Therapeutic Touch Detailed Scientific Review

Overview

Background

Despite its name, "Therapeutic Touch", actual physical touch is not ordinarily used. Instead, the practitioner’s hands typically rest in or stroke the perceived energy field of a person.

In contrast to Reiki practitioners, who receive their ability to heal through attunements and "initiations" by others in a lineage of healers trained by the original teacher, Therapeutic Touch practitioners simply learn their skills from others. Also in contrast to most western traditions of "laying on of the hands" by gifted individuals, Therapeutic Touch proposes that anyone can learn to be effective in energy healing^1-3. The contemporary practice of Therapeutic Touch was developed in the late 1960s and ‘70s by Doris van Gelder Kunz and Dolores Krieger, RN, PhD^1,4-6.

As a child, Ms. Kunz had perceived energy patterns or "auras" around people and had studied this phenomenon as an adult especially among her fellow members of the Theosophical Society. In the 1930s, she collaborated with an immunologist, Dr. Otelia Bengtsson, to study patients with allergic conditions that were difficult to diagnose and/or treat. Ms. Kunz observed what she believed to be emotional patterns within their auras and developed theories concerning their relationship to disease^1,4.

Dr. Krieger joined Kunz and Bengtsson in the 1960s in order to observe the effects of a famous theosophical healer, Oskar Estabany, upon patients with a variety of illnesses. She was impressed not only with the observations of Mr. Estabany, but also with the ability of Ms. Kunz to further describe the pathological conditions of the patients in appropriate medical terminology. No "miraculous cures" occurred during the study, but patients "felt better. . .and symptoms ameliorated or disappeared in the weeks to come."⁴

They subsequently conducted and published two studies reporting significant associations between Estabany’s presence and accelerated sprouting of seeds and wound healing in mice^1,4,5. Although Krieger and Kunz were intrigued by these results, others have found serious deficiencies in both studies⁵. The seed study was criticized for failure to account for variables such as the number of seedlings per pot, average height of plants per pot, plant yield per pot and chlorophyll content per pot. The wound healing study was criticized for failing to report that the healing results were transient and that no significant differences in healing remained by the end of the study (Clark and Clark, cited in 7).

Dr. Krieger continued to seek explanations for the healing effects that she believed had occurred in these studies. In reading descriptions of their experiences from healers in different parts of the world, she notice that they referred to the area around the ill person rather than the persons themselves and that they used a rather limited set of the presence or absence of heat, cold, pressure, tingling, electrical shocks, pulsations and bilateral symmetry⁴.

Estabany believed that one must be born with the gift of healing, but Kunz believed that this was a skill that could be taught. Accordingly, Dr. Krieger became a student of Ms. Kunz. She also turned to eastern literature concerning ancient healing practices and found explanations within the Sanskrit concept of prana or life energy. In this belief system, illness is seen as a deficiency of prana that can be corrected through the transfer of energy from a healthy person^1,4.

Hemoglobin values in red blood cells were the subject of a subsequent series of studies conducted by Dr. Krieger. Results indicated significant effects associated with the laying-on-of-hands, but these studies and conclusions have also been criticized for selection bias, nonequivalent control and experimental groups, differing lengths of treatment for subjects in the experimental and control groups and failure to discuss alternative explanations for results (Schlotfeldt cited in 1; Clark and Clark cited in 7)⁵.

Krieger and Kunz began teaching their concepts of healing through the laying-on-of-hands in classes in the Division of Nursing at New York University in 1974. They separated it from religious connotations by calling it "Therapeutic Touch"^1,5. As Therapeutic Touch spread to other universities, its concepts were further developed in the direction of traditional western scientific understanding. By 1979, it had become integrated with a theory developed by Martha E. Rogers, RN, the science of unitary man (later changed to the science of unitary human beings). This theory has three components:

• Resonancy – A continuous change exists from lower to higher frequencies in the human and environmental energy fields
• Helicity – These same fields progress to greater and greater diversity
• Integrality – Mutual interaction occurs between human and environmental energy fields¹

In 1994, the North American Nursing Diagnosis Association (NANDA) recognized energy field disturbance as an official diagnosis¹. Although proponents of Therapeutic Touch do not define it as a religious practice, the Equal Employments Opportunity Commission ruled in 1988 that employees cannot be required to learn or practice Therapeutic Touch if it conflicts with their religious beliefs⁸.

Proposed Mechanisms of Action

Mechanisms of action in Therapeutic Touch rest upon four premises:

• A human being is an open energy system
• A human being is bilaterally symmetrical
• Illness is an imbalance in a human being’s energy field
• Human beings have natural abilities to transform and transcend their conditions of living³

In order to utilize these premises for the purposes of healing, a practitioner of Therapeutic Touch:

• Centers physically and psychologically, i.e. finds an inner reference of stability
• Uses his/her own chakras, primarily those within the palms of the hands to sense the other person’s energy-field flow patterns. Clues are sought in the flow and rhythm of this energy plus any imbalances in temperature, magnetic pull, energy deficits or hyperactivity, congestion, tingling or pulsations
• Attempts to rebalance the other person’s energy field: smoothing what appears to be rough and opening what appears to be congested. Although the hands may be used to "unruffle" or smooth these perceived imbalances, intentionality is seen as more important than the actual positioning of the hands. For conditions such as excess heat or cold, practitioners visualize the opposite
• Consciously directs his/her own perceived excess energies to assist the other person in repatterning his or her own energies^3,4,9

Adverse Effects

Dr. Krieger cautioned Therapeutic Touch practitioners to avoid overloading energy fields by limiting sessions to two to three minutes, especially for children, the elderly, those with head injuries and those who were very debilitated⁴.

Can Instruments Detect Human Energy Fields?

Instruments now exist that can routinely detect internal electrical energy emissions from the brain (electroencephalogram or EEG) and heart (electrocardiogram or ECG). One of the most sensitive devices for the detection of electrical and magnetic fields uses paired superconductors. Despite their sensitivity, however, they must also be in actual contact with the skin to detect brain or heart electromagnetic fields¹⁰.

Can People Detect Human Energy Fields?

Dr. Krieger reported that she and others could detect human energy fields. Several independent investigators have attempted to test this ability among Therapeutic Touch practitioners. One famous study, known as the Rosa study, tested the ability of single blinded Therapeutic Touch practitioners to detect the presence of a hand over one of their hands. In two series of tests, practitioners were able to identify the correct hand in 123 (44%) of 280 trials, which was no better than chance alone¹¹. The design and conclusions of this study were subsequently criticized for 1) being underpowered to detect significant differences with ten trials per practitioner and two phases, 2) retaining low-scoring practitioners in the second phase, 3) reporting that the results were statistically no different from chance alone when they were actually worse than chance alone, 4) concluding that no differences existed between right and left hands when, in fact, differences did exist as indicated by a chi square statistical test and 5) misleading the participants by informing them that the results would be published as a fourth-grade science-fair project rather than in a peer-reviewed scientific journal, and not controlling for temperature and distance between hands^12,13. Responses to these criticisms, including a picture of a ruler for hand placement (not noted in the original report) have been published on QuackWatch. (Whatever the problems with study design and analysis, this study had passed the peer-reviewed process of a major journal.)

Another experiment published on the Internet tested the ability of a Therapeutic Touch practitioner to detect painful wrists. James Randi, a professional magician, offered an award (still being offered) to any Therapeutic Touch practitioner who could detect a human energy field. The one practitioner who attempted was able to detect the difference between an injured and a healthy arm 11 out of 20 times, but again, this was no better than chance alone^1,7. An Internet posting includes a summary of this experiment and a response by the Therapeutic Touch practitioner, in which she attributed the lack of detection of pain to having passed over the wrists several times thus relieving the pain, a possible effect that she had warned of before the experiment.

Published research in peer-reviewed journals concerning the effectiveness of Therapeutic Touch for patients with cancer or conditions with special relevance for patients with cancer is described in the Summary of Research.

Summary of Research

Amount and Type of Research

A search of Medline between June 2003, and August 2006, for the term "Therapeutic Touch" and cancer or cancer-related terms, identified 15 articles of which two were applicable to treatment with Therapeutic Touch. An additional three applicable articles were identified on the database of CINAHL, but none in the peer-reviewed subset of AltHealthWatch. Thus, a total of five unique related articles were identified.

A previous search of Medline between January 1, 1966, and May 30, 2003, for the term "Therapeutic Touch" and cancer or cancer-related terms, identified 15 articles, of which 11 were applicable to treatment with Therapeutic Touch. An additional 10 applicable articles were identified on the database of CINAHL, three on Psychinfo, but none in the peer-reviewed subset of AltHealthWatch. Thus, a total of 24 unique articles were identified.

Combining the results of these reviews, we have classified these 29 references into the following types of information:

We coded the studies (7) by the following study designs:

^*The National Cancer Institute and other research design authorities consider this to be the strongest type of study design. See About Complementary/Integrative Medicine for information concerning all study designs.

Summary of Human Research

Cancer

Three randomized controlled trials^14-17 and three case reports^18-20 were identified.

Pre- and postoperative patients with breast cancer were evaluated in one partially blinded randomized trial (see Annotated Bibliography for details) that assessed effects of Therapeutic Touch upon anxiety, mood and pain in women who received Therapeutic Touch, music and dialogue, compared with a control group who received structured relaxation, music and dialogue. Multivariate analysis controlling for trait anxiety found a medium effect of pre-operative Therapeutic Touch upon anxiety (P=0.008). Postoperative Therapeutic Touch was not associated with any significant differences in anxiety, mood or pain after controlling for trait anxiety¹⁶.

Patients with bone marrow transplants were enrolled in a non-blinded trial in which Therapeutic Touch and Massage Therapy were each compared to a "Friendly Visit". Benefits perceived by patients were significantly higher for those who received Therapeutic Touch compared with "friendly visits", but also for those who received massage therapy. Complication rates did not differ significantly between Therapeutic Touch and friendly visits, but central nervous system and other neurological complications were significantly lower for those who received massage therapy compared with friendly visits¹⁴.

Patients in the palliative care unit of a hospital had mean well-being scores that increased progressively after each of three sessions of Therapeutic Touch (1.70, SD=1.28, P=0.25) in contrast to those of a control group receiving structured relaxation that decreased slightly over time (0.31, SD=1.12), and the difference between the two groups was significant (P=.0015)¹⁵. No major differences were seen in responses received from 18 randomized, controlled study breast cancer participants¹⁷.

Considering the practical limitations of complete blinding for this type of therapy, each of these studies made reasonable efforts to avoid the possible influence of conscious or unconscious biases. Unfortunately, these were small studies (breast cancer study: n=31, bone marrow: n=88, palliative care: n=20), so they may have lacked the power to detect all significant differences and to adequately control for all factors.

Three case reports described benefits of Therapeutic Touch for patients with pancreatic cancer pre- and postoperatively¹⁸, a patient with esophageal cancer receiving hospice care¹⁹ and a patient with breast cancer and her significant other²⁰.

Conclusions

Conclusions based upon three randomized trials are that Therapeutic Touch could be beneficial for patients with cancer compared with friendly visits or relaxation; however, one RCT indicated that massage therapy may be more beneficial in some situations. (Note that people who are in pain or nauseous are often unable to tolerate physical contact¹⁵.)

A separate review by the collaborative review organization, Natural Standard, concluded that well-being in cancer patients needed more study²⁰.

Brief details of each the studies among patients with cancer are summarized in the Summary Table for Human Studies (pdf) and in the Annotated Bibliography.

Other conditions

Effects of Therapeutic Touch within non-cancer populations may also have implications for patients with cancer. Three recently published reviews of Therapeutic Touch in other populations have been identified.

A review by Daniel Wirth, MS, JD, included five studies of wound healing^22-26, but he was the primary author of all five studies. Three studies were randomized controlled and blinded trials^22,26; the other two were cross-over designs in which each patient was his/her own control^24,25. Two of the randomized trials reported significant increases in the rate of reepithelization (regrowth) of skin in purposefully administered biopsy wounds^22,23. As pointed out in Wirth’s review, these two studies differed from the other three studies in that they allowed the Therapeutic Touch practitioner to place plants and other objects in the room to make the ambience less clinical and the subjects were recruited from close knit groups that already had a high degree of respect for the Therapeutic Touch practitioner²⁷.

A subsequent meta-analytic review by Rosalind Peters, RN, identified 36 research reports between 1986 and 1996, of which nine met inclusion criteria for her review. (One of the five studies in the previous review by Wirth met these criteria and was included²³.) Studies that met criteria for her review had:

• Empirically-based research
• Human intervention with Therapeutic Touch
• Adhered to Krieger’s four phases of Therapeutic Touch
• Study design that was experimental, quasi-experimental or pre-post single group

All of the studies reviewed by Peters were based upon convenience rather than random samples, although once subjects were enrolled, they were randomly assigned to treatment versus control groups. Demographic information was generally not sufficient to describe the populations from which they had come. Psychological outcomes (anxiety) were assessed in five studies^28-32 and physiological outcomes in four studies^23,33-35.

Four of the five psychological outcome (anxiety) studies in Peters’ review had medium methodological scores^28-30,32 that allowed their results to be pooled. The pooled results indicated an overall medium effect compared to control interventions (Cohen’s d=+0.48; range 0.26 – 0.70; combined probabilities p<0.04). Because of insufficient information, it was not possible to test for homogeneity/heterogeneity of effect size. In further analysis, a "fail-safe" estimate was computed for the number of studies that would be needed to reverse the overall probability obtained for these effects and this indicated that only one study could reverse the direction of these effects³⁶.

Only two of the four physiological outcome studies in Peters’ review had at least medium methodological scores^33,35. (Not included were the studies of wound healing²³ and physiological measures of stress reduction³⁴.) The two studies that were included also provided sufficient data to calculate effect sizes on pain reduction as measured on a McGill-Melzack Pain Scale³³ and a Visual Analogue Pain Scale³⁵. Pooling the data from these two studies indicated medium pooled effects on pain reduction (Cohen’s d=+0.61, combined probabilities p<.000003). Comparing pre- and posttest scores within the pooled experimental groups indicated a large average effect size of Therapeutic Touch (Cohen’s d=+1.22) and a fail-safe analysis indicated that 20 studies would be required to reverse the probability of these effects³⁶.

Despite some indications of statistically significant effectiveness, Peters concluded that it was impossible to make any substantive claims based upon these studies because of four major weaknesses:

• Under reporting of data regarding demographic variables and non-significant statistics
• Convenience sampling without clear reporting of randomized assignment to intervention versus control groups
• Lack of descriptions of the actual interventions practiced
• Relationship of the practitioner’s expertise to treatment outcomes³⁶

A third review by the Natural Standard collaborative review organization concluded that:

• Pain may be reduced, but most studies have not been well-designed and further research is needed
• Anxiety reduction in adults was unclear due to conflicting results of different studies
• Anxiety reduction in children with chronic diseases, teenagers with psychiatric disease and premature infants had some clear evidence, but more research was needed
• Wound healing effects were unclear due to conflicting results of different studies
• Alzheimer’s dementia effects needed more study
• Headache relief needed more study
• Blood sugar levels in patients with type I (insulin-dependent) diabetes mellitus were not affected in initial research²¹

A review by the collaborative Cochrane Review Organization is currently in process³⁷.

Therapeutic Touch Summary of Human Studies Table (pdf)

Study descriptions and sources for these data are available in the Annotated Bibliography.

Annotated Bibliography

Human Studies

¹⁷Kelly AE, Sullivan P, Fawcett J, Samarel N. Therapeutic Touch, Quiet Time and Dialogue: Perceptions of Women with Breast Cancer. Oncology Nursing Forum. 2004;31(3):625-631.

Purpose: To assess perception differences on mood and anxiety
Type of study: Randomized, controlled qualitative study
Methods: Eighteen women with early-stage breast cancer were phone interviewed about their perceptions after participating in therapeutic touch and dialogue versus control (quiet time) and dialogue study at their home post surgery.
Results: An equal number of participants were randomly assigned to each group. No major differences were seen in responses received from participants. Both groups reported a feeling of calmness and relaxation. Both groups found the nurse administering dialogue to both groups as a positive element in the experiment (they found her empathetic and supportive). Women who underwent therapeutic touch did report "body sensations" (n=10, 91%) and no one in the control group commented on feeling body sensations when asked a similar question.

¹⁶Samarel N, Fawcett J, Davis MM, Ryan FM. Effects of dialogue and therapeutic touch on preoperative and postoperative experiences of breast cancer surgery: an exploratory study. Oncology Nursing Forum. 1998 Sep;25(8):1369-76.

¹⁴Smith MC, Reeder F, Daniel L, Baramee J, Hagman J. Outcomes of touch therapies during bone marrow transplant. Alternative Therapies in Health & Medicine 2003 Jan-Feb;9(1):40-9.

Purpose: Time to bone marrow engraftment, complication rates, patient perceptions of benefit
Type of study: Randomized controlled trial (RCT)
Methods: (Lymphoma, breast cancer, other) Patients receiving bone marrow transplants (n=88) were randomly assigned to receive Therapeutic Touch (TT), massage therapy (MT), or a "friendly visit" (FV). All patients were screened by nurses for suitability for the study and the screening criteria included massage suitability for all patients. Randomization was stratified by type of transplant received [autologous (self) or allogeneic]. Therapeutic Touch was administered by nurses who had completed formal study, at least one year of experience and were evaluated by interview and demonstration for a researcher with recognized experience. Massage therapy was administered by certified massage therapists with a minimum of three years experience. Friendly visits were conducted by persons who were neither health care professionals nor members of the patient’s family. Sessions for each therapy were 30 minutes long and were conducted on every third day until discharge. A greater proportion of subjects receiving Therapeutic Touch had the more toxic chemotherapy protocol and a smaller proportion had the least toxic chemotherapy compared with the other two groups. Accordingly, toxicity of the regimen was used as a covariate in the analysis. Eleven subjects withdrew from the study because they were not assigned to the type of therapy that they wanted (six in the friendly visit group, three in the Therapeutic Touch group and two in the massage group).
Results:

¹⁵Giasson M, Bouchard L. Effect of therapeutic touch on the well-being of persons with terminal cancer. Journal of Holistic Nursing. 1998 Sep;16(3):383-98.

Purpose: Quality of life
Type of study: RCT
Methods: (Various cancers) The subjects of this study were 20 patients with terminal cancer on the palliative care unit of a hospital. Patients were randomly assigned to equal groups to receive a 15 to 20-minute period of Therapeutic Touch or structured relaxation on days 2, 3 and 4. They completed a Visual Analogue Well-Being Scale on days 1, 2 and 4. Therapists in both the experimental and control groups also completed standard reporting cards assessing the quality of each interaction. The scale included assessments of nausea, pain, appetite, depression, relaxation and general well-being. Before beginning the intervention, the two groups were compared for demographic and medication variables and no significant differences were detected. An assessment was made of the mean daily dose equivalents of analgesics and anxiolytics, but no significant correlation was found so this was removed as a co-variate. Hypothesis 1 was that persons receiving Therapeutic Touch would have higher scores on the well being scale. Hypothesis 2 was that well-being scores would increase following the three Therapeutic Touch treatments. A student t test was performed for the first hypothesis and repeated analyses of variance (ANOVA) using one factor-time were performed to assess the second hypothesis.
Results: The mean Well-Being Scale increased progressively in the Therapeutic Touch group (1.70, SD = 1.28), whereas that of the control group decreased slightly over time (0.31, SD = 1.12) and this difference was significant (t = 3.73; p = .0015). Sensation of well-being improved significantly between times 1 and 4 for the Therapeutic Touch group (P=.025).

¹⁸Smyth PE. Therapeutic touch for a patient after a Whipple procedure. Critical Care Nursing Clinics of North America 2001 Sep;13(3):357-63.

Purpose: Relief of anxiety and pain
Type of study: Case Report
Methods: (Pancreas) A 64-year-old man who had been newly diagnosed with pancreatic cancer was treated with twenty minute sessions of Therapeutic Touch before and after surgery.
Results: During the Therapeutic Touch sessions before surgery, his breathing slowed, his muscles relaxed and he said that he slept better. He was sent to the Recovery Room after 4.5 hours of surgery where he awakened, but was pale. After five minutes of Therapeutic Touch, his color returned and his oxygen saturation went from 96% to 100%. Following additional treatments, he was transferred out having received a total of 5 mg of morphine during his stay. Because of the small amount of morphine received, his bowels became active and he was able to have clear fluids the following day. Slight nausea with the fluids was relieved after Therapeutic Touch. He had no postoperative complications and continued to receive Therapeutic Touch as of the study publication.

¹⁹Dorman K. Case report. Therapeutic touch treatments and hospice nursing. J of Hospice & Palliative Nursing 1999 Apr-1999 Jun;1(2):75-7.

Purpose: Quality of life
Type of study: Case report
Method and Results: (Esophageal cancer) A nurse providing hospice care for a patient observed the patient becoming more peaceful, falling asleep and being relieved of hiccoughs during different sessions of Therapeutic Touch, and the patient requested these sessions each day until he died.

²⁰Klotz LK, Lakomy JM, Deardorff KU. Impact of complementary healing modalities on quality of life and treatment adherence for a family with breast cancer: a case study approach. International J for Human Caring 1999 Fall;3(3):7-13.

Purpose: Quality of life
Type of study: Case report
Method: (Breast) Therapeutic Touch was given to a patient with breast cancer and the technique was also taught to her significant other. Questionnaires concerning demographics, and initial adherence measure tool and the Functional Living Index-Cancer were completed by the patient before beginning the series of 10 sessions by the therapist and eight sessions by the significant other.
Results: The patient was able to follow the chemotherapy protocol exactly as ordered by her physician. Therapeutic Touch was one of the important factors identified by her "significant other" that had helped her to follow the treatment regimen.

Full citations are provided in the Reference List.

Reference List

1. Therapeutic Touch. Amherst, New York: Prometheus Books, 2000.
2. Potter P. What are the distinctions between Reiki and therapeutic touch? Clinical Journal of Oncology Nursing. 2003 Jan-Feb;7(1):89-91.
3. Krieger D. Accepting your power to heal: The personal practice of Therapeutic Touch. Santa Fe, New Mexico: Bear & Company Publishing, 1993.
4. Krieger D. The Therapeutic Touch: How to use your hands to help or to heal. 1st ed. New York: Prentice Hall Press, 1986.
5. Straneva JA. Therapeutic Touch coming of age. Holistic Nursing Practice 2000;14(3):1-13.
6. Nurse-Healers Professional Associates International, Official Organization of Therapeutic Touch. Therapeutic Touch [Web Page].
7. Scheiber B, Selby C. Therapeutic Touch. Amherst, New York: Prometheus Books, 2000.
8. Scheiber B, Selby C, eds. Therapeutic Touch. Amherst, New York: Prometheus Books, 2000.
9. Scheiber B, Selby C, eds. Therapeutic Touch. Amherst, New York: Prometheus Press, 2000.
10. Vrba J, Robinson SE. Signal processing in magnetoencephalography. Methods 2001 Oct;25(2):249-71.
11. Rosa L, Rosa E, Sarner L, Barrett S. A Close Look at Therapeutic Touch. JAMA 1998;279(13):1005-10.
12. Cox T. A nurse-statistician reanalyzes data from the Rosa therapeutic touch study. Alternative Therapies in Health & Medicine 2003 Jan-2003 Feb;9(1):58-64.
13. Dossey L. Therapeutic touch at the crossroads: observations on the Rosa study. Alternative Therapies in Health & Medicine 2003 Jan-2003 Feb;9(1):38-9.
14. Smith MC, Reeder F, Daniel L, Baramee J, Hagman J. Outcomes of touch therapies during bone marrow transplant. Alternative Therapies in Health & Medicine 2003 Jan-Feb;9(1):40-9.
15. Giasson M, Bouchard L. Effect of therapeutic touch on the well-being of persons with terminal cancer. Journal of Holistic Nursing. 1998 Sep;16(3):383-98.
16. Samarel N, Fawcett J, Davis MM, Ryan FM. Effects of dialogue and therapeutic touch on preoperative and postoperative experiences of breast cancer surgery: an exploratory study. Oncology Nursing Forum. 1998 Sep;25(8):1369-76.
17. Kelly A, Sullivan P, Fawcett J, Samarel N. Therapeutic touch, quiet time, and dialogue: Perceptions of women with breast cancer. Oncology Nursing Forum 2004;31(3):625-31.
18. Smyth PE. Therapeutic touch for a patient after a Whipple procedure. Critical Care Nursing Clinics of North America 2001 Sep;13(3):357-63.
19. Dorman K. Case report. Therapeutic touch treatments and hospice nursing. J Hospice & Palliative Nursing 1999 Apr-1999 Jun;1(2):75-7.
20. Klotz LK, Lakomy JM, Deardorff KU. Impact of complementary healing modalities on quality of life and treatment adherence for a family with breast cancer: a case study approach. International J for Human Caring 1999 Fall;3(3):7-13.
21. Natural Standard. Therapeutic Touch [Web Page]. 2002 Dec (Accessed 2003 Jun 11).
22. Wirth DP. The effect of noncontact therapeutic touch on the healing rate of full thickness dermal wounds. International Society for the Study of Subtle Energy & Energy Medicine: Cooperative Connection 1992;13(3):1, 4-8.
23. Wirth D, Richardson J, Eidelman W, O'Malley A. Full thickness dermal wounds treated with non-contact therapeutic touch: A replication and extension. Complementary Therapies in Medicine 1993;1:127-32.
24. Wirth DP, Barrett MJ, jEidelman WS. Noncontact therapeutic touch and wound reepithelialization: An extension of previous research. Complementary Therapies in Medicine 1994;2:187-92.
25. Wirth DP, Barrett MJ. Complementary healing therapies. Int J Psychosom 1994;41:61-7.
26. Wirth DP, Richardson JT, Martinez RD, Eidelman WS, Lopez ME. Non-contact therapeutic touch intervention and full thickness cutaneous wounds: A replication. Complementary Therapies in Medicine 1996;4(4):237-40.
27. Wirth DP, Richardson JT, Eidelman WS. Wound healing and complementary therapies: a review. The Journal of Alternative and Complementary Medicine 1996;2(4):493-502.
28. Quinn J. Therapeutic touch as energy exchange: Replication and extension. Nursing Science Quarterly 1989;2(2):79-87.
29. Quinn J, Strelkauskas A. Psychoimmunologic effects of therapeutic touch on practitioners and recently bereaved recipients: A pilot study. Advances in Nursing Science 1993;15(4):13-26.
30. Simington J, Laing G. Effects of therapeutic touch on anxiety in the institutionalized elderly. Clinical Nursing Research 1993;2(4):438-50.
31. Gagne D, Toye R. The effects of therapeutic touch and relaxation therapy in reducing anxiety. Archives of Psychiatric Nursing 1994;8(3):184-9.
32. Olson M, Sneed N. Anxiety and therapeutic touch. Issues in Mental Health Nursing 1995;16:97-108.
33. Keller e, Bzdek V. Effects of therapeutic touch on tension headache pain. Nursing Research 1986;35(2):101-6.
34. Kramer N. Comparison of therapeutic touch and casual touch in stress reduction of hospitalized children. Pediatric Nursing 1990;16(5):483-5.
35. Meehan T. Therapeutic touch and post-operative pain: A Rogerian research study. Nursing Science Quarterly 1993;6(2):69-78.
36. Peters RM. The effectiveness of therapeutic touch: a meta-analytic review. Nursing Quarterly 1999 Jan;12(1):52-61.
37. O'Mathuna D and Ashford RL. Therapeutic touch for healing acute wounds [Web Page]. In process. (Accessed 2007 May 29).