Thought Field Therapy: Response to Our Critics and a Scrutiny of Some Old Ideas of Social ScienceThis is a preprint of an article published in October 2001 Journal of Clinical Psychology, ©2001 Wiley Publishers http://www.interscience.Wiley.com Roger J. Callahan, Ph.D. E-Mail: email@example.com
This paper was not subjected to peer review. The absence of peer review of both research papers and the reviews themselves emanated from concerns expressed by Dr. Roger Callahan that the review process was biased against TFT. This paper was published in an open review of the original research paper of TFT. The reader is encouraged to read the original article, along with this accompanying review, and the final critique of the Journal's decision to publish this set of nonreviewed articles in order to gain a perspective on the issues presented. _ Larry E. Beutler, editor.
Thought Field Therapy (TFT) is criticized for not following the usual social science guidelines in research which is appropriate for minimum impact therapies. The usual research guidelines are due to a social science bias where crucial subjective reports are ignored, where tests of statistical significance and control groups are required. TFT may be closer to “hard science” than social science due to extraordinarily high level of success. A few valid points are acknowledged and were already covered such as importance of autonomic balance when raising SDNN and necessity to restrict movement when electrocardiograph methods not used in measuring heart rate variability. Rejected as possible explanations of TFT’s robust results are: placebo, regression to the mean (inappropriate in high and low heart rate variability), and passage of time when such time is merely minutes.
"At the heart of science is an essential balance between two seemingly contradictory attitudes -- an openness to new ideas, no matter how bizarre or counterintuitive, and the most ruthlessly skeptical scrutiny of all ideas, old and new. This is how deep truths are winnowed from deep nonsense.”
Carl Sagan, 1996, p304
“In reality, almost all the findings of science offend common sense.”
Etienne Klein, 1996, p24
I have very limited space to respond to a large number of criticisms. I will not be able to answer all but will respond to what I consider the most relevant. First, I must correct an error reported by Rosen and Davison.
The Arizona Board - To set the record straight, the sanction of the Arizona Board referred to by Rosen and Davison, was not against Thought Field Therapy (TFT) but rather claims appearing in a newspaper article. Arizona Board member, David Yandell is quoted “It’s important to understand that we didn’t rule against Thought Field Therapy … we ruled against a practitioner who made misleading statements to potential clients.” (Sandmaier and Cooper, p14).
My Theory - A number of criticisms are directed toward my presumed theory; however, none of the papers presented my theory. Since theory is an attempt to explain certain facts it is pointless to discuss a theory with people who are unaware of, or refuse to acknowledge, the very facts that the theory is attempting to explain. Theory also needs to be distinguished from effectiveness. For example, nitroglycerine has been used successfully for a hundred years to relieve angina with no idea or theory why it worked. Alfred Nobel, a munitions maker used nitroglycerine not only for munitions but also for his angina. A hundred years after the successful use of nitroglycerin for angina, Alfred’s Prize was given to three scientists in 1998 who discovered the mechanism that finally explained why nitroglycerin helped (Ringertz, 2000).
I was a pioneer in cognitive therapy long before it became known and accepted and I used to teach cognitive theory. I personally encountered then the same sort of difficulties with colleagues and cognitive therapy as I encounter now due to TFT. In the very early days of TFT, I explained my results by resorting to cognitive theory with which I was quite familiar. I believed TFT was changing deep beliefs faster and more effectively than any therapy procedure I had ever encountered! Gradually, a growing number of burgeoning facts forced me to completely abandon my cognitive explanation (Callahan and Callahan, 2000).
Fundamental Disagreements - It is clear that I have a number of fundamental disagreements with the critics. They appear to discount the reports of clients while I hold such reports as vital to successful practice. When one is operating with a highly effective, and dose specific treatment such as TFT, feedback in the form of self-report is absolutely indispensable. Self-reports, I believe, are among the most important data for the science of clinical psychology. The critics are impressed with therapy studies that require statistical tests. I am suspicious of the value of studies where the differences between treated and untreated are so small that statistical tests are required. They believe strongly in placebos, I am not sure placebos are real. They believe in control groups and I say control groups are relevant only when it is not immediately and overwhelmingly obvious if anything at all happened as a result of treatment. They believe they are highly scientific, I believe that their social science approach may limit their perceptions.
Richard Feynman, Nobel Laureate in physics has called attention to the pretentiousness of some social scientists. Under the heading: “Science Which Is Not a Science…” Feynman says: Social science is an example of a science which is not a science; they don’t do things scientifically, they follow the forms – or you gather data, you do so-and-so and so forth but they don’t get any laws, they haven’t found out anything. … I have a great suspicion that they don’t know, that this stuff is wrong and they’re intimidating people” (Feynman, p22, 1999).
The Importance of Subjective Reports or Subjective Units of Distress (SUD) - If one is being fitted for eyeglasses or a hearing aid, the subjective report of how well one can see or hear with correction is indispensable in obtaining a proper and optimum fit. More importantly, and for the same reasons, subjective report is indispensable to the proper evaluation of how an effective therapy, especially a rapidly effective therapy is progressing.
The objective and placebo free Heart Rate Variability (HRV) is a powerful contributor to treatment evaluation and to new treatment discoveries (Callahan, a and b, in this issue). As important as I consider HRV to be, it is not a substitute for SUD. Through a SUD a therapist can assess how well she is helping an individual and/or quickly determine which TFT treatment is needed. Standardized scales cannot come close to the relevance of a SUD when tailoring an effective treatment for an individual with a particular problem, or to discover whether a treatment is doing anything at all which then suggests other TFT procedures. It is defeating to the purpose of any effective therapy to receive inflated or inaccurate reports on SUD and I have, therefore, devised a number of procedures to check on SUD accuracy and will explain and demonstrate these when time or space permits.
Findings Overlooked – The reader will observe that some interesting, reproducible findings for the field of clinical psychology are overlooked or not commented upon by our critics. If self reports were not summarily and automatically dismissed, our critics might have been able to perceive some quite interesting findings in the reports by Dr Sakai et al, (this issue) and Dr Johnson et al (this issue).
It appears that the preconceived notions of our critics prevent them from taking even slight notice of the data presented in these reports, including the objective data of Heart Rate Variability (Callahan 2001a and b, and Pignottie and Steinberg, 2001). I strongly recommend a renovation in the procedures and premises that appear to influence highly trained and highly placed social scientists into an apparent inability to recognize potentially interesting information. At first I thought the problem might be due to an overzealous attachment to the conventional therapies they advocate but on deeper reflection, it may rather be the social soft science procedures themselves that are more generally responsible. I refer to such things as: control groups, tests of statistical significance, questionnaires, and excessive concern over placebo.
TFT with Various HRV Equipment - Our HRV results are not limited to our equipment. For example, Fuller Royal, MD introduced me to HRV and used it in order to evaluate various medical treatments. He came across my phobia algorithm, tried it and found it had a greater impact on his (different than ours) HRV than any other treatment. Royal’s report surprised me but the study by Kawachi et al (1995) on the role of phobic anxiety and HRV helped me make sense of this interesting result. A highly experienced HRV operator in Norway tried one of my algorithms and the HRV change on his equipment, also different than ours, was so dramatic he thought something must have gone wrong with his equipment. He found it was the TFT responsible for the changes and his equipment was fine. An experienced HRV operator in Colorado reported that he too had an unprecedented and very surprising change on his HRV equipment after trying my algorithm for anger on a difficult client. A physician in Japan reported dramatic changes in HRV on his still different HRV equipment. We thus have reports of unprecedented dramatic change on four different HRV instruments as a result of TFT.
An important point introduced by Professor Kline is “… we don’t know whether any changes, …would have been mediated by sympathetic and/or parasympathetic nervous systems.” An HRV report yields many interesting indices; we chose to present the SDNN scores for this is the measure of variability itself and SDNN is the index used to predict death and vulnerability to problems (Callahan, a and b, this issue). SDNN is the most stable score in HRV and the most resistant to change. After my HRV papers were submitted, I had a personal meeting (Malik, 2000) with an authority on HRV, Professor Marek Malik (1998 and Malik and Camm (1995), in London. A year earlier, I had sent him a sample of five cases where we had dramatic increases in SDNN. Malik took note of our unusually large increases in SDNN a year later (after our personal meeting) and he checked to make certain that SDNN was not increased at the expense of increasing the sympathetic nervous system. After examining the records of this sample, Malik concluded: “[The large increases in SDNN] … were not likely due to increased sympathetic activity (Malik, 2000).” As profound and unprecedented improvements of SDNN become more common it will be important to ensure that the increase of SDNN not be at “the expense of increasing the sympathetic nervous system (Malik, 2000).” Since TFT rapidly eliminates general stress as well as varied psychological problems, it is not surprising that we found the autonomic nervous system is typically put into better balance after successful TFT treatment.
Herbert and Gaudiano suggest movement might influence HRV scores measured with the photoplethysmyograph (PPG.) instrument. Most of our tests were done with electrocardiograph (ECG) methods but those who used PPG had their subjects sit still for the five minutes of the test (treatment was never done during a test). Giardino (2001) did a comparison of PPG with ECG and found the results were comparable when the subject is at rest.
I believe the reason that HRV is not as well known as it ought to be, given its relevance and importance to life and health, is due to the fact that it is so difficult to improve the highly stable SDNN score. Low SDNN scores are especially difficult or impossible to improve. It is our hope that TFT and other effective therapies, with further research, will change the dismal perception of HRV as a hopeless predictor of death into a positive and powerful predictor of life.
Relaxation - A number of serious and sophisticated professional observers who have witnessed dramatic improvements due to TFT, have commented that the positive change is due to relaxation. Before TFT, I used to teach Progressive Relaxation to clients over a period of months at a time. I found when the client had severe psychological problems it was simply impossible to teach them to relax. In fact, I never saw anyone reach the sublime state of relaxation as depicted in the book. It is true that our clients are relaxed after my brief treatment and they spontaneously report this fact. However, it is the rapid elimination of their psychological problem, as revealed by their rapidly dwindling SUD, that caused them to relax, and not the other way around.
Demand Characteristics - Of the criticisms presented by our academic colleagues, the most puzzling to me is the charge re demand characteristics, i.e., that most paying clients try to please their therapists by reporting falsely that they are getting better. I have been doing psychotherapy for half a century and I can state with confidence that paying clients are not particularly disposed to please therapists nor do they need to please us. It is rather the therapists, who must please their clients by actually helping them. It is the clients who afford therapists a living. If experience in therapy research is largely with professors treating students then I recognize that this is quite a different situation. In this context, it might be noted that TFT is successful with horses, dogs, cats, infants, and very young children and it does not seem likely that demand characteristics operate in these domains either.
Statistical Tests of “Significance”- I am not impressed with psychotherapy studies that rely on tests of statistical significance. As the statistician put it (1992, p19), “If the researcher finds that she/he must use refined statistical tests to reveal whether there are differences, the differences do not matter much.” I am afraid this statement characterizes research on conventional therapies. The minimal differences obtained between groups do not matter much.
Also, I object to the adjective “significance” being smuggled into the public mind, falsely implying that the therapy has clinical significance and leading people, evidently even trained professionals, to believe that the authority of science is speaking. I propose that all therapy studies relying on tests of significance need to be re-examined. I propose also that all therapies should be tested with HRV. Statistical significance is far from good enough. The world and clinical psychology need clinically significant treatments and further, the world desperately needs treatments that minimize suffering for hapless clients.
Placebos - I have been doing psychotherapy for over a half-century. Throughout my career, I would try almost anything to attempt to help a suffering client, including using placebos. I was a pioneer and a fellow in clinical hypnosis. Although I heard and read a lot about placebo I never personally saw a client cured with a placebo or with suggestion. I believe the very concept of placebo is questionable. Scholars are also questioning the so-called placebo effect. After reviewing over 800 of the early studies on placebo: “The authors conclude that the literature relating to the magnitude and frequency of the placebo effect is unfounded and grossly overrated, if not entirely false. (Kienle and Kiene, 1996, p39)” A Danish investigator, Asbjorn Hrbjartsson (2001) is currently developing an even stronger case against placebo. Hrbjartsson’s work is cited on the web of an unusually fair and knowledgeable advocate for placebo. (Brody and Brody, 2000)
Control Groups - In light of the findings discussed in this series of papers, clinical psychologists must consider what conditions or circumstances obviate the need for a control group. I propose that for any treatment with a 75% success rate or above, a control group is not required in order to know something is taking place (see, e.g., Johnson, in this issue). A conservative group of neurologists, discussing how to evaluate treatments for multiple sclerosis made the following comment: "A completely effective treatment would stop worsening in all cases, probably produce improvement in most patients, and would be easy to recognize and a controlled trial of therapy would not be necessary (my emphasis). They add that a minimum impact therapy requires a control group and treatment with placebo: “The recognition of a partially (my emphasis) effective treatment requires the use of control patients treated simultaneously with placebo." (Sibley and The Therapeutic Claims Committee, 1996, p16). The principles are relevant to treating any condition.
TFT and Hard Science - I believe that TFT results may be much closer to hard science than the usual psychological treatments. The success rate of TFT, i.e., the predictions made by TFT at our highest level of performance, appear to be on a par with experiments in physics and chemistry (see Callahan and Callahan, 2000, p59).
McNally attributes our reported success in treating diverse problems presented in our papers, only to “uncontrolled demand characteristics, therapist expectancy, and non specific placebo effects.” The overlooked common feature of these diverse problems is stress (Porges et al, 1994) . Stress leads to heart problems and other illnesses. HRV can reasonably be considered a measure of the impact of stress on the person. Please see my discussion of the observations of Dardik (Callahan, b, this issue), regarding the numerous problems reflected by HRV. Also see Porges’ (1995) finding that circumcision creates stress in infants as indicated by HRV. Another very interesting recent study suggesting the role of stress in pediatrics finds sepsis in infants predictable and can be identified before it happens by low HRV (Griffin and Moorman, 2001).
Tertullian’s Motto - In his paper, Professor McNally of Harvard refers to the shared joke with a biological psychiatrist of the seeming absurdity of my treatment. Professor Kline, of Florida State University, also joins in the humor and finds it difficult to distinguish our observations from “farce.” I have grown used to these kinds of reactions over the last 22 years. Virtually everyone now doing TFT once had a similar laugh over my unusual appearing treatment. But, for those who have actually tried my treatments the “Ha, ha” changes into “Ah, ha!” Koestler (1964) pointed out: “The history of science abounds with examples of discoveries greeted with howls of laughter because they seemed to be a marriage of incompatibles – until the marriage bore fruit and the alleged incompatibility of the partners turned out to derive from prejudice. …Comic discovery is paradox stated – scientific discovery is paradox resolved (p95).” Etienne Kline’s (1996) book also emphasizes the role of paradox in scientific discovery.
Mere Passage of Time and Regression To the Mean on HRV - McNally suggests that the changes supported by HRV that we report for conditions such as severe depression, anxiety, fatigue, anger, and toothache “could have occurred with the mere passage of time.” This notion strikes me as farcical when “the passage of time” is but a matter of minutes. When a therapy takes place over weeks, months, or years then perhaps one is entitled to reasonably speak of the “mere passage of time.”
It is recently reported that HRV scores that are abnormally high is also a predictor of death as well as scores that are too low (de Bruyne, et al, 1999) Such extreme scores are hazardous because they are stable; this is why they can predict death. The statistical artifact “regression to the mean” would be welcomed in such cases if relevant, but it is not. This idea reminds me of someone going on an automobile trip when the gas tank reads “empty” and they are hoping that regression to the mean will cause the tank to suddenly supply additional gas. It is quite significant and of special theoretical interest that TFT not only increases HRV when it is too low, but also can decrease HRV that is excessively high. This interesting fact shows that the drive for health, or health attractor, can result in people responding powerfully and rapidly if only the correct treatment is given. If “regression to the mean” were a such a powerful factor in HRV scores, then low (or overly high) HRV scores would not present the serious problem they bespeak – one would only have to wait for time to pass and an HRV re-test in order to get better. Alas, it doesn’t work that way. Low and hazardous HRV scores, as I documented (Callahan, a, in this issue) and as investigators have shown, Van Hoogenhuyze et al), are among the most stable and most difficult to improve. The Van Hoogenhuyze et al study is illustrative for it shows the individual scores of 55 men and the exact changes in retest may be examined. The authors comment that “Heart rate variability values in the range associated with increased risk of mortality showed less day-to-day variation (i.e., were more reproducible) than the high heart rate variability values in normal subjects (my emphases). (Van Hoogenhuyze, 1996, p1672).
Lohr is quite correct in stating that “other effective treatments” are not cited for improving HRV. In all of the literature we have searched on HRV, we find nothing that compares to the improvements in HRV generated by TFT. Please also consider the roles of “mere passage of time” and ”regression to the mean” in the recent important study done on depression with heart patients (Carney et al, 2000). Depression can be a serious problem for heart patients. Cognitive Behavioral Therapy (CBT) was administered to the patients. The post-therapy measures of HRV were taken after up to 16 CBT sessions. The exact amount of time is not mentioned but it takes considerably more time to do 16 CBT sessions than the minutes it takes to do TFT. Despite this passage of time as well as the possibility of regression to the mean in this study, the SDNN got slightly lower after 16 CBT sessions. The impact of CBT, plus the passage of time, and the regression toward the mean had little or no effect on SDNN. The SDNN was so poor (minus 4.5%) after CBT treatment as to lead the authors (after Nolan, 1998) to speculate that depression may generate a deep, permanent and harmful biological effect on the mechanisms responsible for the variability of the heart.
To informally check the alarming idea that depression can cause permanent and irreparable biologic harm, I looked at 8 cases of severe depression treated with TFT and for whom HRV scores were taken before and after TFT. The average change in SDNN after TFT for depression was plus 85% compared to a minus 4% with CBT (Callahan, 2001,c). Please note that we are not comparing the 24 hour scores used by Carney et al to our 5 minute scores; we are comparing the % of change in SDNN as a result of treatment. Naturally, our informal work must be repeated and we most emphatically encourage others to do this since if our results are replicated it could have profound implications for people with depression, heart problems, and most especially for those who have both.
Conventional treatments have led to or supported more than one pessimistic conclusion and TFT appears to be progressively overturning some of these (see LeDoux’s concept of “indelibility” in Callahan,b and LeDoux et al, (1989); also see the APA Science Directorate Report on the matter of whether phobias are curable (Adler, 1993; Rutter, 1994, Callahan, 1985).
Kosovo - Dr Rosner raises some pertinent questions that require some clarification. Before the war ended Johnson successfully treated trauma at the Kosovo refugee camp in Oslo, Norway. Impressed with TFT, the two ethnic Albanian directors of the camp asked Johnson to lead a relief mission to Kosovo itself, after the war. They were escorts on the first trip, introducing Johnson to their Kosovar physician friends who would become his translators and co-authors of this report (Johnson et al, this issue). Dr Johnson responds: “Treatment was given to everyone who was referred by a physician or who requested it on their own. More than a year had already passed since the precipitating traumatic events, so comparison to first year spontaneous recovery is not relevant. Physician translators compiled a list of traumas for each patient, who was then treated by therapists, trained in TFT causal diagnosis, with additional translation from these physicians. The full procedure, including translations, took as much as an hour or even two, but the TFT itself (causal diagnosis and treatment) ranged from 5 to 20 minutes. Awareness of cultural values and traditions was crucial to the therapeutic success in Kosovo. It determined the preferred setting for therapy, the decision to bypass traditional diagnostic evaluations and the intentional selection of a relatively superficial means of evaluating changes. “Whenever possible, treatment was provided within the context of the nuclear family, in their living room or at the picnic table in the yard. Usually several extended family members were included. It was always intimate and respectful. At no time was there a public display of treatment in front of all the people of a village, as Dr Rosner imagines. Positive expectancy effects would have been a pleasant surprise, as skepticism of TFT was as large in Kosovo as everywhere else. Even our Albanian physicians were skeptical at first. However, April 2, 2001, an office was opened in Kosovo by our Albanian physician friends, no longer skeptics, for the practice of TFT (Johnson, 2001).”
We sincerely appreciate the criticisms of our work; though we reject some we are grateful for all. We hope some of our suggestions will be considered and we plan to benefit from the many criticisms we received.
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I am very grateful to the busy psychologists who took the time to read and respond critically to our TFT papers. Criticism of new ideas and findings is very much needed and most welcomed and appreciated. I am especially thankful to Editor Larry Beutler for inviting me to submit some papers on TFT. I also want to express my appreciation to Hether Brown the editor’s helpful assistant. I want to thank the authors of these TFT papers for their work, their considerable help, and for suggestions in formulating my response. Special thanks go to Monica Pignotti whose many suggestions were especially helpful. The TFT authors and I wish to dedicate our papers to the memory of Yoshinori Takasaki, MD, physician and clinical psychologist, of Wakayama, Japan who suffered a long illness and who died during the writing of these papers. Even during his illness, Yoshi was teaching TFT. Dr Takasaki, was a brilliant and highly esteemed creative pioneer in TFT, an authority on HRV, and a much-loved friend.