What is therapeutic touch (TT)?

Overview

Therapeutic touch (TT) is a form of energy healing popular in nursing in the United States. 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.” TT is used by nurses in a variety of settings, from the medical office to the intensive care unit (ICU). However, there is no meaningful evidence that it is effective.

TT was developed in the early 1970s by two people: Dolores Krieger and a self-professed healer, Dora Van Gelder Kunz. Initially, TT involved setting the hands lightly on the body of the patient, but the method rapidly evolved into a noncontact energy healing method. Certified practitioners can be found in virtually all parts of the United States and in much of the world. TT is available in mainstream health-care facilities including hospices, hospital-based alternative health programs, and even ICUs.

TT 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 unknown to current science.

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 a person’s energy field, thereby leading to enhanced overall wellness. However, there is no meaningful scientific evidence for any of these beliefs.

Scientific Evidence

There has been considerable research interest in TT. However, 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. A similar review in 2008 focusing on pain concluded 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.

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 hands-on therapies such as TT, however, a truly double-blind study is not possible, as 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 also is blinded evaluates their medical outcome. However, such a study still has potential bias; practitioners could communicate a kind of cynicism when they use 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 here, sham TT involved practitioners counting backward in their heads by subtracting 7 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 as a placebo.

Some studies compared TT with no treatment. However, it has been well established that any therapy whatsoever will seem to produce benefit compared to no treatment for various nonspecific 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 nothing. Given these caveats, a summary of the research available thus far is presented here.

At the time of the 1999 review already noted, many published studies of TT were of unacceptably low quality and the results were quite inconsistent. For example, in one trial, thirty-one inpatients in a Veteran’s Administration psychiatric facility received TT, relaxation therapy, or sham TT. The study was designed to evaluate the effectiveness of TT for reducing anxiety and stress. The results appear to indicate that TT was more effective for this purpose than the sham form. However, there are some serious design problems in this study that make the results difficult to trust. The real TT was administered by a woman in “street” clothes and the placebo treatment by a woman in a nursing uniform; 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.

In a better study, sixty people with tension headaches were randomly assigned to receive either TT or placebo touch. TT proved to be significantly more effective than placebo touch. However, in a reasonably well-designed study published in 1993, the use of TT in 108 people undergoing surgery failed to reduce postoperative pain to a greater extent than sham TT.

A series of studies evaluated TT for aiding wound healing. 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 caused by chance.

Subsequent to the 1999 review, several better-quality trials were published. One such study compared real TT and sham TT in ninety-nine men and women recovering from severe burns. Researchers hypothesized that the 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 (twenty-five participants), real TT appeared to reduce the pain of knee osteoarthritis compared to sham TT. Furthermore, in a study of twenty children with human immunodeficiency virus infection, the use of TT improved anxiety while sham touch did not. Another study found that an actor pretending to perform treatment similar to TT produced significant improvements in well-being in people with advanced cancer.

Taking all these studies together, it appears that real TT may be more effective than sham TT (using the serial subtraction technique). However, whether these apparent benefits are caused by 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. 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.

Furthermore, if TT actually involves contact with a person’s “energy field,” it would seem that the practitioners would be able to sense the presence of such a field. However, in a widely publicized study, twenty-one practitioners who had practiced TT for one to twenty-seven years proved unable to do this. 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 said that the experimenter was in the throes of puberty, and for that reason her energy field was too disturbed to detect; others 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 minimum, 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.

Coakley, A. B., and M. E. Duffy. “The Effect of Therapeutic Touch on Postoperative Patients.” Journal of Holistic Nursing 28 (2010): 193-200.

Peters, R. M. “The Effectiveness of Therapeutic Touch.” Nursing Science Quarterly 12 (1999): 52-61.

Pohl, G., et al. “?‘Laying on of Hands’ Improves Well-Being in Patients with Advanced Cancer.” Supportive Care in Cancer 15 (2007): 143-151.

Rosa, L., et al. “A Close Look at Therapeutic Touch.” Journal of the American Medical Association 279 (1998): 1005-1010.

So, P. S., Y. Jiang, and Y. Qin. “Touch Therapies for Pain Relief in Adults.” Cochrane Database of Systematic Reviews (2008): CD006535. Available through EBSCO DynaMed Systematic Literature Surveillance at http://www.ebscohost.com/dynamed.