This review examines TFT as a desensitization treatment which attempts to integrates the eastern philosophy of acupuncture with more contemporary theories of cognitive processing. However, inconsistencies and methodological problems of the theory greatly limit the interpretablity and utilization of the treatment. This paper will highlight some of these weaknesses and emphasize the need for further research.

Thought Field Therapy (TFT) (Callahan, 1996) is a desensitization treatment that has gained a modicum amount of support among clinicians and severe criticism from researchers. The treatment is marketed as a holistic approach to treating traumatic stress based on the mind/body connection. Callahan has developed an array of terms and concepts that are confusing and unclear. The following paragraphs will attempt to clarify some of this confusion. The treatment targets two areas: 1) the client's negative beliefs/emotions; and 2) the physical imbalances in the body's "bioenergy control system (p. 131)." The term "perturbations (p. 130)" was developed by Callahan to describe these imbalances or blockages of energy. A perturbation is an aversive disturbance in the body similar to the increased arousal or agitation symptoms frequently reported among Post Traumatic Stress Disorder (PTSD) victims. Callahan suggests that these disturbances are encoded in the body which ultimately stimulate the negative beliefs/emotions of the "thought field" (p. 130). His model views negative affect and cognition resulting from blockages in the body's energic system (Hooke, 1998).

Based on the meridian system of acupressure, Callahan developed a series of algorithms that attempt to remove the perturbation or blockage of energy in the body. The algorithm is a predetermined sequence of pressure points which are tapped though out the body, and different algorithms are applied depending on the presenting symptoms. According to Callahan (1996), the removal of the perturbations eliminates corresponding pathology.

The procedure requires the clients to "attune to the thought field (p. 130)" (think about the negative beliefs/emotions) while simultaneously tapping various pressure points (algorithm). A Subjective Units of Distress Scale (SUDS) (Wolpe, 1958) rating from 1-10 (10 being the most distress) is reported. Clients will tap points on the face, hands, and body while thinking about the event. According to Callahan, the SUDS rating should decrease in intensity as the various pressure points are tapped. The length of treatment depends on the client's level of distress, or the number of perturbations the client is experiencing. Callahan (1994) suggests that TFT can target Post Traumatic Stress Disorder (PTSD), panic, phobia, all anxiety disorders, sexual problems, depression, addictive behaviors, and heart rate problems. The training of TFT therapists involves four levels of instruction: 1) Video training; 2) Seminar training; 3) Causal Diagnostic training; and 4) Voice Technology training.

Procedure

The first phase of treatment, called the "Causal Diagnostic" procedure, is to test various muscles though out the body for specific points to tap. Pressure points can vary from client to client dependent on their presenting symptoms. However, Callahan reports that the muscle testing stage can be by-passed if the client's presenting symptoms fit an algorithm already developed. Once an algorithm is selected, the client is instructed to think about the targeted beliefs and/or emotions. This is called "tuning of a thought field" (p.130). The algorithm is comprised of 8 steps and is self-administered by the client under the instruction of the TFT clinician. An example of an algorithm for anxiety follows (Figley, 1998):

Step 1: Instruct client to think of a distressing memory or thought while assessing for the corresponding SUDS rating. Clients are informed that the procedure is experimental and may appear unusual.

Step 2: The client is instructed to use two fingers to tap the beginning of the eyebrow above the bridge of the nose. Five solid and firm taps are recommended.

Step 3: The client taps under the eye about an inch below the bottom of the eyeball, at the bottom of the center of the bony orbit, high on the cheek. Again, five solid and firm taps are optimal.

Step 4: The client taps under their arm, about four inches directly below the arm pit with five solid taps. This point is even with the nipple in males, or is the center of the bra line under the arm in the females.

Step 5: The client taps a specific point on the collar bone. The client is instructed to take two fingers of either hand and run them down the center of the throat until the top of the center collar bone notch is reached. From this point they are to go straight down one inch, go to the right one inch, and then firmly tap this point five times.

Step 6: At this time, a second SUDS rating is assessed by the therapist. If the SUDS rating is two or more points lower, step 7 is initiated. However, if there is no change or the SUDS rating has only reduced one point, a Psychological Reversal procedure is conducted (described below). Then steps 1-6 are repeated.

Step 7: This step is called the "Nine Gamut Treatment." To locate the gamut spot on the back of the hand, clients are instructed to make a fist with the non-dominant hand. This causes the large knuckles to stand out as reference points. Clients place the index finger of their dominant hand in the valley between the little finger and ring finger knuckles. They are to move their index finger about one inch back toward the wrist. This point is called the "gamut" point. Clients tap the gamut spot on the back of the hand three to five times per second. Clients continue to tap that point while conducting the following nine exercises: 1) Eyes open; 2) Eyes closed; 3) Open eyes and look down to the left; 4) Open eyes and look down to the right; 5) Rotate eyes around in a full circle in one direction; 6) Rotate eyes around in opposite direction in a full circle; 7) Hum a few bars of any tune (more than one note); 8) Count to five; and 9) Hum a few bars again. The client will continue to tap the gamut spot on the back of the hand five to six times for each of the nine exercises while.

Step 8: Repeat steps 2-6. At this point, another SUDS rating is assessed for residual distress. A rating of one or zero is desired. If the SUDS rating has decreased significantly, but is not yet a 1, the client will initiate a Mini-Psychological Reversal procedure (described below). Then steps 1-8 are repeated again.

In addition to the algorithm, Callahan has developed other techniques to assist the effects of the treatment including the Psychological Reversal (PR) and the Mini-Psychological Reversal Correction (MPRC). If the algorithm has not successfully reduced the SUDS rating, then a PR intervention is initiated to correct the "psychological phenomenon (p.137)" that is blocking the treatment (Callahan, 1998). The blockage occurs from a reverse flow of energy along the meridian system which produces a negativistic and self-sabotaging state for the client. The client is instructed to tap the pr-8-spot, located on the outside edge of the hand about mid-way between the wrist and the base of the little finger, and say three times, "I accept myself, even though I still have this kind of anxiety" in order to correct the blockage. The MPRC is another procedure that starts with tapping the PR spot, as described above, however this time the client is instructed to say three times, "I accept myself even though I still have some of this problem." Both strategies are report to increase the effectiveness of the treatment.

Mechanism of Change

Callahan incorporates the mind-body connection as the basis for change (Callahan, 1996). The basic premise of the theory is that the mind and body are two elements in nature that interact in harmony. If one element is affected, the other will be as well. Therefore, when an individual is confronted by a traumatic event, this interaction is disrupted and the harmony is lost. The body's natural flow of energy becomes blocked. These blockages of energy then create the negative cognitions and/or emotions associated with a traumatic experience. The goal of the treatment is to unblock this flow of energy by tapping on various acupressure points. Change occurs when the body's flow of energy is restored to its original state of balance (Callahan, 1994). Both the tapping of pressure points and cognitive processing need to be occur simultaneously in order to unlock the blockages and bring about this balance. The opening of these energy pathways is the hallmark of Callahan's dualistic approach.

Clinical and Empirical Evidence

To date no treatment outcome research has been conducted. Callahan has not conducted any controlled and randomized studies upon which to base his claims. None of his writings have appeared in peer-reviewed publications, other than TRAUMATOLOGYe (1996, 1997, 1998). The absence of waitlist or placebo controls limit a comprehensive examination and validation of the treatment. Callahan's assertions of TFTs efficacy tend to be based on anecdotal evidence gained by clinician's reports.

Recently, Wayne Hooke (1998) conducted a comprehensive review of TFT. He addressed several unpublished studies frequently cited by Callahan as supporting evidence for his treatment (Callahan, 1987; Figley & Carbonell, 1995; Leonoff, 1995; Wade, 1990; Wylie, 1996). Unfortunately, these results are not interruptible due to several methodological limitations such as "no control groups, nonrepresentative sampling, and demand characteristics of a public radio broadcast (p. 4)" (Hooke, 1998). However, findings from a study conducted by Figley and Carbonell (1995) were more supportive even though the generalizability of the results was limited due to the absence of a control group. This study found that the rate of change in distress levels ratings were faster than those recorded for other exposure-based treatments. Finally, a fifth study conducted by Carbonell (1996) was the only study to possess merit even though it has not been published. The design of the study was to have the experimental group be given a legitimate TFT algorithm and the control group was given a sham algorithm consisting of arbitrary points. Both groups did observe reductions in levels of distress, however the experimental group was found to have significantly greater reduction in distress (as cited in Hooke, 1998). Unfortunately, effect sizes were not reported and therefore these results must be viewed cautiously.

Limitations of Studies Reviewed

Due to the methodological weaknesses of these studies, the rapid reduction of distress resulting from the treatment can only be suggestive and not conclusive. Hooke (1998) emphases that SUDS ratings tend to be a better indicator of momentary emotion rather than long term change which calls into question the use of SUDS ratings as the sole indicator for treatment efficacy. It is recommended that randomized studies be conducted and published. Currently, information on TFT is obtained primarily through the web or special publications that are distributed by Callahan.

Limitations of Treatments Reviewed and Contraindications

A major limitation of TFT is the lack of empirical research validating the treatment. To exclusively rely on subjective reporting by clinicians as the sole criterion for establishing TFTs effectiveness is unscientific and difficult to dispute. His interpretations are baseless without empirical examination. Client's reported reduction in SUDS levels could be a function of factors (distraction, placebo effect) other than those claimed by Callahan.

Hooke (1998) underscores the need for caution when interpreting the theory of TFT due to the "methodological weaknesses, lack of controls, and failure to fully report data/methods (p. 1)." Hooke views Callahan's theory as being internally consistent, but due to "the absence of evidence for the fundamental components of this theory (p. 6)" there is reason for scepticism. He also stressed that the use of clinical reports and case studies as indicators of treatment effectiveness is questionable and not helpful in ascertaining the mechanism of change. Without empirical findings, Callahan's explanations are no more than hypotheses in need of further investigation (Hooke, 1998).

Callahan's writings are convoluted and indeterminable. The development of a TFT language impedes objective examination of the treatment because his terminology is ambiguous. For example, the rationale that "perturbations" in the "thought field" will create "physical imbalances" in the body's "bioenergy control system" is vague and confusing because these terms and phrases are not clearly defined. Are perturbations cognitions or affect, and how does one experience a "physical imbalance?" Also, what and where is the bioenergy control system" in the body? These terms and constructs are in desperate need of further clarification. Hooke (1998) believes that the confusion in Callahan's constructs may be due to his tendency to blend "a hypothetical construct from philosophical quantum physics with what may be a misunderstanding of a construct from nonlinear dynamics" (p. 2).

In addition, the treatment is illogical because there is noempirical evidence support his hypothetical assumptions of an energic system in the body, or that the tapping process will release this energy. The basis of Callahan's theory rests on these two constructs even though he is unable to support these tenets with conclusive data. It is faulty to assume that all emotional distress is a direct result of blockages in the energy system, or that recovery is achieved by tapping on specific pressure points. Callahan (1996) states, "A perturbation is a subtle, but clearly insoluble aspect of a thought field which is responsible for triggering all negative emotions" (p. 121). If one is to follow this argument, then any clinical success whether by talk therapy or Cognitive/Behavioral therapy is spurious and should not emit long term results.

Hooke (1998) presents some other explanations for the reduction of arousal such as counter conditioning, sensory stimulation, placebo response, cognitive restructuring, focused repetitive activity, and alteration in breathing. Whether TFT is effective or not will remain speculative until controlled studies can validate Callahan's assertions. In addition, his theoretical constructs are based on "suspect diagnostic practices" (p. 5) and in need of clarification so that clinicians can make informed decisions when evaluating the utility of the treatment for their clients.

Callahan, R. (1987). Successful psychotherapy by telephone and radio. The proceedings fo the International College of Applied Kinesiology. Publication of limited circulation.

Figley, C. F. & Carbonell, J. (1995). The 'Active Ingredient' Project: The Systematic Clinical Demonstration of the Most Efficient Treatment of PTSD, A Research Plan. Unpublished Manuscript, Psychosocial Stress Research Program and Clinical Laboratory, Florida State University at Tallahassee.

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Hooke, W. (1998). A Review of Thought Field Therapy. [38 paragraphs]. TRAUMATOLOGYe [On-line serial], 3:2(3). Available FTP: http://www.fsu.edu/~trauma

Leonoff, G. (1995). The successful treatment of phobias and anxiety by telephone and radio: A replication of Callahan's 1987 study. TFT Newsletter, 1 (2).

Wade, J.F. (1990). The effects of the Callahan phobia treatment technique on self concept. Unpublished doctoral dissertation, The Professional School of Psychology Studies, California.

Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press.

Wylie, M. (1996, July/August). Going for the cure. Family Therapy Networker, 21-37.