Therapeutic Touch for Pain and Anxiety
By Donna Taliaferro, RN, PhD
A contemporary interpretation of several ancient healing practices, therapeutic touch (TT) was developed by Dolores Krieger, PhD, RN, and Dora Kunz in the early 1970s. During that decade there emerged a heightened awareness of the power to heal. Self-help books began to appear. Biofeedback became a way to train the mind to change body dynamics. Quantum physics continued to explore the relationships between space, time, and energy. The use of one’s own energy became not only a tool, but a healing method to be explored. During periods of stress or illness, the body’s natural rhythm and energy fields change; healing energy such as TT can move that energy back into a natural rhythm.
Psychoneuroimmunology and quantum physics are now uncovering healing methods Eastern cultures and spiritualists have practiced for centuries. Their knowledge not only is being accepted, it also is being tested. In the Western world, these tests can bring controversy. As is often the case, the media coverage about TT during recent years also has brought increased awareness about this alternative therapy.
The practice of TT is more than a means of helping or healing: It involves examining the human condition in a way that often is absent from the traditional, Western medical model. As more Americans seek alternative therapies, it is imperative that nurses understand the uses and values of these new healing modalities and be prepared to offer new treatment methods.
The Technique
Nurses are always seeking new ways to help ease patients’ pain and suffering. TT is a nursing intervention that enhances the practitioner in ways that provide hope and healing, not only for the one being healed but for the healer as well.
The art of facilitating comfort and healing to bring wholeness to oneself is the central meaning of TT practice. TT is based on the belief that a balanced flow of energy is necessary to maintain health and to heal. Although the name implies the use of touch in the traditional way, a TT practitioner does not touch the patient’s body. A TT practitioner’s hands are used as the conduit of energy transfer within the patient’s energy system. Without physically touching a patient, a TT practitioner corrects energy imbalances and removes energy blockages, helping the body regain its natural energy rhythm.
Krieger describes some of the questions regarding energy: "It seemed like pulsating waves of energy flowed through me. I felt strength, as though someone was standing behind and supporting me. My body felt stabilized, more in my control. I didn’t think I’d ever feel like that again. It was like getting back my life."1 Most people are familiar with Einstein’s theory of energy, that energy makes up the world and is everywhere. Scientists can describe energy with atoms and explain it with formulas. But how do you know when energy is really moving?
According to Krieger, the foundational concept underlying the efficacy of TT is intentionality, which implies that the healer has a conscious intention to do something.1 The mind has the intention to achieve a specific goal. Putting oneself totally in the moment and focusing completely on the intent to help or heal is the heart of TT. This concept is difficult for the "concrete" mind that views the world as black and white. TT creates an awareness that goes beyond the world of perception that we currently know.
Centering and intentionality are at the core of TT. The first step when practicing TT, the centering process is a mind-clearing activity that allows practitioners to get rid of all thoughts and actions except the intent to help or heal the person being treated. Only when a practitioner is fully centered can the healer be a conduit of universal life energy. The process of centering can be one of the most difficult aspects for novice practitioners who usually are more concerned about how they are doing TT than what they are doing.
The next step is assessment, a critical step in identifying the energy field and understanding what is happening with the patient’s energy system. Next, rebalancing occurs in forms such as directing energy, modulating energy, or redirecting energy. This is followed with a reassessment of the patient’s energy field to detect any further blockages or changes in the field. Although the steps may be considered in a linear fashion, the art of TT may involve a change in the sequence, as the energy field requires.
Clinical Research
TT gained significant exposure following the 1998 publication in the Journal of the American Medical Association (JAMA) of a study by then-9-year-old Emily Rosa.2 The purpose of the study, conducted with Rosa’s nurse mother, was to test the efficacy of TT, "a widely used nursing practice rooted in mysticism but alleged to have a scientific basis."2 Rosa tested the ability of 21 TT practitioners who each had between 1-27 years of experience to perceive a "human energy field." The test placed the practitioner and the investigator on opposite sides of a curtain. Each practitioner was asked to identify which of his or her hands was nearer the investigator’s hand (determined by flipping a coin). The TT practitioners identified the correct hand in 44% of the tests (123/280), a frequency comparable to random chance. These results prompted the authors to conclude that claims for TT are groundless and professional interest in TT is unwarranted.
The JAMA study failed to take into account the fundamental concepts of centering and intentionality and the initial body scan used to assess energy fields. Although the practitioners are reported as having 1-27 years of experience, information about their level of expertise was not provided. TT is a highly defined skill that develops over time—infrequent use does not provide the experience necessary to be an expert practitioner.
In 1998, Ward wrote that nurses must be prepared to offer new treatment methods when caring for children.3 By choosing conservative, non-invasive, non-intrusive methods, nurses can rebuild, repattern, and facilitate energies to replenish children’s minds, bodies, and souls and to create harmony and wholeness.
Ireland’s study of 20 HIV-infected children demonstrated lower overall mean anxiety scores before, during, and after interventions.4
Giasson and Bouchard compared the effect of three TT treatments or three rest periods on persons with terminal cancer in palliative care.5 Well-being was measured before and immediately following intervention using the Well-Being Scale, a visual analogue scale measuring pain, nausea, depression, anxiety, shortness of breath, activity, appetite, relaxation, and inner peace. Results of the study showed patients in the TT treatment group experienced an increased sense of well-being.
In a study of TT and its effects on patients with osteoarthritis of the knee, Gordon et al found that patients in the TT group had significantly decreased pain and improved function as compared with the placebo and control groups.6 Qualitative depth interviews conducted with study participants confirmed these results.
Researchers at the University of Alabama recently examined the ability of TT to produce greater pain relief as an adjunct to narcotic analgesia and greater reduction in anxiety among patients hospitalized with severe burns.7 Ninety-nine men and women (aged 15-68) were randomized to receive TT or sham TT once a day for five days. Subjects who received TT reported significantly greater reductions in pain (McGill Pain Questionnaire) and greater reductions in anxiety (Visual Analogue Scale for Anxiety) than did those who received sham TT.
In 1999, a group of investigators looked at the effects of TT on biochemical and mood indicators in women.8 Study results indicated that in the TT group mood disturbance decreased significantly over the course of the study. There were significant reductions in tension, confusion, and anxiety, and a significant increase in vigor. The biochemical data indicated that TT produced a significant decrease in nitric oxide levels. The authors believed these results have important implications for reducing symptom distress in cancer patients undergoing chemotherapy.
Conclusion
Much research and practice has been done with TT over the years. Some studies have had methodological problems and others have had limited statistical power. Yet many findings have encouraged the continued use of TT as an accepted nursing intervention.
TT can be the window to the soul. It is a spiritual, soulful activity that brings wholeness and harmony to both the healer and the healee. TT brings about new opportunities for perception and awareness of self. How we incorporate this new awareness can determine how we look at the world and the impact we have on patients’ lives.
References
1. Krieger D. Therapeutic Touch Inner Workbook. Santa Fe, NM: Bear and Company; 1996.
2. Rosa L, et al. A close look at therapeutic touch. JAMA 1998;279:1005-1010.
3. Ward S. Caring and healing in the 21st century. MCN Am J Matern Child Nurs 1998;23:210-215.
4. Ireland M. Therapeutic touch with HIV-infected children: A pilot study. J Assoc Nurses AIDS Care 1998;9:68-77.
5. Giasson M, Bouchard L. Effect of therapeutic touch on the well-being of persons with terminal cancer. J Holist Nurs 1998;16:383-398.
6. Gordon A, et al. The effects of therapeutic touch on patients with osteoarthritis of the knee. J Fam Pract 1998;47:271-277.
7. Turner JG, et al. The effect of therapeutic touch on pain and anxiety in burn patients. J Adv Nurs 1998;28:10-20.
8. Lafreniere K, et al. Effects of therapeutic touch on biochemical and mood indicators in women. J Altern Complement Med 1999;5:367-370.
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