An audit of 12 cases of long COVID following the lightning process intervention examining benefits and harms, 2025, Arroll et al

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https://journals.lww.com/jfmpc/full..._12_cases_of_long_covid_following_the.42.aspx

Case Series
An audit of 12 cases of long COVID following the lightning process intervention examining benefits and harms

Arroll, Bruce1; Moir, Fiona1; Jenkins, Eloise1; Menkes, David Benjamin2

Author Information
1Department of General Practice and Primary Health Care, University of Auckland, New Zealand

2Department of Psychological Medicine, University of Auckland, New Zealand

Address for correspondence: Prof. Bruce Arroll, Department of General Practice and Primary Health Care, University of Auckland, Private Bag, 92019, Auckland 1142, New Zealand. E-mail: bruce.arroll@auckland.ac.nz

Journal of Family Medicine and Primary Care 14(2):p 796-799, February 2025. | DOI: 10.4103/jfmpc.jfmpc_1049_24
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Abstract

To audit the outcomes of patients with long COVID after the lightning process intervention. Retrospective cross-sectional audit.

Patients with long COVID were interviewed through telephone regarding their experience and response to the lightning process.

Physical, emotional, and overall quality of life; perceived harms of the intervention.

None of the 12 participants reported harm from the intervention.

11/12 participants reported being 85% back to normal or more; 8/12 described achieving 85% or greater satisfaction with their emotional, physical, and overall quality of life.

10/12 of the participants reported having heard negative comments about the lightning process but had nonetheless gone ahead with the treatment.

This 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. Randomized, controlled trials are indicated.
 
«The NICE guidelines in the UK questioned the safety of the LP[4] despite a high-quality RCT from the Bristol Clinical Trial Unit showing benefit in adolescents with chronic fatigue.[5] The Bristol study reported no harm from the intervention, yet NICE controversially downgraded its evidence rating due to the report stating no harm. Instead, they quoted a qualitative study of 9 adolescents and 3 parents.[6] The results from the qualitative study were very optimistic about the LP other than two complaints about therapist approaches. CFS experts have challenged the NICE guidelines.[7]

We aimed to conduct an independent, university-based audit on the first long COVID patients treated by the only full-time LP practitioner in New Zealand, considering both reported benefits and harms.»

Yeah, right..
 
This is a 2023 guide for ME/CFS by Bruce Arroll:
Symptom-specific treatments
The specific treatments that can help include:
  1. Cognitive Behavioural Therapy (CBT).
  2. Graded exercise
  3. Lightning Process (for children 12 to 18). There is encouraging evidence from a small RCT in children.4 It has also been used successfully in young adults but has not been studied in RCTs in older age groups.
Activity pacing, where participants are not asked to increase activity beyond their current perceived energy envelope, has not been shown to be effective for fatigue reduction in large trials and systematic reviews.1,3 Part of the problem may be that pacing has been very variably defined: in the large PACE trial, 3 which was negative, participants were asked to limit their exercise to 70% of their perceived energy envelope; other trials that suggest there may be benefit have used higher figures and/or included co-interventions.1 With the above caveats about how to define pacing, there is limited trial evidence that pacing may increase physical functioning and reduce depression and anxiety.1

Graded exercise on the other hand, where patients are encouraged to increase their activity beyond current functioning, has been much more clearly shown to be effective for both fatigue and physical functioning,1,3 and CBT also has a solid evidence base.

Post-exercise malaise; This is the most feared symptom of many patients with CFS/ME. There was reduced post-exercise malaise in the CBT and GE groups in the PACE trial.3 The fact that CBT can help does not imply that the condition has a psychological cause.
 
Had a very brief look. Retrospective self-report, tiny cohort (n=12), no control group. Non-validated instruments? - no discussion of how they were developed or tested. Participants recruited via an LP practitioner who clearly has a financial interest in the outcome & participants paid to undergo the process.

The authors conclude that "primary care clinicians can refer patients for treatment with a high chance of benefit without fear of harm" which is a very strong statement for a tiny uncontrolled case series & suggests to me they have a pre-existing bias in favour of the intervention.
 
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Of 20 patients completing the LP, 12 (60%) were contactable
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Very misleading not including in the abstract that 40% of participants did not followup. Seems plausible that these are the ones that are not better.

Five were self-diagnosed; all had fatigue; 11/12 had tried pacing, 8/12 graded exercise [Table 2], 10/12 (80%) reported receiving discouraging and/or critical comments about the LP before doing it. No harm was reported, and all patients found the LP intervention helpful [Table 3].
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No mention of PEM in patient symptoms. Less likely to be harm in people without PEM.

The participants paid $NZ1595 (Euro 909) for the LP course, which took 3 half days to complete. This cost makes access difficult for some people, but it can be a small price to pay versus losing months or years from work.
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Reads like an advertisement.

time elapsed since completing the LP was a median of 8.5 months with a range of 2 to 12 months.
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And duration of long COVID symptoms before starting lightning protocol was median 9.5 months. Would be good to know what proportion recover between 9.5 months and 18 (9.5+8.5) months after onset.
 
@Nightsong they tried to contact 20, only 12 responded.

Of 20 patients completing the LP, 12 (60%) were contactable; all agreed to be interviewed and the time elapsed since completing the LP was a median of 8.5 months with a range of 2 to 12 months. The average age was 49.5 years, and all were of European ethnicity and all but one was female [Table 1]. Five were self-diagnosed; all had fatigue; 11/12 had tried pacing, 8/12 graded exercise [Table 2], 10/12 (80%) reported receiving discouraging and/or critical comments about the LP before doing it. No harm was reported, and all patients found the LP intervention helpful [Table 3].

To ascertain possible harms, we asked: “Did you experience any harm while doing the LP?
 
forestglip said:
Would be good to know what proportion recover between 9.5 months and 18 (9.5+8.5) months after onset.
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First result on google for ‘long covid recovery rate’: https://www.cidrap.umn.edu/covid-19/9-10-long-covid-patients-study-report-slow-recovery-over-2-years

Over 90% of adult long-COVID patients in France gradually recovered over 2 years, while 5% improved rapidly, and 4% reported persistent symptoms, finds a study published late last week in the International Journal of Infectious Diseases.
 
Nightsong said:
Huh. Because this reads to me more as an observational case series than an audit of clinical practice.
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Promotional case series would be more accurate. This actually reads like an advertisement written by the LP company. It especially has very strong assertions that are not supported by anything but wishes, and passed peer review. Basically, it has become worthless for something to be published in peer-reviewed journals if junk like this passes. It's the equivalent of being on the winning podium at a sports competition, along with the king's cousin, who just showed up in an outfit and got photographed appearing to finish second.

It would be extremely dishonest of any researcher to present this information without making it very clear that reporting positive benefits is literally what the LP is. Even if the 60% response rate were ignored, and it obviously should not be considering that it consists entirely of expressing being recovered, this is a completely absurd level of bias. And that's besides all the other layers of bias involved. The level of bias amounting to fraud here is on the same level as, say, tobacco companies manufacturing fake research disputing the harm of their product. It's basically self-sycophancy, these people invented hot air technology to lick their own asses.

And of course there is zero mention of any of this. This level of bias and misrepresentation is fraudulent in almost every other context in which something similar is done. As in people would actually face investigations for fraud.

Literally zero difference between 'detoxifying' and other junk alternative medicine:
There are two schools of thought around this, as it is seen as an error in the brain that predicts the natural history of the symptom. One is the Bayesian Predictive model for perception[13] and Embodied Predictive Interoceptive Condition.[14] This explains the effectiveness of CBT.
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Speculative ghosts in the machine. Ghosts of dead aliens chased away by a galactic overlord and thrown into volcanoes.
 
I'm thinking of leaving a comment for this study on PubPeer. Any feedback on what I've drafted?

The abstract, discussion, and conclusion do not mention that almost half of the patients (8/20) who did the lightning process (LP) did not participate in this study's survey. It is plausible that those who did not improve would be less likely to want to participate in a followup.

5 of the 12 followed up patients fully recovered, while 11/12 "reported being back to 85% of normal". These participants had had symptoms for a median of 9.5 months before starting the LP, and were followed up 8.5 months after the LP (which took 3 half days to complete). These results are not surprising considering natural improvement is common within the first few years of long COVID.

In a study which followed 2197 long COVID patients up to two years after symptom onset [1], only 4% of participants had symptoms which did not show signs of improving. ~6.4% of participants fully recovered. Considering the small sample size in Arroll et al, the high dropout rate, and the potential selection bias of those most likely to improve doing the therapy, it is plausible that the observed improvement and recovery in this study is due to natural improvement.

[1] Servier, C., Porcher, R., Pane, I., Ravaud, P., & Tran, V. T. (2023). Trajectories of the evolution of post-COVID-19 condition, up to two years after symptoms onset. _International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases_, _133_, 67–74. https://doi.org/10.1016/j.ijid.2023.05.007
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Edit: Fixed some numbers.
 
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Dropout and spontaneous recovery rates are relevant, but the much bigger problem with this "audit" is that self-reports of improvement due to LP can't be taken at face value, because LP teaches participants to misreport. Self-reports would have to be checked against objective outcomes, and this "audit" doesn't include any.
 
forestglip said:
I'm thinking of leaving a comment for this study on PubPeer. Any feedback on what I've drafted?
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Thanks for leaving some critical feedback on this!

I'd avoid saying, '5 of the 11 followed up patients fully recovered' because we don't know that they did - only that the authors say that the participants say that they did, which is two removes from actual fact.

I don't know if you can reference what I gather is the Lightning Process's instruction to participants to say that they've recovered or hugely improved even if they haven't.

I couldn't tell, from a quick glimpse at the study, whether the practitioner put every single participant they'd ever had forward for 'audit' or whether they'd have been free to select the ones who'd had the best outcomes.
 
The other aspect of this (which I don't think is discussed in the paper) is that LP quacktitioners themselves are apparently sometimes selective about which clients they take on - I think we've encountered stories where they only accept patients who have a psychological view of their illness or insist that patients be in some way minded to accept their intervention. I wonder how many patients were excluded from undergoing the LP because of these factors? And the other salient phrase is "completing treatment" - how many dropped out of the "treatment"?
 
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