Rational Inquiry -Volume 7 Number 3
Thought Field Therapy:
The Journal of Clinical Psychology, Special Issue
by Donald A. Eisner
Eisner Psychological Associates
16133 Ventura Blvd., Suite 700
Encino, CA 91436
(818) 788-6512; Fax (818) 788-1847;
Don Eisner is a licensed psychologist and attorney in Encino, CA. He is the author of the book The Death of Psychotherapy: From Freud to Alien Abductions (Praeger Press, 2000), a critique of the effectiveness of psychotherapy. He is a guest contributor to this newsletter.
Over the last 100 years there have been many innovations in psychotherapy. In the last several decades or so there have been at least two significant developments. One is the rapidity with which new psychotherapeutic techniques are devised. Secondly, there has been an enhanced emphasis on marketing and advertisement of new modalities. In the 1970s for example, neurolinguistic programming (NLP) was extremely popular. (Bandler and Grinder 1979). Almost as meteoric as the rise in NLP was its demise within the clinical and mental health community. After a series a systematic series of research negated its underlying basic theoretical tenets, (Sharpley, 1984; Sharpley, 1987; Elich, Thompson and Miller, 1985) there was little further clinical research.
At issue here is the incredible ascendance of Thought Field Therapy (TFT) and its possible fall into oblivion. At the end of the last century it appeared that TFT was about to be tossed into the ash heap of failed and flawed psychotherapy techniques (see Gaudiano and Herbert 2000; Eisner, 2000). However, it appears that TFT may have emerged from the abyss by a remarkable historical event in clinical psychology.
The Journal of Clinical Psychology, (Beutler, 2001) decided to publish five clinical psychotherapy research papers presented by Roger Callahan and his followers. What is most striking is that the articles were not peer reviewed. In fact, as noted by Beutler in the introduction to the special issue of the Journal of Clinical Psychology, if the articles were peer reviewed they would have not been accepted. Thus, in a landmark publication the Journal of Clinical Psychology in 2001 devoted over 100 pages to a special issue on Thought Field Therapy.
There were five separate clinical research presentations followed by critiques, and a final evaluation by Callahan (Callahan, 2001c). The present review will provide an overall assessment of the clinical research published in the Journal of Clinical Psychology.
Thought field therapy was developed by Callahan over twenty years ago (Callahan, 2001a). He states that TFT works very quickly and may require only a few minutes to affect the change and that such change will usually last. Thought field therapy is administered in set formulas known as an algorithm. Thought field therapy is used to treat a variety of psychological problems including anxiety disorders as well as schizophrenia. Thought field therapy incorporates Eastern philosophies within a cognitive or behavioral modality. It is hypothesized that there is a thought field that although imaginary may contain negative emotions. Emotional upsets are thought to be caused by certain perturbations in the thought field.
Looking at the cognitive/behavioral aspect, TFT uses the subjective units of distress (SUD) on a ten point scale which originally was introduced by Wolpe (1969). The patient is asked to indicate how stressed they feel about a particular event at the beginning of therapy with ten being the most stressed and zero being an absence of stress or upset. In addition, advanced technology has been utilized to assess and determine the precise algorithm in treating the patient. A Voice Technology allows a person to detect the perturbations while listening on the phone. Dr. Callahan has provided consultation to clinicians utilizing his Voice Technology for more difficult patients. To date, it appears that there are no publications regarding the exact sequence for the utilization of the algorithms nor is there any published data regarding the use of Voice Technology. It appears that one has to attend various seminars or conferences in order to learn about the various procedures.
The actual procedure of TFT consists of touching various parts of the body in a precise sequence of meridian points which are more commonly known as the acupuncture meridians. (Callahan, 2001a.) Based on a causal diagnosis, the root cause of emotional problems can be literally tapped into. There are a number of tapping sequences or algorithms that have been developed so that therapists, according to Callahan, can usually try the procedure themselves. There is no description as to how the algorithms were ascertained, or how one sequence pattern may be related to a particular diagnostic category.
The Research Studies
In order to assess improvement in psychotherapy there must be a reliable and especially a valid dependent measure. Callahan (2001a) introduces heart rate variability (HRV) as one assessment of change as a result of the TFT procedure. Heart rate variability rates are according to Callahan (Callahan, 2001a) the degree of fluctuation and the length of intervals between heartbeats.
Callahan discusses several studies interrelating HRV and psychological problems. The studies referenced are correlational in nature. For example, healthy people when exposed to trauma themes have noticeable changes in their HRV while a group who has suffered PTSD demonstrates little change in their HRV. Callahan also discusses factors that are known to influence HRV and how HRV can be improved. There are no hypotheses mentioned nor does he discuss the interrelationship between HRV and the theoretical basis of TFT. Prior to conducting the study he does not indicate what if anything should happen to HRV or what an implication of a higher or lower HRV may be.
Regarding his data collection, he appears to forthrightly indicate that he is only presenting TFT treatment in successful cases and that the data were not from a random sample. He presents the data on HRVs with twenty pre- and post-treatment cases with TFT. Examining his twenty cases Callahan found that there was an increase in heart rate variability as well as a decrease in the subjective units of distress immediately after TFT. Thus it appears that there is a correlation between the two measures, but this apparently was not reported. Prior to the conclusion of the study the author asks, "How long will it last?" He states, "This shall be a topic of a future paper..." Thus there is no data presented that indicated how long the diminution in the SUD and the alteration in HRV lasted subsequent to the brief treatment. There is no discussion as to why the SUD scale is or is not related to heart rate variability. There is no theoretical discussion on the implications as to why heart rate variability might be a measure of emotional well-being or lack thereof.
In the next study Callahan (2001b) indicates again that TFT is based on a process called causal diagnosis in which he can amongst other things ascertain acupuncture meridian points on a certain sequence. Apparently different sequences are utilized to treat different mental disorders. There is no information presented that offers how a particular sequence or algorithm is related to a mental disorder. He further notes that HRV is "an objective procedure used in medicine, especially in the domain of heart problems, obstetrics and neurology." He notes that HRV may be useful to help select and develop effective procedures that may be an improvement over simple client awareness on the subjective units of distress scale. Thus, it appears in the second article that Callahan is suggesting that HRV is even more of a beneficial outcome measure than SUD is in terms of the clinical effectiveness of TFT. He believes that with TFT, HRV not only can be raised, but lowered. (Callahan 2001b).
In the next part of the second research presentation he introduces the concept of toxins. He states that "a new discovery for the field of psychotherapy is what I term the domain of Ďindividual energy toxins.í" He further notes that HRV supports his findings regarding toxins. There is no report on his findings of toxins in this article, however. He further states that toxins can be identified by diagnostic tests developed.
There are several anecdotal reports including a 74-year-old female psychotherapist who was extremely fatigued. It was determined that she had a tea toxin. The culprit was Irish breakfast tea. It is not clear how the toxin was identified. After a number of treatments her fatigue was completely gone as a result of what he termed the proper treatment. He does not describe what the sequence of events that lead to the proper treatment. That is, we do not know what tests were done or what the sequences of tapping or algorithms were. There is no indication of how HRV is related to mental health or how it is related to emotional well-being. The interrelationship between SUD, HRV and toxins is not discussed in this article.
The third study was conducted by Pignotti and Steinberg, (2001). Thirty-nine cases were selected from their private practice. In most of the instances the clients' SUD decreases correlated with an increase in HRV if it was too low or decreased when the rate was too high. This study suggested that HRV can be affected in different directions. The authors stated that this study "shows that we are bringing the autonomic nervous system into its optimal state rather than just treating a symptom." It was concluded that TFT was the most effective way to improve HRV, more effective perhaps than exercise, social support, sexual intercourse in cohabiting couples, biofeedback and various drugs. The authors further noted that lower HRV is more stable and more difficult to change.
There was no follow-up in the study to indicate what the magnitude of the change was subsequent to the studies. They state that anxiety, panic disorders, phobias, PTSD and depression are linked to low HRVs. It appears that a few cases were followed up but it is not clear what the significance is after the patient leaves the office. It is also not made clear why a physiological or psychophysiological measure is needed in addition to a subjective units of distress measure in the assessment of change in a patientís mental status.
The fourth reported study was conducted by Sakai, Paperny, Mathews, Tanida, Boyd, Simons, Yamamoto, Mau, and Nutter, (2001). The authors report that this is an uncontrolled study which explores a variety of problems using TFT in a behavioral health care setting. A total of 1,714 patients were treated with TFT. Changes in the patients were assessed by using the SUD as well as the HRV recordings. Three patients were assessed on the HRV factor. According to the authors, significant improvement was noted in all three patients in terms of HRV. The authors concluded that TFT treatments are related to self-reported decreases in a wide variety of symptoms and conditions. It should be noted that there is also no mention of any current or ancillary treatments in the study. (See Lohr, 2001).
In the fifth study Johnson, Shala, Sejdijaj, Odell, and Dabishevci, (2001) traveled to Kosovo and administered TFT to individuals who were traumatized by the war. Rather than use SUD because of cultural factors, the clients were asked whether or not there was the presence or absence of emotional suffering. The results indicated that 103 out of 105 patients showed significant reduction in trauma and after five months there were no relapses on 78% of the patients that were contacted. It was concluded that thought field therapy was responsible for reducing trauma in the people of Kosovo.
Callahan (2001c) was offered a final opportunity to respond to the criticism directed at the five articles published in the Journal of Clinical Psychology. He notes that his therapy is "highly effective and dose specific and in such a situation feedback in the form of a self-report is vital." Regarding the underlying basis of his theory, he states that there was a difference between theory and effectiveness noting that nitroglycerin was used for a long time to relieve angina but nobody knew how it works. It appears that he is analogizing TFT with nitroglycerin. Because of the use of subjective reports as well as heart rate variability, Callahan (2001c) believes that interesting findings are overlooked. Regarding demand characteristics it is Callahanís position that if you have paying clients it is unlikely that they are going to falsely report they are getting better. Further, he notes that the placebo effect cannot explain the results.
Lastly, with regard to control groups Callahanís position is that when a therapy has a 75% success rate a control group may not be required.
Critique of the Clinical Research
Since Callahan essentially dismisses the need to verify the underlying theory, the major issue to be considered is whether there is any effectiveness to the treatment. One of the reasons that Callahan glosses over the theoretical basis may be that the theory underlying TFT is "a hodgepodge of concepts derived from a variety of sources." (Gaudiano and Herbert, 2000) In his writings Callahan refers to electromagnetism as well as to the controversial work of Sheldrake, (1981). What he does not explain is how Sheldrakeís controversial approach on biological formation has anything to do with energy meridians. (See Eisner, 2000). The use of Voice Technology appears to have no scientific rationale whatsoever.
In the materials presented in the Journal of Clinical Psychology, Callahan and the other researchers never explain how it is that Voice Technology can by proxy allow a person who is not present in the office to ascertain the proper tapping sequences. With all of this in mind, therefore it is not too surprising that Callahan is quick to dismiss the need to assess his theory. From the scientific standpoint Callahanís theory does not meet the plausibility test. As demonstrated in the five studies in the Journal of Clinical Psychology it remains untested.
The two main outcome measures in thought field therapy are the subjective unit of distress and heart rate variability. Subjective units of distress are exactly that. It is subjective. It appears that up until recently Callahan had based his outcome measurements on SUD. As noted in the Journal of Clinical Psychology, Special Edition, Callahan expands outcome measures to HRV. The major problem with SUD is that it offers only a very meager measurement of change. It is a ten-point scale where the person is asked during the course of the session to rate their level of stress. Clearly a more sophisticated measure is needed such as utilizing a standardized psychological test which has been well validated and used in many outcome studies. It should be noted that outcome measures in the five studies are significantly difficult to interpret in that many psychodiagnoses are included in one study.
Although Callahan correctly notes that self-reports are useful, (Callahan, 2001c) such measures are only preliminary and are generally thought to be inexact measures of change in terms of one's level of stress. Furthermore, it is totally unclear how SUD would be relevant to the assessment in cases where there is not an issue related to anxiety or stress; for example in depression or where there is no trauma or a general fear. In the Sakai, et. al. 2001 study in Case B, what is the relevance of assessing SUD in a depressed patient who appeared mainly concerned about her interpersonal relationship.
In an apparent effort to bolster the strength of outcome assessments (Callahan 2001a, b) introduces HRV. It is beyond the scope of this review to comment on the reliability of HRV (however, see Kline, 2001). There are severe problems with the validity or utility of HRV as an outcome measure. Firstly, as noted above, Callahan never indicates what the actual interrelationship between thought field therapy and HRV is. Although seemingly more objective HRV, has no necessary relevance to oneís mental health or change in one's mental status. That is, why should HRV reflect improvement in a variety on mental conditions. (See McNally, 2001).
In order to show the efficacy of a therapeutic modality there needs to be clinical research with control groups. Although the Journal of Clinical Psychology indicates that Callahan is going to present some initial research it appears that this is somewhat of a misnomer. There was no clinical research presented in the five studies. There is simply a compilation of anecdotes including over 1000 non-randomly selected clients. There was no research. There were no experimental controls, and there were no alternative therapies that were included in any of these research presentations.
In certain interpersonal interactions and especially where a person consults a professional for treatment, there may be significant demand characteristics (see Orne and Schiebe, 1964). In that study, subjects were informed that in a sensory deprivation situation they may have varied sensory experiences. It appears when given the suggestion that something may happen, it often does. Using only self-reports as an indicator of success in treatment only heightens the possibility of demand characteristics. Furthermore, placebo effects cannot be ruled out. A sham treatment could produce the same results.
Self-authentication of results does not meet a scientific standard. As the United States Supreme Court states, there must be reliability and validity and scientific credibility of a particular scientific enterprise. (See Daubert v. Dow Pharmaceuticals, Inc., 113 Supreme Court 2786 (1993). None of the five studies in the Journal of Clinical Psychology presented remotely resembles a proper research protocol. It is very surprising that after over twenty years there have been no comparisons by neutral investigators of TFT with other modalities. The expectancy effects and demand characteristics of TFT have not been assessed. Therefore there is no way of knowing what if anything are the so-called active ingredients of TFT and whether there are any changes related to the technique itself. The self-boasting of Callahan and his colleagues does not constitute proof of the success of TFT.
The most startling aspect of TFT and their adherents is the glaring lack of any published information as to how to conduct the therapy. One could argue that this information is presented at seminars and workshops and in supervision. However, if there are such miraculous cures why is this information not written in any peer reviewed or non-peer reviewed journal? If there are specific algorithms that relate to the treatment of anxiety for example, where can one find that data? By keeping this information secret it makes it almost impossible to conduct a comparative study. Equally startling is the absence of any information on the amazing Voice Technology apparatus. If there is a machine that could instantaneously over the telephone discern from a personís voice pattern what algorithms need to be used, surely such beneficial information should be made available to the therapeutic community. It appears that Voice Technology is shrouded in secrecy and mystery. Hiding your clinical methods does not comport with advancing psychotherapy research.
After devoting over 100 pages and presenting five studies, it is abundantly clear that there is no plausible theoretical rationale for thought field therapy. After presenting an overview Callahan (2001c), seems to negate the significance of even relying on his underlying theory in order to continue to demonstrate an unproven technique. Without a constant and coherent theory one is free to change constructs, invent new ideas without any rhyme or reason. Therefore at the present time the theory of TFT defies rational analysis and has never been properly tested.
As the five studies show and have been argued it appears that there are no significant or substantial outcome measures. The SUD is a somewhat meager measure and cannot shore up a shaky theory or treatment. Similarly HRV appears to have little if any relevance to TFT. At any rate Callahan has never made the connection. Therefore, there is a glaring lack in terms of adequate outcome measures. The main problem with HRV is its possible lack of relevance, and the lack of a theoretical or practical connection with TFT.
To date, there have been no adequate peer reviewed comparative studies which may contrast TFT with other modalities such as cognitive behavioral therapy. Absent such studies, the results presented in the Journal of Clinical Psychology are no more than a plethora of anecdotes whose only interest may be in the social psychological arena: Why do so many people apparently report positive results when in an interpersonal interaction with a mental health professional?
Lastly, perhaps the oddest thing about TFT is that its basic techniques are not published. If there were a consistent and valid tapping procedure, why werenít the algorithms described in any of the five studies in the Journal of Clinical Psychology, Special Issue? Callahan and his colleagues were given every opportunity to do so. What the articles in the Journal of Clinical Psychology may have done is to open the curtain and expose the wizardís magic tricks. For now, it is strongly suggested that TFT be peer-rejected.
Bandler, R. and Grinder, J., (1979). Frogs into princes: neurolinguistic programming. Moab, Utah: Real People Press.
Beutler, L.E.(2001) Editor's Introduction. Journal of Clinical Psychology . 57, 1149-1151.
Callahan, R. J.(2001a) The impact of Thought Field Therapy on heart rate variability. Journal of Clinical Psychology, (2001). Vol. 57, 1153-1170.
Callahan, R.J. (2001b) Raising and lowering of heart rate variability: Some clinical findings of thought field therapy. Journal of Clinical Psychology, I57, 1175-1186
Callahan, R.J. (2001c) Thought field Therapy: Responses to our critics and a scrutiny of some old ideas of social science. Journal of Clinical Psychology, 57, 1251-1260.
Daubert v. Dow Pharmaceuticals, Inc., 113 Supreme Court 2786 (1993).
Eisner, D.A., (2000). The death of psychotherapy: From Freud to alien abductions. Westport, Connecticut: Greenwood Publishing
Elich, M., Thompson, R.W. and Miller, L. (1985). Mental imagery as revealed by eye movements and spoken predicates: A test of neurolinguistic programming. Journal of Counseling Psychology, 32, 622-625.
Gaudiano, B.A., and Herbert, J.D., (2000) Can we really tap our problems away? A critical analysis of Thought Field Therapy. Skeptical Inquirer, 24, 29-33, 36.
Johnson, C., Shala, M., Sejdijaj, X., Odell, R. and Dabishevci, (2001). Thought Field Therapy - soothing the bad moments of Kosovo. Journal of Clinical Psychology, 57, 1237-1240.
Kline. J.P.. (2001) Heart rate variability does not tap putative efficacy of Thought field Therapy, Journal of Clinical Psychology.57, 1187-1192.
Lohr, J. M. (2001) Sakai, et al. is not an adequate demonstration of TFT effectiveness. Journal of Clinical Psychology 57, 1229-1235.
McNally, R. J.,(2001) Tertullian*s. Motto and Callahan's method. Journal of Clinical Psychology, 57, 1171-1174.
Orne, M. T. and Scheibe, K.E., (1964). The contribution of nondeprivation factors in the production of sensory deprivation of facts: The psychology of the "panic button." Journal of Abnormal and Social Psychology, 68, 3-12.
Pignotti, M, & Steinberg, M (2001) Heart rate variability as an outcome measure for thought field therapy in clinical practice. Journal of Clinical Psychology, 57. 1193-1206.
Rosner, R., (2001). Between search and research: How to find your way around? Review of the article "Thought Field Therapy-soothing the bad moments of Kosovo." Journal of Clinical Psychology, 57, 1241-1244.
Sakai, C., Paperny, D., Matthews, M., Tanida, G., Boyd, G., Simons, A., Yamamoto, C., Mau, C. and Nutter, L. (2001). Thought Field Therapy clinical applications: Utilization in an HMO in behavioral medicine and behavioral health service. Journal of Clinical Psychology, 57, 1215-1227.
Sharpley, C. F.(1984). Predicate matching in NLP: A review of research on the preferred representational system. Journal of Counseling Psychology, 31, 238-248.
Sharpley, C. F. (1987). Research findings on neurolinguistic programming: Nonsupportive data or an untestable theory? Journal of Clinical Psychology, 34, 103-107.
Sheldrake, R. (1981). A new science of life: The hypothesis of formative causation. Los Angeles, California: J. P. Tarcher.
Wolpe, J. (1969) The practice of behavior therapy. New York Pergamon Press.