Dr. Selfridge reports no financial relationships relevant to this field of study.
Summary Points
- Several non-clinical experiments suggest the presence of subtle and yet undefined forces that can be directed to others to produce measurable biological effects.
- So far, conclusions about the therapeutic value of energy therapies are hindered by a lack of well-designed research studies. Current limited evidence best supports touch therapies for low-grade reduction of pain intensity.
- Despite insufficient evidence to support clinical guidelines, the safety and accessibility of energy therapies make them viable options as adjunct treatments when patients express a preference for them.
Accepting the possibilities of healing or creating positive effects on human health and disease through deliberate manipulation of putative subtle energies is challenging for many conventionally trained Western health providers. Even though we take advantage of the body’s constant generation of electromagnetic energy using diagnostic tools such as the ECG, EEG and MRI, energy discharges so small that they escaped detection until we had tools refined enough to discover them, and we find it harder to accept the idea that some other yet unidentified energetic forces might exist in the human body, might be related to health and disease, and might be subject to intentional manipulation. However, the assumption that such subtle energies exist and can be affected by certain individuals has been a keystone of many cultural healing traditions for millennia. Despite separation by time and distance between many of these cultures, the energetic concepts supporting the development of energy therapies are remarkably similar. These cultures assume the presence of a life force or energy that permeates all living things. Examples include the Indian “prana,” Chinese “chi,” and Japanese “qi.” This vital force may travel in well-organized and reliable pathways within the human body (e.g., “meridians” in traditional Chinese medicine) and may generate “fields” of energy that can be detected by certain trained or endowed humans (e.g., “auras” described in several spiritual traditions). Interruption or disorganization of this vital force is presumed to underlie physical, mental, and emotional disease and suffering. It is also assumed that perturbations of this vital force can and must be corrected or augmented for healing, optimum health, and well-being.
Interest in subtle energies in the West is a recent phenomenon. Wilhelm Reich, a protégé of Sigmund Freud, emigrated to the United States from Germany in 1939 to conduct and disseminate research on a vital force he claimed to discover called the Orgone. Although his work was controversial and discredited publicly, he had many followers in the United States and internationally who claimed beneficial effects from his “Orgone accumulator,” including cancer cures.1
The U.S. nursing profession began more widely teaching and implementing energy therapies known as healing touch (HT), therapeutic touch (TT), and Reiki (see Table 1) in the 1970s in clinical and hospital settings. Nurse academicians have produced much of the limited extant research on these modalities. Patients are actively using energy medicine modalities and may not be informing their physicians. A survey from the National Institute of Health Statistics in 2004 reported that about 1% of respondents had used Reiki or qi gong in the previous year. However, this proportion increased to more than 45% when intercessory prayer and healing ritual were included.2 Use of energetic therapies is probably underestimated in patient surveys; many practitioners of other therapeutic modalities, such as nurses, massage therapists, and chiropractors, blend energy therapies into their work without labeling these therapies as such.
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Table 1: Descriptions of a Limited List of Energy Medicine Therapies |
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|
Name |
Description |
|
Healing Touch |
Developed in the 1980s by nurse Janet Mentgen, who integrated energetic therapies she was using in her nursing practice. Relies on a detailed understanding of energy centers and meridian and involves light touch. Requires extensive training for certification. |
|
Therapeutic Touch |
Developed in the 1970s by nurse Delores Krieger and Dora Kunz. Gentle touch is used to manipulate the biofield. |
|
Reiki |
A Japanese energy intervention founded by Japanese Buddhist monk Mikao Usui in the 1920s. Uses prescriptive hand positions, and healing ability is passed on during training during an “attunement” provided by a Reiki master. |
|
Johre |
Founded by Mokichi Okada in the 1930s, it involves channeling light energy to recipients through the hands of the therapist without |
|
Qi gong |
An ancient, traditional Chinese energy therapy balances chi using movement, breath entrainment, and mental/meditation training. |
|
Polarity Therapy |
Developed by Randolph Stone, an osteopath, in the early- to mid-20th century, involves gentle touch, prescriptive diet, and exercise to influence vital energies. |
|
Okada Purifying Therapy |
Another school of the therapeutic techniques founded by Mokichi Okada focuses on energy channeling through the hands of the therapist to the recipient without touch involved. |
|
Thought Field Therapy |
Founded by Roger Callahan and based on traditional Chinese medicine concepts, clients are guided by the therapist to tap on acupoints and meridians in prescriptive sequences for the condition being addressed. |
Non-clinical experiments aimed at exploring possible subtle energy effects challenge one’s skepticism. Radin reported temporal EEG correlations in pairs of people isolated in separate locations when one of the pair was stimulated at random times by live video of the other person.3 This EEG analysis was corroborated by a similar EEG study by Standish in 2004, and a case report using a similar study design showing fMRI correlates under similar circumstances.4,5 These results were supported by Achterberg et al in an fMRI study of 22 subjects: 11 healers using distant intention paired with 11 recipients. Recipients were studied by fMRI while each healer performed distant intention in random 2-minute intervals for his/her paired recipient, according to preferred healing practice. Significant differences were found between the “send” intervals and the “no send” intervals in the activity of the brains of the recipients (P = 0.000127).6 Uchida et al reported the effects of Okada Purifying Therapy (OPT) on the EEG of subjects. In the OPT group, the subjects sat facing a wall with the therapist positioned behind them without touching or making noise. Subjects were given instruction to open and close their eyes at timed intervals during 15 minutes of intentional therapy. Placebo group subjects were positioned similarly with a non-therapist sitting quietly behind them while subject EEGs were similarly monitored and then analyzed. OPT recipients demonstrated a significant increase in alpha wave output during the therapy (P < 0.05).7 Pike et al measured asymmetrical cortical activation during EEG in subjects receiving an energetic therapy called IRECA (Istituto di Ricerca sull’Energia Cosmica Applicata) compared to placebo and no treatment groups.8 This energetic therapy involves practitioner attentional and intentional focus to transfer energy for the purpose of healing or performance enhancement. Subjects were randomized and blinded to the treatments and had been “stressed” immediately prior to the interventions by completing a cognitively demanding task. Left anterior frontal cortex activation was significantly increased in recipients receiving IRECA compared to placebo (P = 0.037) and no treatment (P = 0.002). Left anterior frontal cortex activation has been previously reported in meditation studies to be associated with improved immune function, vitality, well-being, and quicker recovery from exposure to negative stress.8 Abe et al reported increased viability loss in cultured human gastric cancer cells exposed to 72 hours of Johrei treatments compared to cultures of untreated cells.9 The results of these studies strongly suggest “something is happening,” although mechanisms remain elusive. Roe et al performed a meta-analysis of extant research on the effects of intentional energetic therapies on biological systems other than “whole humans,” including studies of bacterial and yeast cultures, whole blood, plants, and cell cultures. Studies were rated on a scale of 10 for methodological quality using an adapted version of the SIGN50 tool created by the Scottish Intercollegiate Guidelines Network (average score was 4.3). Forty-nine studies met inclusion criteria and were subjected to the analysis. A significant effect size was noted (r, the correlation coefficient and a standard measure of effect size, was reported as 0.204, indicating better outcomes for the “treatment” groups compared to controls).10
Energy Medicine/Biofield Modalities
The National Center for Complementary and Integrative Health labels energetic therapies that manipulate putative subtle energies not yet measurable by available technology as “biofield therapies.” Biofield therapy practices include local or proximal practices, wherein the healer guides energy while in the physical presence of the patient, and distance practices, wherein the healer guides energy to the recipient who is in a different physical location. An excellent overview and description of energy medicine is provided by Rindfleisch in Integrative Medicine.11 A limited description of some popular energy medicine interventions covering those modalities that are the focus of this review is provided here in Table 1.
Recent Research
A well-constructed systematic review and best evidence synthesis by Jain and Mills reviewed 66 studies of a variety of proximally practiced biofield therapies that met inclusion criteria: 1) published in English in a peer-reviewed journal, and 2) quantitative biological and/or psychological endpoints. Randomized, controlled trials (RCTs) were included (n = 52), as well as within-subject repeated measure designs (n = 14). All studies were assessed and given points for quality parameters of design and methodology, statistical methods, and outcomes. Studies were rated as high or low quality based on median scores, and the mean score for study quality was 6.4 out of 12. From these studies, levels of evidence were assessed for the efficacy of biofield therapies for specific patient populations, conditions, and outcomes:
- Level 1 – “Strong evidence” supported by findings from two high-quality RCTs and generally consistent findings in other studies
- Level 2 – “Moderate evidence” supported by findings from at least one high-quality RCT and supported by at least one lower-quality RCT or high-quality quasi-experimental study
- Level 3 – “Limited evidence” supported by more than one lower-quality quasi-experimental study and/or lower-quality RCT
- Level 4 – “Conflicting evidence” supported by multiple studies with conflicting results
In a best-evidence synthesis, it was concluded that there is strong evidence for biofield therapy efficacy for reducing pain intensity and improving quality of life in pain populations, although evidence is equivocal for impact on affective measures associated with pain. Only moderate evidence exists for pain intensity reduction in hospitalized and cancer patients. Moderate evidence exists for decreasing negative behaviors in dementia patients and for decreasing anxiety in hospitalized patients. Only equivocal evidence exists for the other clinical conditions studied, including anxiety in heart patients and fatigue and quality of life for cancer patients.12
Anderson and Taylor focused on HT research in clinical practice for a systematic review.13 Five studies met their inclusion criteria and these were assessed for quality and assigned a score using modified Jada criteria. Their conclusions about the efficacy of HT were similar: Methodological flaws and limited number of quality studies make inferences about efficacy impossible.
A 2008 Cochrane Review meta-analysis of “touch therapies” for pain relief, including Reiki, HT, and TT, included 24 studies and 1153 participants. Pain intensity was reduced, on average, by 0.83 units on a 1-10 scale in patients treated with touch therapy compared to control patients (95% confidence interval [CI], -1.16 to -0.50). This review noted that effect size appeared greater for Reiki studies and when more experienced practitioners delivered the treatments. In studies that evaluated analgesic use, touch therapies appeared to reduce analgesic use. Placebo effect in these trials was analyzed, and the authors concluded that no statistically significant (P = 0.29) placebo effect could be identified.14
A 2012 qualitative review of published research on biofield therapies for cancer pain (Anderson and Taylor) written for oncology nurses concluded that evidence of efficacy for these therapies is inconclusive.15 The review limited its focus on those therapies often administered by nurses (TT, HT, and Reiki). Overall, the number of studies specifically addressing cancer pain was small (n = 4). All but one study contained significant methodological flaws, and although the existing studies suggest efficacy, the authors expressed concern that publication bias is likely given that negative study results often remain unpublished. A 2011 systematic review of energy healing for cancer included eight studies (six quantitative and two qualitative). Quality was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) quality scale. Authors determined that none of these studies were of sufficient size or quality to allow conclusions about efficacy.16 A later 2014 qualitative literature review of biofield therapies for cancer symptoms, again for oncology nurses and limited to TT, HT, and Reiki, included 13 studies assessing the main cancer-related outcomes of pain, anxiety, fatigue, and quality of life, and included several of the same studies covered in the aforementioned reviews. These authors found again that most studies were descriptive or of quasi-experimental design, were inadequately powered, and contained diverse methodological flaws.15
A 2010 RCT of medical qi gong for cancer patients (n = 162) assessed the effects on quality of life, fatigue, and mood using validated instruments and included changes in biomarker (CRP) for inflammation.18 This study was adequately powered. However, volunteers were recruited for the study, had a variety of cancer types, and none of the participants or the qi gong instructors were blinded to the condition, introducing some selection and experimental bias. There was no active control group to help control for non-specific effects of the qi gong intervention. In addition, there was a relatively low completion rate (76%). Compared to the control group, the medical qi gong group experienced significant improvement in overall quality of life (mean difference between groups 9.0; 95% CI, 5.62-12.36; P < 0.001), fatigue (mean difference between groups 5.70; 95% CI, 3.32-8.09; P < 0.001), mood disturbance (mean difference between groups -10.64; 95% CI, -19.81 to -1.47; P < 0.021), and inflammation/CRP level (mean difference between groups -23.17; 95% CI, -37.08 to -9.26; P < 0.044).
A 2011 NIH NCCAM randomized, three-armed control study of polarity therapy for cancer-related fatigue showed significant effect size for improving daily fatigue for patients receiving polarity therapy compared to standard care or an active control group receiving modified massage therapy (P = 0.05). The study population consisted of 45 women with breast cancer who were receiving radiation therapy for non-metastatic breast cancer; it was considered a pilot study for assessing effect sizes. Quality-of-life outcomes were also measured and decreased in all groups, but least of all in the polarity therapy group, suggesting a beneficial effect on quality of life using polarity therapy for cancer patients undergoing treatment.19
Anderson and Taylor also provided a descriptive review of biofield research for cardiovascular symptoms. This review concluded that studies contained methodological flaws, making conclusions about efficacy of therapies difficult, but the individual descriptions of these studies did not assess study designs or methodologies in detail, placing more emphasis on describing chosen measures and results, which were largely reported as beneficial.20
Friedman et al reported in a correspondence that the effects of Reiki treatment on heart rate variability (HRV) in a randomized, controlled, three-armed trial.21 Low HRV is associated with increasing age and risk of sudden cardiac death, and higher HRV reflects increased parasympathetic tone, which has been shown to be protective in acute coronary syndrome. Forty-nine patients recovering from acute coronary syndrome and meeting inclusion criteria were divided into one of three groups: a treatment group receiving intervals of Reiki therapy, a control group instructed to rest quietly during treatment intervals, and an active control group that listened to music during the treatment intervals. Changes in high-frequency HRV were measured from continuous ECG monitoring during treatment intervals. Secondary outcomes included screening for changes in negative and positive emotions. Reiki exerted a significant effect on increasing high-frequency HRV compared to rest (P = 0.025) and music control (P = 0.007) groups. Significant increases in positive emotions and decreases in negative emotions were noted on a seven-point Likert scale for the patients treated with Reiki compared to control groups.
A 2009 systematic review of Reiki research reported 12 trials that met inclusion criteria: a human study published in English, a control arm, and an intervention provided by a Reiki practitioner.22 Authors applied modified CONSORT (Consolidated Standards of Reporting Trials) criteria to the studies, and all had deficits in at least one of three key areas: randomization, blinding, and accountability of all patients. Jadad quality scores (a process for assessing clinical trial quality methodology) were determined for each trial. Although nine of the 12 trials studied showed therapeutic effect, 11 out of 12 were ranked “poor” by Jadad scores. Thirty-one outcomes for these 12 clinical trials were reported, suggesting that researchers are still attempting to understand the breadth of potential Reiki benefits. Despite individual studies showing statistically significant benefits for the outcomes studied (in some cases P ≤ 0.0001), the overall quality standards of the studies were poor, creating concern about bias, validity, and causal inference.
TT was a focus of two recently published Cochrane review updates: for anxiety disorders (2009) and wound healing (2012). Only 11 studies on TT for anxiety disorders were uncovered in the literature search, and none of these studies met inclusion criteria.23 The TT for wound healing review resulted in four studies adequately meeting inclusion criteria. All trials were in people with experimental wounds. Two trials of relatively small numbers (n = 44 and n = 24) showed significant increase in healing of wounds with TT: one trial showed no significant treatment affect, and the other showed worse healing after TT. Pooling the studies for analysis showed no significant difference in complete wound healing (relative risk, 1.03; 95% CI, 0.12-8.60). The authors assessed all the included trials as having high risk of bias and being of poor study quality in general.24
Thought field therapy (TFT) efficacy for anxiety was studied in a 2012 RCT. Although results suggested that TFT had an enduring effect on reducing anxiety, the study included only a waitlist control group, which failed to control for the non-specific effects of the intervention. Further, the patients included in the study were not restricted in their use of medication and other therapies during the study period, introducing potential confounding variables.25
Roe’s meta-analysis, reported above, also included a second analysis of 57 human studies meeting inclusion criteria. A small but significant effect size r of 0.115 was determined in this analysis, still indicating better outcomes for the energetic interventions compared to no treatment or placebo, although the authors cited generally poor methodology and evidence of publication bias limiting unequivocal conclusions.10
Conclusion
To date, there is statistically significant evidence that energy medicine may be helpful for low-grade reduction of pain intensity. There remains insufficient high-quality research to support decisions to use energy therapies as treatment or adjunctive therapy for other medical conditions, or even other dimensions of the pain experience. There are, thus far, no reported risks for these therapies, and many are offered by volunteers or as part of normal nursing care and are “free.” As Ferraresi et al stated in a review of these therapies, for use in the dialysis ward, controversial efficacy needs to be balanced against no side effects, frequent availability at no cost (hospital nursing practice and volunteers), and easy, risk-free integration with other conventional and pharmacologic therapies.26 Thus, energy therapies support ethical principles of beneficence (they are possibly beneficial), non-maleficence (they are non-harmful), justice (they are accessible), and autonomy (they are often preferred and chosen by patients), and for these reasons alone can be recommended as adjunctive therapeutic interventions for patients who are open to using them while we await the necessary high-quality research on their efficacy.
References
- Sharaf MR. Fury on Earth: A Biography of Wilhelm Reich. New York: St Martin’s Press; 1983.
- Barnes PM, et al. Complementary and alternative medicine use among adults: United States, 2002. Adv Data 2004;343:1-19.
- Radin DI. Event-related electroencephalographic correlations between isolated human subjects. J Altern Complement Med 2004;10:312-323.
- Standish LJ, et al. Electroencephalographic evidence of correlated event-related signals between the brains of spatially and sensory isolated human subjects. Altern Ther Health Med 2004;10:307-314.
- Standish LJ, et al. Evidence of correlated functional magnetic resonance imaging signals between distant human brains. Altern Ther Health Med 2003;9:121-125.
- Achterberg J, et al. Evidence for correlations between distant intentionality and brain function in recipients: A functional magnetic resonance imaging analysis. J Altern Complement Med 2005;11:965-971.
- Uchida S, et al. Effect of biofield therapy in the human brain. J Altern Complement Med 2012;18:875-879.
- Pike C, et al. Asymmetric activation of the anterior cerebral cortex in recipients of IRECA: Preliminary evidence for energetic effects of an intention-based biofield treatment modality on human neurophysiology. J Altern Complement Med 2014;10:780-786.
- Abe K, et al. Effect of a Japanese energy healing method known as Johrei on viability and proliferation of cultured cancer cells in vitro. J Altern Complement Med 2012;18:221-228.
- Roe C, et al. Two meta-analyses of non-contact healing studies. Explore 2015;11:11-23.
- Rindfleisch A. Human Energetic Therapies. In: Rakel D, ed. Integrative Medicine 3rd ed. Philadelphia: Elsevier Saunders; 2012:980-987.
- Jain S, et al. Biofield therapies: Helpful or full of hype? A best evidence synthesis. Int J Behav Med 2010;17:1-16.
- Anderson J, Taylor AG. Effects of healing touch in clinical practice. J Holist Nurs 2011;29:221-228.
- So PS, et al. Touch therapies for pain relief in adults (review). Cochrane Database Syst Rev 2008; Issue 4. Art. No.: CD006535. DOI: 10.1002/14651858.CD006535.pub2.
- Anderson J, et al. Biofield therapies and cancer pain. Clin J Oncol Nurs 2012;16:43-48.
- Agdal R, et al. Energy healing for cancer: A critical review. Forsch Komplementmed 2011;18:146-154.
- Gonella S, et al. Biofield therapies and cancer-related symptoms: A review. Clin J Oncol Nurs 2014;18:568-576.
- Oh B, et al. Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: A randomized controlled trial. Ann Oncol 2010;21:608-614.
- Mustian KM, et al. Polarity therapy for cancer-related fatigue in patients with breast cancer receiving radiation therapy: A randomized controlled pilot study. Integr Cancer Ther 2011;10:27-37.
- Anderson JG, et al. Biofield therapies in cardiovascular disease management: A brief review. Holist Nurs Pract 2011;25:199-204.
- Friedman RS, et al. Effects of Reiki on autonomic activity early after acute coronary syndrome. J Am Col Cardiol 2010;56:995-996.
- VanderVaart S, et al. A systematic review of the therapeutic effects of Reiki. J Altern Complement Med 2009;15:1157-1169.
- Robinson J, et al. Therapeutic touch for anxiety disorders (review). Cochrane Database Syst Rev 2007; Issue 3. Art. No.: CD006240. DOI: 10.1002/14651858.CD006240.pub2.
- O’Mathuna DP, et al. Therapeutic touch for healing acute wounds (review). Cochrane Database Syst Rev 2012, Issue 6. Art. No.: CD002766. DOI: 10.1002/14651858.CD002766.pub2.
- Irgens A. et al. Thought Field Therapy (TFT) as a treatment for anxiety symptoms. Explore 2012;8:331-338.
- Ferraresi M, et al. Reiki and related therapies in the dialysis ward: An evidence-based and ethical discussion to debate if these complementary and alternative medicines are welcomed or banned. BMC Nephrol 2013;14:129.
Despite insufficient evidence to support clinical guidelines, the safety and accessibility of energy therapies make them viable options as adjunct treatments.
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