The need for research: NLP and health-care

A Need for Research in NLP and its relevance to health-care
By Henrie Lidiard
(Ph.D. INLPTA Master Trainer of NLP)

If the benefits of NLP are to be taken more seriously in the realm of health care, I believe our relatively young and rapidly expanding discipline needs to be researched in a credible way. 
1. A difference of world-view!
The collective world-views of the medical and NLP communities are very different. Consequently the strategies that the two communities use for becoming convinced are also somewhat different. In the medical world there is a need for due authority, analysis, peer reviewed journal publications, science, facts, data and proof derived from credible controlled studies. Whereas in the NLP community many people feel that subjective evidence is sufficient. There is also a segment of the NLP community that can appear ‘new-age’ ‘anti- science’ and imprecise in its claims for the discipline (e.g. simply think positively and you’ll be well).
Given the contrasting world views there are a number of counts where NLP may be perceived as needing to prove itself from within a medical mind-set:
2. Existing research (and not much of it!)
An excellent summary by R.Bolstad (1997) lists several research studies of NLP that are of relevance to Health-care. There are also a number of additional studies since his 1997 review. I can’t help noticing that there is a strange concentration in the research on a few small areas of NLP (e.g. the existence of primary representation systems or the use of predicates) rather than a wider examination of the results of the more therapeutic interventions. The notable exception to this being a relatively large number of studies on the VK Double dissociation Trauma cure.   The list that follows adds a few additional papers to Richard’s summary.
REP systems
Dilts and Epstein (1995) conducted a study on eye movements/ Rep systems and found measurable differences in performance in spelling when different Rep systems/eye positions were used. Falzett 1981 and Hernandez 1981 both provide evidence that supports the eye-accessing cue model as described by NLP. (Although Hernandez didn’t find data to support kinaesthetic related eye movements)
Falzett (1981), Yapko (1981a and b, House 1994), All concluded in various ways and with various emphases that using a person’s preferred sensory predicates in communication with them deepens trust, rapport and measurable levels of trance and relaxation.  
Buckalew and Ross (1981) studied the effect of placebos according to colour and size. Smith and Laird (1930) reported that sound volume has measurable physical effects on stomach contraction.
Unconscious mind
One of the clearest piece of evidence for the existence of the unconscious mind and our ability to communicate with it is in the study of Cheek (1981) who induced 3000 fully anaesthetised patients to produce hand signals for yes and no without their conscious knowledge. There are also excellent case examples of the practical use and effect of Milton Erickson’s language patterns in the emergency Room by Bierman (1987).
VK double-dissociationTrauma-Cure
Denholtz and Mann (1975), Koziey and McLeod (1987), Einspruch (1988), Muss (1991), Hossack and Bentall (1996) all published small scale case-based trials of the trauma cure having achieved significant success with the process. In addition Dietrich et al (200) compare the trauma cure to other ‘alternative’ methods of working with post-traumatic stress disorder and conclude that it is an effective method. Dietrich (2000) also postulates reasons why this technique may work. It is also worth noting that there are some procedural variations in the versions of the trauma cure which are tested.
Davison and Neale (1986) published and article about inducing and removing a phobia using anchoring. Langer (1989) described a study of the incredible physical and psychological benefits of anchoring in working with the elderly.
Anxiety and depression
There are also a number of studies which describe how anxiety and depression have been alleviated using NLP, e.g. Koziey and McCleod (1987), Einspruch (1988), Konefal et al. (1992) Hossack and Standidge (1993) and case examples are also described by Rushworth (1994).

3. Credibility and validity of research
This is a challenging area on two counts: 
Whilst we may need credible research that examines the different aspects of NLP, it is important to recognise that much of the power of the NLP approach lies in the synthesis of a particular set of ideas and practical tools and what can happen when they are used together systematically.
We need, in effect, individuals and/or research teams that have both high levels of skill and awareness in using NLP and corresponding levels of skill and experience in designing research that can stand up to critical scrutiny. 
We have been fortunate to have such a team working together in Ellesmere Port on the Living with Cancer project(Directed by Carolyn Temple and described in more detail by Nancy Moss, Carolyn Temple and Miranda Thurston: Special Iissue of NLP News March 2005.) The results of this important and ground-breaking qualitative research are summarised in this issue and can be read in full in Sargent et al. (2004)
I believe there is also a need for published accounts from medically-trained health professionals about the results they are achieving using NLP in their practice. 

Bierman S.F. 1987 ‘Hypnosis in the Emergency Room’ in Leaves Before the Wind: Leading edge applications of NLP. Edited by Bretto-Milliner C., DeLozier J., Grinder J. and Topel S. 1991
Buckalow L.W. and Ross S. 1981 Relationship of perceptual characteristics to the efficacy of placebos in Psychological Reports vol. 49: 955 -961.
Cheek D. 1981 awareness of meaningful sounds under general anaesthesia in Theoretical and Clinical Aspects of Hypnosis, Symposium Specialists.
Davison G.C. and Neale J.M. 1986. Abnormal Psychology. J.Woley and son. New York 1986.
Denholtz M.S. and Mann E.T. 1975 An automated audio-visual treatment of phobias administered by non professionals. Journal of Behaviour Therapy and Experimental Psychiatry. Vol. 6: 111-115.
Dietrich A.M. 2000A review of VK Dissociation in the treatment of post-traumatic disorders: Theory, efficacy and practice recommendations. Traumatology vol. VI (2) article 3.
Dietrich A.M., Barranovsky A.B., Devich-Navarro M., Gentry J.E. Harris C.J. and Figley C.R. 2000. A review of alternative approaches to the treatment of post-traumatic sequelae. Traumatology Vol. VI (4) article 2.
Dilts R. and Epstein T. 1995 Dynamic Learning, Meta Capitola California.
Einspruch E. 1988 NLP in the treatment of phobias. Psychotherapy in Private Practice Vol. 6: (1) 91-100.
Einspruch E. and Forman B.D. 1985 Observations concerning research literature on NLP. Journal of Counseling PsychologyVol. 32: (4) 589-596.
Falzett W. 1981 Matched versus unmatched primary rep. system predicates and their relationship to perceived trustworthiness in a counselling analog. Journal of Counseling Psychologyvol vol. 28: 305-308.
Graves, C. 1974 Human nature prepares for a momentous leap. The Futurist, April 1974.
Hernandez V.   1981 A study of eye movement patterns in the NLP model. (Doctoral dissertation, Ball State University) Dissertation Abstracts International Vol 42 1587B.
Hossack A and Standisge K. 1993 using an imaginary scrapbook for NLP in the aftermath of clinical depression: a case history. The Gerontologist Vol. 33: (2) 265 – 268.
Hossack A. and Bentall R.P. 1996 Elimination of post-traumatis symptomatology by relaxation and VK-dissociation. Journal of Traumatic Stress Vol. 9: 99-111.
House S. 1994   Journal of Reality Therapy Vol. 14 (1) 61 – 65.
Konefal J , Duncan R.L. and Reese M. 1992 Trait anxiety and locus of control. Psychological Reports Vol. 70: 819 – 832.
Koziey P.W. amd McCleod G.L. 1987   Visual- kinaesthetic dissociation in the treatment of victims of rape. Professional Psychology: Research and Practice Vol. 18: (3) p 276-282.
Langer E.J. 1989 Mindfulness, Addison Wesley. Massachusetts.
Muss D.C. 1991 A new technique for treating post-traumatic stress disorder. British Journal of Clinical Psychology Vol. 30: 91 -92.
Rushworth, C. 1994 Making a Difference in Cancer Care. Practical techniques in palliative and curative treatment. Souvenir Press. London.
Smith E.L. and Laird D.A. 1930 The loudness of auditory stimuli which affect stomach contraction in healthy human beings. Journal of the Acoustic Society of America Vol. 2: 94-98.
Yapko M. 1981 (a) NLP, Hypnosis and interpersonal influence (Doctoral Dissertation United States International University) Dissertation Abstracts International vol. 41. 3204B 
Yapko M. 1981 (b). The effects of matching primary rep system predicates on hypnotic relaxation. American Journal of Clinical Hypnosis vol. 23: 169 -175.

An evaluation of the ‘Living with Cancer’ Project - Dr Miranda Thurston


Some reflections on research

By Dr Miranda Thurston, Centre for Public Health Research, University College of Chester
A lot of research over the last 10 years or more has indicated that cancer patients and their carers do not always experience high quality care. A recurring theme of much of this research has been that health professionals frequently have poor communication skills, which significantly undermine the quality of interactions between patients’ and clinicians and often leave patients and carers feeling uncared for and ignorant about their illness. At a time when both patients and their carers need empathetic support, it appears that they are often least likely to experience it. This has led to an increasing focus on the quality of cancer care in general, and a specific focus on improving the quality of interaction between patients, carers and clinicians through the enhancement of health professionals communication skills.
The Centre for Public Health Research was commissioned to evaluate the ‘Living with Cancer’ Project. It was clear at an early stage that the use of neuro-linguistic programming in cancer care was unusual. A thorough review of the literature revealed that NLP had rarely been used to support patients or carers in dealing with their circumstances, or to try to improve health professionals’ communication skills. What the literature review did reveal to me was that NLP was quite a different approach to the whole subject of ‘communication skills’, which seemed to often be viewed in terms of a set of technical exercises, somewhat divorced from the empathetic dimension of human inter-relationships. NLP seemed to offer considerable potential for health professionals to improve their capacity and capability to care for their patients through developing the affective side of communication and through this, be more responsive to patients’ and clients’ needs and desires, rather than making assumptions about what these were and risk behaving inappropriately.
At an early stage in the research project, considerable attention was given to deciding on an appropriate methodology. It was important for the study to be robust, so that the findings would have a better chance of being taken seriously. However, it became clear that the most appropriate methodology would be a qualitative approach, using focus groups and interviews. This would allow patients, carers and health professionals to talk at length, and in some detail, about their views of NLP. Qualitative research aims to explore matters in depth, and tries to understand things from the point of view of the interviewee: patient, carer, or health professional. Because of this, the findings tend to be based on relatively small samples and can not be quantified. This can mean that people view the findings as ‘anecdotal’ or ‘unrepresentative’ rather than as giving insight into the views of particular client groups.
In terms of health professionals, it was evident that many thought that NLP build on their existing knowledge of communication. However, it was apparent that some professionals were challenged by an alternative and different approach to communication (4 out of 55 according to post training evaluation records Lidiard Pers. Comm..) . Reflecting on this, it may be that many health professionals are too wedded to the biomedical model of practice, a model that does not tend to value the affective aspects of communication and values ‘treating’ above ‘caring’. This is unfortunate, because patients and carers who had attended the NLP classes were unanimously positive about their experiences and described the ways in which they had been helped to develop coping strategies in extremely moving terms. It struck me afterwards that it might be valuable for such patients to talk to clinicians about NLP.
Click here to read the full Research Report on the Living With Cancer Project