CBT repackaged or a novel treatment? The Lightning Process compared with UK specialist medical care for paediatric [CFS], 2021, Anderson et al

Andy

Andy

Retired committee member
Authors: Emma C. Anderson, Maria Loades, Jennifer Starbuck, Phil Parker, Fiona Finch, Rebecca Barnes, Lucy Beasant & Esther Crawley

ABSTRACT

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.

Open access, https://www.tandfonline.com/doi/full/10.1080/21641846.2021.1935373
 
"Funding
This research was funded by the Linbury Trust (Grant no: LIN2623). During data collection, EC was funded by a National institute for Health Research Senior Research Fellowship (SRF-2013-06-013). ML is funded by the National Institute for Health Research (Doctoral Research Fellowship, DRF-2016-09-021)."

How can they then say:
"This report is independent research. The views expressed in this publication are those of the authors, not of the Linbury Trust, the NHS, the National Institute for Health Research or the Department of Health and Social Care."

?

We recommend the following areas for future research: (i) Conducting a large-scale clinical trial comparing LP alone against CBT-F for treating paediatric CFS/ME and including measures of candidate mechanisms of intervention effects (e.g. therapeutic alliance, readiness to change, treatment engagement/belief in the model, attention shift, goal agreement); (ii) Conducting trials to test adding distinct elements of LP to SMC approaches to explore effectiveness (
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the Stakeholder group appears to be:
the basis of a stakeholder consultation to discuss and refine the differentiation of intervention approaches. This consultation process included email exchanges, individual discussions and a 1-hour group meeting (held on 14/02/2019) comprising of:

LP designer (co-author PP) and LP practitioner (co-author FF),
medical clinical lead of a specialist paediatric CFS/ME NHS service (co-author EC),
two clinical psychologists who deliver CBT within the NHS service (co-authors ML, JS) and
three independent researchers (lead author EA, and co-authors RB, LB).

In the group meeting, the lead author presented the initial tables and the LP practitioners and NHS clinicians discussed the key elements in more detail, advised on any changes to be made, and via discussion reached consensus on the elements that were similar and distinct between interventions based on their clinical expertise. The tables and descriptive comparisons presented in this paper were refined within and after this meeting in collaboration with these key stakeholders/co-authors to ensure the core elements of each treatment approach were captured.
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I don't see any patient or carer involvement?

One glaring omission is that children/participants are essentially trained to lie.
 
"...elements of LP which could be explored in future interventions or research aiming to improve clinical outcomes for children with CFS/ME"

:( :( :( LP and children not the combination I was hoping to be reading about today
 
There it is, after decades of re-runs of the jumping the shark episode, this is running an entire season of nothing but the jumping the shark scene. An actual discussion over "angels dancing on hairpins" that is completely serious and oblivious to its own absurdity. They are discussing this seriously, without any criticism whatsoever, taking the claims as if they had any validity.

A system that is unable to see quackery for what it is is probably not capable of doing anything reliably. Complete void of self-awareness or ability to self-reflect on what they do. It's one thing that quacks write drivel like this, it's a whole other thing that multiple layers of (clearly symbolic) checks and balances see nothing wrong with it. This is a system that has failed completely, every part to the maximum possible level.

Notable that it mentions that CBT is part of standard medical care, which makes years of "comparisons" of CBT with SMC completely absurd, especially those weird treatment arms of CBT+SMC, which is so redundant it's basically recursive. But it's not that is any of this matters, contradictions are basically part of the ideology.

At first seeing some of the quotes I thought maybe some sense had come into them, given the names. But no, they genuinely mean those things and find nothing wrong with saying out loud those things or "the bastards just don't want to get better". Those are not anomalies, they accurately represent what is happening here. Decades of unaccountable free-for-all look about as poor as expected.

Shame on everyone involved in this, you are truly the worst your profession has produced in its entire history. At least before modern science genuine ignorance was a valid excuse.
 
Wow. We've been saying for a while that the Lightning Process is basically the same as 'CBT for fatigue', thinking that is a commentary on how absurd, how full of pseudoscience 'CBT for fatigue' is.

And yet here are Crawley and Loades and Phil Parker and the rest actually saying the same thing, even to the point of suggesting that CBT for fatigue should be more like the Lightning Process. And, they were funded to write this stuff. It's truly bizarre.

@dave30th
 
And it is published in Fatigue. that means they likely tried to publish it elsewhere first and got rejected. But it is very weird. As @Hutan says they just have decided to make the linkage themselves between CBT and LP. The idea that they are writing papers with Phil Parker just seems really out there.
 
Jonathan Edwards said:
And where did CBT-F come from?
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I assume this is to distinguish from generic CBT, since we know the CBT for ME is completely different from, say, supportive CBT for cancer or phobias. Even though it's one of their biggest selling points, that even cancer patients see nothing wrong with CBT, showing how silly we are to refuse something that helps even for cancer, a very serious disease. How could this possibly be harmful? They chuckle with fake bonhomie.

Because nothing they say matters. Here they have to point out that it's different, since of course they couldn't seriously argue that this is what standard CBT usually is, especially not the kind they pretend cancer patients also get referred to. In a different setting the same people would say otherwise, gleefully point out how silly we are for it, since it's the same, which they know it isn't, because nothing matters in this ideology.

Pointing this out in any argument with anyone buying into the ideology would be pointless, it's just semantics. So they freely contradict themselves because we are the only ones who care. And since we've been pointing out their lies and contradictions for years without even slowing them down a bit, they truly don't have to care, no one else does, certainly not peer reviewers, editors or other people citing their work, even incorrectly. That's the beauty of de-medicalizing a disease: not a damn thing matters, medical standards don't apply.

As others have pointed out, this obviously shows how their CBT for ME is completely delusional, the distinctions here are completely trivial, it's the same thing as LP/Gupta/The Switch/The Secret for all intents and purposes. Unfortunately that doesn't matter either, nothing does, since nothing that happens to us ever does.
 
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How and why did the Linbury Trust get involved?

Waiting for their tweet promoting the study.

Wouldn't be a core aim of the Trust to help snake oil vendors with money, earn more money. Hard to believe they didn't do due diligence, hard to believe they awarded a grant.
 
Trish said:
Please, please, somebody stop this child abuse.
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I've mentioned this in another thread but LP therapists are not members of any professional organisation that has a charter to oversee the quality of treatment offered by & the conduct of their members. Most UK healthcare professionals are members of such bodies and have to be to practice.

In addition, where children are concerned, other safeguards are usually required. If you are a teaching assistant, want to help coach kids in sports, be a lollipop person then you need to at least undergo basic relevant police checks.

So, if the LP practitioner is not a member of a professional body and hasn't had the appropriate clearance during the police checks then they shouldn't even be let into the same room as children.

That's before we start on the being sworn to secrecy and teaching children to lie to themselves, their parents & teachers.
 
Invisible Woman said:
I've mentioned this in another thread but LP therapists are not members of any professional organisation that has a charter to oversee the quality of treatment offered by & the conduct of their members. Most UK healthcare professionals are members of such bodies and have to be to practice.
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Also as mentioned elsewhere in relation to the reproducibility of research, because of commercial secrecy it is impossible for any independent verification to ever take place. But over and above this, it means that any academic, doctor or clinician recommending LP has no objective information or independent witnesses accounts on what is actually involved. Surely to recommend something that you can not adequately know about is professional misconduct?

Also how can anyone adequately address or analyse this paper if there are huge gaps in what we are allowed to know about one of the interventions discussed.
 
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