The International Electronic Journal of Innovations in the Study of the Traumatization Process and Methods for Reducing or Eliminating Related Human Suffering

Wayne Hooke's Reply to Roger Callahan

Dr. Callahan's response to my review of Thought Field Therapy contains two rhetorical features and a number of substantive assertions that I want to address. The first rhetorical position that I must challenge is Dr. Callahan's assumption that if clinically observable results sometimes - or even often - occur following TFT interventions, then his theory and detailed clinical techniques must be 'right.' This assumption is simply inaccurate. As I have illustrated, there are a variety of alternative explanations for the observed clinical effects of TFT interventions. These alternatives are superior to Callahan's views because they better satisfy the two main criteria of scientific explanations: they are supported by data and they are more parsimonious.

The second feature that I must challenge is Dr. Callahan's rhetorical positioning of my decision not to pursue certification as a TFT practitioner. My review contains much of the detailed information that led to this decision, but does not clarify my reasoning. I want to do this now. Let's assume that tapping interventions actually do produce powerful, regular, clinical effects. This, I must emphasize, is only an assumption. But, let's assume that Callahan's precise algorithms for specific problems really do work. Given this, what could justify not receiving training in the detailed methods of TFT? The best reason that I can think of would be if interventions with less precision and specificity work just as well. Do we have any evidence that this occurs? Yes. As I have documented, clinicians report that the wrong algorithms often work, tapping at random locations has been observed to work as well as tapping at precise points, and, there are a number of practitioners who use a single algorithm for all problems who report the same amazing successes as trained TFT practitioners. Without more convincing data, even assuming that TFT works, it is legitimate to not pursue certification at this time.

Being self-critical, I ask myself, "What about TFT diagnosis?" Callahan claims even more dramatic success rates for TFT diagnostic-based interventions than for algorithm-based interventions. What about that? First, there is the data problem.

Callahan offers no convincing research to support this assertion. In the absence of solid research, this efficacy claim cannot be taken any more seriously than other sorts of clinical reports. Second, a causal-diagnostic scheme of this complexity would require a huge amount of research to properly develop and substantiate. Callahan has not conducted this research. Third, his diagnostic method assumes the existence of energy meridians. As I emphasize in the review, the standard text on acupuncture unequivocally states that to date, no evidence of meridians or their effects has been found. Callahan's failure to offer data in support of meridians or of even attempting a counter-argument forces the categorical rejection of this assumption. Fourth, Callahan's diagnostic method utilizes muscle testing. While there are a variety of muscle testing systems, none have sufficient reliability or validity for use as diagnostic tools. A casual review of the relevant literature on muscle testing has revealed a number of very serious problems These problems include: a grossly deficient body of literature (Klinkoski & Leboeuf, 1990; Kenney, Clemens, & Forsythe, 1988), a differential ability to reliably test different muscles (Lawson & Calderon, 1997), substantial problems with inter-rater reliability (Hsieh & Phillips, 1990; Peterson, 1996; Kenney, et. al., 1988), substantial problems with intra-rater reliability (Peterson, 1996) and, there is as yet no evidence for the validity of using muscle testing as an indicator of emotional arousal (Peterson, 1996).

These are huge, probably insurmountable problems for TFT diagnosis. Even if we assume - simply for the sake of argument - that TFT diagnosis is more effective than algorithm-based TFT, we have absolutely no reason to believe that the reason for this difference is anything more than the effect of placebo. In conclusion, the existence of TFT diagnosis in no way requires a conscientious professional to obtain certification in TFT.

Similarly, the evidence for Voice Technology in no way requires a conscientious professional to obtain certification in TFT. Callahan's claim is that small snippets of vocal production can be recorded - even over the telephone - and the recording can be analyzed to identify the causes of psychiatric disorders (Callahan & Callahan, 1996). Callahan reports an amazing success rate with the use of this technology, but as with his diagnostic system, he has not produced convincing data to support his efficacy claims nor has he conducted the research that would be required to properly develop and substantiate this sort of diagnostic device. Dr. Callahan will have to provide more data and more information before his claims concerning Voice Technology should be taken seriously.

In short, I have not pursued certification in TFT because - even assuming that tapping therapy works - the evidence to date does not support Callahan's elaborate, multi-tiered therapeutic system. Dr. Callahan makes the statement that a practitioner has an ethical requirement to refer a client to a diagnostically trained therapist if an algorithm does not work. This statement must be unequivocally contradicted. No professional code of ethics requires a practitioner to refer a client for an unsubstantiated, experimental treatment.

A general weakness in the TFT literature shows up in Dr. Callahan's response: there is a strong tendency to draw conclusions that are simply not substantiated by the data or the citation. Another serious weakness in Dr. Callahan's response is a tendency to answer objections merely by rephrasing what he has already said.

For example, I make the strong statement that there is no evidence whatsoever for the existence of energy meridians and I cite the standard work in the field. Dr. Callahan's response is to thank the "Asian genius" who made "one of the greatest discoveries of all time." He offers no substantive response, no rebuttal, and no information that would help a professional make an informed decision.

Relatedly, I make the strong assertion that we have no evidence whatsoever that tapping influences extracellular electrical phenomena in the body. Dr. Callahan responds with citations to literature that has no direct applicability to the point at issue, with a digression about sharks and the duck billed platypus, and to an unpublished finding of magnetite in the brain. Nowhere do I deny that there are extracellular/extraneurological electrical phenomena in the human body. These extracellular phenomena are well- documented and are accepted by mainstream scientists. What has not been documented are Dr. Callahan's assertions about this extracellular electrical activity.

The identical weakness occurs in his response to my assertion that there is no evidence whatsoever connecting reversed extracellular electrical polarity with: 1) psychological problems, 2) nonresponsivity to TFT interventions, or 3) techniques for correcting psychological reversal. Dr. Callahan's only substantive response is to cite one obscure, outdated, non-mainstream author's work on electrical activity. No evidence whatsoever is offered in direct support of his position or as a rebuttal to my claim that no supporting evidence exists. Equally concerning, there is no evidence that establishes psychological reversal as a valid construct. Callahan offers testimonial, case examples that could be interpreted in many more reasonable ways, and cites one study - that of Robert Blaich - in defense of this construct. Disturbingly, Blaich's study is not accessible for scholarly review. It was published in The Proceedings of ICAK-USA (International College of Applied Kinesiology), which are neither peer-reviewed nor released to outside scholars (A. Dibbern, personal communication, 10 October, 1996).

Dr. Callahan does offer a few pointed responses to my review. He indicates that breathing, repeating the algorithm, and positive affirmations are not components of his approved algorithms. This illustrates to me the fundamental importance of carefully conducting dismantling studies of tapping interventions. How do we really know whether these or any of the various components of TFT have a positive effect or not? Clinical lore is helpful, but cannot be relied on exclusively. In many ways, though, I am putting the cart before the horse by suggesting dismantling research, since we have not yet really found solid evidence for the efficacy of tapping therapy. Dismantling strategies in research are best conducted after efficacy has been established.

Dr. Callahan has offered further elaboration of his notion of a perturbation in response to my statement that this construct is "somewhat obscurely defined." After carefully reading and rereading his elaboration, I still find this construct obscure. Dr. Callahan seems to be blending a hypothetical construct from philosophical quantum physics with what may be a misunderstanding of a construct from nonlinear dynamics. Dr. Callahan makes the claim that perturbations, rather than brain activity, can easily be shown to be the fundamental causes of negative emotions. After making this bold claim, he simply fails to offer the demonstration. In the absence of a more precise definition and a more careful connection of the construct with something measurable or experiential, this notion remains extremely speculative. As a result, it must be viewed as a very unlikely starting point for exploring psychopathology.

Dr. Callahan makes the unsubstantiated assertion that responses to TFT usually follow a pattern such as the following: SUDS ratings change from 10 to 7 to 4 to1. Dr. Callahan calls these changes "quantum leaps" and intends for us to conclude that these SUDS ratings parallel the finding in atomic physics. Physicists have found that electrons exist only at discrete energy levels and can move between these levels without ever passing through intermediate states. Callahan believes that this pattern of changes in SUDS ratings documents that TFT interventions are effective on an energy system that works at some sort of quantum level. This argument is hopelessly flawed because SUDS ratings are made on an ordinal scale. Ordinal scales by definition cannot document quantum leaps.

Ordinal scales merely differentiate relative position, never precise location. Moreover, SUDS scales frequently contain 4 or perhaps 5 anchor points, not because of quantum effects, but simply because of the crudeness of the measure.

Placebo responding is one likely mechanism driving the reported positive responses to TFT. Dr. Callahan makes three arguments against this possibility. He argues that intentional placebos have not worked in his personal practice, that TFT is lacking in face validity, and that evidence from a new "objective medical diagnostic instrument and technology" disconfirms the role of placebo in TFT.

Dr. Callahan's argument that intentional placebos have not worked in his clinical practice tells us no more than that he has intentionally used interventions that he has known to be inert in his practice and has found them to be just that, inert. Research, on the other hand, consistently shows that placebo interventions have significant effects on clients' behavior (v., e.g., White, Tursky, & Schwartz, 1985). Further, the absence of face validity for TFT may or may not have a significant impact on clients' placebo responses (for instance, has anyone looked at the role of belief in acupuncture and response to TFT?). The placebo response has been shown to be influenced by a large number of variables, many of which apply directly and unequivocally to TFT interventions (v., e.g., White et.al., 1985). While I personally do not believe that the clinical reports of improvement following TFT interventions are fully accounted for by the placebo response, I must adamantly state that the placebo response doubtlessly contributes to these reports and that it may in fact end-up completely accounting for them. Dr. Callahan's third objection to the role of placebo responding in TFT hinges on the undocumented claim that "the autonomic nervous system does not respond to placebo." This statement is contradicted by data showing that autonomic variables do respond to placebo (e.g., pulse and blood pressure) (Ross & Buckalew, 1985). Dr. Callahan's position on this issue is incompatible with what we know about placebo responding.

Dr. Callahan devotes a significant portion of his response to an elaboration of his performance on the Leeza show (The Leeza Gibbons Show; aired October 12, 1996). He states, "Mr. Hooke provides clear evidence on the inability to see what is before his eyes." Dr. Callahan's first objection is to my statement that there was a 50% refusal rate in the children who were offered TFT interventions. Upon reviewing the tape, I observed the same 50% refusal rate that I first found. Please keep in mind that we are dealing with only 4 cases. One case is in question. This case involves a boy who was tapped partially but who succeeded in escaping from receiving the treatment. I base my conclusion on the obvious attempt of the child to avoid treatment rather than to submit to it. I cited the program in my review because it was one of only two pieces of data that directly addressed refusal rates in TFT. The possibility of client refusal and noncompliance is an important consideration in reviewing a new treatment. For the record, this 50% refusal rate is unlikely to hold in many populations and many other samples.

Dr. Callahan's second objection to my reporting of the interventions on the Leeza show is my failure to discuss the cases documented on the program. He says, "Mr. Hooke shockingly does not believe it is worthy to mention our rather startling successes on this show." I agree with Dr. Callahan that the interventions documented on this program merit careful scrutiny. I disagree, however, with Dr. Callahan's categorization of these cases as "startling successes." In my opinion, these cases do not support a conclusion that TFT interventions are efficacious for the following reasons.

There are numerous problems with the demonstrations on this program. The fears of two children responded in some undeniable way. Both were actively engaged in the spectacle of a televised talk show. The fears of two children did not respond in any obvious way. Neither was actively engaged in the proceedings. This suggests the strong possibility that the two responders were more strongly influenced by the demand characteristics of the public demonstration. This failure to control for response to demand characteristics makes it impossible to determine what led to the change in these children.

There are several problems interpreting the demonstration involving the boy with the fear of lobsters. First, Dr. Callahan taps at two distinctly different points on the back of the boy's hand during the gamut sequence component of the treatment. The change in tapping points appears inadvertent. Regardless, the second point is clearly not the gamut point. So, for much of the treatment, tapping does not occur at the proper spot. Second, the boy startles at the lobster and remains somewhat fearful of it after the treatment (though improved according to his brother's report). There is no evidence that his fear is gone, just that it is being managed in more socially appropriate ways. The boy's behavior can easily be ascribed to "tightening his belt" because he is on national television.

There are several problems interpreting the demonstration involving the boy with the fear of getting his hair cut. First, we do not see him being treated. Second, his mother reports that he is afraid of the noise of the clippers, yet, when he is getting his hair cut at the end of the program, the barber is not using the electric clippers. If his fear really is of the buzzing clippers, then the demonstration is practically useless. Third, Leeza describes the barber who is successfully cutting the boy's hair as a specialist in cutting children's hair. Perhaps the barber - experienced in making children comfortable during haircuts - is to be given the credit for helping the child.

There are also significant problems interpreting the demonstration involving the boy with the fear of loud noises . This boy was only partially treated and showed "50% improvement" according to his mother. The partial treatment consisted of tapping under the eye and tapping on the boy's back rather than under his arm. His mother clearly misses the acupoint under the arm. Nevertheless, she reports 50% improvement in the boy's response - but she bases her assertion on the boy's apparent lack of a reaction to the clapping of the audience. Problematically, we have no reason to believe that the boy ever demonstrated fear of clapping or that his fear of loud noises - and apparently of loud toys in particular - was ameliorated in any way.

Dr. Callahan uses the Leeza show as an example of his assertion that people will not see what they do not believe in. For me, it serves as a warning that it is all too easy to see just what one wants to see - whether it is there or not. In his response, Dr. Callahan suggests that the observed results of TFT are so obvious as to not require controlled investigation. A careful description of the clinical demonstrations performed on the Leeza Show reveals why this argument from obviousness must be rejected. Without careful controls, we cannot really identify what - if any component - of TFT works and why.

In conclusion, Dr. Callahan's response to my review has not provided any clarification of the difficulties involved in understanding TFT. We have no additional data nor additional insight into already existing data. We have yet to be provided with convincing evidence that TFT works. Even assuming that TFT does work, Dr. Callahan's complex practical and theoretical system with its multi-tiered clinical hierarchy is overelaborated and undocumented. His system is based on suspect diagnostic practices for which he offers no documentation of reliability or validity. Further, his theory remains too speculative to be helpful in understanding the phenomena. Nonetheless, clinical reports of impressive successes continue to appear from practitioners of TFT (and from practitioners of similar tapping therapies such as EFT). These clinical reports merit serious consideration - the kind of serious consideration that can come only with careful research and critical thinking.

References

Callahan, R.J. & Callahan, J. (1996). Thought Field TherapyTM (TFTtm) and trauma: Treatment and theory. TFT Training Center, Indian Wells, CA.

Hsieh, C.Y. & Phillips, R.B. (1990). Reliability of manual muscle testing with a computerized dynamometer. J Manipulative Physiol Ther, 13(2), 72-82. Abstract available from Medline. Unique Identifier: 90171818.

Kenney, J.J., Clemens, R., & Forsythe, K.D. (1988). Applied kinesiology unreliable for assessing nutrient status. J Am Diet Assoc, 88(6), 698-704. Abstract available from Medline.

Klinkoski, B. & Leboeuf, C. (1990). A review of the research papers published by the International College of Applied Kinesiology from 1981-1987. J Manipulative Physiol Ther, 13(4), 190-194. Abstract available from Medline. Unique Identifier: 90278258.

Lawson, A. & Calderon, L. (1997). Interexaminer agreement for applied kinesiology manual muscle testing. Percept Motor Skills, 84(2), 539-546. Abstract available from Medline. Unique Identifier: 97260727.

Peterson, K.B. (1996). A preliminary inquiry into manual muscle testing response in phobic and control subjects exposed to threatening stimuli. J Manipulative Physiol Ther, 19(5), 310-316. Abstract available from Medline. Unique Identifier: 96384432.

Ross, S., & Buckalew, L.W. (1985). Placebo agentry: Assessment of drug and placebo effects. In L.White, B. Tursky, & G.E. Schwartz (Eds.), Placebo: Theory, research, and mechanisms (pp.67-82). New York: Guilford.

White, L., Tursky, B., & Schwartz, G.E. (1985). Placebo: Theory, research, and mechanisms. New York: Guilford.

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