Eye movements, deep breaths, and psychology’s ‘science-practice gap’

How the rise of Accelerated Resolution Therapy (ART) highlights psychology's 'science-practice-gap'

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If a new psychotherapy seems effective, practitioners take it on tour and hope more clinicians will use it. But often, that’s before really knowing how it works, or why. (Image Courtesy of ART International Training and Research.)

If a new psychotherapy seems effective, practitioners take it on tour and hope more clinicians will use it. But often, that’s before really knowing how it works, or why. (Image Courtesy of ART International Training and Research.)

This story is from The Pulse, a weekly health and science podcast.

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I sit in an office chair in a Philadelphia hotel conference room facing Amy Shuman, a clinical social worker.

She’s silent, waving one hand about two feet from my face. I follow with my eyes, back and forth.

This is part of something called Accelerated Resolution Therapy, or ART. It’s relatively new. Shuman is running a training session for clinicians, and has allowed me to drop in.

“OK, so check your body head to toe,” she says. “Find what emotions and physical sensations you have in your body right now.”

I tell her I have a kind of energy feeling in my gut, like when you drink too much coffee. But I’m actually lying to her — what I feel is fear. I’ve never been in any kind of mental health anything. It’s all weird and new.

“Notice that coffee feeling in your abdomen,” she says, and starts waving again. I follow with my eyes, back and forth really quickly.

The basic idea with this form of psychotherapy is to focus on the physical at first, instead of what’s going through your head. A handful of similar therapies have been cropping up in recent years. They look at what you are feeling as opposed to thinking and involve doing some physical action — eye movements here, but others use finger tapping, for instance.

“One of the theories that we would base this on is the fact that we’re tied somatically to whatever we’re experiencing emotionally or cognitively, that they’re all tied together,” Shuman says.

Anxiety, for example, has a physical or somatic aspect: a pit in your stomach, a lump in your throat. Shuman describes the ART approach as bottom-up — you work on the simpler body feelings before the complicated thought patterns.

Unlike what you might expect in a typical therapist’s office, there’s very little actual talking.

“It’s never discussing. We don’t do the cognitive kinds of discussing that we’ll do in talk therapy,” she says. “The closest we’ll get to that is using imagination. As a matter of fact, when I work with someone, they don’t have to say a word about what they’re working on. I could know nothing about the content.”

Whatever it is, Shuman says she can reprogram it, going through this process, following her hands. She says she can change my response to whatever it is that’s bothering me. And she can do it quickly, she says — in only three or four sessions.

“It’s amazing, that’s what makes it hard for people to believe that it’s really true,” Shuman says.

She works for a nonprofit, ART international, crisscrossing the country spreading this ART gospel, training counselors and therapists. It’s most associated with treating trauma, Shuman says, but it can work for lots of issues: things like depression, obsessive-compulsive disorder, sleep, and even pain.

The mental health professionals here in this Philadelphia conference room seem convinced. One calls it miraculous, hopes it will finally heal her patients where other treatments have failed.

But this therapy is just somebody waving their hand in front of my face, me — moving my eyes around.  I wondered: is this legit? Where does this approach come from? And, how has it caught on?

“You would have seen my eyes just flickering diagonally”

It turns out that ART was created about 10 years ago, and that it’s based on an older, similar therapy, called Eye Movement Desensitization and Reprocessing, or EMDR.

Deany Laliotis runs training for the EMDR Institute. She tells me about the founding mother of that therapy, American psychologist Francine Shapiro.

“Dr. Shapiro was a force of nature and a true, true visionary. She always had the vision that EMDR could help with world peace,” Laliotis said.

The story goes that EMDR was first kind of revealed to Shapiro in a park — she was a psychology graduate student at the time, in the late 1980s. As she was walking, she noticed that when she thought about something disturbing and moved her eyes in a certain way, the thought didn’t trouble her.

“Then I started doing it deliberately, and the thought faded, and when it came back it wasn’t as disturbing,” she says in an old TV interview. The presenter asks Shapiro to describe the scene.

“You would have seen my eyes just flickering diagonally, and so what I thought I had discovered was some mind processes that worked with thoughts,” Shapiro says in the interview.

Shapiro, who passed away in 2019, spent years developing the method, pushing for studies and training.

“She said, ‘This is what’s working, this is going to help people and give them symptom relief and help people heal,’” Laliotis says.  “And she gave it away.”

ART, the approach I tried, also had a founding mother, Laney Rosenzweig, a family therapist and former student of EMDR. It has had a pretty similar visionary-driven trajectory.

I had assumed therapies got more boring starts at universities or research labs, underwent a bunch of studies and proofs, and then got farmed out all at once to professionals in the field. The EMDR/ART origin stories seem almost religious by comparison, kind of cult-like.

But it turns out, they’re completely routine.

“There’s kind of a growth curve where you pick up adherents, right?” says David Baker, a University of Akron professor who studies the history of psychology. “You are pickup practitioners, you pick up clients.”

He says psychotherapies typically grow this grassroots way. Some visionary practitioner or group will go around proselytizing.

“You don’t have to go much further than to think about psychoanalysis and Sigmund Freud. The question is, would we have psychoanalysis without Sigmund Freud,” he says.

Freud did wide-ranging speaking tours, touting his brand new psychoanalysis. And that kind of thing still happens today. New therapies need believers, people who go on clinical intuition, something like faith, and eventually the hope is you reach what Baker calls a critical mass of followers.

Psychoanalyst Dr. Sigmund Freud of Vienna departs on his first airplane flight from Tempelhof Field in Berlin, Germany on Nov. 9, 1928. (AP Photo)

“You reach, I guess, enough of a critical mass where those become more widely known and become subject then to empirical testing,” he says.

A treatment seems to work, so more people use it — even before knowing precisely why it works. The horse comes before the cart, because it kind of has to. Psychology is still relatively young — no one has all the answers when it comes to the mind.

Baker says the evidence is mounting for these new therapies, but the verdict is still out on whether they’re the real deal.

The science-practice gap

The spread of these therapies worries some in the field, like Robin Cautin, a psychologist and dean at Sacred Heart University in Connecticut.

“The fact that there’s very scant evidence for the effectiveness of a particular treatment or a particular technique, that doesn’t necessarily mean that it won’t be widely used in clinical practice. We know, in fact, that many unsubstantiated techniques are used in clinical practice,” she says.

There are science-based treatments and evidence-based treatments, Cautin says. Those sound similar, but she explains there are big differences.

“Unfortunately, the American Psychological Association’s criteria for what constitutes evidence-based — to my mind, the bar is really low,” she says.

Basically, if enough patients say a treatment helped them, it’s considered evidence-based. But that’s not enough for Cautin.

“Not all data is created equal,” she says. “So someone could say, ‘This therapy really worked for me.’ And then … someone says, `Well, how do you know?’ ‘Well, I felt better afterwards.’”

The problem, Cautin says, is that doesn’t tell you why a treatment helped someone, or how it works. If it could tell you that, it would be science based.

These new eye-moving, finger-tapping therapies, they illustrate what Cautin and others call psychology’s science-practice gap.

“The science-practice gap is real and enduring,” she says.

On one hand, this is bad for the overall health of the industry — a houses-built-on-sand type of thing. And on the other, if you don’t really examine what’s working in therapies, what’s the truly active ingredient, you can’t improve therapy. Cautin thinks all of it is getting worse.

“If I were to be realistic about it, I think it’s an uphill battle, quite frankly,” she says. “I think narrowing the science-practice gap is an uphill battle.”

Actually, a researcher in Florida has been conducting the kind of science Cautin wants to see, University of South Florida epidemiologist Kevin Kip. He’s been studying Accelerated Resolution Therapy for years.

I ask him what Cautin is asking: How does this approach work?
“With respect to ART, we don’t have the foggiest idea,” he says.

But he hopes a brain scan study he’s just begun will have some answers. His best guess at the moment: The therapy may exploit the general malleability of memory.

Each time, you recall memories from wherever in your brain, they change, “undergo protein synthesis, molecular change, whether you want that to occur or not,” Kip says.

In ART, eventually, you start purposely editing your memories in your head, remembering what happened and also imagining how you wish things would have gone down, deep breaths, eye movements the whole while. Enough of this practice, and the bad memories just don’t bother you as much.

“There’s still, I would say, tremendous skepticism. What’s happening right now is that training is outpacing the research,” Kip says. “Research is slow, but because of just some word-of-mouth and the limited data we have and just anecdotes as well. The requests now for training of clinicians is very substantial.”

There are thousands practicing ART and EDMR nationwide. Why are so many professional clinicians so ready to start using this approach, to leap over or into the science-practice gap?

Part of the attraction may be that very serious people are taking this stuff seriously. For example, one of the therapy’s big boosters is an Army colonel.

So effective, “it’s hard to do anything else …”

Col. Wendi Waits heads up behavioral health at Walter Reed National Military Medical Center. She had two problems in treating veterans during the height of the Iraq and Afghanistan wars. First, treatments took too long, and vets would drop out too soon. Second, with two wars raging, there were too many people needing help.

Accelerated Resolution Therapy promised to work fast and, crucially for vets, it could work without forcing patients to show any vulnerability or break down while retelling their traumas to some shrink.

“I was thinking if we can get patients in and out of the clinic in three to four sessions and moving on with their lives, that would be a big win,” she says.

And it was. Not just, by the way, for post-traumatic stress disorder. Waits treats the family members of veterans, as well.

“I’ve used it for addictions. I’ve used it for panic disorder or panic attacks. I’ve used it even in adolescent populations for things like perfectionism, bullying, family discord, body image issues,” she says.

After we speak, the colonel’s public affairs officer calls me to drive home this point, that Waits believes ART could be part of the solution for so much more.

“I mean many of us who’ve been trained in ART have a hard time really — how do I say this? It’s hard to do anything else when you know how effective ART can be,” she says.

Laney Rosenzweig is the founder and developer of Accelerated Resolution Therapy. Part of ART’s appeal is that it has promised to work fast and without forcing patients to show any vulnerability in retelling traumas to mental health professionals. (Image Courtesy of ART International Training and Research.)

Waits is a soldier, I imagine goal- and mission-oriented. The how and why of ART is less important to her than to Cautin, the Sacred Heart University dean. Waits needs something that works now. ART seems to, and that’s enough.

Time, and maybe brain scans, will tell if these therapies are the real thing or just widening psychology’s science-practice gap.

I recall being in the hotel conference room, doing ART with Shuman, the clinical social worker I was facing with that anxious feeling and saying it was from too much coffee.

But I also remember this: Whatever it was in my stomach, sitting in that chair, by the time Shuman finished waving her hand — it was gone.

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