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The Lightning Process (LP) is a three-day personal training programme developed and trademarked by British osteopath Phil Parker. [1] It makes unsubstantiated claims to be beneficial for various conditions, including chronic fatigue syndrome, depression and chronic pain.
Developed in the late 1990s, it 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 also applies some ideas drawn from neurolinguistic programming (a pseudoscience), as well as elements of life coaching.
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. [2] [3] Two corrections of this article were published due to methodological weaknesses. [4]
The approach has raised some controversy due to using psychological techniques to cure a physical illness. [5] The website was amended after the Advertising Standards Authority ruled that it was misleading. [6] In 2021, after a review of the available evidence, the National Institute for Health and Care Excellence explicitly advised against the use of Lighting Process among patients with chronic fatigue syndrome. [7]
The Lightning Process comprises three group sessions conducted on three consecutive days, lasting about 12 hours altogether, conducted by trained practitioners. [8] [9] [10]
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 practice a learnt series of steps to habituate the calming method. [9] [11]
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. [12]
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. [13] It also incorporates ideas drawn from neuro-linguistic programming and life coaching. [14] A basic premise is that individuals can influence their own physiological responses in controlled and repeatable ways. [15] Such learnt emotional self-regulation, it is suggested, could help overcome illness and improve well-being, if the method is practised consistently. [15]
Parker advocates attending the training course in order to gain a full understanding of the tools in a safe and supportive context. [16] 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'). [17] [18] He claims that the programme has helped to resolve various conditions including depression, panic attacks, insomnia, drug addictions, chronic pain and multiple sclerosis. [19] The program has also been used with chronic fatigue syndrome. [20] [11]
The Lightning Process is trademarked. [8]
There has been criticism of the cost of the three-day course. [21] [22] There has also been criticism of the claimed benefits (see also below). [5] [22] 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." [5] 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. [5] 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. [5] Prominent advocates of the process include British journalist Patrick Strudwick, [26] French dancer Chris Marques, [27] and singer Laura Mvula. [1]
In 2011 Hampshire Trading Standards requested that the UK Advertising Standards Authority (ASA) give a ruling on the website www.lightningprocess.com, arguing that the information on the site was misleading in four areas. [28] ASA upheld two of the four challenges. [6] They concluded that although there seemed to be some evidence of participant improvement during trials conducted, the trials were not controlled, the evidence was not sufficient to draw robust conclusions, and more investigation was necessary; consequently, the website's claims at the time were deemed misleading and was amended. [6]
A registered clinical trial (UK SMILE pilot study) was conducted in England at Bristol University, with results published in 2017. [2] The results did not change the stance of the National Health Services in the United Kingdom which does not recommend the method. [3]
A peer reviewed qualitative study on experiences of the course among a group of young people with chronic fatigue syndrome was published in 2012. [29] A Norwegian Support Group patient survey showed mixed experiences. [30] 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. [31]
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. [7]
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. [20] The SMILE study received some public criticism for recruiting children when adult subjects are available. [32] [33] [34] The study was approved by the National Research Ethics Service. [25] [35] 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." [20]
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." [36] Reactions to their briefing were stronger than expected: "it was the criticism from within the scientific community that we had not anticipated." [36] The briefing [37] invited four psychologists to make comments on the study, [38] 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. [36]
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]
The ME Association is a UK health charitable organization that provides information, advocacy, and services to persons and families affected by ME/CFS, and raises funds for research into ME/CFS. It has been reported to be one of the two largest UK charities for ME/CFS.
Rintatolimod, sold under the tradename Ampligen, is a medication intended for treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). There is some evidence it may improve some ME/CFS symptoms.
ME Research UK is a medical research charity based in the United Kingdom with the principal aim of commissioning and funding scientific (biomedical) investigation into the causes, consequences and treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS is a debilitating illness which affects between 120,000 and 240,000 people in the United Kingdom alone, but which is not well understood nor, in many cases, properly recognised.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has a long history with an evolution in medical understanding, diagnoses and social perceptions.
Management of ME/CFS focusses on symptoms management, as no treatments that address the root cause of the illness are available. Pacing, or regulating one's activities to avoid triggering worse symptoms, is the most common management strategy for post-exertional malaise. Clinical management varies widely, with many patients receiving combinations of therapies.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an illness with a long history of controversy. Some professionals within the medical community do not recognize ME/CFS as a genuine condition, nor is there agreement on its prevalence. There has been much disagreement over the pathophysiology of chronic fatigue syndrome, how it should be diagnosed, and how to treat it.
Clinical descriptions of ME/CFS vary. Different groups have produced sets of diagnostic criteria that share many similarities. The biggest differences between criteria are whether post-exertional malaise (PEM) is required, and the number of symptoms needed.
Graded exercise therapy (GET) is a programme of physical activity that starts very slowly and gradually increases over time, intended as a treatment for chronic fatigue syndrome. Most public health bodies, including the CDC and NICE, consider it ineffective, and its safety is disputed. However, GET still enjoys support among a minority of clinicians and organizations.
Daniel Peterson is an American physician in private practice in the state of Nevada, and has been described as a "pioneer" in the treatment of chronic fatigue syndrome (CFS). He graduated from the University of Rochester School of Medicine, Rochester, New York, in 1976 and was an intern and resident at the University of Utah Medical Center from 1976 to 1979. In 1979, he became a diplomate of the American Board of Internal Medicine. He is president of Sierra Internal Medicine of Incline Village, established in 1981.
The Chronic Fatigue Syndrome Advisory Committee (CFSAC) was formed in response to the use of funds by the United States Centers for Disease Control and Prevention in the study of chronic fatigue syndrome (CFS). The CFSAC was charted under the Public Health Service Act of the US and funded by the United States Department of Health and Human Services (HHS). The CFSAC advises the Secretary of Health and Human Services on issues related to its mandate, including issues related to access and care for individuals with CFS, research, public health, clinical care and education regarding CFS. In November, 2008, support for CFSAC activities was changed to the Office on Women's Health, a division of the Office of Public Health and Science. It held it first meeting in 2003.
Dr. José Gilberto Montoya is a prominent researcher known for his contributions to the field of infectious diseases, particularly in the area of chronic fatigue syndrome (CFS) and the role of infectious agents in its development. His research has shed light on the potential involvement of pathogens and immune dysregulation in the pathophysiology of CFS. He was a Professor of Medicine in Infectious Disease at the Stanford University School of Medicine, where he led Stanford's Initiative on Chronic Fatigue Syndrome. He has worked on a wide variety of projects, including research focused on the efficacy of new smallpox vaccines. Additionally, he was the founder and co-director of the Immunocompromised Host Service and works at the Positive Care Clinic at Stanford. He is originally from Cali, Colombia.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating long-term medical condition. People with ME/CFS experience delayed worsening of the illness after minor physical or mental activity, which is the hallmark symptom of the illness. Other core symptoms are a greatly reduced ability to do tasks that were previously routine, severe fatigue that does not improve much with rest, and sleep disturbances. Further common symptoms include dizziness or nausea when sitting or standing, along with memory and concentration issues, and pain.
Rosamund Vallings is a medical doctor, known as one of the leading authorities on Chronic Fatigue Syndrome (ME/CFS) in New Zealand.
Post-exertional malaise (PEM), sometimes referred to as post-exertional symptom exacerbation (PESE), is a worsening of symptoms that occurs after minimal exertion. It is the hallmark symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and common in long COVID and fibromyalgia. PEM is often severe enough to be disabling, and is triggered by ordinary activities that healthy people tolerate. Typically, it begins 12–48 hours after the activity that triggers it, and lasts for days, but this is highly variable and may persist much longer. Management of PEM is symptom-based, and patients are recommended to pace their activities to avoid triggering PEM.
Idiopathic chronic fatigue (ICF) or chronic idiopathic fatigue or insufficient/idiopathic fatigue is a term used for cases of unexplained fatigue that have lasted at least six consecutive months and which do not meet the criteria for chronic fatigue syndrome. Such fatigue is widely understood to have a profound effect on the lives of patients who experience it.
Peter C. Rowe is a physician and academic. A leading researcher in chronic fatigue syndrome, he is Professor of Pediatrics, Sunshine Natural Wellbeing Foundation Professor of Chronic Fatigue and Related Disorders, and Director of the Children's Center Chronic Fatigue Clinic at Johns Hopkins University School of Medicine.
DecodeME is an ongoing genome-wide association study searching for genetic risk factors for ME/CFS. With a planned recruitment of 25,000 patients, it is expected to be the largest such study to date. Recruitment closed on 15 November 2023 and results are expected in 2024.
The Open Medicine Foundation (OMF) is a US-based charity that funds research into the illnesses myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia, post-treatment Lyme disease syndrome, and long COVID.
A 2-day CPET is a cardiopulmonary exercise test given on two successive days to measure the effect of post-exertional malaise (PEM) on a patient's ability to exercise. PEM is a cardinal symptom of myalgic encephalomyelitis/chronic fatigue syndrome and is common in long COVID as well.
Carmen Scheibenbogen is a German immunologist who is the acting director of the Institute for Medical Immunology of the Charité university hospital in Berlin. She specialises in hematology, oncology and immunology. She leads the Outpatient Clinic for Immunodeficiency and the Fatigue Centre at the Charité hospital. She is one of the few doctors specialised in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in Germany, and also researches long COVID.
The pilot study conducted with the International Centre For Wellness Research reported positive results from a sample of 17 participants. However, we understood that the study was not controlled and had concluded that further investigation was necessary... We noted that the trials conducted by the ME Association, the Brighton and Sussex Medical School and the Sussex & Kent CFS/ME Society reported positive results but were self-assessment studies and had not been controlled. We considered that those studies and surveys did not constitute a suitably robust body of evidence to demonstrate the effectiveness of the LP in the treatment of CFS/ME. Because of that, we concluded that the CFS/ME page of the website was likely to mislead... The claims on the website should not appear again in their current form. We told Phil Parker Group to ensure they did not make medical claims for the LP unless they were supported with robust evidence.
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.