Article:

The cause of chronic fatigue syndrome/myalgic encephalopathy (CFS/ME) is not well understood and is disputed, and therapeutic options are limited. Many patients who attended the Lightning Process course reported positive effects. This should lead to a randomised controlled intervention trial.

Since 2008 several thousand patients with CFS/ME have attended the Lightning Process (LP) course in Norway (1). The course is a three-day intensive brain rehearsal programme with the option for follow-up. Although what triggers CFS/ME in the individual case may vary, it is assumed that symptoms maintenance and chronification can be attributed to a stress response with elevated state of alertness and persisting activation of the sympathetic nervous system, driven by classic and operant conditioning mechanisms. The Lightning Process is based on these theories of stress.

What is the Lightning Process?
The Lightning Process course is a form of psychoeducation comprising both a theoretical component and exercises which participants practice at home. The course has elements in common with cognitive behavioural therapy, a therapeutic method that has demonstrated results in CFS/ME (2). Both methods take the association between thoughts, feelings and actions as their starting point, and aim at breaking self-reinforcing and inconvenient spirals. However, the Lightning Process differs from cognitive behavioural therapy in certain aspects: The course is designed as a three-day mental brain rehearsal, led by a coach with specific Lightning Process training. Whereas cognitive behavioural therapy addresses the contents of patients’ thoughts, LP places more emphasis on discussing how one relates to the thought patterns (3). Patients are furthermore encouraged to seek out experiences that engender positive emotions, without a fixed plan, instead of analysing negative thoughts and emotions. In addition, considerable attention is paid to the importance of semantics – how words and concepts contribute to negative thought patterns.

Research
To our knowledge, two scientific studies of the Lightning Process have been conducted, both of them qualitative. In one study, seven of nine adolescents reported significant improvement, while two did not experience any effect (4). The second study investigated patients’ experiences and found that higher scores on understanding of one’s own condition, feelings of confidence towards the course leader and positive bodily response distinguished patients who reported a positive effect from patients who reported a negative or no effect (5). Both studies indicate that the course may be beneficial for some patients with CFS/ME. In England a pilot study has also been conducted with children/adolescents which will lead to a randomised controlled trial (6).

A telephone questionnaire survey was conducted in collaboration with Godthaab Health and Rehabilitation of all participants who had attended Lighting Process courses in 2008 (7). The majority reported an improvement in quality of life and activity level. The improvement persisted one year after course participation, and no serious adverse effects were reported. The user survey of course only allows the generation of hypotheses, but indicates that the course can have a positive effect on these conditions.

Need for further knowledge
CFS/ME can be debilitating for the individual and represents a significant societal problem. There is a great need for more research on the effects of various forms of treatment. The Lightning Process has shown promising results, but these need to be reproduced in randomised controlled trials. Before the results of such studies are available, the evidence base is insufficient for recommending that the Lightning Process be systematically used in the health services.

Chronic fatigue syndrome and experience with the Lightning Process, by L Landmark, R M B Lindgren, B Sivertsen, P Magnus, S Conradi, S N Thorvaldsen,J K Stanghelle in Tidsskr Nor Legeforen 2016; 136:396, Nr. 5 – 15. mars 2016