By John Hunter, Ph.D

If you have ever been invited by an enthusiastic family member, friend, or work colleague to attend the graduation of a seminar that “transformed” their life, but they refused to provide details about what actually took place in this seminar, then you were probably being invited to a large group awareness training recruitment evening.

Large group awareness training (LGAT) is the generic term used to describe a type of “transformational” seminar that typically takes place over a few days to a week. At least four million people on six continents have participated in some form of these trainings since they were popularised in San Francisco in the 1970s. While there are superficial differences between LGATs – and while they often do not acknowledge being related to one another — a comprehensive review reveals that their structure, processes, results, and influences are astonishingly similar.

At a high level they generate significant psychological stress for approximately the first seventy-five percent of the training, while exhausting participants mentally and depriving them of sleep. Under conditions of extraordinary control, participants are encouraged to reveal and relive traumatic experiences from their pasts, urged to visualise frightening scenarios, told that they are responsible for the pain in their lives, and frequently harassed and mocked by the trainer with what is framed, “tough love”. Over the course of the training participants are convinced that questioning and reason are barriers to “transformation”, and that personal experience (or some equivalent) is the only way to be certain of anything. Having paid a significant amount to attend, trusting the person who recruited them, and having conceded that their lives are not perfect (of course, no one’s life is!), participants open themselves up to this argument, drop their defences, and agree to “participate” in the hope of attaining the promised “transformation”. On the final day of the LGAT the guilt, fear, and inadequacy are replaced with affirmation and praise, and a graduation ceremony of sorts takes place.

Although research suggests that most graduates experience a euphoric state (“transformation”), these participants likely do not understand how this (transient) state is generated and are equally unaware that this manipulation of mood may be part of a sophisticated process of persuasion, aimed at making them willing salespersons for and – not infrequently – unpaid employees of these organisations. Because participants have been primed to trust “experience” – and because they are often too physically, mentally, and emotionally exhausted to think carefully about what they have been put through – many uncritically accept this elevated state as evidence of the validity of the training. What graduates may also not realise is that some participants react very badly to LGAT processes, and that certain researchers claim that when psychological casualties occur – and there have been numerous testimonies and published accounts of these negative reactions – the organisations in question deny responsibility and settle out-of-court, under the condition that those hurt do not speak publicly about their experiences. It is instead suggested that those harmed ignored warnings about risks to mental health and are (as per the LGAT doctrine) fully “responsible”; although many of these participants had no history of mental illness prior to participation.

Justifying his investigation into the “toxic effects” of these types of trainings, Professor Morton Lieberman of the University of California, San Francisco, explained, “… practitioners have encountered patients who were distraught and at times seriously psychiatrically ill subsequent to their participation.”

Claims of harm often involve extreme mood swings (mania/depression) and periods of psychosis; however, at the time of Lieberman’s research there was no way to explain these negative effects (or, indeed, the “positive” altered states). As stated by Lieberman in 1987:

There is no reason to assume, on the basis of the evidence we have so far been able to gather, that large group awareness training could not create psychiatric risk for some. What is clearly lacking, however, is a coherent theory for linking a set of experiences ordinarily encountered in large group awareness training to the development, exacerbation, or intensification of psychopathology

My own research, based on an understanding of the triggers, symptoms, and theorised psychology and neurobiology of bipolar disorder, provides an explanation for both the LGAT “transformations” as well as the frequently reported casualties. According to a 2015 review article published in the Journal of Affective Disorders, the most commonly reported triggers of hypomania (a milder, and often highly pleasurable, form of mania) and mania include: (1) stress; (2) sleep disruption; and (3) goal-attainment. LGATs appear to be little more than a structured process of extraordinary stress, sleep disruption, and goal-attainment (“graduation”), under the guise of personal development. When one examines the claims made by LGATs about their results, the testimonies of graduates, and the observations of those interacting with graduates, a strong case can be made that the effects of this “transformation” are, for most, indistinguishable from the symptoms of hypomania. Graduates report seeing the world in a new and profoundly positive way, experiencing sudden confidence and sociability, having more energy, being more productive, requiring less sleep, and feeling elated, euphoric, or “high”. While some report greater “decisiveness”, their behaviour is often described by others as impulsive, or reckless, and those intimately familiar with the symptoms of hypomania and mania should have little difficulty noting the parallels. LGATs, therefore, incorporate established bipolar triggers and appear to elicit bipolar symptoms in (ostensibly healthy) participants.

Psychosis, while often associated with schizophrenia, also occurs in mania, and both the elevated mood states of bipolar disorder (hypomania/mania), and psychosis, are theorised to be associated with elevated levels of dopamine. While this research was not available when LGATs were popularised in the 1970s (or studied by Lieberman and others in the 1980s), stress, sleep disruption (a form of stress), and goal-attainment (“stress removal”) have more recently been shown to elevate dopamine. There is, therefore, now a plausible explanation for how LGATs generate their altered states (through the manipulation of dopamine) and, crucially, for why there will inevitably be psychological casualties if these trainings apply a one-size-fits-all approach to groups of inadequately screened, and psychologically diverse, participants.


John Hunter, PhD, is researcher and lecturer who, having lived with bipolar disorder for many years, focuses on understanding mood and its impact on thinking, belief-formation, and behaviour.


  • PsySSA, the Psychological Society of South Africa, is the national professional body for psychology. Committed to transforming and developing psychological theory and practice in South Africa, PsySSA strives to serve the needs and interests of a post-apartheid country by advancing psychology as a science, profession and as a means of promoting human well-being. This blog hopes to engage psychologists and citizens in debating issues, from mental health to the socio-political. Visit


Psychological Society of South Africa

PsySSA, the Psychological Society of South Africa, is the national professional body for psychology. Committed to transforming and developing psychological theory and practice in South Africa, PsySSA strives...

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