Research is very important to the Alexander Technique profession. We are always seeking to better understand the different ways that learning the Alexander Technique can benefit people, how it ‘works’ and how we can further develop the ways in which we teach it. Next time I’ll describe some of the research that has been done on the Alexander Technique but today I’d like to say something about how I have been involved in research.
I was privileged to be part of the core study team for the large, randomised, controlled trial called ATLAS, which demonstrated the long-term effectiveness of taking Alexander Technique lessons in reducing pain and disability for people living with chronic neck pain [1,2]. The trial was based at the University of York and involved more than 500 participants. This was almost a 10 year commitment for me, from first discussions with the principal investigator, participating in the design of the trial and funding applications, in setting up and running the study, and then all the way through to publishing the final paper.
I’m now involved in a study that is at the other end of the ‘research spectrum’ in terms of both size and aims. Together with colleagues in the STAT Research Group, we’ve begun a very small, exploratory study to investigate how we might capture some of the diversity of benefits that are often experienced by people learning the Alexander Technique. Rather than studying one specific area, for example pain or stress, we are wondering if there may be a way of producing a more holistic picture of what is happening when people incorporate the Alexander Technique into their daily lives?
In research related to health and wellbeing there are, broadly speaking, two general approaches, either measuring outcomes (for example, the degree of pain reduction), or taking a more open, process-oriented approach to see what unfolds. Outcomes-based research will be needed if you want to be able to demonstrate the effectiveness (or ineffectiveness) of an intervention. Whereas, for example, interview-based qualitative research can get at some of the nuances of what is going on and why.
In the field of healthcare, it’s becoming fairly common to combine both research approaches, in order to give a fuller picture than either alone can provide. We saw this in the ATLAS study, where the ‘numbers’ gave us the picture in terms of being able to show a statistically and clinically significant reduction in long-term pain and disability [1,2]; and this was complemented by the qualitive research in which study participant interviews illustrated how learning the technique enabled them to feel calmer and more in control of their condition [3].
So back to our current small pilot study. We are testing out a particular outcome measure to see how useful it might be in evaluating the effects of Alexander Technique lessons – can this research tool capture some of the psychological, as well as physical and other less tangible effects that we know from our own teaching practices are often experienced? It’s important to use a recognised outcome measure that has been properly validated. The reason we have chosen the one that we have is that it was developed to evaluate a broad range of physical, psychological and social factors. So, for example, it asks to what extent you feel able to take care of yourself, or feel connected with friends and family, as well as questions more directly related to health. Using this tool, we hope to track any changes that may happen from before Alexander lessons to during and after a course of lessons. We will also interview people to see what else we can learn about their experiences.
It’s early days yet. I’ve just started asking new clients whether they would be happy to participate in this small pilot study – but before doing this we needed to draw up an information sheet and consent form, so that people can make an informed decision on whether they want to take part. As with all research, participation is always completely optional, but I’m aware that simply by asking I’m placing an extra demand on people. So far, I’ve been relieved that I don’t think anyone has been annoyed to be invited, and I’ve been surprised to discover that many people are interested in taking part. Participating involves completing the online questionnaire (takes about 5 minutes) before the first lesson and at intervals thereafter. There is also an additional option of taking part in an interview with one of the research team about the experience of using the questionnaire and of the Alexander lessons.
I’ll report back once the study is complete. If the pilot is successful, we could perhaps use the outcome measure more widely in the profession to inform our teaching practice. In addition, what we learn could potentially feed in to designing a larger ‘service evaluation’ of Alexander teaching. A service evaluation does not give the same robust evidence that say a randomised, controlled trial could give you – for example, there is no control group, so you can’t separate out benefits that might relate to the intervention itself from, say the known wider benefits that result from receiving one-to-one understanding and support. On the other hand, a service evaluation does tend to reflect more accurately the pragmatic, ‘on the ground’ reality of having lessons, away from the more controlled environment of a clinical trial.
Conducting research is a small part of what the STAT Research Group does. The group was created in 2010 with the main aims of promoting research into the Alexander Technique and communicating about such research to the general public, health and social care professionals and academics, and other Alexander teachers. We also provide an advisory role for STAT in liaising with external organisations and government bodies to represent the interests of the Alexander teaching profession in relation to research evidence issues. All our work is done on an entirely voluntary basis.
Our main ways of communicating about the wide diversity of AT research to the public and within our profession are through Alexander Studies Online and brief research summaries on the STAT website. You can find out more about research related to the Alexander Technique through these two links and/or in my next monthly post.
References
- MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, Atkin K, Bland M, Eldred J, Essex H, Hewitt C, Hopton A, Keding A, Lansdown H, Parrott S, Torgerson D, Wenham A, Watt I. Alexander Technique lessons or acupuncture sessions for persons with chronic neck pain: A randomized trial. Annals of Internal Medicine 2015;163:653-62.
- Woodman J, Ballard K, Hewitt C, MacPherson H. Self-efficacy and self-care-related outcomes following Alexander Technique lessons for people with chronic neck pain in the ATLAS randomised, controlled trial. European Journal of Integrative Medicine 2018;17:64-71. doi: 10.1016/j.eujim.2017.11.006.
- Wenham A, Atkin K, Woodman J, Ballard K, MacPherson H. Self-efficacy and embodiment associated with Alexander Technique lessons or with acupuncture sessions: A longitudinal qualitative sub-study within the ATLAS trial. Complementary Therapies in Clinical Practice 2018;31:308–14.