Healing Touch

Healing Touch

PEP Topic 
Depression
Description 

Healing touch is an energy-based therapeutic approach to healing (Poznanski-Hutchinson, 1999; Mentgen, 1996). Healing touch uses touch to influence the body’s energy system, thus affecting physical, emotional, mental, and spiritual health and healing (Mentgen, 2001). The goal of healing touch is to restore balance in clients’ energy systems, thereby placing clients in a position to self-heal.

Mentgen, J. (1996). The clinical practice of healing touch. Imprint, 43, 33–36.

Mentgen, J. (2001). Healing touch. Holistic Nursing Care, 36, 143–157.

Poznanski-Hutchinson, C. (1999). Healing touch: An energetic approach. American Journal of Nursing, 99, 43–48.

Effectiveness Not Established

Systematic Review/Meta-Analysis

Gonella, S., Garrino, L., & Dimonte, V. (2014). Biofield therapies and cancer-related symptoms: A review. Clinical Journal of Oncology Nursing, 18, 568–576. 

doi: 10.1188/14.CJON.568-576
Print

Purpose:

STUDY PURPOSE: To review the evidence regarding the effects of biofield therapies for relief of cancer-related symptoms
 
TYPE OF STUDY: Systematic review

Search Strategy:

DATABASES USED: PubMed, CINAHL, PsycINFO, Trip database, and Cochrane Collaboration
 
KEYWORDS: Not provided 
 
INCLUSION CRITERIA: Cancer diagnosis; age > 18 years old; undergoing biofield therapies (BT) to relieve cancer-related pain, anxiety, and fatigue, or to increase well-being and quality of life
 
EXCLUSION CRITERIA: Studies related to surgical pain were excluded

Literature Evaluated:

TOTAL REFERENCES RETRIEVED: 121
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Not stated

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED = 13 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,003
  • SAMPLE RANGE ACROSS STUDIES = 16–230 patients
  • KEY SAMPLE CHARACTERISTICS: Various tumor types, patients in active treatment undergoing chemotherapy or radiation therapy

Phase of Care and Clinical Applications:

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Palliative care 

Results:

Interventions considered to be BT were healing touch, Reiki, and therapeutic touch. The effect on pain was examined in seven studies. There were some mixed findings, but most showed a reduction in pain over short time periods. Fatigue was assessed in five studies. These demonstrated fatigue reduction post-treatment, but data were conflicting over a longer period of four to eight weeks. Anxiety and depression were examined in seven studies. All but one found a significant reduction in mood disorders, but a study comparing Reiki, sham Reiki, and usual care found no difference between the sham and actual Reiki groups. Most studies were of descriptive or quasi-experimental design; potential confounding variables were not examined, and placebo effects could not be ruled out.

Conclusions:

Studies using biofield therapies for relief of pain, anxiety, fatigue, and depression generally showed benefit; however, the evidence is not strong due to the limitations of the studies included.

Limitations:

Low-quality design studies and the short duration of study follow-up

Nursing Implications:

BT therapies have not demonstrated effectiveness in well-designed clinical studies; however, though it is weak, evidence suggests potential benefit. There were no adverse effects of these interventions reported. Biofield therapies are not expensive and are low-risk, so they can be considered in the management of cancer-related symptoms. Well-designed clinical trials are needed to establish efficacy.

Research Evidence Summaries

Lutgendorf, S.K., Mullen-Houser, E., Russell, D., Degeest, K., Jacobson, G., Hart, L., . . . Lubaroff, D.M. (2010). Preservation of immune function in cervical cancer patients during chemoradiation using a novel integrative approach. Brain, Behavior, and Immunity, 24, 1231–1240.

doi:10.1016/j.bbi.2010.06.014
Print

Study Purpose:

To examine the effects of healing touch on natural killer (NK) cell activity, mood, and specific clinical and quality-of-life outcomes among women receiving chemoradiation for locally advanced cervical cancer

Intervention Characteristics/Basic Study Process:

After consent, patients randomized to one of three treatment arms: healing touch, relaxation, and control (usual care). The healing touch and relaxation interventions were administered individually four days per week throughout chemoradiation, on nonchemotherapy days, immediately following radiation. Healing touch participants received on average 15.25 (±6.97) sessions versus 11.75 (±5.20) sessions for relaxation (p = 0.08). Psychosocial surveys were completed for a total of four assessments (including baseline) over six weeks of chemoradiation. Each healing touch or relaxation session lasted 20–30 minutes and was delivered by experienced practitioners.

Sample Characteristics:

  • The sample was composed of 51 participants.
  • The mean age of the healing touch group was 48.1 years (SD = 16.0 years); the range of ages was 25–82 years. The mean age of the relaxation group was 43.1 years (SD = 9.6 years); the range of ages was 24–60 years. The mean age of the usual-care group was 48.0 years (SD = 13.8 years); the range of ages was 26–77 years.
  • Female: 100%, with stages IB1–IVA cervical squamous or adenocarcinoma. All patients were receiving a standard six-week course of chemoradiation.

Setting:

  • Single site
  • Outpatient
  • Iowa, United States

Phase of Care and Clinical Applications:

Active treatment

Study Design:

Prospective, randomized clinical trial with repeated measures

Measurement Instruments/Methods:

  • Center for Epidemiological Studies Depression Scale (CESD). Scores of 16 or higher indicate ‘‘probable cases of depression.”
  • Two subscales from the Profile of Mood States-Short Form (POMS-SF), to differentiate effects on anxiety versus depressed mood.
  • Functional Assessment of Cancer Therapy (FACT) quality-of-life measure.
  • Fatigue Symptom Inventory (FSI).
  • Five-item scale, modified from the Treatment Credibility Scale (TCS), administered at study entry to assess patient expectations before receiving group assignment.
  • Mean of three blood pressure measurements taken at two-minute intervals before and three measurements after the second relaxation or healing touch session, in weeks 1, 3, and 5, to assess extent of relaxation
  • Clinical and demographic information.
  • Immune measures as quantified by NK cell activity.

Results:

  • Healing touch group showed preservation of NK cell activity over time, as compared to NK activity in the other two groups, which had significant declines in NK cell activity over time (weeks 1–6). The usual-care group showed a 68% drop in NK cell activity. The relaxation group showed a 43.7% drop in NK cell activity. The healing touch group showed a 26.6% decrease in NK cell activity.
  • Authors reported a significant decline in depression in the healing touch group over time (p = 0.03), but the other two groups did not show such a decline. By week 6, mean CESD scores of healing touch patients were below 16 (the cutoff for clinical depression), whereas mean scores of the relaxation and usual-care groups were still in the depressed range (p = 0.07).
  • Anxiety significantly decreased in all groups over time.
  • Authors reported no significant effects on quality of life or fatigue in any group.

Conclusions:

Results indicate that, in patients with cervical cancer who are undergoing chemoradiation, healing touch may be effective in preventing some aspects of decreased immunity and reducing depressed mood.

Limitations:

  • The study had a small sample size, with fewer than 100 participants.
  • The study was possibly underpowered and had a risk of bias due to no blinding to the treatment condition. Relaxation was offered as a way to control for expectation of active treatment.
  • Brachytherapy protocol changes over the course of the study may be a confounding factor.

Nursing Implications:

Complementary interventions may be an important adjunct for patients during active treatment, in both improving depressed mood as well as maintaining immunocompetence. However, the intervention must be feasible and acceptable to patients. This very well-reported study took five years to accrue a final sample of 51 patients (fewer than one patient per month), which illustrates the complexity of performing such research.

Post-White, J., Kinney, M.E., Savik, K., Gau, J.B., Wilcox, C., & Lerner, I. (2003). Therapeutic massage and healing touch improve symptoms in cancer. Integrative Cancer Therapies, 2, 332–344.

doi: 10.1177/1534735403259064
Print

Study Purpose:

To determine if massage therapy and healing touch were effective in reducing anxiety, mood disturbance, pain, fatigue, and nausea and in improving the relaxation and satisfaction with care of patients receiving chemotherapy treatment

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned to one of three groups: therapeutic massage, healing touch, or caring presence. All received four weekly 45-minute sessions of the intervention and four weeks of standard care (control). After four weeks, patients were crossed over to another intervention or the control. Order of the intervention and usual-care control were randomized. Pre- and post-assessments of pain, nausea, and vital signs were done at each session. Assessments of intervention effects were done at the beginning and end of each four-week session. Therapeutic massage was provided in a standardized fashion, using a Swedish massage protocol. Healing touch followed a previously developed protocol incorporating centering, unruffling, magnetic unruffling, full-body connection, mind clearing, chelation, and lymphatic drain. Presence consisted of patients lying down for 45 minutes with relaxing music and the presence of a therapist. The therapist asked patients how they were feeling and if they had any questions. Conversation may or may not have occurred, according to the patient’s preference; the purpose of the therapist was to be attentive but to avoid therapy or physical intervention. The control condition consisted of usual care, which the authors did not describe.

Sample Characteristics:

  • The study reported on a sample of 164 patients.
  • Mean patient age was 57.4 years, with a range of 27–83 years.
  • The sample was 87% female and 13% male.
  • The most common cancer types were breast, gynecologic or genitourinary, gastrointestinal, hematologic, and lung.
  • The majority of patients had stage III or IV disease, and 50% were in the first month of chemotherapy treatment.
  • All patients had a score of at least 3 on a 10-point scale of symptom severity. The most frequently reported symptoms were fatigue, pain, anxiety, and nausea.

Setting:

  • Single site
  • Outpatient setting

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

A randomized, controlled, parallel-group, crossover design was used.

Measurement Instruments/Methods:

  • Symptom rating scales (0–10)
  • Brief Pain Inventory
  • Brief Nausea Index
  • Profile of Mood States
  • Satisfaction measure according to a four-point Likert-type scale

Results:

  • Of those who initially entered the study, 29% dropped out. Half of the dropouts were due to changes in the cancer treatment protocol; half were because patients wanted an intervention different from the one assigned. Those who dropped out had higher pain, nausea, mood disturbance, and fatigue at baseline (p < 0.05) than those who did not.
  • Massage and healing touch groups showed immediate post-session reduction of respiratory rate, heart rate, and blood pressure (p < 0.01), and these interventions were more effective (p < 0.01) in achieving these reductions than were control and presence conditions. Massage and healing touch were associated with pre- and post-session reduction in current pain (p < 0.001).
  • Over the four-week study period, mood disturbance decreased over time in all patients. Massage therapy, compared to the control condition, was more effective at reducing total mood disturbance (p = 0.004) and anxiety (p = 0.023). Healing touch reduced mood disturbance (p = 0.003) and fatigue (p = 0.028).
  • Mean pain scores in all cases declined over time.
  • There were no differences between groups in nausea or use of antiemetics.
  • There were no differences between groups in overall satisfaction. Massage and healing touch were associated with higher satisfaction with the intervention than was presence (p < 0.0001).

Conclusions:

Massage therapy and healing touch were more effective than presence alone or standard care in improving mood, reducing anxiety, pain, and fatigue and in reducing heart rate, blood pressure, and respiratory rate immediately postintervention.

Limitations:

  • The control condition may not have provided appropriate attentional control.
  • The study had risk of bias due to no blinding.
  • The anxiety measure was not a rigorous, valid tool; it was a 10-point scale.
  • The study had a large drop-out rate.

Nursing Implications:

Massage therapy and therapeutic touch can be beneficial to patients because the interventions induce physical relaxation and reduce pain, fatigue, and anxiety. In this study, these interventions were more effective in this regard than was therapeutic presence alone. Massage therapy and therapeutic touch are complementary therapies that nurses can consider and advocate for on behalf of patients who may benefit from them.


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