Therapy on tap: Thought Field Therapy offers superficial solutions to deep disturbances

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Peter Panayi
Peter Panayi
Peter Panayi is a PhD student in Clinical Psychology at the University of Manchester, having just completed his MSc in Early Intervention in Psychosis at King’s College London. He has worked in a variety of roles in community and inpatient mental health services, most recently as a patient advice & liaison officer for the South London & Maudsley NHS Foundation Trust.

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Therapy on tap: Thought Field Therapy offers superficial solutions to deep disturbances

Proponents claim remarkable results from Thought Field Therapy and Emotional Freedom Technique, but the evidence tells a different stor

“…within less than a minute, my anxiety went away. I felt a sense within my body of a physical release of tension and…an emotional high…I had never in my life experienced anything like this.” (Pignotti, 2005, p. 395)

If not for the title of this article, one might interpret the above extract as describing an orgasm. Actually, it’s describing a miraculous experience of Thought Field Therapy (TFT), a controversial energy psychotherapy that claims to cure mental health issues in minutes (Callahan & Trubo, 2001). Developed in 1985 by psychologist Roger Callahan, TFT supposes that disturbances of the body’s “energy field” underlie physical and mental health problems (Callahan & Stancliffe, 1985). This is grounded in energy psychology and Chinese philosophy, rather than medical science – though, when examining the evidence, it becomes clear that TFT is simply pseudoscience.

So, how does this miracle cure work? Callahan and Callahan (2000) theorised that, when picturing an event, individuals construct a field of energy (the ‘thought field’) around them. Consideration of specifically traumatic events disturb this field, causing negative emotions. These points of disturbance (“perturbations”) are said to coincide with physical meridian points, which reduce the perturbations when tapped. The TF therapist taps these points in specific sequences (“algorithms”) whilst the client envisions past trauma, to ultimately reduce the associated negative reactions. Callahan and Trubo (2001) explain that this tapping method works by balancing the flow of qi, the life force energy underpinning principles of alternative Chinese medicine (Frantzis, 2008). TFT is fully administered in a single session lasting approximately 15 minutes, though Callahan has argued that it can cure symptoms of post-traumatic stress disorder (PTSD) in just 5 minutes (Callahan & Stancliffe, 1985).

There are several issues with Callahan’s theory. For one, research reviews have reported no evidence of thought fields (Bakker, 2013; Bausell, 2007). Notice these are not meta-analytic combinations of studies, owing to the lack of scientific research on thought fields and energy psychology. The same applies to qi (Lee, Pittler & Ernst, 2008). In fact, attempts to confirm or deny the existence of qi have explained its effects in terms of other observable/measurable phenomena (e.g., the result of training and skill rather than balance of energy; Carroll, 2003). In any case, given their invisible and immeasurable nature, both the thought field and qi are unfalsifiable, rendering them untestable by Popper’s (1959) definition of science. The theory behind TFT is, in this way, theoretically and empirically pseudoscientific.

A drawing of a brain, sitting above an outstretched hand

In a not-so-systematic literature review, Feinstein (2008) devised an alternative theory of TFT. He outlined that tapping meridian points during TFT reduces activity in the amygdala and associated brain areas, lowering hyperarousal. Interestingly, Feinstein did not include references to back up his argument; this pattern of claims has continued 10 years later (Feinstein, 2019). This is largely representative of Callahan’s initial theorising on TFT, but attempts to be based on biopsychology without empirical support. The available evidence on the biopsychology of acupressure (such as that applied during TFT) has shown that activation patterns in the amygdala mirror those observed following exposure therapy (Schienle et al., 2007). This suggests that any neurobiological effect of TFT may be attributable to the recall of trauma during therapy, acting as exposure. Thus, the available data disconfirm Feinstein’s hypotheses.

Perhaps the lack of evidence for TFT theory could be excused if the approach significantly reduced human suffering. Indeed, this would be cause for research in the area. However, most “research” into TFT consists of anecdotal evidence and uncontrolled studies, some of which don’t even employ tests of statistical significance (Bakker, 2013). Some efficacious evidence of TFT has been published. For instance, Irgens et al. (2012) conducted a randomised controlled trial (RCT) showing that TFT significantly reduced anxiety scores, and this was upheld post-treatment. Superficially, this would seem to support the efficacy of TFT in treating anxiety. However, this was in comparison to a wait-list group, making it unclear how these effects would have compared to an established treatment (e.g., cognitive behavioural therapy [CBT]). Plus, there was no control condition, making it unclear whether the results are due to placebo effects. Some participants were even in receipt of additional pharmacological- and psychotherapies, making it difficult to rule out whether the observed effects were due to these ongoing treatments. These factors make this study’s conclusions questionable.

To resolve these limitations, Irgens et al. (2017) ran another RCT showing that TFT performed comparably to CBT in reducing symptoms of agoraphobia, relative to a wait-list group. This was sustained 12 months’ post-treatment, suggesting that TFT is a viable alternative to CBT in treating this disorder. Yet, again, there was no placebo condition, so results could be due to non-specific treatment effects (e.g., expecting the treatment to work, therapist enthusiasm; Kazdin, 1979). As above, any effect may be due to exposure. Indeed, Elverum (2011) reported that the introduction of TFT tapping made no further reductions to post-traumatic stress than imagined exposure. Thus, effects of TFT may be attributed to the envisioning of past trauma. Such methodological issues are rife within the TFT literature, and rarely warrant the grand conclusions its authors draw.

Consistent with this critique, well-designed experimental studies on TFT have proven incongruent with its assumptions. Pignotti (2005), for example, conducted an RCT comparing “legitimate” TFT tapping sequences to randomised tapping. No significant differences in changes to emotional distress between conditions were found post-treatment, suggesting that the tapping element of TFT serves little purpose. Accordingly, meta-analytic and systematic reviews of TFT studies generally show an overarching ineffective trend (Pignotti & Thyer, 2009; McCaslin, 2009; Gurda, 2015). Empirically, TFT is continually disproven to work; this is unsurprising, given its lack of evidence-based theory.

The results of Pignotti (2005) illustrate the importance of placebo conditions in psychotherapeutic research. An unwavering problem with TFT research is the lack of a placebo condition (perhaps Pignotti’s research explains the hesitation). It has been argued that it is impossible to create a placebo condition, as tapping anywhere on the body alters the energy field, explaining away placebo effects (Wells et al., 2003). It has also been posited that:

“Strict adherence to the original tapping protocols is considered by most practitioners to be unnecessary,” (Feinstein, 2009, p. 263)

A therapist holding the hand of a patient

Which means that random tapping could be authentic. The resistance of TFT’s proponents to account for placebo effects could be interpreted as attempts to avoid scientific scrutiny. Callahan himself has argued that TFT effects cannot be due to placebo, since clients doubt its efficacy at face value (Hooke, 1998). This demonstrates a misinterpretation of placebo: the effect persists whether the client believes in a treatment or not (Dodes, 1997; Bootzin, 1985). This tendency among TFT practitioners to evade clinical testing lends itself to pseudoscientific practice.

Another cause for concern is the secretive nature of TFT training. Though open science is yet to be the norm, there is an overwhelming shift to this ideal – this is not the case with TFT. McCaslin (2009) reports that full TFT training costs more than $102,000, with trainees sworn to secrecy regarding TFT algorithms. Furthermore, in his review, Feinstein (2008) did not declare any conflicts of interest, though he and his wife have written several books on TFT (Feinstein, Eden & Craig, 2005). This contrasts empirically-based psychotherapies like CBT, where the underlying principles and practices are readily available in various textbooks and scientific journals. This cult-like nature of TFT training thickens the mystery surrounding its theory and practice.

So, if TFT has been discredited by scientific research, why do clients access it, and clinicians practice it? It may be that these questions have similar answers: TFT is advertised as a rapid cure for most, if not all, mental health problems for all ages (Callahan & Trubo, 2001). This offers clients a remedy for their suffering and clinicians a one-for-all treatment for their clients. This might explain the initial access of TFT, but the question remains: why do individuals believe in TFT? Given TFT’s premise that thoughts affect energy fields, belief therein satisfies Vyse’s (1997) definition of magical thinking. As such, individuals with this cognitive style might be likely to believe in TFT. Several factors contribute to this belief (French & Stone, 2014), although research in this area would be essential to confirm this hypothesis.

Carroll (2003) defined pseudoscience as unscientific theories presented scientifically, or as science – this contrast is important, as not all pseudoscientific theories involve intentional deception. Pignotti (2007) notes from her personal relationship with Callahan that he truly believes in the science of TFT; this is left at the reader’s discretion. Overall, it seems irrefutably clear that TFT constitutes pseudoscience, given its lack of empiricism in theory, research and practice.

References

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