By David Tuller, DrPH
The Lightning Process, which I have covered extensively, isn’t the only program out there making big assertions about its impact on how the brain functions. These assertions piggyback on the emerging science of neuroplasticity and related concepts and involve the brain’s capacity to generate new neural pathways when it adapts to changes in stimuli. The existence of that capacity does not mean that an intervention hypothesizing a mechanism by which it is inducing the brain to generate these new neural pathways is in fact inducing the brain to generate new neural pathways.
So caution must be taken when assessing programs that present themselves as involving brain retraining as a treatment for serious illnesses. That includes the program called the Dynamic Neural Retraining System, which is based in Victoria, Canada. It has gained adherents in Canada and elsewhere. On its website, DNRS is described as €œa drug-free, step-by-step, intensive limbic rehabilitation program” that is based on €œneuroplasticity therapy, which rewires the limbic system to build more functional neural pathways.€ People who apply the system can, per the website, “find relief from” the following disorders:
- Adrenal Fatigue
- Allergies (pollen, food, perfume, chemical, environmental)
- Bacterial overgrowth
- Body temperature regulation issues (hot or cold)
- Central Sensitization
- Chronic Fatigue Syndrome/ Myalgic encephalomyelitis (CFS/ME)
- Chronic Inflammatory Response Syndrome) CIRS or Mold Illness
- Constipation / Diarrhea
- Chronic Pain
- Cognitive Function €“ memory or brain fog
- Eating disorders
- Electric Hypersensitivity Syndrome
- Environmental Illness (EI)
- Food Sensitivities
- Gulf War Syndrome
- Heart Palpitations
- Heavy Metal Toxicity
- Irritable Bowel Syndrome
- Lack of sex drive
- Latent infections
- Leaky Gut Syndrome
- Lyme Disease
- Mast Cell Activation (MCAS)
- Mold Illness
- Multiple Chemical Sensitivity
- Obsessive Compulsive Disorder
- Pain (chronic)
- Panic Attacks
- Poor circulation
- Post Traumatic Stress Disorder
- POTS (Postural Orthostatic Tachycardia Syndrome)
- Sensitivity to smell, taste. light, sound, touch
- Skin Conditions €“ eczema, rash, hives
- SIBO (small intestinal bacterial overgrowth)
- Thyroid Disorders
Here’s how DNRS is said to work:
“We directly target brain function and a maladapted stress response that is at the root of suffering for so many. We do not chase your symptoms €“ we teach you how to change the function and structure of your brain. When you rewire the limbic system, you move your body from a state of survival to a state of growth and repair €“ where true healing can take place. Find out how it can help you.”
DNRS founder Annie Hopper, a compelling speaker, is not a doctor or a scientist and does not pretend to be. The website identifies her as a €œlimbic system rehabilitation specialist.€ In 2004, according to the website, Hopper was fully engaged as a “core belief counselor, newspaper columnist and talk show guest as an expert in Emotional Wellness.” Then Hopper’s health began to deteriorate, for unknown reasons. As the website explains:
“Mysterious symptoms like insomnia, headaches, body aches and pains, chronic exhaustion and an increasing list of sensitivities ensued. Toxic overload was the eventual diagnosis. But even after undergoing detoxification treatments and an extensive list of healing treatments from over thirty different practitioners, her symptoms continued to escalate. This was the beginning of what can only be described as a type of science fiction nightmare. After almost 4 years of suffering that eventually led to homelessness, Hopper deduced that a toxic brain trauma was most likely at the root of her suffering. Hopper went on to creatively rewire the neural circuits in her brain that had been altered due to toxic trauma and the symptoms of illness eventually dissipated.
In 2008, as a result of her own experiences, Hopper launched DNRS, which offers five-day in-person workshops as well as individual coaching, online courses, access to support groups, and so on.
Buzzy and evolving constructs
When it comes to DNRS, the Lightning Process, and other adventures in proposed but unproven mechanisms like limbic rewiring, I don’t question anyone’s personal journey or experiences of relief from suffering. People have the right to pursue strategies based on buzzy and evolving understandings, or based on nothing at all. If these programs incorporate such elements as meditation practices, relaxation techniques, positive affirmations, body awareness exercises, psychological counseling and whatever else, they could possibly help reduce stress, enhance feelings of self-confidence, and prompt useful reflection on past and present actions–whether or not limbic rehabilitation has occurred.
Beyond that, such programs can have generalized impacts unrelated to the content. For some, spending time in a group of like-minded people might have an ameliorative effect. In a 2013 critique of “brain retraining” programs like DNRS on the site Science-Based Medicine, Yale neurologist and professional skeptic Steven Novella noted the following: “Just doing something, anything, to address a chronic problem is likely to make someone feel better. In the case of €œbrain training€ interventions, there are real cognitive benefits to the increased mental activity. The problem is the layer of pseudoscience placed on top of this legitimate but limited intervention.”
Whatever their possible benefits, however, these strategies also have possible medical and psychological harms. And they are not evidenced-based treatments for major medical conditions and diseases, no matter how expansive the list on the DNRS website. The site also includes many endorsements from health care professionals and from satisfied customers. These accounts might provide some sense of what the program entails while also serving as marketing tools, but such testimonials do not constitute proof of effectiveness.
The website’s €œresearch€ button leads to a page about a single study, which was conducted by investigators at McMaster University in Hamilton, Canada. The page includes a video of a presentation about the study delivered on November 17, 2019, at a major primary care conference in Toronto. The speaker, Dale Guenter, is a family physician, an associate professor at McMaster, and a proponent of therapeutic approaches focused on “retraining the brain”–an approach he outlined in a 2017 talk.
The participants in the study that Guenter presented last November were recruited from among attendees of eight DNRS workshops–five in Canada, two in the US and one in the UK. It was not an experimental study, such as a randomized clinical trial, that would allow investigators to make causal inferences. The study had no control group of patients who did not receive DNRS in order to compare sets of outcomes.
The presentation does not make it clear whether the participants paid for the DNRS program. If they did, as seems likely, that investment could have biased them toward providing more positive assessments; after all, most people prefer not to think they threw money away. Furthermore, the study by its design was capable only of documenting associations. It did not and could not document that the intervention was responsible for any reported changes. To make causal claims based on these data is not justified.
Nevertheless, Guenter introduced his talk on DNRS by noting €œhow well it worked for the people who were in our study.” At the end, he thanked the audience for “taking the time to learn about how DNRS is working for people.” Whatever enthusiasm he has for DNRS based on his experiences as a clinician, the findings in this study have so many limitations and caveats that they provide little insight about the intervention’s overall impacts–including whether it “worked” as touted.
So what were the results?
Of 150 DNRS participants, 102 agreed to fill out questionnaires for the research–meaning almost a third declined, for unknown reasons. The respondents were predominantly white women, and the average age was 51. They reported an average of five diagnoses each, with fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivities, depression, and anxiety among the most common. As Guenter himself noted, these diagnoses were not confirmed. Whether they were rendered by a competent clinician or whether patients diagnosed themselves is unknown.
At three months, six months, and 12 months, respectively, the number of participants responding to the questionnaires dropped to 80, 70, and 64. This represents a fairly high rate of what epidemiologists call “loss to follow up.” A significant rate of loss to follow up is not considered a positive endorsement of an intervention, since people who perceived it to be helpful could be considered more likely to respond. When properly accounted for in statistical analyses, a higher drop-out rate can reduce the apparent benefits attributable to an intervention.
The study’s main outcome measure was the SF-36, a quality of life questionnaire with eight sub-scales. One is the physical function sub-scale that is often used in ME/CFS research; other sub-scales focus on mental health, social function, bodily pain, general health and so on. Since these outcomes are subjective and self-reported, they are prone to significant bias and placebo effects, especially given the intervention’s promises of relief from suffering. With no objective measures in the study, the reported findings are difficult to interpret and cannot be called robust.
The mean scores for all eight sub-scales follow a similar path, a major improvement from baseline to three months, with minimal further changes at six and twelve months. The pattern of eight lines trending upwards in tandem looks impressive on a graph, but there is less here than meets the eye. The analysis seems to have involved averaging the scores received from whichever participants submitted them at any given assessment point. If that’s the case, the apparent improvements in scores could be largely or fully an artifact of the drop-outs.
Let’s say the participants who were most impaired at baseline were more likely to drop-out at subsequent points, a reasonable assumption. Let’s say everyone else stayed the same from baseline through 12 months–no worse, but no better. Given that set of facts, the average mean scores calculated from participants who continued to submit data would rise from baseline even though no individual scored any better.
And what if many or most of the 22 participants who were lost to follow up at three months found DNRS not just useless but actually harmful? What if many or most got worse, as some ME patients have reported after going through the Lighting Process?
Demonstrating an improvement in the mean scores of a shrinking pool of participants tells us little if we know nothing about the many who dropped out. In any event, an improvement in mean scores can be influenced by outliers and reveals nothing about how many individuals improved their scores, and by how much. Perhaps the investigators have individual-level data that would indicate actual improvement in a significant number of individuals. If so, they should share these data as well.
Guenter acknowledged that a trial with a control group would provide more robust information, as would the development of biomarkers to measure the hypothesized changes. All true.
Until then, does this presentation really demonstrate that DNRS “is working for people”? No. Does that mean people shouldn’t do it? That’s not my call.