The Lightning Process (LP) is a three-day personal training programme developed and trademarked by British osteopath Phil Parker.[1] It has been applied to a range of health problems and disorders.[2]

Developed in the late 1990s. It is a mind body training that aims to teach techniques for managing the acute stress response that the body experiences under threat. The course aims to help recognise the stress response, calm it and manage it in the long term. It was developed from concepts from Positive Psychology, health education theory, mindfulness, osteopathy, coaching and Neuro-Linguistic Programming (NLP).[3]

A clinical trial in 2017 found that Lightning Process was effective when added to treatment for chronic fatigue syndrome, but it is not recommended by the NHS.[4][5] Two corrections of this article were published due to methodological weaknesses.[6]

Description

The Lightning Process comprises three group sessions conducted on three consecutive days, lasting about 12 hours altogether, conducted by trained practitioners.[7][8][9]

According to its developer, Phil Parker, the programme aims to teach participants about the acute stress response the body experiences under threat. It aims to help trainees spot when this response is happening and learn how to calm it. Techniques based on movement, postural awareness and personal coaching are intended to modify the production of stress hormones. Participants practise a learnt series of steps to habituate the calming method.[8][10]

The Lightning Process is based on the theory that the body can get stuck in a persistent stress response. The initial stressor may be a viral or bacterial infection, psychological stress, or trauma, which causes physical symptoms due to the body's stress response. These symptoms then act as a further stressor, resulting in overload of the central nervous system and chronic activation of the body's stress response. Neuroplasticity then causes this abnormal stress response to persist and be maintained. The Lightning Process suggests that while this disruption initially happens at an unconscious level, it is possible for the patient to exert conscious control and influence over the process, eventually breaking the cycle.[11]

The rationale for the programme draws on ideas of osteopaths Andrew Taylor Still and J M Littlejohn regarding nervous system dysregulation and addressing clients' needs in a holistic manner rather than focusing solely on symptoms.[12] It also incorporates ideas drawn from neuro-linguistic programming and life coaching.[13] A basic premise is that individuals can influence their own physiological responses in controlled and repeatable ways.[14] Such learnt emotional self-regulation, it is suggested, could help overcome illness and improve well-being, if the method is practised consistently.[14]

Parker advocates attending the training course in order to gain a full understanding of the tools in a safe and supportive context.[15] He also lays emphasis on the trainee playing an active role in recovery (the course is framed as a fully participatory 'training', not a passive 'treatment' or set of answers given to a 'patient').[16][17] He claims that the programme has helped to resolve various conditions including depression, panic attacks, insomnia, drug addictions, chronic pain and multiple sclerosis.[18] The program has also been used with chronic fatigue syndrome.[19][10]

The Lightning Process is trademarked.[7]

Criticism and support

There has been criticism of the cost of the three-day course.[20][21] There has also been criticism of the claimed benefits (see also below).[22][21] John Greensmith, of the British advocacy group ME Free For All, stated "We think their claims are extravagant... if patients get better, they claim the success of the treatment – but if they don't, they say the patient is responsible."[22] In 2022 the World ME Alliance issued the statement "The World ME Alliance and its members do not endorse the Lightning Process for people with Myalgic Encephalomyelitis (ME), sometimes called Chronic Fatigue Syndrome (CFS)."[23]

Some chronic fatigue syndrome patient support groups have strongly objected to the perceived implication that the disease has psychological causes.[22] However, the Lightning Process website states that it is a neuro-physiological approach and that it considers CFS/ME to be a physical illness.[24]

Nigel Hawkes writing for The BMJ describes the Lightning Process as being "secretive about its methods, lacks overall medical supervision, and has a cultish quality because many of the therapists are former sufferers who deliver the programme with great conviction" and that "Some children who do not benefit have said that they feel blamed for the failure".[25]

Some people have claimed rapid cures for longstanding illnesses.[22] Prominent advocates of the process include British journalist Patrick Strudwick,[26] French dancer Chris Marques,[27] and singer Laura Mvula.[1]

Research

A registered clinical trial (UK SMILE pilot study) was conducted in England at Bristol University, with results published in 2017.[4] The results did not change the stance of the National Health Services in the United Kingdom which does not recommend the method.[5]

A peer reviewed qualitative study on experiences of the course among a group of young people with chronic fatigue syndrome was published in 2012.[28] A Norwegian Support Group patient survey showed mixed experiences.[29] Patient surveys are considered low quality evidence compared with peer reviewed studies. For various reasons they cannot answer questions about the results of intervention.

A pilot intervention study exploring the efficacy of the Lightning Process training programme for reducing chronic fatigue and improving health-related quality of life in cancer survivors with reported significant fatigue issues were conducted at the National Cancer Hospital in Norway (Radiumhospitalet) and published in August, 2021. The study involved 13 participants and did not include a control group, which prevents causal attribution of any effect a given treatment may have. Significant improvement was reported at 3 and 6 months compared to baseline. No adverse effects were reported and the authors argued that a larger controlled clinical trial may be recommended.[30]

Given the limited clinical evidence, the National Institute for Health and Care Excellence (NICE) explicitly states that "[d]o not offer the Lightning Process, or therapies based on it, to people with ME/CFS" in their guideline for the management of ME/CFS published in 2021.[31] In 2023, 2 years after the publication of the report 50 academics in the field authored a peer-reviewed published article expressing deep concerns about the current NICE ME/CFS guidelines. 'NICE should now reconvene a panel with an appropriate mix of specialists, methodologists and patients (both recovered and those still unwell), to revise the guideline, based on these new reviews. In the meantime, both patients and clinicians may wish to remember that NICE guidelines are advisory, not mandatory.' They state'The consequences of this (the current NICE guidelines) are that patients may be denied helpful treatments and therefore risk persistent ill health and disability.' [32]

Public reaction to research

Esther Crawley said that "I never expected it would work" and that "This is an important study as it provides another treatment approach that some may find helpful. However, while these results are promising, further research is needed to establish which aspects of the process are helpful, whether it is an effective treatment on its own, and whether it could be used to help more severely affected patients."[25]

Research into chronic fatigue syndrome is often a target of criticism.[19] The SMILE study received some public criticism for recruiting children when adult subjects are available.[33][34][35] The study was approved by the National Research Ethics Service.[25][36] The paediatrician supervising the study, Esther Crawley, has commented "If the Lightning Process is dangerous, as they say, we need to find out. They should want to find it out, not prevent research."[19]

Results of the study by Crawley were publicized at the Science Media Centre in September 2017; an editorial on its own presentation of the results of the SMILE study stated: "If you had only read the headlines for the CFS/ME story you may conclude that the treatment tested at Bristol might be worth a try if you are blighted by the illness, when in truth the author said repeatedly that the findings would first have to be replicated in a bigger trial."[37] Reactions to their briefing were stronger than expected: "it was the criticism from within the scientific community that we had not anticipated."[37] The briefing[38] invited four psychologists to make comments on the study,[39] who were mild in their reactions, while the commentary on the 28 September 2017 article evoked detailed, well-referenced but anonymous criticisms of the SMILE study and the Lightning Process in the comments section.[37]

Dorothy Bishop from Oxford University commented that "The gains for patients in this study seem solid. However, while the patient allocation and statistical analysis of the trial appear to be done to a high standard, the intervention that was assessed is commercial and associated with a number of warning signs. The Lightning Process appears based on neurolinguistic programming, which has long been recognised as pseudoscience".[25]

References

  1. 1 2 "Laura Mvula: 'I don't think I'm good at being a pop star. It's making me too paranoid'", The Independent, 16 February 2014
  2. ↑ P. Parker, J. Aston, L. de Rijk (July–August 2021). "A systematic review of the evidence base for the Lightning Process". Explore. 17 (4): 372–379.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ↑ P. Parker, J. Aston, L. de Rijk (July–August 2021). "A systematic review of the evidence base for the Lightning Process". Explore. 17 (4): 372–379.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. 1 2 Crawley, Esther M; Gaunt, Daisy M; Garfield, Kirsty; Hollingworth, William; Sterne, Jonathan A C; Beasant, Lucy; Collin, Simon M; Mills, Nicola; Montgomery, Alan A (20 September 2017). "Clinical and cost-effectiveness of the Lightning Process in addition to specialist medical care for paediatric chronic fatigue syndrome: randomised controlled trial". Archives of Disease in Childhood. 103 (2): archdischild–2017–313375. doi:10.1136/archdischild-2017-313375. PMC 5865512. PMID 28931531.
  5. 1 2 "Lightning Process 'could help children with chronic fatigue syndrome', study claims". nhs.uk. 21 September 2017. Retrieved 5 October 2017.
  6. ↑ Tuller, David (20 May 2019). "Trial By Error: The Lightning Process Is "Effective"? Really?".
  7. 1 2 Crawley E, Mills N, Hollingworth W, et al. (2013). "Comparing specialist medical care with specialist medical care plus the Lightning Process for chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME): study protocol for a randomised controlled trial (SMILE Trial)". Trials. 14: 444. doi:10.1186/1745-6215-14-444. PMC 3879423. PMID 24370208.
  8. 1 2 Parker 2010, p. 7
  9. ↑ Parker, Phil. "What is the Lightning Process?". The Lightning Process. Retrieved 12 February 2016.
  10. 1 2 Rimmer, Vikki (August 2008). "The Lightning Process Treatment for ME". Positive Health Magazine (150). Retrieved 25 May 2011.
  11. ↑ Parker, Phil (June 2018). "Understanding the Lightning Process Approach to CFS/ME; a Review of the Disease Process and the Approach" (PDF). Journal of Experiential Psychotherapy. 21 (2): 21–28.
  12. ↑ Parker 2010, pp. 42–44
  13. ↑ Cormier, Zoe (8 March 2008). "'Talk Therapy' Takes on Chronic Fatigue Syndrome: Coming Soon To Canada". The Globe and Mail. Retrieved 25 May 2011.
  14. 1 2 Parker 2010, p. 17
  15. ↑ Parker 2010, p. 11
  16. ↑ Parker 2010, pp. 13–16
  17. ↑ Parker 2010, p. 27
  18. ↑ Parker 2010, pp. 25–26
  19. 1 2 3 Hawkes, Nigel (22 June 2011). "Dangers of research into chronic fatigue syndrome". British Medical Journal. 342 (d3780): d3780. doi:10.1136/bmj.d3780. PMID 21697226. S2CID 27301336.
  20. ↑ Kinnes, Sally (2 September 2007). "Coping with ME". The Sunday Times.
  21. 1 2 Cormier, Zoe (13 March 2009). "Medicine: 'Talk therapy' takes on chronic fatigue syndrome: coming soon to Canada". The Globe and Mail. Retrieved 28 September 2017.
  22. 1 2 3 4 Cormier, Zoe (18 April 2008). "Lightning Process – Controversial training program comes to Canada". CBC News.
  23. ↑ "World ME Alliance do not endorse the Lightning Process" 3 August 2022
  24. ↑ Parker, Phil. "Facts and Myths". The Lightning Process. Retrieved 5 October 2017.
  25. 1 2 3 4 Hawkes, Nigel (21 September 2017). "Training for children with chronic fatigue works better than medical care alone, finds study". The BMJ: j4372. doi:10.1136/bmj.j4372. S2CID 5186250.
  26. ↑ Strudwick, Patrick (22 February 2011). "Lightning cure ... or a flash in the pan?". The Times. pp. 7–8.
  27. ↑ "Young ME sufferer Anna thanks her 'cool' headteacher". Mid Sussex Times. 14 April 2008.
  28. ↑ Endresen Reme, Silje (2012). "Experiences of young people who have undergone the Lightning Process to treat chronic fatigue syndrome/myalgic encephalomyelitis – a qualitative study". British Journal of Health Psychology. 18 (3): 508–525. doi:10.1111/j.2044-8287.2012.02093.x. PMID 22989369. S2CID 42004568.
  29. ↑ Bringsli, Gunn J.; Gilje, Anette; Getz Wold, Bjørn K. (12 May 2013). "ME syke i Norge Fortsatt bortgjemt?" [ME patients in Norway Still hidden?] (PDF). Norwegian ME Association. (in Norwegian). Oslo. Different forms of graded exercise therapy and Lightning Process are considered to have led to aggravation in more than half of those who have tried the treatments.
  30. ↑ Fauske, Lena; Bruland, Oyvind Sverre; Dahl, Alv Andreas; Myklebostad, Aase; Reme, Silje Endresen (13 August 2021). "Does the Lightning Process Training Programme Reduce Chronic Fatigue in Adolescent and Young Adult Cancer Survivors? A Mixed-Methods Pilot Study". Cancers. 13 (16): 4076. doi:10.2139/ssrn.3857641. hdl:10852/90596. ISSN 1556-5068. PMC 8394577. PMID 34439229. S2CID 240583465.
  31. ↑ "Recommendations | Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management | Guidance | NICE". nice.org.uk. 29 October 2021. Retrieved 18 November 2021.
  32. ↑ White, P., Abbey, S., Angus, B., Ball, H. A., Buchwald, D. S., Burness, C., Carson, A. J., Chalder, T., Clauw, D. J., Coebergh, J., David, A. S., Dworetzky, B. A., Edwards, M. J., Espay, A. J., Etherington, J., Fink, P., Flottorp, S., Garcin, B., Garner, P., … Zeman, A. (2023) (August 2023). "Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis". Journal of Neurology, Neurosurgery & Psychiatry. 94 (12).{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
  33. ↑ "Study involving children and the Lightning Process is unethical, says joint charity statement". 5 August 2010. Retrieved 25 May 2011.
  34. ↑ "SMILE Study". Invest in ME Research. October 2010. Retrieved 25 May 2011.
  35. ↑ Gill, Robin (30 November 2010). "Church Times: Dr Esther Crawley responds to Prof Robin Gill (SMILE Lightning Process pilot study)". ME Agenda. Retrieved 25 May 2011.
  36. ↑ Britton, Tony (6 January 2011). "Ethics committee finally approves controversial 'SMILE' pilot study into Lightning Process and children with ME/CFS". ME Association. Retrieved 25 February 2011.
  37. 1 2 3 Fox, Fiona (28 September 2017). "Inconvenient truths". Science Media Centre. London. Retrieved 4 October 2017.
  38. ↑ "The Lightning Process – a controversial treatment for children with chronic fatigue". Science Media Centre. London. 20 September 2017. Retrieved 4 October 2017.
  39. ↑ "Expert reaction to controversial treatment for CFS/ME". Science Media Centre. London. 20 September 2017. Retrieved 4 October 2017.

Bibliography

  • Parker, Phil (2010), Introduction to the Lightning Process, Nipton Publishing Hay House, ISBN 978-0955648205
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