Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Sunday, February 15, 2015

Mindfulness in Early Intervention, Sure; Tapping, No

The publication Zero to Three makes a point of connecting science, policy, and practice related to work with young children, and for several decades it has done a good job of this. But occasionally somebody slips, either in writing or in the review process, and something emerges that cannot be called science-based.

That has happened in an article in the January 2015 issue (Shahmoon-Shanok, R., & Stevenson, H.C. [2015]. Calmness fosters compassionate connections: Integrating mindfulness to support diverse parents, their young children, and the providers who serve them. Zero to Three, 36(3), 18-30). The authors spend pages emphasizing the role of mindfulness and calm in allowing us to be aware of the thoughts and needs of other people—and no one can argue with the idea that a person who is not calm is likely to misread others’ communications and behave in ways that are mistaken and noncompassionate. An angry or fearful caregiver can do a very poor job, especially with children whose communications are hard to understand.

But--  by page 25 it becomes clear that one of the authors has a curious take on mindfulness. Not only does she connect awareness with EMDR (Eye Movement Desensitization and Reprocessing), a form of psychotherapy based on an implausible theory and with weak empirical support, but she favors the methods of one Laurel Parnell, author of Tapping in: A step-by-step guide to activating your healing resources through bilateral stimulation. (Boulder, CO: Sounds True [sic]). And yes, this means actual physical tapping.

The Zero to Three article advises using Parnell’s technique, and describes a situation where an early intervention worker was having difficulty helping an undocumented Mexican immigrant mother who complained a great deal (and had much to complain about!). Her EI worker had been in the habit of asking the client to give more and more information about each of her complaints. But, after learning about Parnell’s technique, the EI worker instead asked the woman to describe where she felt tension in her body and guided her to breathe deeply and relax. The worker then asked for a description of a “safe place”—a time when the mother had felt safe and optimistic. Following a description of being in her grandmother’s lap, the EI worker guided the woman to remember sensations and smells she associated with the sense of safety.

And here’s where the “tapping” comes in. “Once the mother elaborated these sensory details, the worker said ‘Let’s tap this in’…, alternating tapping her feet on the floor, or her hands on her thighs. The worker smiled and said, ‘When you tap one side of your body and then the other, you make this happy memory of your yaya even stronger. This is a good place to go when you’re upset. She’s right there to help you calm down and feel better. You can practice this coming week and when I come next time, we’ll practice some more” (Shamoon-Shanok & Stevenson, 2015, p. 21).

Sounds harmless, even pleasant, doesn’t it? So why am I concerned that this practice is being presented as scientifically supported through publication in Zero to Three? The first reason is simply that there is no scientific evidence that these methods are effective. There have been lengthy arguments about EMDR, the claimed source of the “tapping” technique, and these have concluded that to the extent that EMDR is an effective treatment, it is so because it shares various factors common to all effective psychotherapies, such as interaction with a warm and supportive therapist or helper. The specific methods of EMDR--  eye movement and other forms of bilateral stimulation--  are probably irrelevant to the outcome of the treatment. Similarly, while it was comforting for the mother described earlier to think of a pleasant and safe memory, and while this was a positive experience which might help her stay calm and responsive to her children, “tapping it in” had nothing to do with the outcome.

Telling either the mother or the EI worker that bilateral tapping is magically helpful is not only untrue, but encourages them to think about mental processes in inaccurate ways and thus opens them to consideration of treatments that are potentially harmful in either direct or indirect ways. In addition, the stress on tapping distracts people from using evidence-based treatments that they may find more challenging than the simple ritual they are offered. A persuasive analogy to computer programming is employed when the EMDR language of “installation” is used.

Where does the tapping ritual come from? Parnell references the writings of Francine Shapiro, originator of EMDR, and her claim that when the body is bilaterally stimulated this experience hastens the “processing” of negative thoughts and events. Shapiro apparently based this claim on her experience when walking in the woods one day and moving her gaze back and forth while brooding on an unhappy memory. After her walk, she felt better--  which she attributed not to the passage of time or a pleasant walk, but to the fact that she had been moving her eyes back and forth. Because she naturally had been using both eyes in a coordinated fashion, she decided that it was the bilateral movement that did the trick.

Now, it’s nice that Shapiro felt better, but how could she not have been experiencing bilateral movement, during her walk or at almost any other time in her life? Except for people who have lost an eye or have paralyzed eye muscles on one side, all of us are coordinating our right and left gazes at all times, whether by changing the direction of the gaze to one side or the other or by converging or diverging the eyes as we look at nearer or more distant objects. Similarly, the act of walking involves bilateral coordination, as one foot takes up the body weight transferred from the foot that is taking a step. Simultaneously, the shoulders and torso counter-rotate in order to maintain the body’s balance as a foot is lifted; the counter-rotation in turn causes the arms to swing back and forth in opposition to the legs’ movements. We are all doing this all the time, so Shapiro’s  and Parnell’s claims that EMDR uses a specialized technique can hardly be supported.

The idea that bilateral activity is special and magical seems to have derived from the claims of the alternative practitioners Doman and Delcato in the 1960s. These people argued that the movement of crawling involved bilateral action as walking did not (but see above), and that this bilateral action provided sensory feedback that acted to “build” the brain. Those who had brain-related disorders such as autism or cerebral palsy must not have had enough bilateral movement, and they could be cured by being forced to crawl, or subjected to “patterning” in which helpers moved the patient’s head, legs, and arms in ways that imitated reflexive crawling movements of very young infants. It has been well known for many years that these methods are completely ineffective, but the appeal of bilateral stimulation persists and the na├»ve are still easily sold on this idea.

Another book by Parnell, A therapist’s guide to EMDR (W.W.Norton), provides another insight into the “tapping” approach. Parnell’s “tapping in” is clearly related to the various energy therapies such as Thought Field Therapy and Emotional Freedom Technique, where physically tapping at certain points on someone’s body and at certain rates of speed are expected to free the individual from emotional distress. This practice appears to be based on the idea that the human body has  “meridians”--  lines that enable the flow of psychic energy or qi and which if blocked will cause unpleasant psychological experiences. Tapping at a given rate of speed on a given meridian is claimed to release qi to flow appropriately. In spite of various efforts to test these claims, there is no evidence that energy therapies employ tapping to good effect, and of course the theories behind that use of tapping are implausible in terms of the accepted foundations of the scientific study of psychology.

Of course it is tempting to say that if the mother described earlier liked tapping, she should get to have it—until we question whether public funds should be expended on ineffective treatments.. The mother and her EI worker may well feel that if she feels better following her tapping experience, her improvement must have been caused by that experience, and the treatment should be not only allowed but encouraged. However, today’s standards for how we spend scarce public resources are much more stringent than that, and professionals on the whole turn to scientific evidence to help decide whether a method is actually effective. I hope that in the future Zero to Three’s reviewers will also take that approach.  




9 comments:

  1. Jean:

    Have a question.

    This bilateral: is it the same as binaural which I seem to have been hearing about in the last two weeks?

    Challenge and ritual - important aspects of human development; central to child development.

    And when you talked about the things we do all the time in terms of motor and sensory stimulation as general, not specialised - that did strike a chord or two.

    What was W W Norton doing publishing such a book? Knowing that press for semi-academic or academic books - it is such a come-down!

    And isn't qi just steam from rice? [at least its character]. What do they think about rice and food play?

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    1. They seem to think that stimulating both sides of the body (bilateral stimulation) in any way has magic effects, and I think that would include binaural (both ears) stimulation. However, messages to the left ear are carried to both the left and the right sides of the cortex, and same for the right ear, so I'm not sure how binaural stimulation would be special, except that it allows us to tell which direction a sound is coming from.

      I was shocked to look at the W.W. Norton site and see what junk they are listing. I suppose the thing is that publishing is a business, and they are bringing out what they think will sell. But it's a shame to see a respectable publishing house go in this direction.

      The term qi, as used here, refers to "spiritual energy" which supposedly resides in the spine and needs to circulate freely. I think the term must have many meanings-- steam from rice is an interesting one, and you can see the analogy!

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  2. From memory, Jean, I thought you would have this quite straight. Your early work [1968-1971] was on such sensory stimulation and its effects on infant and adult development.

    Yes, this "walking/hearing/seeing/eating" in both directions can be quite "mystical".

    Here is an article that Australians in infant development are thinking about profusely:

    Does controlled crying really work? Hooton 2015: Sydney Good Weekend Magazine, Fairfax Media

    Raises issues of early intervention and parental training and mindfulness such as we have discussed.

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    1. Yes, I probably would remember if I had done that kind of work! Maybe you're confused by the titles of some of my papers from way back when. They didn't involve infants, or effects on development, but they were about the temporary effect of some kinds of stimulation on specific perceptual abilities-- like being able to tell what is straight ahead of you, or being able to identify vertical or horizontal lines as they really are, rather than making the mistake of choosing one that is tilted just a tiny bit. These effects last only briefly and are apparent only when a person has very little else to look at or listen to.

      Thanks for sending the link-- I will have a look at it.

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  3. There's a whole subset of delusional self-proclaimed trauma mamas who swear by tapping:
    http://ramblingsofatraumamamma.blogspot.com/2012/04/tapping-and-healing.html?m=1

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    1. To quote "The Color Purple": "it all just too triflin and confuse". It's gotten to the point where I get the creeps when I see the word "healing"-- it always seems to be associated with some cockamamie idea. Yet, I am finding it very difficult to get American Psychological Association members interested in the idea that we need to fight back actively.

      Thanks for this one too (although I did not wish to know about it!).

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  4. When I was in therapy for a short time a few years ago, my therapist tried to do EMDR on me. It didn't seem to work, but it probably wasn't a fair test as I couldn't stop laughing when she was doing it!

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    1. Sounds like it cheered you up anyway!

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