Tuesday 2 September 2008

The ATEAM Study

Last week, the British Medical Journal published the long-awaited results of an NHS-funded study into the effectiveness of AT in helping people with chronic and recurring lower back pain. The results showed that 24 AT lessons or 6 AT lessons followed by a program of prescribed exercise was more effective in the longer term in relieving the symptoms than massage or exercise alone.

I'm pleasantly surprised at the effect that the publicity has had on the number of enquiries I have received. Within one week of the results being broadcast on the BBC and appearing in the national press, I had signed-up six new pipils and had several other serious enquiries.

Several thoughts spring to mind about how this new understanding of AT might evolve.

One of my closest friends is an NHS GP. He has always ribbed me about AT being "a degree in advanced navel-gazing" and my response to that is not printable! However, now that AT has been awarded some legitimacy as a therapy, he says that he could now recommend AT to patients with chronic back pain. However, he could only do so on the same basis as he would recommend osteopathy - i.e. he could suggest that a patient might try it but he can't pay for the patient's lessons.

I wonder if health insurers will now place AT in the same category as the other approved "alternative therapies". If so, how many lessons might they be prepared to pay for. My guess would be six (typically at a cost of £180 total) and not the 24 (£720) that the study seemed to be justifying. It seems to me that the ATEAM study showed a statistically significant outcome at 12 months for those who had received 24 lessons over those that had received 6 lessons plus prescribed exercise but that the difference between the two may not have been clinically significant from a cost-benefit point of view. I understand that a post trial cost-benefit analysis is to be undertaken and if so, I will be very interested to see the results.

As for AT teachers, I can foresee a number of reactions.

After getting over the initial euphoria of this new market of pupils, they will have to get used to a new kind of pupil: someone who comes seeking a specific therapeutic outcome. This idea goes somewhat against the grain of what AT is about. We are not there to "treat" a specific problem. Rather, we apply a tested and trusted formula developed by FM Alexander for dealing with the whole person. In due course, with an improved use of the whole body, the specific symptoms (back pain in this case) will subside.

It will become more important for teachers to resist the tendency of pupils to want to control the agenda in a lesson. Yes, they may think they have paid for the teacher to "treat" their back pain but actually they have paid to be taught how to prevent undue tensions in their bodies including their chronic back pain. They are there to learn how to treat themselves.

I have no doubt that the old guard conservative teachers will see this development as a step in the wrong direction. It's not. There has always been an argument put forward that AT is education and not therapy. This is despite the numerous references that Alexander made in his writing of people who had been sent to him because of this or that ailment! I've never really understood why some teachers are so hung-up about promoting AT as a therapy. It's "educational therapy" - by teaching pupils to undo their bad habits, a therapeutic outcome is achieved - even if that wasn't the reason why they originally came for lessons.

The important thing to understand is that we are now on the threshold of a new era where AT will finally take its rightful place as a respected healing technique. Those who achieve a positive outcome for their chronic conditions will also experience the fringe benefits in terms of a greater sense of well-being.

There are also dangers. As money becomes available for AT therapy there will be those who want to cash-in by posing as AT teachers when, in fact they have only ever read a couple of books on the subject and possibly attended a few group sessions. Only yesterday, I had to fire-off a few emails to a distance-learning provider and their accreditors for offering a certificate in AT by distance learning. They had might as well print their certicicate on a piece of bog paper!


  1. There are several problems with discussing the AT as a therapy. Wikipedia defines "therapy" as "the attempted remediation of a health problem, usually following a diagnosis". Usually, 'health problems', 'diagnosis', 'treatment' and 'therapy' are the domain of doctors. AT providers are not doctors. Secondly, the medical profession is used to therapies having very specific indications. The AT intervenes at a very fundamental level and a wide range of benefits can be expected. In this point in time, the best evidence for the use of the AT is for long term relief of chronic back pain. As such, medical care providers should recommend it for this indication. But that does not define the AT as a therapy for back pain. The AT is an educational technique. It is analogous to good nutrition. To teach a person to move from an unhealthy diet will likely help with the elevated cholesterol, but that does not mean that nutrition is simply a therapy for high cholesterol. Good nutrition is fundamental to living well. Similarly, we have not yet cataloged the range of benefits that can be expected with the AT. One must be aware that the notion of 'therapy' is inherently narrowing and the benefits from the AT involve the entire self.

  2. Thanks for your comment Joseph. I don't think we need dictionary definitions to define AT in terms of therapy. I have said elsewhere on this blog that I consider AT to be Educational Therapy.

    In other words we achieve therapeutic outcomes by re-educating the individual in their manner of Use. There is no question that beneficial therapeutic effects are achieved using AT and our MO involves education.

    I would agree that AT has to be taught holistically but I see no problem with addressing a pupil's symptoms of dis-ease in doing so.