Conducting Single Subject Research on EP Techniques 

The first part of this article covers theory and overview of SSD Research. At the end of the article is a suggested protocol for conducting single-subject design studies. 

In order for energy psychology (EP) techniques to gain credibility in the scientific psychological community, it is imperative that we as clinicians conduct research that validates our use of these techniques. Experimental designs using random assignment of subjects to experimental and control groups are the ‘gold standard’ for clinical research. However, most clinicians do not have the resources to conduct such group experiments. An alternative experimental method that is well suited to clinical practice is the Single Subject Design (SSD). Because an SSD study does not have a control group, it attempts to rule out alternative explanations for client improvement by comparing assessments of the same subject to her/himself over time. This is done by taking repeated assessments before and after the EP intervention is conducted. 

In 1995, the American Psychological Association Division 12 Task Force on Promotion and Dissemination of Psychological Procedures published a list of empirically validated treatments. To make the list of "well-established treatments”, two independent series of more than nine SSD (Single Subject Design) experiments were required, which demonstrated the efficacy of one treatment method compared with other methods. To make the list of "probably efficacious treatments”, a series of four or more single study design experiments which demonstrated efficacy were required (Chambless et al., 1966). This guideline established by the APA opened the door for single-subject designs done by clinicians in their own settings. 

It is helpful also to remember that the field of clinical psychology, going back to Freud, began with single subject case studies, i.e. careful clinical observation of single patients, and writing these up as case studies. 

At this time, we are recommending that clinicians focus on one of the following issues for SSD studies: anxiety (social anxiety, test anxiety, performance anxiety, panic attacks); depression; trauma/PTSD; or chronic pain.

Simply taking measures/questionnaires of the target symptoms before and after the EP therapy will not rule out alternative explanations for client improvement. Alternative explanations need to be controlled for. 

• Passage of Time: One alternative explanation is that the mere passage of time accounted for the decrease in symptoms. The way to control for this possibility is to take at least two and preferably three assessments at one-week intervals before having any treatment sessions with the client. If there is little or no decrease in the symptoms from the first to the second or third test administrations, this lowers the possibility that subsequent improvements that occur during the therapeutic intervention are a result of the passage of time. 
  
  This series of pretests can be conducted by sending the client the self-administered questionnaires and by collecting information for the clinician-administered test instruments over the telephone, or online. If the pretests are done in this remote manner, it is important that the client fill out the questionnaires and that the clinician administer the over-the-phone measures at a consistent day, time and place. It is probably a good idea for the client to send in the self-administered questionnaires by mail or e-mail immediately after they fill them out, to insure consistency of administration. 

• Therapeutic Contact: A second, more likely alternative explanation for the client’s improvement is therapeutic contact. Our goal as EP clinicians/researchers is to demonstrate that the EP techniques result in significant symptom improvement above and beyond the personal contact with an empathic and insightful therapist. The way to accomplish this is to have two or more sessions with the client before beginning the intervention. The questionnaires should be administered before each of these therapy sessions. If there is no significant improvement during these initial sessions prior to initiating EP, then you know that any improvements following EP intervention are likely caused by the intervention.
   
• Initiating EP Treatment: You are now ready to begin the EP intervention. Continue to collect the questionnaire data in the waiting room prior to each treatment session. Although you may adapt your use of EP techniques to fit your own treatment style in your clinical practice, YOU MUST USE STANDARDIZED PROTOCOLS FOR THE PARTICULAR MODALITY YOU ARE USING while conducting SSD research (to ensure validity and replicability of your findings). (Standardized research protocols for TFT and EFT may be found on the ACEP website

Once the intervention has been initiated, take followup assessments after the series of treatments is over (= ‘post’), and again at three and/or six-month intervals. These can be filled out by the client at home and/or online. It is recommended that you provide a reward of some kind, to increase the likelihood of actually getting the followup assessment. 

This protocol is an A - B - A design, where A = the non-treatment phase, and B = experimental treatment (experimental variable) phase. 

CHARTING: If the subject’s condition you are studying has an observable behavior(s), please have them monitor and chart this behavior, on a daily/weekly basis. (Observable behaviors can include panic attacks, anxiety attacks, stuttering episodes, nightmares, flashbacks, anger outbursts, # hours slept, etc.) If the subject has a partner, you may have the partner do the monitoring and charting for the subject. 

ASSESSMENTS: It is recommended that each subject complete one or two assessments for each condition (pain, anxiety or PTSD) being studied. There are psychological assessments for virtually all human behaviors. (See CRITERIA AND ASSESSMENTS section below.)

Week One: Subject comes in for first interview, discuss study details, answers questions. Subject signs informed consent; completes first round of assessments. Begins charting daily behaviors (if daily charting is part of the study). (This interview can be 30 minutes, + time for assessments). There is no treatment yet. 
 
Week Two: Subject comes in for second interview/case history. Completes second round of assessments, continues daily charting of behaviors (and will continue on through the 180 day followup). Therapist takes case history (after assessments). There is no treatment yet. 
 
Week Three: Subject comes in, takes third round of assessments. (These three initial assessments form the baseline against which any/all future changes are compared). Therapist conducts first intervention after assessments are completed. 

Week Four: Subject comes in, takes fourth round of assessments. Therapist conducts second intervention. 
 
Weeks Five – Eight: Subject comes in for third – sixth interventions. Takes fifth round of assessments in session 8, before last (6th) intervention. 
 
Week Nine: Subject completes fifth round of assessments (online, or in office); one week after last intervention. 
 
90 or 180 day followup: Subject takes sixth (final) round of assessments (online, or in office).