All in the Head

Three Approaches to Mental Health Treatment That Stretch the Boundaries -- and, Sometimes, Credulity

Imagine being able to quickly banish phobias by rhythmically tapping on various body parts. How about a painless treatment that eliminates depression by exerting gentle pressure on a patient's shoulders or torso? What if it were possible to overcome attention-deficit hyperactivity disorder (ADHD) by having a child focus on a computer image that retrains his brain waves?

These are among the promises made by many practitioners of three alternative treatments -- thought field therapy (TFT), craniosacral therapy and neurofeedback -- that increasingly are being used to treat an encyclopedic array of psychological and behavioral problems.

Experts estimate that about 200 alternative mental health treatments are on the market, said Scott O. Lilienfeld, an associate professor of psychology at Emory University in Atlanta and an expert on unorthodox therapies. Some, such as relaxation exercises and yoga, are widely used as part of specific physical and mental health treatments and have been subjected to at least some scientific study. But others, including past life therapy and dolphin-assisted therapy, have little or no grounding in science.

While alternative psychological treatments have always existed, experts say, the Internet has been a boon to alternative practitioners, enabling them to reach vast audiences easily.

"The rapidity of marketing is unprecedented," said Lilienfeld, founding editor of the Scientific Review of Mental Health Practice, a semi-annual journal devoted to examining the theory and practice of both alternative and conventional therapies. Lilienfeld and other critics say the growth of many alternative therapies contravenes the move in psychology toward evidence-based treatments.

The majority of unorthodox therapies, Lilienfeld said, amount to pseudoscience; they are based on unvalidated theories and bolstered by anecdote. Few have been subject to peer review and most have never been validated by studies that randomly assign patients to receive different treatments and control for factors such as the placebo effect -- improvement not attributable to treatment -- that can skew the results.

Among the more notable examples, in the view of Lilienfeld, co-editor of "Science and Pseudoscience in Clinical Psychology" (Guilford Press, 2002), are eye movement desensitization and reprocessing (EMDR), a treatment for trauma in which a therapist waves his fingers in front of the eyes of a patient visualizing an event, and rebirthing or attachment therapy, which was implicated in the death four years ago of a 10-year-old girl in Colorado who suffocated while being held under a blanket by therapists trying to cure her behavioral problems.

Alternative therapies often sound convincing, observed James D. Herbert, an associate professor of psychology at Drexel University in Philadelphia, who has analyzed some of them. "They're packaged very nicely, there's a lot of psychobabble, a lot of jargon, and they sound impressive" to therapists who aren't well trained and to patients desperate for help.

Unlike conventional therapy, alternative approaches often claim to be useful or even curative for a huge array of unrelated problems. By contrast, conventional treatments typically have narrow applications.

John Upledger, the osteopath who developed craniosacral therapy, said in an interview that his hands-on treatment can vanquish depression, chronic pain, post-traumatic stress disorder, migraines, scoliosis, autism and colic -- among other ailments.

Roger J. Callahan, the clinical psychologist who invented thought field therapy, said his tapping treatment has a 98 percent success rate and works for "almost everything."

While many alternative mental health treatments do not appear to be harmful, some are costly. The expense and energy devoted to these treatments could prevent or delay the pursuit of more effective and less expensive therapies, Lilienfeld noted.