New Study Validates EFT’s Effectiveness.

Story at-a-glance

  • Energy psychology uses a form of psychological acupressure, based on the same energy meridians used in traditional acupuncture to treat physical and emotional ailments for over 5,000 years, but without the invasiveness of needles
  • Recent research found that, compared to the control group, it significantly increased positive emotions, such as hope and enjoyment, and decreased negative emotional states like anger and shame
  • Another recent review found statistically significant benefits in using energy psychology for anxiety, depression, weight loss, PTSD, phobias, athletic performance, cravings, pain, and more
  • A review published in the American Psychological Association’s journal found that EFT “consistently demonstrated strong effect sizes and other positive statistical results that far exceed chance after relatively few treatment sessions”

Although frequently overlooked, emotional health is critical for your physical health and healing. No matter how devoted you are to the proper diet and lifestyle, you’re unlikely to achieve optimal health if emotional barriers stand in your way.

Energy psychology uses a psychological acupressure technique based on the same energy meridians used in traditional acupuncture (which has been used to treat physical and emotional ailments for over 5,000 years) but without the invasiveness of needles.

The Emotional Freedom Techniques (EFT) is the most popular form of energy psychology and was developed in the 1990s by Gary Craig, a Stanford engineering graduate specializing in healing and self-improvement. I routinely used EFT in my practice, and highly recommend it to optimize your emotional health.

The method involves tapping specific points on your head and chest with your fingertips while thinking about your specific problem—be it a traumatic event, an addiction, pain, etc.—and voicing positive affirmations. This can be done alone or under the supervision of a qualified therapist.1

The combination of tapping the energy meridians and voicing positive affirmation works to clear the emotional block from your body’s bioenergy system, thus restoring your mind and body’s balance.

Clinical trials have shown that EFT is able to rapidly reduce the emotional impact of memories and incidents that trigger emotional distress. Once the distress is reduced or removed, your body can often rebalance itself, and accelerate healing.

While some still view energy psychology with suspicion, EFT has actually met the criteria for evidence-based treatments set by the American Psychological Association for a number of conditions, including post-traumatic distress syndrome (PTSD).2

Research Validates EFT’s Effectiveness

In a critical review published in the American Psychological Association’s (APA) journal Review of General Psychology3 last year, researchers found that EFT “consistently demonstrated strong effect sizes and other positive statistical results that far exceed chance after relatively few treatment sessions.”

Other recent studies demonstrate how EFT can accomplish remarkable progress in a very short amount of time for people with a history of trauma. For example:

1.    A 2009 study4 of 16 institutionalized adolescent boys with histories of physical or psychological abuse showed substantially decreased intensity of traumatic memories after just ONE session of EFT.

2.    An EFT study5 involving 30 moderately to severely depressed college students was conducted. The depressed students were given four 90-minute EFT sessions. Students who received EFT showed significantly less depression than the control group when evaluated three weeks later.

Most recently, a study published in the Energy Psychology Journal6 confirmed that the benefits from EFT are the result of the tapping process and not a placebo effect. The study included 20 college students who were divided into two groups. One group did EFT while the control group received mindfulness training. Before and after the sessions, positive and negative emotions were assessed.

This included enjoyment, hope, pride, anger, anxiety, shame, hopelessness, boredom, and mindfulness. Overall, the EFT group experienced significantly greater increases in positive emotions, such as hope and enjoyment, along with greater decreases in negative emotional states like anger and shame. The study concluded that:

“No significant change was found for mindfulness. Tapping on acupoints, combined with the vocalization of self-affirming statements, appears to be an active ingredient in EFT rather than an inert placebo. The results were consistent with other published reports demonstrating EFTs efficacy for addressing psychological conditions in students.”

Tapping Alters Conditioned Responses

Such findings come as no great surprise to other researchers in the field, such as Dr. Dawson Church, Ph.D., founder of the National Institute for Integrative Healthcare. Dr. Church told the Examiner:

“We learn early on to disassociate from our emotions. EFT is a way that people can feel safe and empowered to process their emotions. When we tap and use affirmative statements, we can actually change our old conditioned responses.”

Earlier this year, Dr. Church published a review7 of more than 40 different EFT studies evaluating the effectiveness of the method. In his paper, he cites studies demonstrating the method’s effectiveness for a wide range of emotional problems, including:


Post-traumatic stress disorder (PTSD)




Weight loss and food cravings

Athletic and academic performance

Test anxiety


Dr. Church’s website,,8 is a great resource if you want to learn more about EFT and the research that has been done on each of these ailments, as well as other problems. According to Dr. Church:

“EFT has been researched in more than 10 countries, by more than 60 investigators, whose results have been published in more than 20 different peer-reviewed journals… EFT research includes investigators affiliated with many different institutions.”

It’s worth noting that as a general rule, the research being done on EFT is done using the techniques originally developed by Gary Craig.9 An expanding list of similar techniques has sprung up since then, and while they might provide similar benefits, EFT is the only empirically validated treatment version. (The APA defines an empirically validated treatment as one for which there are two different controlled trials conducted by independent research teams.)

Operation Emotional Freedom

EFT has shown particular promise in the treatment of war veterans with post-traumatic stress.10 I want to highlight this aspect of its use as PTSD is hard to treat, and studies have shown drugs like antidepressants and antipsychotics to be on par with placebo for the treatment of this condition.

The documentary film entitled Operation: Emotional Freedom,11 directed by Eric Huurre, follows a number of veterans and their families who went through intensive therapy using EFT. Gary Craig, along with other EFT practitioners worked very closely with veterans who were all suffering from PTSD, depression, anxiety and a few were suicidal. The results were truly astounding. At the end of treatment, each one of them describes a new feeling of peace and hope that there is help and they were able to overcome emotional traumas experienced in combat.

The film offers a close look at the current state of health care for combat veterans diagnosed with PTSD, and examines the myths and misconceptions surrounding the chemical approach to treating emotional conditions and why drugs are not “the answer” that pharmaceuticals promise. (You can learn more about the efforts to assist veterans and their families through energy psychology on the film’s website,

Research performed by the Iraq Vets Stress Project13 also demonstrates the effectiveness of EFT. In a study that included 100 veterans with severe PTSD,14 90 percent of the veterans had such a reduction in symptoms that they no longer met the clinical criteria for PTSD after six one-hour EFT sessions! Sixty percent no longer met PTSD criteria after just three EFT sessions. At the three-month follow-up, the gains remained stable, suggesting lasting and potentially permanent resolution of the problem.

How to Perform EFT

For a demonstration of how to perform EFT, please view the video below featuring EFT practitioner Julie Schiffman. This is a general demonstration that can be tailored to just about any problem. You can also find text instructions and photographs of where to tap on my EFT page. For when you’re on the go, there are at least four different EFT applications available in the iTunes store. The apps range from a simple recap of the EFTs Basic Recipe to a sophisticated virtual coaching app for specific mental health problems like anxiety and depression.

Bear in mind that while EFT is quite easy to learn and perform, I strongly encourage you to seek out a qualified therapist for more serious or complex issues. It is an art, and tapping for deep-seated issues typically require the kind of skill that only a well-seasoned practitioner will have. If you try to self-treat, you may end up falsely concluding that EFT doesn’t work, when nothing could be further from the truth… This is particularly pertinent if you’re trying to address trauma-based stress such as PTSD or grief following the loss of a loved one.


6 Ways to Help Your Child Deal with Anger.

Anger is a feeling that we all experience at some point or another. Yet, similarly to sadness or fear, it’s the kind of feeling we’d rather not be seen with in public. It’s what is classed as a ‘negative’ feeling, a ‘bad’ feeling and we don’t want to be around it.

For many years I worked with children who experienced their own emotions and social interactions as challenging and, as a result, displayed behaviour that was challenging for the adults who took care of them. Unfortunately, many common approaches that were and are still employed to try and help these children are based on this assumption that feelings such as anger are bad, thereby giving children bad messages about their feelings as well as themselves.

Most approaches merely manage the behaviour, i.e. the symptoms but and don’t offer much help in dealing with the cause, the feeling itself.

Here’s what I think would really help a child in dealing with their anger and other difficult feelings:

1. Distinguish between the person, the feeling and the behaviour

Let your child know that it is okay to experience anger and that you understand. Don’t reject them because they are angry. If they start to display behaviour that is harmful to themselves and/or others you need to intervene and possibly remove them from the situation but stay with them and make it clear that you are stopping them from hurting others and/or themselves and not punishing them.

2. Teach mindfulness

Instead of teaching children that anger is a bad feeling that they need to try and get rid of as soon as possible, teach them skills such as mindfulness that enable them to stay with it when it arises and to watch it disappear by itself. Teach them the skill when they are calm and sit with them and guide them through it when they are angry.

3. Facilitate a positive outlet for it

Teach children ways to express and explore their anger safely, for example write down how they are feeling or draw a picture of their anger. Alternatively, just take your child for a walk in nature.

4. Teach children to take responsibility for their feelings

No one makes anyone feel anything. It’s important for children to understand that although a situation might have triggered their anger, the cause of their anger is never the situation but a need of theirs that hasn’t been met. Help them understand that they need to become aware of and take responsibility for their needs and learn how to express them/request for them to be met. (Non-Violent Communication techniques can really help with this. Marshall Rosenberg’s book: ‘Non-violent communication. A language of life’ will give you a great introduction.)

5. Improve self-awareness and communication skills

A lot of anger in children is frustration that comes from the inability to be aware of and express their own needs. Mindfulness, non-violent communication and philosophy for children (P4C) are all great ways to improve these skills.

6. Be a good role model

Most importantly, show your child how to deal with anger by being a good role model. Don’t hide or suppress your own anger. Say that you are angry when you are angry and model self-awareness by explaining why you are angry. Explain the choices you are making as a result.

What do you do to help your child deal with anger?

Jealousy: it’s in your genes.

A tear-filled green eye

Around a third of the variation in levels of jealousy across the population is likely to be genetic in origin. Photograph: Tim Flach/Getty Images

How would you feel if you suspected your partner had enjoyed a one-night stand while away on holiday without you? What if, instead of having sex on the trip, you believed she or he had fallen in love with someone? In either case, if your partner will probably never see the other person again, would that make the situation any easier to cope with?

Faced with either scenario, most of us would feel intensely jealous: it’s a very basic, normal reaction. But does the universality of jealousy indicate that it might be genetically programmed?

The first study to investigate the genetic influence on jealousy was recently published. Researchers put the questions at the top of this article to more than 3,000 pairs of Swedish twins. Fraternal twins share about 50% of their genes; identical twins share exactly the same genetic make-up. By comparing the answers given by each group of twins, the researchers were able to show that around one third of the differences in levels of jealousy across the population are likely to be genetic in origin.

In both scenarios – fears about a partner sleeping with or falling in love with a stranger – women reported more jealousy than men. But the researchers also found a gender difference between relative reactions to the idea of sexual or emotional betrayal. Men were far more troubled by the thought that a partner had been sexually unfaithful than by potential emotional infidelity. Women tended to respond to each scenario with equal levels of jealousy.

Why is this? The answer, according to some scientists, may lie in evolutionary pressures. For both men and women, reproduction is key. But men, unlike women, cannot be certain that they are the biological parent of their child, and so they are naturally more perturbed at the thought of sexual infidelity than they are about emotional infidelity – because it jeopardises the successful transmission of their genes. Women, though relatively less perturbed by the idea that their partner may have been sleeping around, are nevertheless dependent on their mate for their survival and that of their offspring.

That’s the theory. Given that we can’t zip back in a time machine to human prehistory, it’s an explanation that seems impossible to prove or disprove.

Though genes appear to play a part in jealousy, the Swedish results also show that the kinds of things that happen to us in our lives – the way we’re brought up, the people we’re around, the events we experience – are far more important. Only one third of the variation in jealousy seemed to have a genetic origin, so the rest must have been down to environmental differences.

But whether genetic or environmental, hardwired or learned, there’s no doubting the ubiquity of jealousy. It’s an emotion that almost everyone feels at some point, and a major cause of relationship problems. Although much of this jealousy is illusory, we all know that the eye (if nothing else) can wander. In Britain, the National Survey of Sexual Attitudes and Lifestyles found that 82% of men and 76% of women reported more than one lifetime partner, with more than a third of men and almost a fifth of women clocking up 10 or more. Some 31% of men and 21% of women said they had started a new relationship in the previous year, with 15% of men and 9% of women seeing more than one person at the same time.

Occasionally, then, we have grounds to be worried: jealousy alerts us to a looming problem in our relationship. If your partner has been unfaithful in the past, naturally you’ll worry that they might stray again in future. Much of the time, though, jealousy is pointlessly corrosive, making both partners miserable for no good reason. In these cases, how can we get the better of our jealousy? How can the “green-eyed monster” be tamed?

Consider the evidence for your jealousy. What about the evidence that might contradict our fears? What would we tell someone if they came to us with the same worries? Have a chat with a trusted friend to get an independent perspective on how likely it is that your partner is deceiving you.

Talk to your partner. When two people hold differing views of what’s acceptable in the relationship – how much time to spend together, how frequently to keep in touch, whether it’s okay to stay in contact with ex-partners and so on – misunderstanding and jealousy are always a risk. If you haven’t agreed the ground rules for your relationship, make it a priority.

Weigh up the pros and cons. People often believe that their jealousy – for all the pain it brings – actually helps them. So it’s a good idea to draw up a list of the pros and cons, both of being jealous and of trusting your partner. On balance, which one seems the best option?

Get to the bottom of your fears. What is it, do you think, that lies at the root of your jealousy? Do you dread being alone? Do you fear humiliation? When you’ve identified the fears fuelling your jealousy, think constructively about how you’d handle the situation.

Set yourself some ground rules. We can find ourselves trapped in a vicious cycle: jealous behaviour feeds jealous thoughts, which in turn trigger more jealous behaviour. And so on. To break this cycle, it helps to set ourselves some ground rules. When you find yourself worrying about your partner’s faithfulness, save those thoughts for a daily “worry period”. Set aside 15 minutes each day, and postpone all your worrying until then.

Concentrate on the good stuff. Jealousy skews our perspective. To counter it, we need to make a deliberate effort to view things more positively. That means focusing on the good parts of our relationship: the things about our partner and our life together that we like, the things that keep us coming back for more. Focus on the positive by doing more positive things together. And remember to have your own interests and activities that boost your self-esteem.

4 Ways to Improve Your Health and Connect to Your Higher Mind.

Ever feel grumpy? Alone? Isolated? Not sure of which direction to take in your life or career? Tired of “doing it” on your own?


Although uncomfortable, each of these situations provide us with fertile ground, encouraging us to reconnect to the Light within and expand our awareness of who we are and who we are meant to be.

But how you may ask? By putting us in touch with our deepest needs and reasons for being. When we are willing to listen.

The body is an amazing biofeedback system, constantly providing us with vital information for our physical, emotional, mental, and spiritual health. Whether you live in a big city (me in NYC!) or a small town, we all struggle with stress and may sometimes find it difficult to rebound.  Heck, just going to the grocery store can be overwhelming! The key to improving our sense of well being lies in recognizing the body’s signals and knowing when and how to read them.

The following descriptions will help you to identify the Four Aspects of Stress, as they are occurring, followed by remedies to help you resolve them.

1. Physical Stress

Effects our energy and vitality levels. Pain, chronic tension, and the mental, emotional and spiritual aspects of stress are strong influencers in determining our physical health.

Solution:  Pay attention to the cues your body provides, whether it’s a sore back or tension in your jaw. First and foremost, be honest with yourself about your feelings, needs and wants. Then, when and if appropriate, communicate them to those involved.

2. Emotional Stress

Triggered by fear, emotional stress can be debilitating.

Fear of not having enough, not being enough, not doing enough, enough, enough, enough! Emotional stress can also be triggered by expectations, our interpretations of people, places and events, and by reliving past experiences.***

Solution:  Learning how to identify the source of emotional stress is the first step to managing it. Begin by noticing your response to disappointment and when you feel an internal or external sense of pressure. Then step back and take a breath. Giving yourself time to recoup from emotional stress will help you to assess and respond to the situation more objectively, and will leave you feeling better about yourself and those involved.

***Note: Relieving experiences that conjure up feelings of joy will help to produce endorphins and improve your mood, to boot.

Finding satisfying ways to get your needs met is another key component in developing good emotional health.

3. Mental Stress

What we think (our self-talk) plays a huge role in how we feel, and is often unconscious and habitual. (I have heard it said that we have

60,000 thoughts a day, and most of them are the same!) Unfortunately, the

messages we give ourselves are not always the most thoughtful or kind. How we see the world, and tje beliefs we hold true about it, also contribute to our mental health and well-being.

Solution: Notice what you’re focusing your attention on as you move throughout your day. Are you thinking in ways that promote stress or a sense of health and well-being? If you are thinking stressful thoughts, gently shift your attention and try to look at the situation differently. Give yourself messages that are affirming, such as “I am safe,” and “Everything I need is within me.”  And don’t forget to check out your assumptions and the accuracy of your perceptions.

4. Spiritual Stress

Spiritual stress affects all aspects of our health: physical, mental, and emotional, and stems from feeling disconnected from ourselves and others.

Solution: When feeling out of sorts and unable to connect with yourself or the world around you, find one person you can reach out to and connect with (animals are great, too!) Find ways to nurture and replenish your Spirit. Spend time in nature, get out for a walk, or engage in a creative pursuit.

In addition to better health, alleviating stress will serve to enhance other aspects of your life.  For instance, you may notice your relationships improving, synchronicities occurring, and life looking bigger and brighter. What’s more, access your Higher Mind will become natural, as you clear away the old and make room for intuitive insights and guidance.

Source: Purpose fairy


Sarah Garfinkel, consciousness researcher, on your sixth sense.

There’s a new area of scientific study that has uncovered a skill that could be considered our sixth sense. It’s called interoception and it’s the ability to monitor your own internal organs. For instance, how interoceptive you are can be measured by your ability to accurately count your heart beat, by just tuning into it.


So it’s a skill, or talent, that involves being quite in tune with one’s body. And this ability is associated with some interesting and useful traits. Those who are highly interoceptive are also highly intuitive and aware of their “gut” feelings. They also apparently have a better memory for emotional information and are more emotional overall. Awareness of one’s emotional and physiological state may also reward people with an ability to control it. For instance, one study has found that those who have good interoceptive ability are also less anxious when speaking in public.

SmartPlanet caught up with Sarah Garfinkel, a post-doc researcher at the Sackler Centre for Consciousness Science at the University of Essex, and asked her to explain interoception, how it is measured and how one might be able to improve their own interoceptive ability.

SmartPlanet: How do we measure interoception? Or in the case of heart rate, how do we count our heart beats?

Sarah Garfinkel: Heartbeat is the measurement of interoception that I’ve been interested in. There are two ways to test people’s ability to count their own heartbeat. You give set periods of time and you have people count how many heartbeats they’ve perceived in that space of time.

The other way people have done it is to present tones or some sort of external signal, like a flashing light, and the tones exactly match the beating heart, or they’re time-shifted slightly and people have to say whether the tones are in sync or out of sync with their heartbeats.

That sounds hard.

It’s really hard. The majority of people, maybe 80 percent of people can’t tell if their heart beat is in sync with the tones. It’s so difficult because it involves integrating an outside signal with an inside process. People tend to be better at counting their heart beats [within a specific time frame.] Because most can do it, the counting one gives a really lovely spread of sort of bad, intermediate and good.

So some people are good at it, some people are bad at it. How do people typically try to count their heart beat? Most of us only “feel” our heart beat when it races during exercise or a highly emotional event.

So just to clarify, [the test] always happens at rest. Because you are right, if you’re doing physical exercise or if we scare anyone beforehand then everyone will have an enhanced ability to detect a heart beat.

To measure their accuracy we create a ratio of actual heart rate relative to perceived rate. So a ratio of one would be perfect. A ratio of 0.7 is considered good.

Are some types of people better than others, on average?

Yes, fitter young men tend to be very good. Fitness is an indicator, one of the many indicators of whether you’re good or bad.

What is another indicator?

Age. People get worse as they get older. Although heartbeat perception is considered a stable trait, age has a declining effect on it.

You’ve mentioned before that there is an association between interoception and the ability to remember emotions. How do we even know this?

I love these sorts of experiments. They just blow my mind. First of all, people who are more interoceptive tend to have a richer emotional experience.

If you record people’s physiological responses or get them to rate emotional pictures, people with higher interoception will rate them as more emotionally intense.

Why is this?

Well theories of emotion, such as the James-Lange theory of emotion, state that fear or emotion perception arises from the detection of changes of internal bodily sensations.

So the emotion itself is “the noticing of a physical change” in one’s body?

Yes, some argue emotions arise from the detection of changes in the body. It reminds us of the famous question from William JamesDo you run from the bear because you’re afraid, or are you afraid because you run?

And he would argue that you’re afraid because you run because you feel all the physiological changes of the body. So if you then extrapolate from that: Those people who are better able to detect physiological changes [e.g., heart rate changes] they are going to report the experience as being more emotional.

This makes sense.

We tend to remember something if it’s more emotional. But now people with interoception find things more emotional. So this can suddenly start impacting our cognitive processes. And why they tend to remember emotions.

Apparently those who are highly interoceptive also have better intuition?

At the Sackler Centre for Consciousness Science, we are interested in what it means to have conscious knowledge.

Our gut instinct, or intuition, is where you know something is right but we just don’t know why. But everything in one’s gut tells us that it’s right. This is because your body can also hold information.


Right. What gives rise to that feeling of knowing? It can be represented in the autonomic nervous system, so your body can have an enhanced arousal response. Like a sweat response. Or your pupils can also change size, they can dilate. And this can happen with regard to true information or previously encountered experiences.

And then the degree to which you can articulate or know you know it is an extra level of consciousness. So if you believe this premise that our body reacts to things and reacts to things correctly, and that can happen detached from your conscious awareness, then that means that those people who are better able to tap into those autonomic bodily channels are better able to use that as a cue to guide them.

On one hand we’ve heard these things anecdotally over and over again. That is “gut instinct.” But now science is putting this structure around it.

I know, I love it. I really love it. We’ve all had this experience where you bump into someone and you know you know them. Everything in your body says that you’ve had an encounter before, but you can’t recall when or where. But you feel it. And now we’re able to understand that those who are interoceptive are better at detecting [the gut feeling.] It’s been shown experimentally.

Also I have heard that interoceptive people have less anxiety speaking in public than the rest of us?

Yes that is from a published experiment. But that experiment was slightly contrary to all the other body of experiments that have shown that those with high anxiety tend to be interoceptive.

So why do you think this study showed less anxiety speaking in public?

Well if you are aware of how your body is changing and you can feel it and predict it, then that does potentially make it more manageable.

So it’s the idea that if you are aware of something you can control it more?

Yes. I published a study this year with Hugo Critchley called, “What the Heart Forgets.” We show that if you process words when your heart is beating — meaning exactly when your heart beats, as opposed to the off-beat, you’re less able to remember words that were presented when your heart beats. It has an interference effect if you see a word exactly during a heart beat. You forget them much more easily.

However, if you are interoceptive you are good at detecting your internal bodily signals, and better able to eliminate the interferences effect of heart beats on memory.

This fits with the idea that if you are able to detect a bodily process and you’re more able to protect against its interfering or detrimental influences.

That is amazing. You’ve mentioned that people can be trained to get better at interoception. How?

Based on our own observations, there is a potential in some people to learn. Because people sometimes don’t know what to focus on. For example, I was terrible when I started. I kept trying to focus on my chest. And actually people don’t necessarily feel their heart beat in their chest. They can feel it in other parts of their body.

So once you’re aware of that, then you can start focusing on other parts and maybe then you’ll be more sensitive to a signal. That is where the training component can come in. But that might only true for people who have the ability to tap into the signal but just don’t know where to focus. Whereas there are others who can never feel the signal, it doesn’t matter where they’re focusing on.

I have heard that biofeedback can sometimes help people tap into interoceptive ability.

Yes this is based on a process by Yoko Nagai. Basically people can watch a caterpillar move on a screen, and their body is wired up to a device that measures their skin conductance [which measures sweat as a signal of arousal]. When you’re relaxed the caterpillar will go in one direction and when you’re not relaxed the caterpillar will go in another direction.

This is based on the premise that people may think they’re in a relaxed state, but actually their body is not relaxed. So having this external manifestation of bodily states can help potentially train people to understand what it really means to have your body in a relaxed state or not.

So they get a sense of it, of what “relaxed” is supposed to feel like.

Yes, exactly. So that even if they may be bad at understanding their internal bodily process, they can learn it based on external cues and then emulate it in the future.

Source: Smart Planet

Association of Elevated Blood Pressure With Low Distress and Good Quality of Life: Results From the Nationwide Representative German Health Interview and Examination Survey for Children and Adolescents.


Objective Quality of life is often impaired in patients with known hypertension, but it is less or not at all reduced in people unaware of their elevated blood pressure. Some studies have even shown less self-rated distress in adults with elevated blood pressure. In this substudy of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KIGGS), we addressed the question whether, also in adolescents, hypertensive blood pressure is linked to levels of distress and quality of life.

Methods Study participants aged 11 to 17 years (N = 7688) received standardized measurements of blood pressure, quality of life (using the Children’s Quality of Life Questionnaire), and distress (Strengths and Difficulties Questionnaire).

Results Elevated blood pressure was twice as frequent as expected, with 10.7% (n = 825) above published age-, sex- and height-adjusted 95th percentiles. Hypertensive participants were more likely to be obese and to report on adverse health behaviors, but they showed better academic success than did normotensive participants. Elevated blood pressure was significantly and positively associated with higher self- and parent-rated quality of life (for both, p ≤ .006), less hyperactivity (for both, p < .005), and lower parent-rated emotional (p < .001), conduct (p = .021), and overall problems (p = .001). Multiple regression analyses confirmed these findings.

Conclusions Our observation linking elevated blood pressure to better well-being and low distress can partly be explained by the absence of confounding physical comorbidity and the unawareness of being hypertensive. It also corresponds to earlier research suggesting a bidirectional relationship with repressed emotions leading to elevated blood pressure and, furthermore, elevated blood pressure serving as a potential stress buffer.


In this substudy of the KiGGS survey, we have examined the association of elevated blood pressure with psychological distress and health-related quality of life in a large, nationally representative sample of German adolescents aged 11 to 17 years. In 825 of 7688 study participants (10.7%), elevated blood pressure levels above published age-, sex-, and height-adjusted 95th percentiles were documented by means of standardized oscillometric measurement, demonstrating twice the rate expected from earlier normative samples (28). Hypertensive blood pressure was independent of socioeconomic status and most frequently found in postpubertal boys.

The central finding of this investigation was that adolescents with elevated blood pressure levels reported significantly better quality of life and lower levels of distress on multiple domains of two well-validated instruments. Moreover, concordant results were observed for both self- and parent-rated versions of the two instruments and for both systolic and diastolic blood pressure as predictors. All associations remained stable when adjusted for a variety of possible confounders in multivariate analyses. These observations in adolescents seem to contradict several reports from adult patients who are aware of having arterial hypertension. The adult patients may already feel concerned about possible long-term health complications, the necessity of regular visits to a physician, and costs and adverse effects of antihypertensive medication. Together with hypertensive end-organ damage present sometimes, this may impair quality of life (1,12,20).

In contrast, our results confirm earlier studies in adult populations showing an inverse association between hypertension and subjectively measured distress (19,20). For example, Winkleby et al. (19) found that hypertension as defined by elevated office blood pressure and/or current use of antihypertensive medications was negatively related to an index of self-rated job stressors in 1428 San Francisco bus drivers, and the same effect was observed also for continuous blood pressure values. Remarkably, this inverse association was equally found in nonmedicated (and possibly unaware) and medicated (and probably aware) participants.

Most of the hypertensive adolescents identified in the KiGGS study were not aware of their elevated blood pressure, which was only detected by routine screening performed as part of this survey. It is well known that individuals unaware of having high blood pressure usually report less bodily pain and show higher scores in physical functioning and general health than those with known hypertension (1,20,35,36). However, this putative unawareness does not explain why elevated blood pressure was actually associated with better quality of life and lower distress. Several possible explanations might account for this inverse association observed in our sample. a) Some adolescents may be more achievement oriented and, thereby, more successful in their school careers than others. This may occur at the expense of chronic (objective) stress and elevated blood pressure but lead to better self-esteem and quality of life. b) Repression of emotions may lead to better self-ratings of distress and quality of life, and repressed emotions might at the same time lead to elevations in blood pressure, as suggested by a line of research recently summarized by Mann (37). c) Elevations in blood pressure themselves might dampen negative emotions, possibly via vagal afferents. These three possible explanations are not mutually exclusive, and each one merits further discussion. However, the cross-sectional nature of our data does not allow us to draw firm causal conclusions.

In our sample, hypertensive participants performed better at school than did normotensive participants. Better school performance was associated with both better quality of life (data not shown) and elevated blood pressure. However, good quality of life was not mainly driven by better school success because elevated blood pressure and quality of life remained positively associated even after controlling for irregular school career. School success may, on the other hand, have been achieved at the expense of an increased stressor burden contributing to both high blood pressure and adverse health behaviors.

Our data are also consistent with the emotion repression theory of hypertension. Following that theory, repressed emotions, which could manifest themselves in low self-rated distress, might drive blood pressure up, probably via autonomic arousal (38). Interestingly, however, also parents of hypertensive adolescents rated their children as less distressed, less hyperactive, and more satisfied with their lives than did parents of normotensive adolescents. This indicates that not only hypertensive adolescents themselves but also their close family members perceived them as less distressed. Whether this means that repression of emotion in adolescents leads to distorted perception in their parents via changes in adolescents’ expressive behavior or whether these parents are repressors themselves, unable to recognize negative emotional clues in their children, cannot be concluded from our data.

Finally, our data could reflect a repeatedly described stress-dampening effect of hypertension (37,39–41). Arterial mechanoreceptors in the aortic arch and carotid sinus, which are sensitive to changes in systemic blood pressure, function as key elements in the transmission of hemodynamic information to the brain via vagal afferents. From some experimental studies performed almost 20 years ago, it is well documented that elevated blood pressure can thereby have pain- and stress-lowering effects (38–43). Previous reports have suggested the presence of an inhibitory feedback loop for adaption to chronic stressors, in which activation of baroafferent pathways by mechanical stretch caused by elevated blood pressure reduces somatic muscle tone, increases cortical synchronization, and blunts the level of pain and anxiety, all of which may have a beneficial impact on emotional well-being but may also lead to the transition of stress-induced hypertensive reactions to sustained chronic hypertension (38,44). Provided that a rise in blood pressure is involved in the reduction of perceived stress, the endogenous baroreceptor-brain circuitry constitutes a reinforcing mechanism, which rewards phasic elevations of blood pressure in stressful conditions, a reaction that could be learned over time (39). More recently, it has been shown that exogenic stimulation of the vagus nerve may have anticonvulsive and antidepressant properties (45). Interrupting the baroreceptor-brain circuitry by antihypertensive drug therapy, on the other hand, commonly reduces health-related quality of life and, possibly, also may impede adherence to pharmacological treatment (46).

There are some limitations to this study, mainly based on its cross-sectional and post-hoc design, which does not allow a causal interpretation for the observed link between high blood pressure and quality of life. Because the survey was originally not planned to specifically examine associations between blood pressure and well-being, no ambulatory blood pressure monitoring is available. However, the blood pressure readings in KiGGS were obtained under highly standardized conditions by trained physicians and with devices well validated for this age group. They have been published and accepted as new reference values for German children and adolescents (25). Nevertheless, the assignment to the hypertensive group was not based on a medical diagnosis, but on blood pressure levels above previously reported age-, sex-, and height-adjusted 95th percentiles, determined during one complex and potentially demanding diagnostic assessment. They are likely to be biased in the same way as typical office blood pressure recordings are. The unexpectedly high prevalence of elevated blood pressure found in this study cohort should therefore be interpreted with caution. Finally, the effect sizes of systolic and diastolic blood pressure on quality of life were small. However, they were still within the range of other known determinants for health-related quality of life, such as sex, body weight, and alcohol consumption. The small effect sizes may be caused by the relatively small range of blood pressure values and to sample heterogeneity; however, the highly consistent findings across self-rating and parent rating on several dimensions of distress and quality of life suggest a real and epidemiologically relevant association.

Our investigation also has several strengths. Data were available for a large, representative and well-characterized sample, giving sufficient statistical power and generalizability to our observations. Another strength is the well-standardized assessment of blood pressure, quality of life, and distress as well as the use of individual norm-based blood pressure cutoffs rather than one simple threshold. Our analysis was based on the widely accepted reference from the National High Blood Pressure Education Program Working Group on Children and Adolescents (28) because this reference also included overweight individuals, and, moreover, used relatively high cutoff levels (26). The results found for categorized blood pressure data were fully confirmed with continuous readings for both systolic and diastolic blood pressure as predictors in multivariate models, which were adjusted for a variety of possible confounders. Furthermore, we obtained psychometric evaluations by both adolescents and their parents, using instruments that had been well validated beforehand and applied independently of the authors of this substudy, who we were not involved in data collection.

In summary, in this representative sample of German adolescents, we demonstrate a significant and epidemiologically relevant association of hypertensive blood pressure with lower psychological distress and better health-related quality of life. To our knowledge, this is the first report linking elevated blood pressure to quality of life and psychosocial adaptation in a large epidemiological study of adolescents. Besides the absence of confounding from physical comorbidity and a formal diagnosis of hypertension, our cross-sectional assessment may capture a stress-dampening effect of high blood pressure or effects of repressed emotions on blood pressure already at an early stage, not yet fixed by vascular remodeling.



Chimpanzees and Bonobos Exhibit Emotional Responses to Decision Outcomes.


The interface between cognition, emotion, and motivation is thought to be of central importance in understanding complex cognitive functions such as decision-making and executive control in humans. Although nonhuman apes have complex repertoires of emotional expression, little is known about the role of affective processes in ape decision-making. To illuminate the evolutionary origins of human-like patterns of choice, we investigated decision-making in humans’ closest phylogenetic relatives, chimpanzees (Pan troglodytes) and bonobos (Pan paniscus). In two studies, we examined these species‘ temporal and risk preferences, and assessed whether apes show emotional and motivational responses in decision-making contexts. We find that (1) chimpanzees are more patient and more risk-prone than are bonobos, (2) both species exhibit affective and motivational responses following the outcomes of their decisions, and (3) some emotional and motivational responses map onto species-level and individual-differences in decision-making. These results indicate that apes do exhibit emotional responses to decision-making, like humans. We explore the hypothesis that affective and motivational biases may underlie the psychological mechanisms supporting value-based preferences in these species.

General Discussion

Overall, our results indicate that chimpanzees and bonobos show affective and motivational responses when making decisions. In the temporal task, apes responded more negatively to waiting, exhibiting all three target behaviors more often following a choice for the delayed option. In the risk task they responded negatively to undesired outcomes, producing all three target behaviors more often when they chose the risky option and received the low-value payoff. In addition, apes selectively attempted to switch their choices following undesired outcomes. These results indicate that the types of emotional displays that apes exhibit in conspecific social interactions, such as negative vocalizations, are also exhibited in economic decision-making contexts. Overall, these results indicate decision-making in apes involves affective and motivational processes, similar to those seen in humans.

Some weaker evidence further suggests that these processes may be related to overall differences in choice preferences. In line with previous work [21][22][23][24], the current studies indicted that chimpanzees and bonobos show divergent patterns of decision-making: chimpanzees were more patient and more risk-prone than were bonobos. Some aspects of the apes’ responses mapped onto these differences in their preferences at the species- or individual- level. In the temporal choice task, the more patient chimpanzees showed more intense negative responses (with more emotional vocalizations specifically) while waiting than did bonobos. In the risk task, the most risk-averse bonobos showed the strongest reactions to disparities in reward outcome and made the most attempts to correct their choices following undesirable outcomes. Notably, these patterns of emotional responses in the two species did not always align with our original predictions (based on human studies) that bonobos might be more impatient and more risk-averse because they have strong negative reactions in response to waiting for rewards and receiving bad payoffs. In the temporal task, chimpanzees in fact exhibited more negative reactions to waiting than did the bonobos. In the risk task, chimpanzees and bonobos showed similar negative responses to bad outcomes (both in terms of the affect score measure and choice switching behaviors). However, these emotional responses had different impacts on the two species: whereas bonobos who often attempted to correct their choices (e.g., showed high levels of ‘regret’) were most risk-averse, there was no relationship in chimpanzees. Moreover, whereas bonobos modulated their current choices based on previous outcome, chimpanzees did not.

What can account for these patterns in the two species? In the risk task, there was some suggestion that differences in reward sensitivity may have been an important influence on the two species’ behavior. In particular, chimpanzees may be so motivated to acquire the high-quality payoffs that they showed strong preferences for the risk option, despite pronounced negative response to receiving the bad outcome. That is, although both species reacted negatively to receiving the bad outcome, only bonobos actually modulated their subsequent choices in response to previous outcomes. Another possibility raised by result from the discounting task is that these species differ in their ability to regulate their emotional responses in some contexts. Human are able to exert cognitive control over their emotional responses, in particular by reappraising how they view events. These regulatory strategies are quite complex, and are thought to be lacking in some nonhuman models [5]. However, evidence from apes suggests that individuals may be able to engage in some relevant regulatory behaviors while waiting delays [80]. While previous studies have assessed how apes can use self-distraction to redirect attention, this type of paradigm could also be used to address whether chimpanzees and bonobos differ in their ability regulate their emotional responses when waiting. A final possibility is that although both species exhibited negative responses such as scratching and vocalizing, they actually differed in terms of the more specific emotion they experienced response to the two tasks. An analogous phenomenon occurs in chimpanzees’ and bonobos’ hormonal responses to food competition. While both species show similar behavioral responses with faced with competition with partners of various relative dominance status, these behaviors are supported by different underlying biological mechanisms: chimpanzees exhibit changes in testosterone in response to unequal-sharing situations, whereas bonobos exhibit changes in cortisol [81]. Thus, in the current set of studies, the underlying psychological experiences of the two species may have differed in a subtle way that our behavioral measures did not capture, because delineating fine-grained differences in emotions is difficult in animals who cannot provide self reports.

An important consideration for future research is whether these emotional responses play a causal role in ape decision-making, as they do in humans. The current results indicate that apes show emotional responses to decision-outcomes, and some of the evidence relating patterns of emotional responding to patterns of choice is also suggestive of the possibility that these processes causally influence choice strategies. However, future research should more directly investigate the causal role of emotions in ape decision-making. There are several approaches that could address this issue. First, studies that involve larger numbers of trials per subject would have more power to relate emotional reactions to subsequent choices on a trial-by-trial basis. Although we examined how previous outcome related to subsequent choice in the current risk task, larger number of trials would be needed to conduct similar trials involving emotional response data (given that such responses do not occur every trial). Second, studies that actively manipulate the apes’ emotional state could examine whether such changes can shift strategies, much like studies involving mood induction in humans [34][35][36][37]. Indeed, there is some suggestion that related psychological states play a causal role in ape behavior. In particular, chimpanzees and bonobos are more risk-prone following competitive interactions [24]. As some views suggest that competitive contexts alter emotional or motivation states in apes [82][83], this indicates that manipulating the ape’s emotional or motivational state might causally impact their patterns of decision-making. Finally, affect can influence human preferences via several different pathways – including immediate emotions at the time of choice and expectant emotions about what will happen in the future [1]. Physiological measures that assess the apes’ emotional state immediately prior to choice [55],[84] could therefore be used assess the role of anticipatory emotions in these species’ decision-making. This type of evidence will be critical to further test the hypothesis that emotion and motivation shape the divergent economic preferences exhibited by chimpanzees and bonobos at the mechanistic level.

Previous studies comparing temporal choices in chimpanzees and bonobos involved delay titration methods that identify a unique ‘indifference point’ for each individual [21], whereas the current study used a temporal task with set delays. Comparisons of their risk preferences have used quantitative variance in the amount of amounts received [22], variation in knowledge concerning the location of rewards provided by the risky option [23], and qualitative differences in food types as in the current study [24]. Although it is difficult to conclusively demonstrate species differences in behavior or cognitive skills, overall this set of results suggest that differences between the two species might be robust across different populations of apes and at least some variations in task structure. The current studies investigated the proximate-level factors (e.g., emotional and motivation responses) that may underlie this difference. At the ultimate evolutionary level, we have proposed that chimpanzees and bonobos may exhibit these divergent species-typical preferences due to differences in their wild feeding ecology. Relative to bonobos, who are thought to have evolved in more productive environments, chimpanzees on average face more seasonal food variability, more competition in food patches, and have less access to common fallback foods like terrestrial herbaceous vegetation [85][86][87][88],[89][90][91]. Our evolutionary hypothesis is therefore that feeding ecology has shaped psychology in Pan such that chimpanzees are more willing than bonobos to accept ‘costs’ to obtain food – including in situations involving delays, travel time, effort, or risk – thus promoting adaptive patterns of decision-making in these species. Interestingly, chimpanzees and bonobos do not show differences in how they respond to ambiguity (or knowledge about probabilities of outcomes) when level of risk is equated [66], nor did they generally differ on most tasks in battery examining a wide range of cognitive skills [92]. This suggests that these species may exhibit targeted differences in only certain aspects of cognition and behavior that are related to differences in their socio-ecology [93].

These types of evolutionary analyses suggest that studies of apes may be important for addressing a major problem in the human cognitive sciences: characterizing functional systems supporting complex cognitive functions in the mind and the brain. Although investigations of chimpanzee and bonobo neurobiology are rare, largely due to important ethical considerations, non-invasive studies of these apes may provide a critical test for mapping function onto structure – especially for psychological features that may not be widely shared by common model species. For example, observed differences in the relative size and cytoarchitecture of orbitofrontal cortex of chimpanzees and bonobos [94] are consistent with this region’s role in reward processing, emotional responses, and decision-making. Our results further predict a number of neurobiological differences between chimpanzees and bonobos: the anterior insula’s role in risk-aversion [95] and the ventral striatum’s role in both risky and intertemporal choice [95][96] suggest that bonobos and chimpanzees may show divergence in these regions [97][98]. More broadly, comparative analyses of brain evolution indicate that brain systems or networks can be characterized by examining whether given regions evolve together [99]. This type of evolutionary approach suggests that psychological capacities that evolve in tandem may act together to solve a given ecological or social problem. If the patterns of decision-making seen in Pan are an adaptive solution to their divergent natural ecologies, then changes in complex abilities such as decision-making may require joint selection on emotional and cognitive systems. The integration of such ultimate-level hypotheses into the human cognitive sciences can lead to an understanding of psychological and neurobiological systems in humans that is grounded in evolutionary function – what such systems are actually designed to do.

Source: PLOS