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Introduction: The Lightning Process (LP) is a neuro-physiological training programme based on self-coaching, concepts from positive psychology, osteopathy and Neuro Linguistic programming (NLP). It has a developing evidence base for its efficacy with a range of issues, including Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (CFS/ME), but little has been published about its hypothesis on the disease processes, and its approach to this disabling disease. Objectives: This paper aims to resolve these gaps in the research and contextualise the approach within current theories and research into the disease. Methods: A literature review was undertaken of the published evidence supporting the main current models of aetiology and disease process for CFS/ME. An evaluation of the LP’s conceptualisation of the aetiology of the disease and the hypothesis behind its approach was undertaken, through a review of the literature and semi-structured interviews with the programme’s original researcher (this paper’s lead author). These models were then compared to identify similarities and differences. Results: The review identified that the LP adopts a multifactorial, multisystem disease process for the disease, which is well aligned with current research and established conceptual frameworks for CFS/ME pathology. It identified that the LP shared the established perspective that the illness is a physiological, and not a psychological, one. It found the LP applies a self-regulation approach to neuro-physiology processes to influence the physical disease process. Conclusion: This paper resolves the identified gaps in the research and clarifies the hypotheses behind this approach, which has been identified by the evidence base as providing successful outcomes for some. It is hoped this clearer understanding of the approach will assist researchers, clinicians and those with this disabling disease to identify some additional options for potential recovery.
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Journal of Experiential Psychotherapy, vol. 21, no 2 (82) June 2018
21
Understanding the Lightning Process Approach to CFS/ME;
a Review of the Disease Process and the Approach
Phil Parker, DO*
i
, Jacqui Aston, BSc (Hons)**, Fiona Finch, MSc DipCOT***
*School of Psychology, London Metropolitan University, UK,
**London, UK, ***Bath, UK
Abstract
Introduction: The Lightning Process (LP) is a neuro-physiological training programme
based on self-coaching, concepts from Positive Psychology, Osteopathy and Neuro Linguistic
Programming (NLP). It has a developing evidence base for its efficacy with a range of issues,
including Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (CFS/ME), but little has been
published about its hypothesis on the disease processes, and its approach to this disabling disease.
Objectives: This paper aims to resolve these gaps in the research and contextualise the
approach within current theories and research into the disease.
Methods: A literature review was undertaken of the published evidence supporting the main
current models of aetiology and disease process for CFS/ME. An evaluation of the LP’s
conceptualisation of the aetiology of the disease and the hypothesis behind its approach was
undertaken, through a review of the literature and semi-structured interviews with the programme’s
original researcher (this paper’s lead author). These models were then compared to identify
similarities and differences.
Results: The review identified that the LP adopts a multifactorial, multisystem disease process
for the disease, which is well aligned with current research and established conceptual frameworks
for CFS/ME pathology. It identified that the LP shared the established perspective that the illness is
a physiological, and not a psychological, one. It found the LP applies a self-regulation approach to
neuro-physiology processes to influence the physical disease process.
Conclusions: This paper resolves the identified gaps in the research and clarifies the
hypotheses behind this approach, which has been identified by the evidence base as providing
successful outcomes for some. It is hoped this clearer understanding of the approach will assist
researchers, clinicians and those with this disabling disease to identify some additional options for
potential recovery.
Keywords: neurology, physiology, intervention, hypothesis, fatigue
i
Corresponding author: Phil Parker, School of Psychology, London Metropolitan University, 166-220 Holloway Rd,
London N7 8DB, phil@philparker.org, www.londonmet.ac.uk.
Journal of Experiential Psychotherapy, vol. 21, no 2 (82) June 2018
22
Introduction and Objectives
The Lightning Process (LP) is a neuro-
physiological training programme based on self-
coaching, concepts from Positive Psychology,
Osteopathy and Neuro Linguistic Programming (NLP).
The intervention was developed in a similar way to other
novel approaches, such as Motivational Interviewing
(W. Miller & Rollnick, 1991), through an iterative
process of practice-based evidence (Leeman &
Sandelowski, 2012) and qualitative inquiries into
clients’ experience.
It has been used by those seeking help with a
range of issues, including Chronic Fatigue Syndrome/
Myalgic Encephalomyelitis (CFS/ME), an illness
defined as a chronic, fluctuating, neurological condition
that causes symptoms affecting many body systems,
particularly the nervous and immune systems. Early
reports of complete recovery from many and an absence
of results from others (ME association, 2010) resulted in
a lack of clarity about its value in a field already prone
to misinformation and strong debates. Further research
has developed an evidence base, with an RCT finding
the approach, when combined with specialist medical
care, increases positive outcomes for some groups with
CFS/ME, compared to specialist medical care alone
(Crawley et al., 2017), a smaller study identifying
positive outcomes for pain (Hagelsteen & Moen Reiten,
2015) and two studies reporting on patient experiences
(Reme, Archer, & Chalder, 2013; Sandaunet &
Salamonsen, 2012). However, an outline of the
theoretical basis of the LP intervention for CFS/ME has
been missing from the evidence base, a gap which this
article sets out to address.
Methods
The structure of this paper follows other
authors’ suggestions (Adams, 2007; Miller, 1983) to
identify peer-reviewed research to evaluate how a
practice-based evidenced intervention fits with current
models of aetiology and disease processes.
Firstly, a literature review of the published
evidence was undertaken, supporting the main current
models of aetiology and disease process for CFS/ME.
Secondly, an evaluation of the LPs conceptualisation of
the aetiology of the disease and the hypothesis behind its
approach was undertaken. This was achieved through a
review of the literature and semi-structured interviews
with the programme’s original researcher and developer.
Thirdly, a synthesised review of these models was then
developed to compare, in order to identify similarities
and differences.
Results The results of the synthesised review are
presented sequentially. It begins with models of
aetiology and treatment followed by the evidence for,
and a description of the LP’s approach.
Models of aetiology and treatment
Aetiology, symptoms and treatment of
CFS/ME - Diagnosis of the illness is recognised to be
challenging and is complicated by the variance in
aetiology and presentations. Onsets can vary widely and
include post infection (bacterial or viral), trauma,
anaesthetic, drug reaction, emotional stress and
unknown aetiology (Panelli, 2017). There is some
familial clustering and although genetic factors have
been suggested, they remain unconfirmed (Edwards,
McGrath, Baldwin, Livingstone, & Kewley, 2016).
Symptoms also vary in intensity from case to case and
over time, but include post exertional malaise and
fatigue that is unresponsive to rest, and often include
pain, cognitive impairment, general malaise, autonomic
dysregulation, unrefreshing sleep, digestive issues and
hypersensitivity to a range of stimuli such as noise, light
and scents.
This multifactorial and multisystem illness
presents a challenge to a simple single cause and effect
model of health and, despite searches for a novel
infectious agent, and a single pathognomic test, nothing
consistent has yet been identified, resulting in the
unsatisfying situation of diagnosis by exclusion. This
has resulted in a strong treatment focus on symptomatic
relief, with CBT, to help cope with the illness, and
pacing, to increase exercise tolerance and reduce
inflammation, remaining the main NICE approved
approaches (NICE, 2007). In the absence of identifying
the aetiology, authors suggest there is a need to explain
the physiological disturbance behind the symptoms
(Edwards et al., 2016).
The physiological disturbance and the LP
hypothesis of the disease process. There is general
agreement (Edwards et al., 2016) concerning the
importance in the disease process of the activation of the
Sympathetic Nervous System (SNS), sensitisation of the
Central Nervous System (CNS), dysregulation of
immune and Hypothalamus Pituitary Axis (HPA)
systems, and addressing issues within these systems are
central to the LP model. The hypothesis of the LP is that
although the symptoms of the disease are precipitated by
the original agent or incident, they are maintained by the
aberrant ongoing response to that original event, which
disrupts the usual process of recovery. As a result the
Journal of Experiential Psychotherapy, vol. 21, no 2 (82) June 2018
23
LP’s primary focus is on considering how to restart the
disrupted recovery process. Although there are a number
of proposed theories accounting for this disrupted
recovery process, such as the severity of infection
(Hickie et al., 2006) and genetic predisposition
(Falkenberg, Whistler, Murray, Unger, & Rajeevan,
2013; Nater et al., 2008), the aetiology of why the
recovery process is disrupted is currently uncertain.
Disrupted Recovery Process. Physical,
chemical and even emotional threats to the body,
independent of their cause, trigger a stress response
(Selye, 1936) which, the LP theory suggests, has a
significant impact on the disease process. In the LP this
stress response is termed the Physical Emergency
Response (PER) to clarify its physical nature and
distinguish it from the more common interpretation of
stress as a purely cognitive-emotional response. This
additional terminology was created to clarify the LP’s
position that, although it is considering the physiological
effects of the humoral stress response, it is not
suggesting the illness is psychological in origin.
The short-term activation of the PER is a
valuable adaptive physiological shift to threat, however
there are physiological consequences to its activation.
These include: temporary arousal of the Sympathetic
Nervous System, changes in blood flow to the limbs and
away from most organs, alteration in blood sugar
management, a switch from reflective to more reactive
cognition, a decrease in digestive function, increased
vigilance and an interruption of sleep and a suppression
of immune function.
The LP hypothesis suggests two stages to the
development of CFS/ME and these elements are
supported by a number of authors (see figure 1):
1) That in CFS/ME the PER begins to become
chronically activated, causing 1) dysautonomia and
neurological sensitisation, 2) altered immune responses,
3) impaired digestion, 4) disrupted sleep and 5) poor
cognition. These disturbances correlate to key
symptoms of the illness, 1) symptoms in multiple
systems including neural, muscular and circulatory
systems (Wyller, Eriksen, & Malterud, 2009) 2) non-
recovery of original and subsequent infections, poor
lymphatic drainage of tissues (Perrin, 2005),
inflammation in CNS (Nakatomi et al., 2014) 3) food
intolerances and Gastro Intestinal symptoms (Lakhan &
Kirchgessner, 2010) 4) poor, unrefreshing sleep 5) brain
fog, difficulty concentrating.
2) That the CNS role in dampening down this
PER activation and restoring homeostasis is also
interrupted by the ongoing PER via two mechanisms.
Firstly, the flood of unusual, alarming signals from the
wide range of affected systems have an overloading
effect on the CNS. This produces an overwhelming
array of information for the CNS process, which
requires detailed and appropriate responses. Normally
this would be manageable, however, the second
consequence of the PER is the affect it has on the CNS
ability to process and respond to these signals in an
effective way. This is due to the direct impact of altered
hormonal and neurotransmitter levels, caused by the
PER, on the neurological tissues (Joëls & Baram, 2009;
Popoli, Yan, McEwen, & Sanacora, 2012).
These altered levels result in changed synaptic
thresholds and altered signal processing (Landgrebe et
al., 2008). Simply put, this means signals that should be
amplified, such as increasing blood flow or lymphatics
to the muscles, can be supressed, and others that should
be quietened down, such as pain from tissues, can be
amplified. This inability of the CNS to respond
appropriately to the incoming signals or manage the
outgoing instructions to the tissues prevents effective re-
regulation of the various systems affected by the disease
process. As a result, the unresolved physiological
changes perpetuate and worsen, creating an additional
threat to the body and re-triggering a further cascade of
PER changes (Craddock et al., 2014).
As this altered body-wide state of
dysregulation and sensitisation continues, a further
factor, neuroplasticity, begins to have an effect.
Neuroplasticity is the ability of the nervous system to
change as a result of usage and is vital in the process of
learning and responding to change. This ongoing
adaptive process causes pathways that are most used to
become faster, easier to activate and have a bigger effect
on brain function as a whole. Unfortunately, in this case,
the repeated activation of these disruptive pathways
results in them becoming more influential and efficient,
and this enhances the stability of the altered neurological
and physiological responses (Edwards et al., 2016). The
effect of this widespread dysfunction can affect all body
systems and produce a wide range of fluctuating
symptoms, which are therefore too extensive to list here.
However, with fatigue and muscular symptoms being a
core symptom of the illness, the muscular system is
particularly interesting to consider further. The
reduction in activity levels caused by the altered
physiology, as described above, has a direct effect on the
condition of muscles and also on the venous and
lymphatic fluid circulation. The fluid circulation in these
systems partly relies on movement to encourage the
return of fluid from the extremities; as a result, a lack of
Journal of Experiential Psychotherapy, vol. 21, no 2 (82) June 2018
24
activity prevents good function of these vital systems.
As they have an essential role in removing the by-
products of metabolism from the tissues, and are an
essential part of the circulatory and immune system,
poor function in these systems creates a worsening of
symptoms across all systems, compromising immune
function and creating an extra threat. This threat triggers
a further PER. Finally the psycho-social effects of
experiencing the severity of the illness, the lack of
sustained recovery and sometimes the lack of awareness
of this ‘invisible’ illness by others, creates a further
threat response, adding another turn to this now self-
perpetuating cycle (Falkenberg et al., 2013).
LP approach: Evidence and description
New intervention possibilities. Considering the
disease as a disruption of the normal recovery process
raises interest as to how to restore normal homeostasis in
the systems affected. Approaches that could directly
influence these homeostatic systems might have an
impact on the disease process. These homeostatic
mechanisms are usually managed by an involuntary
process of minutely adjusting and checking to ensure
levels are within normal limits. As a result of this moment
by moment variability, pharmaceuticals, that are difficult
to deliver with the precision and variability required, are
not the first choice for management of such systems. It
was also considered that these involuntary systems were
beyond conscious control. However research has
suggested that, with training, it is possible to have
influence on such systems, including blood pressure and
heart rate (Campbell, Labelle, Bacon, Faris, & Carlson,
2012; Carlson, Speca, Faris, & Patel, 2007; Chen, Yang,
Wang, & Zhang, 2013), blood sugar levels (Hartmann et
al., 2012; Rosenzweig, Reibel, Greeson, & Edman, 2007;
Youngwanichsetha, Phumdoung, & Ingkathawornwong,
2014), SNS activation, temperature regulation and
immune system function (Carlson, 2012; Davidson, 2003;
Ditto, Eclache, & Goldman, 2006; Kox et al., 2014),
improved muscle function (Brick, McElhinney, &
Metcalfe, 2018) and hormone production (Speer, Bhanji,
& Delgado, 2014; Speer & Delgado, 2017).
The LP approach. Supported by this research,
the LP’s approach is to systematically develop
individuals conscious influence on their CNS, and
through that on homeostatic mechanisms. In advance of
attending a seminar, the training programme begins with
a pre-course audio programme that highlights the
concepts of conscious control of the CNS and the
consequential role of the patient as an active participant
in the change process. This is followed up with a
conversation with a practitioner to answer any questions
and help the individual decide if they wish to proceed
with this approach. On attending the three consecutive
half day’s seminar, the individuals are coached through
a three-phase strategy: Awareness; Interruption; and
Redirection, outlined below. The three consecutive day
Figure 1: The self-perpetuating spiral. Adapted from Parker (2012)
Neuroplasticity
enhances
stability of
cycle through
usage
Original
causative
agent
Journal of Experiential Psychotherapy, vol. 21, no 2 (82) June 2018
25
structure provides opportunities for deeper familiarity
with the tools, practice, focused coaching and feedback
on progress. Once the seminar is completed, a minimum
of three hours, and more if required, follow up sessions
are provided to support the adoption of the new skillset.
The three-phase strategy. For the purpose of
this paper there follows a brief outline of the process,
however the details of the complete 3 day process is also
available for those interested in a fuller understanding of
its mechanics (Parker, 2013).
Awareness: A key element of the training is for
the individual to develop an awareness of which
neurological pathways they are activating. They learn to
identify if those pathways contribute to the homeostatic
imbalance, or encourage the restoration of function and
health. Participants are introduced to the research into
conscious influence on physiological processes, and the
association between the use of language and changes in
neurological activity (Eck, Richter, Straube, Miltner, &
Weiss, 2011; Richter et al., 2014; Richter, Eck, Straube,
Miltner, & Weiss, 2010). The trainer also assists the
participants to develop a new awareness of the type of
language being used, which helps them to notice which
pathways are being activated.
Interruption: Once the activation of unhelpful
pathways has been identified a number of cognitive,
linguistic, embodied cognition and gentle movement
techniques are used to interrupt those pathways. This
interruption process is deigned to alter the involuntary
use of these pathways (Adamczyk & Bailey, 2004).
Interrupting these dysregulating pathways has been
found to encourage improved neuro-endocrine function
and resilience (Barber, Bagsby, & Munz, 2010;
Burgdorf, M. Colechio, Stanton, & Panksepp, 2017;
Carney, Cuddy, & Yap, 2010; Cohen & Pressman, 2006;
Faymonville, Boly, & Laureys, 2006; Posner, Russell,
& Peterson, 2005; Quoidbach, Berry, Hansenne, &
Mikolajczak, 2010).
Redirection: The final phase is to adopt a
compassionate self-coaching role. This provides a
mechanism to gain access to effective coaching by
applying the skills of coaching to oneself. A structured
self-coaching strategy is then employed to firstly access
a sense of self-compassion and support (Neff,
Kirkpatrick, & Rude, 2007). Secondly, to help the
individual to identify what their desired affective or
physiological state is (Bandler & Grinder, 1979;
Duckworth, Kirby, Gollwitzer, & Oettingen, 2013). And
thirdly, to encourage the activation of that desired state,
by structured and detailed re-vivification of appropriate
reference desired states/memories whenever required
(Faymonville et al., 2006; Grinder & Bandler, 1981;
Langer, 2009; Quoidbach et al., 2010; Speer et al., 2014;
Speer & Delgado, 2017). This gives the individual an
opportunity to activate new pathways that encourage
improved physiology and restoration of homeostasis.
It is proposed that through using this sequence,
and via instrumental learning and neuroplastic processes,
provided by repetition, the old ‘anti-homeostatic’
pathway can be ‘hijacked’ and rerouted, increasingly by
default, to trigger new more helpful pathways (Briones et
al., 2005; Hunter & Stewart, 1993; Murphy & Corbett,
2009; Vrensen & Nunes Cardozo, 1981).
Once the tools have been mastered, physical
and mental repetition processes are taught to enhance the
familiarity with the new neurology and to prepare for
specific situations which have been identified as
previously symptom producing; these include
implementation intention (Gollwitzer, 1999) , pseudo
orientation in time (Erickson, 1954), future pacing
(Grinder & Bandler, 1981) and brain rehearsal (Parker,
2013) approaches.
Increasing physical endurance. Changing the
physiological response to exercise is a priority for
recovery from CFS/ME and so is discussed in more
depth here.
The standard models employed are pacing,
CBT and GET. These models primarily advocate
gradual change through small step, incremental usage
and the physiological effects of exercise (Cox, Ludlam,
Mason, Wagner, & Sharpe, 2004). The CBT elements
often add coping strategies for managing the illness and
an identification of where cognitive appraisals of lack of
ability are at odds with actual ability. Instead, the LP
employs a pacing approach to recovery, combined with
a neurological model for influencing physiological
change and increasing exercise tolerance. This appears
to contribute to the rapid change in ability experienced
by many (Reme et al., 2013). However, due to the
dominance of the other models, and their experience of
slow and variable change, it has given rise to caution
about the LP approach. This in turn has fuelled
inaccurate opinions, based on those models, that the LP
must encourage individuals to ignore their illness (Reme
et al., 2013). From the outline below, it can be seen that
this opinion does not reflect the actual approach.
The LP approach to increasing physical
endurance. Through self-coaching, and initially with
support to ensure goals are achievable, appropriate desired
exercise goals are set (this could be walking 10 steps or
running a mile depending on the current level of severity of
the illness). The LP tools are then used to improve
Journal of Experiential Psychotherapy, vol. 21, no 2 (82) June 2018
26
physiological ability prior to increasing any physical
exertion, based on the brief description of the 3 phases
outlined above. This is not simply pretending, hoping or
‘faking it’, and it requires some practice to actually make a
physiological shift, through use of in-depth re-vivification
of previous successful exercise experiences.
Once the individual feels confident they have
assisted their physiology to change to the required level
for the exercise goal, the exercise is commenced. If
during the exercise they feel they might be over doing it
or notice symptoms or signs of activating
physiologically unhelpful pathways, then the LP
approach is to stop the activity. Next they take a
supportive self-coaching role towards themselves, and
then use the LP tools once again to shift their physiology
until it is at an appropriate level to continue on with their
goal. However, if they are unable to achieve the required
change in physiology to continue, or feel their current
physical limit of endurance has been almost reached,
then the activity is stopped. Whatever the outcome they
are asked to remain supportive and kind to themselves
throughout this process.
After the physical exercise has finished, the
process is then used to assist positive changes in the
physiology. In this case it is directed to in-depth re-
vivification of previous successful post-exercise
experiences. This encourages physiological processes
that support effective recovery in muscles and joints that
maybe unused to exercise and to avoid post exertional
fatigue associated with the condition (Brick et al., 2018;
Speer & Delgado, 2017).
Adaptation. As many of those seeking help for
this condition are unable to concentrate for extended
periods, tolerate noise or light, or travel, the process is
often adapted to meet their needs, and can be taught in
manageable chunks of 10 minutes or less, at low sound
levels, in the dark and at home, to meet participants
needs. As a result the range of those receiving the
approach spans from those able to attend sessions in a
clinic to the extremely debilitated.
Discussion and Conclusion
This paper set out to review the LP’s
perspective and approach to this debilitating disease and
to contextualise the approach within current theories and
research. And as such it is the first peer reviewed article
to explore these themes. It found that the LP is aligned
with current models of the disease process and it adopts
a multifactorial, multisystem disease process model for
the disease. It identified that the LP shared the
established perspective that the illness is a
physiological, and not a psychological, one. It found the
LP applies a self-regulation approach to neuro-
physiology processes to influence the physical disease
process. The review identifies that, although supported
by the literature, these hypotheses have yet to be
evidenced experimentally. It is hoped that this paper
encourages further quantitative research that tests these
hypotheses through fMRI and biochemical analyses. It
is also hoped that a review of the existing evidence
supporting the efficacy of the approach is undertaken to
further develop the evidence base.
In conclusion this paper resolves the identified
gaps in the research and clarifies the hypotheses behind
this approach. It is hoped this clearer understanding of
the approach will assist researchers, clinicians and those
with this disabling disease to identify some additional
options for potential recovery.
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.
... The LP is a non-medical training programme that combines concepts derived from the fields of neuro-linguistic programming, positive psychology and self-coaching [11]. A key assumption of the LP is that chronic fatigue arises from dysregulations of the central and autonomic nervous systems, thereby resulting in a "false alarm" that can be turned off through top-down mental processes [11]. ...
... The LP is a non-medical training programme that combines concepts derived from the fields of neuro-linguistic programming, positive psychology and self-coaching [11]. A key assumption of the LP is that chronic fatigue arises from dysregulations of the central and autonomic nervous systems, thereby resulting in a "false alarm" that can be turned off through top-down mental processes [11]. To the best of our knowledge, this is the first study to investigate the efficacy of the LP in relation to AYA cancer survivors with chronic fatigue. ...
... The LP course, primarily developed for patients with chronic fatigue and pain, and not for AYA cancer survivors was delivered in three consecutive half-day seminars (four to five hours each), which were attended by groups of three to six participants. Each seminar included both a theory session comprising psychoeducation regarding stress physiology, mind and body interaction and chronic fatigue, and helpful or unhelpful thought processes and a practical session to put the learned skills into practice [11,13]. The participants were trained to recognise their thoughts and symptoms, and they were taught how to influence and avoid unhelpful physiological responses. ...
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Background: We report on 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. Methods: 13 adolescent and young adult cancer survivors previously treated for sarcoma or Hodgkin lymphoma were enrolled. A mixed-methods approach was applied. This involved the use of five validated patient-reported outcome measure (PROM) questionnaires at baseline and the three- and six-month follow-up points to obtain quantitative data. Semi-structured interviews were conducted after the intervention with emphasis on the participants' experiences and outcomes. A reflexive thematic analysis was applied to the transcripts. Results: A significant reduction (p < 0.001) in the total fatigue score from baseline to the three- and six-month follow-up points was documented. The correlation coefficients between the various PROMs at baseline and the six-month follow-up point indicated considerable overlap between the measures. The qualitative findings of the interviews corresponded well with the PROM findings. Most participants experienced both less fatigue and explicit improvement in their energy level. The aspects of the intervention found to be particularly helpful were the theoretical rationale and the coping techniques mediated. Conclusion: These encouraging results here reported should be of interest to the general oncological community, although they require confirmation through a larger and controlled study.
... Neurolinguistic Programming [NLP]), which has contributed to scepticism about the approach [23]. The designer of LP describes it as addressing dysregulated physical stress responses that can serve to maintain conditions such as CFS/ME, proposing that LP improves neurology, drawing parallels with literature on the physiological effects of psychological techniques such as mindfulness [24]. This remains theoretical at present due to a lack of evidence. ...
... acute infectious illness) in combination with other biopsychosocial triggers or predisposing factors (e.g. stressful life events, genetic predisposition) [3,24], the factors involved in the maintenance of CFS/ME are central to interventions, and explanations focus on these. CFS/ME maintenance is conceptualised as a combination of physical and behavioural factors in all SMC approaches (GET, AM and CBT-F), with CBT-F adding cognitive factors to these ( Table 2). ...
... This establishes the basis of the CBT-F approach in addressing cognitions and behaviour to help break maintaining cycles of CFS/ME. Contrastingly, LP maintains entirely neurophysiological and biological explanations, conceptualising CFS/ME maintenance as sustained arousal of the autonomic system (or heightened physical stress response), described as the 'Physical Emergency Response' (PER) [24]. The rationale centres on neurological rewiring to enable enhanced physiology and reduce the PER. ...
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Rationale UK specialist medical care (SMC) for paediatric Chronic Fatigue Syndrome (CFS/ME) includes behavioural approaches (Graded Exercise Therapy; Activity Management) and Cognitive Behavioural Therapy for fatigue (CBT-F). Treatment is suboptimal with a third of children not recovering after 6 months of SMC. Many families seek alternative treatments at personal cost, including the Lightning Process (LP). Evidence shows LP can improve patient outcomes, though this intervention is not widely known/understood. Objectives To describe LP in comparison with SMC approaches in order to identify distinct elements, inform clinicians about treatment options, and generate hypotheses around effectiveness. Methods Theoretical comparison including stakeholder consultation. Results While overlaps with SMC approaches were identified, and CBT-F in particular, distinct elements of LP were its focus on language style, neurophysiological rationale, affective/physiological change technique and mode of delivery. Conclusion This theoretical comparison identified distinct elements of LP which could be explored in future interventions or research aiming to improve clinical outcomes for children with CFS/ME, and informs clinicians about treatment options available for families.
... The LP is a non-medical training programme that combines concepts derived from the fields of neuro-linguistic programming, positive psychology and self-coaching [11]. A key assumption of the LP is that chronic fatigue arises from dysregulations of the central and autonomic nervous systems, thereby resulting in a "false alarm" that can be turned off through top-down mental processes [11]. ...
... The LP is a non-medical training programme that combines concepts derived from the fields of neuro-linguistic programming, positive psychology and self-coaching [11]. A key assumption of the LP is that chronic fatigue arises from dysregulations of the central and autonomic nervous systems, thereby resulting in a "false alarm" that can be turned off through top-down mental processes [11]. To the best of our knowledge, this is the first study to investigate the efficacy of the LP in relation to AYA cancer survivors with chronic fatigue. ...
... The LP course, primarily developed for patients with chronic fatigue and pain, and not for AYA cancer survivors was delivered in three consecutive half-day seminars (four to five hours each), which were attended by groups of three to six participants. Each seminar included both a theory session comprising psychoeducation regarding stress physiology, mind and body interaction and chronic fatigue, and helpful or unhelpful thought processes and a practical session to put the learned skills into practice [11,13]. The participants were trained to recognise their thoughts and symptoms, and they were taught how to influence and avoid unhelpful physiological responses. ...
... The Lightning Process (LP) is a mind-body training program designed to help individuals to develop conscious influence on their neurological function and affect change in physiological processes (Parker et al., 2018). It teaches practical tools to do this, using discussion, gentle movement and meditation-like techniques. ...
... It teaches practical tools to do this, using discussion, gentle movement and meditation-like techniques. There is a growing evidence base, including an RCT and a Systematic Review (Crawley et al., 2018;Finch, 2010Finch, , 2013Finch, , 2014Parker et al., 2018Parker et al., , 2020 reporting its efficacy for improving outcomes in a range of issues such as Multiple Sclerosis, Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), Complex Regional Pain Syndrome (CRPS), Chronic Pain and Fibromyalgia, as well as a range of emotional and cognitive issues such as anxiety, depression and substance use disorders. ...
... To provide ease of access, the program is delivered via a 4 hr audio home-study program with 1 hr of phone coaching, as preparation for the 3 training seminars (4 hr each) with a registered practitioner, which are delivered face to face or online with 3-8 attendees. It was developed from concepts from Positive Psychology, health education theory, mindfulness, osteopathy, coaching and Neuro-Linguistic Programming (NLP) and has two phases 1) teaching core concepts and 2) adopting practical tools (Parker et al., 2018). Phase 1 In phase 1, In phase 1, participants are presented with relevant theory and research to understand how the mind-body connection can be utilised in order to influence physiology (Locher et al., 2017). ...
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This paper details the conceptual framework and sequence of steps of the Lightning Process training intervention
... The scheme is trademarked by a British osteopath and neurolinguistic programmer, Phil Parker. On his website, Parker (2021) describes LP as: "a neuro-physiological training programme based on self-coaching, concepts from Positive Psychology, Osteopathy and Neuro Linguistic Programming [176,177]. Health psychologist Gareth Roderique-Davies (2009) suggests that NLP is 'cargo cult psychology' [178]. NLP and LP are both certainly this. ...
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Full-text available
The psychosomatic approach to medically unexplained symptoms, myalgic encephalomyelitis and chronic fatigue syndrome (MUS/ME/CFS) is critically reviewed using scientific criteria. Based on the 'Biopsychosocial Model', the psychosomatic theory proposes that patients' dysfunctional beliefs, deconditioning and attentional biases cause or make illness worse, disrupt therapies, and lead to preventable deaths. The evidence reviewed suggests that none of these psychosomatic hypotheses is empirically supported. The lack of robust supportive evidence together with the use of fal-lacious causal assumptions, inappropriate and harmful therapies, broken scientific principles, repeated methodological flaws and an unwillingness to share data all give the appearance of cargo cult science. The psychosomatic approach needs to be replaced by a scientific, biologically grounded approach to MUS/ME/CFS that can be expected to provide patients with appropriate care and treatments. Patients with MUS/ME/CFS and their families have not been treated with the dignity, respect and care that is their human right. Patients with MUS/ME/CFS and their families could consider a class action legal case against the injuring parties.
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There is a developing interest in recovery-based approaches, positive psychology and the importance of flourishing in alcohol use disorders (AUD). However, there has been little research into approaches that focus on flourishing in AUD and some concerns have been raised that this new focus will supplant or conflict with the existing impulsivity-reducing approaches, creating poorer alcohol use outcomes. The study addressed research questions on how the approach was adopted and valued by participants, how it compared to other approaches, how aware participants were of changes in recovery capital and positive psychology-focused concepts, such as flourishing or impulsivity. A thematic analysis (TA) evaluated the experiences of participants with harmful alcohol regarding the efficacy and acceptability of The Rediscovery Process, a brief, recovery-focused approach for AUD designed to support flourishing and address impulsivity issues. The TA identified two main themes (1) control and (2) flourishing and many participants noted differences between this approach and others and the majority found the intervention effective in reducing alcohol use. This study helps bridge the gap between the more traditional focus of addressing the psychopathology and approaches developing flourishing in AUD and the wider implications are discussed.
Article
Background: The Lightning Process (LP), a mind-body training programme, has been applied to a range of health problems and disorders. Studies and surveys report a range of outcomes creating a lack of clarity about the efficacy of the intervention. Objective: This systematic review evaluates the methodological quality of existing studies on the LP and collates and reviews its reported efficacy. Data sources: Five databases, PsycINFO, PubMed, CINAHL, Embase, ERIC (to September 2018), and Google and Google Scholar were searched for relevant studies. Study Selection: Studies of the LP in clinical populations published in peer-reviewed journals or in grey literature were selected. Reviews, editorial articles and studies/surveys with un-reported methodology were excluded. Data extraction: Searches returned 568 records, 21 were retrieved in full text of which 14 fulfilled the inclusion criteria (ten quantitative studies/surveys and four qualitative studies). Data synthesis and Conclusions: The review identified variance in the quality of studies across time; earlier studies demonstrated a lack of control groups, a lack of clarity of aspects of the methodology and potential sampling bias. Although it found a variance in reported patient outcomes, the review also identified an emerging body of evidence supporting the efficacy of the LP for many participants with fatigue, physical function, pain, anxiety and depression. It concludes that there is a need for more randomised controlled trials to evaluate if these positive outcomes can be replicated and generalised to larger populations.
Article
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Objective Investigate the effectiveness and cost-effectiveness of the Lightning Process (LP) in addition to specialist medical care (SMC) compared with SMC alone, for children with chronic fatigue syndrome (CFS)/myalgic encephalitis (ME). Design Pragmatic randomised controlled open trial. Participants were randomly assigned to SMC or SMC+LP. Randomisation was minimised by age and gender. Setting Specialist paediatric CFS/ME service. Patients 12–18 year olds with mild/moderate CFS/ME. Main outcome measures The primary outcome was the the 36-Item Short-Form Health Survey Physical Function Subscale (SF-36-PFS) at 6 months. Secondary outcomes included pain, anxiety, depression, school attendance and cost-effectiveness from a health service perspective at 3, 6 and 12 months. Results We recruited 100 participants, of whom 51 were randomised to SMC+LP. Data from 81 participants were analysed at 6 months. Physical function (SF-36-PFS) was better in those allocated SMC+LP (adjusted difference in means 12.5(95% CI 4.5 to 20.5), p=0.003) and this improved further at 12 months (15.1 (5.8 to 24.4), p=0.002). At 6 months, fatigue and anxiety were reduced, and at 12 months, fatigue, anxiety, depression and school attendance had improved in the SMC+LP arm. Results were similar following multiple imputation. SMC+LP was probably more cost-effective in the multiple imputation dataset (difference in means in net monetary benefit at 12 months £1474(95% CI £111 to £2836), p=0.034) but not for complete cases. Conclusion The LP is effective and is probably cost-effective when provided in addition to SMC for mild/moderately affected adolescents with CFS/ME. Trial registration number ISRCTN81456207
Article
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We are delighted to announce a new section in the Journal of Translational Medicine, ‘Illnesses of Unknown Etiology’. This section aims to provide a translational medicine forum for the publication of research on illnesses, multisystem diseases and syndromes of unknown etiology. Examples of these include Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia Syndrome.
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Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is comparable to multiple sclerosis, diabetes or rheumatoid arthritis in prevalence (∼0.2% to 1%), long-term disability, and quality of life,[1–5] yet the scale of biomedical research and funding has been pitifully limited, as the recent National Institutes of Health (NIH) and Institute of Medicine reports highlight.[6,7] Recently in the USA, NIH Director Francis Collins has stated that the NIH will be ramping up its efforts and levels of funding for ME/CFS,[8] which we hope will greatly increase the interest in, and resources for researching this illness. Despite scant funding to date, researchers in the field have generated promising leads that throw light on this previously baffling illness. We suggest the key elements of a concerted research programme and call on the wider biomedical research community to actively target this condition.
Article
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Reminders of happy memories can bring back pleasant feelings tied to the original experience, suggesting an intrinsic value in reminiscing about the positive past. However, the neural circuitry underlying the rewarding aspects of autobiographical memory is poorly understood. Using fMRI, we observed enhanced activity during the recall of positive relative to neutral autobiographical memories in corticostriatal circuits that also responded to monetary reward. Enhanced activity in the striatum and medial prefrontal cortex was associated with increases in positive emotion during recall, and striatal engagement further correlated with individual measures of resiliency. Striatal response to the recall of positive memories was greater in individuals whose mood improved after the task. Notably, participants were willing to sacrifice a more tangible reward, money, in order to reminisce about positive past experiences. Our findings suggest that recalling positive autobiographical memories is intrinsically valuable, which may be adaptive for regulating positive emotion and promoting better well-being. Copyright © 2014 Elsevier Inc. All rights reserved.
Article
Objectives Previous research has supported the beneficial effects of relaxation training on running economy. However, no studies have compared the effects of brief contact instructions to alter facial expression or to relax on running economy or running performance. The primary aim of this study was to determine the effect of such attentional instructions on movement economy, physiological, and perceptual responses during running. Method Using a repeated measures design, 24 trained runners completed four 6 min running blocks at 70% of velocity at VO2max with 2 min rest between blocks. Condition order was randomized. Participants completed running blocks while smiling, frowning, consciously relaxing their hands and upper-body, or with a normal attentional focus (control). Cardiorespiratory responses were recorded continuously and participants reported perceived effort, affective valence, and activation after each condition. Results Oxygen consumption was lower during smiling than frowning (d = −0.23) and control (d = −0.19) conditions. Fourteen participants were most economical when smiling in contrast with only one participant when consciously relaxing. Perceived effort was higher during frowning than smiling (d = 0.58) and relaxing (d = 0.49). Activation was higher during frowning than all other conditions (all d ≥ 0.59). Heart rate, affective valence, and manipulation adherence did not differ between conditions. Conclusion Periodic smiling may improve movement economy during vigorous intensity running. In contrast, frowning may increase both effort perception and activation. A conscious focus on relaxing was not more efficacious on any outcome. The findings have implications for applied practice to improve endurance performance.
Article
Recalling happy memories elicits positive feelings and enhances one’s wellbeing, suggesting a potential adaptive function in using this strategy for coping with stress. In two studies, we explored whether recalling autobiographical memories that have a positive content—that is, remembering the good times—can dampen the hypothalamic–pituitary–adrenal axis stress response. Participants underwent an acute stressor or control task followed by autobiographical memory recollection (of only positive or neutral valence). Across both studies, recalling positive, but not neutral, memories resulted in a dampened cortisol rise and reduced negative affect. Further, individuals with greater self-reported resiliency showed enhanced mood, despite stress exposure. During positive reminiscence, we observed engagement of corticostriatal circuits previously implicated in reward processing and emotion regulation, and stronger connectivity between ventrolateral and dorsolateral prefrontal cortices as a function of positivity. These findings highlight the restorative and protective function of self-generated positive emotions via memory recall in the face of stress.
Article
Background: Positive emotions have been shown to induce resilience to depression and anxiety in humans, as well as increase cognitive abilities (learning, memory and problem solving) and improve overall health. In rats, frequency modulated 50-kHz ultrasonic vocalizations (Hedonic 50-kHz USVs) reflect a positive affective state and are best elicited by rough-and-tumble play. Methods: The effect of positive affect induced by rough-and tumble play was examined on models of depression and learning and memory. The molecular and pharmacological basis of play induced positive affect was also examined. Results: Rough-and-tumble play induced Hedonic 50-kHz USVs lead to resilience to depression and anxiety, and facilitation of learning and memory. These effects are mediated, in part, by increased NMDAR expression and activation in the medial prefrontal cortex. Conclusions: We hypothesize that positive affect induces resilience to depression by facilitating NMDAR-dependent synaptic plasticity in the medial prefrontal cortex. Targeting MPFC synaptic plasticity may lead to novel treatments for depression.
Article
CFS/ME patients’ different experiences with Lightning Process Background: Lightning Process (LP) is a course-based training program which is under debate as a treatment for CFS/ME. Method: This qualitative study aims to provide more insight into CFS/ME patients’ different experiences with LP. We have investigated the accounts of two patient groups that described different impact of LP on their CFS/ME. One of the groups described a positive impact of LP, while the other reported that the program was without impact or had a negative impact on their condition. The analysis is based on the account of 22 informants where 13 described a positive impact while 9 described a lack of impact or that LP had a negative impact on their condition. The accounts were given 10 to 26 months after the course. Results: The accounts of the two groups differed along three dimensions; (a) the response to the theory and fundamental principles in LP, (b) how they experienced the supervision on the course, and (c) their body’s response to LP. Conclusion: Further questions regarding CFS/ME-patients different experiences with LP are raised through this analysis. Our argument is that it is particularly necessary to pay more attention to the communication between the LP-instructor and the course participant.