Tapping therapy and the importance of reliable evidenceby Marc Wilson
We need good science to prove the effectiveness of various therapies.
‘Dear Ed. Marc Wilson is an idiot. My personal experience of [insert topic] is completely different to what he says.” Fortunately for my self-esteem, letters like this are uncommon, and I appreciate the time people take to put their thoughts into words.
In recent weeks I’ve received a fair few letters, some from people I know and respect, commenting on how their personal experiences of “tapping” therapy contradict my position that there isn’t reliable evidence to support its use. These letters have unanimously described the benefits that people using the technique have observed.
How do we reconcile these two positions? Can we reconcile them? As odd as it sounds, saying there isn’t reliable evidence for the efficacy of tapping isn’t automatically the same as saying it isn’t effective.
By “reliable evidence” I mean there aren’t enough competent studies showing that tapping achieves statistically better outcomes than other treatments, no therapy or “sham” therapy (where participants receive something that looks like a therapy but has no therapeutic content).
Competent studies are those done by researchers who have tried to make their experimental design as watertight as possible – by using a sham condition, often by matching participants across conditions so any differences in results can’t be attributed to one group being less serious or otherwise different from the other, and by doing their best to eliminate experimenter and demand effects, among other things.
Sham conditions are important for all the reasons I’ve talked about over the past few weeks. They can still produce positive effects, through the mechanism of a placebo effect on the participant. Experimenter effects are a little like these, but involve the influence on the interpretation of data and results on the part of the researchers themselves.
These effects occur when experimenters are aware, for instance, of which condition participant X comes from, and this knowledge subtly influences how they behave with the participants in ways that affect how participants respond (a demand effect) and their own evaluation of progress one way or the other (an experimenter effect).
If you’re a practitioner who believes that something will help, then you will interpret ambiguous outcomes as indicating that it is helping.
The situation is complicated further by the problem that practitioners can get real positive effects that have nothing to do with what they get participants to do.
Eh? An important part of therapeutic success may be the result of what’s called the working alliance – shared understandings by the practitioner and the client of the goals and tasks of therapy, and the bond or rapport between them. Although the goals and tasks might differ from therapy to therapy, the bond or rapport might be considered a “common factor” across therapies – having a practitioner who approaches the relationship with the expectation that therapy will be helpful, and who is warm, respectful and empathic.
In fact, it has even been argued (originally by Luborsky, Singer and Luborsky in the 1970s) that part of the effectiveness of most therapies is that, to some degree, they share these common factors.
The strong position (the “dodo-bird verdict”) that therapy content has nothing to do with efficacy is hard to support, however. Numerous reviews now show Cognitive Behavioural Therapy, or CBT, (working to change maladaptive thoughts and behaviours) is an effective therapy for many people and many concerns, but also more effective than can be explained with these common factors alone.
Back to tapping. I don’t doubt some people benefit from Emotional Freedom Techniques. But there isn’t scientific evidence to show that any of those benefits are greater than those from other established therapies like CBT and that even where there are benefits, they come from the content of the therapy. Ultimately, the answer lies in good science, and until that happens, the jury is out.
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