUD ratings following treatment (p < .001), SUD internet in the form of an online study course.
during the Behavioral Approach Test (p < .002), Church, Piña, Reategui, & Brooks (2009)
and two fear of animal questionnaires (p < .02, p administered a single session of EFT to a PTSD-
<.00) and the BAT (p < .03). positive sample of abused adolescents living in a
A follow up averaging .4 years later showed group home. On one-month followup, the scores
that the treatment effectiveness was maintained, of all participants had reduced to normal levels,
albeit in a reduced amount. This attested to the ef- while those of a no-treatment group had stayed the
fectiveness of EFT over Rogerian counseling and same. As is typical in EP studies, the effect size
supported the Wells et al. findings. was so large (p < .00) that the results were high-
Salas, Brooks, & Rowe (2009) have partially ly statistically significant though the sample was
replicated the Wells et al. study, where 22 subjects small (n = 16).
served as their own controls. Half of the subjects A study of elite athletes used a very brief EFT
received Diaphragmatic Breathing (DB) first and treatment (Church, 2009c). Members of a champi-
EFT second. The other half received EFT first and onship university basketball team were tested on
DB second. The three criterion ratings were the their performance at free throws, and the height
Beck Anxiety Inventory, a modified Behavioral of their vertical jumps. After 15 minutes of EFT,
Approach Test (BAT), and SUD ratings prior to the difference between the treatment group and
treatment and after the first and the second treat- a placebo control group was 38% on free throws
ment. EFT produced significant reductions of anx- (p < .03), though no significant improvement was
iety on all three measures, whether it was used as found in jump height.
the first or the second treatment. DB did not have Andrade & Feinstein (2004) published clini-
this effect. Irgens, Uldal, & Hoffart (2007), using cal research on the treatment of anxiety disorders
a wait list control, demonstrated the effectiveness done in South America. This five-year pilot study,
of TFT for anxiety disorders. A study by Schonin- of 5,000 patients diagnosed with a variety of anxi-
ger (2004) showed the effectiveness of a one hour ety disorders, used randomized, controlled, and
Thought Field Therapy (TFT) session (n = 24) blind rated data. Patients were randomly assigned
compared with a wait list (n = 24) in the treatment to an experimental group using Thought Field
of public speaking anxiety. Therapy (TFT), a form of acupoint therapy, or a
Following the successful within-subjects control group using Cognitive Behavior Therapy
pilot studies of veterans with clinical levels of (CBT) with medication (benzodiazepines).
8 Energy Psychology 1:1 • Nov 2009 The Neurochemistry of Counterconditioning
Ratings were taken at one, three, six and 12 cally significant change for entrance exam scores
months by independent clinicians, who were blind between the two groups.
to whether the patients had been in the treatment The evidence presented above demonstrates
or control group. Raters only knew the initial di- that acupressure treatments reduce the stress re-
agnosis, symptoms, and severity of patient anxiety sponse by changing brain function, nervous sys-
problems. Patients were rated using categories of: tem arousal, gene expression, hormone levels,
no improvement, some improvement, and complete neurotransmitter levels, and associated brain func-
remission. At the close of therapy, 90% of the acu- tioning. The research indicates that acupressure
point desensitization group showed at least “some calms down the FFF response and replaces it with
improvement” compared with 63% of the control a relaxation response. As demonstrated by Wolpe
group. In the “complete remission” category, the (1981), we know that the relaxation response is a
acupoint desensitization group had a 76% success key element in the counterconditioning of anxiety,
rate (i.e. of being symptom free), compared to a phobias and traumatic memories. Given this cur-
51% success rate for the CBT/ medication group. rent understanding, it is desirable to use the quick-
At one-year follow-up, the gains observed with est, least invasive and most economical techniques
the acupoint tapping treatments were less prone for counterconditioning in psychotherapy. There-
to relapse or partial relapse than those with CBT/ fore, having clients activate the fear response
medication, as indicated by the independent raters’ through active imagination and then tap and/or
assessments. The mean number of treatment ses- rub their own acupoints appears to be one of the
sions for the acupoint treatment was three sessions, treatments of choice.
while the mean number of treatment sessions for
the CBT/ medication group was 15.
Advantages of Using Acupoint
Another substudy by Andrade & Feinstein
Desensitization
(2004), indicated a change in neurotransmitter
profiles, with the acupoint treatment resulting in There are many advantages to using acupoint
lower levels of norepinephrine (a stress related desensitization techniques. Acupressure can be
neurotransmitter) and higher levels of serotonin framed as a technique for stress management and
(a calm inducing neurotransmitter) than the CBT/ self-comforting. This makes it easy for clinicians
medication group. to explain this novel treatment to clients, and to
A third substudy of 78 subjects compared incorporate it into various types of psychotherapy.
the efficacy of acupoint tapping with acupoint The acupressure procedures take only a short time
needling. The results indicated that tapping re- to learn and are easy to apply. The techniques can
duced anxiety symptoms in 8.5% of the sub- be used to desensitize traumatic material rapidly,
jects, while inserting acupuncture needles into thereby minimizing the risk of retraumatization
the same points reduced anxiety in 50% of the (Mollon, 2007).
subjects, a finding consistent with other pub- Preliminary studies have shown that acupres-
lished reports that acupressure is at least as ef- sure desensitization is an effective tool for com-
fective as needling. bat veterans and survivors of auto accidents who
Two randomized controlled trials of EP for suffer from PTSD (Church, 2009a; Church et al.,
test anxiety in students have demonstrated statis- 2009; Irgens et al., 2007; Swingle et al., 2004).
tical significance. Benor, Ledger, Toussaint, Hett, Given the numbers of returning combat veterans,
& Zaccaro (2009) compared two EP treatments this easily learned technique can reduce much
with cognitive behavior therapy. All three treat- pain and suffering. The techniques can be used
ments were found to reduce test anxiety, but the outside the office by the client as homework, or
two EP treatments required two sessions, while the as a self-help tool. Effective acupoint desensiti-
CBT treatment required five. In the second study, zation ensures that the client’s alarm response is
Sezgin & Ozcan (2009) examined the test scores no longer spontaneously triggered by associated
and anxiety levels of students applying for a uni- memories or conditioned stimuli. The client no
versity entrance exam. They randomized groups longer feels compelled to avoid stimuli associated
into EFT and diaphragmatic breathing (DB). The with the traumatic event or memory. The reduc-
EFT group was found to have reduced anxiety, and tion of compulsive avoidance may have beneficial
lower test scores, though there was not a statisti- effects upon maladaptive behavior patterns such
The Neurochemistry of Counterconditioning Energy Psychology 1:1 • Nov 2009 9
as addictive cravings and other compulsive behav- The reduction of chronic SNS hyperarousal
iors. Church & Brooks (in press) found an 83% has powerful implications for physical health as
reduction (pre/ post test, p < .00) in cravings (for well (Atanackovicab, Krögerc, Serked, & Deterb,
cigarettes, alcohol, drugs, etc.) among a group of 2004; Brattberg, 2008; Ebrect, Hextall, Kirtley,
healthcare workers, after 20 minutes of applying Taylor, Dyson, & Weinman, 2004; Kendall-Tack-
EFT. Acupoint desensitization allows the client ett, 2009; van der Pompe, Duivenvoorden, Antoni,
to calmly rethink aspects of traumatic events and Visser, & Heijnen, 1997). Kendall-Tackett (2009)
put this information into a more reasonable and/ notes that traumatic stress increases chronic in-
or broader frame of reference. As Perry (999) flammation and deregulates the sympathetic nerv-
and Van der Kolk (2002) point out, the ability to ous system. A large epidemiological study by Fe-
analyze data effectively is enhanced by the reduc- litti et al. (998) found that childhood emotional
tion of the FFF response. The client feels a greater trauma correlates with many adult diseases, in-
sense of calm, competency and self-esteem. cluding cancer, heart disease, hypertension, diabe-
tes, and depression.
Beyond Counterconditioning, Acupressure-assisted psychotherapy can help
conditions like diabetes, where the FFF response
Implications for Psychotherapy
increases blood sugar levels, as well as speed-
and Health
ing the healing of wounds (Ebrect et al., 2004),
Acupoint desensitization is the first step in the and reducing the symptoms of fibromyalgia that
psychobiological healing process of countercondi- are brought on and exacerbated by chronic stress
tioning FFF reactions. This frees the client from (Brattberg, 2008). It is established that chronic
reflexively reacting in a panicked manner to stim- physiological stress reduces immune function
uli. Next, the reduction of the SNS alarm response (Atanackovicab et al., 2004; van der Kolk, 1996;
increases access to prefrontal lobe and neocortex van der Pompe et al., 99). Reduction of unnec-
thinking (Amen, 2002; Perry, 1999; Rudin, 2005; essary heightened states of stress through acupres-
van der Kolk et al., 1996). Experiencing a relative sure desensitization can regulate the sympathetic
sense of calm, the client can create new cognitive parasympathetic balance and enhance the body’s
frames of reference which restructure the memory own ability to heal. The management of pain and
(e.g. “I’m a resilient person who got through a dif- is another application of acupressure desensitiza-
ficult challenge”). This process can be facilitated tion. Church & Brooks (in press) found that 20
by a simple question such as: “Now that you feel minutes of EFT resulted in a 68% reduction in
differently, how do you think about the traumatic pain (pre- posttest, p < .00), among a group of
event/s differently?” This process can also be fa- healthcare workers. Several studies show that acu-
cilitated with EMDR (Shapiro, 2002), cognitive point stimulation reduces pain (Fang et al., 2008;
behavioral therapy (Meichenbaum, 1994), hyp- Napadow et al., 2007; Ulett, 1992). EP provides
notherapy (Rossi, 2002) psychoanalytic therapy a natural, self-applied, side-effect-free alternative
(Mollon, 2008), or other therapies. for those patients otherwise confined to medica-
Thirdly, the therapist can help the client in- tion for chronic pain. Elder et al. (2007) demon-
stall and strengthen an adaptive behavioral reper- strated the effectiveness of TAT acupressure on
toire and cognitive framework, regarding how to helping subjects maintain weight loss. These are
handle challenging situations in the future. This just a few of the ways that acupoint desensitization
can be facilitated by a simple question such as: can improve physical health.
“How would you like to see yourself handling a Practitioners working with traumatized cli-
potential trigger situation in the future?” A host ents need to consider that acupressure assisted
of other therapies that are part of the therapist’s psychotherapy does not work 100% of the time,
tool box can facilitate this process. In short, the nor does any other technique. Andrade and Fein-
client is able to transform the disabling traumatic stein (2004) noted that 90% of people with anxiety
event, think more clearly about the event, think disorders were helped by TFT acupressure desen-
more positively about him- or herself, and develop sitization, yet subjects asked to review traumatic
strategies and skills that help him or her deal more incidents can get retraumatized (van der Kolk,
effectively with life. I call this process “acupres- 1996). Mollon (2007) indicates that this danger
sure assisted psychotherapy.” is typically minimized with EP. Yet, care must be
0 Energy Psychology 1:1 • Nov 2009 The Neurochemistry of Counterconditioning