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Mental Help Procedures to Avoid

Based upon an article by Stephen Barrett, M.D. at Quackwatch.com

The following mental health procedures should be avoided as they are not found to be beneficial and often result in a waste of time and money and sometimes leads to harm. Most therapists in the Columbus area do not offer these services, but with the Internet, providers who do engage in the following services can be found in the State of Nebraska. Beware!

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.

Eye Movement Desensitization and Reprocessing (EMDR)

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 [6]. 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 [7]. 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 [8]. 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].

Facilitated Communication

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 [13]. 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 [14]. In 1994, the FTC settled charges that two companies had made false and unsubstantiated claims about "facilitated communication" devices they had marketed.

Neural Organization Technique (NOT)

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 [15]. 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.

Neuro Emotional Technique (NET)

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." [16] Its proponents claim that everyone has such blocks and that the body "replays" these old memories, which can adversely affect health [17]. 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 [17]. 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." [18]

Neurolinguistic Programming

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 [19].

Neurotherapy

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].

Optometric Visual Training

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 [22]. 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

"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].

Routine Personality Testing

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 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].

Stimulation of False Memories

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., has 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 [28].

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." [29] 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 [30]. 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 [31]. Additional information about false memories is available on the Web site of Elizabeth Loftus, Ph.D., a professor at the University of Washington.

Subliminal Tapes

Thousands of videotapes and audiotapes purported to contain repeated messages are being marketed with claims that they can help people: lose weight, stop smoking, enhance athletic performance, quit drinking, think creatively, raise IQ, make friends, reduce pain, improve vision, restore hearing, cure acne, conquer fears, read faster, speak effectively, handle criticism, relieve depression, enlarge breasts, and do many other things. At least one company has offered subliminal tapes for children, including a toilet-training tape for toddlers. Many tapes contain music said to promote relaxation. Most are claimed to contain messages that are inaudible or barely audible, but some are barely or fully audible. Videotapes may feature images, said to be relaxing, combined with repeated visual messages shown so briefly that they cannot be seen at normal playing speed.

Many researchers have found that subliminal tapes provide no benefit to the user. One who tested tapes from several companies concluded that they contained no embedded messages that could conceivably influence behavior [1]. A research team tested volunteers for a study of tapes said to improve memory and self-esteem, but switched the tapes for half of the participants (to create a control group). Regardless of the tape used, about half of the volunteers claimed to achieve the results they were told to expect-but objective tests of memory and self-esteem showed no change [2]. A National Research Council committee has concluded that although many people claim that subliminal self-help tapes contribute to self-improvement, there is no scientific evidence to support such claims [3]. Thus there is no reason to believe that musical tapes with subliminal messages can do anything more for physical or mental well-being than listening to ordinary music. There is no scientific evidence that messages which cannot be heard are unconsciously or subconsciously perceived or can influence behavior [4].

Self-Help Instructional Programs

Many entrepreneurs use cable television infomercials to promise that their instructional materials can increase self-confidence, improve people's performance, and bring success in various ways. A 1995 article in Forbes magazine noted that "inspirational" programs may serve a useful purpose if they enable someone to act more decisively [10]. However, the programs have not been validated by scientific studies and probably will not help most people who buy them.

Bach Remedies

These are homeopathically prepared (highly dilute) products said to have been developed during the 1930s by Edward Bach, a British bacteriologist and homeopath [11,12]. Ellon USA, Inc., of Lynbrook, New York, states that Bach "believed that the only way to cure illness was to address the underlying emotional causes of disease." This company markets an "emergency rescue formula" for "calming and stabilizing emotions" and a line of 38 "flower remedies" said to alleviate negative emotions. The Rescue Remdy is also said to be "of great benefit to all animals, no matter how large or small" and "useful in easing the trauma of transplanted plants, falling flowers, or injured trees." [11] The various remedies can be selected using Ellon's 116-item "self-help questionnaire." Someone who feels overwhelmed with work, for example, is advised to take the product called Elm, whereas someone who has strong opinions and is easily incensed by injustices is advised to use Vervain. An Ellon competitor describes its Rescue Remedy as "the one product you need to take care of all kinds of emergency emotional stress." This company's catalog states that this product "helps center the emotions until the crisis is past" and depicts it as useful for: (a) a woman under stress because her computer "froze," (b) a mother coping with a cranky toddler, (c) the partner of a doubles tennis player who missed a few shots, (d) participants in a minor auto accident, and (e) a man racing to board a plane who suddenly realizes he forgot to pack his suit and left his keys and ticket at home. A few companies market additional products they say are based on Bach's principles.

Flower remedies are also promoted through books, seminars, private practitioners, and telephone consultations. Some proponents state that the remedies can "balance out the body's subtle energy fields" and "prevent disease before physical symptoms develop." Of course, neither the theories nor the products make any sense.

Aromatherapy

Aromatherapy involves the use of aromatic oils from plants to affect mood or promote health. The oils are administered in small quantities through inhalation, massage, or other applications to the skin. Aromatherapy products include diffusers, lamps, pottery, candles, pendants, earrings, shampoos, skin creams, lotions, bath salts, and shower gels. The aromatic oils are alleged to contain hormones, antibiotics, and antiseptics, and to represent the “life force,” “spirit,” or “soul” of the plant. Some proponents claim that aromatherapy is a complete medical system that can “revitalize cells,” strengthen defense mechanisms, and cure the cause of disease. Others promote the products as useful for sharpening mental function or coping with stress. Although pleasant odors may enhance a person’s effort to relax, there is no scientific evidence that they can improve mental function or influence the course of any disease [13]. In 2000, in a false advertising case, a California court approved a consent agreement under which the manufacturer was barred from claiming that certain products would "sharpen the mind," "freshen the mind," "make the mind more alert," "create sustained intellectual power," "increase mental concentration, or "address the physical effects of stress." [14]

1. American Academy of Pediatrics Committee on Children with Disabilities. Auditory integration training and facilitated communication for autism. Pediatrics 102:431-433, 1998.
2. Executive Committee, American Academy of Audiology. Position statement: Auditory integration training. Audiology Today 5(4):21, 1993.
3. American Academy of Pediatrics. Policy statement: The Doman-Delacato treatment of neurologically handicapped children. Pediatrics 70:810-812, 1982.
4. American Academy of Pediatrics. Policy statement: The Treatment of Neurologically Impaired Children Using Patterning. Pediatrics 104:149-1151, 1999.
5. Novella S. Psychomotor Patterning. Quackwatch Web site, updated July 7, 2001.
6. New PTSD therapy: Innovative or smoke and mirrors? Psychiatric News, May 15, 1998, pp 14, 42.
7. McNally RJ. EMDR and Mesmerism: A comparative historical analysis. Journal of Anxiety Disorders 13:225-236, 1999.
8. Pitman R. Emotional processing during eye movement desensitization and reprocessing therapy of Vietnam veterans with chronic posttraumatic stress disorder. Comprehensive Psychiatry 37:419-429, 1996.
9. Lilienfeld SO. EMDR treatment: Less than meets the eye. Skeptical Inquirer 20(1):25-31, 1996.
10. Lohr JM, Tolin DF, Lilienfeld SO. Efficacy of eye movement desensitization and reprocessing: Implications for behavior therapy. Behavior Therapy 29:126-153, 1998.
11. Mulick JA and others. Anguished silence and helping hands: Autism and facilitated communication. Skeptical Inquirer 17:270-280, 1993.
12. Wheeler DL and others. An experimental assessment of facilitated communication. Mental Retardation 31:49-59, 1993.
13. Jacobson JW, Mulick JA, Schwartz AA. A history of facilitated communication: Science, pseudoscience, and antiscience: Science Working Group on Facilitated Communication. American Psychologist 50:750-765, 1995.
14. American Psychological Association. Resolution on facilitated communication. Aug 14, 1994.
15. Cooke P. The Crescent City cure. Hippocrates 2(6):61-70, 1988.
16. Walker S. Transcript of Audiotape Intro.
17. 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.
18. The ONE Foundation. Health Pyramid Web site, August 15, 1998.
19. Druckman D, Swets JA, editors. Enhancing Human Performance. Washington D.C., 1988, National Academy Press.
20. Lohr JM and others. Neurotherapy does not qualify as an empirically supported behavioral treatment for psychological disorders. The Behavior Therapist, 24, 97-104, 2001.
21. 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.
22. Metzger RL, Werner DB. Use of visual training for reading disabilities. Pediatrics 73:824-829, 1984.
23. Spanos NP. Past-life hypnotic regression: A critical view. Skeptical Inquirer 12:174-180, 1988.
24. Baker RA. Hidden Memories: Voices and Visions from Within. Amherst, N.Y., 1992, Prometheus Books.
25. Lilienfeld SO. Projective measures of personality and psychopathology. How well do they work.? Skeptical Inquirer 23(5):32-39, 1999.
26. Lillienfeld SO, Wood JN, Garb HN. The scientific status of projective techniques. Psychological Science in the Public Interest 1(2):27-65, 2000.
27. Lillienfeld SO, Wood JN, Garb HN. What's wrong with this picture? Scientific American, May 2001, pp 81-87.
28. Gardner RA. True and False Accusations of Child Abuse. Cresskill, NJ: Creative Therapeutics, 1992.
29. Gardner M. The false memory syndrome. Skeptical Inquirer 17:370-375, 1993.
30. False Memory Syndrome Foundation Newsletter, December 1997, pp 7-9.
31. Patient wins suit over false memory. American Medical News, Sept 20, 1999.
32. Callahan RJ. What is the Callahan Techniques Thought Field Therapy (TFT)? Callahan Techniques Web site, accessed Feb 27, 2000.
33. Craig G. The evolution of EFT from TFT. Emotional Freedom Techniques Web site, accessed Nov 23, 2000.
34. Hooke W. A review of thought field therapy. Traumatology 3(2), 1998.
35. Swensen DX. Thought field therapy: Searching for the quick fix. Skeptic 7(4):60-65, 2000.
36. Gaudiano B. Debunking thought field therapy
37. 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.
38. Foxhall K. Arizona board sanctions psychologist for use of thought field therapy. APA Monitor Online, Sept 1999.
39. Murray B. APA no longer approves CE sponsorship for thought field therapy. APA Monitor Online, Dec 1999.

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Portions of this article have been adapted from the 7th edition of Consumer Health: A Guide to Intelligent Decisions.