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Therapeutic Touch (TT) is a form of “energy healing” popular in the American nursing community. In the words of its official organization, “Therapeutic Touch is an intentionally directed process of energy exchange during which the practitioner uses the hands as a focus to facilitate the healing process.” 1 TT is used by nurses in a variety of settings, from the office to the Intensive Care Unit (ICU). However, there is as yet no meaningful evidence that it is effective.
What Is Therapeutic Touch? TOP
Therapeutic Touch was developed in the early 1970s by two people: Dolores Krieger, PhD, RN, and a self-professed healer named Dora Van Gelder Kunz. At first, TT involved setting the hands lightly on the body of the patient, but the method rapidly evolved into a non-contact, “energy healing” method. Today certified practitioners can be found in virtually all parts of the U.S. and in much of the world. TT is available in mainstream health care facilities including hospices, hospital-based alternative health programs, and even ICUs.
Therapeutic Touch is sometimes described as a scientific version of “laying on of hands,” a technique practiced by faith healers. However, there is more spirituality than science to this method; it makes use of beliefs and principles common in spiritual healing traditions but alien to current science culture.
According to TT, the body has an “energy field,” and, without physical contact, the energy field of one person can substantially affect the energy field of another. The practitioner is said to heal, balance, replenish, and improve the flow of the patient’s energy field, thereby leading to enhanced overall wellness. However, there is no meaningful scientific evidence for any of these beliefs.
What Is the Scientific Evidence Regarding Therapeutic Touch? TOP
There has been considerable research interest in TT. However, as yet the evidence for benefit is no more than weakly positive at best. A 1999 review of all published studies concluded that many of the studies had serious design flaws that could bias the results; in addition, the manner in which they were reported did not meet adequate scientific standards.2 A similar review in 2008 focusing on pain concluded that that TT (along with Healing Touch and Reiki) may have modest effects on pain relief, particularly in the hands of more experienced practitioners, but the evidence was still fairly weak.13
To be fair, proper study of TT presents researchers with some serious obstacles. The only truly meaningful way to determine whether a medical therapy works is to perform a double-blind, placebo-controlled trial. (For the reasons why this is true, see Why Does This Database Rely on Double-blind Studies?) For hands-on therapies such as TT, however, a truly double-blind study is not possible—the TT practitioner will inevitably know whether he or she is administering real TT or fake TT!
The best type of study that can be performed on TT is a single-blind study with blinded observers. In such studies, participants do not know whether they received real or fake TT, and an observer who is also kept in the dark evaluates their medical outcome. However, such a study still has potential bias in it; practitioners could very well communicate a kind of cynicism when they fake TT, and this problem appears to be insurmountable.
Further problems are involved in the choice of fake treatment. In most of the studies described below, sham TT involved practitioners counting backward in their heads by subtracting seven serially from 100. The intent of this method was to avoid any possibility of projecting a healing concentration. It has been pointed out that this somewhat stressful effort would cause the practitioner to communicate tension rather than relaxation to study participants, and this too could bias results. However, it is difficult to suggest what should have been used instead for placebo.
Some studies compared TT to no treatment. However, it has been well established that any therapy whatsoever will seem to produce benefit compared to no treatment for various non-specific reasons; because of this, such studies say little to nothing about the specific benefits of TT. Finally, numerous trials have simply involved enrolling people with a medical problem, applying TT, and seeing whether they improve. Trials of this type prove absolutely nothing at all; for at least a dozen reasons, it would be rather surprising if benefit were not seen. (The reasons why are discussed in Why Does This Database Rely on Double-blind Studies?)
Given these caveats, here is a summary of the research available thus far.
At the time of the 1999 review noted above, many published studies of TT were of unacceptably low quality and, in any case, the results were quite inconsistent.
For example, in one trial, 31 inpatients in a VA psychiatric facility received Therapeutic Touch, relaxation therapy, or sham Therapeutic Touch.3 The study was designed to evaluate the effectiveness of TT for reducing anxiety and stress. The results appear to indicate that Therapeutic Touch was more effective for this purpose than sham Therapeutic Touch. However, there are some very serious design problems in this study that make the results hard to trust. The real TT was administered by a woman in street clothes, and the placebo treatment by a woman in nursing garb; to make matters more complex, the relaxation therapy was administered by a man dressed as a clergyman. These large differences in appearance could only be expected to considerably influence the results in ways that cannot be predicted.
A series of studies evaluated Therapeutic Touch for aiding wound healing.6 Some found TT more effective than placebo, others found no significant effect, and still others found placebo more effective than real treatment. These results suggest that the effects seen were due to chance.
Subsequent to the 1999 review, several better-quality trials were published. One such study compared real TT and sham Therapeutic Touch in 99 men and women recovering from severe burns.7 Researchers hypothesized that use of TT would decrease pain and anxiety during that arduous and traumatic process, and indeed some evidence of benefit was seen.
In a smaller study (25 participants), real TT appeared to reduce the pain of knee osteoarthritis compared to sham Therapeutic Touch.8 Furthermore, in a study of 20 HIV-infected children, use of TT improved anxiety while sham Therapeutic Touch did not.9 Another study found that an actor pretending to perform a form of treatment similar to TT produced significant improvements in well-being in people with advanced cancer.12
Taking all these studies together, it appears that real TT may be more effective than sham TT (using the serial subtraction technique described above). However, whether these apparent benefits are due to the energy-healing effects claimed by practitioners or, more simply, through emotional communication, remains unclear.
Some studies provide preliminary evidence that TT does not work in the manner practitioners believe it does. For example, in one well-designed study, TT produced no effect when conducted without eye contact.10 The researcher, an influential person in the history of TT, had hypothesized that TT involved a kind of energy transfer that would not need eye contact. The fact that no effects were seen without the addition of eye contact suggests that it might be focused attention that makes the difference, not energy transmitted through the hands. Similarly, in a study involving 76 breast cancer survivors, real TT (with healing intent) was no better than sham touch (without healing intent) in reducing cancer-related fatigue.14 However, both were more effective than no touch at all.
Furthermore, if TT actually involves contact with the “energy field” of a patient, it would seem that the practitioners would be able to sense the presence of such a field. However, in a widely publicized study, 21 practitioners who had practiced TT for 1 to 27 years proved unable to do this.11 In this trial, TT practitioners placed their hands face up through holes in a barrier. The experimenter (a nine-year-old student) held a hand above one of the practitioner’s hands, and the practitioner was asked to sense its presence. The practitioners' guesses proved to be no more accurate than chance would allow. This study has been strongly criticized by proponents of TT. Some have said that the experimenter was in the throes of puberty, and for that reason her energy field was too disturbed to detect; others have complained about the disturbing presence of video cameras. While these criticisms are potentially valid, the burden is actually on proponents of TT to prove that there really is such a thing as a human “energy field.”
Nonetheless, the studies already performed do indicate that, at the very least, concentrated, positive attention provided by one human being to another is consoling and calming. This is a wonderful fact, even if there is no special “energy field” involved.
What to Expect During a Therapeutic Touch Session TOP
Therapeutic Touch is generally administered in a session that lasts about 20 minutes. You will be asked to lie still, relax, and remain quiet. The practitioner will place his or her hands a few inches above your body and move them slowly and rhythmically.
Some people experience a variety of subjective sensations while receiving TT, such as heat and moving energy. Most people find TT generally relaxing, but some undergo cathartic emotional experiences.
How to Find a Qualified Therapeutic Touch Practitioner TOP
The original and most well-established Therapeutic Touch organization is Nurse Healers–Professional Associates International, Inc. (NH-PAI). This organization certifies training programs in TT. For more information, call them at (801) 273-3399, contact them by e-mail at firstname.lastname@example.org, or visit their Web site at http://www.therapeutic-touch.org.
Safety Issues TOP
There are no known or suspected safety risks with TT.
References[ + ]
1. Nurse Healers – Professional Associates International. The Official Organization of Therapeutic Touch. The Nurse Healers – Professional About Therapeutic Touch page. Available at: http://therapeutic-touch.org/what-is-tt-2/. Accessed November 22, 2002.
2. Peters RM. The effectiveness of therapeutic touch: a meta-analytic review. Nurs Sci Q. 1999;12:52–61.
3. Gagne D, Toye RC. The effects of therapeutic touch and relaxation therapy in reducing anxiety. Arch Psych Nurs. 1994;8:184–189.
4. Keller E, Bzdek VM. Effects of therapeutic touch on tension headache pain. Nurs. Res. 1986;35:101–106.
5. Meehan TC. Therapeutic Touch and postoperative pain: A Rogerian research study. Nurs Sci Q. 1993;6:69–78.
6. Wirth DP. Complementary healing intervention and dermal wound reepithelialization: an overview. Int J Psychosom. 1995;42:48–53.
7. Turner JG, Clark AJ, Gauthier DK, et al. The effect of therapeutic touch on pain and anxiety in burn patients. J Adv Nurs. 1998;28:10–20.
8. Gordon A, Merenstein JH, D'Amico F, et al. The effects of therapeutic touch on patients with osteoarthritis of the knee. J Fam Pract. 1998;47:271–277.
9. Ireland M. Therapeutic touch with HIV-infected children: a pilot study. J Assoc Nurs AIDS Care. 1998;9:68–77.
10. Quinn JF. Therapeutic Touch as energy exchange: replication and extension. Nurs Sci Q. 1989;2:79–87.
11. Rosa L, Rosa E, Sarner L, et al. A close look at therapeutic touch. JAMA. 1998;279:1005–1010.
12. Pohl G, Seemann H, Zojer N et al. Laying on of hands" improves well-being in patients with advanced cancer. Support Care Cancer. 2006 Oct 13 [Epub ahead of print]
13. So PS, Jiang Y, Qin Y. Touch therapies for pain relief in adults. Cochrane Database Syst Rev. 2008;CD006535.
14. Jain S, Pavlik D, Distefan J, et al. Complementary medicine for fatigue and cortisol variability in breast cancer survivors: a randomized controlled trial. Cancer. 2012;118(3):777-787.
Last reviewed September 2014 by EBSCO CAM Review Board
Last Updated: 9/18/2014
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