Dear Doctor David,
I am interested in your Scared Stiff anxiety workshop, as 95% of my primary care patients deal with this in some way, and I would argue that it is more common and in some ways more harmful than depression. I am a fan of CBT.
Question: is TFT (“tapping”) a lot of hooey or is there something to it? I have had some good personal experience, and would like to use it with primary care patients because I like simplicity and something that I can teach the patient to use at home (like deep breathing technique or affirmations). I like tools that the stressed patient can do RIGHT NOW, without an appointment or prescription, without spending money, without regard to insurance status, without needing more than 2 or 3 minutes, and without depending on an external source like the bottle of Jack, the pill (legal or otherwise), the partner, the “provider”, etc.
I respect your work, and you are an MD. I would appreciate your thoughts on the TFT technique.
Dr. David’s Answer
Thank you for your question. TFT and EMDR combine something new (like tapping on your eye brow or jiggling your eyes back and forth) with exposure techniques that have been around for decades. I am skeptical that these types of distraction add much, if anything, to good, old-fashioned exposure. You can read about “Tapping” TFT if you click this link and you can read about EMDR at if you click this link
When I treat anxiety disorders, I combine a wide variety of exposure techniques with cognitive techniques, motivational techniques, and the Hidden Emotion Technique. You can read about these four treatment models in my book, When Panic Attacks, or in my psychotherapy eBook. I do not use eye jiggling or tapping on body parts during exposure, and have not found them to be necessary for outstanding or even dazzling results.
In my psychotherapy eBook I have a chapter entitled “The Clinician’s Illusion.” This refers to various ways that therapists and researchers fool themselves into believing things that may not be true. One problem I describe is called “coupling.” That’s where you combine an old, established technique, such as exposure, with some new technique, like eye jiggling or tapping on the eyebrow or whatever. Of course, exposure can be remarkably helpful, but you may mistakenly attribute the clinical improvement to the new technique that you are “coupling” with the older and more established technique.
In some cases, therapeutic enthusiasm may be due to the illusion of “seeing is believing.” If you use one of these newer techniques and your patient improves, it is natural to conclude that the treatment worked and that they theory is valid. But the special component you are using (such as eye jiggling, rhythmic knee tapping, or eyebrow or clavicle tapping) may, in fact, just be hooey, to use your language. The patient probably improved because of the exposure, and not because of the new component. Unfortunately, it is really easy for us to become “true believers,” especially if some new treatment is skillfully and aggressively marketed. Then we get invested and don’t like to be challenged, but challenging our thinking is the basis of science.
Another potential problem that confuses therapists and researchers alike is the placebo effect, which can be powerful. What’s the placebo effect? If people strongly believe something will help, it has a good chance of helping, even if it is nonsensical. When patients take an antidepressant and recover, or try some new treatment and recover, we think the pill or the therapy was the effective ingredient—but in most cases, the improvement is just due to the placebo effect.
I used to joke in workshops that we could create a new “ear tugging” school or psychotherapy, based on tugging on the ear lobes to let the evil spirits and pressures out of the brain, so the brain can get back into a proper balance again. I used to say that if you could get your depressed patients to believe in this notion, 35% to 50% would recover in three weeks as a “result” of their ear-tugging, especially if they work hard and do their five minutes of “ear tugging” homework every night. But in reality, it would just be the placebo effect.
Therapists in my workshops seemed to get a kick out of this example and laughed when I illustrated “ear tugging.” However, several years later a physician approached me during one of the breaks at my workshop, and asked if I’d heard about a fantastic new treatment for depression and anxiety. He had literature promoting the new treatment and wanted permission to distribute it. He swore that the new treatment had a 90% success rate and worked almost immediately.
I was intrigued and asked what the treatment was. He said it was called “Ear Tugging.” This is the honest truth. And he had paid quite a lot of money to attend a training program in this new “treatment!”
We all want to believe in something. People who challenge our beliefs are sometimes punished. In part, that’s probably why Socrates was put to death and forced to drink the poison hemlock–the people of ancient Greece did not want their cherished beliefs challenged.
Well, I’m no Socrates, and my thinking about TFT and EMDR may not be fair or accurate. It’s just my take on things, and I want to apologize ahead of time if I am way off-base. I’m just sharing my own thinking, for what it’s worth, but remember that I don’t know all the answers, and often my point of view is wrong.
Please let me know if I can post your interesting question, and my reply, on my website.
All the best,
David D. Burns, M.D.
Dr. Burns —
I’m happy to be part of your online discussion, and thank you for this thoughtful perspective – I appreciate it very much!
Didn’t Galileo face a similar problem as Socrates when he proposed that the Sun and not the Earth was the center of the world? There is so much we don’t fully perceive and thus can’t understand, and so much associated fear.
I think it is important and interesting to collaborate broad-mindedly in figuring out what works, and in differentiating the genuinely effective intervention from its lucky-underwear surroundings.
These effectiveness questions are interesting and important, because isn’t the use of science-based exploration how CBT evolved into TEAM and how things improve generally? I think so, and I am glad I asked you.
I come from a long line of people with depression and some bipolar as well, as well as apparently menopause-induced psychosis. That’s why I have always been interested in exploring what helps and what doesn’t and why.
Revolutionary to me was the idea that you are more than your thoughts, and that it is possible to change your frame of mind by working with the content of your thoughts. The shift from a negative to a positive orientation through thoughts and behaviors over which one has some control has been enormously helpful to me and makes so much sense.
So thank you!
And thank you for this response, and I will hope to attend one of your workshops in the future.
Dr. David’s Second Response
You are so right. There were decades of suffering due to the Copernican revolution. And you are right that therapy methods can evolve rapidly, just as computer chips keep getting faster and better. Every week we develop new treatment and training techniques at my weekly training groups at Stanford and other locations around the SF Bay region.
Getting quantitative feedback from every patient at every session is tremendously helpful, both from a clinical and from a research perspective, because you can see what really works, and what does not.
I hope to meet you at an upcoming workshop!
All the best,
David Burns, MD