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What does it take for the American Psychological Association to bless an alternative type of therapy?
It's a question that Harvard Medical School psychiatrist Rick Leskowitz, director of the Integrative Medicine Project at Spaulding Rehabilitation Hospital, has been asking for years.
Dr. Leskowitz sent me an email after I wrote about yoga for treating veterans with post-traumatic stress disorder. He said that another approach, called Energy Psychology, a kind of psychological acupuncture without needles, is "the most impressive intervention I've encountered in 25 years of work." I was intrigued.
From Facebook Fight to Alternative Treatment
One of his patients, Nicole McCarthy, told me that after she was hit by a car — intentionally, by a teenage driver — and suffered a traumatic brain injury, among other damage, Energy Psychology was the most effective treatment to heal her emotionally. McCarthy, a 41-year-old dancer, said the therapy allowed her to talk about the accident for the first time without hyperventilating and crying, and to overcome the deep fear and psychic trauma associated with the hit-and-run. (It occurred after a Facebook feud between her daughter's teenage friends spiraled out of control). Just one session, she said, "was a life-altering experience for the better. It's a tool I will use for the rest of my life."
Dr. Leskowitz cites his own clinical experience and a growing number of studies showing the benefits of the practice. For instance, two recent studies involving combat veterans found that after six sessions of intensive Energy Psychology, the vets show marked relief from their PTSD symptoms.
The APA Just Says No
But the American Psychological Association says the science behind the therapy still isn't adequate, and it won't grant continuing education credits for training in Energy Psychology.
This, even as the treatment has shown positive results in clinical studies on a range of stressed out and traumatized people: orphaned survivors of the Rwandan genocide, high school kids who experience debilitating stress before a test, patients with chronic pain and phobias.
Here's an overview of the work to date and several peer-reviewed studies here, here and here. (Reading them makes me think: Wouldn't it be nice to offer some psychological relief to the record number of over-stressed college freshmen, or the large number of war vets with PTSD or other mental illness?)
Energy Psychology, which is also called Emotional Freedom Technique, or just "tapping" uses exposure and desensitization to "defuse" the painful emotions associated with the traumatic incident. One recent study describes a veteran undergoing this treatment as he pairs a traumatic memory with a statement of self-acceptance:
“Even though I had to shoot the kid who ran toward my Humvee wearing an explosive vest...” (memory), “I deeply and completely accept myself” (self-acceptance statement)."
Then you tap on a sequence of points on the body and, in theory, the emotional intensity associated with the bad memory simply deflates.
The mechanism at work here isn't totally clear. But one group of researchers who used EEG to measure the brain states of patients found that as the troubling emotions decreased during Energy Psychology treatment, "the neural frequencies associated with stress also reduced." Other researchers believe that the energy therapy induces neurotransmitter changes in the brain that down-regulate activity in the amygdala, the brain's fear center.
Flaky Or Effective?
Ok, I know what you're thinking. Energy Psychology? Emotional Freedom Technique? Yes, it does sound flaky, and when I mentioned it to my engineer husband, he rolled his eyes. (I'm not sure if this will convert skeptics or increase their numbers, but Dr. Leskowitz is also co-creator of the documentary, "The Joy of Sox," which explores the "invisible fan energy" of Red Sox devotees, and teaches viewers techniques to boost the impact of their cheers in the "sacred space" of Fenway Park.)
But I digress. When it comes to Energy Psychology, which has been around for more than a decade, the APA has rejected formal requests by the sponsor, the Association for Comprehensive Energy Psychology (ACEP), an umbrella group of practitioners, to grant continuing education credits to psychologists who want to learn the technique. No CE credits mean no new trainees, no blossoming of the practice, no possibility of insurance coverage. And, no respect.
(Practitioners are required for licensure to get a certain number of CE credits or hours every couple of years, so it's a way to keep providers current, and it also provides income for the sponsors that offer the courses. Weirdly, marriage therapists, alcohol abuse counselors and some other providers can get CE credits in Energy Psychology through different sponsors. But when it comes to psychologists, most states take their cues from the national organization. )
The APA accepts therapies such as as hypnosis and "Positive Psychology," in that it allows sponsors to offer continuing education credits for training in those techniques. EMDR, Eye Movement Desensitization and Reprocessing, another kind of treatment for PTSD, also sounded pretty crunchy when it first emerged. Now, after a long fight, it's approved and rated as highly effective for trauma.
No Longer Radical
And it's not as if alternative treatment is radical these days. Complementary and alternative medicine now have their own division at the National Institutes of Health, and even Harvard teaching hospitals, like Massachusetts General, have embraced non-traditional approaches to medicine, for instance, its in-house Benson/Henry Institute For Mind Body Medicine. Dr. Leskowitz says his Harvard-affiliated hospital, Spaulding, supports his work, if for no other reason than chronic pain patients are notoriously difficult to treat, and many have mental-health issues at the heart of their physical pain.
I asked the APA what the problem is. I got a call from Kim Mills, the deputy executive director of public and member communications, who said: "The American Psychological Association does not approve or endorse specific therapy techniques; we therefore have no policy position on energy psychology. APA does not grant continuing education credits for any programs teaching energy psychology because the APA Continuing Education Committee did not find sufficient evidence of its treatment efficacy." Their full denial letter is here.
David Feinstein, a clinical psychologist based in Ashland, Oregon, says only with continuing education credits will the practice get "onto the radar of psychologists." By disallowing it, he says, the APA is in essence branding it as "quackery." He says when he recently presented his work on Energy Psychology in Disaster Relief at a giant conference for psychotherapists his was the only one out of 170 presentations that included this program note: "This presentation does not qualify for APA CE credit." Feinstein voices his frustration that men and women returning from Iraq and Afghanistan don't have ready access to this therapy, and cites this video showing veterans before and after treatment using Energy Psychology. His group, the ACEP, says it will appeal the APA's decision this summer.
Feinstein and other backers of Energy Psychology say they have more than met the APA's requirements, and despite the association's pushback, the technique is gaining tractions. He says at least 5,000 licensed psychotherapists are using energy psychology methods in their practices. And, he notes, it's being practiced in traditional health care settings such as Kaiser Permanente [using a variation called the Tapas Accupressure Technique] and Veteran’s Administration Hospitals."
Still, when I asked two savvy Cambridge psychologists if they'd heard of Energy Psychology, they both said "No." And another local psychologist who does offer Energy Psychology — and says it's incredibly effective for treating trauma and phobias — said she doesn't want to be quoted because of the clash with the APA.
A New Patient — Me
To find out more, I asked Dr. Leskowitz to give me a little demo. We met at the Needham Public Library, where he told me to look for a balding guy with a beard (and a ponytail.) I spotted him at once.
Energy Psychology, he explained, is a “meridian-based therapy” that engages with the same energy meridian system that is used in acupuncture. (I will avoid chakras and energy pathways here and just say the point of it all is to stimulate key points on the body while simultaneously exposing yourself to your fear.) Dr. Leskowitz describes how patients imagine and rekindle the trauma, and then, by practicing some deep acceptance and relaxation at the same time, they desensitize or simply neutralize the fear or anxiety; releasing the negative emotions stuck in the body that have built up around those intense feelings. Sounds good.
So, I put down my notebook and become the patient. First, I review my fears, in my case terrible anxiety over flying, which I have written about previously. I detail, aloud, all of the emotions attached to my anxiety — fear of death by crashing, anxiety about my loss of control, embarrassment, etc. And with each emotion, I slowly tap my elbows, opposite hand to opposite elbow. I affirm that I accept myself despite these feelings, and say that another person, in this case my mother, also accepts me. Between each affirmation, I take a deep breath.
Memories of Turbulence
Then Dr. Leskowitz leads me through an eight minute or so round of applying pressure to specific points: between my eyebrows, corner of the eyes, cheekbones, under my nose and mouth, the collarbones, upper ribs, fingers. Again, I breathe between pressure points and say a short phrase, for instance, "That Flight" recalling the bad incident (violent turbulence while I was 7 months pregnant). Then I roll my eyes around in circles, clock-wise and counter clock-wise. At the end I gently hold the front and back of my head, channeling serenity.
Now I'm no doctor, nor any kind of mental health expert, but still, growing up in New York City in the 1970s, the child of divorced hippie parents who summered in Wellfleet, I've been exposed to plenty of therapy. And even though my brief encounter with Energy Psychology was mostly as a reporter, I have to say I did feel somewhat calmer after the experience, like my fear was somehow more distant. But who knows, maybe I just got happy envisioning the vanilla latte I planned to pick up as I headed home. Or maybe it was something more.
This program aired on January 28, 2011. The audio for this program is not available.
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