Dr. Ackerman is associate research epidemiologist at the UCLA School of Public Health in Los Angeles.
Dr. Cameron is assistant clinical professor of psychiatry at the UCLA Neuropsychiatric Institute.
Acknowledgments: The authors report no financial, academic, or other support of this work.
Why do people from different cultural backgrounds seek energy-based methods for stress relief? Energy healing is the fastest-growing alternative therapy for relaxation and stress reduction. The energy-based therapies include the self-help methods—eg, meditation, yoga, and other movement therapies—and the touch therapies—eg, therapeutic touch, external qigong, Reiki, and pranic therapy—in which there is believed to be a transfer of energy between the practitioner and the patient. The results from anecdotal reports, case reports, nonrandomized or uncontrolled studies, and a few controlled studies suggest that energy therapies appear to have beneficial effects. Experts offer various explanations for the observed benefits, based upon different functional levels of organization: mind-body interactions, chemical reactions, and electromagnetic energy. Devotees of energy therapies believe they normalize the universal life force, qi, which consists of neurochemicals or electrical impulses. Skeptics believe the effects are placebo effects. Most agree that these therapies need to be studied, particularly because millions of Americans are using them.
A recent survey of trends in the use of alternative therapies found that energy healing is the fastest-growing alternative therapy for chronic health problems, relaxation, and stress reduction.1 The energy-based therapies include the self-help methods—eg, meditation, yoga, internal qigong, and other movement therapies—and the touch therapies—eg, therapeutic touch, external qigong, Reiki, and pranic therapy—in which there is believed to be a transfer of energy between the practitioner and the patient. Throughout most of the accumulating medical literature in which these treatments have been evaluated on convenience samples or self-selected patients, improvements have been seen in quality of life, reduced anxiety, lower blood pressure, and improved tolerance of pain. All are changes consistent with the relaxation response, which Benson2 described after studying practitioners of transcendental meditation (TM).
The energy-based therapies are founded on the paradigm of a universal life force, or energy field, that coexists with and interpenetrates the physical body. In the West, the philosophical roots of the various self-help methods may be downplayed with an emphasis instead on harmonizing mind-body connections. Nevertheless, restoring the life force is the ultimate goal in restoring overall health and well-being to the individual. Depending on the tradition, this force is referred to as qi or chi (in Chinese medicine), ki (in Japanese), prana (in Ayur vedic medicine), and “the will to live.” Uncontrolled and suppressed emotions and habitual stress, worry, anger, and frustration are said to result in qi depletion.
Meditation is one of the more common self-help stress-reduction methods. There are two basic forms of meditation: concentration and mindfulness. Concentration requires focusing the mind on one thing—eg, breath, an image, a sound—and holding that focus for a period of time. All other mental activity is considered a distraction. Mindfulness meditation requires paying attention to a detail of momentary reality, such as the breath or a sensation, while the field of awareness is allowed to expand to other sensations or objects in the environment. This practice interrupts automatic stress reactions.
Transcendental meditation, popularized in the 1960s by the Maharishi Mahesh Yogi, involves concentrating on a mantra or sound and holding that concentration for 20 minutes or more, twice a day. Jevning and colleagues3 reviewed the literature describing physiologic changes observed among practitioners of TM. These changes are consistent with subjective reports of relaxed alertness. The authors consider these changes to reflect a hypometabolic state, with decreased oxygen consumption and carbon-dioxide elimination, decreased respiration, decreased adrenal-corticol activity, enhanced recovery from stressful stimulation, increased electroencephalogram coherence, and evoked potential changes (shorter latencies and larger amplitude of response) and sensory and motor responses consistent with increased alertness.
Mindfulness-Based Stress Reduction
Mindfulness-based stress reduction (MBSR) is an 8-week group program in which subjects learn, practice, and apply “mindfulness meditation” as a self-regulatory approach to stress reduction and emotion management. This type of meditation uses the method of focusing on breath as a way to learn moment-to-moment awareness. The awareness thus developed enables individuals to view their experiences more realistically: thoughts are just thoughts, sensations are just sensations. This approach has been widely used within medical settings in the last 20 years, and many claims have been made regarding its effectiveness. Jon Kabat-Zinn developed the program in 1979 at the Stress Reduction Clinic at the University of Massachusetts Medical Center in Worcester.
The 8-week program consists of weekly 2-hour classes that include meditation instruction in a variety of mindfulness meditation techniques, silent and guided meditations, simple hatha yoga exercises and stretching, and group discussion. Practice assignments and audio cassettes are given for between-class work with meditations on breath, bodily sensations, and the senses. In a series of uncontrolled studies, Kabat-Zinn and colleagues4-8 have demonstrated that mindfulness meditation reduced symptoms of anxiety and panic and helped maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia.
Several controlled studies have demonstrated favorable results. Williams and colleagues9 compared an 8-week mindfulness program with educational materials and encouragement to use existing community resources for stress management. Fifty-nine self-selected community residents in the intervention group learned, practiced, and applied mindfulness meditation 20 minutes a day. The 44 controls received educational materials and were encouraged to use community resources for stress management. The intervention group reported significant decreases in daily hassles (24%), psychological distress (44%), and medical symptoms (46%). These changes were maintained at the 3-month follow-up.
Reibel and colleagues10 assessed 136 medical outpatients, before and after the 8-week program, using the Short-Form Health Survey, Medical Symptom Checklist, and Revised Symptom Checklist. They looked for changes in vitality, pain, role limitations caused by physical health, and social functioning. Subjects showed a reduction in psychological distress and alleviation of physical symptoms. Improvement on many measures was maintained after the 1-year follow-up.
Mindfulness-based cognitive therapy (MBCT) integrates aspects of group cognitive behavioral therapy for depression11 with components of MBSR (without yoga exercises). Teasdale and colleagues12 compared an 8-week MBCT program with treatment-as-usual for 145 patients newly recovered from recurring depression. Patients were stratified on time since recovery (<1 year versus 1–2 years) and number of previous episodes (2 versus >2). Relapse/recurrence was assessed for 60 weeks. The relapse rate was twice as high in the treatment-as-usual group as in the MBCT group, and a positive linear relationship between number of episodes and risk of relapse was found in the treatment-as-usual group but not in the MBCT group. The relapse rate was lowest among 112 patients who had three or more previous episodes. The authors surmised that MBCT interferes with reactivation of “depressogenic” thinking patterns at times of potential relapse/recurrence.
External qigong involves the transfer of qi from a qigong master to another person. The master may touch areas on the person’s body or simply pass his hands over the body. Internal qigong, a distillation of meditation, yoga, and breathing exercises, is practiced by individuals to promote self-healing. Sancier13,14 briefly summarized research conducted in the past 30 years (mostly in China) that showed benefits of qigong for hypertension and heart disease, respiratory disease, cancer, and drug addiction.
Therapeutic touch was developed by Delores Krieger and Dora Kunz in 1972. In therapeutic touch, the most studied of the “touch” therapies, the therapist moves his or her hands above the body to “repattern” the body’s energy. Two review articles15,16 identified more than 38 research articles that reported on the use of therapeutic touch for a wide variety of medical problems in a wide variety of subjects. Decreased pain and anxiety were the most often observed effects, though most of the studies were uncontrolled.
A few randomized controlled trials have been conducted that compared therapeutic touch with no treatment, treatment as usual, or a sham therapeutic touch procedure. Turner and colleagues17 observed reduced anxiety, pain, and T-lymphocyte concentrations among burn patients who received therapeutic touch compared with sham therapy. Lafreniere and colleagues18 reported reduced anxiety and tension and increased vigor in healthy volunteers who received therapeutic touch over 3 months compared to no treatment. Giasson and Bouchard19 compared therapeutic touch with rest in terminally ill cancer patients and found enhanced well-being in the treatment group. Samarel and colleagues20 compared therapeutic touch with rest and dialogue in two groups of women before and immediately after surgery for breast cancer. They found that the experimental group had lower preoperative state anxiety than the control group. Gagne and Toye21 compared therapeutic touch with sham therapy and guided relaxation therapy among psychiatric inpatients. Both therapeutic touch and relaxation produced similar reductions in subjective anxiety compared with the control.
Healing touch is similar to therapeutic touch. Developed by Janet Mentgen,22 healing touch emphasizes practitioner self-care and the patient-practitioner relationship, and sometimes includes physical touch. One recent crossover study found that a majority of subjects had increased immunoglobulin A (IgA) concentrations, lower self-reported stress, and enhanced pain tolerance after healing touch treatment.23
Reiki (pronounced RAY-kee), developed in Japan in the late 1800s by Mikao Usui, is a technique similar to healing touch involving light touch and the use of 13 specific hand positions. The Reiki practitioner must first be “attuned” by a Reiki master. Reiki was introduced to the Western world in the mid-1970s. A recent uncontrolled study24 of the effects of Reiki on healthy subjects compared state anxiety, salivary IgA, cortisol, blood pressure, galvanic skin response, muscle tension, and skin temperature before and after Reiki treatment. The after-treatment change in all physiological measurements was consistent with greater relaxation (and with regression to the mean).
Various explanations for the observed benefits of energy-based healing mind-body interactions, electromagnetic energy, and placebo effects, have been offered. Brody25,26 summarized the work of Pert and others that has shown mental states can modulate the immune system and trigger the release of endorphins and other neuropeptides that influence mood, behavior, and immune function. Pert and colleagues27 hypothesized that the nervous, endocrine, and immune systems are functionally integrated. Emotions trigger the secretion of peptides throughout the body and are thereby the link between mind and body, psyche and soma, soul and matter. Mobile immune cells transport peptides between the brain and the body along pathways that correspond with qi pathways, or meridians. Stimulating points along these pathways, through methods such as acupuncture, may start the flow of endorphins and immune-system cells.
The mind-body relationship offers an explanation for self-regulatory therapies like biofeedback, meditation, yoga, self-hypnosis, etc. But how do energy healers influence the flow of energy in their patients even when there is no physical contact? The challenge has been to devise more sensitive methods to measure the body’s energy field. Do healers emanate their own energy that triggers changes in the recipient?
At present, the detection and direct measurement of qi has eluded Western-based investigations. In the early 1960s, Kirlian photography was promoted as a way of visualizing the human energy field. Discovered by Semyon Davidovich Kirlian, a Russian electrician, the photographic phenomenon occurs when an electrically grounded object discharges sparks between itself and an electrode generating the electrical field. However, the technique and its interpretation remain controversial.
In a controversial study to determine whether practitioners of therapeutic touch can actually perceive a human energy field, 21 practitioners were correct in identifying which of their hands was closest to the investigator’s hand in 123 (44%) of 280 trials.28 The study was subsequently criticized on grounds that the detection of human energy field was taken out of context of the actual therapeutic environment, which may require a genuinely ill patient and a practitioner whose intention is to heal.
Oschman29 summarized the vast literature on bioenergetics. Extremely low frequency (ELF) energy is produced by the human body and creates a biomagnetic field. Externally applied electromagnetic fields in the ELF range accelerate the healing of soft-tissue injuries and bone fractures. Healers produce strong biomagnetic fields in the ELF range. During noncontact therapeutic touch and related methods, the biomagnetic field of the therapist may penetrate into the body of the patient.
The results from anecdotal and case reports, as well as nonrandomized, uncontrolled, and a few controlled studies, suggest that energy therapies appear to have beneficial effects. Some Western doctors credit the beneficial effects of the energy therapies to placebo effects. However, investigations have shown that belief is capable of affecting matter. Placebo analgesia is mediated by the endogenous opiate system.30-32 Similarly, in Parkinson’s disease, placebo effects appear to be mediated by dopaminergic pathways.33
A major shift in the Western paradigm of medicine has been necessitated by the evidence that brain function is modulated by neuropeptides. In his recent book The Psychobiology of Mind-Body Healing, Ernest Rossi34 suggests that neuropeptides may be the basis of many hypnotherapeutic, psychosocial, and placebo responses. Thus, the neuropeptide system may be the psychobiological basis of folk, shamanistic, and spiritual forms of healing currently in vogue. Perhaps cognitive therapies have the same effect by modifying thoughts that lead to physiological and neurochemical changes in the brain.35
In February 2001, Newsweek reported that 27 hospital-sponsored clinics provide a mixture of alternative medical treatments (including qigong, acupuncture, and meditation) combined with standard primary care.36 Devotees of energy therapies believe that qi consists of neurochemicals or electrical impulses. Skeptics believe the effects are placebo effects. Most agree that these therapies need to be studied, if only because millions of Americans are using them. PP
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