Heart Assisted Therapy® (HAT®) is a unified mind-body-energy approach to psychotherapy that incorporates the use of heart influence, thinking, emotion, sensation, intention, mindfulness, respiration, and a stabilizing breathing treatment while overlapping hands are placed over the heart (“heart breaths”). HAT is a mindful, treatment focused psychotherapy model that uses “Awareness Streaming” in concert with the body’s electro-physiology and respiration to facilitate healing and stabilizing shifts in emotion, sensation, cognition, and behavior. HAT is a hybrid of traditional psychotherapy with learning from energy psychology approaches.
HAT is designed to complement a clinician’s existing skills and orientation as a psychotherapist. It is a gentle, self-nurturing, humanistic approach that is easy to engage. The HAT protocol is designed to maximize therapeutic skills in listening, observing, and planning while integrating procedures that enable the opportunity for the individual to be validated, and to heal, shift emotions and thinking, adapt, and move forward in life.
HAT has been used to successfully treat a wide variety of psychological conditions including trauma/PTSD, anxiety/phobia, depression, loss/grieving, self-perception and self-regulation issues, anger/stress management, and pain management. Use with sport and performance enhancement has also been beneficial.
Heart Assisted Therapy is the original work of psychologist John H. Diepold, Jr., Ph.D. The HAT model evolved from over 30 years of learning and experience as a psychologist in clinical practice. The first 15 years involved learning and use of the more traditional psychotherapy approaches (e.g., psychoanalytic, Roger’s client-centered, behavioral, cognitive-behavioral, Ericksonian hypnosis) and the last 15+ years studying and integrating use of recent innovative and intriguing approaches (e.g., EMDR, Thought Field Therapy, HeartMath, mindfulness, somatic approaches, and various meridian and chakra assisted methods).
The original model of HAT first presented in 2006 by Dr. Diepold was more in keeping with the protocol used in the meridian assisted psychotherapy approach known as Evolving Thought Field Therapy (Diepold, Britt, and Bender, 2004). The difference was that meridian alarm and treatment points were no longer used and the heart became the focal treatment area. However, as clinical use continued, in 2009 a more fluid and encompassing model of HAT evolved that melded the traditional and innovative models of psychotherapy and blended nicely with any orientation in psychotherapy. Thus HAT for the traditional psychotherapy practice became available. It is this second model of HAT that uses “Awareness Streaming”, and is the model that Dr. Diepold uses exclusively in clinical practice, workshop teaching, and research.
The HAT model constitutes a versatile and comprehensive psychological treatment methodology that is easy to use, blends comfortably with traditional and innovative forms and orientations in psychotherapy, and can be used to address a wide variety of life issues.
 Diepold, J. H. Jr., Britt, V., and Bender, S. S. (2004). Evolving Thought Field Therapy: The Clinician’s Handbook of Diagnoses, Treatment, and Theory. W W Norton, NY, NY.
During the summer (2022) I was invited by Dr. Robert Schwarz, the Executive Director of the Association for Comprehensive Energy Psychology (ACEP), to respond to a series of inquiries regarding the development and use of HAT.
The HAT approach engages our natural electro-physiology of the heart-hands-brain interactions. When hands are placed over the heart there is simultaneous access or contact with multiple and powerful biophysical, biochemical, and electro-magnetic energy conduits involving the biophysical heart-brain-hands, endocrine and respiratory systems, acupuncture meridians, and chakras. The electro-physiology of mind-body polarity, relating to neurological organization, is adjusted and self-regulated throughout HAT treatment.
The biophysical systems include the heart, brain, vagus nerve, respiratory system, endocrine system, and hands.
The acupuncture meridian system is engaged with hands over the heart and involve 3 Yin (Lung, Heart, Pericardium) and 3 Yang (Large Intestine, Small Intestine, Triple Warmer) meridians along with the Kidney (Yin- K-27 on the chest) and the Central Vessel.
The Heart Chakra and the Hand Chakras systems are engaged when hands are placed over the heart.
Since both the therapist and patient maintain overlapping hands placed over the heart for the duration of the HAT session, there is also a synchronized resonance that is established between the two participants.
When facilitating HAT, the individual is invited to focus their awareness on a “Treatment Focus” (TF) after taking the initial 9 Self-Regulating Heart-Breaths. The TF is most often the identified cause of the person’s distress (e.g., past or current event, memory, future activity) that spawns the upsetting feelings, nightmares, unwanted behaviors, and sensations. Examples of a TF could be: “the loss of your mother / husband / best friend,” “when the helicopter went down,” “how you were treated by your mother / father / family,” “walking point in Viet Nam,” “what happened that night,” “What he / she did to me,” “having to give that talk.”
After every opportunity for “mindful contemplation” of the TF with heart-breaths, the individual is asked, “What are you aware of?” The HAT process engages an individualized “in the moment” focused awareness that directs the therapy.
Compared to traditional, mainstream psychotherapy approaches, HAT is an integrative model that evolved after over 30 years of clinical experience. The HAT psychotherapy model synthesizes and incorporates components of traditional and energy therapies, along with observations of spontaneous hands placement over the heart, and integrates specific innate psychophysiological mechanisms into a full mind-body-energy approach to healing. Accordingly, HAT is a holistic, humanistic, mindfulness-enhancing, culture-free, and energy-science model of individual psychotherapy.
HAT is primarily client-centered and is easy for both therapist and client to engage. The HAT process follows the idiosyncratic, phenomenological experiences of the individual regarding their cognitions, emotions, sensations, images, and behaviors relative to the TF.
Like most therapies, the HAT approach is engaged after a safe and trusting relationship is established. A thorough understanding of the patient’s personal history relative to their treatment goals is similarly obtained. The HAT approach complements other psychotherapy models, and allows the therapist to integrate their full array of clinical expertise before and after the use of the HAT protocol.
Unlike other psychotherapy models, the HAT process adheres to Four Guiding Principles and simultaneously involves respiration monitoring, use of heart-breaths, and speaking aloud Acceptance Statements (AcS) while overlapping hands are placed over the heart. While the HAT protocol is engaged, there is an absence of offering interpretations, insights, and suggestions. (There is time for this, as perceived beneficial, before or after the HAT session.) The therapist respectfully holds space for the patient to experience their awareness while using the Four Guiding Principles to assist the patient to accept and process their thoughts, feelings, and sensations.
From an energy psychology perspective, HAT has roots in Thought Field Therapy (TFT), Evolving Thought Field Therapy (EvTFT), and the use of Touch-and-Breathe on acupuncture meridians. HAT utilizes a Treatment Focus (TF), which is similar to a Thought Field used in TFT and EvTFT.
The HAT protocol recognizes and constantly corrects for mind-body polarity shifts before and throughout treatment for optimal effectiveness.
There is the option to use muscle-checking, as well as the use of SUD ratings, as needed or desired.
As with similarities, there are also differences. With HAT there is an absence of overtly focusing and utilizing acupuncture meridians or chakras. However, as described in response to question 1 above, acupuncture meridians and the heart chakra are involved automatically when overlapping hands are placed over the heart.
HAT engages the energy of the heart, and uses the influence of the heart-brain-hands interactions and respiration throughout treatment to facilitate healing shifts in emotion, cognition, and sensation.
HAT uses Four Guiding Principles to assist the therapist throughout the protocol. The first Guiding Principle is “Accept the negative”. Accordingly, HAT makes use of individually tailored Acceptance Statements (AcS) based upon what the individual reports after mindful-contemplation of the TF. A grounding fundamental of HAT is that acceptance must precede change. [Please note that an AcS is not an affirmation of any kind. An AcS addresses what is; an affirmation deals with what is wanted.] The remaining three Guiding Principles are, “Ponder the neutral”, “Accentuate the positive”, and “Prepare for the future”.
The direction of the HAT approach is determined solely by the content shared by the patient in response to mindful-contemplation of the Treatment Focus. When doing individual psychotherapy, there are no diagnostic procedures or pre-determined patterns to apply. Every thought, feeling, and sensation is “in play” and used to guide the therapist utilizing the Four Guiding Principles.
The HAT model makes extensive use of the individual’s respiration pattern throughout the protocol. The heart-breaths are used as a guide for when to reverse hands placement over the heart and progress through the AcS and other aspects of the protocol.
The HAT-Self-Regulation (HAT-SR) protocols are typically for individuals to use outside of individual therapy, and constitute a generic, self-regulating application of HAT. The HAT-SR protocols are standardized templates used to easily manage a variety of concerns. However, patients can learn to tailor and individualize these HAT-SR protocols based on their circumstances.
Many of the unique features of HAT have already been described in the paragraphs above.
The HAT model of psychotherapy is a unique integration of over 30 years of clinical experience with mainstream approaches (e.g., cognitive, existential and phenomenology, Adlerian, Ericksonian hypnosis, biofeedback, EMDR, and Energy Psychology (e.g., TFT, EvTFT, TAT). All of these psychotherapy models taught me a variety of ways to watch, listen, learn, and intervene in some way with intent to help. For example, observations of patients with their spontaneous behavioral and physiological responses (Ericksoian hypnosis), the interaction of thinking, emotion, and physiology (e.g., CBT, RET, biofeedback), the value of every person’s unique perceptions and interpretations within their social context of experience (e.g., Adlerian, phenomenology, existentialism), and the value of engaging the interplay of mind-body-energy for maximum influence for change (e.g., biofeedback, EMDR, TFT, EvTFT).
The HAT model uniquely and intentionally engages the energy of the heart, the heart-brain-hands interaction influences, and respiratory function and response throughout treatment. These covert biophysical, electrophysiological, and electromagnetic workhorses serve as ever-present change agents that occur spontaneously with thinking, feelings, sensations, behavior, imagery, and memory recall when overlapping hands are placed over the heart. The sequence of reversing the hands over the heart throughout the HAT protocol serves to maintain an open polarity gateway regardless of the content or strength of emotions.
The HAT protocol allows the individual to become aware of, verbalize, and experience their unique perceptions of life events within a gentle and non-judgmental psychotherapeutic framework. The individual has the opportunity to share their “story” in any way regarding their associations to the TF. In every situation the person is guided to “Love and Accept” themselves regardless of their experiences, feelings, thoughts, behaviors, and sensations.
Many of the mainstream psychotherapy approaches are designed for the therapist to be the change agent via keen listening skills in order to provide feedback, offer interpretation, insights, and suggest alternate ways to think and behave given the content.
Even with many Energy Psychology models, it is the therapist who is directing the tapping (sequence and placement), which was initially void of the person’s “story” while tapping. HAT is largely opposite to this approach, except for the importance of watching and listening. While the therapist offers the structure of the HAT protocol, the therapist refrains from any type of feedback, interpretations, offering of insights, and the like during the HAT treatment. The individual chooses the direction and flow of their therapy. The protocol allows the patient to become aware of, discover, have insights, and experience shifts in thinking, feeling, and sensations on their own.
In the words of Milton Erickson, “It’s the patient who does all the work.” Accordingly, the HAT protocol is designed to allow the patient to “do the work”, and for the therapist to get out of the way so the individual can do their work. There is always time before and after the formal HAT session for the patient and therapist to share relevant information.
HAT has been successfully used with children, adolescents, adults, and seniors. The HAT protocol has also been used beneficially to enhance performance (e.g., sports, arts, exam-taking), to prepare for and heal from surgery, to cope and heal regarding death, loss, and grieving, and with veterans to heal from the causes of PTSD.
Diepold J.H. Jr., Schwartz G.E. (2022). Clinical effectiveness of an integrative psychotherapy technique for the treatment of trauma: A phase I investigation of Heart Assisted Therapy. Explore (NY). 2022 Nov-Dec;18(6):698-705. doi: 10.1016/j.explore.2022.07.002. Epub 2022 Jul
Diepold, J. H., Jr., Pfrommer, M., Siegert, E., & Thompson, J. A. (2015). The health effects of Heart Assisted Therapy-SR. Unpublished manuscript.
Pfrommer, M., McConnell, E.S., Diepold, Jr. J.H., Siegert, E.A., & Thompson, J.A. (2015). Heart Assisted Therapy-Self Regulation (HAT-SR) for caregivers of persons with dementia. Gerontology and Geriatric Research, S4:005 http://dx.doi.org/10.4172/2167-7182.S4-005
The HAT Book:
Diepold, J. H., Jr. (2018). Heart Assisted Therapy: Integrating Heart Energy to Facilitate Emotional Health, Healing, and Performance Enhancement. Parker, CO: Outskirts Press;
In the works:
The scientific underpinnings of HAT.
The use of hands over the heart does play a vital role in the treatment process as it amplifies the heart-brain connection/communication. To be presented in the following paper:
Schwartz, G.E., De La Cruz, V., & Witman, T. (in preparation). Psychophysiological mechanism verification of an integrative psychotherapy technique for the treatment of trauma: Heart assisted therapy..
I did not intend to create a psychotherapy model. I just ended up with it.
The concept and use of Heart Assisted Therapy (HAT) has been evolving in conceptualization and practice since 2005. After sharing observations and procedures with patients and colleagues, I was encouraged to continue my course of using the heart in psychotherapy. The first formal presentation of HAT was in 2006 at the Energy Psychology Conference in Germany.
However, the current clinical practice of engaging HAT is vastly different from the original model. The original HAT protocol followed the one used with EvTFT of diagnosing and treating identified meridians. However, instead of Touch-and-Breathe (TAB) on the diagnosed meridian treatment points, whenever the muscle check was weak to the TF, the person took a full respiration with overlapping hands over their heart. With continued experience and experimenting, by 2010, the evolving HAT protocol was free of diagnosing and treating meridians, no longer required checking for reversals or polarity disruptions (because of self-corrections), exclusively employed overlapping hands over the heart in concert with heart-breaths and Acceptance Statements (AcS), and followed Four Guiding Principles as the person shared their awareness to the TF.
Integrating the covert and potent energy components into to a complete mind-body-energy psychotherapy paradigm had become easier, more comfortable for therapist and patient to engage, more traditional-looking, markedly effective, and thorough.
There have been many background influences that served to steer me in the evolution of the HAT model of psychotherapy. Here are some:
a) Learning and using numerous orientations in psychotherapy and being engaged in clinical practice for 35+ years.
b) My learning from using TFT, Evolving Thought Field Therapy (EvTFT) and Touch-and-Breathe (TAB).
c) The need to find a more accepted, easier, effective, and natural way to facilitate change. My experience was that traditional approaches were lacking in consistency of outcomes, and the meridian-based approaches were considerably different and unusual resulting in reduced acceptance and professional criticism.
d) Learning that breath is the most natural way to facilitate the flow of life-force energy (Chi or info-energy), and that breath is a carrier of intention (from my conversations with Bill Tiller).
e) When working with beliefs using EvTFT, I noticed that patients more frequently than not would place their hand(s) over their heart when sharing strongly held beliefs. As a result, I began inviting patients to place one hand on their heart while doing TAB on diagnosed meridian points. The feedback was that it felt comfortable and qualitatively different.
f) My first experience using overlapping hands over the heart was when I attended a break-out session on Whole-Hearted Healing given by Grant McFetridge at a Toronto EP conference. This was employed as part of a regression technique to trace the roots of negative emotions. While I did not know what to do with that experience at that time, the experience remained in my mind.
g) I was also influenced by the new research at the time from the HeartMath Institute regarding heart energy, and the influence of the heart on the brain. This focus on the heart and heart energy led me to research and gather a broad range of information about heart facts and functions.
h) The formulation of “energy cardiology” (Schwartz & Russek) and “cardio-energetics” (Pearsall) helped me learn more about the role of the heart and its energetic influences.
i) I began to observe more and more that individuals would unconsciously touch one or both hands to their chest in the heart area when emphasizing a strong belief, conviction or excitement, upset, and when making statements of a personal nature, sharing a truth, etc. This was evident with people everywhere (my patients, family members, people in the movies, TV shows, and photographs). I also observed that even when done right before my eyes, the person was unaware that they had done so.
I observed that stained glass windows in churches and ancient sculptures depicted individuals with overlapping hands over the heart. I was curious…
j) I researched and gathered information in an area that I call “heart lore” that revealed that references to the heart have been made since ancient times pertaining to function, emotions, religion and cultural beliefs, and afterworld experience. The heart has been a vital player in the lives of people for civilizations. I reasoned that it must also be vital now in our emotional and physical healing and well-being. So, I experimented and found that patient and colleague feedback was encouraging
k) People are usually unaware of their heart, which functions within the autonomic nervous system (ANS). Similarly, breathing is within the ANS. More specifically, the Sympathetic branch of the ANS functions as an accelerator via inhalation, while the Parasympathetic branch functions as the brakes via exhalation. I noticed that when people experience anxiety and upset that their breathing spontaneously changes. Respiration can become short and quick or even stops for a while. Again, usually out of the person’s awareness. Since I have been using TAB successfully for years in lieu of tapping on meridian points, I began to understand the connection, the importance, and the interplay of the heart, brain, respiration, and spontaneous hand placement over the heart. As a result of I have come to posit that this spontaneous and largely unconscious act of placing hands over the heart is one of our innate ways to self-regulate, which is engaged when facilitating HAT.
l) My daughter, Julia, who grew up with me sharing with her the use of muscle checking and meridian point treatments (tapping and TAB). Julia has since become a Board-certified physician in Family Practice Medicine and Integrative Medicine. So, I was looking for a way to help her bring effective, alternative approaches into Family and Integrative Medicine that were potentially feasible in the world of physical medicine. Accordingly, using the heart, self-acceptance, and respiration as primary change vehicles for patients with concomitant emotional symptoms was reasonable for acceptance. Julia’s use of HAT within her medical practice (now exclusively holistic and integrative medicine) has been effective and appreciated by her patients.