Is the neurolinguistic programming intervention rapid phobia cure effective for fear of heights? A randomized controlled triala randomized controlled trial

Problem

Some UK GPs use Neurolinguistic Programming (NLP) therapies. The evidence base is limited and the therapies are controversial. The rapid phobia cure (RPC) is a popular NLP technique and phobias are common in primary care with thirteen percent of patients meeting diagnostic criteria. We wish to evaluate the effectiveness of RPC in a randomised controlled trial (RCT).

Approach

Fear of heights (acrophobia) was chosen as it is common and there are questionnaires to assess outcomes. Participants needed a score of >29 on the Heights Interpretation Questionnaire (HIQ), a questionnaire validated against actual height exposure, aged over 15 years and able to speak and understand English. The design was an RCT with concealed randomisation and blinded to other participants’ intervention. The intervention was a single “rapid phobia cure” session or a control group with a 15 minute meditation. The participants were a convenience sample of the public. The outcome was the proportion of participants with a score <26 on the HIQ at 8 weeks on an emailed questionnaire to maintain blinding. The interviewers had two hours of training and followed a script. The study was powered for 96 participants and 107 were recruited to cater for drop outs. The intervention requires the participants, in their imagination, to run a movie forward, in black and white, of a fearful experience and watch the movie from a seat in an imaginary movie theatre and then watch themselves watch the movie from the projection box (two orders of dissociation). They then turn the movie to colour, and run it in reverse in one second. They do this three times or more until the fear of heights is diminished.

Findings

98 (92%) returned their questionnaire and were included in the intention to treat analysis. The proportion of participants with an HIQ score < 26 was 34.6% (18/52) in the intervention group and 15.2% (7/46) in the control group RR=2.26, 95% CI (1.05, 4.95) and (p=0.028). The number needed to treat was six 95% CI (3 to 36). A reduction to a score of < 26 was associated with a very much improved fear of heights. The intervention takes less than 15 minutes in actual practice.

Consequences

This is the first RCT of the rapid phobia treatment in any setting. It is brief, easily learnt, safe, low cost and probably effective. This is the largest RCT of any treatment for acrophobia. The RPC is an exposure therapy akin to computerised virtual reality treatments which are effective but expensive to create. GPs may wish to continue using or to learn to use the RPC knowing there is now some high quality evidence on its effectiveness.