Clinical emotional freedom techniques for psychological and physiological stress reduction: A systematic review and network meta-analysis.

Stress is a major global public health concern with well-established psychological and physiological impacts. Clinical Emotional Freedom Techniques (EFT) is a manualised, evidence-based intervention integrating cognitive and exposure components with acupoint stimulation. Although randomized controlled trials (RCTs) support its efficacy, no prior meta-analysis has synthesised its effects across both psychological and biological stress outcomes. This study conducted a systematic review and frequentist network meta-analysis (NMA) in accordance with PRISMA guidelines. RCTs examining Clinical EFT for stress in adults were included. Interventions were compared using random-effects NMA with standardized mean differences (SMDs), and network consistency was assessed via node-splitting. Seventeen RCTs met inclusion criteria. For physiological stress (6 studies; n = 399), Clinical EFT showed a significant small-to-moderate reduction versus control (SMD = -0.48, 95% CI [-0.85, -0.12]). Other active interventions were not significant. For psychological stress (14 studies; n = 1051), Clinical EFT demonstrated a large, significant reduction versus control (SMD = -2.39, 95% CI [-3.18, -1.59]). Cognitive behavioural therapy, guided imagery, and music also showed significant effects, while treatment as usual and breathing interventions were imprecise. No significant inconsistencies were found between direct and indirect comparisons. Most studies had some concerns or high risk of bias. Clinical EFT is associated with large reductions in psychological stress and modest improvements in physiological stress. Further high-quality trials incorporating both self-report and biological measures are needed to confirm durability of effects.