Journal of Health and Social Care Improvement

Can Tide Table Tapping Relieve Symptoms of Chronic Fatigue Syndrome? Author: Hilary Jones RESULT and SUCCESS group member, University of Wolverhampton, Faculty of

Education, Health and Wellbeing ___________________________________________________________________________________ next thing’. Improvement in current worst symptom score after a call averaged 5%; end-of-study improvements averaged 7%.

Abstract

Objectives: The objectives for this study were to trial a gentle energy technique with people who have Chronic Fatigue Syndrome (CFS/ME), to maximise the effect of tapping by following the peak flow of chi according to the time of day (a technique described as Tide Table Tapping), to keep the research method as light as possible, and to see what could be achieved by minimal intervention.

Conclusion: For a minimal amount of effort, over a relatively short period of time, even on symptoms that have persisted for years, Tide Table Tapping appeared to bring about some beneficial changes, enough perhaps to warrant more rigorous experimentation.

Methodology: The research was conducted by questionnaire and by telephone. Six participants rated their general health and specific symptoms before and again after the study. For one month, they received twice daily calls in which they tapped for two minutes, rating their current worst symptom before and after each call.

Correspondence: [email protected] Key words: Anxiety, Cognitive dysfunction, Chronic

Fatigue Syndrome (CFS/ME), Emotional Freedom Techniques (EFT), Fatigue, Tapping Submitted for Publication – 7th May 2015 Accepted for publication – 5th June 2015

Results: Everyone reported some positive change, eg

felt calmer, less anxious, more alert, able to ‘do the

EFT (Emotional Freedom Techniques), developed by Gary Craig in the 1990s, combines elements of conventional talk therapy with light tapping of acupressure points on the upper body and hand in a simple yet remarkably effective technique.

Introduction Chronic Fatigue Syndrome (CFS/ME) is thought to affect 250,000 people in the UK (source: Action for ME), that’s 0.2-0.4% of the population according to NICE. It is a debilitating illness most common in women aged 25-50, but it can affect men, women and children of all ages, social and ethnic groups. Diagnosis is based on duration (at least 6 months), the exclusion of other illnesses, and the presence of symptoms such as fatigue and post-exertional malaise, muscle weakness and cognitive impairment.

This study aimed to trial an even gentler variant for the benefit of people with CFS/ME, especially the housebound or severely affected. The research method was also kept light, given the limited energy resources of this population. What could be achieved with minimal intervention, just two minutes tapping twice a day? To enhance potential benefits, the study used Tide Table Tapping (see Fig.1), where the order in which points were tapped followed the peak flow of chi around the body (cf tapping down the body to the next nearest point as in Official EFT)

Research into the causes of CFS/ME is ongoing but there is as yet no accepted known cure and no accepted universal treatment. Emphasis tends to be on the treatment and management of symptoms (eg pain, sleep disturbance) and activity (eg pacing and switching).

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Journal of Health and Social Care Improvement, 2015 September Issue Method

Acupressure tapping point

Time

Meridian

Little finger (inside edge of nail)

11.00 – 13.00

Heart

Karate chop (outside edge of palm)

13.00 – 15.00

Small intestine

In a brief telephone call to each participant, midmorning and mid-afternoon, on weekdays, for four weeks, we tapped each of the fourteen EFT (Emotional Freedom Techniques) acupressure points, without words but using this chart to follow the natural peak flow of chi (meridian energy) around the body:

Eyebrow (near the nose) 15.00 – 17.00

Bladder

Collarbone (depressions either side of tie knot)

17.00 – 19.00

Kidney

Middle finger (tip)

19.00 – 21.00

Pericardium

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Ring finger (by nailbed, facing little finger)

21.00 – 23.00

Triple Heater

Side of eye (outside, on bony rim)

23.00 – 01.00

Gall Bladder

Before the study began participants were asked to rate their general level of health against their key CFS/ME symptoms* for the previous month, giving each a score out of 10. (*based on The MEA 2010 Survey of 4000 people with CFS/ME)

  

At the beginning of each call, I asked ‘What is your worst symptom right now?’ ‘On a subjective 0-10 scale (where 10=worst), how bad is it?’ The participant focused on that symptom while I led us both through the tapping sequence (two rounds, 10-12 gentle finger taps on each point). Then I asked the participant: ‘On 0-10 scale, how bad is it now?’

Finally, participants assessed their general health and specific CFS/ME symptoms again at the end of the study period, for that month. Three men and three women volunteered to take part. Ages ranged from 40 to 78 (median and mode both 46 years old).

Under breast(F), 2-3cms 01.00 – below nipple(M) 03.00

Liver

Thumb (outside, by base of nail)

03.00 – 05.00

Lung

Index finger (facing thumb, by base of nail)

05.00 – 07.00

Large Intestine

Under eye (below pupil, on bony rim)

07.00 – 09.00

Stomach

Underarm (10cms from armpit, mid bra-strap)

09.00 – 11.00

Spleen

Based on: Meridian Energy with Stephen Hunter and Gwyneth Moss; workshop March 2010

Fig.1Tide Table Tapping – method and times of peak energy flow through the meridians: A. Rate your worst current symptom and focus on that while you are tapping: B. Begin by tapping in the dip above your mouth; about 10-12 taps C. Tap all the points in the table in order, starting at the appropriate time of day; do two rounds of the table; 10-12 gentle, finger taps at each point D. Finish by tapping below your mouth, in the crease of your chin; 10-12 taps. E. Rate your symptom again.

All had had CFS/ME for 3 to 18 years (mean 10 years). All had been diagnosed by a GP and/or consultant. One participant was only able to take part for one week; another, one day a week. Participants did not anticipate any other changes in treatment or lifestyle during the trial. Results Given the small numbers and study method, results are inevitably subjective and empirical, offering ‘case study’ glimpses rather than cast-iron scientific or statistical evidence. 146 pairs of daily ‘before’ and ‘after’ scores and 36 pairs of monthly ‘before’ and ‘after’ symptom data were collected.

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Journal of Health and Social Care Improvement, 2015 September Issue Daily Tapping Results

Examples of feedback, in the participants’ own words:

Most found the tapping relaxed them; or gave a better quality of rest or sleep, eg for one person that meant taking her afternoon rest straight afterwards; for another, concerned she slept too much, that meant just cat-napping then feeling more alert to carry on.

Have felt better, energy-wise (A) I found a slight improvement… rest better (A) Backache a little better (B) (I’m) surprised and delighted (at the pain going down) (B) One does relax (B) Ready for my sleep/could go to sleep now/very relaxing/so relaxed (C) Going warm all over (C) Tiredness was less… felt brighter (C) Made a big, big difference… walking around the house wasn’t an effort (C) My breathing has slowed right down (D) I feel I have got some control over it (anxiety) again (D). Allows me to think about doing things I couldn’t otherwise do (D) More benefit than anything else in recent years (D) Doing me more good than any tablets (D) At (appointment), didn’t feel fatigued at all (F) Pain is not as strong… limp not so pronounced when I walk (F) Slept soundly for three hours and woke without the headache (F) Lovely! Dozed off only briefly… felt refreshed after (F) I know this makes a positive difference (F)

Frequently, participants’ scores before and after tapping were unchanged (ie that symptom stayed the same) yet other benefits were reported, eg still as tired but felt very relaxed, or warmer, or it was some time later when they noticed the change. One participant found that the symptom change after tapping was enough to enable him to ‘do the next thing’, to get him through to the next tapping session, or to his ‘best’ time of day (when symptoms were generally less troublesome). It calmed him enough to concentrate on some small task or reengage in some hobby, eg tidy a drawer, potter in the shed.

Based on scores alone, there was an average improvement after tapping of +5.14%. Similar changes were reported in morning and afternoon calls: in 70 morning calls, total scores dropped from 506.5 to 481.0 after tapping (average +5.03%); in the afternoon, from 528.0 before tapping to 500.3 after (average +5.25%).

Sometimes the change was subtle eg a throbbing head or stomach-ache was still as painful but no longer throbbing. Sometimes scores remained unchanged but participants called that a positive outcome, eg several things had happened around the time of the call and they knew that normally they would have been worse off.

However, in 47 calls, the same scores were given before and after tapping but the person verbally reported some other benefit or, at the next call, a delayed benefit, eg felt more relaxed, felt warmer, had more energy, slept better.

Ironically, with an improvement in symptoms comes that temptation to do more – sometimes too much, too soon. On one or two occasions scores possibly hint at this, so it was important individuals took care to pace themselves. In fact, no one reported being worse off for taking part in this research, and everyone reported some positive change during the course of the four weeks.

On another 14 occasions, the same scores were given before and after tapping but a positive change was observed or heard, eg from slightly out of breath to breathing deeply; sighs, yawns (indicators of relaxation); voice lighter after tapping. In addition, it often seemed that I had ‘lost’ the participant during the tapping because the ‘silence’ at the other end of the phone became so peaceful! So it is reasonable to assume that +5% underestimates the actual changes.

Fig.2 Daily Results: symptom scores pre-and post-telephone calls (146 telephone calls) Person No of Sum of scores Sum of scores calls before tapping after tapping A 4 30.0 28.0 B 32 235.0 233.5 C 30 203.5 204.5 D 38 267.5 228.5 E 8 62.0 58.0 F 34 236.5 228.8 Total 146 1034.5 981.3

Following one participant’s symptoms, a pattern emerged where each morning the benefit ‘held’ until the afternoon call; it improved after the next set of tapping, then there was a partial loss of progress overnight. By the end of each week there had been a 3

Journal of Health and Social Care Improvement, 2015 September Issue noticeable improvement, eg from 10 down to 6. Then – with no weekend tapping – each Monday morning his score started higher again.

Fig.4 Monthly symptom scores before and after the study (36 pairs of data) by symptom

Fig.3 Case Study: Participant D: Reporting on top two current worst symptoms S1 = anxiety; S2 = tiredness; scores before and after tapping (week 1 results)

CFS/ME Month before At end of Symptom study study month Muscle fatigue 45 42 Cognitive 42 34 dysfunction Pain 44 40 Sleep problems 50 47 Mobility 38 39 Other* 51 48 *low, tearful, lonely; temperature changes and night

S 1 S 2

am 7.56 -

Mon pm 6-6

Tue am pm 7-6 5-4

am 7-5

Wed pm 6-4

am 7-6

Thur pm 6-5

-

6-5

6-4

5-5

5-5

5-5

am 65 55

6 participants x 6 symptom scores out of ten; symptoms based on The MEA’s 2010 Survey

Fri pm 5-4 9-9

Case Study: Participant D: Reporting on Two Symptoms

sweats; food, chemical, odours and noise sensitivities; difficulty standing/sitting; anxiety; dizziness

This was interesting because the tiredness was masked until the anxiety came down a little – in that first tapping call. The anxiety continued to fall day by day, as above, until it was just a 4 by Friday afternoon. But this remarkable improvement would have been missed if he had only reported his worst symptom (as per the terms of the experiment), because the tiredness was now dominant, a 9.

Other Benefits Reported  

He said the tiredness was a delayed reaction after a hot, sleepless night, noting in addition that normally it would have been accompanied by a similar rise in anxiety.

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Case Study: Participant E: Weekly Surrogate Tapping

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This participant only felt able to take part one day a week. As his arm muscles were weak, we discussed alternatives to him tapping on himself, eg tapping on the card illustrating points (hands working with gravity rather than against), or having a carer do the tapping for him. He opted to just focus on his symptom while I tapped on myself, ie surrrogately, on his behalf.

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His results indicated some limited benefit even from this remote input – but probably insufficient to bring about lasting symptom change, eg feel nice and calm; feels a little better; nice circulation around the back of my head and shoulders.

Monthly Tapping Results

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For the whole survey period, the biggest improvement overall was in cognitive function. There was some improvement in every symptom category except mobility. Across all symptoms, the average improvement was +7.41%.

I found it very relaxing, also backache is much improved. After tapping, my anxiety calms down, which enables me to cope better with the rest of the day. Also, more interest in normal, daily things. I found that, even if I did fall asleep, I felt refreshed when I woke up. No need to travel to an appointment (which can outweigh any benefits from going): ‘Why can’t they offer this on NHS?’ Receiving treatment in your own home (comfort zone) One participant’s partner remarked on the positive changes she observed: ‘You don’t get as worked up over little things’ Participants discovered that different postures (sitting, standing) or rooms in the house (noise, relaxation) could make a difference; using a slimline or hands-free phone could conserve energy/stress on weak arms Participant D noticed, a second month down the line, that his benefits still held

Limitations of this Study  

According to participants’ scores, in total 16 symptoms had improved, 17 had stayed the same and 3 were worse. According to their perception, 7 symptoms had improved, 29 had stayed the same but none were worse.

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Small sample size Project length – four weeks with such a gentle technique not long enough to make a significant difference to serious symptoms that have persisted for years Subjective nature of scoring to record symptom changes

Journal of Health and Social Care Improvement, 2015 September Issue 

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Recommendations – The Way Forward

No mechanism for accommodating or measuring delayed effects – no regular follow-up question, only patchily recorded and thus possibly underestimated No way of attributing reported effects directly or exclusively to tapping – if the current worst symptom is always reported, when a different worst symptom is identified we can only infer that the earlier symptom is less bad – but not that this is the result of tapping CFS/ME symptoms can be notoriously variable and unpredictable How to ensure nothing is overlooked without influencing participants, eg did including the word ‘relaxation’ in the original brief or giving examples of ‘other’ symptoms affect results? Did not giving the extended list mean some symptoms were overlooked, especially given that cognitive problems are typically present? No scope under the terms of this research to follow up on changes, eg in quality of pain, to discharge or reduce them further; known as Chasing the Pain Some benefits may not be noticed or not attributed to the tapping, eg we ‘forget’ something was ever a problem once it has ‘gone away’; the Apex Effect Participants unlikely to expect other, indirect benefits to result from tapping, but Borrowing Benefits is a well-known phenomenon in Official EFT Non-specific targeting of symptoms: Official EFT uses specific set-up and reminder phrases and thus offers a more direct approach For personal use, TideTable Tapping – darting between face and hand points – requires more concentration than standard ‘tap from the top down’ EFT

For people with CFS/ME: How much is enough and what is too much? Experiment with more frequent tapping and other times of day, eg three times a day, hourly, include weekends; build in breaks as needed – increase gradually, as your overall condition allows – and continue for longer time spans than one month. For further research: Use larger numbers of volunteers and more rigorous testing methods, eg monitor changes in blood pressure and heart rate, ask more questions. Use the complete list of CFS/ME symptoms (28 in The MEA’s 2010 Survey), have participants keep diaries for lag effects. More comprehensive research would probably mean working with less severely affected participants, at least initially. To involve more people: Set up an online self-administered experiment (cf Carol Look’s Eyesight Experiment). Put the tapping sequences onto CD/audiotape. Arrange conference video/phone calls. Conduct Randomised Controlled Trials: Establish three groups (one receiving just the daily calls, another receiving calls and Official EFT, a third receiving calls with Tide Table Tapping):  to establish how much, if any, benefit is due to the daily contact by telephone  to establish whether or how much following the flow of chi (Tide Table Tapping) has greater impact than Official (tap from the top down) EFT

References Boath, E, Stewart, T & Carryer A. (2012) A narrative systematic review of the effectiveness of Emotional Freedom Techniques (EFT). Staffordshire University, CPSI Monograph.http://www.staffs.ac.uk/research/cpsi/ar eas/index.jsp Craig, G, Bach, D, Groesbeck, G, & Benor, D. (2009). Emotional Freedom Techniques (EFT) for traumatic brain injury. [Electronic journal article]. International Journal of Healing and Caring, 9.

Conclusion For a minimal amount of effort, over a relatively short period of time, even on symptoms that have persisted for years, Tide Table Tapping appeared to bring about some beneficial changes, enough perhaps to warrant more rigorous experimentation.

Craig, G. (2011). The EFT manual (2nd ed.). Fulton, CA: Energy Psychology Press. Feinstein, D. (2010). Rapid treatment of PTSD: Why psychological exposure with acupoint tapping may be effective. Psychotherapy: Theory, Research, Practice, Training, 47, 385–402. doi:10.1037/a0021171 5

Journal of Health and Social Care Improvement, 2015 September Issue

Feinstein, D. (2012). Acupoint Stimulation in Treating Psychological Disorders:Evidence of Efficacy. Review of General Psychology. Advance online publication. doi:10.1037/a0028602 Feinstein, D, & Church, D. (2010). Modulating gene expression through psychotherapy: The contribution of non-invasive somatic interventions. Review of General Psychology, 14, 283–295. doi:10.1037/a0021252 Look, C. (2006) Improve Your Eyesight with EFT (Emotional Freedom Techniques) NICE Guidelines CG53. (2007) Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): Diagnosis and management of CFS/ME in adults and children. Shepherd, C & Chaudhuri, A. (2013) ME/CFS/PVFS: An Exploration of Key Clinical Issues Stewart A, Boath E, Carryer A, Walton I & Hill L. (in press) Can Emotional Freedom Techniques (EFT) be effective in the treatment of emotional conditions? Results of a Service Evaluation in Sandwell. Journal of Psychological Therapies in Primary Care 2013; 2:71-84. The ME Association. (2010) Managing my ME: What people with ME/CFS and their carers want from the UK’s health and social services. The Results of the ME Association’s Major Survey of Illness Management Requirements

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