Mental Help: Procedures to Avoid
Stephen Barrett, M.D.
Many types of practitioners who profess to treat mental problems are engaged in questionable practices. The following procedures should be avoided.
Auditory Integration Training (AIT)
AIT was developed as a treatment for autism by Guy Berard in France in the 1960s and was introduced into the United States in 1991. It has also been advocated for children and adults with learning disabilities, attention deficit disorder, depression, migraine headaches, and many other conditions. Proponents claim that individuals with these disorders often have hearing that is disorganized, hypersensitive, different between the two ears, or otherwise abnormal. The first step in AIT is an audiogram that determines the auditory thresholds to more frequencies than are typically measured during hearing tests. Suitable individuals then undergo "training sessions"—typically two half-hour sessions per day over a 10-day period—that involve listening to music that has been computer-modified to remove frequencies to which they supposedly are hypersensitive. The American Academy of Pediatrics and the American Academy of Audiology have warned that no well-designed scientific studies demonstrate that AIT is useful [1,2]. AIT devices do not have FDA approval for treating autism, attention deficit disorder, or any other medical problem. In 1997, the FDA banned the importation of the Electric Ear or any other AIT device made by Tomatis International, of Paris, France.
This approach, also called "patterning," was developed during the mid-1950s and is offered at the Institutes for Human Potential in Philadelphia, Pennsylvania. Its proponents claim that the great majority of cases of mental retardation, learning problems, and behavior disorders are caused by brain damage or "poor neurological organization." The treatment is based on the idea that high levels of motor and sensory stimulation can train the nervous system and lessen or overcome handicaps caused by brain damage. Parents following the program may be advised to exercise the child's limbs repeatedly and use other measures said to increase blood flow to the brain and decrease brain irritability. In 1982 and 1999, the American Academy of Pediatrics issued position statements concluding that "patterning" has no special merit, that its proponents' claims are unproven, and that the demands on families are so great that in some cases there may be actual harm in its use [3,4]. The National Down Syndrome Congress has endorsed the 1982 statement and published it on its Web site. In 1996, neurologist Steven Novella, M.D., reviewed the scientific literature and concluded that "patterning" was a pseudoscience .
EMDR is promoted for the treatment of post-traumatic stress, phobias, learning disorders, and many other mental and emotional problems. The method involves asking the client to recall the traumatic event as vividly as possible and rate certain feelings before and after visually tracking the therapist's finger as it is moved back and forth in front of the client's eyes . EMDR's developer and leading proponent, Francine Shapiro, Ph.D., received her nonaccredited doctoral degree in 1988 and established the EMDR Institute to train mental health professionals. She and her associates have trained more than 22,000 clinicians worldwide in workshops that in 1997 cost $385 . EMDR resembles various traditional behavioral therapies for reducing fears in that it requires clients to imagine traumatic events in a gradual fashion in the presence of a supportive therapist. However, controlled research has shown that EMDR's most distinctive feature (visual tracking) is unnecessary and is irrelevant to whatever benefits the patient may receive . Recent reviews have concluded that the data claimed to support EMDR derive mostly from uncontrolled case reports and poorly designed controlled experiments and that the theory of EMDR clashes with scientific knowledge of the role of eye movements [9,10].
This is a process in which a "facilitator" supports the hand or arm of a severely handicapped person who spells out a message using a typewriter, a computer keyboard, or other device containing a list of letters, numbers, or words. It is alleged to help individuals strike the keys they desire without influencing the choice of keys. Some speech therapists and other special-education providers are using this procedure for nonverbal individuals with autism or severe mental retardation. Proponents claim that it enables such individuals to communicate. However, many scientific studies have demonstrated that the procedure is not valid because the outcome is actually determined by the "facilitator." [11,12] In one study, for example, autistic patients and facilitators were shown pictures of familiar objects and asked to identify them under three types of conditions: (a) assisted typing with facilitators unaware of the content of the stimulus picture, (b) unassisted typing, and (c) a condition in which the participants and facilitators were each shown pictures at the same time. In this last condition the paired pictures were either the same or different, and the participant's typing was "facilitated" to label or describe the picture. No patient gave a correct response when the facilitator had not been shown the picture. The researchers concluded that the facilitators were not aware that they were influencing the patients . The American Psychological Association has denounced facilitated communication and warned that using it to elicit accusations of abuse by family members or other caregivers threatens the civil rights of both the impaired individual and those accused . In 1994, the FTC settled charges that two companies had made false and unsubstantiated claims about "facilitated communication" devices they had marketed.
This approach is based on the notion that learning disorders, childhood psychoses, mental retardation, cerebral palsy, bedwetting, and colorblindness are related to muscle imbalances caused by misaligned skull bones. NOT, a variation of cranial therapy, was developed by New York chiropractor Carl Ferreri and has been taught to hundreds of other chiropractors. Its proponents claim to correct "blocked neural pathways" by "adjusting" the bones of the skull with pressure to various parts of the head. NOT came to public attention when chiropractors subjected children to it in a "research" project sponsored by school officials in California. A 1988 report in Hippocrates magazine described how children with epilepsy, Down's syndrome, cerebral palsy, dyslexia, and various other learning disorders were forced to endure painful pressure against their skull, roof of the mouth, and eyes. One parent complained that pressure against her son's eye sockets had caused a seizure . In 1991 a jury ordered Ferreri to pay $565,000 in damages to seven children and their parents who had filed suit for physical and emotional pain related to the treatment. Two other chiropractors involved in the case settled out of court for a total of $207,000.
NET is another chiropractic approach focused on "releasing patients' emotional blocks stored in the body's memory." Its developer, Scott Walker, D.C., of Encinitas, California, describes NET as "a body-mind way, a non talk-it-out way, of dealing with emotional aberrations."  Its proponents claim that everyone has such blocks and that the body "replays" these old memories, which can adversely affect health . According to a recent article, when chronic patients do not seem to get better over a course of treatment, and where structure, nutrition and "toxicity" have been addressed, NET practitioners look for a "Neuro Emotional Complex (NEC)" that they feel is preventing healing. The practitioner uses muscle testing (applied kinesiology) to "isolate a troublesome event"; asks the patient to hold in mind a "snapshot" of the emotional state while the chiropractor adjusts the patient's spine and acupuncture points; and prescribes supplement products and homeopathic remedies. Walker states that during the ten years he has been teaching the technique, 2,700 health care practitioners (mostly chiropractors but some physicians, psychologists and dentists) have learned it, and most use it regularly in their practice. According to Walker, "the reason homeopathy works so well is that it allows the body to remember what toxins it needs to get rid of in order to reestablish homeostasis." He also says that although psychotherapy is valuable, an "emotional memory locked in the body" can't be resolved through therapy alone . The ONE (Our NET Effect) Foundation was incorporated in 1993 "to help NET practitioners scientifically validate their technique, promote their practices, and bring NET to the world." 
Neurolinguistic programming (NLP) is a variable system of procedures purported to enable people to communicate more effectively and influence others. It is said to involve modifying the patterns or "programming" created by interactions among the brain (neuro), language (linguistic), and the body that produce both effective and ineffective behavior. Proponents claim that NLP has cured phobias, allergies, and other problems in one or a few brief sessions. Its core postulates are: (a) people are most influenced by messages that reflect how they internally represent whatever they are doing; and (b) this representation is reflected by eye-gaze patterns, posture, tone of voice, and language patterns. The internal representation can be visual (picturing what they are involved with), auditory (hearing it sounded out), or can involve other senses. Proponents claim, for example, that a someone experiencing a mental image might use the words "I see," whereas someone in an auditory mode might say "that sounds right to me. Scientific studies have demonstrated no correlation between eye movements and visual imagery, reported thoughts, or language choices. A National Research Council committee has found no significant evidence that NLP's theories are sound or that its practices are effective .
Neurotherapy—also called neurofeedback and EEG neurofeedback—is a form of behavior modification that uses electroencephalographic (EEG) biofeedback technology to increase voluntary control over the amplitude and pattern of various brain wave frequencies. Proponents claim that modifying brain wave patterns is effective against anxiety reactions, mood disorders, substance abuse, attention deficit disorders and various other mental and emotional problems. Research shows that brain wave activity can be altered through various forms of biofeedback. However, a comprehensive review has concluded that none of these claims is supported by well-designed studies [20,21].
This approach is based on the idea that learning can be improved by exercises that improve coordination of the eye muscles or improve hand-eye coordination. Its proponents assume that the basic problem that leads to reading disability is some deficit in the visual system. The American Academy of Pediatrics and the American Academy of Ophthalmology have criticized this approach and cautioned that no eye-muscle defects can produce the learning disabilities associated with dyslexia . Dyslexia is a reading disorder characterized by omissions, faulty word substitutions, and impaired comprehension. It is not due to mental retardation, lack of schooling, or brain damage.
"Past-life therapy" is based on the notion that psychologic disorders arise from the influence of traumas and personality traits from previous lives intruding on the subconscious. Proponents of this approach use hypnosis, meditation, or guided imagery to "regress" the patient to alleged earlier incarnations ("past lives") that, when recalled, lead to resolution of the patient's problems. There is, however, no scientific evidence that this theory is valid.
Experiments have shown that "past-life" reports during hypnotic trances are related to the subject's suggestibility and proneness to fantasize. In one experiment, 35 out of 110 subjects who were asked to regress to times before their birth enacted "past lives." In most of these cases, their past-life personalities were the same age and race as themselves. In another experiment, half of the subjects were informed by researchers that previous incarnations were often a different sex or race and had lived in exotic cultures. Those who received this advice were significantly more likely to incorporate one or more of the suggested characteristics into their past-life descriptions. In another experiment, researchers found that subjects who gave information specific enough to be checked were much more often incorrect than correct. Past-life reports obtained from hypnotically regressed subjects are fantasy constructions of imaginative persons absorbed in make-believe situations and responding to regression suggestions—and that those who believe in reincarnation are the most likely to believe that such fantasies are related to an actual past life [23,24].
Personality tests are intended to reveal aspects of a person's view of self and others, along with interpersonal and emotional tendencies. Some psychologists use them routinely as part of their evaluation or treatment methods. However, most psychiatrists and many psychologists believe that the information gained is not cost-effective in terms of time, effort, and fees. A personality assessment should not be performed unless the assessor has a sound rationale for the instruments used.
Critics have expressed concerns that: (a) projective tests
are unlikely to reveal useful information that is not obtainable
by talking with the patient; (b) such tests may reflect the characteristics
of the person who does the scoring rather than those of the person
tested; (c) the testing process can convey an incorrect message
that the therapist can extract information and provide treatment
to a patient who does not participate actively in the treatment
process; and (d) there is little research evidence that projective
personality testing leads to more accurate diagnosis or better
treatment outcomes. A recent review concluded that the Rorschach
Inkblot Test, Thematic Apperception Test, Draw-a-Person Test (DAP),
Bender-Gestalt Test, Rozenzweig Picture-Frustration Study (PFS),
and Sentence Completion Test (SCT) are unlikely to contribute
information that cannot be obtained from simpler tests or from
other sources [25-27].
If sexual abuse during childhood is a factor in a person's upset, it is unlikely to be forgotten. However, patients who are suggestible or eager to please their therapist may "remember" childhood events that did not actually take place. Usually it is the therapist who stimulates this process, either deliberately or unwittingly. Occasionally, however, the patient (possibly inspired by a book or television talk show) initiates the problem and the therapist fails to help sort fact from fantasy. Some therapists encourage their patients to confront and possibly sue the alleged perpetrator.
Critics are using the term "false memory syndrome" (FMS) to describe the mental state generated in these situations. Psychiatrist Richard A. Gardner, M.D., identified several indicators which suggest that a "memory" is false. One is that the patient considers the revelation to be the turning point of her life and the answer to all of her psychologic problems. Another is that the alleged abuse took place after the child was six, was forgotten for many years, but is suddenly remembered in therapy. (Memory gaps of this type are not credible.) Yet another is a strong desire to seek widespread publicity .
The False Memory Syndrome Foundation (FMSF) was formed in 1992 to deal with the problem of adults who mistakenly believe that they were victims of incest or child abuse. The foundation has been contacted by thousands of distressed families for advice on how to cope with sudden attacks by angry children who accused them of misdeeds that may not have taken place. The burgeoning number of FMS cases has been called "the mental health crisis of the 1990s."  In 1997, FMSF tabulated the results of 105 false-memory malpractice suits filed by former patients against their therapists. One case was dropped, 42 were settled out of court, and 53 were pending. All nine that went to trial ended in a verdict favorable to the former patient . As of July 1999, the largest settlement was an agreement to pay $10.7 million to a woman who said she had been convinced by doctors that she had repressed memories of being sexually abused and of abusing her two sons . Additional information about false memories is available on the Web site of Elizabeth Loftus, Ph.D., a professor at the University of Washington.
TFT's founder, psychologist Roger J. Callahan, Ph.D., claims that TFT "provides a code to nature's healing system. . . . addresses their fundamental causes, balancing the body's energy system and allowing you to eliminate most negative emotions within minutes and promote the body's own healing ability."  The Callahan Techniques Web site also recommends dietary supplementation for persons who "suffer from multiple environmental sensitivities and even allergies which aggravate psychological problems." During TFT sessions, the therapist uses sequences of finger taps on "acupressure points" (primarily of the hands, face, and upper body) and the patient does repetitive activities (repeats statements, counts, rolls the eyes, hums a tune) while visualizing a distressing situation.
TFT is claimed to be nearly 100% effective in treating depression, phobias, and other psychologic problems. It is based on the notion that acupressure points are related to blockages ("perturbations") of "body energy" associated with physical or emotional illness. Proponents claim that the finger-tapping releases the blockages and increases to the body's energy flow. TFT's advanced techniques include muscle-testing (a variation of applied kinesiology) and "voice technology," in which the practitioner analyzes patients' voices over the phone and determines where the patients should tap themselves. "Voice technology" training for practitioners costs $100,000.
Emotional Freedom Technique (EFT), developed by a Callahan disciple named Gary Craig, is said to be a simpler version of TFT that works more quickly . Other variations include Tapas Acupressure Technique (TAT), Negative Affect Erasing Method (NAEM), Midline Energy Treatment (MET), Healing Energy Light Process (HELP), Energy Diagnostic and Treatment Methods (EDxTM), Getting Thru Techniques (GTT), Be Set Free Fast (BSFF), and Whole Life Healing (WLL), all of which are sometimes referred to as "emotional acupressure."
Critics have noted that TFT's underlying theories clash with established scientific knowledge and that studies alleging benefit have been poorly designed [34-37]. In 1999, the Arizona Board of Psychologist Examiners reprimanded a psychologist for using TFT and voice technology in his psychology practice  and the American Psychological Association's Continuing Education Committee notified CE providers that TFT courses will no longer be approved for continuing education credits . For further information, visit Debunking Thought Field Therapy.
Vagus Nerve Stimulation for Depression
The NeuroCybernetic Prosthesis System consists of a generator that is implanted under the collar bone like a pacemaker and connects by wire to the vagus nerve in the neck, where it delivers electrical signals to the brain. The device is FDA-approved and medically accepted for treating difficult cases of epilepsy. It is also FDA-approved for difficult-to-treat cases of depression, but serious questions have been raised about whether it should have been. The supporting evidence is slim, serious adverse effects (including deaths) have been reported, and research and promotional activities have involved individuals with undisclosed financial conflicts of interest [40-42].
Information on Other Sites
- American Academy of Pediatrics Committee on Children with Disabilities. Auditory integration training and facilitated communication for autism. Pediatrics 102:431-433, 1998.
- Executive Committee, American Academy of Audiology. Position statement: Auditory integration training. Audiology Today 5(4):21, 1993.
- American Academy of Pediatrics. Policy statement: The Doman-Delacato treatment of neurologically handicapped children. Pediatrics 70:810-812, 1982.
- American Academy of Pediatrics. Policy statement: The Treatment of Neurologically Impaired Children Using Patterning. Pediatrics 104:149-1151, 1999. Reaffirmed May 1, 2006.
- Novella S. Psychomotor patterning. Quackwatch Web site, updated July 7, 2001.
- New PTSD therapy: Innovative or smoke and mirrors? Psychiatric News, May 15, 1998, pp 14, 42.
- McNally RJ. EMDR and Mesmerism: A comparative historical analysis. Journal of Anxiety Disorders 13:225-236, 1999.
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- Wheeler DL and others. An experimental assessment of facilitated communication. Mental Retardation 31:49-59, 1993.
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- Cooke P. The Crescent City cure. Hippocrates 2(6):61-70, 1988.
- Walker S. Transcript of Audiotape Intro.
- Casura LG. Interview with Scott Walker, D.C., founder of neuroemotional technique (NET), and Steve Shaffer, an NET practitioner. Townsend Letter for Doctors & Patients, July 1998, pp 128-134.
- The ONE Foundation. Health Pyramid Web site, August 15, 1998.
- Druckman D, Swets JA, editors. Enhancing Human Performance. Washington D.C., 1988, National Academy Press.
- Lohr JM and others. Neurotherapy does not qualify as an empirically supported behavioral treatment for psychological disorders. The Behavior Therapist, 24, 97-104, 2001.
- Kline JP and others. A cacophony in the brainwaves: A critical appraisal of neurotherapy for ADHD. Scientific Review of Mental Health Practice, Vol 1, No.1, Spring/Summer 2002.
- Metzger RL, Werner DB. Use of visual training for reading disabilities. Pediatrics 73:824-829, 1984.
- Spanos NP. Past-life hypnotic regression: A critical view. Skeptical Inquirer 12:174-180, 1988.
- Baker RA. Hidden Memories: Voices and Visions from Within. Amherst, N.Y., 1992, Prometheus Books.
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- Lillienfeld SO, Wood JN, Garb HN. What's wrong with this picture? Scientific American, May 2001, pp 81-87.
- Gardner RA. True and False Accusations of Child Abuse. Cresskill, NJ: Creative Therapeutics, 1992.
- Gardner M. The false memory syndrome. Skeptical Inquirer 17:370-375, 1993.
- False Memory Syndrome Foundation Newsletter, December 1997, pp 7-9.
- Patient wins suit over false memory. American Medical News, Sept 20, 1999.
- Callahan RJ. What is the Callahan Techniques Thought Field Therapy (TFT)? Callahan Techniques Web site, accessed Feb 27, 2000.
- Craig G. The evolution of EFT from TFT. Emotional Freedom Techniques Web site, accessed Nov 23, 2000.
- Hooke W. A review of thought field therapy. Traumatology 3(2), 1998.
- Swensen DX. Thought field therapy: Searching for the quick fix. Skeptic 7(4):60-65, 2000.
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- Guadiano BA, Herbert JD. Can we really tap our problems away? A critical analysis of thought field therapy. Skeptical Inquirer 24(4):29-33, 2000.
- Foxhall K. Arizona board sanctions psychologist for use of thought field therapy. APA Monitor Online, Sept 1999.
- Murray B. APA no longer approves CE sponsorship for thought field therapy. APA Monitor Online, Dec 1999.
- Wolfe S. Letter to FDA urging that the Vagus Nerve Stimulator not be approved for treatment of depression. Health Research Group publication #1741, May 11, 2005.
- Barglow P. Corporate self-interest and vagus nerve stimulation for depression. Skeptical Inquirer 32(5):35-40, 2008.
- BlueCross BlueShield Association Technology Evaluation Center. Vagus nerve stimulation for treatment-resistant depression. TEC Assessment Program 21(7), Aug 2006.
This article was revised on November 9, 2008.