Asthma and Allergy Management A Qualitative Research Study by Hanne Lund

by Hanne Lund, NLP Master Practitioner

A. Bandura says: “People’s expectations influence how they behave–and the outcomes of their behavior change their expectations.”

This is a description of a one year multi-center study of integrated education of 46 patients suffering from asthma. The study was run by general practitioner Jorgen Lund and of the government and several private foundations. The design of the study was approved by the “Commitee of Etic Science” and the results were statistically worked out by help of the University of Copenhagen, i.e., that statistics are in accordance to principles of proper medical research. Eight doctors from general practices carried out the medical work, and I worked with the patients in the intervention group as a NLP Master Practitioner.

The research started in May 1993 and ended in May 1994. The results were presented first at the yearly congress of “Danish Society of Allergology” in August ’94, then at the congress of “European Respiratory Society” in Nice, France, October ’94, then at the yearly congress of “Danish Society of General Medicine” and at a NLP Health Certification Training Seminar, October ’94.

The patients were divided into 2 groups, 30 in an intervention group and 16 in a control group. Both groups got the same medical education at the doctors, i.e. self-monitoring of lung-function, self-adjusting of medication, agenda they could use in case of worsening etc. The intervention group received in addition to the above-mentioned NLP therapy.

Complete articles about the results including the statistics are sent to British Medical Journal for publication.

Method

Let’s concentrate this article about the patients in the intervention group. They were selected from eight general practices and were not at all motivated for psychotherapeutical treatment, only 1 had heard of NLP. They all joined a one-day intro-seminar together with their family doctors, where they were educated in “self-management of asthma,” the NLP communication model, emotions, negative and limiting beliefs and their influence of health, “psychoneuroimmunological relationsä. Some of the patients realized by then the importance of the psychological factors, some focused mainly on the conventional medical model (monitoring of lung function and agenda), some were terrified by the mere thought of psychotherapy.

Halfway during the project they had a 1/2 day seminar to discuss the preliminary results and adjust the further education.

As already mentioned, it was a difficult group to work with because of their low motivation not so much to get well as to understand the influence of the psychological factors on their health. They were -of course -treated as individual persons with individual needs. Generally we focused very little upon their asthma, but talked a lot about their daily life, what was functioning well for them, and what was not.

They became much aware of their own emotional relations and behavioral patterns. They realized how they motivated themselves, limited themselves, and which negative or limiting beliefs they had, what was valuable for them, how stress influenced their symptoms, how much negative expectations provoked negative reactions and so on.

An understanding of these relationships led to the work of establishing new ways of reflecting, redetecting resources, changing attitudes to emotions and through that heading against a change of behavior.

When the changed behaviors led to positive results the patients provided the background of personal “triumphs” which again created new knowledge, new behavior etc.

Generally spoken we worked with emotions like anger, sadness, fear, hurt and guilt. Negative and/or limiting beliefs, as for example: do not deserve; not good enough; worthlessness; can only reach the point “x”; other people can do better than I. Traumas and phobias (all their allergies were treated as phobias). Lots of the patients started their symptoms shortly after a traumatic event.

As tools have been used all the well known NLP-tools such as TIME LINE THERAPY to deal with the emotions, REIMPRINTING to deal with negative/limiting beliefs, REFRAMING to help them look at the bright sight of life, MENTOR-WORK and NEUROLOCICAL LEVELS to strengthen their resources, detecting of METAPROGRAMs and METAMODELs, SUB MODALITIES to realize how they limit themselves, SLIGHT OF MOUTH, THE COUNTER EXAMPLE PROCESS for the allergic responses.

Dealing with emotions, it was characteristic that ANGER was a feeling most of them denied. The denial was nevertheless more an example of their anti-aggressive attitude.
Generally spoken: a lack of power to say no and express their own needs – consequently a camouflaged anger not to be able to act -a sense of powerlessness. The anger was so to speak often addressed to themselves.

The anger goes close together with another emotion: SADNESS, the feeling of which is closely connected to low self-esteem, and again to the inability to say no.

FEAR is a part of most asthmatics daily life. Fear of allergic reactions, of worsening of symptoms of dying, of the future, of bad financial circumstances. Fear of new, unknown environments. Fear of not being accepted. And: fear because they know they were not able to set up boundaries or express own wishes and needs. So they turned over the power to other ones which often led to immediate response from their asthma.

SECURITY is one of the keywords in an asthmatics life. And it was characteristic that what helped the individual patients to get better was partly a better understanding of their illness and a better self-monitoring, and partly the feeling of being understood. The security is determined for the patients’ possibility to find other mastery strategies for emotional strain.

HURT -this feeling was well known to -most of them cried out easily. The behavior of associates was often experienced as personal attacks or rejections. Asthmatics are often in need of special care, and if this need is not fulfilled, they interpret it as lack of respect.

GUlLT does often go with asthma. Guilt as for example a feeling of not being able to fill in one’s role as a spouse, mother, father, friend or at work. They are inclined to take responsibility when anything goes wrong or is impossible.

The patients’ negative/limiting beliefs were frequently founded in early childhood where they developed a reaction-pattern that has grown permanent and will function as a conditioned reflex. This or those conditioned reflexes prevent the patient from obtaining what he really wants. During the therapy you could often find the warning voice of the father or mother as releasing the patient’s reaction. The insight in these relations has been very important and a condition of the further work in finding the resources of the patient to change his behavior and find other and more appropriate coping strategies.

Most of the patients had a lot of negative experiences related to their illness. Earlier, severe asthma-attacks, places they did not support to stay at, allergens to which they used to react, times of the year where the asthma got worse, asthma caused by effort. The bare thought of ãI do hope, I will not get my asthma” is enough to release the symptoms. That is why it has been part of the therapy to make the patients define what they want to obtain instead of what they don’t want It is characteristic that patients often define what they want to avoid, get rid of instead of what they want.

Is there a general character sketch?

It seems as if there are several traits that have been characteristic for the main part of this intervention group.

* Low self-confidence.

* Lack of ability to express feelings. Anti-aggressiveness.

* Difficulty to set up boundaries.

* Despect of one self as an individual.

* Insecurity, let other persons take responsibility for them.

* Sensitiveness, i.e. to shift of “atmosphere” in the surroundings.

* Powerlessness.

Most of the patients experienced worsening in symptoms in connection to different sorts of stress widely spoken. If they act inconsistently to what is valuable to themselves öand they often do according to their characteristics -the symptoms will worsen. So they became aware of the symptoms as a stress marker, a signal from the body. They became capable to medicate themselves properly in case of worsening of their symptoms and at the same time very much aware of underlying emotional causes, negative expectations and limiting beliefs. They became so to speak able to communicate with their symptoms.

The NLP part ended with an interview according to a questionnaire made at the NLP Health Certification Training with Suzi Smith- Tim Hallbom and Robert Dilts and at the question “HOW DID THE THERAPY HELP YOU” the answers were: “I got quite a new life;” “More open;” “Colossal strength and self-confidence;” to mention a few of the answers. One person did not think that the therapy had helped him “but it has provoked thoughts and I have learned to see things from another angle.”

Several of the patients started new jobs, new relationships, new education (2 of them NLP training) during this year. The time used at NLP therapy was averagely 13 hours (3- 36).

Results:

Of the 30 patients in the intervention group 26 completed the investigation. All 16 in the control group completed the research.

A lot of different data were recorded, but I will mention only a few of the most remarkable results.

The stability of the lung function is measured by so-called peak-flow meter, and the results of this measurement expresses the resistance of the airways.

At the start of the study all patients showed daily variations of their peak-flow at about 30-40%.

All patients in both group obtained more stable lung function, but the study showed remarkable differences as follows:

At the end of the study the daily variations in the control group decreased to 25% -but in the intervention group the variation fell down to below 10%, which is absolutely statistically significant.

We expect that the lung capacity of adult asthmatics decrease about 5d ml pr year. In the control group we actually found this decrease, but in the intervention group the study showed an increase of about 200 ml.

No patients died during the study. The rate of hospital admission was reduced remarkably in the intervention group, and so was the number of episodes of acute severe asthma.

This is found in accordance to the stable lungfunction obtained and to the fact that the consumption of acute as-needed medication was reduced in the intervention group to near ZERO.

Another result of the stable lung function was that the rate of sleep disorders in the intervention group was reduced from 50% to ZERO, while the reduction in the control group was noticed from 70% to 30%.

Conclusion

According to internationally confirmed guidelines, stable lung function is considered most valuable to obtain “good asthma control.” In this study this goal was obtained in both groups, but the additional psychological education of the intervention group led to extremely good results.

It is therefore concluded that the integration of medical and psychological treatment is extremely valuable.

It was interesting to realize that the patients goals very often headed against a level which I considered rather low compared to what I expected them to be able to obtain.

This study has dealt with asthmatics, but we consider the principles of this integrated work valuable in treatment of patients with any disease, and the next step will be to train medical staffs to this model. You are welcome to contact us for further information about seminars, lectures etc.

Hanne Lund, NLP Kreativ Kommunikation©, Bredgade 11, DK 7400 Herning, Denmark, Phone (+45) 97215624, Fax (+45) 97223681

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