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The
Impact of Thought Field Therapy This is a
preprint of an article published in October 2001 By Roger J.
Callahan, Ph.D. This paper was not subjected to peer review. The absence of peer review of both research papers and the reviews themselves emanated from concerns expressed by Dr. Roger Callahan that the review process was biased against TFT. This paper was published in an open review of the original research paper of TFT. The reader is encouraged to read the original article, along with this accompanying review, and the final critique of the Journal's decision to publish this set of nonreviewed articles in order to gain a perspective on the issues presented. _ Larry E. Beutler, editor. ABSTRACT
Thought Field Therapy (TFT) is a rapid treatment for psychological problems typically taking only minutes. HRV has been shown to be a strong predictor of mortality and is adversely affected by such problems as anxiety, depression, and trauma. Interventions presented in the current literature show modest improvements in HRV. Twenty cases, treated by the author and other therapists with TFT, are presented. The cases include some with diagnosed heart problems and very low HRV, which is ordinarily more resistant to change. The degree of improvements that are registered on HRV as a result of TFT treatment exceeds reports found in the current literature. There is a close correspondence between improved HRV and client report of reduced degree of upset. HRV may prove to be an appropriate objective measure of psychotherapy efficacy, given the correspondence between client report and HRV outcome. Further research in TFT and HRV is encouraged by these results. INTRODUCTION
“Our hearts are at the mercy of our minds.” (Gilbert, p. 216) The purpose of this paper is to introduce the use of Heart Rate Variability (HRV) as an objective measure for the effectiveness of a therapy known as Thought Field Therapy (TFT). Clinicians have often looked for methods of evaluating the effects of psychotherapy and HRV is a tool that can meet this need. HRV shows signs of becoming increasingly popular as an outcome measure for psychotherapy (Cohen, Matar, Kaplan & Kotler, 1999). These authors note “From the interest it has raised, it may be expected that this method will be in widespread use in clinical practice in the future, providing a useful tool, both for diagnostic and prognostic purposes, as well as serving as a further aid towards monitoring therapeutic interventions” ( p. 59). Although the use of HRV as an outcome measure for psychotherapy is still relatively new, it is my expectation and prediction that HRV will, in the near future, be in widespread use in the field of psychology. What is TFT? TFT is a very rapid method of treating psychological problems typically requiring only a matter of minutes to effect change, which usually endures. TFT can be administered by formulas or recipes, known as algorithms or by individually determined treatments, by a method known as causal diagnosis and can be used to treat psychological problems including phobias, anxiety, trauma, loss, addictive urges, obsessions, compulsions, and a wide variety of other problems (Callahan, 1985; Callahan & Perry, 1991; Callahan & Callahan, 2000; Callahan & Trubo, in press). The first case treated with TFT was a woman in her 40s who had suffered from a life-long severe phobia of water. She had already been in therapy for a year and a half for the phobia and I had tried a variety of traditional approaches with no results. With TFT, this phobia was eliminated by a treatment that took less than a minute (Callahan, 1996). The treatment took place in 1980 and she has had no recurrences of her phobia in the 20 years since. In a study done on TFT and acrophobia (Carbonell, 1995) subjects were randomly assigned to receive a treatment consisting of the correct TFT treatment points or to receive a placebo treatment consisting of sham treatment points. The group that received the real TFT treatment was shown in the post test was shown to have significantly more change than the group that had the placebo treatment, both by their self-report and by an actual behavioral test of having them climb a ladder. Although the difference was statistically significant, a flaw in the study should be noted; the control group showed some improvement (although less than the experimental group) because the subjects in the control group were given part of the real treatment. To show the true difference, a study would need to be conducted where the control group got no real TFT treatment. Meridian
Points The TFT treatment consists of stimulation of (usually by tapping) a precise sequence of meridian points on the body, which are the points of what are more commonly known as the acupuncture meridians. TFT proposes and demonstrates through its successful procedures, that the meridian system, when addressed with precision, provides the basis for the control system for the disturbing emotions and more generally, for healing. When the appropriate encoded form for each disturbing emotion is addressed then rapid and complete results typically ensue. Algorithms and
Causal Diagnosis
Algorithm is a concept and term that originated in mathematics and refers to a common solution for a problem such as finding the greatest common divisor. The general notion of algorithm (Youngson, 1994) is defined as: “A sequence of instructions to be followed with the intention of finding a solution to a problem. Each step must specify what steps are to be taken, and although there may be many alternate routes through the algorithm, there is only one start point and one end point” (p. 232). The term has been
adopted in medicine. For example, emergency personnel and ambulance
drivers learn easily applied medical solutions to emergency problems and
these procedures are called algorithms. Most psychotherapy consists of
algorithms that various innovators have offered. Since I have
developed a unique causal diagnosis procedure that determines the precise
treatment, it is necessary to distinguish between my recipes or algorithms
and my diagnostically based treatments. Unlike traditional
nosological diagnosis, I call my method causal diagnosis because in
identifying which treatment points need to be addressed and in what
sequence, I am diagnosing what I believe to be the root cause of emotional
distress. All of the TFT algorithms were discovered and developed
through my causal diagnostic procedures. The algorithms were tested
on hundreds of individuals by myself and found to have a high success
rate. The fact that I have developed a number of algorithms or recipes makes it easy for therapists, without specialized training, to try my approach and to carry out their own experiments and discover for themselves the power, speed, and effectiveness of this approach. It should be kept in mind that an algorithm does not have the power of treatments that are specifically determined for a particular individual from causal diagnosis, which requires a more advanced level of TFT training (Callahan, 1998). What is Heart
Rate Variability (HRV)?
HRV refers to the degree of fluctuation in the length of the intervals between heart beats (Malik & Camm, 1995). Two people could have exactly the same average heart rate and yet when the variation is precisely measured in milliseconds (ms) it can be demonstrated that there is variance between individual beats and that the degree of variance is different for different individuals under different conditions. This degree of variance between different beats is called Heart Rate Variability or HRV. How HRV is Measured Two types of tests for HRV exist: the long-term 24 Holter monitor test and the short-term HRV test which can be 2-15 minutes in length (Bigger, Fleiss, Rolnitzky, Steinman, 1993). Short-term measurements of HRV have the advantage that they can be done over very short periods of time in which both the physiological and the psychological state of the individual being monitored is constant (Kautzner & Hnatkova, 1995). This is opposed to the 24 hour Holter Test in which the daily activities are generally unknown. It has been observed that: . . . indexes of HR variability calculated during a 24 hour period include not only HR rhythms caused by respiration, blood pressure control, and thermoregulation, but also slower diurnal rhythms. HR variability determined from short electrocardiographic recordings under standard conditions may therefore be a better predictor of sympathovagal balance, and hence, of the risk of sudden cardiac death compared with 24-hour recordings (Kawachi, Sparrow, Vokonas & Weiss, 1995, p. 884). Short and long term HRV testing was compared in a study of 715 patients (Bigger, et al., 1993) and they concluded that “Power spectral measures of RR variability calculated from short (2 to 15 minutes) ECG recordings are remarkably similar to those calculated over 24 hours. The power spectral measures of RR variability are excellent predictors of all-cause mortality and sudden cardiac death” (p. 927). The HRV measures that deal with the variation in beat-to-beat intervals of the heart are called time domain measures (Kleiger, Bosner & Rottman, 1995). The following are some of the time domain variables commonly used in studies as described by Kleiger et al. (1995) who also note a high degree of correlation amongst these variables: SDNN – The Standard Deviation of all Normal-to-Normal intervals during the entire test period. In a 24-hour test, a cut-off point of <50 ms (milliseconds) was determined to be “highly depressed HRV” and an SDNN of <100 ms to be “moderately depressed HRV” and these cut-off points are considered “likely to be broadly applicable.” (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996) p. 1055. SDANN – Standard Deviation of the Average of 5 minute Normal-to-Normal intervals over an entire 24 hour recording period (applies only to the 24 hour test) SDSD – Standard Deviations of differences between adjacent N-N intervals HRV as a
Predictor of Mortality
Although it has been known for quite some time that HRV exists, it is only in the past 35 years or so that it has been discovered that beat-to-beat variation is a measure of health of the cardiovascular system. Previously it had been assumed that such variance was pathological (Malik & Camm, 1995). More recently, the use of HRV has become increasingly popular, with a Medline database search on the words “Heart Rate Variability” revealing over 2,000 studies from the period 1988 to 1998 (Huikuri, Makikallio, et al., 1999). What the current data show is that variability in heart rate is “the reflection of a healthy, well-developed ANS [Autonomic Nervous System]” (Hirsch, Karin & Akselrod, 1995, p. 518). The importance of HRV was first discovered when unborn infants were attached to cardiac sensors in utero. Initially, the importance of heart rate variability was not recognized (Hon, 1958). Later it was found that very even intervals between fetal heart beats were a precursor to death (Hon & Lee, 1963). It was further observed in this group that the beat-to-beat intervals would become progressively more even until death was reached. The same progressive trend toward less variability in approaching death has been since observed in adult patients (Nakagawa, Saikawa & Ito, 1994). These authors also suggest that sequential measurements of HRV may be useful in predicting sudden death. More recent research demonstrates a direct relationship between low HRV and sudden cardiac death (Magid, Martin & Kehoe, 1985; Kleiger, Miller & Bigger, 1987; Dougherty & Burr, 1992; Bigger, Fleiss, Rolnitzky & Steinman, 1993; Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996; Tsuji et al., 1996; Dekker, et al., 1997; Galinier, et al., 2000). Kleiger et al. (1987) concluded that “the relative risk of mortality was 5.3 times higher in the group with HR variability less than 50 ms than the group with HR variability of more than 100 ms” (p.256). Singer & Ori (1995) note that low HRV has been found to be “a powerful predictor of all-cause mortality” (p.433). Huikuri, Jokinen, et al. (1999) found that low HRV can also predict the progression of atherosclerosis and found that this predictability went beyond that achievable by taking the usual risk factors into consideration. As part of the Framingham study, Tsuji et al. (1996) examined, in retrospect, a subset of the population with no clinical symptoms or signs of cardiac vulnerability prior to their death, who suddenly and unexpectedly died of a heart attack. They found this group to have very low HRV that could have predicted their propensity to sudden cardiac death. Camm and Yap (1998) thus suggested that the HRV may be sensitive to sub-clinical heart disease. The Stability
and Reliability of HRV Measures
HRV has been shown to be very stable over periods of up to 2 months (Kleiger,
et al., 1991; Bigger, Fleiss, Rolnitzky & Steinman, 1992; Stein, Rich,
Rottman & Kleiger, 1995) making it an excellent research tool with
which to measure possible changes in HRV following interventions.
While circadian variation of SDNN was found in healthy individuals with
higher HRV during the daytime (Molgaard, Sorensen & Bjerregaard, 1991)
individuals with chronic heart disease who have low HRV were found to have
varied less on HRV measures than those with higher HRV (Van Hoogenhuyze,
et al., 1991). Van Hoogenhuyze et al. did two successive 24 hour HRV
tests on both a group of normal subjects and a group of subjects with
congestive heart failure and showed the Pearson product-moment test-retest
correlation coefficients of the four different HRV measures studied to be
high in both groups (.89, .87, .93 and .95 for the healthy group and .97,
.87, .97 and .97 for the unhealthy group). He noted that there was
variation in HRV measures with certain individuals, particularly those in
the healthy group. The Lack of Placebo Effect in HRV It has been established that there is no placebo effect with HRV. Baseline and placebo 24-hour HRVs were done on 14 subjects, 3 to 65 days apart (Kleiger, et al., 1991) and this study found that “Mean and standard deviations [of HRV] for baseline and placebo were nearly identical, establishing no placebo effect” (p. 628). Subsequent studies of placebo-controlled clinical trials for the drug scopolamine, an anti-cholinergic drug, using HRV, have confirmed the lack of placebo effect, showing no statistically significant changes in HRV between baseline and placebo. A clinical trial with scopolamine on 61 male patients after acute myocardial infarction (Vybrial, et al., 1993) showed no significant changes between baseline and placebo. Another study of 20 patients after myocardial infarction (De Ferrari, Mantick & Vanoli, 1993) similarly showed no placebo effect. A double blind, randomized placebo-controlled study or 16 patients with chronic heart failure and eight normal subjects (Casadei, Conway, Forfar & Sleight, 1996) showed that “There was no statistical difference between the placebo and the baseline data.” (p. 276). In another clinical trial of Scopolamine consisting of 12 patients with congestive heart failure (Venkatesh, et al., 1996) the authors similarly noted “the absence of a significant change in any time domain measure while on placebo. . .” (p. 139). This lack of placebo effect as well as its stability make HRV a very accurate research tool because it does not change without cause and is not influenced by placebo. Aside from placebo responses, questions have been raised as to whether or not the degree of an individual’s suggestibility can have any impact on HRV. A series of three studies by Ray et al. (2000) found that the degree of hypnotic susceptibility in an individual was not related to degree of change in HRV. HRV and Psychological Problems There have been numerous studies done which show an interrelationship between HRV and psychological problems. A study was carried out on 9 people who suffered from Post Traumatic Stress Disorder (PTSD), as compared with 9 matched healthy controls (Cohen, et al., 1998). It was found that that the healthy group, when exposed to a trauma-related reminder, had a distinct change in their HRV, while the group with PTSD demonstrated almost no response in their HRV and that their initial HRV scores were significantly lower (even without the deliberate exposure) than the normal group. The authors noted that “The PTSD patients demonstrated a degree of autonomic dysregulation at rest which was comparable to that seen in the control subjects' reaction to the stress model” (p. 1054). This shows the apparently negative effect that PTSD can have upon a person’s autonomic nervous system, as evident in their HRV. A number of studies show the relationship between low HRV and phobias or anxiety disorders. A study was done on 581 men, where their degree of phobic anxiety was assessed using the Crown-Crisp Index which had previously been shown to be a predictor of mortality (Kawachi, Sparrow, Vokonas & Weiss, 1995). This study found that the men who scored at the highest level of phobic anxiety on the Crown-Crisp had significantly lower HRV scores than the men who scored lower on the anxiety scale. Several other studies show similar connections between panic or anxiety disorders and low HRV (Middleton, 1990; Friedman & Thayer, 1998a; Friedman & Thayer, 1998b; Watkins, Grossman, Krishnan & Blumenthal, 1999). There are also data that suggest that there is a relationship between low HRV and depression, although this is a more controversial area since some studies have shown a connection and others have not (Carney, Freedland & Stein, 2000). A comparison study of 19 depressed patients versus 19 non depressed people showed the depressed group to have significantly lower HRV (Carney, et al., 1995). Another study done on 42 coronary artery disease patients (Krittayaphong, et al., 1997) showed that the higher their depression score on the MMPI-D scale, the lower their HRV. Balogh, Fitzpatrick, Hendricks and Paige (1993) note that short-term 5 minute HRV testing can serve as a useful outcome measure for treatments for depression. Other studies showed no connection between depression and low HRV (Watkins, et al., 1999; Yeragani, et al., 1991) although both of these studies did show a connection between low HRV and anxiety. Relationship
Between Self-Ratings of Emotional Stress and HRV A recent study (Dishman, et al., 2000) was conducted in which 5-minute HRV tests on 92 healthy men and women were conducted, and self-ratings of anxiety and perceived emotional stress during the past week obtained. A statistically significant relationship between self-rated perceived emotional stress and HRV was found; the more self-rated stress a person was under, the lower their HRV was. This statistically significant relationship between self rated anxiety/emotional stress and HRV was found to exist independently of age, gender, trait anxiety, cardiorespiratory fitness, heart rate, blood pressure and respiration rate. This study refutes the notion that a positive change in HRV after a successful psychological intervention is due solely to slowed respiration rate, as these differences were found to exist independently of this factor. What Factors are Known to Influence HRV? Sociodemographic Factors A study of 300 healthy women between the ages of 30 and 65 showed that the women who had lower social support and were more socially isolated had statistically significantly lower HRV than those with more social connections (Horsten, et al., 1999). However, the actual differences are very small, even though statistically significant. For example, there was only a four ms (10%) difference in SDNN between the group with the highest support vs. the group with the lowest support. Age is another factor found to influence HRV; the older a person is, the lower it tends to be and the decline becomes detectable as early as between the ages of 5 and 10 years old (Odemuyiwa, 1995). Measures of HRV are significantly correlated with increasing age in healthy subjects (Jensen‑Urstad, et al., 1997) which would not necessarily be the case in unhealthy people, who could have low HRV regardless of their age. To a lesser degree, gender is also associated with HRV, females tending to have lower HRV than males (Liao, et al., 1995) although this difference tends to apply mainly to women under 40 years of age (Ramaekers, Ector, Aubert, Rubens & Van de Werf, 1998). Potentially
Negative Influences on HRV It has been shown that a significant rise in HRV occurs after subjects quit smoking cigarettes (Stein, Rottman & Kleiger, 1996). Another study (Gerhardt, Vorneweg, Riedasch & Hohage, 1999) found a sizeable decrease in HRV due to smoking. Furthermore, it was shown that HRV increased immediately and continued to increase within the first month of stopping smoking (Yotsukura, et al., 1998). Many drugs have also been shown to worsen HRV including atropine, central anticholinergic agents, most antiarrhythmic agents, certain antihypertensive drugs, diazepam and other sedatives, analgesics and anesthetics (Fei, 1995). Negative emotions can also have an impact on HRV, as shown in the previous studies cited on the relationship between anxiety and HRV. Another aspect of HRV is that it measures the balance between the sympathetic and parasympathetic nervous systems and that a state of hostility brings about increased sympathetic and decreased parasympathetic activity (McCraty, Atkinson, Tiller, Rein & Watkins, 1995). McCraty et al. asked subjects during a 5 minute HRV test to recall situations in their life that they still feel angry about and in doing so, showed a dominance of their sympathetic nervous system. The same subjects showed more parasympathetic activity leading to improved HRV when asked to think of situations where they felt appreciation. This study shows that what emotions a person is focused upon may influence the HRV test. What Can
Improve HRV?
In an article entitled “Measurement of Heart Rate Variability: A Clinical Tool or a Research Toy?” the authors (Huikuri, Makikallio, et al., 1999) note that “. . . no specific therapy is currently available to improve the prognosis for patients with abnormal HR variability” (p. 1878). They conclude with “Before the measurement of HRV variability can be considered to be of any clinical value, however, therapeutic interventions are needed in the patients who present with abnormal values” (p. 1882). A study of the effects of biofeedback training on survivors of sudden cardiac arrest showed a statistically significant change in HRV, but the actual change was only 147 ± 38 ms pre-training vs. 159 ± 37 ms post-training (an 8% change) after six weeks of biofeedback training (Cowan, Kogan, Burr, Hendershot & Buchanan, 1990). A study on dogs at risk for cardiac events showed an increase in SDNN of 74% after six weeks of daily exercise training (Hull, et al., 1994). A study of exercise in normal older human adults (Stein, Rottman, Kleiger & Ehsani, 1996) showed statistically significant increases in SDNN of 126 to 142 (a 12% change) and in SDANN of 116 to 129 (an 11% change). A study of 17 men with chronic heart failure randomly assigned to an exercise program or rest (Coats, et al., 1992), showed that the exercise group had a daytime SD [sic] of 101 after 8 weeks of exercise training compared to the group that rested, who had a daytime SD of 90.5 (a 12% difference and statistically significant), although the differences in 24 hour SD were not significant. Another study, also after 8 weeks of exercise training in 20 patients with congestive heart failure (Adamopoulos, et al., 1992) showed a 21% increase in SD. There are a number of studies testing the effectiveness of the drug, scopolamine which yielded statistically significant increases in time domain measures of HRV, which ranged from 10% to 56% improvements (Vybrial, et al., 1990; Vybrial, et al., 1993; De Ferrari, et al., 1993; LaRovere, et al., 1994; Casadei, et al., 1996; Venkatesh, et al., 1996). A study on the effects of the drug Digoxin (Flapan, Goodfield, Wright, Francis & Neilson, 1997) showed a 20% improvement in SDNN after 7 days on the drug, in 10 patients with stable chronic cardiac failure. However, Stein and Kleiger (1999) report that Digoxin “does not reduce mortality” (p256). A study on the effects of the antidepressants fluoxtine and doxepin (Khaykin, et al., 1998) showed significant changes, an increase in SDANN of 28% in the group that responded to doxepin. However, there were no significant changes with the fluoxtine group. It is also important to note that the analyses were done, separately for the responders and the nonresponders. When analyzed together, no significant changes were found for either drug. The nonresponders to doxepin, when examined separately, were actually shown to have significantly worsened SDNN after taking the drug. A study done which evaluated the effects of cognitive therapy on panic disorder patients (Middleton & Ashby, 1995) reported statistically significant changes in HRV, but there was no mention in the article of which particular HRV measures were used, nor was the degree of change mentioned. In the literature examined thus far, the author is aware of no studies that have shown clinically significant changes, where people with abnormally low HRV have been shown to change to a normal HRV range due to a particular drug or other therapeutic intervention. Clearly, further studies testing other interventions are needed in order to see if HRV can be changed in a clinically meaningful way, especially given the fact that low HRV is associated with psychological problems and an increased risk of sudden death. METHODS Data Collection Data Collection
Since the purpose of this paper is to give preliminary data on what the
HRV changes are before and after TFT treatment in successful cases, the
data presented in this report did not come from a random sample. The
author posted a request to the e-mail listserv of TFT practitioners to
send some of their results. Although only a few had HRV equipment,
at that time, seven therapists who did have HRV responded with reports.
The data from HRVs done on twenty cases, pre and post treatment with TFT
presented in this paper were obtained from the author’s own clients and
also from the seven other therapists trained in TFT who responded to my
request. The therapists administered the HRV tests. Measures
Five-minute heart rate variability readings were obtained through the use of the Biocom HeartScanner (Biocom Technologies, 1998‑1999) which conforms to the standards of the Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). All subjects were given 5-minute HRV tests with the Biocom HeartScanner by the TFT therapist, prior to treatment with TFT while sitting upright in a straight-backed chair. A TFT treatment was then administered. After the brief treatment, the subjects were then given a post treatment HRV test, again 5 minutes in length. The time domain measure reported is the SDNN which measures the standard deviation of differences of the intervals between heart beats, measured in milliseconds (ms). Subjects were asked to think about the presenting problem while undergoing both the pre test and the post HRV testing. A Subjective Units of Distress (SUD) scale rating was obtained (Wolpe, 1969) from subjects that were aware of emotional distress during the pre testing phase. The SUD scale is a self-report from the subject of emotional distress or physical pain, on a scale of 1 to 10, where the number 1 indicates complete absence of any emotional distress and 10 indicates the worst possible emotional distress or physical pain. Aggregate data shown in Table 2 were calculated using the SPSS® Statistical Package Version 8.0. The TFT Treatment Protocol The following treatment protocol was used for all cases presented in this paper: Step 1: The subject was asked to think about the presenting problem and rate the emotional distress, if applicable, on a scale of 1-10 (the SUD). It is not necessary for the person to talk about the problem, as long as attention is focused on it during the treatment although the problem can briefly be identified, if the subject desires. The 5-minute pre-HRV test is administered with the client sitting in a chair, in the upright position. Step 2: The therapist determines which TFT treatment to use and in what sequence, through TFT’s causal diagnosis procedure or selects an appropriate TFT algorithm. The TFT procedure is carried out while the client is instructed to focus on the problem being addressed. Step 3: When it is determined which treatment points to use, the subject is then instructed to stimulate these points by tapping them 5-7 times on each point in the specific, set sequence. Step 4: After the treatment, the subject is again asked for a SUD. The treatment is considered complete when the SUD is down to a 1 (the client self-report of no trace of emotional or physical distress). At this time, a post-HRV test is done, also with the subject sitting upright as in the pre test. RESULTS The results of 20 cases where there was an increase in SDNN and a decrease in the SUD (there were 5 cases included where SUD was not relevant) immediately after TFT treatment are shown in Table 1. The treatments took approximately 1 to 15 minutes to carry out. In viewing the table the correspondence between the client’s self-reported SUD and the increase in SDNN is apparent. In each case that the client reported a SUD of 1, an improvement in SDNN is evident and averaged 61.4 ms. The cases ranged in age from 13 to 83 years old and presented with a wide variety of psychological and/or physical problems. A brief description of each individual case follows: Case 1. This is a 40 year old male psychologist who is chief of a large hospital’s heart education program and who is very familiar with HRV but not with TFT. He volunteered to have a problem treated with TFT while connected to HRV, but did not disclose to the therapist what the problem was (in TFT it’s only necessary that the person focus on the problem; there is no need to verbalize what the problem is). The pre treatment SDNN while thinking about the problem was 89.9 and after TFT treatment the SDNN improved 75% to 157.5. He reported a drop in SUD from 9 to 1. After TFT was administered, which, because of the unusual nature of the treatment, the psychologist thought was quite strange, all trace of the long-lasting problem was immediately reported to be gone. Case 2. A 16 year old boy underwent a required examination by a medical doctor in order to be on the high school track team. The physician was concerned about the results and asked the boy to see a cardiologist. His worried mother brought him in for an HRV and a TFT treatment prior to seeing the cardiologist. The boy reported no SUD. The baseline SDNN was 25.2 and after TFT it improved to 45.2. The cardiologist gave the young man medical clearance to engage in track events. Although these HRV results were given to the cardiologist, we do not know whether these results were considered in the decision for athletic clearance. The improvement in the SDNN is 79%. Case 3. A 13 year old boy whose mother brought him in for treatment because he is very upset and frustrated with school. His pre-therapy SDNN was 62. After TFT his SDNN went to 98. His SUD on the upset and frustration improved from a 7 to a 1. Case 4. Here is an 83 year old woman who has suffered from what she described as chronic arthritic pain, for several years for which nothing gave relief. The pain was reduced from a SUD of 8 to a 1. Again we see a correspondence between the reported SUD and an improvement in HRV which was 101%. Case 5. This 38-year old business man was very stressed because his business was being threatened. He rates his stress at a 6. In minutes TFT brings stress down to a 1 and his SDNN increased 48%. Case 6. A 40-year old woman felt emotionally devastated and anxious from being under constant criticism at her job. After TFT, her SDNN improved 68% along with reporting complete elimination of her emotional distress. Case 7. A 72-year old woman suffered from trauma and grief, due to husband’s death from cancer. After TFT treatment, her SDNN increased 78% and her disturbing emotions were completely eliminated. Case 8. This was a 44 year
old man who was born with a heart condition called dextrocardia, where his
heart was on the right, instead of the left side of his chest.
Throughout his life he has carried a note on his person with instructions
for emergency room personnel. His increase in SDNN was 88%.
He reported no SUD. It is obvious that the treatment does not
correct the placement of the heart. However, it is also obvious that
there is a profound improvement in his HRV scores which, as a strong
predictor of mortality and morbidity, may help him live a longer and
healthier life. Case 9.
A 30 year old male, although having been a world class athlete, had been
turned down 14 years earlier for Olympic competition after an Olympic
doctor’s examination, due to a previously undetected heart problem.
He came to get TFT treatment for a severe dental phobia. In addition
to completely eliminating this phobia, the treatment produced a change in
his extremely low SDNN (17.7) of 349% to 79.5. Case 10.
A 57 year old male physician had suffered from severe depression for eight
years and had tried various medications that had not helped him. His
pre treatment SDNN was 32 and his Total Power, which is another HRV
measure, was only 54. An HRV expert present at the time of his
treatment remarked that this was the lowest Total Power that he had ever
seen. Post treatment, he reported complete elimination of his
depression along with an increase in his SDNN to 144 and an extremely
large increase of his Total Power from 54 to 6596. Case 11. This was a 54 year old man traumatized by a dog attack. His upset over this trauma was completely eliminated, along with an increase in his SDNN of 102%. Case 12. A 35 year old man’s heart had stopped for one hour, three months previously during a hospitalization. As noted earlier, very low SDNN’s such as this are extremely stable and yet this person’s SDNN quadrupled, from 16.3 pre-TFT treatment to 91.4, immediately after TFT treatment. Case 13. A 36 year old woman was anxious about her upcoming divorce. Along with complete elimination of her anxiety, her change in SDNN was 184%. Case 14. This is a 33 year old female graduate student who reported anxiety when submitting papers to journals. Although this person had previously tried cognitive therapy and while cognitive therapy had helped her to take the action of actually submitting the papers, she still experienced anxiety while doing so. After treatment with TFT, she reported complete elimination of all traces of anxiety and reported to the therapist in a follow-up a week later that this treatment had held up. In addition to completely eliminating this anxiety, her SDNN increased 137%, from 53.9 to 127.8. Case 15. A 53-year old man reported anger about a conflict with a business associate. The pre-treatment HRV was done while he was talking about this conflict and his anger and showed an SDNN of only 42.9. After treatment, his anger was completely eliminated and his SDNN rose to 157.6, an increase of 267%. During the posttest, he again talked about the conflict with his colleague, but it no longer was impairing his HRV and it no longer caused him any self-reported emotional distress. Case 16. A 35-year old woman with issues of procrastination and anxiety over taking action on tasks in her life that needed to get done. After treatment, her anxiety was completely eliminated and her SDNN increased from 47.0 to 96.3. Case 17.
This was a 74 year old man who suffered from extreme fatigue. After
the treatment, his fatigue was completely eliminated with an 84%
improvement in his HRV. Case 18.
A 54-year old man had severe tooth pain, which he rated with a SUD of 8.
The treatment completely eliminated his pain, as well as increased his
SDNN from 45.2 to 118.8. Two Cases of
Repression The next two cases involve people who did not report a SUD while thinking about the identified problem. We have known for some time that even if the person cannot get upset while thinking about a problem, that we can still successfully treat such people. This treatment success is supported by the changes in HRV that took place in both of these cases, even though there was no reported SUD. Case 19. A 60 year old man had a phobia of driving. Although he was being treated in the therapist’s office and was not able to report a SUD just thinking about the problem (he had to be in the situation of actually driving to feel his anxiety) his SDNN nearly tripled following the treatment and later when he was in the situation, reported being free of his anxiety whereas before, driving had always caused him anxiety. Case 20. A 46 year old woman had a trauma which had occurred over 20 years earlier, although she reported no level of upset while thinking of it. The protocol for this case differed from the others, in that two pre-treatment 5-minute HRV tests were conducted. First, a baseline HRV test was done while she was not thinking about the trauma, which produced an SDNN of 110. Then, her attention was directed to the trauma while another 5-minute HRV test was done. The result of this second HRV test done while thinking about the trauma was that her SDNN dropped to 50, less than half of what it had been when not thinking about the trauma. Next, while her attention was focused on the trauma, a TFT treatment was done. Immediately after this treatment, another 5-minute HRV was administered which showed that her SDNN had increased to 112 even while continuing to think about the trauma. Aggregate Data Table 2 shows the mean and standard deviations for pre and post treatment SUD, pre and post treatment SDNN and the mean percent change in SDNN. The mean percentage change in SDNN was calculated by adding up all the individual percent changes (see Table 1) and then dividing the sum by the number of cases (20). The mean percent change in SDNN was 156%, indicating that the SDNN, on average, more than doubled with TFT therapy. The percentage change in SDNN ranged from 48.5% to 460.7%. Because of the large standard deviation for percentage change in SDNN (114), medians were also calculated, the median percent change being 103%. All who initially reported a pre-treatment SUD, reported a post-treatment SUD of 1, indicating a strong correspondence between the clients’ self-report of emotional distress and the HRV’s increase in SDNN. DISCUSSION
It is important to note that this was not a random sample and therefore
the aggregate data presented in Table 2 cannot be generalized.
However, the changes in SDNN found after TFT treatment are unprecedented
in the current literature. The cases presented here were selected in
order to demonstrate what TFT can do in relation to changing HRV.
These changes are not unusual and rather typical in the author’s
clinical experience and that of other reports received from therapists
trained in TFT who have access to HRV. The author has not been able
to find any studies or even a single case that showed the degree of change
documented here with TFT. The changes were brought about by treatments
that took only minutes to carry out. Especially noteworthy are cases 9 and 12, which had extremely low SDNNs of 17.7 and 16.3, respectively, both of whom had known medically diagnosed heart problems. After a simple TFT treatment, lasting minutes, the post-test for Case 9 revealed that the SDNN had more than tripled and for Case 12 it had more than quadrupled, taking it out of the zone of being rated dangerously low (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996). Again, I am unaware of any intervention in the literature that has shown the ability to do this in even a single case. This is not to imply that TFT is a substitute for medical treatment and practitioners must make this clear to their clients. However, these changes do show that something clinically significant has occurred and that TFT is worthy of further study and research in both psychology and cardiology. Also very evident in these cases and consistent with Dishman, et al. (2000) is the strong relationship between the client’s reduction in self-reported emotional distress (SUD) and the HRV improvements. However, in the cases presented here, the change is a reduction of emotional distress (a SUD of 1) and improved HRV, whereas the Dishman et al. (2000) study, which did not involve an intervention, showed an increase in self-reported emotional distress that was related to reduced HRV. How Long Will it Last?
A question I get asked frequently is how long the results of these
treatments will last. Usually, the changes do hold up over time, but
in those cases where problems returned, I have found a way to help this
situation. This shall be a topic of a future paper on HRV and TFT. CONCLUSION
The literature reports that little can be done to improve HRV. (Huikuri,
Makikallio, et al., 1999). However, large improvements have
been shown on HRV with just TFT algorithms. Anyone interested who has an
HRV can learn to apply this protocol with our algorithms and generate
improvements on HRV. Anyone who wishes, for instance, to try my algorithm
for trauma can easily obtain full instructions for this procedure in a
recent book (Callahan & Callahan, 2000) or by contacting me
personally. All of my algorithms will appear in my upcoming book
(Callahan and Trubo, in press). Seligman (1994) states “optimism is necessary for change to take place” (p253). This notion describes a usual condition for the operation of placebo. For those who do my therapy experiment by trying one of my algorithms, it will be readily seen that my unusual treatment does not engender optimism. Quite the contrary, the treatment seems so peculiar and so different than anything before considered as psychotherapy, it brings about militant skepticism; not only in clients but also in therapists. We find repeatedly, however, that the beliefs or negative expectations of both the therapist and the client are totally irrelevant to the success of the treatment. For those who are, nevertheless, skeptical about the client’s self-report of change in SUD, we now have supporting evidence with the HRV, since HRV has been shown (see studies cited earlier) to not be responsive to the placebo effect. For anyone who suspects placebo effect to be operative, it would have to be explained how the negative expectancies engendered by my peculiar procedures can get translated into such robust positive change. It appears likely that TFT, as it becomes more known and practiced, will change the hopelessness regarding the ability of any intervention to change a low HRV in a clinically meaningful way. As Tsuji et al. (1996) found in the Framingham study, a person who has a low HRV, even with no noticeable symptoms, is more vulnerable to sudden death. Can something be done about this all too common problem? At this point, an appropriate stance towards our new findings concerning the improvement of HRV, is perhaps best expressed by Stein and Kleiger (1999), writing in the Annual Review of Medicine: “Because decreased HRV is strongly associated with an adverse outcome, the obvious question is: Can HRV be increased, and would increased HRV be associated with a better outcome? There is no direct evidence that increasing HRV will improve survival rates. On the other hand, many, though not all, of the interventions associated with decreased mortality are also associated with increased HRV (p.256).” It remains to be demonstrated whether the improvements in HRV of the magnitude now possible, will have the positive effect of decreasing mortality. However, due to the non-invasiveness, speed, and ease of effecting the degree of changes shown in this paper, it is a subject of scientific and clinical urgency to begin such investigations. Considering the
link between HRV and a variety of psychological problems, it appears that
reducing or eliminating psychological problems may be a very effective way
to improve low HRV. It is our hope that due to our work with HRV,
perhaps other psychotherapies will explore the role of their work in
improving HRV. Singer and Ori (1995) state quite succinctly that,
“HRV can be used as a simple tool for monitoring therapeutic
effectiveness” (p434). Our results strongly support this idea as
well as the suggestion by Cohen et al (1999), that HRV may be a useful way
to monitor the results of psychotherapy. I want to thank Monica Pignotti, CSW, for help in research, considerable help in editing, her many helpful suggestions, and for constructing the tables. I also want to thank Roger Holland, MD, PhD, Anu De Monterice, MD, Professor Richard Petty, MD, PhD, Caroline Sakai, PhD, Yoshi Takasaki, MD, Tony Roffers, PhD and Professor Rita Weinberg, PhD, for a number of very helpful suggestions. I would like to thank the following TFT trained therapists for contributing cases with HRV reports for this paper: Audrey Ardapple, LCSW; Jenny Edwards, PhD; Gale Joslin, PhD; Monica Pignotti, CSW; Caroline Sakai, PhD; Mark Steinberg, PhD and Jill Strunk, EdD. Thanks especially to Fuller Royal, MD, for introducing me to HRV and for showing me the positive impact my simple algorithm (for phobias) can have on HRV.
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Table 1. Individual Cases Pre and Post TFT Treatment
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