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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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