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Rethinking MRT as an Ideomotor Effect Energy Psychology 10:2 • November 2018 13
ORIGINAL RESEARCH
Emerging from the Mystical: Rethinking Muscle
Response Testing as an Ideomotor Effect
Anne M. Jensen, Queensland, Australia
Anne M. Jensen, MSc, DC, DPhil, is a forward-thinking
healer who earned her doctorate from Oxford University
researching the validity of muscle testing. Through her back-
ground in chiropractic and psychology, her empathic abil-
ity and sense of curiosity, she developed HeartSpeak (www.
heartspeak.me), a unique and empowering stress-reduction
tool. Correspondence: Anne M. Jensen, 7 Sydney Street,
Mackay, Queensland 4740, Australia; email: dranne@
drannejensen.com. Disclosure: The author receives income
from muscle response testing training.
Muscle Response Testing (MRT), com-
monly referred to simply as “muscle
testing,” is an assessment tool estimated
to be used by over one million people world-
wide, mainly in the eld of alternative health
care, which includes kinesiologists, chiroprac-
tors, physiotherapists, osteopaths, and psycholo-
gists (Jensen, 2015b). During a test, a practitioner
Abstract
Muscle Response Testing (MRT) is an
assessment tool estimated to be used by over
one million people worldwide, mainly in the
eld of alternative health care. During a test, a
practitioner applies a force on a patient’s iso-
metrically contracted muscle for the purpose of
gaining information about the patient in order to
guide care. The practitioner notes the patient’s
ability or inability to resist the force and inter-
prets the outcome according to predetermined
criteria. Though recent research supports the
validity of MRT, little is known about its mech-
anism of action. Nevertheless, its causation is
often attributed to an ideomotor effect, which
can be dened as muscular activity, potentially
nonconscious, and seemingly brought about by
a third-party operator. Accordingly, the aim of
this study is to investigate whether the ideomo-
tor effect is a plausible explanation of action
for MRT.
Methods: This is a retrospective, observational
study of data extraction from a previously re-
ported study of the diagnostic accuracy of MRT
used to distinguish true from false statements.
Additional analysis was carried out on the data-
set of assessing for potential sources of bias—
both practitioner bias and patient bias.
Results: When practitioners were blind, they
achieved a mean MRT accuracy of 65.9% (95%
CI 62.3–69.5), and when they were not blind,
63.2% (95% CI 58.3–68.1). No signicant
difference was found between these scores
(p = 0.37). When practitioners were inter-
mittently misled, the mean MRT accuracy
decreased to 56.6% (95% CI 49.4–63.8), which
proved to be signicantly different from when
the practitioners were blind (p = 0.02), yet not
signicantly different from then the practition-
ers were not blind (p = 0.11). In addition, no
evidence of patient bias was uncovered.
Summary: The results of this study demon-
strate that when comparing blind and not blind
conditions, the practitioner evokes no inu-
ence, so it is unlikely that the practitioner is
responsible for an ideomotor effect. Likewise,
the patient has been shown to produce no sig-
nicant inuence either, so it is also unlikely
that the patient is responsible for an ideomotor
effect. The limitations of this study are those of
any retrospective, observational study in that
data were not collected to answer the specic
research question of this study. Future research
should include a study specically designed to
answer this question, for example, intentionally
attempting to induce bias in the practitioner. In
summary, the ideomotor explanation of MRT
should be regarded as obsolete until such a time
as a more plausible explanation of its mecha-
nism of action is established.
Keywords: ideomotor, muscle testing, muscle
weakness, lie detection, accuracy, kinesiology
Energy Psychology 10:2 • November 2018 Rethinking MRT as an Ideomotor Effect
14
applies a force on a patient’s isometrically con-
tracted muscle for the purpose of gaining more
information about the patient in order to guide
care. The practitioner notes the patient’s abil-
ity or inability to resist the force and interprets
the outcome according to predetermined criteria.
Though MRT has been shown to be sufciently
accurate in distinguishing lies from truth (Jensen,
Stevens, & Burls, 2016), its mechanism of action
is largely unknown, though commonly attributed
to an ideomotor effect, which can be dened as
muscular activity, potentially nonconscious, and
seemingly brought about by a third-party operator.
The results from a recent study on the accuracy of
MRT suggest, however, that the ideomotor effect
may not be the mechanism of action. Therefore,
the purpose of this paper is to dene what MRT
is, then to review the evolution and key features
of the ideomotor effect, and nally to outline the
specic results of the recent study that preclude
an ideomotor effect as a plausible explanation of
MRT’s mechanism of action.
Muscle Response Testing
MRT is one type of manual muscle testing
(MMT) in which a patient’s muscle—often the
deltoid muscle—is tested repeatedly as the target
condition changes. Conventionally, the practi-
tioner detects the outcome of the muscle test to
be either “strong” or “weak.” The interpretation of
the outcome (strong or weak) is dependent upon
the practitioner’s choice of paradigm. A com-
mon usage of MRT is to distinguish true from
false spoken statements, and a common paradigm
employed is: A true statement results in a strong
muscle response, and a false statement results in a
weak muscle response (Jensen et al., 2016; Monti,
Sinnott, Marchese, Kunkel, & Greeson, 1999).
Another common usage of MRT is to detect stress
in a patient (Gallo, 2000; Frost & Goodheart, 2013;
Thie & Thie, 2005; Krebs & McGowan, 2013),
and in this paradigm, a weak muscle response is
usually indicative of stress, and a strong response
usually suggests the absence of stress.
MRT differs distinctly from other forms of
MMT, such as orthopedic/neurological MMT
(O/N-MMT) and Applied Kinesiology–style
MMT (AK-MMT). In both of these other forms,
any muscle of the body may be tested, whereas
in MRT, only one muscle is usually tested and
it is commonly called the indicator muscle. In
O/N-MMT, muscles are tested to assess muscle
strength and graded on a 0–5 scale, with 5 being
normal. In MRT (and in AK-MMT), muscles are
tested to assess conditions other than strength and
are graded on a binary scale: either strong or weak.
Another distinction between AK-MMT and MRT
is that in AK-MMT, the test outcome is depen-
dent upon the muscle being tested. For instance,
if a psoas muscle is found to be weak, this may
indicate a kidney concern (Walther, 1981, 2000).
Whereas in MRT, the practitioner decides on the
parameters of the test prior to its execution. As an
example, a patient may report having neck pain,
the practitioner may perform MRT using the del-
toid muscle to detect the presence (or absence) of
stress in the neck, and a weak response will indi-
cate that stress is present. The practitioner may
then continue to use MRT to zero in on the source
of the stress. For a summary of the similarities and
differences of the three types of MMT, see Table 1.
The Current Status of the Evidence
of MRT
Until the development of the Standards for the
Reporting of Diagnostic Accuracy (STARD) guide-
lines in 2003, the evaluation of diagnostic tech-
niques lagged behind that of interventions and had
Table 1. The Three Types of Manual Muscle Testing (MMT): A Summary of Their Similarities and Differences
O/N-MMT AK-MMT MRT
Muscles used Any muscle Any muscle One muscle*
Detects NMS conditions Many conditions Many conditions
Outcomes Graded 0 to 5 Binary Binary
Results Assesses strength Depends on muscle tested Depends on condition
Note: *An Indicator Muscle.
Abbreviations: O/N-MMT = Orthopedic/Neurological Manual Muscle Testing; AK-MMT = Applied Kinesiology–style of Manual
Muscle Testing; MRT = Muscle Response Testing; NMS = Neuromusculoskeletal.
Rethinking MRT as an Ideomotor Effect Energy Psychology 10:2 • November 2018 15
been notoriously fraught with inconsistencies and
bias (Knottnerus & Buntinx, 2009; Bossuyt et al.,
2003b; Hall, Lewith, Brien, & Little, 2008). This
is especially true of the inconsistent use of termi-
nology to describe the validity of a diagnostic test:
Various terms (e.g., accuracy and precision) are
confused in colloquial English and at times in the
scientic literature as well (Slezák & Waczulíková,
2011). In assessing the current status of the MRT
literature, this difculty is further amplied by the
confusion regarding the term “muscle testing,”
which, as previously described, can have different
meanings in different contexts.
With this in mind, using the electronic data-
bases MEDLINE, MANTIS, PsycINFO, and
CINAHL, a literature search was conducted, and
only papers published in peer-reviewed journals
were considered. The outcome of this search was
26 papers that used either MRT or AK-MMT to
detect a specied target condition. The reference
lists of the included papers were also checked for
relevant research, which resulted in no additions.
Few rigorous studies have attempted to esti-
mate the diagnostic accuracy of MRT or AK-
MMT; however, one must take into account that
only one of these, Schwartz et al. (2014), was
published after the publication of the STARD
guidelines. This study attempted to measure
the diagnostic accuracy of MRT to distinguish
between substances that were toxic and nontoxic
to the body, and reported that MRT accuracy was
indistinguishable from chance. This means, in this
case, that MRT was unsuccessful. Likewise, two
systematic reviews of the AK literature (Hall et al.,
2008; Klinkoski & Leboeuf, 1990) found no evi-
dence of diagnostic accuracy, but the standards for
reporting were pre-STARD, and therefore lacking.
There are, however, numerous studies that
have looked at other characteristics of MMT, such
as reliability (Drouin, Valovich-McLeod, Shultz,
Gansneder, & Perrin, 2004; Florence et al., 1992;
Haas, Peterson, Hoyer, & Ross, 1994; Jepsen,
Laursen, Larsen, & Hagert, 2004; Perry, Weiss,
Burneld, Gronley, 2004; Pollard, Lakay, Tucker,
Watson, & Bablis, 2005; Wadsworth, Krishnan, &
Sear, 1987), validity (Drouin et al., 2004; Perry et al.,
2004; Ladeira et al., 2005), inter-examiner agree-
ment (Pollard et al., 2005; Lawson & Calderon,
1997), intra-examiner agreement (Wadsworth
et al., 1987; Leboeuf, Jenkins, & Smyth, 1988),
predictability (Pollard, Bablis, & Bonello, 2006;
Perry, Ireland, Gronley, & Hoffer, 1986), internal
consistency (Bohannon, 1997), and diagno-
sis in general (Jacobs, Franks, & Gilman, 1984;
Nahmani, Serviere, & Dubois, 1984; Omura, 1981;
Pothmann, Hoicke, Weingarten, & Lüdtke, 2001;
Schmitt & Leisman, 1998; Tiekert, 1981; Triano,
1982). The sheer number of terms used to describe
the validity of MRT is frankly confusing. More-
over, the appropriateness of the application of some
of these analyses to MRT or AK-MMT is question-
able. However, some published studies do report
accuracy estimations, most of them published prior
to the publication of the STARD guidelines.
Using the AK-style of MMT, Caruso and
Leisman (2000) reported that experienced prac-
titioners (≥5 years’ experience) predicted muscle
strength more accurately compared to inexperi-
enced practitioners (<5 years’ experience), with
accuracies of 98% and 64%, respectively. In other
studies, it was found that MRT was used to accu-
rately predict low back pain (Pollard et al., 2006)
and simple phobia (Peterson, 1996), and AK-MMT
accurately predicted food allergies (Garrow, 1998).
Further studies found that AK-MMT was unable to
accurately predict nutritional needs (Triano, 1982;
Kenney, Clemens, & Forsythe, 1988), nutritional
intolerance (Pothmann et al., 2001; Jacobs, 1981),
and thyroid dysfunction (Jacobs et al., 1984).
Nevertheless, one study, Monti et al. (1999),
successfully used MRT to differentiate between
true and false statements, similar to the current
study (Jensen et al., 2016). Monti et al. found that
when a muscle is tested following a true spoken
statement, it yields signicantly different results
compared to MRT following false spoken state-
ments. Their study found that the indicator muscle
stays “strong” after a patient speaks true statements
and goes “weak” after a patient speaks false state-
ments. Their statements were self-referential state-
ments, which used the speaker’s name, as in “My
name is (insert one’s name or another name).” One
problem with using self-referential statements is
that, in all likelihood, both the muscle tester and
the test patient were aware of the verity of the state-
ment, and therefore neither was blind. Blinding
of the muscle testers was not specically reported
in Monti’s paper. Even though tester bias was
examined in Monti’s study, there is a chance that
unblinded testing may have introduced other biases
and thus inuenced the test’s outcome. While it is
generally accepted among those who use various
types of MMT that some bias can exist, little is cur-
rently known about the degree of this bias.
Energy Psychology 10:2 • November 2018 Rethinking MRT as an Ideomotor Effect
16
Development of Ideomotor Principles
The term ideomotor is derived from ideo,
meaning “an idea or mental construct,” and motor,
meaning “muscular activity,” suggesting that mus-
cle movement can be driven by thoughts (Stock &
Stock, 2004). While the phrase “ideomotor effect”
was coined by William Carpenter in 1852, its
principles stem from earlier that century and have
two clear roots: one British and the other German.
The main difference between the two theories is
that in the German model (the older model), the
ideomotor effect can be brought about by either
conscious (voluntary) or nonconscious (involun-
tary) effort, while the British primarily focused on
nonconscious muscular activity (Stock & Stock,
2004; Braid, 1855). An evolutionary tree outlining
the primary inuencers of ideomotor theory can
be found in Figure 1.
Carpenter’s predecessor, Thomas Laylock,
observed in 1845 that people appeared at times to
have “no deliberate control over their own behav-
ior,” and also acknowledged this was not a new
concept but dated back to the 17th and 18th centu-
ries (Stock & Stock, 2004). Another inuence on
ideomotor principles was James Braid, the founder
of modern hypnotism and Carpenter’s good friend
and sounding board. Braid used Carpenter’s new
ideomotor effect to explain some of the phe-
nomenon he observed in hypnotized subjects.
For example, a hypnotherapist (also called the
“operator”) may suggest to the hypnotized subject
that he cannot rise from the chair or open his eyes,
so the subject takes on this belief and, as a result,
nds that it is actually impossible for him to rise
or open his eyes—his muscles will not allow it.
Braid and Carpenter suggested that this is not
because the will of the subject is controlled by the
operator but rather that his will is controlled by his
own belief in the operator’s suggestion (Carpenter,
1852)—an important but subtle distinction.
Braid and Carpenter extended this principle
beyond motor/muscular control and suggested that
any reex action can be elicited through thought.
For instance, at the suggestion that the room is
exceptionally hot, a subject may actually perspire
(Carpenter, 1852). As a result of its connection
with hypnosis, the ideomotor effect then came
to be singularly associated with a seeming loss
of voluntary control, whereas the original theory
was concerned with ideas exerting both voluntary
and involuntary control over muscular actions
(Braid, 1855).
At the same time that Braid formalized hyp-
notherapy and Carpenter proposed his ideomo-
tor theory, occultism was on the rise. There was
widespread use of the pendulum, divining rod,
and Ouija board, and seances and mediumship
were popular. Largely due to proximity, and also
the lack of other plausible explanations, many of
these paranormal phenomena were explained by
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Figure 1. Inuencers of the ideomotor theory.
Rethinking MRT as an Ideomotor Effect Energy Psychology 10:2 • November 2018 17
ideomotor action. Coincidentally, because of the
popularity of and the fascination with the occult
that enchanted Europe in the mid-19th century,
Carpenter’s ideomotor effect also gained wide-
spread support (Stock & Stock, 2004). Conse-
quently, by the end of the 19th century, the two—
the ideomotor effect and the occult—became
intertwined in the public mind and that connection
persists to this day.
William James (1890s), often regarded as the
Father of American Psychology, was committed
to demystifying the mechanisms of movement and
discovering their true neurocognitive pathways
(Ondobaka & Bekkering, 2012). In attempt to dis-
entangle the ideomotor effect and the occult and
add credibility to the emerging discipline of mod-
ern psychology, James adopted Carpenter’s term
ideomotor but opposed its application to occult or
paranormal phenomena (Stock & Stock, 2004).
Rather, James suggested that any action may be
the result of an ideomotor effect; thus, essentially,
he adopted the British term but the German princi-
ples (Stock & Stock, 2004).
In an attempt to put more distance between
the modern psychological principles and the
occult, Edward Lee Thorndike, then president of
the American Psychological Association, vehe-
mently and publicly attacked ideomotor theory
in his speech at their 1912 conference (Stock &
Stock, 2004). As a result of Thorndike’s scath-
ing rebuke, the original ideomotor principles fell
into oblivion, and to this day the term “ideomotor
effect” is attached to paranormal phenomena and
is looked upon with repugnance.
It is in the category of ideomotor effect that
muscle testing has been incorrectly placed today,
alongside the pendulum, dowsing, Facilitated
Communication, automatic writing, the Ouija
board, and other unexplained phenomena. Mus-
cle testing’s poor face validity and the lack of
rigorous evidence of its mechanism of effect may
have contributed to this continued categorization.
Despite its lack of evidence of effect, however, the
mechanism cannot be justied by the ideomotor
effect.
Dening the Ideomotor Effect
As the meaning of ideomotor has changed
markedly since its inception, for the purpose of
clarity, this paper will use the following contem-
porary denition:
Ideomotor effect: the process whereby a
thought brings about a seemingly reexive or
automatic muscular action, potentially slight,
and conceivably outside the subject’s aware-
ness (Shin, Proctor, & Capaldi, 2010).
In light of this denition and upon review
of the literature, there seem to be two consistent
features of the ideomotor effect (Stock & Stock,
2004; Ondobaka & Bekkering, 2012; Carpenter,
1852, pp. 147–153; Carroll, 2012; Hyman, 1999;
Jackson, 2005):
1. The subject seems to have no control over
his/her actions; and
2. Ideas seem to be at the suggestion of the
operator.
Putting these features in terms of MRT, the
translation might be as follows:
1. The patient seems to have no control over
the strength of his/her muscle; and
2. The practitioner may be suggesting to the
patient the outcome desired, or in other
words, the practitioner seems to exert an
inuence during the test, or in still other
words, seems to bias the muscle test.
With these features in mind, it is easy to
understand how the ideomotor effect was used as a
plausible explanation of MRT: A patient’s muscle
seems to stay strong during one test and then goes
weak during the very next test, with the patient
seeming to have no control.
If data are uncovered to disprove either of
these points, however, then MRT cannot be cred-
ited to an ideomotor effect. This study will assess
the second feature and investigate if blinding the
participants inuences MRT accuracy. It is reason-
able to theorize if the practitioner is not blind to
the expected outcome of the MRT (i.e., s/he knows
what the outcome should be), then s/he will or can
introduce bias and try to sway the test toward the
expected outcome, thereby articially inating the
accuracy. Consequently, the null hypothesis (H0)
of this study is that MRT accuracy when the prac-
titioner is not blind is greater than MRT accuracy
when the practitioner is blind:
H: MRT accuracy (not blind) > MRT
accuracy (blind)
0
If blinding has no effect on MRT accu-
racy, then the null hypothesis will be rejected,
Energy Psychology 10:2 • November 2018 Rethinking MRT as an Ideomotor Effect
18
demonstrating that MRT cannot be explained by
an ideomotor effect.
Methods
Using the results from a previously reported
study on the accuracy of MRT (Jensen et al.,
2016), additional analyses were made on the data-
set of Study 1, focusing on the second of the two
ideomotor features described above: the inuence
of bias during a muscle test.
The study previously reported and used for
additional analysis was a prospective study of diag-
nostic test accuracy, registered with two clinical tri-
als registries (the Australian New Zealand Clinical
Trials Registry [ANZCTR; www.anzctr.org.au;
ID#ACTRN12609000455268] and the US-based
ClinicalTrials.gov [ID#NCT01066312]), and re -
ceived ethics committee approval to collect data in
the United Kingdom and the United States. Data
collection in the United Kingdom was approved
by the Oxford Tropical Research Ethics Com-
mittee (OxTREC Reference Number 34-09), and
data collection in the United States, by the Parker
University Institutional Review Board (Approval
Number R09-09). The study under further analy-
sis was the rst in a series of studies undertaken
for the degree of DPhil (PhD), which was granted
by Oxford University in 2015 (Jensen, 2015a).
Written informed consent was obtained from
all participants, and all other tenets of the Dec-
laration of Helsinki were upheld. In addition,
this study was reported in accordance with the
Standards for the Reporting of Diagnostic Test
Accuracy Studies (STARD) guidelines (Bossuyt
et al., 2003a; Bossuyt et al., 2003b; Bossuyt &
Leeang, 2008).
General Summary of Study Methods
In this study, 48 practitioners experienced in
MRT (Practitioners) were paired with 48 naïve and
unique test patients (TPs), who had no prior expe-
rience with MRT. Both types of participants, Prac-
titioner and TP, each viewed their own computer
screen, on which pictures of common objects were
displayed. TPs were instructed via an earpiece to
speak a statement in reference to the displayed pic-
ture; sometimes the statement was true, other times
it was false. (For a pictorial description of the test-
ing scenario layout, see Figure 2.) The sequence of
true and false statements was randomly generated
by the computer. In Part 1 of this study, Practi-
tioners were shown either the same picture as the
TP or a blank, black screen. In the latter case, the
Practitioner was considered blind, and in the for-
mer, not blind. The Practitioner-blind condition
was used to calculate mean MRT accuracy (as
percent correct). The Practitioner-not blind condi-
tion was used to assess if practitioners could be
persuaded (or biased) toward choosing the correct
response.
Once the TP viewed the picture and spoke
the given statement, the Practitioner performed
a deltoid muscle test in order to determine if the
statement was true or false. At this point, the TP
entered the MRT outcome on his/her computer
keyboard, which advanced the screens of TP and
Practitioner to the next picture/statement. Part 1
consisted of 40 MRTs, and Part 2, of 20 MRTs. In
Part 2, the Practitioner’s computer also randomly
displayed pictures that were different from the
TP’s, creating the “Practitioner-misled” condition,
and potentially a bias away from choosing the cor-
rect response. See Figure 2 for a diagram of the
testing scenario, and Figure 3 for the Participant
Flow Diagram. (For a more detailed description
of these study methods, refer to the original paper
[Jensen et al., 2016].)
Blinding of Participants
Since it was an aim of the original study to
investigate the impact that blinding had on MRT
accuracy, much thought was given about how to
blind participants, both TPs and Practitioners.
Blinding of participants is the key feature of this
report.
First, since TPs were MRT-naïve, they were
unaware of what MRT involved and were unfa-
miliar with any MRT paradigms. Also, while it
was impossible to blind TPs to the reaction of
their arms, they were not explicitly told when
their arm stayed strong or went weak, and in many
instances, the Practitioner’s determination of test
outcome (“strong” or “weak”) was not obvious to
myself, an observer, during testing. In addition,
because Practitioners were randomly blinded, TPs
were effectively blind to the Practitioner’s blind-
ness. Furthermore, TPs were blind to the interpre-
tation of the MRT outcome (“Weak” was inter-
preted as “lying” and “Strong” was interpreted as
“truth”) and blind to what the Practitioner entered
into the computer (e.g., “W” or “S”). Furthermore,
Rethinking MRT as an Ideomotor Effect Energy Psychology 10:2 • November 2018 19
Monitor
Monitor
Practitioner
Test
Patient
PI
An example of what TP may hear through the earpiece:
“Say, ‘I see an apple’” (True)
or: “Say, ‘I see a cloud.’” (False)
Figure 2. Testing scenario layout: The Practitioner (light gray) viewed a monitor (also light gray) that the Test
Patient (TP) could not see and entered his results on a keyboard. The Test Patient (dark gray) viewed a monitor
(also dark gray) that the Practitioner could see, had an ear piece in his ear through which he received instructions,
and used a mouse to advance his computer to the next picture/statement. Note that in the part of this study currently
under analysis, Practitioners were presented with (1) the same picture as the Test Patient, (2) a blank, black screen,
or (3) a picture that was different from the Test Patient’s picture. Also note that the Principal Investigator (PI) was
present in the room and observing during all assessments.
Abbreviations: TP = Test Patient; PI = Principal Investigator.
no ndings or results were discussed with the
TP during the testing, nor was the TP’s opinion
sought. Finally, TPs were theoretically not blind
to the verity of the statements they spoke. That is,
it was presumed that TPs were aware of when they
spoke true statements and when they spoke false
statements.
On the other hand, blinding the Practitioner
was, in many respects, more straightforward. To
begin with, clearly Practitioners were not blind to
the paradigm being used. They were also aware of:
(1) the primary aim of the study (i.e., to estimate
MRT accuracy in detecting deceit), (2) that TPs
were naïve to MRT, (3) that TPs were unaware of
the paradigm being used, and (4) TPs were going
to be instructed either to lie or to tell the truth.
Practitioners were, however, randomly blind to the
verity of the spoken statement. In addition, in a
second part of the study (Part B), when they were
misled about the sameness of the picture they were
shown, they were also blind to being blind. Taking
all these factors into consideration, I believe that
overall a high level of participant blinding was
achieved.
Data Extraction Methods
Specic data were extracted from the study’s
dataset to assess for participant bias: Practitioner
bias and TP bias. Practitioner bias was evaluated
by comparing the mean MRT accuracies under
three different conditions: (1) when the Practi-
tioner was blind, (2) when the Practitioner was not
blind, and (3) when the Practitioner was misled.
While the primary outcome of this study was the
mean MRT accuracy when the Practitioners were
blind, if this measure was signicantly different
from either of the other two conditions, then it
might suggest bias was present.
TP bias was assessed by subgroup analysis by
comparing the mean MRT accuracy of the group
where TPs reported guessing the paradigm being
investigated to the mean MRT accuracy of the
group who did not report guessing the paradigm
Energy Psychology 10:2 • November 2018 Rethinking MRT as an Ideomotor Effect
20
under investigation. It was hypothesized that if
a TP was not blind to the paradigm under inves-
tigation, then s/he could introduce a degree of
response bias.
Finally, some researchers have noted a
heightened belief in a process following a positive
personal experience—a phenomenon they (pos-
sibly inaccurately) labeled an “ideomotor action”
(Hyman, 1999; Dillon, Fenlason, & Vogel, 1994).
In any event, in the original study, participants
were asked to rate their levels of condence on
a 10 cm Visual Analog Scale (VAS) before and
after testing. TPs ranked the level of condence
they had in MRT in general, in their Practitioner,
and in their Practitioner’s MRT ability. Simi-
larly, Practitioners rated their level of condence
in MRT in general and in their own MRT abil-
ity. While not proven to be correlated to positive
personal experience, condence rating data were
reanalyzed and re-reported.
Due to word limit restraints imposed by sci-
entic journals, some of the results of the origi-
nal study presented here have not been previously
reported yet were peer-reviewed during the degree
conferring process (Jensen, 2015a).
Statistical Methods
An error-based measure of MRT accuracy is
reported as overall percent correct, with a 95%
condence interval (95% CI). Using pilot data, a
sample size for this full-scale study was calculated,
powered to 80%. Based on these assumptions and
using a 95% condence interval, it was deter-
mined that a study of 48 practitioner-patient pairs
would have good statistical power to demonstrate
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Figure 3. Participant ow diagram.
Note: *Touching wrist & observing.
Abbreviations: MRT = Muscle Response Testing; TP = Test Patient.
Rethinking MRT as an Ideomotor Effect Energy Psychology 10:2 • November 2018 21
whether MRT can be used to distinguish a lie from
a truth. Statistical advice was sought during the
design phase, after piloting, and before data anal-
ysis. All data were analyzed using Stata/IC 12.1
(StataCorp LP, College Station, Texas), speci-
cally the commands ttest and pwcorr.
Results
Specic data were extracted from the data-
set of Study 1 in a previously reported series of
diagnostic test accuracy studies on MRT. (For the
results of this series, see Jensen et al., 2016).
Bias Toward a Desired Outcome: Blind
vs. Not-Blind Practitioners
In Part 1 of this study, MRT accuracies were
compared when the Practitioners were blind to
when they were not blind. When the Practitioners
were blind, they achieved a mean MRT accuracy
of 65.9% (95% CI 62.3–69.5), and when they were
not blind, 63.2% (95% CI 58.3–68.1). See Table 2.
No signicant difference was found between the
scores (p = 0.37), and they were signicantly cor-
related (r = 0.383, p = 0.01).
Bias Away from a Desired Outcome: An
Attempt to Mislead Practitioners
In this previously unreported part of this study,
where Practitioners were intermittently misled,
mean MRT accuracy dropped to 56.6% (95% CI
49.4–63.8), which proved to be signicantly dif-
ferent from when the Practitioners were blind (p =
0.02), yet not signicantly different from then the
Practitioners were not blind (p = 0.11). See Table 2.
Test Patient Bias
Also compared were the mean accuracies
of those pairs whose TP reported guessing the
paradigm (n = 21) to those pairs whose TPs did
not report guessing the paradigm (n = 27). For
those pairs whose TP reported guessing the para-
digm, the mean MRT accuracy was 66.1% (95%
CI 59.1–73.0), and for those pairs whose TP did
not report guessing the paradigm, the mean MRT
accuracy was 64.9% (95% CI 61.0–68.8). No sig-
nicant difference was found between these two
groups (p = 0.38).
Pre- and Posttesting Condence Ratings
Overall, while TP condence ratings increased
signicantly (see Table 3A), this did not seem to
inuence MRT accuracy (see Table 3B). Fur-
thermore, while Practitioner condence ratings
dropped slightly, their differences did not reach
signicance (see Table 3A). Moreover, these rat-
ings were not correlated with MRT accuracy
scores, regardless whether practitioners were
blind or misled (see Table 3C). However, MRT
accuracies under blind conditions did correlate
with MRT accuracies in the misled condition.
Discussion
In this further analysis of the dataset from a
previously reported study, sources of potential bias
were assessed. In Part 1 of this study, Practitioners
were given an opportunity to introduce bias into
their testing by being given suggestions about the
verity of the TP statements (i.e., they were inter-
mittently made aware when a statement was true
or false). For this part, the mean MRT accuracy
when the Practitioners were blind was compared
to when they were not blind, and the difference
was found to be insignicant (p = 0.37). This sug-
gests that even when the Practitioners knew what
the outcome of the muscle test should be, they
performed similarly to when they did not know,
suggesting that they did not exert an inuence on
(i.e., bias) the outcome of the test.
In Part 2 of this study, Practitioners were given
further opportunities to induce bias into their mus-
cle testing when it was attempted to sway them
away from—and also again toward—choosing
the correct response. When the MRT accuracy
when the Practitioners were blind (65.9%; 95%
CI 62.3–69.5) was compared to the MRT accuracy
Table 2. The Impact of Blinding and Misleading
Practitioners on MRT Accuracy
Condition MRT accuracy†
Mean 95% CI p-value
Part 1 Blind
Not blind
0.659
0.632
0.623–0.695
0.583–0.681
0.37
Part 2 Not blind
Blind
Misled
0.639
0.659
0.566
0.595–0.693
0.623–0.695
0.494–0.638
0.53
0.02*
Notes: †Accuracy = % correct.*Signicance reached.
Abbreviations: MRT = Muscle Response Testing; CI = Con-
dence Interval.
}
}
Energy Psychology 10:2 • November 2018 Rethinking MRT as an Ideomotor Effect
22
Table 3A. Comparing Pre- and Posttesting Condence Ratings
Pretesting Posttesting p-value
Mean
rating
95% CI Mean
rating
95% CI
Test patients Condence in MRT in general 6.76 6.16–7.36 7.22 6.63–7.81 0.03*
Condence in Practitioner 6.95 6.30–7.61 7.63 7.01–8.25 0.01*
Condence in Practitioner’s MRT ability 7.00 6.35–7.65 7.76 7.10–8.41 0.01*
Practitioners Condence in their own MRT ability 8.43 8.02–8.85 8.15 7.67–8.63 0.37
Condence in MRT in general 8.67 8.22–9.12 8.43 7.94–8.92 0.47
Note: *Signicance reached.
Abbreviations: MRT = Muscle Response Testing; TP = Test Patient; CI = Condence Interval.
Table 3B. Correlation Table (including p-values): MRT Accuracy and the Difference in Test Patient Condence
Ratings (r)
1. 2. 3. 4.
1. The change in TP condence in MRT in general: Post–Pre 1.00
2. The change in TP condence in Practitioner: Post–Pre 0.33 1.00
p-value: 0.02*
3. The change in TP condence in Practitioner’s MRT ability: Post–Pre 0.30 0.87 1.00
p-values: 0.04* <0.01*
4. MRT accuracy
p-values:
0.12
0.41
0.06
0.71
0.09
0.56
1.00
Note: *Signicance reached.
Abbreviation: MRT = Muscle Response Testing.
when the Practitioners were misled (56.6; 95%
CI 49.4–63.8), a signicant difference was found
(p = 0.02), suggesting that, in this case, the Prac-
titioners exerted an inuence. On the other hand,
when comparing blind vs. not blind Practitioners’
MRT accuracies in Part 2 (as was done in Part 1),
the difference in the means was likewise found to
be insignicant (p = 0.53). This once again sug-
gests that Practitioners did not exert an inuence.
Potential sources of TP bias were also evalu-
ated. Since in this testing scenario, the TPs were
not themselves blind to the verity of their spoken
statements, it was possible for them to exert an
inuence on the MRT outcome. However, only
naïve volunteers were recruited into this study as
TPs. They had no prior experience with MRT, and
each TP also did not know the Practitioner who
was performing the testing. In addition, TPs were
kept blind to the paradigm being used; that is,
they were not explicitly told that a true statement
would result in a strong MRT and a false statement
would result in a weak MRT. As anticipated, some
TPs reported guessing this paradigm; however, no
signicant difference between these groups was
found (p = 0.38).
Previous research reported that a positive per-
sonal experience could heighten belief in a pro-
cess, which they (perhaps inappropriately) called
an “ideomotor action” (Hyman, 1999; Dillon et al.,
1994). While this current study did not track on
“positive-ness” of experience, participants were
asked to provide condence ratings. However, no
correlation was found between MRT accuracy and
any condence rating.
Possible Explanations and Implications
in Regard to the Ideomotor Effect
The fact that practitioners performed simi-
larly whether they were blind or not blind sug-
gests that they were not exerting an inuence
on MRT outcomes. Correspondingly, this makes
sense: If an operator is blind, then s/he cannot sug-
gest a correct outcome. This, then, contradicts the
Rethinking MRT as an Ideomotor Effect Energy Psychology 10:2 • November 2018 23
second feature of an ideomotor effect, in that the
subject is inuenced by an idea suggested by the
operator. Consequently, in this regard, MRT can-
not be explained by an ideomotor effect.
On the other hand, during the condition when
the Practitioners were misled, MRT accuracy
diminished (compared to the blind condition),
which seems to imply that Practitioners did exert
a bias in Part 2. This may be one explanation of
these results; there may be other explanations. For
example, since Practitioners were required to per-
form 60 MRTs, fatigue may have contributed to
their underperformance in Part 2. However, since
there was no signicant difference between the
MRT accuracy in the blind condition of Part 2 and
the MRT accuracy in the blind condition of Part 1,
fatigue is an unlikely explanation. Alternatively,
the drop in MRT accuracy in the misled condition
of Part 2 could mean that Practitioners started to
doubt themselves while being misled. This paral-
lels their slight drop in condence ratings (from
pre- to posttesting), a change that may have
reached signicance had this study been powered
for subgroup analysis.
Similarly, it is also unlikely that TPs exert
an ideomotor effect on MRT outcomes. This is
supported by the result that whether or not TPs
reported guessing the paradigm, MRT accuracy
scores were not impacted. Likewise, because no
correlation was found between MRT accuracy
and any condence rating, this further supports
the argument that MRT cannot be explained by an
ideomotor effect.
Another explanation of these results may
explain a source of confusion. It may be that the
terminology in use today is either inaccurate or
inconsistent. Perhaps the way the term ideomotor
effect is currently used does not match the way it
was and is dened. For example, in neuro-linguistic
programming (NLP), an ideomotor response is
dened as “unconscious physical manifestations
of mental events” (Wingett, 2013). Examining
MRT in regard to this denition and the rst fea-
ture described previously (i.e., the subject seems
to have no control over his/her actions), then the
ideomotor effect may be a plausible explanation
of MRT. However, this NLP denition does not
incorporate the second feature of an ideomotor
response, that of the operator’s (practitioner’s)
inuence (or bias). Since the study described here
suggests that practitioners do not seem to bias the
MRT, there may be two effects at play. If this is
the case, then perhaps another term is needed for
the NLP phenomenon, because the use of the term
ideomotor effect is not accurate in this case.
Strengths and Limitations
Clear strengths of the original study include
a high degree of blinding and the choices of refer-
ence standard and target condition. It is commonly
thought that practitioners can introduce a great deal
of bias during MRT. One way to limit practitioner
bias was accomplished through random blind-
ing of Practitioners. Similarly, it is thought that
patients can introduce bias in MRT by letting their
arms go weak at will, an example of response bias
(McGrath, Mitchell, Kim, & Hough, 2010; Haas
et al., 1994) or social desirability bias (King &
Bruner, 2000); however, much effort was made to
keep TPs blind as well. Furthermore, the choices
of reference standard and target condition were
clear and well dened. In studies of diagnostic test
accuracy, it is presumed that the target condition is
Table 3C. Correlation Table (including p-values): MRT Accuracy and the Difference in Practitioner Condence
Ratings (r)
1. 2. 3. 4.
1. Change in Practitioner’s condence in MRT in general: Post–Pre 1.00
2. Change in Practitioner’s condence in own MRT ability: Post–Pre
p-value:
0.50
<0.01*
1.00
3. MRT accuracy (blind condition)
p-values:
0.14
0.34
0.06
0.67
1.00
4. MRT accuracy (misled condition)
p-values:
0.04
0.79
0.06
0.68
0.35
0.02*
1.00
Note: *Signicance reached.
Abbreviation: MRT = Muscle Response Testing;
Energy Psychology 10:2 • November 2018 Rethinking MRT as an Ideomotor Effect
24
either present or absent (Martin & Lovett, 1915)
and, ideally, the best available method for detect-
ing the presence or absence of the target condi-
tion is used as the reference standard (Bossuyt
et al., 2003b). Ideally, studies of diagnostic test
accuracy employ a true “gold” standard, which
demonstrates perfect accuracy in distinguishing
the presence or absence of the target condition.
However, perfect gold standards are rare in medi-
cal testing, so an imperfect reference standard is
normally employed (Glasziou, Irwig, & Deeks,
2008). In the original study, the reference stand-
ard was the actual verity of the spoken statements,
each of which was denitively known to be either
true or false—a perfect reference standard; it may
therefore be considered a true “gold” standard.
A limitation of the original study is its lack
of generalizability to other applications of MRT.
While MRT may be useful in distinguishing false
statements from true statements, this study does
not determine whether MRT is useful for other
applications, such as detecting a food allergy
(Garrow, 1998; Teuber & Porch-Curren, 2003) or
the need for homeopathy (Moncayo, Moncayo,
Ulmer, & Kainz, 2004) or a nutritional supplement
(Triano, 1982). This point is important to empha-
size due to the widespread and varied use of MRT.
Limitations of this present study include those
regarding its retrospective, observational design,
drawing on data previously presented. For instance,
data were not collected to answer the specic
research question of this study, and the use of second-
ary data of this nature may be criticized (Tripathy,
2013; Emma, 2008). For example, other biases may
have been introduced, such as misclassication bias,
missing variables (unmeasured confounding), and
missing data (Benchimol et al., 2015).
In this study, no mechanical testing devices
were utilized, such as force plates or a dynamom-
eter. Some may consider this a limitation of this
study; however, this point was considered care-
fully and rejected. This study attempted to repro-
duce a real clinical setting, and force plates are
not routinely used in clinical practice. Supporting
this decision, previous studies using force plates
showed a distinct difference between muscles
labeled “strong” and “weak” (Monti et al., 1999;
Caruso & Leisman, 2001; Conable, Corneal,
Hambrick, Marquina, & Zhang, 2006), making
their use in this study redundant.
Only two other published papers were
found in the scientic literature that mention the
ideomotor effect in regard to MRT. One study
was a review of the literature and a commentary
(Schmitt & Cuthbert, 2008), and because it is not
experimental in design, it will not be included in
this discussion. In a second study, Pollard et al.
(2011) report assessing the reliability of MRT to
detect low back pain, while also attempting to
minimize any potential impact of an ideomotor
effect, which they dened as “the unconscious
and inadvertent cueing of desired responses.”
They reported accomplishing this by minimiz-
ing all nonverbal and visual cues, especially in
regard to pain status, and by eliminating any other
communication between practitioner and patient.
While great efforts were clearly made to minimize
inadvertent cueing, it is unclear if this was suc-
cessfully accomplished since no assessments of
these efforts were reported. Furthermore, their
denition of ideomotor effect may not have been
in alignment with current consensus (Stock &
Stock, 2004; Ondobaka & Bekkering, 2012; Shin
et al., 2010).
Directions for Future Research
While the results of this study cast doubt on
whether MRT can be explained by the ideomo-
tor effect, more research is certainly required. In
regard to MRT, the two features identied as char-
acterizing an ideomotor effect are as follows:
1. The patient seems to have no control over
the strength of his/her muscle; and
2. The practitioner may be suggesting to the
patient the outcome desired, or in other
words, the practitioner seems to exert an
inuence during the test, or in still other
words, seems to bias the muscle test.
The results of this study challenge the second
feature. While on the one hand, clinically it makes
sense that the practitioner may indeed have an
inuence on MRT outcomes, in this study when
blind and not blind conditions were compared, no
practitioner inuence was observed. Further pro-
spective research is needed to assess and, if pos-
sible, quantify and qualify the type of inuence a
practitioner may evoke.
Likewise, future researchers may also wish
to investigate the rst feature of an ideomotor
effect, by answering the question: In MRT, does
the subject have any control over his/her actions?
To assess this, studies must be designed to try to
Rethinking MRT as an Ideomotor Effect Energy Psychology 10:2 • November 2018 25
inuence (or bias) the patient. In addition, this
may also involve nding ways to successfully
blind the patient during MRT.
Should future research support the ndings
of this study, and it become established that MRT
cannot be explained by the ideomotor effect, then
future researchers may wish to investigate other
mechanisms of actions. There are many theories
used to explain the weakening of a muscle dur-
ing a muscle test, such as: (1) a stress (Jensen,
2012), (2) a disruption in homeostasis (Thie &
Thie, 2005; Walther, 1988), and (3) other similar
disturbances (Rolfes, 1997). Since none of these
hypotheses have been substantiated by rigorous
science, future research may wish to investigate
the plausibility of these and other theories that
may arise.
On the other hand, I believe that there are
much more important research questions to answer
rst, particularly in the area of MRT’s clinical
validity. This can be accomplished by answering
the question, “How does the use of MRT inu-
ence patient outcomes?” In other words, studies
are needed of this structure: “Is [MRT technique]
effective at inuencing the symptoms of [condi-
tion] in [patient population] compared to [another
intervention].” For example:
1. Is HeartSpeak effective at inuencing the
severity of panic attacks in panic-prone
but otherwise healthy adults, compared to
CBT?
2. Is Nutritional Response Testing mediated
by a kinesiologist (who uses MRT) more
effective than nutritional counseling medi-
ated by a nutritionist (who does not use
MRT) at decreasing the severity and dura-
tion of symptoms of irritable bowel syn-
drome in women aged 18 to 65 years.
Certainly, more research into the validity of
MRT is required in order to determine how and
when it is best employed.
Summary
Detractors of MRT explain its mechanism as
being an ideomotor effect, likening it to trickery
or hypnotic suggestion and placing it alongside
the pendulum, dowsing, Facilitated Communica-
tion, automatic writing, the Ouija board, and other
unexplained phenomena (Hyman, 1999; Carroll,
2015; Barrett, 2014). Recent research suggests
that this is likely incorrect. In order for a phenom-
enon to be an ideomotor effect, the practitioner (or
operator) must be suggestive or evoke an inu-
ence on the subject (or patient). The results of
this study demonstrate that when comparing blind
and not blind conditions, the practitioner evokes
no inuence, so it is unlikely that the practitioner
is responsible for an ideomotor effect. Likewise,
the patient has been shown to produce no signi-
cant inuence either, so it is also unlikely that the
patient is responsible for an ideomotor effect. The
limitations of this study are those of any retrospec-
tive, observational study in that data were not col-
lected to answer the specic research question of
this study. Clearly, more prospective research is
required. Another explanation of these results may
lie in the colloquial use of inaccurate or incon-
sistent terminology, which could be resolved by
clearer denitions. In the interim, the ideomotor
explanation of MRT should be regarded as obso-
lete until such a time as a more plausible explana-
tion of its mechanism of action is established. For
now, when asked the question “How does muscle
testing work?” the only accurate response is: “We
do not yet know.”
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