Therapeutic touch (TT) is widespread in nursing, having gained acceptance in very high places. But what merit does this still-controversial technique have?
In TT, practitioners "center" themselves and then assess the client's energy field by moving their hands about 4 inches above the client's body. Practitioners claim to be detecting areas where the field is weak or soft or with excess energy. They diagnose the imbalance and choose an intervention.1
Interventions entail removing excess energy (usually by shaking it off the fingers at the foot of the bed), adding their own energy, or redistributing the client's energy. Despite the name, therapeutic touch does not include actual touching.
Delores Krieger first introduced TT 25 years ago. Since that time, roughly 130 published papers have discussed TT. Given the time frame, this number is fairly small, averaging only 5 reports per year. More remarkably, the scientific community accepts little of this research as valid. This review focuses on two studies frequently cited by TT proponents as proof of efficacy.2,3 Both are relevant to nursing and discuss healing rates and pain relief. Unfortunately, both clearly illustrate the methodology and bias problems that plague TT research.
This most cited TT study was the first of five to examine the healing rates of full-thickness dermal wounds treated using TT. The researcher used a dermal punch on volunteers, who then placed the injured arm through an opaque screen for either TT or no treatment.2
The researchers obtained remarkable results for the treatment group. More than half of the treated subjects had complete healing by day 16, while none of the control group did.
This study suffers from methodologic problems. For example, treatment and control groups were wounded on different days, introducing the possibility of nonuniform wound depths. The study can also be rejected based on Wirth's subsequent inability to duplicate the results. Wirth himself commented in a later retrospective analysis: "The results of the experiments indicated significance for the treatment group in the initial 2 studies and non- and reverse-significant results for the control group in the remaining 3 experiments... The overall results of the series are inconclusive in establishing the efficacy of the treatment interventions examined."4 In other words, the control group healed as well or better than the treatment group in 3 of the 5 trials.
The Department of Defense financed this University of Alabama study at a cost of S355,000 to taxpayers.3 The goal was to create a TT protocol for use in the Army. Researchers designed the study to show TT's effectiveness in relieving pain and preventing infection in burn patients over a 6-day period. The study tested TT against mock TT.
Using one pain measurement scale (McGill), the TT group seemed to have less pain. However, using the visual analog scale (VAS), they found no statistical differences between the groups. Day 3 pain measurement results obtained immediately before and after TT or mock TT were better (P = .038) for TT subjects. Anxiety as measured by VAS between days 1 and 6 was lower among TT patients than in the control group, but not significantly (P = .06). However, 3 patients in the TT group developed nosocomial infections compared with only 1 patient in the control group.
In 1994, this study's author boasted, "If we can successfully complete this study, this will be the first real scientific evidence there is for therapeutic touch."5 This statement not only showed a problematic researcher bias, it also accurately assessed TT research to date; after almost 20 years of research, this could have been the first real evidence.
The author noted a significant difference in pain between the two groups "on day 3." However, results show the TT group used slightly more pain medication than controls, confounding or possibly contradicting the claim of better pain relief. Additionally, infections, arguably the most serious problem in burn treatment, were three times more prevalent in the TT group.
Despite proponents' claims that this study shows TT effectiveness on pain and anxiety, analysis shows no significant differences between the group receiving real TT and that receiving mock TT in most measures. In the researcher's own words, "The greatest lesson learned from this process is that the inclusion of a true control group in addition to a sham and treatment group is required because a strong placebo effect occurs from the special attention given to patients in the 'sham' treatment." This study adds further evidence that this placebo effect is responsible for any positive results obtained for TT.
In 1998, a study published in the Journal of the American Medical Association tested whether 21 trained TT practitioners could detect the human energy field they claimed to be assessing, manipulating, and "unruffling."6 Researchers suggested that TT proponents should be able to at least detect human energy fields with 100% accuracy. However, participants were only able to correctly identify a human hand 44% of the time, slightly less than chance.
The response to this study from TT researchers was telling. Although the study was published in a highly regarded, peer-reviewed journal, Delores Krieger stated that the researchers "completely misunderstood what the nature of basic research is."7
The Colorado School for Healing Touch urged rejection of the study, continuing to cite Wirth's research as evidence of TT's effectiveness, despite Wirth himself refuting this claim 3 years earlier. Cynthia Poznanski Hutchison, DNSc, RN, CHTP/I, research coordinator for Healing Touch International, immediately announced that sensing energy fields was, in fact, not required for TT; she admitted that for the first several years of her practice, she, too, could not sense energy fields.8
One need only imagine this practitioner moving her hands mystically back and forth over her clients as if she were actively assessing and correcting their energy fields but who now admits she could not sense those energy fields to see the inherent flaw of this modality. It is based solely on the magical thinking of the practitioner and the placebo effect of focused attention on the client. The research simply does not support any other conclusion.
1. Krieger D: Accepting your power to heal: The personal practice of therapeutic touch. Santa Fe, N.M.: Bear and Company, 1993.
2. Wirth DP: The effect of non-contact therapeutic touch on the healing rate of full thickness dermal wounds. Subtle Energies 1990;1(1):1-20.
3. Turner JG: The effect of therapeutic touch on pain and anxiety in burn patients. Final Grant Report, 1996.
4. Wirth DP: Complementary healing intervention and dermal wound re-epithelialization: An overview. Int J Psychosomatics 1995;42(1):48-53.
5. Butgereit B: Therapeutic touch: UAB to study controversial treatment for Pentagon. The Birmingham News 1994;November 17(sections1A):10A.
6. Rosa L, Rosa E, Sarner L, et al.: A close look at therapeutic touch. JAMA 1998;279:1005-10.
7. Kolata G: Research: Her simple test discredits a common alternative treatment. New York Times 1998;April 1.
8. Hutchison CP: Official response from Healing Touch International: A nurse researcher's response to the April 1, 1998 JAMA article "debunking" therapeutic touch. 〈http//www.healingtouch.net〉
[April 15, 1998].