BACKGROUND: Between 75-90% of nursing home (NH) residents with dementia develop behavioral symptoms (BSD) which may be associated with a stress response. Therapeutic touch has been shown to decrease restlessness in NH residents, however the mechanism is unknown. The purpose of this randomized controlled trial (RCT) was to examine the effect of therapeutic touch on BSD and basal cortisol levels among NH residents with dementia. PARTICIPANTS AND METHODS: Using a double blind experimental interrupted time series ABAB design, 65 participants were assigned to one of three groups. The experimental group received therapeutic touch with contact on the neck and shoulders delivered twice daily for 3 days (administered over 2 separate treatment periods); the placebo group received a mimic treatment identical in appearance, and the control group received routine care. Study outcomes were BSD, measured by the modified Agitated Behavior Rating Scale (mABRS), and salivary cortisol levels, measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: 64 residents, aged 67-93 years (M = 85.5, SD = 5.50), completed the study. Restlessness was significantly reduced in the experimental group compared to the control group (p = 0.03). There was a significant difference in morning cortisol variability among groups across time periods (<0.0001). Findings suggest that therapeutic touch may be effective for management of symptoms like restlessness coupled with stress reduction. At a time when cost containment is a consideration in health care, therapeutic touch is an intervention that is non-invasive, readily learned, and can provide a non-pharmacologic alternative for selected persons with BSD. Copyright 2009 S. Karger AG, Basel.

Forsch Komplementmed. 2009 Jun;16(3):181-9. Epub 2009 Jun 5. Woods DL, Beck C, Sinha K. School of Nursing, University of California Los Angeles, CA 90095-6919, USA. lwoods@sonnet.ucla.edu

PURPOSE: To better understand how Therapeutic Touch can be used in today's health care arena, this integrative literature review will examine current research that will help answer the question, Does Therapeutic Touch reduce pain? METHOD: An extensive search was conducted of the online databases MEDLINE, CINAHL, Cochrane Library, EMBASE, PsychLIT, and PubMed to retrieve research articles published from 1997 to 2007. FINDINGS: Seven studies that were conducted between 1997 and 2004 were found and only five of the seven were included as pertinent evidence to answer the question. All of the research that was reviewed to answer whether Therapeutic Touch could significantly reduce pain revealed a majority of statistically significant positive results for implementing this intervention.

CONCLUSION: Because there are no identified risks to Therapeutic Touch as a pain relief measure, it is safe to recommend despite the limitations of current research. IMPLICATIONS: Therapeutic Touch should be considered among the many possible nursing interventions for the treatment of pain.

J Holist Nurs. 2009 Jun;27(2):85-92. Epub 2009 Mar 19. Monroe CM. New York University, USA. carolynmonroe2008@hotmail.com

Full Title: Effectiveness of the application of therapeutic touch on weight, complications, and length of hospital stay in preterm newborns attended in a neonatal unit

OBJECTIVE: To determine the effectiveness of therapeutic touch on weight, the presence of postnatal complications, and length of hospital stay in preterm newborns, as well as on parental satisfaction with the care provided. METHOD: We performed an experimental study in the Neonatal Intensive Care Unit of the Virgen Macarena University Hospital in Seville (Spain). Seventy eight premature neonates were randomly assigned to one of the comparison groups (39 in the control group and 39 in the experimental group). The outcome variables of weight, length of hospital stay, the presence of complications, and parental satisfaction were evaluated. Control variables related to maternal socio-demographic and clinic characteristics were also measured. The intervention was based on the application of therapeutic touch. RESULTS: The mean weight in grams was 1,867.80 (SD=149.72) in the experimental group and 1,860 (SD=181.92) in the control group (t=0.148; p=0.883). Length of hospital stay was 16.82 (SD=6.47) in the experimental group and 20.30 (SD=8.04) in the control group (t=2.100; p=0.039). Complications developed in 5.3% of the premature neonates in the experimental group and in 20% of those in the control group (chi(2)=3.78; p=0.049). The odds ratio for developing complications was 1.673 (CI 1.089-2.571). CONCLUSIONS: The application of therapeutic touch reduces the length of hospital stay and the presence of complications. Nevertheless, further research in larger samples is required.

Enferm Clin. 2009 Jan-Feb;19(1):11-5. Epub 2009 Feb 6. Domínguez Rosales R, Albar Marín MJ, Tena García B, Ruíz Pérez MT, Garzón Real MJ, Rosado Poveda MA, González Caro E. Hospital Universitario Virgen Macarena, Sevilla, España.

Full Title: A double-blind randomized controlled pilot trial examining the safety and efficacy of therapeutic touch in premature infants

PURPOSE: To explore the hypothesis that nontouch therapy such as therapeutic touch (TT) reduces stress to a clinically important degree and is safe to use in preterm infants. DESIGN: A pilot randomized, double-blind, controlled trial. SUBJECTS: Two groups of 10 infants were enrolled and randomly assigned to treatment or nontreatment groups. Gestational age was less than 29 weeks. Demographic descriptions of the 2 groups were statistically similar. METHODS: The observer and staff were blinded to assignment; the TT practitioner was blinded to observed measurements. Each infant received either TT or no therapeutic touch (NTT) for 5 minutes on 3 consecutive days at the same time of day, behind a curtain. Heart period variability (HPV) was measured 5 minutes before, during, and after the treatment phase. RESULTS: Examination of the parameters of oxygen saturation and episodes of apnea demonstrated no increase in adverse events in TT group compared with NTT group. Repeated-measures multivariate analysis of variance on HPV revealed differences in the interaction of group assignment with low-frequency, high-frequency, and low-to-high- frequency ratio interaction (F2,143 = 8.076, P = .000) and for group, day, and low-frequency, high-frequency, and low-to-high-frequency ratio (F2,288 = 3.146, P = .015), and in the posttreatment time period (F1,16 = 6.259, P = .024), reflective of greater parasympathetic activity in TT group. CONCLUSION: In this pilot trial, HPV showed an increase for the TT group compared with the NTT group. The study reveals no adverse effects of TT in preterm infants.

Adv Neonatal Care. 2008 Dec;8(6):315-33. Whitley JA, Rich BL. Neonatal Nurseries, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada. julie4453@cogeco.ca

This is quantitative research conducted with 42 students of a public university using the Therapeutic Touch - Krieger-Kunz Method and the application of a questionnaire validated in Brazil to assess anxiety in three sessions. Subjects were divided into two groups: experimental (1), in which the complementary therapy was used; and control (2), in which a mock of the technique, with no therapeutic intention, was applied. The objective was to identify the gradual influence of that health complementary therapy upon the students' state of anxiety. The analysis of the data showed a statistically significant reduction of the state of anxiety in both groups, with pd' 0.05.

Rev Bras Enferm. 2008 Nov-Dec;61(6):841-6. Gomes VM, Silva MJ, Araújo EA. Departamento de Enfermagem Médico-Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP.

by Barbara Goulding, RM

I would like to start off by talking about touch healing with Reiki energies. There are various positions used by the healer or practitioner to use in a healing session. Many practitioners would choose to use the touch method as it's more personal and gives the energy a direct contact with the client. The typical session starts out at the top of the client's head and works it's way down the body as directed by the energy needed by the client and sometimes by the practitioner. The typical session lasts 45 minutes for a full body healing session. How long the sessions are would be determined by the practitioner and considering the needs of the client involved. There are sessions that can be done from a chair with the client in an upright position and the healer works at the shoulder level during that session. Other sessions are done on a Reiki or massage table where the client is laying down on their back and the healer works from the top of the head and down the length of the client to the feet. In either case it is up to the client to decide what is most comfortable for them.

I prefer to use the hands-off method of healing as it's good for those who have a fear of another person being in their body space. The energy works with the body's auric system or etheric body and flows to where it is needed most anyway. The healer then works their hands two inches above the client and is guided either by the energies or intuition as to where to move the hands to next. The method does not matter in either case because the healing energies go to where they are needed by the client and that is what is done in all sessions.

[More]

To better understand how Therapeutic Touch can be used in today's health care arena, this integrative literature review will examine current research that will help answer the question, Does Therapeutic Touch reduce pain? Method: An extensive search was conducted of the online databases MEDLINE, CINAHL, Cochrane Library, EMBASE, PsychLIT, and PubMed to retrieve research articles published from 1997 to 2007. Findings: Seven studies that were conducted between 1997 and 2004 were found and only five of the seven were included as pertinent evidence to answer the question. All of the research that was reviewed to answer whether Therapeutic Touch could significantly reduce pain revealed a majority of statistically significant positive results for implementing this intervention. Conclusion: Because there are no identified risks to Therapeutic Touch as a pain relief measure, it is safe to recommend despite the limitations of current research. Implications: Therapeutic Touch should be considered among the many possible nursing interventions for the treatment of pain.

J Holist Nurs. 2009 Mar 19. Monroe CM.

The purpose of this study was to investigate the effects of non-contact therapeutic touch on post-surgical pain in an elderly population receiving occupational therapy in an acute care hospital unit in the United States. Ninety participants were randomly assigned to three groups (experimental, control and placebo) using a three-group experimental pre-test-post-test design and a randomized clinical trial. The experimental group received the non-contact touch intervention, the control group received routine care and the placebo group received the sound of a metronome set at a steady slow pace. Objective measures included the Memorial Pain Scale, the Tellegen Absorption Scale, the Health Attribution Scale and measures of pulse rate and pupil size, which were performed as repeated measures. In the experimental group, 22 out of 30 (73%) demonstrated a statistically significant decrease in pain intensity scores from pre-test to post-test (t [7] = 7.24, p < 0.01) and were better able to participate in occupations. Further research is recommended to replicate this study. 2009 John Wiley & Sons, Ltd

Occup Ther Int. 2009;16(1):44-56. McCormack GL. Department of Occupational Therapy and Occupational Science, University of Missouri-Columbia, Columbia, MO 65211-4240, USA. mccormackg@health.missouri.edu

To explore the hypothesis that nontouch therapy such as therapeutic touch (TT) reduces stress to a clinically important degree and is safe to use in preterm infants. DESIGN: A pilot randomized, double-blind, controlled trial. SUBJECTS: Two groups of 10 infants were enrolled and randomly assigned to treatment or nontreatment groups. Gestational age was less than 29 weeks. Demographic descriptions of the 2 groups were statistically similar. METHODS: The observer and staff were blinded to assignment; the TT practitioner was blinded to observed measurements. Each infant received either TT or no therapeutic touch (NTT) for 5 minutes on 3 consecutive days at the same time of day, behind a curtain. Heart period variability (HPV) was measured 5 minutes before, during, and after the treatment phase. RESULTS: Examination of the parameters of oxygen saturation and episodes of apnea demonstrated no increase in adverse events in TT group compared with NTT group. Repeated-measures multivariate analysis of variance on HPV revealed differences in the interaction of group assignment with low-frequency, high-frequency, and low-to-high- frequency ratio interaction (F2,143 = 8.076, P = .000) and for group, day, and low-frequency, high-frequency, and low-to-high-frequency ratio (F2,288 = 3.146, P = .015), and in the posttreatment time period (F1,16 = 6.259, P = .024), reflective of greater parasympathetic activity in TT group. CONCLUSION: In this pilot trial, HPV showed an increase for the TT group compared with the NTT group. The study reveals no adverse effects of TT in preterm infants.

Adv Neonatal Care. 2008 Dec;8(6):315-33. Whitley JA, Rich BL. Neonatal Nurseries, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada. julie4453@cogeco.ca

Fibromyalgia is a common, chronic pain condition for which patients frequently use complementary and alternative medicine, including Reiki. Our objective was to determine whether Reiki is beneficial as an adjunctive fibromyalgia treatment. DESIGN: This was a factorial designed, randomized, sham-controlled trial in which participants, data collection staff, and data analysts were blinded to treatment group. SETTING/LOCATION: The study setting was private medical offices in the Seattle, Washington metropolitan area. SUBJECTS: The subjects were comprised 100 adults with fibromyalgia. INTERVENTION: Four (4) groups received twice-weekly treatment for 8 weeks by either a Reiki master or actor randomized to use direct touch or no touch (distant therapy). OUTCOME MEASURES: The primary outcome was subjective pain as measured by visual analog scale at weeks 4, 8, and 20 (3 months following end of treatment). Secondary outcomes were physical and mental functioning, medication use, and health provider visits. Participant blinding and adverse effects were ascertained by self-report. Improvement between groups was examined in an intention-to-treat analysis. RESULTS: Neither Reiki nor touch had any effect on pain or any of the secondary outcomes. All outcome measures were nearly identical among the 4 treatment groups during the course of the trial. CONCLUSION: Neither Reiki nor touch improved the symptoms of fibromyalgia. Energy medicine modalities such as Reiki should be rigorously studied before being recommended to patients with chronic pain symptoms.

J Altern Complement Med. 2008 Nov;14(9):1115-22. Assefi N, Bogart A, Goldberg J, Buchwald D. Department of Medicine, University of Washington, Seattle, WA, USA.

This pilot study explored the experience of participating in a Therapeutic Touch practice group. A qualitative descriptive-exploratory method was used, involving 12 members of practice groups in Ontario and British Columbia, Canada. Analysis of the data using an extraction-synthesis process yielded four themes: (a) learning with others through sharing and hands-on experience is valued; (b) connecting with a network of supportive relationships that sustain self and Therapeutic Touch practice; (c) comfort-discomfort arising with self, others, or ideas; and (d) meaningful changes emerge while experiencing group energy and Therapeutic Touch. The findings expand current knowledge about the positive aspects of participating in practice groups and provide a beginning understanding of member discomfort, which had not been previously reported. This knowledge will be useful to Therapeutic Touch organizations, practice group leaders, and group members. It will also guide health care agencies and practitioners of other healing modalities who may be considering establishing practice groups.

J Holist Nurs. 2008 Sep;26(3):161-8; discussion 169-72. Moore T, Ting B, Rossiter-Thornton M. The Centre for Movement Disorders, Markham, Ontario. tmooremscn@rogers.com

Pain is a global public health problem affecting the lives of large numbers of patients and their families. Touch therapies (Healing Touch (HT), Therapeutic Touch (TT) and Reiki) have been found to relieve pain, but some reviews have suggested there is insufficient evidence to support their use.

OBJECTIVES: To evaluate the effectiveness of touch therapies (including HT, TT, and Reiki) on relieving both acute and chronic pain; to determine any adverse effect of touch therapies. SEARCH STRATEGY: Various electronic databases, including The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and others from their inception to June 2008 were searched. Reference lists and bibliographies of relevant articles and organizations were checked. Experts in touch therapies were contacted.

SELECTION CRITERIA: Randomized Controlled Trials (RCTs) or Controlled Clinical Trials (CCTs) evaluating the effect of touch on any type of pain were included. Similarly, only studies using a sham placebo or a 'no treatment' control was included.

DATA COLLECTION AND ANALYSIS: Data was extracted and quality assessment was conducted by two independent review authors. The mean pain intensity for completing all treatment sessions was extracted. Pain intensity from different pain measurement scales were standardized into a single scale. Comparisons between the effects of treatment groups and that of control groups were made.

MAIN RESULTS: Twenty four studies involving 1153 participants met the inclusion criteria. There were five, sixteen and three studies on HT, TT and Reiki respectively. Participants exposed to touch had on average of 0.83 units (on a 0 to ten scale) lower pain intensity than unexposed participants (95% Confidence Interval: -1.16 to -0.50). Results of trials conducted by more experienced practitioners appeared to yield greater effects in pain reduction. It is also apparent that these trials yielding greater effects were from the Reiki studies. Whether more experienced practitioners or certain types of touch therapy brought better pain reduction should be further investigated. Two of the five studies evaluating analgesic usage supported the claim that touch therapies minimized analgesic usage. The placebo effect was also explored. No statistically significant (P = 0.29) placebo effect was identified.

AUTHORS' CONCLUSIONS: Touch therapies may have a modest effect in pain relief. More studies on HT and Reiki in relieving pain are needed. More studies including children are also required to evaluate the effect of touch on children.

Cochrane Database Syst Rev. 2008 Oct 8;(4):CD006535. So PS, Jiang Y, Qin Y. Surgery, Prince of Wales Hospital, Ward 3D, Prince of Wales Hospital, Ngan Shing Street Shatin, Hong Kong, Hong Kong, China, HKSAR. Sophiaso@gmail.com

Complementary and alternative medicine (CAM) techniques are commonly used in hospitals and private medical facilities; however, the effectiveness of many of these practices has not been thoroughly studied in a scientific manner. Developed by Dr. Dolores Krieger and Dora Kunz, Therapeutic Touch is one of these CAM practices and is a highly disciplined five-step process by which a practitioner can generate energy through their hands to promote healing. There are numerous clinical studies on the effects of TT but few in vitro studies. Our purpose was to determine if Therapeutic Touch had any effect on osteoblast proliferation, differentiation, and mineralization in vitro. TT was performed twice a week for 10 min each on human osteoblasts (HOBs) and on an osteosarcoma-derived cell line, SaOs-2. No significant differences were found in DNA synthesis, assayed by [(3)H]-thymidine incorporation at 1 or 2 weeks for SaOs-2 or 1 week for HOBs. However, after four TT treatments in 2 weeks, TT significantly (p = 0.03) increased HOB DNA synthesis compared to controls.

Immunocytochemistry for Proliferating Cell Nuclear Antigen (PCNA) confirmed these data. At 2 weeks in differentiation medium, TT significantly increased mineralization in HOBs (p = 0.016) and decreased mineralization in SaOs-2 (p = 0.0007), compared to controls. Additionally, Northern blot analysis indicated a TT-induced increase in mRNA expression for Type I collagen, bone sialoprotein, and alkaline phosphatase in HOBs and a decrease of these bone markers in SaOs-2 cells. In conclusion, Therapeutic Touch appears to increase human osteoblast DNA synthesis, differentiation and mineralization, and decrease differentiation and mineralization in a human osteosarcoma-derived cell line. (c) 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

J Orthop Res. 2008 Nov;26(11):1541-6. Jhaveri A, Walsh SJ, Wang Y, McCarthy M, Gronowicz G. Department of Orthopaedics, University of Connecticut Health Center, Farmington, Connecticut 06030-3105, USA.

CONTEXT: The use of complementary therapies in conjunction with conventional care has great potential to address patient pain, complication rates, and recovery time. Few studies of such therapies have been conducted in hospital settings where some of the most stressful procedures are performed on a regular basis. OBJECTIVE: We hypothesized that patients receiving healing touch (HT) would see improved outcomes. DESIGN: Patients were randomized into 1 of 3 treatment groups: no intervention, partial intervention (visitors), and an HT group. SETTING: This study was conducted in an acute-care hospital in a large metropolitan area. PATIENTS OR OTHER PARTICIPANTS: Patients undergoing first-time elective coronary artery bypass surgery were invited to participate. There were 237 study subjects. INTERVENTION: HT is an energy-based therapeutic approach to healing that arose out of nursing in the early 1980s. HT aids relaxation and supports the body's natural healing process. MAIN OUTCOME MEASURES: This study consisted of 6 outcome measures: postoperative length of stay, incidence of postoperative atrial fibrillation, use of anti-emetic medication, amount of narcotic pain medication, functional status, and anxiety. RESULTS: Analysis was conducted for all patients and separately by inpatient/outpatient status. Though no significant decrease in the use of pain medication, anti-emetic medication, or incidence of atrial fibrillation was observed, significant differences were noted in anxiety scores and length ofstay. All HT patients showed a greater decrease in anxiety scores when compared to the visitor and control groups. In addition, there was a significant difference in outpatient HT length of stay when compared to the visitor and control groups.

MacIntyre B, Hamilton J, Fricke T, Ma W, Mehle S, Michel M. Cardiovascular Telemetry, HealthEast Saint Joseph's Hospital, St Paul, Minnesota, USA. Altern Ther Health Med. 2008 Jul-Aug;14(4):24-32.

CONTEXT: Spinal cord injury often results in chronic pain syndromes that conventional pain management is unable to resolve. Healing Touch (HT) is a biofield therapy that involves using the hands to promote healing and mediate the perception of pain by affecting the energy field of the person. The practice of HT is based on the premise that the energy field has the ability to provide valuable information about the person's physical, emotional, mental, and spiritual condition and can influence the dense matter of physical form. OBJECTIVE: This secondary analysis using case study reviews describes two different experiences of receiving a HT session for management of chronic neuropathic pain and its sequelae, utilizing energy field data and reports of participants and their HT practitioners. DESIGN: Qualitative case study approach was used. SETTING: Data were obtained from 42 HT sessions that took place within the homes of seven veterans with spinal cord injury. METHOD: Two cases involving the most common patterns of response were selected from seven cases to represent the participants' and practitioners' experiences. A descriptive qualitative approach informed the results. RESULTS: The findings indicate that a variety of experiences can exist in individuals with chronic pain due to spinal cord injury; experiences will also vary with their healing touch practitioners. There are commonalities in the perception of the practitioners in the damage to the energy field and energy centers, with individualized and consistent resolution of the field over time.

Wardell DW, Rintala D, Tan G. The University of Texas Houston, Health Science Center, School of Nursing, Houston, TX, USA. diane.wardell@uth.tmc.edu Explore (NY). 2008 May-Jun;4(3):187-95.

Reiki touch therapy is a complementary biofield energy therapy that involves the use of hands to help strengthen the body's ability to heal. There is growing interest among nurses to use Reiki in patient care and as a self-care treatment, however, with little supportive empirical research and evidence to substantiate these practices. The purpose of this integrative review is to begin the systematic process of evaluating the findings of published Reiki research. Selected investigations using Reiki for effects on stress, relaxation, depression, pain, and wound healing management, among others is reviewed and summarized. A summary of Reiki studies table illustrates the study descriptions and Reiki treatment protocols specified in the investigations. Synthesis of findings for clinical practice and implications for future research are explored.

Vitale A. Villanova University, 800 Lancaster Avenue, Villanova, PA 19085, USA. annern2@gmail.com Holist Nurs Pract. 2007 Jul-Aug;21(4):167-79; quiz 180-1.

BACKGROUND: Therapeutic touch (TT), a complementary therapy, has been shown to decrease stress, anxiety, and pain in adults and children, as well as improve mobility in patients with arthritis and fibromyalgia. However, less has been reported about the effectiveness of this therapy with infants, particularly preterm infants. OBJECTIVES: The aims of this research study were to explore the nature of the use of TT with preterm infants and describe a TT treatment process for this vulnerable population. DESIGN: Narrative inquiry and qualitative descriptive methods were used to discover knowledge about how TT is used with preterm infants. DATA COLLECTION: Telephone/in-person interviews and written narratives provided the data describing nurses' use of TT with preterm infants. PARTICIPANTS: The participants were registered nurses who practiced TT with preterm infants for varying years of experience. RESULTS: The participants described the responses of infants, 25 to 37 weeks postgestational age, whom they treated with TT. The infants' responses to TT included reduced heart and respiratory rates, enhanced ability to rest, improved coordination in sucking, swallowing, and breathing, and a greater ability to engage with the environment. The practitioners described the phases and elements of TT for preterm infants, which revealed unique patterns, for example, the treatment phase included the elements of smoothing and containing. CONCLUSION: The description that emerged from the practitioners' narratives of the TT treatment process for preterm infants provides preliminary data for the systematic use and evaluation of TT as an adjunct to facilitating preterm infants' physiological, behavioral, energy field development, and well-being.

Hanley MA. School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX. Explore (NY). 2008 Jul-Aug;4(4):249-58.

BACKGROUND: Energy medicine (EM) practitioners often claim to be able to perceive an energetic field associated with the body and to be able to use this skill to diagnose illness and guide treatment strategies. If a biofield associated with cells growing in culture is perceptible to EM practitioners, such an in vitro model would be a useful resource for investigating biofield perception that would provide some unique advantages over clinical models. OBJECTIVE: To evaluate whether EM practitioners can perceive the presence of cultured human cells without visual cues. DESIGN: Three randomized double-blinded pilot studies were used to evaluate the ability of participants to distinguish a flask containing cancer cells growing in culture medium from a flask containing either culture medium or sterile water. Each study consisted of six independent experiments: three with EM practitioners and three with non-practitioners. The number of independent trials for each experiment was estimated by statistical power analyses of the design. Practitioners' feedback from the first two studies was used to revise the protocol for the subsequent studies, with the intent to eliminate potential problems in making this distinction. Labeled flasks ("cells" and "no-cells") were added to serve as references for comparison in the second study and the number of experimental trials was reduced in the third study. SUBJECTS: Eight experienced EM practitioners and nine non-practitioners (laboratory personnel with no EM training). SETTING: A basic science laboratory and office at an academic medical center. OUTCOME MEASURES: In the first 2 studies, we determined the number of correct determinations in a series of 34 trials. In the third study, we determined the number of correct determinations in a series of 10 trials. RESULTS: All participants performed at the level expected by chance. CONCLUSION: While preliminary and inconclusive, these pilot studies found no evidence that EM practitioners can perceive a biofield associated with cancer cells growing in culture. Copyright Mary Ann Liebert, Inc.

J Altern Complement Med. 2004 Jun;10(3) Yount G, Smith S, Avanozian V, West J, Moore D, Freinkel A. California Pacific Medical Center Research Institute, San Francisco, CA 94115, USA. yountg@sutterhealth.org

OBJECTIVES: Biofield energy healing involves controversial concepts, and although numerous controlled trials have evaluated the effects, little attention has been paid to the phenomenon from the perspective of the therapists themselves. DESIGN: Qualitative research. SETTINGS/LOCATION: Large Midwest metropolitan area. Interviews were generally conducted in the therapists' place of business. SUBJECTS: Experienced biofield energy therapists from several different disciplines. INTERVENTIONS: In-depth semistructured interviews, tape-recorded, transcribed verbatim, videotapes of demonstrations. OUTCOME MEASURES: We used a grounded theory approach to uncover relevant dimensions and themes related to the process of biofield energy healing. RESULTS: Major overall themes related to the "nature of energy" and the "healer-client relationship." Seven dimensions of the nature of energy include sources of energy, entities with energy, human energy anatomy, descriptions of energy, movement of energy, action of energy, and perception of energy. The dimensions build on one another to describe an energetic world view. The other major theme, the healer-client relationship, contains the central concept of healing facilitation as the goal of the experience. Compatibility and collaboration are critical to that process, as are creating a sense of trust and adhering to ethical standards. Communication underpins the whole process. CONCLUSIONS: The biofield energy therapists share a common energetic world view, wherein they must surrender to a universal energy while simultaneously creating a therapeutic alliance with the client who is also an active agent in healing process. This understanding has the potential to alter our assumptions about research design in biofield energy healing.

J Altern Complement Med. 2004 Dec;10(6) Warber SL, Cornelio D, Straughn J, Kile G. University of Michigan, Michigan Integrative Medicine, 715 East Huron Street, Ann Arbor, MI 48104-1555, USA. swarber@umich.edu

OBJECTIVE: To evaluate a battery of biofield awareness tasks that address bioelectromagnetic and consciousness related mechanisms of action, and examine individual differences in integrative biofield awareness (IBA). METHODS: Six (6) biofield awareness tasks were designed: 2 involved the experimenter placing his or her hands near the subject, 2 involved intense staring with associated eye movements approximately 3' from the subject, and 2 involved gentle intention with virtually no movement. Each task required a binary response from the subject. There were 10 trials per task for a total of 60 trials; blocks of 6 trials contained one of each task. Subjects were 165 undergraduate psychology students at the University of Arizona Tucson, AZ. Subjects were also assessed on their awareness of their own biofields, and they filled out various questionnaires, including estimates of how well they thought they would do and their openness to spiritual beliefs and experiences. RESULTS: Percent IBA accuracy for the entire sample (n = 165) was 57.7 +/- 10.3% and was significantly above chance (50%) performance (t = 9.58, p < 0.0000001). Each of the 6 tasks was individually significant. Subjects significantly (t = -2.72; p < 0.007) underestimated their IBA performance below chance (mean, 46.1 +/- 18.4%). However, higher estimates predicted higher IBA (r = 0.26, n = 164, p < 0.0008). Measures of subjects' self-awareness of their own biofields, as well as belief in, and experience of, extrasensory perception (ESP) also predicted higher IBA. CONCLUSIONS: The findings support claims of energy healers that biofield awareness can be modulated both bioelectromagnetically (locally) and via conscious intent (distally), and that individual differences in biofield awareness are related to self-awareness and sensitivity to others.

J Altern Complement Med. 2005 Feb;11(1) Nelson LA, Schwartz GE. Department of Psychology, University of Arizona, Tucson, AZ 85721-0068, USA.

OBJECTIVES: To explore the biofield aspect of cancer care; to identify the benefits of energetic approaches in cancer care; and to examine one approach through a case study. DATA SOURCES: Current research and national reports on biofield approaches in complementary therapies. CONCLUSION: Caring for the biofield is important in assisting the patient with cancer to enhance vitality, reduce pain, fatigue, and other side effects as a result of cancer treatments. IMPLICATIONS FOR NURSING PRACTICE: Cancer care must be holistic to provide maximal healing opportunities for patients. Consideration of the biofield is an important aspect of this care.

Semin Oncol Nurs. 2005 Aug;21(3) Hibdon SS. Student Health and Wellness Center, University of North Texas, Denton, TX, USA. Hibdon@dsa.admin.unt.edu

Reiki touch therapy is a complementary biofield energy therapy that involves the use of hands to help strengthen the body's ability to heal. There is growing interest among nurses to use Reiki in patient care and as a self-care treatment, however, with little supportive empirical research and evidence to substantiate these practices. The purpose of this integrative review is to begin the systematic process of evaluating the findings of published Reiki research. Selected investigations using Reiki for effects on stress, relaxation, depression, pain, and wound healing management, among others is reviewed and summarized. A summary of Reiki studies table illustrates the study descriptions and Reiki treatment protocols specified in the investigations. Synthesis of findings for clinical practice and implications for future research are explored.

Holist Nurs Pract. 2007 Jul-Aug;21(4) Vitale A. Villanova University, 800 Lancaster Avenue, Villanova, PA 19085, USA. annern2@gmail.com

CONTEXT: Spinal cord injury often results in chronic pain syndromes that conventional pain management is unable to resolve. Healing Touch (HT) is a biofield therapy that involves using the hands to promote healing and mediate the perception of pain by affecting the energy field of the person. The practice of HT is based on the premise that the energy field has the ability to provide valuable information about the person's physical, emotional, mental, and spiritual condition and can influence the dense matter of physical form. OBJECTIVE: This secondary analysis using case study reviews describes two different experiences of receiving a HT session for management of chronic neuropathic pain and its sequelae, utilizing energy field data and reports of participants and their HT practitioners. DESIGN: Qualitative case study approach was used. SETTING: Data were obtained from 42 HT sessions that took place within the homes of seven veterans with spinal cord injury. METHOD: Two cases involving the most common patterns of response were selected from seven cases to represent the participants' and practitioners' experiences. A descriptive qualitative approach informed the results. RESULTS: The findings indicate that a variety of experiences can exist in individuals with chronic pain due to spinal cord injury; experiences will also vary with their healing touch practitioners. There are commonalities in the perception of the practitioners in the damage to the energy field and energy centers, with individualized and consistent resolution of the field over time.

Explore (NY). 2008 May-Jun;4(3):187-95. Wardell DW, Rintala D, Tan G. The University of Texas Houston, Health Science Center, School of Nursing, Houston, TX, USA. diane.wardell@uth.tmc.edu

by Anne H. Spencer. Ph.D.

You have healing power! This is a truism that everyone can honor if they will let the energy flow. Mother's rub their babies back and the little child falls into a peaceful sleep. Nurses stroke infants in Intensive Care and they rest easily. Daddies kiss skinned knees and they are all better. Sisters hold the dying and they slip into heavenly bliss. Therapists touch clients and relaxation occurs. What is this "Mystical Power?"

[More]

Our objective was to assess the effect of Therapeutic Touch (TT) on the proliferation of normal human cells in culture compared to sham and no treatment. Several proliferation techniques were used to confirm the results, and the effect of multiple 10-minute TT treatments was studied. Design: Fibroblasts, tendon cells (tenocytes), and bone cells (osteoblasts) were treated with TT, sham, or untreated for 2 weeks, and then assessed for [(3)H]-thymidine incorporation into the DNA, and immunocytochemical staining for proliferating cell nuclear antigen (PCNA). The number of PCNA-stained cells was also quantified. For 1 and 2 weeks, varying numbers of 10-minute TT treatments were administered to each cell type to determine whether there was a dose-dependent effect. Results: TT administered twice a week for 2 weeks significantly stimulated proliferation of fibroblasts, tenocytes, and osteoblasts in culture (p = 0.04, 0.01, and 0.01, respectively) compared to untreated control. These data were confirmed by PCNA immunocytochemistry. In the same experiments, sham healer treatment was not significantly different from the untreated cultures in any group, and was significantly less than TT treatment in fibroblast and tenocyte cultures. In 1-week studies involving the administration of multiple 10-minute TT treatments, four and five applications significantly increased [(3)H]-thymidine incorporation in fibroblasts and tenocytes, respectively, but not in osteoblasts. With different doses of TT for 2 weeks, two 10-minute TT treatments per week significantly stimulated proliferation in all cell types. Osteoblasts also responded to four treatments per week with a significant increase in proliferation. Additional TT treatments (five per week for 2 weeks) were not effective in eliciting increased proliferation compared to control in any cell type. Conclusions: A specific pattern of TT treatment produced a significant increase in proliferation of fibro-blasts, osteoblasts, and tenocytes in culture. Therefore, TT may affect normal cells by stimulating cell proliferation.

J Altern Complement Med. 2008 Mar 27 Gronowicz GA, Jhaveri A, Clarke LW, Aronow MS, Smith TH. Department of Surgery, University of Connecticut Health Center, Farmington, CT.

Therapeutic Touch (TT) is a complementary healing modality used by health care providers to reduce anxiety, accelerate relaxation, decrease pain, and enhance immunity. Research studies report outcomes of TT treatments, but few describe the specific process. This qualitative research study was conducted to describe the nature of the core process of TT in adults and full term infants as practiced by five professional nurses, each treating one adult and one infant. Analysis of data obtained from interviews and focused participant observations was conducted. Findings provide empirical data to depict an overall process divided into three phases: (a) preparation, (b) treatment, and (c) termination, that adheres to the standard process as described by Krieger. It expands on the description of each phase, including two new subcomponents, orienting and disengagement, not previously seen in the literature. Lastly, the study describes the modification of the TT process with infants compared to adults.

J Holist Nurs. 2008 Mar;26(1):17-24. Coppa D. University of Rhode Island.

Limited effective strategies exist to alleviate or treat disruptive behaviors in people with Alzheimer's disease. Fifty-one residents of a long-term care facility with Alzheimer's disease were randomly assigned to one of three intervention groups. A multiple time series, blinded, experimental design was used to compare the effectiveness of therapeutic touch, simulated therapeutic touch, and usual care on disruptive behavior. Three forms of disruptive behavior comprised the dependent variables: physical aggression, physical nonaggression, and verbal agitation. Physical nonaggressive behaviors decreased significantly in those residents who received therapeutic touch compared with those who received the simulated version and the usual care. No significant differences in physically aggressive and verbally agitated behaviors were observed across the three study groups. The study provided preliminary evidence for the potential for therapeutic touch in dealing with agitated behaviors by people with dementia. Researchers and practitioners must consider a broad array of strategies to deal with these behaviors.

West J Nurs Res. 2008 Feb 13 Hawranik P, Johnston P, Deatrich J. University of Manitoba.

Rogers's Science of Unitary Human Beings framed this study of pandimensional pattern changes in healers and healees paired for an 8-week series of Therapeutic Touch (TT) sessions. Comparison of healee patterns before and after 141 TT sessions supported the hypotheses that healees would manifest decreased pulse and blood pressure, and reduced pain and stress (p < .05). Duration of TT sessions was not preset but determined by healers according to energy cues. TT time was not related to pattern changes, consistent with the clinical practice of TT and the atemporal nature of Rogers's conceptual framework. Healers and healees showed parallel changes after the TT series. Participants manifested greater spirituality (p <.05). Although increases in three of the four dimensions of power were significant (p <.05), changes in power measured as a whole were not. Contrary to expectations, manifestations of diversity were decreased in healers and healees.

J Holist Nurs. 2007 Dec;25(4):217-25; discussion 226-7. Smith DW, Broida JP. University of Southern Maine College of Nursing and Health Professions, USA.

This paper analyses the demarcation problem from the perspective of four philosophers: Popper, Kuhn, Lakatos and Feyerabend. To Popper, pseudoscience uses induction to generate theories, and only performs experiments to seek to verify them. To Popper, falsifiability is what determines the scientific status of a theory. Taking a historical approach, Kuhn observed that scientists did not follow Popper's rule, and might ignore falsifying data, unless overwhelming. To Kuhn, puzzle-solving within a paradigm is science. Lakatos attempted to resolve this debate, by suggesting history shows that science occurs in research programmes, competing according to how progressive they are. The leading idea of a programme could evolve, driven by its heuristic to make predictions that can be supported by evidence. Feyerabend claimed that Lakatos was selective in his examples, and the whole history of science shows there is no universal rule of scientific method, and imposing one on the scientific community impedes progress. These positions are used in turn, to examine the scientific status of therapeutic touch theory. The paper concludes that imposing a single rule of method can impede progress, in the face of multiple epistemologies, and the choice of scientific approach should be a pragmatic one based on the aims of the programme.

Int J Nurs Pract. 2007 Dec;13(6):324-30. Newbold D, Roberts J. Florence Nightingale School of Nursing and Midwifery at King's College London, London, UK. david.newbold@kcl.ac.uk

PURPOSE: The purpose of this randomized pilot was to determine feasibility of testing Reiki, a complementary therapy intervention, for women undergoing breast biopsy (BB). BACKGROUND: Increasingly women face the possibility of BB, the definitive test for breast cancer. Psychological distress associated with BB includes anxiety and depression. Reiki was proposed as an intervention to decrease anxiety and promote relaxation. METHOD: Thirty-two women scheduled for BB were randomized to Reiki intervention versus conventional care control. Anxiety and depression were evaluated using self-report questionnaires. FINDINGS: Analysis found no significant mean differences between groups over time. Comparably low baseline anxiety levels (possible selection bias) decreased naturally with time allowing little room for observing treatment effect. CONCLUSIONS: Reiki, when administered in the naturalistic setting of a complementary therapy office, did not suggest evidence of efficacy. An intervention offered within the bounds of the conventional care setting may be more feasible for addressing BB distress.

J Holist Nurs. 2007 Dec;25(4):238-48; discussion 249-51. Potter PJ. University of Washington School of Nursing.

Given the current necessity of retaining qualified nurses, a self-care program consisting of Yoga, Tai Chi, Meditation classes, and Reiki healing sessions was designed for a university-based hospital. The effectiveness of these interventions was evaluated using self-care journals and analyzed using a Heideggerian phenomenological approach. Outcomes of the self-care classes described by nurses included: (a) noticing sensations of warmth, tingling, and pulsation which were relaxing, (b) becoming aware of an enhanced problem solving ability, and (c) noticing an increased ability to focus on patient needs. Hospitals willing to invest in self-care options for nurses can anticipate patient and work related benefits.

Issues Ment Health Nurs. 2007 Oct;28(10):1141-55. Raingruber B, Robinson C. University of California-Davis Medical Center, 2315 Stockton Boulevard, Sacramento, CA 95817, USA. Bonnie.raingruber@ucdmc.ucdavis.edu

To explore the hypothesis that nontouch therapy such as therapeutic touch (TT) reduces stress to a clinically important degree and is safe to use in preterm infants. DESIGN: A pilot randomized, double-blind, controlled trial. SUBJECTS: Two groups of 10 infants were enrolled and randomly assigned to treatment or nontreatment groups. Gestational age was less than 29 weeks. Demographic descriptions of the 2 groups were statistically similar. METHODS: The observer and staff were blinded to assignment; the TT practitioner was blinded to observed measurements. Each infant received either TT or no therapeutic touch (NTT) for 5 minutes on 3 consecutive days at the same time of day, behind a curtain. Heart period variability (HPV) was measured 5 minutes before, during, and after the treatment phase. RESULTS: Examination of the parameters of oxygen saturation and episodes of apnea demonstrated no increase in adverse events in TT group compared with NTT group. Repeated-measures multivariate analysis of variance on HPV revealed differences in the interaction of group assignment with low-frequency, high-frequency, and low-to-high- frequency ratio interaction (F2,143 = 8.076, P = .000) and for group, day, and low-frequency, high-frequency, and low-to-high-frequency ratio (F2,288 = 3.146, P = .015), and in the posttreatment time period (F1,16 = 6.259, P = .024), reflective of greater parasympathetic activity in TT group. CONCLUSION: In this pilot trial, HPV showed an increase for the TT group compared with the NTT group. The study reveals no adverse effects of TT in preterm infants.

Adv Neonatal Care. 2008 Dec;8(6):315-33. Whitley JA, Rich BL. Neonatal Nurseries, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada.

The purpose of this study was to determine if Reiki energy therapy, level I, was taught as a self-care practice to healthcare providers, would their caring perceptions change? Methodological triangulation technique, including a self-report caring scale and interviews, was used, demonstrating positive changes in perceptions of participants' caring behaviors.

Brathovde A.

Monmouth Medical Center, Long Branch, NJ 07740, USA. abrathovde@sbhcs.com

Holist Nurs Pract. 2006 Mar-Apr;20(2):95-101.

Tactile touch is a complementary therapy that is rarely undertaken in intensive care units (ICUs) in Sweden. This study was a part of a larger project that examines whether tactile touch can relieve the suffering of patients in the ICU. The aim of this study was to describe nurses' lived experience of preparation before giving tactile touch in an ICU. Four assistant nurses and one registered nurse, each with diplomas in tactile touch working at three different ICUs in Sweden, participated in the study. A phenomenological approach was chosen to achieve experience-based and person-centred descriptions. Data were collected through interviews and analysed following Giorgi's method. The main finding was that before providing tactile touch, the nurses needed to add the new role as touch therapists, to their professional one. The essential aspect being the transition from nurse to touch therapist. Findings included a general structure, with four constituents; a sense of inner balance, an unconditional respect for the patients' integrity, a relationship with the patient characterised by reciprocal trust, and a supportive environment. Furthermore, the study underlines the difficulties to integrate a complementary caring act, such as tactile touch, in a highly technological environment.

Henricson M, Berglund AL, Segesten K.

University College of BorÂs, School of Health Science, Allegatan, SE-501 90 BorÂs, Sweden. maria.henricson@hb.se

Intensive Crit Care Nurs. 2006 Aug;22(4):239-45. Epub 2006 Mar 15.

Complementary and alternative medicine (CAM) has become much in vogue, and CAM practitioners have increased in tandem with this. The trend of using CAM for treating epilepsy does not differ from that in other medical conditions, with nearly one half of patients using CAM. In this article we review the major complementary and alternative medicines used for treatment of epilepsy. They include mind-body medicines such as reiki and yoga; biologic-based medicine such as herbal remedies, dietary supplements, and homeopathy; and manipulative-based medicine such as chiropractic. In the available literature, there is a sense of the merit of these therapies in epilepsy, but there is a paucity of research in these areas. Individualized therapies such as homeopathy and reiki cannot be compared with medicines in a conventional pharmaceutical model. Hence, many studies are inconclusive. In a science of double-blind, randomized controlled trials, appropriate designs and outcome measurements need to be tailored to CAM. This article explains the principles of the major CAM therapies in epilepsy, and discusses peer-reviewed literature where available. More effort needs to be put into future trials, with the assistance of qualified CAM professionals to ensure conformation to their therapeutic principles.

Ricotti V, Delanty N.

Curr Neurol Neurosci Rep. 2006 Jul;6(4):347-53.

After the diagnosis of cancer in a child is made, many families complement conventional medical care with lifestyle changes including diet, exercise, environment, and mind-body therapies. Biomechanical, bioenergetic, and other therapies are also sometimes sought. These include massage, chiropractic, acupuncture/acupressure, therapeutic touch, Reiki, homeopathy, and prayer. Some of these complementary therapies have well-established roles in cancer therapy for children, whereas others are controversial and require more research.

McLean TW, Kemper KJ.

Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. tmclean@wfubmc.edu

J Soc Integr Oncol. 2006 Fall;4(4):187-93.

GOALS OF WORK: Therapeutic touch (TT) is a complementary and alternative medicine (CAM) treatment modeled on the ancient practice of "laying on of hands" that has been developed into a contemporary supportive care intervention. Evidence-based support for TT is emerging with increasingly more sophisticated studies; however, flaws in early research contributed to a perception that TT is poor science. Yet TT is a safe CAM treatment that is highly valued by patients and can be integrated into conventional settings. Having offered TT as a supportive care intervention within a provincial cancer agency for 20 years, we have grappled with the issues of evidence and of satisfying both patient demands and administrative needs. Our TT practice evolved in response to changing needs and our experience may be useful to those who are contemplating offering a CAM treatment within a conventional setting. OBJECTIVES: The objectives are to describe TT practice within a conventional cancer agency and to identify the important issues and success factors of this program and, secondly, to discuss TT research and our approach to the issues. MAIN RESULTS AND CONCLUSIONS: TT is a safe and beneficial intervention for cancer patients that can be integrated within a conventional setting, providing that the program evolves with changing patient and organizational needs. Lessons gleaned include (1) positioning TT within the context of research and evidence-based practice, (2) developing and adhering to standards of practice and professionalism, and (3) maintaining a nonpartisan attitude and communicating a plausible rationale.

Support Care Cancer. 2007 Jul 3 Stephen JE, Mackenzie G, Sample S, Macdonald J.

Faculty of Health Sciences, Simon Fraser University, East Academic Annex #1000, 8888 University Drive, Burnaby, British Colombia, V5A 1S6, Canada.

The nervous breakdown of a 22-year-old, young woman was caused by severe sexual abuse in childhood, which was repressed over many years. During therapy, the patient accumulated resources to start the painful integration of these old traumas. Using holistic existential therapy in accordance with the life mission theory and the holistic process theory of healing, she finally was able to confront her old traumas and heal her existence. She seemingly recovered completely (including regaining full emotional range) through holistic existential therapy, individually and in a group. The therapy took 18 months and more than 100 hours of intensive therapy. In the beginning of the therapy, the issues were her physical and mental health; in the middle of the therapy, the central issue was her purpose of life and her love life; and at the conclusion of the therapy, the issue was gender and sexuality. The strategy was to build up her strength for several months, mobilizing hidden resources and motivation for living, before the old traumas could be confronted and integrated. The therapy was based on quality of life philosophy, on the life mission theory, the theory of ego, the theory of talent, the theory of the evil side of man, the theory of human character, and the holistic process theory of healing. The clinical procedures included conversation, philosophical training, group therapeutic tools, extended use of therapeutic touch, holistic pelvic examination, and acceptance through touch was used to integrate the early traumas bound to the pelvis and scar tissue in the sexual organs. She was processed according to 10 levels of the advanced toolbox for holistic medicine and the general plan for clinical holistic psychiatry. The emotional steps she went through are well described by the scale of existential responsibility. The case story of Anna is an example of how even the most severely ill patient can recover fully with the support of holistic medical treatment, making her feel, understand, and let go of her negative beliefs and life-denying decisions.

ScientificWorldJournal. 2006 Feb 2;6:1965-76. Related Articles, Links

Ventegodt S, Clausen B, Merrick J.

The Quality of Life Research Center, Copenhagen K, Denmark. ventegodt@livskvalitet.org

Research on touch therapies is still in the early stages of development. Studies of Therapeutic Touch, Healing Touch, and Reiki are quite promising; however, at this point, they can only suggest that these healing modalities have efficacy in reducing anxiety; improving muscle relaxation; aiding in stress reduction, relaxation, and sense of well-being; promoting wound healing; and reducing pain. The multidimensional aspects of healing inherent in patient care continue to be expanded and facilitated by our understanding and application of energy therapies.

Nurs Clin North Am. 2007 Jun;42(2):243-59.

Engebretson J, Wardell DW.

Department of Target Populations, School of Nursing, University of Texas Health Science Center-Houston, 6901 Bertner Avenue, Room 764, Houston, TX 77030, USA.

The growing popularity and use of therapeutic touch (TT) is an issue that has generated controversy and concern within the medical community. While anecdotal and traditional scientific evidence suggest that TT would be an advantageous addition for clinics and hospitals to include in their armamentarium of complementary interventions within the realm of traditional medicine, TT has not become widely available in the U.S. One reason for the lack of availability may be the dearth of conclusive scientific support for TT's efficacy and, therefore, its inclusion in clinic and hospital treatment planning would give it the appearance of legitimate practice, which it may not yet deserve. Whether or not deserved, if TT were added to hospital and clinic treatment protocols without substantial scientific support, it would be thought to have the implicit support of the scientific community, at which point the question of its efficacy would be moot in the minds of many people; thus patients would utilize it, because they believe it works rather than because it works. Since TT has not yet been scientifically proven as per Western standards, leaders of the health care community are likely wary of lending support to TT at this time. If TT can be found to be a scientifically sound therapeutic technique, then it will be more readily accepted in the health care community. This paper reviews TT.

ScientificWorldJournal. 2006 Aug 25;6:2188-95. Huff MB, McClanahan KK, Omar HA.

Division of Adolescent Medicine, Department of Pediatrics, University of Kentucky, Lexington, KY, USA.