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Research into NLP

Here we'd like to add current research and news on the development and application of NLP in healthcare. If you have anything you would like to share, please send it through. In addition to this research there have been articles in local/national press and hospital papers -----------------------------------------

Does NLP improve outcomes in patients with Type 2 Diabetes Mellitus – A case-crossover study

Dr CJ Beyer

Dovecot Health Centre, L14 0NL, United Kingdom

Background:

Patient concordance with doctors’ recommendation is poor. Diabetes education has been accepted in diabetes care but the effect of diabetes education on glycaemic control and the components of education responsible for such an effect are uncertain.

The Oxford English Dictionary defines Neuro-linguistic programming (NLP) as “a model of interpersonal communication chiefly concerned with the relationship between successful patterns of behaviour and the subjective experiences (esp. Patterns of thought) underlying them” and “a system of alternative therapy based on this which seeks to educate people in self-awareness and effective communication, and to change their patterns of mental and emotional behaviour”.

UKPDS 35 has shown that each reduction in HbA1c by one percent point reduces the risk of death related to diabetes by 21%.

We hypothesised that using NLP during consultations will make clinicians more effective at convincing patients to make lifestyle changes and adhere to treatment which should be reflected in changes of the glycosylated haemoglobin (HbA1c).

Objective: To evaluate whether a two day course in NLP for health care professional improves outcomes in patients with Type 2 Diabetes Mellitus

Design: Case-crossover study

Setting: General Practice in a deprived inner city area in the United Kingdom

Patients: 94 patients with Type 2 Diabetes Mellitus

Measurements:

Comparison of the average change of the HbA1c within the year before and the year after a course in NLP lasting two full days one month apart.

Results:

The mean difference of the HbA1c within twelve months before NLP was -0.006 (95% confidence interval -0.068 to 0.081), the mean difference of HbA1c within twelve months after NLP was -0.28 (95% confidence interval -0.35 to -0.21, N=93).

Conclusions:

NLP may lead to a clinically and statistically significant improvement of the HbA1c. It is likely that the improvement is due to NLP because all patients have been reviewed by the same practice nurse before and after she attended the NLP course and no changes in treatment algorithms have been made, although it is very difficult to know whether our practice nurse has always used NLP during her consultations. As the patients have been their own controls, the study design controls for characteristics of patients that may affect concordance with treatment which do not change over a period of time.

Abbreviations: NLP – Neuro Linguistic Programming, HbA1c – glycosylated Haemoglobin

Background:

It is well known that patient concordance with doctors’ recommendation is poor. Diabetes education has largely been accepted in diabetes care but the effect of diabetes education on glycaemic control and the components of education responsible for such and effect are uncertain.

The Oxford English Dictionary defines Neuro-linguistic programming (NLP) as “a model of interpersonal communication chiefly concerned with the relationship between successful patterns of behaviour and the subjective experiences (esp. Patterns of thought) underlying them” and “a system of alternative therapy based on this which seeks to educate people in self-awareness and effective communication, and to change their patterns of mental and emotional behaviour”.[1]

UKPDS 35 has shown that each reduction in HbA1c by one percent point reduces the risk of death related to diabetes by 21%.[2]

We hypothesised that using NLP during consultations will make clinicians more effective at convincing patients to make lifestyle changes and adhere to treatment which should be reflected in changes of the glycosylated haemoglobin (HbA1c).

Our objective was to evaluate whether a two day course in NLP improves outcomes in patients with Type 2 Diabetes Mellitus.

Setting:

This case-crossover study has been performed in a two partner practice in Liverpool in an area with a generally more deprived and poorer health status. The practice provides General Medical Services for approximately 3800 patients. Population age breakdowns and birth rates are similar to the Liverpool average. The main causes of death are ischaemic heart disease and cancers.

Methods:

The author conducted a case-crossover study. The design of case-crossover studies has been shown to apply best if the exposure is intermittent (disease reviews by health care professionals trained in NLP), the effect on risk is immediate and transient, and the outcome is abrupt (intermittent measurements of HbA1c as a proxy for risk reduction).[3]

Both General Practitioners and the Practice Nurse performing the annual diabetes reviews and follow-up of most patients with type 2 diabetes mellitus participated in a course in NLP on two full days one month apart (October and November 2007). The instructor is a Master Trainer in NLP.

The author compared the mean difference between the last HbA1c value and the first HbA1c value within a year before the NLP course (HbA1c2-HbA1c1 (Illustration 1)) and the mean difference of the last value within one year after and the last value before the NLP course on the same patient population (HbA1c3-HbA1c2 (Illustration 1)). As the patients have been their own controls, the study design controls for characteristics of patients that may affect concordance with treatment which do not change over a period of time.

Additionally, age and gender distribution and number of patients with at least two HbA1c recordings in the year before the NLP training and at least one recording in the following year as well the mean, 95% confidence intervals, median and mode of the first HbA1c one year before and the last just before NLP have been calculated.

Results:

Table 1 shows mean, median, mode and 95% confidence intervals of the HbA1c one year before NLP as well as the number of patients (N) with complete (93), incomplete (46) or without (27) recordings of HbA1c before and after NLP.

HbA1c one year before NLP Mean Median Mode 95%  Confidence interval N
With complete recordings of HbA1c before and after NLP 7.0 3.8 6.9 6.6 – 7.6 93
No recording of HbA1c after NLP 6.5 6.3 6.3 5.9 – 7.2 46
No recording of HbA1c before NLP - - - - 27
Total 6.9 6.6 6.3 6.5 – 7.3 139 excluding 27 patients without recordings of their HbA1c one year before NLP

Table 1: HbA1c one year before NLP

 

Of the 166 patients on our Diabetes Register, 93 had at least two HbA1c recordings in the year before the NLP training and at least one recording in the following year. The average HbA1c in patients with complete recording s before and after NLP has been slightly higher than the average HbA1c were incomplete. Although it is conceivable that patients, whose diabetes is well controlled are not followed up as often as those whose diabetes is not well controlled, 95% confidence intervals show that this difference is not statistically significant.

Forty-six patients were male and 47 patients female aged 40 to 89 years (mean = 67 years, median = 70 years, mode = 74 years).

 

The mean difference of HbA1c within twelve months before NLP was -0.006 (95% confidence interval -0.068 to 0.081), the mean difference of HbA1c within twelve months after NLP was       -0.28 (95% confidence interval -0.35 to -0.21, N=93)

Discussion:

Diabetes education has largely been accepted in diabetes care but the effect of diabetes education on glycaemic control and the components of education responsible for such an effect are uncertain. A meta-regression analysis on 28 educational interventions (n=2439) revealed that face-to-face delivery, cognitive reframing teaching method and exercise content collectively explained 44% of the variance in glycaemic control – the net glycaemic change being 0.32% lower in the intervention group than in the control group.[4] This is in keeping with the findings with our patients.

Norris et al. observed in their meta-analysis of 31 trials that self-management education on adults with type 2 diabetes improves glycosylated haemoglobin levels at immediate follow-up by 0.76% (95% CI 0.34 to 1.18) more than the control group, declines by 0.26% (95% CI – 0.73% decrease to 0.21% increase) one to three months after intervention and by 0.26% (95% CI 0.05% to 0.48%) at more than three months. The authors conclude that learned behaviours change over time.[5]

Mean and 95% confidence intervals of the HbA1c one year before NLP of patients with and without complete recordings of HbA1c support the assumption that patients with well controlled diabetes are followed up less often than patients with poorly controlled disease. Selection bias however is unlikely as the 95% confidence intervals of the two groups of patients overlap.

Similar to Norris et al. and Ellis et al. the author observed a mean change of -0.21 to -0.35 percent points. This change is certainly clinically significant as it would lead to a reduction in risk for deaths related to diabetes of four to seven percent. The 95% confidence intervals of the mean difference of the HbA1c before and after NLP suggest that the improvement after NLP is also statistically significant.

Cost analysis indicates that where costs associated with patient education were in the region of £500-600 (€570 -683, US$813 – 975) per patient, benefits over time would have to be very modest to offer an attractive cost-effectiveness profile. [6]

The cost for the NLP trainer for fifteen delegates for 2 full days was around £2000 (€2270, US$3245) and is therefore likely to be cost effective.

NLP may lead to a clinically and statistically significant improvement of the HbA1c. It is likely that the improvement is due to NLP because all patients have been reviewed by the same practice nurse before and after she attended the NLP course and no changes in treatment algorithm have been made, although it is very difficult to know whether our practice nurse has always used NLP during her consultations.

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Gray, R. M. (In Press). NLP and PTSD: The Visual-Kinesthetic Dissociation
Protocol. Current Research in NLP: Proceedings of 2010 Conference.
Gray, R. M. (2011). Pseudo Orientations in Time. Acuity, (2), 1, April 2011,
12-26.
Gray, R. M. & Liotta, Richard F. (In Press). PTSD: Extinction,
Reconsolidation and the Visual-Kinesthetic Dissociation Protocol.
Traumatology.
Gray, R. M. (2010). NLP Patterns and Principles. Acuity, (1), 1, November
2010, 6-16.
Gray, R. M. (2010). The Brooklyn Program: Applying NLP to Addictions.
Current Research in NLP: Proceedings of 2008 Conference, 1(1), 88-98. .
Gray, R. M. (2002). "The Brooklyn Program: Innovative Approaches to
Substance Abuse Treatment." Federal Probation Quarterly, 66(3), December
2002.
Gray, R. M. (2001). "Addictions and the Self: A Self-Enhancement Model for
Drug Treatment in the Criminal Justice System." Journal of Social Work
Practice in the Addictions, 1(2).

This one is not from a Journal but it provides significant scientific
support for some of the submodality distinctions.

Gray, R. M. (2008). NLP and Levels of Motivation. Suppose, the Official

CANLP/ACPNL Bilingual Newsletter. Fall 2008, pp. 20-24.

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Attention deficit hyperactivity disorder: A clinical interventive approach with case vignettes.
Author(s): Chavis, Michael H
Citation: Dissertation Abstracts International Section A: Humanities and Social Sciences, 2008, vol./is. 69/3-A(1155), 0419-4209 (2008)
Publication Date: 2008
Abstract: This historical phenomenological and clinically practical dissertation uses an integrated psychotherapeutic approach to explore the individual and interpersonal psychological dynamics of Attention Deficit Hyperactivity Disorder in its socio-cultural context. In particular, it explores the use of psychodynamic strategic-solution focused therapy and Neuro-linguistic programming (NLP) to foster client movement toward well-formed outcomes. This study first surveys the history of ADHD in the United States, from 1950 to 1980 and it explores the connections between socio-cultural thinking and the medicalization of ADHD. The relationship between ADHD and PTSD (Complex ADHD) is investigated and the integrated psychological mechanisms of this relationship are described. The insight developed is used to design and implement psychotherapeutic interventions. When individual and interpersonal issues are addressed concurrently powerful unconscious forces are triggered as the remembered places of the individual psyche intersect with the energy of here and now interpersonal activity. It is important to acknowledge the usefulness of medications; however, the non-pharmacologic humanistic method presented offers a useful model for individual, social, and academic health. Using the voices several children and adolescents, this dissertation presents several ADHD type narratives that confront and counter the notion that ADHD generally represents a state of cultural and academic abnormality. This study offers a contemporary alternative to the use of medications with some children and supports a humanistic ways of treating children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Source: PsycINFO
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Title: Neuro-linguistic programming and application in treatment of phobias.
Citation: Complementary Therapies in Clinical Practice, Nov 2010, vol./is. 16/4(203-7), 1744-3881;1873-6947 (2010 Nov)
Author(s):Karunaratne M
Abstract: Phobias are a prevalent and often debilitating mental health problem all over the world. This article aims to explore what is known about the use of Neuro-linguistic Programming (NLP) as a treatment for this condition. Whilst there is abundant experiential evidence from NLP practitioners attesting to the efficacy of this method as a treatment for phobias, experimental research in this area is somewhat limited. This paper reviews evidence available in literature produced in the UK and US and reveals that NLP is a successful treatment for phobias as well as being particularly efficient due to the relatively brief time period it takes to effect an improvement. Copyright [copyright sign] 2010 Elsevier Ltd. All rights reserved.
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Title: Closing the gap between NLP research and clinical practice.Citation:Methods of Information in Medicine, 2010, vol./is. 49/4(317-9), 0026-1270;0026-1270 (2010)
Author(s): Chapman WWLanguage:EnglishPublication type:Editorial,Introductory Journal Article
Source: MEDLINE
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Title: Neuro-linguistic programming as an innovation in education and teaching.
Citation: Innovations in Education and Teaching International, 08 2010, vol./is. 47/3(317-326), 1470-3297;1470-3300 (Aug 2010)Author(s):Tosey, Paul,Mathison, Jane
Abstract: Neuro-linguistic programming (NLP)--an emergent, contested approach to communication and personal development created in the 1970s--has become increasingly familiar in education and teaching. There is little academic work on NLP to date. This article offers an informed introduction to, and appraisal of, the field for educators. We review the origins of NLP, and summarise its nature as a method of, and conceptual framework for, education and teaching, with brief examples of applications. We argue that NLP offers an innovative praxis, underpinned in principle by Bateson's epistemological thinking, which informs a distinctive methodology known as 'modelling'. The credibility of the field relies, in our view, on its ability to address seven critical issues. These form a possible research agenda and a focus for dialogue between NLP practitioner and academic communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
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 NLP coaching.
Author(s): Grimley, Bruce
Citation: Handbook of coaching psychology: A guide for practitioners., 2008(193-210) (2008)
Publication Date: 2008
Abstract: (from the chapter) Neuro-linguistic programming (NLP) coaching is an atheoretical, pragmatic approach which shares a philosophy with constructivist, behaviourist and experiential psychology. It is unashamedly eclectic in its orientation drawing on many psychological approaches. The founders of NLP unlike Kurt Lewin would not say 'there is nothing so useful as a good theory'. They made no commitment to theory, regarding such as being more complex and not as useful. Instead they described NLP as a meta-discipline. As they studied the structure of subjective experience, their prime concern was a description of how somebody worked without needing to understand why they worked that way. NLP has been described as an attitude with a methodology that leaves behind it a trail of techniques. When one works as an NLP coach one adopts an approach which emphasises usefulness for the client rather than truthfulness for the coach. This chapter gives an overview of this approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

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The theoretical roots of NLP-based coaching.
Author(s): Linder-Pelz, Susie, Hall, L. Michael
Citation: The Coaching Psychologist, April 2007, vol./is. 3/1(12-17), 1748-1104 (Apr 2007)
Publication Date: April 2007
Abstract: NLP (Neuro-linguistic programming) is a communication model; it is about the internal representation of experience and how people communicate with themselves as well as others. In recent years NLP has informed much coaching practice (McDermott & Jago, 2001; Dilts, 2003; McLeod, 2004). Yet 'the relationship between NLP and academe has been tenuous and somewhat strained, influenced in part by the apparently atheoretical stance of the founders' (Tosey, Mathison & Michelli, 2005). This paper details the theoretical origins of the NLP model and its roots in established psychological theories. Our intent is to offer an informed view of NLP as well as to contribute to the development and validation of professional coaching practices that are grounded in established psychological theory and research.
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Title: Meta-coaching: A methodology grounded in psychological theory.
Citation: International Journal of Evidence Based Coaching and Mentoring, 02 2008, vol./is. 6/1(43-56), 1741-8305 (Feb 2008)
Author(s): Linder-Pelz, Susie,Hall, Michael
Abstract: In this conceptual article we suggest that understanding clients' self-reflexive processes enables coaches to become even more effective in helping clients make changes in how they think, feel and act. Our aim is also to throw light on the relationship between metacognition, change and coaching. We begin with an overview of theories of metacognition and then set out 10 principles of meta-level processing which, together with an understanding of NLP (neuro-linguistic programming), lead Hall to propose the Meta-States model of self-reflexivity (Hall 1995/2000). We then describe the Meta-States model and how it in turn led to the development of the Axes of Change model (Hall and Duval 2004). Following that we outline how the NLP, Meta-States and Axes of Change models underpin the Meta-coaching methodology and we illustrate with case studies. Finally we reflect on how the ideas presented here address issues raised in the coaching literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
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Title: Hypnosis for smoking cessation: An NLP and hypnotherapy practitioner's manual.
Citation: Hypnosis for smoking cessation: An NLP and hypnotherapy practitioner's manual., 2007 (2007)Author(s): Botsford, David
Abstract: This book examines the use of hypnosis for smoking cessation. The book provides the reader with an extensive overview of the whole process of helping someone to stop smoking. Not only is there great detail on how to approach the client during the actual therapeutic session but there is also excellent material which shows the therapist how s/he needs to prepare individually for every single client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)