A Review of Thought Field Therapy

Wayne Hooke, M.A.
Vancouver, Washington
Private Practice

Abstract
Methodological weaknesses, a lack of controls, or the failure to fully report data and methods in the few TFT studies that have been conducted limit their interpretability. Clinical reports are suggestive, but careful research has yet to confirm whether or not TFT interventions cause a rapid decrease in subjective distress. Research published to date provides neither sure conclusions nor insight into any of the many other questions surrounding TFT. Current TFT theory is highly elaborated, but too speculative to be helpful in understanding the potential therapeutic mechanisms of TFT.

A Review of Thought Field Therapy

Introduction

Thought Field Therapy (TFT) is a relatively unique, alternative approach to psychotherapy that combines thinking about a distressing problem with tapping on various points on the body in order to eliminate psychological distress. While lacking in face validity, TFT has received slow but continued attention from clinicians over the last 17 years and is beginning to attract the attention of researchers. Much, but not all of this attention comes from clinicians and researchers seeking more effective means of treating the aftermath of psychological trauma.
TFT is practiced in a variety of ways. While data are not available, the majority of practitioners likely use algorithms in their work with clients. The algorithms consist of a series of prescribed activities that are followed in cookbook fashion. There are different algorithms for different problems. A readily available algorithm for psychological trauma (Figley, 1995) consists of a number of steps.
First, the client "attunes" to the thought field. This is no more than to say that the client needs to be in the distressing situation or be thinking about the distressing situation while tapping. Clients then rate their self-perceived level of anxiety using a subjective units of distress scale (SUDS) rating (usually consisting of a rating between one-and-ten). Clients then tap (with two fingertips) a variety of points on the face, hands, and body while staying attuned to the thought field. The points that are tapped are known as acupoints because these points were originally used in acupuncture treatments. Subsequent to tapping and a deep breath, another SUDS rating is provided.
If the second rating is not noticeably lower than the first, tapping continues on a specific point on the fleshy part of the hand while repeating to oneself, "I accept myself, even though I still have this kind of anxiety." This phrase is repeated three times and then the algorithm begins again at the start. TFT proponents report that this intervention corrects "psychological reversal" a hypothetical condition in which the flow of energy along the meridians is reversed. Psychological reversal (PR) is understood to interfere with a therapeutic response to tapping on acupoints.
The algorithm continues, adding tapping on a specific point on the back of the hand (known as the gamut spot) while performing a variety of activities, such as rolling the eyes, humming, counting, etc. (See the appendix for the specific algorithm.) The gamut spot is tapped in TFT treatments in conjunction with eye movements and the performing of activities normally controlled by different brain hemispheres. The gamut treatments are understood to be a unitary intervention and are "used in treating most problems" (Callahan & Callahan, 1996, p. 102). The algorithm then ends by repeating the tapping and SUDS rating procedures. Normally, the algorithm is repeated at least four times.
This algorithm is unique to treating trauma. Other problems are treated by different algorithms that modify the order of the points that are tapped, and by tapping at different points.

Clinical Reports
Callahan (1994) reports that 80% of "clients will get some level of immediate relief" from the following types of problems by properly administered TFT: panic, phobia, post traumatic and general stress, anxiety, substance and food addiction, sexual problems, pain, depression, irrational guilt, self-sabotage, chronic anger, and rejection. Clinicians who responded to a request over the internet forum, Traumatic-Stress, report an almost identical array of problems responding successfully to TFT interventions -- though this author received no corroborative reports of the successful treatment of addictions or sexual problems. Additionally, a single case of the successful treatment of self-mutilatory fantasies via TFT was reported (Michael Galvin, personal communication, 1996).
Clinical reports suggest that TFT is useful in the treatment of a wide array of mental health problems. The absence of carefully gathered data and experimental controls is cause for some caution. None of the claims for the clinical efficacy of TFT are based on published, controlled studies. Further, data comparing TFT to credible placebos has yet to be published and replicated. Therefore, all clinical reports -- whether corroborative or disconfirming of TFT -- must be interpreted cautiously.
Callahan (1995) reports that TFT does not increase clients' discomfort or distress. Several clinicians have reported some increases in subjective distress during TFT that are associated with dissociation and axis II disorders (particularly borderline personality disorder)(Dan Dunlap, personal communication, 1996; Moore, personal communication,1996). Cazabat (personal communication, 1997) reports 1 case of increased SUDS ratings out of approximately 100 that he has treated with TFT. This case did not involve either dissociation nor a personality disorder. Self-consciousness or embarrassment during the procedure may interfere with a positive outcome (Cazabat, personal communication, 1996). Dan Dunlap estimates that approximately 50% of his rural clients refuse TFT, probably due to embarrassment (personal communication). Callahan's demonstration of TFT for children's phobias on the Leeza Gibbons Show revealed the same 50% refusal rate (aired October 12, 1996). Dunlap -- a man -- has observed a connection in his practice between TFT refusal and a history of sexual abuse in women (Personal communication, 1996).
The rapid reduction in subjective distress reported by TFT proponents does not always occur. Some clients reportedly respond more gradually (Dunlap, personal communication, 1996). Michael Galvin (personal communication, 1996) reports that he expects to spend as long as 20 minutes in reducing a SUDS rating of 8-10 down to a 0-1. Further, he reports that complicated problems may not be this responsive (Galvin, personal communication, 1996). However, the potential rapid response to TFT is of clinical interest and has been used by at least one clinician during crisis calls and to stabilize distressed clients at the end of sessions (Dunlap, personal communication, 1996). While a rapid response to TFT is commonly reported by clinicians, repeated treatments are often -- probably most often -- utilized. For example, a woman suffering from PTSD reported excellent results from using the TFT algorithm for trauma five times a day for the first week and two-to-three times a day for the second week (Callahan, personal communication, 1996).

Research Reports
Data have been reported in four studies of TFT (Callahan, 1987; Leonoff, 1995; Wade, 1990; Wylie, 1996). Each of these studies report noticeable changes in SUDS ratings, most of which occurred in a matter of a few minutes. None have appeared in their entirety in the peer-reviewed literature. Both Callahan and Leonoff used callers to radio talk shows for subjects. Callahan reported an average pre- and post-treatment SUDS ratings change of 6.25 and Leonoff reported an average change of 6.61 (Callahan & Callahan, 1996). Due to limitations in these studies' designs (e.g., no control groups, nonrepresentative sampling, contamination by the demand characteristics of a public radio broadcast, use of SUDS ratings as the exclusive measure in the study, etc.), a circumspect conclusion about the Callahan/Leonoff data is that these clinicians are reporting very dramatic changes in levels of subjective distress taking place very quickly.
The Figley/Carbonell data (reported in Wylie, 1996) are more suggestive -- though the absence of a control group limits the interpretability of this study. This latter study shows an average change in SUDS ratings pre and post treatment of approximately 3.3 points. A similar decrease in SUDS ratings -- an average decrease of 3.4 points -- was found by Wade (1990) in a three-month follow-up of a TFT intervention for phobias (compared to a decrease of less than half a point in a wait-list control group). Similar changes in the magnitude of SUDS ratings have been observed within and between sessions in a study utilizing exposure techniques (Foa & Chambliss, 1978). While the degree of change in SUDS ratings in these studies is comparable between TFT and an exposure-based intervention, the rate of change is not. TFT apparently produced changes in SUDS ratings in minutes -- much faster than occurs in more traditional exposure-based therapies. Similarly rapid -- but short-term changes in arousal can occur in nonclinical populations with other interventions: e.g., cognitive restructuring combined with relaxation techniques, or even after a global redirection of attention. Other rapid methods capable of reducing arousal in nonclinical populations involve the redirection of attention or the direct modification of the disturbing cognitions. Most TFT interventions do not directly modify disturbing imagery/cognitions nor do they require a global redirection of attention.
The Figley/Carbonell study also found an unspecified reduction in stress symptoms associated with treatment via TFT. Friedman's preliminary analysis of an unfinished and unpublished study he is conducting involving TFT suggests that adding TFT to an integrative treatment package accelerates "the positive change on the stress symptom measures, especially over the first 5 sessions" (Phil Friedman, personal communication, 1996).
A fifth study has been reported. Joyce Carbonell (1996) reports finding significant clinical changes in acrophobics treated with TFT as well as significant differences between subjects treated with the actual TFT algorithm compared to subjects treated with a placebo algorithm. The methodology and data from this study has not yet been published, so it is not possible to draw reliable conclusions. However, two points merit emphasis. The first is that the TFT algorithm is reported to have produced better results than the sham algorithm. The second is that the sham algorithm -- which involved tapping at the wrong spots -- did result in clinical improvement. The extent of the clinical improvement, and the degree of difference between the two interventions is currently unreported.
In summary, these studies must be viewed as merely suggestive that TFT can produce a rapid decrease in the subjective distress associated with traumatic imagery. A lack of controls or other methodological limitations constrain the conclusions that can be drawn from the studies that have reported data. Additionally, SUDS ratings are questionable outcome measures. They are too responsive to momentary changes to measure anything other than current level of distress. As measures of momentary subjective distress, SUDS ratings are worthwhile, correlating with such physiological responses as heart rate and peripheral vasoconstriction (Grant Devilly, personal communication, 5 February 1996). As outcome measures, SUDS ratings alone are of minimal use.

Mechanisms of Action
The points on the face, limbs, and body that are tapped in TFT are the traditional points needled by acupuncturists. Proponents of TFT argue that tapping on acupoints directly modifies a hypothetical bioenergic system (acupuncture's meridian system) via a transduction of the mechanical energy of the tapping directly into bioenergy (Callahan, personal communication, 4 February 1996; Gallo, 1995a). This transduction of the mechanical energy of the tapping is argued to remove "perturbations". A perturbation is a somewhat obscurely defined disturbance, blockage, or imbalance in the body's energic system that is the cause of negative emotions. In this view, neurochemistry and cognition do not cause negative emotions -- disruptions in the body's energic system are the cause. The theory asserts that small energic perturbations at specific points along the energy meridians cause negative emotions and that the tapping provides physical energy that is transformed into the energy of the meridian system which then removes or transforms the blockages, eliminating the negative emotion and its corresponding pathology (Callahan, 1996).
One additional therapeutic factor is attributed to this energic system. When tapping at the appropriate points along the meridians fails to correct the energy flow and produce a lowered SUDS rating, TFT theory asserts that this failure results from "psychological reversal" (PR). PR is understood to be a harmful condition resulting from the reversal of the normal flow of energy in the meridian system. The tapping on the side of the hand and repeating the phrase "I accept myself...." is the therapeutic intervention that corrects the reversed energy flow and returns it to the normal, healthy state (Gallo, 1995a).
In summary, Callahan argues that tapping on acupoints while thinking distressing thoughts corrects perturbations in the body's energic control system. This correction occurs because the mechanical/kinetic energy added to the system by tapping removes perturbations associated with the distressing thought. When this tapping does not work, Callahan argues that the hypothetical, energic control system is experiencing reversed polarity (called psychological reversal or PR). Callahan has devised several techniques to correct this polarity reversal (only one of these interventions is included in the appended algorithm). TFT proponents suggest that correction for psychological reversal often results in a therapeutic response to tapping on acupoints.
While Callahan's theory is internally consistent and highly elaborated, there is a concerning absence of evidence for the fundamental components of his theory. The four fundamental components are: 1) the existence of an energic bodily control system known as the meridian system; 2) the transduction of the mechanical/kinetic energy of tapping into the energy of the meridian system; 3) the existence of reversed polarity within this system; and 4) the correction of this reversed polarity by means of psychological reversal techniques.
Traditionally, Chinese acupuncturists have explained the therapeutic effect of the needling of acupoints as a correction of the flow of chi (the energy of yin/yang) through the body. The traditional idea is that the chi flows through the body along channels known as meridians. The modern search for evidence of the meridian system has become acupuncture's search for the Holy Grail. A number of researchers have claimed to have found evidence for energy meridians, but to date these claims have been unconvincing (v., e.g., Stux & Pomeranz, 1995; Lewith & Lewith, 1983; Chaitow, 1990). For example, Vernejoul claimed to have actually photographed the meridian system (Vernejoul, 1985). Efforts at replication have led most researchers to conclude that Vernejoul photographed the lymphatic system rather than a meridian system (v. Stux & Pomeranz, 1995). While many practitioners of acupuncture assume the existence of meridians, after a significant amount of research, no convincing evidence has been found for their existence. Convincing evidence does exist for local and total body effects of acupuncture interventions, but none has been found for meridian effects (Stux & Pomeranz, 1995).
The second fundamental component of Callahan's theory, the transduction of the energy of tapping into the energy of the meridian system, has never been documented. Callahan does not report a single measure of this phenomenon. This component of TFT theory is purely a hypothetical construct with no supporting evidence.
The documented evidence for the existence of psychological reversal is similarly deficient. The TFT literature provided to this author by Dr. Callahan had no references to any published work supporting the objective existence of psychological reversal. TFT assumes a connection between PR and bioelectric currents in organisms without any support more substantial than conjecture (v. Callahan, 1995a). Callahan (1995b) suggests that PR is related to cancer, dyslexia, reversed concepts (saying "up" when one means "down"), and the supposedly paradoxical response of ADD sufferers to methylphenidate. This broad application of a bioelectric hypothesis to such varied clinical phenomena must be viewed as highly speculative in the absence of direct evidence. Similarly speculative are Callahan's interventions to correct PR: tapping, eye-rolling, and the repetition of positive affirmations. Neither evidence nor a convincing explanation has been offered that clarifies how tapping and eye-rolling reverse extracellular bioelectric currents.
In summary, TFT theory is overly speculative. None of the fundamental components of this theory are grounded in observed processes. As currently elaborated, TFT theory is not helpful in understanding TFT's mechanism of action. For these reasons, a more careful analysis of the components of TFT interventions is suggested. The purpose of this analysis is to identify possible mechanisms that might contribute to the reduction in subjective distress that has been tentatively associated with TFT. It should be noted that none of these conventional explanations have been adequately explored in relation to TFT. Therefore they should be understood as no more than hypotheses for consideration.
Conditioning: For tapping therapy to be effective, the thought field must be attuned. This is just to say that the client needs to be in the distressing situation or be thinking about the distressing situation while tapping. Most TFT interventions make no attempt to modify distressing thoughts, images, or situations. While similar in these regards to exposure techniques, the reported rapidity of therapeutic responses to TFT suggest a different mechanism. It is likely that the active ingredients of TFT will be best explained in light of the substantial research on classical or Pavlovian conditioning. Classical conditioning research has shown that simply pairing stimuli and responses in various combinations can produce dramatic changes in organismic reactions. Nathan Denny (1995) makes a related argument focusing on the orienting response and its influence on cognitive restructuring in relation to TFT.
Sensory stimulation: Acupoints are tapped during TFT. While acupoints are not characterized by the exclusive presence of any particular structure, nerves are very strongly correlated with acupoints (Stux & Pomeranz, 1995). Further, convincing evidence exists for the causal role of neurochemical activity in acupuncture. Effective acupuncture interventions are closely associated with the stimulation and firing of small diameter, myelinated afferent nerves (Stux & Pomeranz, 1995). Acupoint evidence strongly suggests that there is no transduction of energy during tapping: merely the possible response of the peripheral nervous system.
Tapping therapy's selection of acupoints consist of sites primarily on the face, hands, and the upper body. Craig and Fowlie's (1995) comprehensive tapping protocol includes five sites on the face, six on the hand, and two on the upper body. A comparison of these tapping locations with Penfield and Rasmussen's (1950) somatosensory homunculus reveals that these three areas take up approximately fifty-percent of the somatosensory cortex and are just the locations (especially the face and hands) on the body that one would select if trying to maximize cortical response to discrete sensory stimulation. The feet are the only other surface area with a large cortical representation. Interestingly, Callahan (personal communication, 1996) has indicated that tapping can be performed on the feet instead of the usual locations. Presumably head, hand, and foot locations are preferred in tapping therapy because the end points of the meridians are located at the extremities. Without belaboring the hypothetical nature of the meridian system further, it should be pointed-out that not every traditional approach to energy meridians assumes that the meridians have end points -- some believe the energy circulates repetitively through the body (Odajnyk, 1993).
Data indicate that the tapping performed during TFT -- five firm taps in each spot -- is unlikely to produce its clinical effect by the same mechanisms as acupuncture. Effective acupuncture requires precision in both the placement and manipulation of the needles. The needles are left in place for extended periods of time (20 minutes is common and the duration can last noticeably longer), a large number of sites are needled simultaneously, and the effect (only researched with analgesia) takes approximately 30 minutes to be noticed (Stux & Pomeranz, 1995). While Callahan asserts that tapping must occur in precise locations and in precise sequences, there is no published study which supports this assertion and some clinical reports to the contrary. Phil Friedman (personal communication, 1996) reports that he has had successful clinical results when a few clients inadvertently tapped in the wrong place/order. Eduardo Horacio Cazabat (personal communication, 1996) reports a large number of dramatic, successful clinical outcomes for a variety of non-traumatic problems using the algorithm designed to cure traumas. Gary Craig and Adrienne Fowlie (1995) promote a similar tapping therapy that utilizes a single algorithm for every problem. Further, Craig (personal communication, 23 August 1997) adamantly rejects the importance of tapping acupoints in any specific order. Wayne Hooke (1996) observed an indistinguishable -- but positive -- response to tapping in accordance with an algorithm and to tapping at arbitrary points (chin, elbow, breast bone, wrist bone, hip bone, and thumb). Arbitrary points were selected because it is not logically possible to tap anywhere on the body and ensure that a meridian is not being influenced (Fred Gallo, personal communication, 1996). Since the hypothetical meridian system cannot be circumvented to adherants' satisfaction, only the specific acupoints and the order of tapping can be varied. The duration of the tapping interventions does not come close to that utilized in acupuncture needling. Also, the often reported immediate response to TFT compared to the delayed response to acupuncture strongly suggests the direct mediation of central nervous system activity in TFT.
The tapping of acupoints may involve a significant stimulation of the peripheral nervous system and the somatosensory cortex. While hypothetical, it is possible that the tapping of acupoints in TFT has the effect of overcoming the inhibition of sensory input to the cortex that occurs during the distress associated with fear and anxiety reactions (v. Hugdahl, 1995). If so, tapping acupoints might somehow facilitate conditioning. This may be a worthwhile area for psychophysiological investigation.
Placebo response: While not emphasized in this review, it is possible that the therapeutic effects associated with TFT are substantially or even wholly the result of the placebo response. While proponents of TFT deny that the placebo response is a significant component of the positive response to TFT (Callahan & Callahan, 1996), several points are important to note: 1) the placebo response contributes to the positive outcome in most -- if not all -- medical and psychological interventions (White, Tursky, & Schwartz, 1985); 2) placebo responses show an average effect size of .56 in psychotherapy studies (Bootzin, 1985); 3) significant clinical responses to placebo have been found to occur in up to 70% of subjects in some studies (v. Benson, 1996); 4) self-perceived levels of arousal are particularly subject to placebo responding (Ross & Buckalew, 1985); and 5) placebo responses are strongest when subjects are motivated to improve, when salient features of the treatment match the subjects' expectations (e.g., rapid relief), and with novel therapies (Plotkin, 1985).
Positive affirmations: TFT adherents often point out that tapping therapy often remains ineffective until the PR or mini-PR intervention is performed. The argument is made that tapping is ineffective because the polarity of the body's meridian system has reversed itself and must be corrected. Once this reversal has been corrected, the tapping can then be effective. Several interventions for PR have been created. One involves tapping either hand on the fleshy part below the little finger (the karate chop spot) while repeating a phrase such as "I accept myself even though I have this kind of anxiety". Another intervention for correcting PR involves rubbing a spot below the left collar bone while repeating the same phrase. Given the complete absence of evidence for these techniques' ability to correct a purely hypothetical polarity reversal in a purely hypothetical meridian system, the reports of improvement following the use of these techniques requires another explanation. The therapeutic effect of these interventions may be best understood as an example of modifying negative self-statements. This technique is common in cognitive psychotherapy -- though does not produce such a rapid result. There is support for the relationship between positive self-statements and better adjustment versus negative self-statements and pathology and distress (v. Schwartz, & Garamoni, 1986).
Focused, repetitive activity: TFT interventions involve the repetition of a very ritual-like activity. Many spontaneous strategies utilize repetitive, ritual-like activity to attempt to manage anxiety and distress. Common examples include compulsive behaviors, trichotillomania, self-mutilative practices, and various superstitious and religious practices. Herbert Benson (1975; 1996) has identified a relationship between focused, repetitive activity in meditation and a decrease in -- among many other things -- arousal (see also, Carrington, 1993). Perhaps the similarly focused, repetitive activity of TFT lowers arousal. Since TFT pairs this lowered arousal with a distressing situation, thought, or image, perhaps a novel conditioned response is created.
Breathing: While not a part of Callahan's algorithms, breathing has been added to the trauma algorithm distributed by Charles Figley (see appendix). Phil Friedman (personal communication, 1996) finds that the addition of a focus on breathing appears helpful in his clinical work with TFT. Alterations in breathing also seemed significant in a case report involving TFT and the treatment of irritable bowel syndrome (Hooke, 1996). Altered respiration has been implicated in stress responses (Fried, 1993) and may sometimes be involved in the therapeutic changes found in TFT. Relatedly, changes in respiration have been found to parallel the saccades in EMDR (Wilson, 1991). Perhaps a similar parallel change occurs to the patterned movements/stimulation in TFT.
In conclusion, a component analysis of TFT interventions suggests that the rapid reduction in arousal may be achieved through focused repetition, alterations in breathing, cognitive restructuring, sensory stimulation, and perhaps the placebo response. Perhaps this rapid reduction in arousal, being paired with the distressing situation, imagery, or thoughts results in the formation of a novel conditioned response to the distressing cognitive components. This improved response is dramatic to the client, and creates the feeling of mastery (Bandura, 1977) and the expectation of a more generalizeable therapeutic gain (Emmelkamp, 1982).

Suggestions for Clinicians
TFT interventions are experimental procedures. Utilize appropriate consent procedures and careful monitoring of clients who are being treated with TFT. The only negative reactions to TFT reported to date -- beyond embarrassment -- are apparently rare increases in SUDS ratings. These increases are loosely associated with dissociation and personality disorders.
Substantial enthusiasm exists for TFT's ability to reduce the disruptive arousal associated with traumatic stress. Clinical reports are suggestive, but the lack of controlled research combined with the absence of a convincing theory forces caution in the use of these techniques by clinicians.

Suggestions for Future Research
Outcome: Research has yet to answer the basic question, does TFT produce therapeutic change? The next step in the development of TFT interventions must be controlled investigations of the algorithms utilizing outcome measures with more reliability and validity than is possible with SUDS ratings. Acupoint evidence and clinical reports suggest that specific algorithms for specific problems may not be required. Comparative outcome studies utilizing different algorithms for the same problem and the same algorithm for different problems are essential.
Mechanisms: A componential analysis of the trauma algorithm suggests that several features of the TFT intervention -- either alone or in combination -- may be the active ingredients in TFT. If controlled studies show TFT to reliably produce therapeutic change, a dismantling research strategy would be the necessary next step. This strategy would provide crucial information about the therapeutic mechanisms in TFT interventions.

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Appendix
TFT Algorithm (Figley, 1995) Follow this procedure:
1. Think of the cause of your anxiety (we all have them from time to time), including the cause (e.g., a traumatic experience) and work up as much disomfort as you can. However, do not spend more than a few moments on this phase.
2. At a point where your anxiety is feel is at its peak, choose a number between 1 and 10 that best represents the intensity of your discomfort, with 10 being the highest and 1 being the lowest. Thus, circle a number below:
1....2....3.....4.....5.....6.....7.....8....9.....10
3. After you have circled a number, using your two finger tips, tap solidly five times while thinking about the anxiety, (but not too hard to cause a bruise) just above the bridge of your nose, approximately where either eyebrow begins.
4. Then tap five times approximately one inch below either eye (again, not too hard).
5. Next, tap five times under either arm, approximately 4 inches below the pit of the arm.
6. Then tap five times on your chest just below the collarbone, approximately one inch on either side of the center of your chest.
7. Now take a deep breath and measure your anxiety again: Choose a number between 1 and 10 that best represents the intensity of your anxiety right now. Thus, circle a number below:
1.....2.....3....4.....5.....6.....7.....8.....9.....10
8. If the intensity of your anxiety is now at least 2 numbers lower that it was initially, go to step #9. However, if it is not, follow this procedure:
Join your fingers together (either hand) and tap the little finger side of the other hand (We Americans call it the part we use for a "Karate chop."), while saying the following: "I accept myself, even though I still have this kind of anxiety." Repeat this statement three times while continuing to tap. Then, repeat steps 3 through 7.
9. Next is a sequences of activities that are done while tapping at a spot on the back of either hand. spot is just below and between the knuckle of the little finger and the knuckle of the next finger. With the hand flat, tap this spot continually while doing the following activities (about 5 taps for each of the 9 activities):
eyes closed
eyes open
eyes look down and to the right (head still)
eyes look down and to the left
roll eyes in a circle
roll eyes in a circle in the opposite direction
hum some tune (two or three notes only)
count to five
hum some tune
count to five
10. Follow procedures #3 through #6.
11. As you did before, take a deep breath and measure your anxiety again: Choose a number between 1 and 10 that best represents the intensity of your anxiety right now. Thus, circle a number below:
1.....2....3.....4.....5.....6.....7.....8.....9.....10
12. Follow the above procedure at least four times.

Author's Comments
Readers should be aware that I have not had formal training in TFT nor have I vigorously pursued applying tapping therapy in my private practice. This paper is the result of my preliminary investigations into TFT, from the perspective of a scientist-practitioner.

Acknowledgments
Thanks to everyone who provided information about their clinical experience with TFT. Thanks also to everyone who has commented on this project: Jeff Bakely, Laura Caldwell, Roger Callahan, Eduardo Horacio Cazabat, Suzanne Connolly, Harry Corsover, Phil Friedman, Fred Gallo, Linda Hamm, Sherrill Hooke, Shirley Keyes, Glenn Leonoff, Deborah Mitnick, Monica Pignotti, Jerry Rosen, Babette Rothschild, Kara Seaman, Michael Tunnecliffe, and others. Not all of the commentators agreed with the positions expressed in this paper.
Letter to the Editor
from Monica Pignotti, MSW, CSW, TFTdx
New York City