Neurolinguistic programming: Old wine in new glass

What if, irrespective of age or gender, there is a way to rewire your neurons and reprogram your brain to lead a successful life? The possibility sounds good enough to raise the curiosity of the public. Neurolinguistic programming (NLP) or neurolinguistic programming therapy (NLPt) has made such promises recently, with questionable evidence. NLP is a field of psychology and communication that focuses on the relationship between neurological processes, language, and behavioral patterns.[1] It was developed in the 1970s by Richard Bandler and John Grinder by studying counsellors renowned for their ability to communicate with influence, bringing significant change to their patients.[2] It uses basic principles of communication techniques to bring change in thinking and behavior. It is an emerging technology used in clinical, business, and other managerial fields primarily to influence people. Aggressive marketing was used to make it popular initially in Europe, and it is now spreading to other countries. While many practitioners have found value in its practical applications for personal development, communication, and therapy for various psychiatric disorders, many have challenged its uses. Given this, it is crucial to delve into a more comprehensive examination of the topic. DEFINITION There is no universally agreed-upon definition of NLP. Various definitions within the field share a set of core principles that suggests that our subjective experiences are rooted in our neurological processes. These include how we perceive and interpret information from the external world, create mental representations, and generate emotions. Individuals tend to favor a specific sensory modality in their internal representations of the world. This dominant modality, known as the Preferred Representational System (PRS), is often discernible through behavioral patterns and language.[1] NLP involves observing and analyzing individuals’ behaviors and thought patterns to change outward emotional responses. At the core of NLP lies the hypothesis that communication becomes more effective when it aligns with the PRS of the recipient. NLP practitioners leverage an individual’s PRS as a foundation to build rapport, facilitate modeling, elicit well-defined goals, and employ anchoring or conditioning techniques.[1] PRINCIPLE NLP techniques include framing (the initial way in which a situation is presented) and reframing (changing viewpoint of the situation), anchoring (creating a link between a specific stimulus and emotional state), creating new behaviors, breaking apart or finding similarities, revising values, belief control, faith chaining (linking positive beliefs or experiences), and breaking negative anchors.[3] The maximum body of evidence of NLP comes from research in patients with anxiety disorders.[4] Hence, let us understand the technique of NLP, taking an example of phobia. In phobia, the development of fear exemplifies the rapid acquisition of Pavlovian classical conditioning, resulting in a consistent reaction learned after a single instance. When an individual is exposed to a stimulus concurrently linked to fear, a potent association is formed between the two events. Subsequently, even the mere thought of this stimulus can trigger a fear response. In the context of NLP, this process can be understood as anchoring, where a stimulus capable of triggering a physiological response is termed an anchor. These anchors can be of any sensory modality. The collapsing of this anchor is established by stimulating contrasting anchors simultaneously. First, a positive state is elicited and anchored (e.g., candlelight dinner), often through touch. Then, the negative state is recalled (e.g., fear of darkness) and anchored in a similar manner. The individual is then asked to recall each state in turn, with the corresponding anchor applied. Finally, both anchors are triggered simultaneously, with the negative anchor being removed before the positive one. After this process, when asked to imagine the negative situation, an individual could do so without manifesting negative physiological responses.[4] It seems simple to comprehend yet challenging to execute, with unclear methods of implementation and indications. Hence, we took a closer look at the existing literature. EVIDENCE Sturt et al.[1] (2012), in response to the National Health Service audit, conducted a systematic review to find the evidence base for NLP. The review included ten studies, of which five were randomized controlled trials (RCTs) and five were pre-post studies. The authors concluded that there is insufficient evidence to recommend NLP for any health condition outside research purposes. Another group of NLP practitioners conducted a meta-analysis including 12 prospective studies on NLPt. They included both peer-reviewed and non-peer-reviewed publications and found that NLPt may add an overall standardized mean difference of 0.54 with a confidence interval of 0.20–0.88. Significant heterogeneity was noted in the included studies in terms of health condition, population, outcome measures, number of sessions, and type of technique used.[5] To our knowledge, no systematic review has been conducted using Cochrane methods. NLP as a psycho-therapeutic modality has been used in anxiety disorders, morning sickness, depression, allergic reactions, and weight management.[3,4,6,7] But, at the same time, experts have refuted its claims due to lack of evidence.[8] It is evident from the fact that none of the psychology textbooks, to the authors’ knowledge, mention NLP. This leads to the question of its scientific worth. The basic principles of NLP share commonalities with Cognitive Behavioural Therapy and Acceptance and Commitment Therapy. The strength of evidence would be established if RCTs with such well-established forms of therapies as comparison groups were conducted. There is a loophole in the method of implementation. Studies claiming support to NLPt do not clarify whether PRS varies across situations. Only one study has mentioned that matching the PRS brings beneficial effects.[9] On the contrary, Heap (1988) scrutinized 63 studies and suggested that the hypothesis of identifying PRS through careful observation of eye movements and behaviors was not well substantiated.[10] Heap added that the inability of researchers to convincingly demonstrate the purported advantages of predicate matching (aligning with the person’s “predicates” or sensory-based words used during communication) cast doubt on the efficacy of such procedures in therapy.[10] There is no reliably demonstrated method for assessing individuals’ PRS. Considerable money is being spent on NLP-related activities, primarily in the United Kingdom.[1] NLP organizations primarily target medical and healthcare practitioners, especially psychology students, imparting training by organizing seminars, lecture series, and workshops.[11,12] Both online and offline courses of this nature are gradually gaining popularity in other countries such as USA, Canada, Australia, and India.[1,13,14] Despite these courses being available worldwide, it has yet to find its place in psychology curricula.[9] CONCLUSION NLP is a significant industry, enticing individuals with promises of remarkable transformations, personal development, and therapeutic benefits. The heterogeneity in definition, training period, requirements, and intervention techniques in the form of the number of sessions and hours of each session limits the applicability. Existing evidence on various psychiatric disorders should be taken with a pinch of salt, given these limitations. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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