Have you heard of brainspotting? It’s been around since 2003 when it was invented out of whole cloth (not “discovered”) by psychotherapist David Grand. It seems to be gaining in popularity recently, so it is worth the SBM treatment.
Here is how proponents describe the alleged phenomenon:
“Brainspotting makes use of this natural phenomenon through its use of relevant eye positions. This helps the Brainspotting therapist locate, focus, process and release a wide range of emotionally and bodily-based conditions. Brainspotting is also a brain-based tool to support the therapy relationship. We believe that Brainspotting taps into and harnesses the body’s natural self-scanning, self-healing ability. When a Brainspot is stimulated, the deep brain appears to reflexively signal the therapist that the source of the problem has been found.”
This is all complete and utter neurological rubbish from beginning to end, but let’s break it down. The idea is that trauma (not necessarily traumatic memories, but “trauma” in the abstract sense) is somehow located in specific spots in the deep brain, such as the brainstem. This is an extraordinary claim, and it is coupled with another equally extraordinary claim – that where your eyes physically look also maps to specific subcortical locations. These overlapping maps can then be used to locate the “trauma”.
Of course these maps do not exist. There is no neuroanatomical correlate to either component of the core principles of brainspotting. The anatomy of eye movements is fairly well understood, and does not correlate in any way with this core notion of brainspotting.
This is a main feature of pseudoscience – the core underlying principles are not established science. In this case they are also highly implausible and run counter to actual neuroscience. How did Grand come up with this idea if it is so counter to neuroscience? That brings up another common feature of pseudoscience – it is often based on anecdote, and sometimes a single anecdotal observation.
According to Grand’s own account, he was performing his own version of EMDR (another pseudoscientific therapy modality) on a 16 year old skater when he noticed that her eye movements would get stuck in one spot. He had her maintain here gaze in that location, which he claims resulted in her “releasing” her trauma. The next day she was able to complete a triple loop, which was the performance issue for which she was seeing him.
A proper scientific reaction to an anecdotal experience such as this is to generate a hypothesis, and then objectively test that hypothesis to see if it is real. But that is not how gurus respond – rather they leap to conclusions and then engage in confirmation bias. In this way chiropractic was born out of a single observation by DD Palmer, and iridology came from a single observation by Ignaz von Peczely. They typically confuse their confirmation bias, looking for and selecting observations that appear to support your belief, with actual evidence.
I can only find two publications by Grand on the machanism of Brainspotting – neither present any new evidence or research. They are just musings about neuroanatomy and what might be going on. Both are published in the journal Medical Hypotheses, which is a notorious crank journal full of such naked speculation.
Grand has had 23 years to convince the scientific community that he is onto something, the better part of a career, and has made no progress as far as I can tell. This is because he has been focusing on building Brainspotting as a treatment, not testing the underlying principles.
In the last 23 years neuroscience research has improved tremendously, with tools such as fMRI scanning. If he were, in fact, onto a real fact about the neuroscience of trauma then he should be able to demonstrate this, and other neuroscientists would have picked up on it and expanded his research. But that is not the pattern we see – rather, we just have a single anecdote, followed by a lot of hand-waving speculation about neuroanatomy with zero evidence, while promoting this new therapy as a revolution and it creator as a genius. Classic pseudoscience.
Brainspotting also shares some features with other medical and neurological pseudoscience. The underlying idea is to find some hack, this one crazy trick that allows for the bypassing of all that difficult diagnosis and treatment. You don’t have to spend weeks or months exploring your emotional and cognitive issues in all their complexity. You don’t have to spend weeks, months, or even years working on cognitive behavior therapy, understanding yourself, processing trauma, and developing improved coping and adaptive skills. Just look at this one spot, and your trauma will melt away.
It also shares the common feature of being based on some map or homonculus in the body. Straight chiropractic, acupuncture, reflexology, and iridology all share this feature – some part of the body maps to the entire body, or it maps to specific problems someone may be facing. Just activate this point, and it will fix or at least diagnose the problem. For all of these systems, however, there is no evidence to support the existence of such a map, not even an underlying plausible mechanism.
Interestingly, there are actual homonculus maps in the brain. The motor cortex, for example, occurs along a strip of gyrus that maps to the body. This is how the brain develops. The visual cortex likewise physically maps to your visual field, like a bit map. There is no such map in the midbrain, as Grand claims, that maps to specific eye positions. Further, there is no subsequent map, as Brainspotting requires, that maps to traumatic memories or biological effects.
This is the point at which proponents of a pseudoscience would say something along the lines of – well, we are not sure how it works, we just know that it works, and we are too busy helping people to work out the details. That is not an acceptable excuse for bypassing science. But also, we can determine if a treatment works without knowing how it works. There are standard research protocols for establishing efficacy. Grand hasn’t bothered to do this either.
Determining efficacy is critical in medicine, even in therapy. It is, admittedly, challenging in therapy because it is difficult to control for all the possible variables, and outcomes are often subjective. But this is not a reason to abandon science, it is a reason to have especially rigorous research methodology. At the very least we would like to see some blinded clinical trials with some objective outcome measure. You could randomize clients to treatment vs placebo, with the placebo group receiving some other novel element introduced into the therapy sessions but without any expectation or claim of efficacy. You could also compare both of these groups to a usual therapy control.
Taking this approach to establish the reality of a new treatment requires more than just a single trial. We would need to see a consistent effect that can be replicated with significant effect sizes. Ideally we would see some sort of dose-response curve, and some long term benefit to suggest it’s not just an immediate placebo effect. But that is something we never get with such pseudosciences – simultaneous rigorous clinical trials with statistically and clinically significant results that replicate.
What Grand has done is preliminary clinical trials – small studies that are not designed to establish or refute efficacy. In one study he compared Brainspotting to EMDR in PTSD, with no other control. The main outcome was subjective report of symptoms. This is the type of preliminary research almost guaranteed to generate false positive results, and not capable of determining efficacy. Claiming it is as effective as EMDR is also not impressive, since EMDR has also not established specific efficacy in my opinion.
I think this entire approach to therapy, so-called brain-body therapies, is a blind alley. It is born out of a desire for a quick fix, a hack or trick that can lead to easy quick results. No such therapy has been able to pass scientific muster, but we are likely to see a continued multiplication of such therapies. It’s easy to come up with some new gimmick and make hand-waving claims for how it might work, then combine that with uncontrolled observations or maybe some weak preliminary studies. It’s all nonsense until we do rigorous clinical research grounded in actual neuroscience.
