Bringing it all together: Latest imaging science and neuroscience

Primo vascular system

Here we get into the details of how acupuncture meridians, knowledge of which has survived over millennia, meet modern science. We look at the imaging of the Primo Vascular System (PVS)³ and the neuroscience of Memory Reconsolidation⁴.

EFT’s leading scientific researcher, Dr Peta Stapleton of Bond University, Australia, in a YouTube video presentation⁵, as well as in her talk at the April 2023 Mind Heart Connect Conference in Melbourne (see footnote 1), explains the science of how we now understand the tapping to work via the newly-mapped and -named Primo Vascular System, a system that corresponds with charts of the meridian system and has been shown to run through the body’s fascia or connective tissues. Research discovery of this system has taken place in Korea, first in the 1960s, then with Ultrasound technology in 2002 corresponding with 80% accuracy to the known meridian system, then in 2021 by injecting tracer dyes at known acupoints and observing linear migrations closely aligned with the established meridian system. Other papers have published images from surgery showing the system. This work supports an anatomical basis for meridians as well as supporting previous evidence that they operate within connective tissue. This research has shown that known acupuncture points occur where the tissue coagulates to form a vascular density point.

Large proteins within the skin enable piezo-electric energy to be generated via percussion or pressure on acupuncture points within this PVS system, with collagen understood to be the transmitter/conductor. Acupoints have less electrical resistance, so are able to generate this kind of electrical effect. A double-blind study comparing acupuncture with needles and acupressure involving non-penetrating pressure found equivalent clinical improvements for both interventions – great news for those who don’t like needles, as well as making the technique available to millions for self-help, help literally at your own fingertips.

Electrical signals are sent via the principle of mechanosensory transduction to the limbic brain, where the signal is understood to ‘deactivate’ the amygdala, calming the brain’s stress response. Dismantling studies have shown that the tapping on acupoints is a key part of the process. There have been ten studies comparing use of actual acupuncture points with sham acupuncture points, all of which showing that the use of actual acupuncture points is critical. David Feinstein⁶ quotes in his overview a 10-year study of acupuncture carried out at Harvard showing with fMRi imaging that the “amygdala, hippocampus and other brain areas associated with fear” reliably experience prominent decreases in activity with the stimulation of acupoints⁷ and that acupuncture is able to produce “extensive deactivation of the limbic-paralimbic-neocortical system”.⁸

In summary, we know that the somatic element within EFT, the tapping, is critical and it has the effect of calming emotional centres in the brain. Anecdotally, anyone who has ever experienced EFT will confirm this from their own personal experience of their first or second round of tapping. The very least that ever happens is they report feeling calmer.

Memory reconsolidation

Now consider the neuroscience of Memory Reconsolidation in Psychotherapy as explained in the book by Ecker, Ticic and Hulley, Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation. This book was first published in 2012 by Routledge. Routledge in 2022 published the second edition, this time as one of the 9 Psychotherapy textbooks in their Psychotherapy Classics series. This indicates that it is considered a significant step forward in Psychotherapy, underpinned by neuroscience developments in the first decade of this century.

Prior to the 21st century developments in neuroscience, with multiple research projects involving both animal and human models, it was believed that implicit, fragmented, emotional memories, such as persist in memory from emotionally highly charged or traumatic times, the type of memory fragments that result in PTSD and other mental health symptoms, were hopelessly locked down in the brain and would continue to cause problems. In the 20th century and still today, since new research discoveries are slow to spread into wider practice, therapy attempted “extinction” of these memories, meaning through extensive repetition and training something else such as a relaxation technique would be superimposed. However this therapy tended to work only when the client was well-resourced and in times of crisis the emotionally-charged memories would re-emerge as once again troublesome.

These 21st century developments in neuroscience have shown that it is possible to create a process for “erasure” rather than ‘extinction’ of these memories, such that they are erased or transformed and never again problematic. This is achieved with Memory Reconsolidation, for which there are three crucial steps. The results are not unique to any one type of psychotherapy; they can be achieved by any therapy that has a means of incorporating the three steps. There are several such therapies and acupoint tapping (EFT) is but one, albeit possibly the gentlest, simplest and quickest one.

Memory Reconsolidation – the steps

1. Reactivate: Re-trigger/re-evoke the target knowledge by presenting salient cues or contexts from the original learning
2. Mismatch/unlock: Concurrent with reactivation, create an experience that is significantly at variance with the target learning’s model and expectations of how the world functions. This step unlocks synapses and renders memory circuits labile (susceptible to being updated by new learning)
3. Erase or revise via new learning: During a window of about 5 hours Before synapses have re-locked, create a new learning experience that contradicts the labile target knowledge. (This new learning experience may be the same as or different from the experience used for mismatch in Step 2; if it is the same, Step 3 consists of repetitions of Step 2)
4. Test for markers of erasure:
   • A specific emotional reaction abruptly can no longer be reactivated by cues and triggers that formally did so or by other stressful situations.
   • Symptoms of behaviour, emotion, semantics, or thought that were expressions of that emotional reaction also disappear permanently.
   • Non-recurrence of the emotional reaction and symptoms continues effortlessly and without counteractive or preventive measures of any kind.

The above markers can result only from memory erasure, that is via reconsolidation. They cannot be produced by extinction or other counteractive/competitive processes, which are inherently susceptible to relapse, particularly in new or stressful situations. Whenever these markers are observed and firmly established in clinical work, erasure via reconsolidation is a valid inference.

How the steps of memory reconsolidation are achieved with EFT tapping

1. Reactivation. A key skill for any EFT Practitioner is that of being able to do the detective work to find the bothersome past specific event that lies at the root of any issue or symptom. EFT has a superb technique for thoroughly working through a bothersome specific event, finding all the aspects that hold an emotional charge. In the hands of a skilled and experienced practitioner this is done very gently and safely, without risk of retraumatisation due to the plethora of gentle techniques used to contain and work with traumatic memories.
2. Mismatch. Several other therapies are used to perform memory reconsolidation, many requiring multiple sessions of discussion with the client to find appropriate material for a cognitive mismatch. The strength of EFT is that the tapping itself, given that it calms the brain’s emotional centre and stress response, provides a somatic experience that itself constitutes the mismatch. Thus, with the client’s focus carefully and safely directed and held on the troublesome memory, constant tapping then keeps the emotional brain calm and the client’s experience is mismatched in that s/he is surprised to be able to access the memory either without experiencing or with quickly calming the usual expected emotional response.
3. Erasure/New Learning. This mismatch is reinforced the more the EFT practitioner engages the client in recollection of the details of the past event, with continuous tapping about every upsetting aspect that comes to mind. Often by the end of this very thorough process, the client experiences spontaneous cognitive shifts and reframing, a sign that the old and troublesome memory is beginning to find context within autobiographical memory, where it will become reconsolidated.
4. Test for markers of erasure. At every stage of the work, a well-trained EFT Practitioner will use the 0-10 Subjective Unit of Distress Score (SUDS). The objective is to keep working through aspects of a troublesome emotion or memory until the client scores zero or close to zero on every aspect. Before the work can be considered complete, the client is also asked to run through a mental movie of the original troublesome event, considering every detail, making colours brighter, sounds louder, testing to see if there is anything left in the memory that upsets them. If there is, more EFT tapping will be applied until the client rates the intensity of emotional pain at zero for every section of the movie.

The most effective techniques within EFT just happen to match the steps involved in memory reconsolidation so closely, that it seems highly likely that memory reconsolidation provides the mechanism explaining how it works so quickly and transformationally. In the testing phase described above, the client will score zero for every aspect of a memory that s/he, earlier in the session, had scored as highly emotionally charged, meaning the emotionally-charged part (the implicit nature) of the memory worked on has been “erased” and the memory is reconsolidated with context in autobiographical memory. Indeed in the literature on memory reconsolidation, the “erasure” phase is also referred to as the “transformation” phase. We often refer to a series of EFT sessions as being transformational work.

Scientific Discussion in an Index Medicus (Core Clinical) Journal, 2011. EFT vs EMDR

Suggestions on how EFT achieves comparable results to EMDR

The Journal of Nervous and Mental Disease in June 2011 published the first ever controlled comparison between EMDR and EFT (Karatzias et al, J Nerv Ment Dis 2011; 199: 372-378).  A total of 46 participants were randomised to either EMDR or EFT.  The participants were assessed at baseline and then reassessed after an 8-week waiting period.  Two further blind assessments were conducted at posttreatment and 3-months follow-up.  Overall, the results indicated that both interventions produced significant therapeutic gains at posttreatment and follow-up in an equal number of sessions.  Similar treatment effect sizes were observed in both treatment groups.

The authors suggest, “given the speculative nature of the theoretical basis of EFT, a dismantling study on the active ingredients of EFT should be subject to future research”.  They assert that the fact that EFT produced significant posttreatment effects comparable with those of a well-established intervention such as EMDR suggests that the EFT protocol does somehow facilitate recovery from trauma symptoms.  They consider several possible hypotheses:

• The stimulation of the meridian points may release serotonin in the amygdala and prefrontal cortex and therefore quite rapidly reduce hyperarousal
• The stimulation of the meridian points has been shown to increase plasma and brain tissue levels of endomorphin-1, beta endorphin, enkephalin and serotonin.  These may cause sedation.
• The protocol may facilitate the release of oxytocin, a hormone that promotes relaxation and decreased sympathoadrenal activity.
• EFT provides a gentle method enabling the client to concentrate on a traumatic event and thus facilitates exposure through imagination or narrative to aspects of the event.  Repeated exposure can have a desensitising effect on the distress associated with traumatic memories.
• Exposure may facilitate the emotional processing of the traumatic event and modify associated cognitions that underlie PTSD and decrease hyperarousal.
• The affirmations included in the EFT protocol may have a meditative effect and create some sort of beneficial trance state.

Karatzias et al have difficulty explaining why EFT produces gains comparable with such a well-established therapy as EMDR given the speculative nature of its theoretical basis, but they note that both EFT and EMDR share similarities between them and perhaps CBT(cognitive behavioural therapy).  Both protocols incorporate distraction and desensitisation coupled with exposure.

This study was carried out before the bulk of academic material on memory reconsolidation in psychotherapy was published. We can see now how the similarities noted for both therapies indicate the therapeutic mechanism to likely be memory reconsolidation.