Epistemic Spot Check: The Tapping Solution (Nick Ortner)

This is part of a series called epistemic spot checks, in which I investigate claims a book makes to see if it’s worth paying attention to, without attempting to be comprehensive about it.

Introduction

This is a weird review to write.  I went into reading The Tapping Solution with two beliefs:

1. The scientific claims would be far less supported than the author implies.  The best case scenario was “as terrible as your average therapy research.”
2. The book’s prescriptions work for me anyway, in the sense that they make me calmer and happier and enable me to take better actions.

This book is about EFT, which stands for emotional freedom technique. I write that in a very small font in the hopes you won’t notice how stupid it sounds.  EFT is also known as tapping, because the primary action is tapping your fingers against your face.

I originally learned about EFT in a book that went full blown magic about it: you tap your fingers on your face, it changes energy currents in your body, and the universe magically gives you what you want.  There’s no point evaluating the science in books like that; they are what they are.   The Tapping Solution markets itself as the more studious cousin of that book.  It keeps the energy channels but backs off the magic gifts claim, offering the much more defensible explanation that tapping changes something in you that lets you create better outcomes.

The basic idea of EFT is you tap out a pattern on your body, mostly your face, while repeating a statement about something with a lot of negative emotional affect for you, especially ones that activate the sympathetic nervous system (fight/flight/freeze).  Repeat until you feel better.

[There’s a lot of different techniques claiming to be The Best EFT Script and, while I suspect there are individual variations in what works best for each person, I can’t possibly care about the intra-EFT wars.  Any script you use should just be a starting point for making your own anyway.]

Why would tapping improve your mood?  I have some guesses:

• It makes anxiety et al. boring.  There are a lot of activities where people deliberately activate their SNS (sky diving, horror movies, drugs), so there must be something fun rewarding about being activated.    Plus, lots of the things that happen to you in response to anxiety are quite pleasant.  People cuddle you and bring you ice cream.  You put off doing the stressful thing.  I don’t think many people deliberately push themselves into hysterics for the attention, but I do think these benefits bias how people handle their stress.  Tapping does not offer those kinds of rewards; after two or three rounds of tapping, you are bored.  There are times I have gone and done the stressful thing because I would rather deal with it than have to do another round of tapping.  It’s nice to have my intolerance for boredom harnessed for good.
  • I suspect this is some of how cognitive behavioral therapy works as well.  Having taught myself both, EFT is less work and yet harder to develop an immunity too, although hybrid systems do better still.
• A sense of control lowers stress.  Having A Thing You Can Do While Stressed that you think lowers your stress level is already lowering your stress level.  You can dismiss this as a self-fulfilling prophecy, but that’s only the point if you’re actually evaluating the concept of energy meridians.  If what you want is to calm down so you can respond to comments on your code review, it doesn’t matter if it’s a placebo.
• Something something vagus nerve.  The vagus nerve is this weird nerve that skips the spinal cord and runs all over your body, including most major organs and a lot of your face.
  • Its tasks include:
    • Parasympathetic (relaxing) stimulation of all major organs except the adrenal glands.
    • Parasympathetic stimulation of muscles around the mouth and larynx.
    • Possibly reduces systemic inflammation
    • Sympathetic (fight/flight/freeze) stimulation of blood vessels.
    • A bunch of sensory stuff around the face.
  • Activity on your face is already known to affect your body via the vagus nerve.
    • Cold water on the face slows down your heart, and this is attributed mainly to the vagus nerve.
    •  Direct electrical stimulation of the nerve is touted as a cure for all kinds of stuff.  My sense is the science on that is… optimistic, but there is a reason it is being done to the vagus nerve and not something else.
  • There’s an alternate EFT script that involves tapping only on the hands.  I have fond this to be a calming distraction at best.  Hands are also pretty innervated, so this points to the effects being due to something specifically in the face, as opposed to sensitivity in general.
  • I yawn *a lot* while tapping.  Heart problems can cause yawning via the vagus nerve. I’m obviously not damaging my heart by tapping, I mention this just to show that the vagus nerve and yawning are related.
  • So I don’t know what’s going on, but I suspect the effect of tapping is mediated via the vagus nerve.
• It’s a framework for breaking your problem into bite sized chunks, which is the ideal size for problems to be.  EFT practices vary in how much you work off a verbal script you’re given, vs introspect on your own issues and tap on what comes up.  I predict script-style work to be at best competitive with relaxation exercises, and only introspective EFT leads to actual improvements.
• Who knows, maybe energetic meridians are a real thing, or at least a workable metaphor for a real thing.  Lots of things sound stupid until you know how they work.
  • In particular, if you mixed up the explanations for EFT and the much more legitimate EMDR (deliberate eye movements rewiring your brain), I’m not convinced anyone could tell which one was the Officially Sanctioned Therapy and which was the crackpot treatment.
  • Mark at meditationstuff.com argues that what gets sensed as energy flow is severe awareness of your own nervous system.  He provides no compelling evidence for this, but it is interesting.
  • Many Properly Credentialed Authorities believe things that are no weirder.

 

How I evaluated this book: usually when doing these checks I evaluate any statement I find interesting.  In this case, I’m sticking to the ones for which the author explicitly claims scientific backing.  For stuff that is essentially running on placebos and metaphors, I find a calm, confident, made up explanation is better than a hedged, hesitant, literally true one, so I’m not going to investigate the obviously exaggerated claims.  But if you’re going to claim scientific validity, I am going to check.

Claim: “The amygdala is the source of emotions and long term memories, and it’s where negative experiences are encoded (p4)”.

True.  Simplified, but obviously trying to explain how the amygdala was relevant to a particular concept, not give a comprehensive overview of our friend the amygdala.  The amygdala is in fact so good at emotional memory that it can be invoked by visual cues even in people blinded by brain damage.  This confused me at first, so let me note that the amygdala is not involved in fight/flight/freeze, but the longer, cortisol-driven chronic kind of stress.

Claim: Stimulating acupoints calms down the amygdala, and this is observable in fMRI and PET machines (p5).

Misleading, either bad faith or credulous.  Both studies cited were done with acupuncture, not acupressure or tapping.  I consider that relevant evidence for EFT, but dislike that he tried to make it even stronger evidence by hiding that both studies involved needles.  The effectiveness of acupuncture appears to have large if weak support; I very quickly pulled up many more studies demonstrating the exact same thing, all of which were tiny (the largest was 18), and used fMRIs, which are suspect.

In general, studies of acupuncture have shown that it kind of works, but Official Legitimate Chinese Medicine Points don’t do any better than a random spot, so this adds more legitimacy to randomly stabbing yourself than it does to meridian points.

Claim: Other studies show that pressure works just as well for stabbing, maybe even better for anxiety (p5).

Seems legit.  I didn’t find any citation for this but I’m willing to spot him that touching works better than stabbing for anxiety.

Claim: A study demonstrated that EFT reduces cortisol levels in the saliva (p5).

True, evidence weak but better than I guessed.  The study cited is real, and with some effort I even found a full PDF.  EFT did better than both a support group and no treatment on both a symptoms assessment and cortisol levels (24% decrease vs 14%).  The differences in symptoms between EFT and the other groups are small, and some were not statistically significant.  OTOH, every one of them goes in the same direction.  I find this pretty compelling, assuming they published every trait they recorded.  As usual, small study, vulnerable to p-hacking, etc.

Claim: This John Hopkins approved doctor agrees with us (p7).

Misleading, possibly very.  The named person (David Friedman) does exist, but he’s a doctor of psychology, not psychiatry.  The level that JHU approves of him is unclear.  On his CV (PDF) he lists himself as “research associate”, “instructor”, and “faculty.”  None of these words are “professor”, which makes me think he was an adjunct and certainly didn’t have tenure.

Claim: Competing systems telling you to never think about the negative are idiotic.  True things are true (p8).  In particular The Secret is bullshit.

Seems legit.  “Make bad things approachable”  just seems like a better tactic than wishing really hard. I also enjoy watching different alt modalities fight with each other.

Claim: Meridians have been scientifically validated, they’re called Bonghan channels (p10).

False.  The official name of Bonghan channels is the primo-vascular system, and there’s minimal evidence it exists.  Given that it’s pretty hard to prove that there’s a link between them and meridians in any scientific sense.  But it’s established fact within the meridian community, so it’s at least well sourced bullshit.

 

A few more notes on The Tapping Solution.

As expected, Tapping Solution has failed the RCT test.  What about the model test?

Well, it’s a fairly vague model, and energy meridians can be used to power anything.  On the other hand it avoids my biggest complaint about heal-yourself-with-the-placebo-effect books, and also religion, certain parts of medicine, and psychology, which is that the solution to failure is often do the same thing harder.  Tapping by and large avoids that trap.  For actual physical problems you’re encouraged to see a doctor first, then tap, and if that doesn’t work see a doctor again.  If a particular tap isn’t working you’re given alternate prompts to try.  Additionally, tapping claims that often it will work so well you’ll forget you will ever upset about something, and the solution is not to hand over money to the nice man to keep the good vibes flowing, it’s to keep track of how upset you are at the beginning of the session.  That level of empiricism shouldn’t make a book stand out, but it does.  Tapping Solution, although not every book on EFT, is also pretty clear that you’re not imposing your will on the universe, you’re calming down so you can take better actions.

I don’t want to write out instructions for tapping because I believe the process of reading a book adds a lot of value over a quick run through (the same way doing yoga is better for you than waving a magic wand and becoming more flexible).  But to help you decide if even starting the book is worth your time, here are some genres of problems I think tapping is most appropriate for:

• Somaticizations, especially back pain.
• Emotions you find too overwhelming to deal with, especially anxiety.
• Legit life problems that are just too big to deal with all at once and need to be broken into bite size pieces.

Model

Simplicity: very low.  “Magical energy currents” sounds simple in that you can explain it quickly, but it takes a very long time to explain what things it can’t do and why.

Explanation quality: poor.  Merdians can power anything.

Explicit predictions: okay. You have to make your own explicit predictions, but the book very much encourages you to do so.

Acknowledging limitations: mixed.

Relative to other heal-yourself-with-the-placebo-effect systems, The Tapping Solution is modest in its claims about what your mind can do.  It goes out of its way to establish that the mind-body connection is in fact a connection, it doesn’t mean your body is a hallucination you can will into whatever form you want.

And then on the next page there’s a story of how a woman cured her lung cancer with EFT.  So it’s not amazing on this axis.

Measurability: extremely good.  This is where EFT really shines.  They claim it’s such a good technique you will forget you ever had a problem, and encourage you to keep track so you won’t forget.

 

Empirics

I’m deliberately not giving a lot of details on how to do it yourself, because I think there might be value to going through the book beyond the technique.

I taught this technique to five people, one of whom had a good response to it. Counting myself, that’s 1/3 successes, which is not great. But it’s cheap enough and has high enough potential I still recommend trying it.