MICHELE NORRIS, Host:
From NPR News, it's ALL THINGS CONSIDERED. I'm Michele Norris.
MELISSA BLOCK, Host:
And I'm Melissa Block.
After Hurricane Katrina, hundreds of well-meaning mental health professionals descended on the Gulf region to help a traumatized population. For the most part, they did a tremendous amount of good, but there are some mental health workers who were using untested therapies, and that is causing concern.
NPR's Alix Spiegel tells us about one controversial treatment called thought field therapy, which is being used to help victims of Katrina in New Orleans.
ALIX SPIEGEL: When Sherry Pelagal (ph) arrived for her therapy appointment, her hair wasn't brushed and there was a slightly wild look in her eyes. She'd spent the previous night without sleep, watching her sick dog labor for breath and fighting back waves of panic. The morning light didn't ease her anxiety. In fact, it seemed to have intensified.
NORRIS: I'm just like, what else, you know? What else can you take? You know, your city's a mess, my house is a mess, I don't have a job, and now my last little dog is getting ready to die, too, if she makes it through the night. I'm full of anxiety, and I am just an emotional wreck.
SPIEGEL: A small gray-haired man with a trimmed beard and soothing voice sat on the couch beside her. Herb Aris had traveled to New Orleans with a group of thought field therapists. They had been invited by Charity Hospital, one of the city's most prestigious medical institutions, to treat the hospital staff, many of whom appeared to be struggling with depression, anxiety and post-traumatic stress disorder in the wake of Katrina.
That actually is how Pelagal found herself sitting beside Aris. Before she was an emotional wreck, Pelagal was a nurse at Charity, a calm cool presence in the midst of chaos, but no longer. And after listening to her short explanation, Aris asks to get started.
NORRIS: What problem do you want to work on specifically?
NORRIS: I don't know, Herb, would it be sadness? Is it anxiety or fear of the unknown?
SPIEGEL: They decided to concentrate on despair. Aris asked Pelagal to stand facing him, her feet shoulder length apart, her eyes closed.
NORRIS: The first thing I need you to do is to think about the problem or upset.
SPIEGEL: Pelagal stood, silently conjuring her private image of despair. Then Aris asked her to raise her hand to her face.
NORRIS: I want you to tap on the side of your eye, right over here. Okay, okay, good.
SPIEGEL: After tapping the side of her eye, Aris asked her to do the same to her collarbone, the tip of her eyebrow and the bone under her arm.
NORRIS: Okay, tap on the side of your hand.
SPIEGEL: After five minutes of tapping, Aris paused, looked at his patient.
NORRIS: What's happening to you right now?
NORRIS: I'm feeling relaxed and my shoulders are starting to relax and it doesn't seem so overwhelming.
SPIEGEL: Still they continued, tapping the brow, the collarbone, hand, ribcage in a careful deliberate sequence. They spoke very little and after 10 full minutes Aris declared the therapy session over. Pelagal's anxiety and depression, he explained, would trouble her no more.
NORRIS: Your affect, or feeling level, is back to where it should be.
NORRIS: The distress associated is not going to be there.
NORRIS: Right, that feeling of overwhelmed, I can't cope, I'm scared.
NORRIS: I'm, I gotcha.
NORRIS: I gotcha.
SPIEGEL: Thought field therapy, also known as TFT, is a fringe psychological treatment, one of many practiced throughout the United States with very little challenge from the major mental health associations. The concept behind TFT is that mental illness is the product of disturbances in what practitioners call thought fields and that tapping on a series of acupuncture-type points in the body will free the sufferer from emotional pain.
According to the creator of thought field therapy, psychologist Roger Callahan, major problems like depression can be cured with this method in rapid time.
D: It depends on the individual, but an average case of depression is usually less than 15 minutes.
SPIEGEL: Post-traumatic stress disorder, he claims, is also easily dispatched in 15 minutes. Anxiety, addiction, phobias, even the most serious cases, Callahan says, are subject to quarter-hour cures.
D: It's really remarkable the number of things we can successfully treat. We just successfully treated malaria down in Africa.
SPIEGEL: But many mainstream mental health professionals are skeptical of Callahan's claims. James Herbert is a psychology professor at Drexel University who recently wrote a review of what little research exists on the efficacy of TFT.
D: So I would say that the scientific status of thought field therapy is basically nonexistent. There is no evidence that it does what it claims to do.
SPIEGEL: The American Psychological Association agrees with Herbert. Their official statement describes TFT as an approach that "lacks a scientific basis." Nevertheless, in the chaotic aftermath of catastrophes like Katrina, where need is great and conventional mental health providers are scarce, James Herbert says fringe treatments like TFT often flourish.
NORRIS: That's clearly the case, that fringe therapies do flourish in the aftermath of trauma. This happened after 9/11 and it's certainly happened after Katrina.
SPIEGEL: In the aftermath of 9/11, a controversial approach called debriefing was widely practiced. Research has since found the method to be of uneven benefit, and in some cases actually harmful. But it's important to note that at the time, there were many anecdotal reports that recipients of the therapy found it useful. Likewise in the case of Katrina, the staff of Charity and other organizations served by TFT therapists have appeared to find TFT beneficial. This is Ecoy Rooney (ph), a nurse at Charity who helped to arrange a series of group therapy sessions for the staff.
NORRIS: We had 87 of our staff members go through the training out of the 300 that are there. And overwhelming response, people were sending other people.
SPIEGEL: Rooney says that following the therapy sessions, she was inundated with positive e-mail about TFT. And even the CEO of Charity, Dwayne Thomas, contacted NPR in order to testify that he found the sessions beneficial. These anecdotal reviews, however, should probably be viewed with a certain amount of skepticism, as is demonstrated by the story of Monica Pignotti.
Monica was a leading practitioner of thought field therapy who later became a critic. She said she first heard of TFT through a web site for mental health therapists.
NORRIS: So many people were talking about it and just raving about it. I thought well I'll just get this over with and try it, then I can say I've tried it and that will be that.
SPIEGEL: Though Pignotti began as a skeptic, after a month of using the therapy, she began to change her mind.
NORRIS: I was getting, apparently, really good results where people were reporting their problems were instantly eliminated, different phobias, traumas, that kind of thing. And that interested me in taking further training.
SPIEGEL: Pignotti took a basic class, became convinced that TFT worked and decided to do even more. In Callahan's TFT, there are a series of levels of techniques for therapist to learn.
NORRIS: It goes all the way up to his precision voice technology, done over the telephone, that he claims has a 98 percent success rate, and he charges people $100,000 to train in this voice technology. And he charges clients up to $600 an hour to receive voice technology.
SPIEGEL: Pignotti took these classes. In fact she's one of the only therapists Callahan trusted enough to teach the technique without his supervision. But she can't describe the theory behind voice technology therapy for NPR. As a trainee, she signed a contract promising not to disclose Callahan's trade secrets. But she says that as time went on, she began to notice troubling contradictions in the therapy.
NORRIS: And so that was what led me to wondering if any of the sequences were valid or if it was just suggestion that maybe people knew they were going to get this precise, wonderful technology and that was what made them have success with this treatment.
SPIEGEL: To clear her doubts and test the effectiveness of TFT, Pignotti decided to conduct a controlled study. She divided a pool of clients into two groups. She gave one group the series of tapping points that Callahan had designed. And the other group she gave a sham treatment.
NORRIS: And the sham treatment was simply treatment points that I drew randomly, that I selected, in any old order and I did these, and I got exactly the same results.
SPIEGEL: In both cases, 97 percent of the clients self-reported that their problems had been cured. But since the sham treatment performed as well as the "real" treatment, Pignotti came to see the self-reports as a product of the placebo effect.
D: Suggestion can be a very powerful thing.
SPIEGEL: Roger Callahan, of course, dismisses this explanation.
D: You don't take people from the depths of despair and depression in a few minutes or horrible phobias by any kind of placebo. I think most of the placebo talk is nonsense.
SPIEGEL: But Drexel psychology professor James Herbert agrees with Monica Pignotti. He says that the placebo effect is tremendously powerful, particularly when people get treatment in a ritualized medical setting.
D: Pretty much, anything that you do, if you sit and talk with somebody, and especially, if you have sort of a ritualized thing that you do with them, that's likely to generate some positive expectations for improvement, and so some short-term subjective effects.
SPIEGEL: But, he points out, placebo effects from pseudotherapies wear off in a way that tested therapies won't, and there's potential dangers, he says, when people in genuine psychological trouble use questionable therapies instead of empirically tested ones.
NORRIS: It would be analogous to someone who needs chemotherapy or radiation for cancer drinking grapefruit juice instead.
SPIEGEL: Despite the skepticism about TFT therapy that both Herbert and Pignotti share, neither feel that TFT practitioners are intentionally trying to mislead anyone. On the contrary, they're so desperate to help, Monica Pignotti says, that they've suspended their critical judgment.
NORRIS: I don't think Dr. Callahan is intentionally scamming anyone in terms of he really believes that this works, and his sincerity certainly came across, as did the sincerity of almost all the people that are practicing, I mean, I want to say this up front. The people that are working with survivors of Katrina, I know most of these people personally, and they're very compassionate, well-intentioned people who really do want to help, but I think they just got too invested in the whole thing and lost their objectivity completely and have not done the proper scientific studies to support their claims.
SPIEGEL: As for Sherry Pelegal, the Charity nurse treated by Herb Aris for anxiety and other problems, several months after the therapy, she reports mixed results. She liked the sessions, thought that the therapy helped her to stop eating late at night and also help relieve her anxiety, or anyway, helped to relieve her anxiety at first. She says that after several weeks, her feelings of panic returned.
There were anxiety attacks and some late-night sessions at the refrigerator, but Pelegel blamed herself for these slips, though Roger Callahan, the creator of TFT, has said that short sessions can eliminate problems forever. Pelegel was under the impression that it was important to continue tapping, and so she blamed her lack of success on her own inability to tap enough. It was, she says, her fault.
NORRIS: I find that, you know, I don't tap like some of the other people that were there. They seem to tap more often, and I'm probably not a good patient.
SPIEGEL: This past week, another group of TFT therapists returned to New Orleans for additional sessions. Herb Aris says that the group worked again with Charity, with Children's Hospital, Volunteers of America and several other organizations.
Alix Spiegel, NPR News.
BLOCK: There's a sample TFT treatment sequence, plus a closer look at the question surrounding the scientific basis of the therapy, at our web site, NPR.org.