Trial By Error: New Hyped-Up Lightning Process Study from New Zealand

By David Tuller, DrPH

In January, the Journal of Family Medicine and Primary Care published a paper from New Zealand called “An audit of 12 cases of long COVID following the lightning process intervention examining benefits and harms.” It reads like a Lightning Process marketing effort cosplaying as an academic study.

As a reminder, the LP is a mish-mash of, among other approaches, neurolinguistic programming, positive affirmations, relaxation and meditative strategies, and osteopathy, delivered over the course of three days. It was created by British osteopath and spiritual healer Phil Parker, who had previously reported that he had “developed this ability to step into other people’s bodies… to assist them in their healing with amazing results.” Parker also co-led a spiritual healing course that included modules on Tarot reading, diagnosis by aura, and related psychic-therapeutic modalities.

In the LP, participants are dissuaded from acknowledging ongoing pain and suffering. The intervention trains them to make only optimistic and uplifting statements about how they feel; that is the essence of the LP. Doing the opposite essentially means you’ve failed the program. Given such a strategy, it is challenging to assess subjective statements about success from LP participants.  

(I wrote about the LP for Codastory.com in 2021, and in multiple blog posts over the years. I also exposed Professor Esther Crawley’s 2018 pediatric trial of the LP as an example of research misconduct.)

The lead author of this new paper is Professor Bruce Arroll, a general practitioner and Lightning Process devotee at the University of Auckland, in New Zealand. In a 2023 treatment guide for ME/CFS, Professor Arroll recommended the LP, along with CBT and GET. He is one of several co-signers of a statement posted on the LP site and titled “Support for the Evidence-Based Research on the Lightning Process: A Letter from Academics and Medical Professionals.”

The new paper involved retrospective interviews with 12 participants who underwent the LP for Long Covid with a woman said to be New Zealand’s sole full-time practitioner. Here’s what the abstract claims: “The study suggests that the lightning process is a promising and safe intervention for symptoms of long COVID. Primary care clinicians can refer patients for treatment with a high chance of benefit without fear of harm.”

In response to the study, the ME Association alerted readers on its Facebook page that the 2021 ME/CFS guidelines from the National Institute for Health and Care Excellence warn against the LP. The problems with the paper have also been discussed on a thread at the Science for ME forum and in cogent comments posted on PubPeer.

Of the 12 participants, five had self-diagnosed with Long Covid. Specific symptoms experienced by patients are not described at length. Did they suffer from post-exertional malaise? Did any of them meet diagnostic critera for ME/CFS? Who knows? It is impossible to tell.

The study included no comparison group, so it is impossible to make any legitimate causal conclusions–even though the authors clearly do. The participants took the LP around less than a year, on average, after their bout with COVID-19. That means they could easily have been on a normal path of recovery. Assumptions or claims that any reported improvements were due to the Lightning Process are unjustified and violate standard scientific principles.

Another point: Although the paper is confusing in parts, it appears that 20 Long Covid patients had completed the LP with the practitioner, but only 12 of them “were contactable.” What does that mean, exactly? It’s not clear from the paper’s explanation of its methodology. Presumably, most or all of the eight who were classed as not contactable didn’t want to be contacted or participate in the study. So one could argue that the baseline number of LP participants with Long Covid is really not 12, but 20—with eight of them “lost-to-follow-up,” as this status is called in epidemiology.

Why would former LP clients choose not to participate in such a study? Some logical possibilities: they didn’t like the LP, they deteriorated after the LP, they thought the LP was a waste of money. The paper includes no discussion of this 40% drop-out rate, so we really have no idea what happened to them. But that big unknown undermines any sunny assertion that the study findings show the LP to be “safe and effective.”

**********

Bogus reasons for exempting study from ethical review

One striking aspect is that the Professor Arroll and his colleagues exempted the study from ethical review on the grounds that it was an “audit of clinical practice” rather than research. That’s nonsense. You don’t get to interview participants in person and make broad-based conclusions that an intervention is “safe and effective” in an audit. Professor Arroll should know that, given that he has previously written about his own experience of being accused of publishing “research” under the guise of a “clinical audit.”

New Zealand, like other countries, has official guidelines on the differences between “clinical audit,” which does not require ethical review, and “research,” which does. It is indisputable that this purported “audit” is research and required ethical review. That the authors unilaterally exempted it from such review is obviously unacceptable. Any competent peer review should have picked that up and rejected the paper on those grounds.

(Nina Steinkopf, a patient advocate in Norway, has tackled this issue in her most recent post on her blog, MElife. She has written to the journal editor to inform him that the paper constitutes research, not an audit.)

Here are some other issues with this paper.

In the introduction, the authors declare that the LP has “a developing evidence base for efficacy, particularly for CFS/ME.” It is worth noting that the reference for this claim is an article published in something called the Journal of Experiential Psychotherapy. The lead author of the article was spiritual healer Parker himself. The journal is sponsored by the Romanian Society of Experiential Psychology in cooperation with the Faculty of Psychology and Educational Sciences at the University of Bucharest. Professor Arroll and LP fans are of course free to consider this journal a top-notch and reputable venue. I do not share that opinion.

Here is how the Journal of Experiential Psychotherapy describes itself: “The journal valorizes and releases studies, original research, Romanian and international scientific contributions in the field of personal development, experiential counseling and psychotherapy, therapy of unification (T.U.) – a Romanian humanistic-experiential method of standard and experiential psychodiagnosis, applied in the assistance offered to adults, children, couples, families, transgenerational relationships, organizations and communities.” Perhaps Romania is ripe for more LP practitioners!

Moving on, the article refers to “a high‑quality RCT [randomized controlled trial] from the Bristol Clinical Trial Unit showing benefit in adolescents with chronic fatigue.” This reference is to the trial from Professor Crawley, Bristol University’s now-retired methodologically and ethically challenged pediatrician and former grant queen. The trial in question was fraudulent and should have been retracted; instead, it carries a 3,000-word correction/clarification, and a 1,000-word editorial statement that explains the tortured logic used to decide not to retract it.

Strikingly, Professor Arroll and his co-authors contradict themselves in the paper’s two last paragraphs, In the final paragraph of the discussion, they note that “it is impossible to generalize our study findings to a broader group of patients because of the small sample size and restricted demographic variation.” That disclaimer notwithstanding, here’s what they write in the next paragraph, which constitutes the paper’s conclusion: “Primary care clinicians can be assured that this is likely to be a safe and effective intervention.”

In other words, they have generalized their inflated and biased findings to all patients with Long Covid that a primary care clinician might encounter—despite their own admonishment against doing so. The whole thing would be laughable if it weren’t so pathetic.

**********

Disclosure: I am a senior fellow in public health and journalism at the Center for Global Public Health, which is part of the School of Public Health at the University of California, Berkeley. My academic position is largely supported by donations to the university via the campus crowdfunding platform from people with ME/CFS, Long Covid, and related disorders.