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Biofield Therapies: Helpful or Full of Hype? A Best
Evidence Synthesis
Shamini Jain &Paul J. Mills
Published online: 24 October 2009
#The Author(s) 2009. This article is published with open access at Springerlink.com
Abstract
Background Biofield therapies (such as Reiki, therapeutic
touch, and healing touch) are complementary medicine
modalities that remain controversial and are utilized by a
significant number of patients, with little information
regarding their efficacy.
Purpose This systematic review examines 66 clinical
studies with a variety of biofield therapies in different
patient populations.
Method We conducted a quality assessment as well as a
best evidence synthesis approach to examine evidence for
biofield therapies in relevant outcomes for different clinical
populations.
Results Studies overall are of medium quality, and gener-
ally meet minimum standards for validity of inferences.
Biofield therapies show strong evidence for reducing pain
intensity in pain populations, and moderate evidence for
reducing pain intensity hospitalized and cancer populations.
There is moderate evidence for decreasing negative
behavioral symptoms in dementia and moderate evidence
for decreasing anxiety for hospitalized populations. There is
equivocal evidence for biofield therapies' effects on fatigue
and quality of life for cancer patients, as well as for
comprehensive pain outcomes and affect in pain patients,
and for decreasing anxiety in cardiovascular patients.
Conclusion There is a need for further high-quality studies
in this area. Implications and future research directions are
discussed.
Keywords Biofield .Therapeutic touch .Qigong .Pain .
Cancer .CAM
Introduction
The concept of subtle energy and methods of its use for
healing has been described by numerous cultures for
thousands of years. These vital energy concepts (which
include the Indian term prana, the Chinese term ch’i, and
the Japanese term qi) all refer to so-called subtle or
nonphysical energies that permeate existence and have
specific effects on the body-mind of all conscious beings.
Similar concepts in the West are reflected in the concepts of
Holy spirit,orspirit, and can be dated back to writings in
the Old Testament as well as the practice of laying on of
hands [1].
Despite differences in ontologies of these proposed
forces, a common thread within their theories is the
development of specific techniques that purport to use
subtle energy to stimulate one's own healing process. These
are clearly reflected in internal (intrapersonal), movement-
oriented practices such as yoga, tai-chi, and internal qi-
gong, for example; and are often noted as part of the
experience of meditation and prayer. In addition, different
Electronic supplementary material The online version of this article
(doi:10.1007/s12529-009-9062-4) contains supplementary material,
which is available to authorized users.
S. Jain (*)
UCLA Division of Cancer Prevention and Control Research,
Los Angeles, USA
e-mail: sjain@ucsd.edu
e-mail: shaminijain@ucla.edu
P. J. Mills
Department of Psychiatry, University of California,
San Diego, USA
P. J. Mills
Symptom Control Group, Moores Comprehensive Cancer Center,
University of California,
San Diego, USA
Int. J. Behav. Med. (2010) 17:1–16
DOI 10.1007/s12529-009-9062-4
cultures have developed external (interpersonal) practices
that purport to specifically use subtle energies for the
process of healing another. These include local or proximal
practices such as external Qigong, pranic healing, and
laying on of hands, where a healer transmits or guides
energy to a recipient who is physically present; as well as
distance practices where a healer sends energy to a
recipient in a different physical location, such as interces-
sory prayer or distance healing.
Although many of these practices have been used over
millennia in various cultural communities for the purpose
of healing physical and mental disorders, they have only
recently been examined by current Western empirical
methods. The impetus for the research in the West is likely
due to a resurgence of public interest in some of these
modalities, such as therapeutic touch, healing touch, and
Reiki. These modalities, collectively termed by the National
Center for Complementary and Alternative Medicine as
biofield therapies
1
, began to be more widely taught and
used by U.S. nurses in many clinical and hospital settings
starting in the 1970s. Concurrently, patient demand and
utilization of these modalities outside of conventional
medicine settings have prompted scientists and clinicians
to examine more closely these so-called healing techniques
and their claimed effects. However, such studies are still in
their infancy, in part due to the dearth of research funding
in this area to conduct large-scale randomized controlled
trials (RCTs) of biofield therapies.
Despite the lack of scientific study of biofield ther-
apies, they are actively used by patients with or without
the knowledge of their physicians and with or without
information based on scientific studies. A survey from
the National Center of Health Statistics estimated that
over 5% of respondents had used Reiki, Qigong, or
healing rituals [2]. Within clinical populations, energetic
and spiritual healing is notably highly used as comple-
mentary medicine by cancer, pain, and palliative care
patients [2–9].
This review integrates a variety of published studies with
different biofield therapies for the purpose of systematically
examining whether such modalities might affect positive
outcomes for health and reduction of disease symptoms.
The review combines clinical studies that examine the
efficacy of biofield-based modalities as they are used
proximally (i.e., with the patient and practitioner in the
same room). Several recent reviews have examined the
literature surrounding a specific biofield-based technique
while excluding others [10–14]. Other more integrative
reviews have included distant healing and nonhuman
populations [15] and/or have been of a purely descriptive
nature [16]. In this review, we examine study quality of the
current literature, provide a best evidence synthesis of
studies with specific clinical populations, and discuss
methodological issues as well as directions for future
research.
Method
Methodological details for this review were performed
according to QUORUM checklist guidelines and are listed
below.
Search Strategy
A literature search for clinical studies in biofield modalities
was conducted using the PUBMED, PSYCINFO, AMED,
and CINHAL databases. “spiritual healing,”“subtle ener-
gy,”“energy healing,”“biofield healing,”“external qi
therapy,”“emitted chi,”“emitted qi,”“qi-therapy,”“Joh-
rei,”“pranic healing,”“polarity therapy,”“Reiki,”“thera-
peutic touch,”and “healing touch.”In the case where a
multitude of nonclinical studies or articles not related to the
subject matter appeared (e.g., the keywords “therapeutic
touch”in PUBMED yielded 576 publications), search terms
were narrowed to include only clinical studies (e.g., a
search with “therapeutic touch”with the limit of “clinical
trials”yielded 62 publications). Reference sections of
eligible studies and other review papers were also searched
for additional studies.
Study Selection
Inclusion criteria for studies were as follows: (1) published
in a peer-review journal in English language, (2) use of a
proximally practiced (i.e., practitioner and client in same
room) biofield-based modality, and (3) quantitative (bio-
logical and/or psychological) endpoints. RCTs are included
in this review, as well as within-subject designs that
incorporated appropriate pre- and postmeasures and/or
historical control groups.
As the nature of this review focused on examining the
effects of proximally practiced biofield therapies on human
health outcomes, exclusion criteria were as follows: (1)
studies incorporating distant healing or intercessory prayer
(unless a separate group with only proximal healing was
also examined), (2) studies that integrated other modalities
with biofield-based modalities in a manner where the
interventions could not be separated (e.g., combining Reiki
1
NCCAM describes biofields as “putative energy fields [that] have
defied measurement to date by reproducible methods. Therapies
involving putative energy fields are based on the concept that human
beings are infused with a subtle form of energy.”(Medicine, 2004)
2 Int. J. Behav. Med. (2010) 17:1–16
with meditation for the same group, with no separate group
for Reiki alone), (3) animal, plant, and/or in vitro studies,
(4) clinical studies with group assignment but no random-
ization to groups, (5) purely descriptive studies (e.g., case
reports or qualitative review with no formal analysis), and
(6) unpublished dissertations (dissertations that were pub-
lished in a peer-reviewed journal were included).
Data Extraction
Several types of information were extracted from each
study for the purposes of qualitative and systematic data
evaluation, including participant characteristics, interven-
tion information, methodological characteristics, statistical
methods, and outcomes. Specific information extracted for
evaluation follows below.
Study Characteristics and Validity Assessment
Table 1depicts the descriptive information extracted for the
review, and Table 2depicts the systematic point rating
criteria used for the review. Each study was carefully
examined for participant characteristics and intervention
information and was systematically evaluated for design
and methodology, statistical methods, and outcomes
reported using the criteria listed below. Both authors
conducted study reviews. Interrater reliability for study
quality assessment was examined for a subset (35%) of
studies, yielding an intraclass correlation coefficient of
0.95.
1. Participant information: This information was simply
noted for each study, with no point ratings given.
Information on patient population, sample size, mean
age, gender breakdown, and ethnic breakdown were
reviewed.
2. Intervention description: The following aspects of the
intervention were noted for each study: modality used,
number and training of practitioners, duration of each
session, frequency of treatment, and total number of
treatment sessions. This information was coded but no
rating points were given for these aspects of interven-
tion description.
3. Methodology: Studies were noted to be either between-
subject or within-subject designs (no points were
awarded based solely on type of design). Points for
methodology were then awarded for specific informa-
tion. One point was given for the use and description of
each of the following: use of a standard control and/or
baseline, use of a comparison group, use of a placebo/
nonspecific control, delineation of proper randomiza-
tion or counterbalancing procedure, description/testing
for recipient blinding, description/testing of blindness
of outcome assessors, reporting of attrition, and
inclusion of follow-up data. Thus, studies could earn
0–8 points for methodology.
4. Statistical methods: One point was given for each of the
following: proper data analysis procedure, alpha con-
trol, and assessment/use of covariates. A range of
points (0–3) was allowed for statistical power based on
sample size. Studies that had serious statistical report-
ing issues (e.g., improper or insufficient information to
determine data analysis procedure, failure to report
means and standard deviations) that could be threats to
inferences were noted as problematic studies and
docked two points. Studies with suboptimal data
analysis procedures (e.g., series of paired ttests for
several different time points in a repeated measures
design vs repeated measures analysis; tests between
groups on posttest means only instead of repeated
measures analysis of variance (rmANOVA), analysis of
covariance (ANCOVA), or change scores) were docked
one point. Thus, studies could accrue a range of −3to6
points for statistical methods.
Table 1 Descriptive criteria assessed
Participant Information
Sample population studied
Sample mean age
Sample gender breakdown
Number of participants studied
Intervention and Study Information
Biofield modality studied
Number of practitioners used
Training/experience of practitioners
Mean duration of treatment session
Frequency of treatment session
Total number of treatment sessions
Study design (between or within-subjects)
Percent attrition
Outcomes Information
Use of psychological outcomes
Use of biological outcomes
Use of qualitative outcomes
Number of positive psychological outcomes reported
Total number of psychological outcomes reported
Ratio of positive/total psychological outcomes reported
Number of positive biological outcomes reported
Total number of biological outcomes reported
Ratio of positive/total biological outcomes reported
Total positive outcomes reported
Total outcomes reported
Ratio of positive/total outcomes reported
Int. J. Behav. Med. (2010) 17:1–16 3
5. Outcomes assessed: Studies were given one point for
each of the following: multiple types of outcomes
assessed (i.e., biological+ psychological, or psycholog-
ical+qualitative, or qualitative + biological, or all three)
and use of reliable/valid measures. With respect to
the latter, studies that reported several reliable/valid
measures but one or more unreliable/valid measure
were scored based on ratio (e.g., a study with five
outcome measures but only four reliable/valid measures
was given 0.8 points for reliability/validity of
measures). Thus, studies could earn from −1to2
points on outcomes assessed.
Points from each of the categories were summated to
provide an overall rating of quality for each study. Thus,
the range for overall study quality could be between −3
and 16 points. The reader may note that these study
rating criteria include three of the five criteria used in the
Jadad method [17] of study quality evaluation for RCTs:
(1) procedure to ensure “double-blinding”(here, of patient
and outcomes evaluator) was assessed and was appropri-
ate, (2) randomization procedure was described and was
appropriate, and (3) withdrawals and dropouts were
described. This study did not explicitly include the other
two criteria: (1) study was randomized, and (2) study was
“double-blind,”because this review also included within-
subject clinical trials that were not RCTs (however,
between-subject designs did require randomization to
groups). Table 3lists each study with overall study quality
ratings.
Best Evidence Synthesis
Following reviews for quality, studies were grouped by
patient populations examined and then by outcomes
assessed, in order to determine whether biofield therapies
showed efficacy for particular medical ailments or
aspects of functioning. Studies had to meet the following
minimum criteria to be included in the best evidence
synthesis: (1) appropriately conduct and adequately
describe data analysis procedures, and (2) include an
Criteria Points
awarded
Points
deducted
Methodology
and design
Used standard control group or baseline condition 1 NA
Used comparison group or condition 1 NA
Used placebo/nonspecific control group or condition 1 NA
Delineated proper randomization/counterbalancing procedure 1 NA
Described/tested for recipient blinding 1 NA
Described/tested blinding of outcome assessors 1 NA
Reported attrition 1 NA
Utilized follow-up data 1 NA
Statistical
methods
Used proper statistical analysis 1 NA
Assessed for/adjusted for covariates 1 NA
Used alpha control for multiple comparisons 1 NA
Reported effect sizes 1 NA
Used adequate sample size
n≤19 per group 0 NA
20≤n< 30 per group 1 NA
n≥30 per group 2 NA
Poor data analysis procedure (i.e., improper statistical analysis) 0 −2
Suboptimal data analysis procedure (e.g., using series of several
paired ttests for repeated measures data without alpha control
examining between-group differences for repeated measures data
using only unadjusted posttest means, no means/SD reported)
0−1
Outcomes
methods
Used reliable and valid measures 0–1NA
Did not use any reliable/valid measure 0 −1
Utilized more than one outcome area (e.g., biological +
psychological, psychological+ qualitative)
1NA
Total possible
points
16 −3
Tab l e 2 Study quality rating
criteria
NA not applicable
4 Int. J. Behav. Med. (2010) 17:1–16
Table 3 List of all studies reviewed, with overall quality ratings and subdomain ratings
Authors Year Published Overall Study Rating Methodology Points Stats Points Outcomes Points
Cleland et al. 2006 [59]12 6 4 2
Beutler et al. 1988 [54] 11.5 5 5 1.5
Meehan 1993 [43]11 4 5 2
Laidlaw et al. 2006 [60]11 5 4 2
Woods, Craven, & Whitney 2005 [49]10 5 4 1
Smith et al. 2003 [37] 10 4 4.5 1.5
Quinn 1989 [52]10 5 4 1
Post-White et al. 2003 [35]10 5 3 2
Lin & Taylor 1999 [22] 10 4.5 3.5 2
Aghabati, Mohammadi, Esmaiel 2009 [38]10 3 6 1
Movaffaghi et al. 2006 [61] 9.5 4.5 4 1
Gerard et al. 2003 [23] 9.5 4.5 3 2
Olson, Hanson, & Michaud 2003 [36]9 4 3 2
Gillespie, Gillespie, & Stevens 2007 [34]9 3 5 1
Redner et al. 1991 [30]8 3 3 2
Peck 1998 [62] 8 2.5 3.5 2
Gordon et al. 1998 [29]8 4 2 2
Abbot et al. 2001 [3]8 4 2 2
Turner et al. 1998 [45] 7.5 3.5 3 1
Simington & Laing 1993 [63] 5.5 4.5 1 2
Randolph 1984 [64] 7.5 3 2.5 2
Jang & Lee 2004 [65] 7.5 5 2 0.5
Yang, Kim & Lee 2005 [24]7 3 3 1
Naito et al. 2003 [66]7 4 2 1
Laidlaw et al. 2003 [67]7 4 1 2
Gagne & Toye 1994 [68]7 5 1 1
Engle & Graney 2000 [69]7 2 3 2
Cook, Guerrerio, & Slater 2004 [70] 6 3.5 2.5 1
Shore 2004 [71] 6.5 4 1.5 1
Seskevich et al. 2004 [53] 6.5 3 3 0.5
Quinn 1984 [51] 6.5 1 3.5 2
Keller & Bzdek 1986 [31] 6.5 2 3.5 1
Woods & Dimond 2002 [48]6 3 2 1
Tsang, Carlson, & Olson 2007 [39]6 3 2 1
Sundblom et al. 1994 [28]6 3 1 2
Shiflett et al. 2002 [47]6 3 2 1
MacKay et al. 2004 [55]6 2 2 2
Lee et al. 2005 [72]6 2 2 2
Cox & Hayes 1999 [46]6 1 3 2
Vitale & O’Connor 2006 [44] 5.5 2 1.5 2
Lee et al. 2003 [73] 5.5 2 3 0.5
Krieger 1976 [74] 5.5 1 3.5 1
Dixon 1998 [75] 5.5 2 2 1.5
Blankfield et al. 2001 [76] 4.5 3 0.5 2
Wilkinson et al. 2002 [77] 4 2 1.5 1.5
Sneed et al. 2001 [56]5 1 3 1
Pohl et al. 2007 [78] 5 3 1.5 0.5
Olson et al. 1997 [79]5 3 1 1
Lee et al. 2001 [25]5 1 2 2
Int. J. Behav. Med. (2010) 17:1–16 5
adequate control, comparison, or placebo control group
or condition. Levels of evidence, akin to those reported
in previous best evidence synthesis reviews (e.g., [18]), were
assessed separately for the efficacy of biofield therapies for
specific patient populations and underlying outcomes.
Stipulations for levels of evidence were as follows:
Level 1. Strong evidence as indexed by findings in two or
more high-quality RCTs and by generally con-
sistent evidence in other studies.
Level 2. Moderate evidence as indexed by at least one
high-quality RCT and supplemented by findings
in at least one lower quality RCTs or high-
quality quasi-experimental study.
Level 3. Limited evidence as indexed by more than one
lower quality quasi-experimental study and/or
lower quality RCT.
Level 4. Conflicting evidence as indexed by the existence
of multiple studies with conflicting results on
identical outcomes, such that the number of
studies reporting positive vs null outcomes were
nearly equal to each other.
Studies were rated as high or low quality based on
median scores of quality score ratings. Evidence for an
effect for the given biofield therapy was determined by
whether the null hypothesis was rejected at a significance
level of p<0.05 for the outcome(s) examined, such that the
biofield therapy showed positive results.
Results
Study Information
This search strategy initially yielded 88 clinical studies
using the inclusion criteria mentioned above. Of these,
eight were excluded for failure of randomization to groups,
four were excluded for providing only descriptive informa-
tion about groups with no analyses, three were excluded for
integrating another mind–body intervention with proximal
healing, three were excluded for solely examining effects of
healing on practitioners with no clinical outcomes/analyses
solely for recipients, and four were excluded for integrating
or comparing only distant healing with proximal healing.
Thus, a total of 66 studies were examined in this review.
Of the 66 studies reviewed, 52 were between-subjects
randomized controlled trials, and 14 were within-subject
repeated measures designs with appropriate baseline/control
conditions. Of the between-subjects designs, 31 utilized a
mock or placebo-controlled treatment group, 11 utilized
comparison groups, and 32 utilized no treatment or
treatment-as-usual control groups (some studies utilized
more than one of these groups; e.g., a wait-list control and
comparison group). In terms of the biofield interventions
used, 27 used therapeutic touch, 10 used Qigong, 10 used
Reiki, 5 used spiritual healing, 5 used healing touch, 5 used
Johrei, 2 used laying on of hands, 1 used Johnson
bioenergy, and 1 used polarity therapy.
Table 3 (continued)
Authors Year Published Overall Study Rating Methodology Points Stats Points Outcomes Points
Laidlaw et al. 2005 [41]5 3 1 1
Brooks, Schwartz et al. 2006 [80]5 2 2 1
Lee et al. 2001 [32]5 2 1 2
Roscoe et al. 1995 [81]4 2 1 1
Lee et al. 2003 [26] 4 2 0.5 1.5
Lee et al 2005 [72]4 1 2 1
Ireland 1998 [82]4 1 1 2
Wardell & Engebretson 2001 [83]4 1 1 2
Crawford, Leaver, & Mahoney 2006 [84]4 2 1 1
Olson & Hanson 1997 [27] 3.5 1 2 0.5
Lee et al. 2003 [33]3 1 1 1
Larden, Palmer & Jannesen 2004 [85]3 4 –21
LaFreniere et al. 1999 [86]3 1 0 2
Lee, Rim, & Kang 2004 [87]2 1 1 0
Giasson & Bouchard 1998 [42] 2.5 1 1 0.5
Denison 2004 [88] 2 1.5 –0.5 1
Taylor & Lo 2001 [89]1 1 –11
a
Studies noted as problematic due to poor or incomplete reporting of study analysis procedures
6 Int. J. Behav. Med. (2010) 17:1–16
Nearly all studies reported sufficient basic information
such as participant number, gender, age, and clinical
condition. Disappointingly, 69% of studies failed to report
on ethnic breakdowns of the sample. Most studies provided
adequate information on intervention details, including
modality used, number and experience of practitioners,
length of intervention, and number and frequency of
treatment sessions. The length of healing sessions reported
ranged from 3 to 90 min; the average was 23 min, and the
median was 17.5 min. Studies reported a range of treatment
sessions from one to 15; the average was four treatment
sessions, and the median was 3.
Systematic Quality Ratings
The range of overall study quality for all reviewed
publications was between one to 12; the mean score was
6.4, and the median was 6. Thus, according to the review
criteria stipulated, the average study was of medium quality.
Chi-square analyses with study quality split into high and
low based on median score indicated that studies of higher
quality had significantly more points assigned for statistical
and methodological criteria (p<0.015 in both cases); there
was no difference between high- and low-quality studies in
terms of outcome rating criteria (i.e., using reliable and
valid measures and/or using multiple measures; p= 0.35).
Studies could earn from 0 to 8 possible points for
methodology; the range of points for reviewed studies was
from 1 to 6, with the mean score being 2.9 and the median 3.
Thus, studies overall could have improved by better reporting
of methodology. For example, although all between-group
studies reported randomization to groups, just over half
actually delineated the randomization procedures. Similarly,
under a third of studies reported blinding of outcome
assessors, and of those that utilized placebo-controlled
designs, only 34% described strategies for testing for blinding
of participants to condition. Only 53% of studies reported
attrition rates; of those studies, the average attrition rate was
18%, with the median being 14.5%.
Studies could earn from −2 to 6 points on statistical
criteria; the range of statistical points for all studies was
from −2 to 5, with a mean of 2.2 and a median of 2. Thus,
the average study scored fairly low on statistical criteria.
This was primarily due to lack of assessment/use of
covariates, lack of reporting on effect sizes, and lack of
alpha control (it should be noted, however, that many
studies that did not formally utilize alpha control reported
pvalues that would have remained significant with
Bonferroni correction). In addition, the average study for
this review used 20–30 participants per group, giving an
average and median point rating of 1 for sample size for
these reviewed studies. Of the 67 studies, four had serious
statistical analysis issues that rendered inferences problem-
atic (e.g., not accounting for potential baseline differences
along with no reports of means or standard deviations); and
six studies had suboptimal or questionable statistical
strategies (e.g., inconsistent or poorly described strategies,
examining posttest means only with repeated measures data
over several different time points). Regression analysis
revealed that these ten studies had significantly lower
overall study quality than the other 57 studies (F
(1,61)
=
9.1, p=0.004).
Finally, out of a total of two possible points for outcome
measure criteria, the range for this review was from 0 to 2,
with a mean of 1.4 and median of 1.5. Of note is that the
average score for reliability and validity of outcome
measures assessed for all studies was 0.89 (median was
1); thus, most studies used reliable and valid outcome
measures in their investigations, but did not necessarily
utilize all types of outcomes (i.e., biological, self-report,
qualitative).
Thus, the average study reviewed was of average quality,
and minimum quality standards required for validity of
inferences (i.e., randomization, use of control or comparison
groups or conditions, and appropriate statistical procedures)
were generally met. This review reports a lower overall
study quality than that reported by Crawford, Sparber, and
Jonas [15]; these authors reported a 65% overall rating on
internal validity of the clinical hands-on-healing studies
reviewed. However, it should be noted that these authors
only included randomized controlled clinical studies, while
this study also included within-subject designs with
appropriate baseline measurements. This review may, thus,
reflect a slightly more accurate assessment of study quality
in a larger range of the literature.
Outcomes Results
Of the 66 studies reviewed, 85% reported psychological or
self-report outcomes, 54% reported biological or objective
functional outcomes, and 9% examined qualitative reports.
Fifty-four percent of the studies utilized more than one
outcome domain (mostly biological+psychological outcomes).
Assessing Potential Bias of Problematic Studies
To determine whether the ten problematic studies may have
shown bias in terms of reporting outcomes compared to the
other studies, linear regression analyses were conducted on
number of positive psychological outcomes reported,
number of positive biological outcomes reported, and
respective ratios of biological/total and psychological/total
outcomes assessed. There was a trend (p= 0.055) for these
studies to report less positive psychological outcomes
compared to the 56 nonproblematic studies; however, they
did not significantly differ in terms of reported positive
Int. J. Behav. Med. (2010) 17:1–16 7
biological outcomes or ratio of positive/total outcomes,
either for biological or psychological data (p>0.46 in all
cases). Thus, it did not appear that the ten problematic
studies showed bias in reporting more positive outcomes.
However, given that these studies rendered problematic
inferences due to inappropriate or questionable statistics,
these studies were excluded from the best evidence
syntheses conducted below.
Best Evidence Syntheses
In order to glean useful information on the potential
efficacy of biofield interventions for particular ailments,
we conducted a best evidence synthesis of the remaining
nonproblematic studies using the guidelines previously
described in the Methods section. Studies were first
separated by population. A variety of populations were
studied; the most commonly studied patients were those
with chronic pain or pain-related disorders (n= 15), cancer
patients (n=11), postoperative or rehabilitation patients (n=
6), patients with dementia (n=4), and patients with varying
cardiovascular ailments (n= 4). While some studies utilized
student populations (n= 9) and a number of studies utilized
healthy participants (n= 13), these were not included in best
evidence syntheses due to the heterogeneity of outcomes
assessed within these populations. Also, a few studies
examined outcomes for other types of disorders (i.e., mood,
substance use), but due to the low number of studies per
population and heterogeneous outcomes, best evidence
syntheses could not be conducted for these miscellaneous
studies. Descriptive information on these studies (student,
healthy, and miscellaneous populations) may be found in
Tables 4f,g,helectronic (online) supplementary material.
All 67 studies (separated by population/ailment studied)
are presented in Tables 4a,b,c,d,e,f,g,has electronic
supplementary material. These tables present information
on study characteristics, outcomes assessed, results
reported, and relative strengths and weaknesses. Best
evidence syntheses for pain disorders, cancer, postopera-
tive, dementia, and cardiovascular ailments follow.
Pain-Related Disorders
Descriptive details for each pain-related study may be
found in Table 4ain the electronic supplementary material.
Of the 15 pain-related studies, two were flagged as
problematic due to poor statistical procedures and/or
reporting and were not included in the best evidence
synthesis. Of the remaining 13 studies, using median scores
for quality ratings as described in Table 4, there were nine
high-quality RCTs, one high-quality quasi-experimental
study, one lower quality quasi-experimental study, and
two lower quality RCTs. Seven studies used placebo
controls (i.e., mock healing), and seven studies used
standard care controls or comparison groups (some studies
utilized multiple groups). Six of the 13 studies were
specifically targeted toward chronic pain patients, three
were with elderly pain patients, and the remaining had
varied populations (including arthritis, painful diabetic
neuropathy, and restricted movement disorders).
Most studies utilized unidimensional scales (i.e., the
visual analog scale or VAS) to rate pain intensity, with
fewer studies using more comprehensive pain question-
naires (e.g., the McGill pain rating scale). This is in keeping
with the general literature on pain interventions, where the
VAS is generally the most frequently used assessment tool
[19]. The VAS and related measures (i.e., numeric rating
scale or NRS) are reliable and valid and have been used for
decades in pain assessment research [20]. Notably, VAS
ratings in pain patients have been found to be associated
mainly with sensory aspects of pain and may not accurately
reflect cognitive and functional aspects of pain reduction
[21], but rather, sensory perception of pain intensity.
Seven studies examined pain intensity using the VAS,
and one used a similar scale, the NRS. Of these eight
studies, six studies (three high-quality RCTs, two lower
quality RCTs, and one lower quality within-subjects study)
noted significant reductions in pain [22–27]. Four of these
studies were placebo control designs, suggesting that the
reductions in pain intensity may be beyond nonspecific
effects. However, two higher quality RCTs reported null
effects on VAS-rated pain [3,28]. Thus, while overall
studies suggest a strong (level 1) level of evidence for the
effects of biofield therapies to reduce pain intensity as
noted via the VAS, the emergence of two studies with null
findings suggest the need for further study.
Studies using more comprehensive pain assessments
(i.e., the McGill or Multidimensional Pain Inventory)
provide an inconsistent (level 4) level of evidence for pain
relief from biofield therapies. Three high-quality studies
[29–31] found significant reductions in these comprehen-
sive pain assessments for biofield groups compared to
placebo. However, two high-quality studies, also with
placebo controls, did not report significant differences
between groups. Importantly, these studies were with
varied populations; evidence from future studies will help
to better assess whether biofield therapies may be more
effective for pain relief for certain types of pain-related
disorders.
Eight studies (six high-quality RCTs and two low-quality
RCTs) examined mood variables (such as depression,
anxiety, and general mood disturbance) as secondary
variables in these pain populations. Three studies used the
Profile of Mood States (POMS), two used the Hospital
Anxiety and Depression scale (HADs), one used the
Spielberger State–Trait Anxiety Inventory (STAI), one used
8 Int. J. Behav. Med. (2010) 17:1–16
the Beck Depression Inventory (BDI), and one used VAS
measures of anxiety and depression. Findings from these
studies suggest conflicting (level 4) evidence on biofield
therapies' impact on depression and anxiety as reflected in
the current literature. Two high-quality RCTs and two lower
quality RCTs reported findings suggesting reductions in
anxiety and negative mood [22,24,32,33]. However, four
high-quality RCTs [3,23,28,30] suggested no change in
these variables. These findings are consistent with the
equivocal findings on comprehensive pain measures that
incorporate affective components of pain perception,
suggesting that overall, there is conflicting evidence on
the impact of biofield interventions on affect in pain
populations.
Three studies also examined health-related quality of life
(QOL) measures in these pain populations; all were high-
quality RCTs. Abbot et al. [3] reported an increase in SF-
36-rated physical functioning for healing vs mock healing;
this was replicated by Gerard et al. [23], who also reported
notable and significant improvements on SF-36-rated
energy/vitality. Gillespie, Gillespie, and Stevens [34] also
reported borderline significant (p= 0.05) findings on a QOL
measure specific to their diabetic population. Thus, while
studies are definitely limited in this area, currently there is
strong evidence (level 1) suggesting that biofield therapies
may improve QOL-rated physical functioning as rated by
the SF-36.
In summary, data for biofield studies in pain populations
suggest strong (level 1) evidence for biofield therapies to
provide reductions in pain intensity. However, findings
from studies on the effects of biofield therapies on
comprehensive assessment of pain reduction are equivocal
(level 4), suggesting that the effects of biofield interven-
tions on affective components of pain perception are less
clear. In line with these findings, conflicting evidence (level
4) on affective variables such as anxiety and depression
suggest the need for further research in this area. Positive
findings from a few high-quality RCTs suggest that biofield
interventions positively impact health-related quality of life
domains such as physical functioning. However, more
studies are needed that examine QOL as a primary measure
before conclusions can be drawn on effects of biofield
interventions on QOL for pain patients. Studies in this area
could also be greatly enhanced by the addition of functional
measures and biomarkers relevant to the pain disorder of
interest.
Cancer Patients
Descriptive information about cancer studies may be found
in Table 4bin the electronic supplementary material. There
were ten studies that examined outcomes of biofield
therapies in cancer patients. Of these, one study had a
questionable statistical analysis procedure which rendered
inferences problematic; and one study became quasi-
experimental due to the healer unblinding his status and
quitting the study. These studies were excluded from the
best evidence synthesis. The remaining eight studies were
conducted with a number of different types of cancer
populations, including those undergoing bone marrow
transplant, those undergoing chemotherapy treatment,
patients with metastatic illness, patients with terminal
illness, and other populations. Several studies utilized
heterogeneous samples (e.g., gynecological and breast
cancer patients). Of these, using median scores for quality
ratings as described in Table 4, four studies were rated as
high quality and four as lower quality.
Studies were also heterogeneous with respect to specific
outcome measures examined; however, overall primary
outcomes were related to cancer symptomatology (e.g.,
fatigue, pain, and nausea) and/or quality of life. Few studies
examined physiological or functional measures; two studies
examined heart rate, blood pressure, and respiration either
during or prepost biofield sessions [35,36], and one study
examined time for engraftment and treatment complications
as a result of bone marrow transplant [37].
Four studies examined cancer-related pain. Three studies
examined pain acutely (pre- and postsessions). A high
quality RCT by Aghabati, Mohammadi, and Esmaiel [38]
examined the effects of five days of TT vs. placebo and
standard care for a heterogenous group of female cancer
patients undergoing chemotherapy. They reported signifi-
cant decreases in VAS-related pain for those in the TT
group as compared to both a placebo and standard care
group. Olsen et al. [36]’s smaller, lower quality RCT
examined Reiki vs a control group for patients with
advanced cancer. Post-White et al. [35]’s high-quality
crossover design examined healing touch compared to
massage and a nonspecific control (presence) group for
breast cancer patients undergoing chemotherapy. Both
reported positive outcomes on pain for biofield therapies
vs control groups. Post-White et al. [35] also indicated
massage to be efficacious in reducing pain compared to the
control group, with no significant differences between
massage and biofield therapy on pain intensity. However,
Post-White et al. also reported no longer term intervention
effects on pain index or pain interference for any group.
Another pilot, crossover Reiki study [39] with a heteroge-
neous group of cancer patients reported significant reduc-
tions on Edmonton Stage Assessment System ratings of
pain over a 2-week intervention period; however, these
reductions were not significantly different from the resting
condition.
Thus, while the limited number of studies prevents firm
conclusions, studies thus far suggest moderate (level 2)
evidence for biofield therapies to reduce acute pain in
Int. J. Behav. Med. (2010) 17:1–16 9
cancer. Currently, there is little evidence for longer term
pain outcomes in cancer, and it is unclear whether biofield
therapies offer benefit over other modalities (such as
massage) on pain in cancer.
Three studies specifically examined fatigue as a primary
outcome. Aghabati et al.’s[38] high-quality RCT reported
significant acute decreases in the Rhoten Fatigue Scale for
patients in the Therapeutic Touch vs. placebo and standard
care control groups. In the study of Roscoe et al. [40],
smaller, lower quality RCT suggested that a short duration
of treatment with polarity therapy vs a wait-list control
reduced fatigue as measured by the Brief Fatigue Inventory.
Tsang et al. [39]’s study suggested that treatment with Reiki
reduced fatigue (via the Functional Assessment of Cancer
Therapy—Fatigue) over the course of the intervention;
however, this reduction was not significantly different from
the resting condition. Two other studies examined fatigue as
a secondary outcome using the fatigue scale in the POMS.
The high-quality, large-scale crossover study of Post-White
et al. [35] reported significant reductions in POMS fatigue
for healing touch compared to an active control condition
(presence). In the study of Laidlaw et al., smaller, lower
quality RCT [41] did not find significant reductions in
POMS fatigue for metastatic breast cancer patients receiv-
ing Johrei compared to hypnosis.
Taken together, these five studies suggest conflicting
(level 4) evidence for biofield therapies' effects on reducing
fatigue. Notably, each of these studies examined fatigue in
slightly different cancer populations at different times of
treatment (e.g., radiation therapy, chemotherapy, metastatic
disease). Larger scale studies with longer durations of
treatment, more comparisons with nonspecific controls (i.e.,
mock healing groups), and more focused outcomes with
respect to cancer-related fatigue will be helpful to better
deduce potential positive effects of biofield therapies on
cancer-related fatigue.
Three biofield studies with cancer patients also exam-
ined quality of life as primary outcomes. Olsen et al. [36]
reported increased quality of life after 1 week of Reiki
treatments compared to controls, while Laidlaw et al. [41]
reported no difference in quality of life after a 4-week
Johrei intervention compared to a control group. Giasson
and Bouchard’s[42] lower quality RCT reported increases
in well-being for terminal cancer patients receiving TT vs. a
presence control. Thus, the limited data, thus, far suggests
conflicting (level 4) evidence for biofield therapies' impact
on quality of life for cancer patients; certainly more studies
are needed to clarify these initial findings.
Finally, two studies examined the effects of biofield
therapies in cancer patients with respect to basic physio-
logical indices of the relaxation response. High-quality
crossover study of Post-White et al. [35] reported that
healing touch sessions reduced systolic blood pressure and
heart rate compared to both a resting control and an active
control condition (presence alone). Healing touch also
reduced respiratory rate compared to the resting control
condition. However, in the study of Olsen et al. [36],
smaller scale RCT found no pre- and postsession differ-
ences between Reiki and control groups for systolic blood
pressure or heart rate, though there was some indication of
decreased diastolic blood pressure for those in the Reiki
group. Thus, similar to outcomes for well-being, conflicting
(level 4) data from limited studies suggest the need for
further research to better determine the impact of biofield
therapies on physiological indices of the relaxation
response.
Thus, best evidence syntheses for effects of biofield
therapies for cancer populations may be summarized as
follows: There is moderate (level 2) evidence for positive
effects on acute cancer pain. To date, there is conflicting
(level 4) evidence for longer term pain, cancer-related
fatigue, quality of life, and physiologic indicators of the
relaxation response. Of note is the relative dearth of total
studies in this area compared to the high utilization of this
and other complementary and alternative medicine modal-
ities by cancer patients. Further studies are warranted to
adequately examine and disseminate information regarding
efficacy for troublesome symptomatology in cancer.
Hospitalized and Postoperative Patients
Descriptive information for studies with hospitalized and
postoperative patients may be found in Table 4cin the
electronic supplementary material. Six studies (five high
qualities and one low quality, using median scores for
quality ratings as described in Table 4) examined effects of
biofield therapies on hospitalized or postoperative patients,
with most studies examining effects on pain and anxiety.
In the study of Meehan [43], high-quality RCT examined
a notably short intervention duration (one 5-min session) of
therapeutic touch (TT) vs mock TT or standard care control
(pain medication injection) on pain and analgesic medica-
tion use for 108 patients who had undergone pelvic or
abdominal surgery. Pain medication administration was
significantly superior to TT and mock TT in reducing pain;
there was a trend (p=0.06) for TT to be associated with
reduced pain compared to mock TT. There was also a
significant delay in requests for analgesic pain medication
for persons receiving TT vs mock TT. A more recent,
though lower quality RCT conducted by Vitale and
O’Connor [44], also examined effects on postoperative
pain, as well as anxiety, on women undergoing abdominal
hysterectomy. Three 30-minute sessions of Reiki were
given pre- and postoperation and compared to standard
care. Results indicated that women in the Reiki group
reported significantly less pain at 24 h postoperation;
10 Int. J. Behav. Med. (2010) 17:1–16
however, there were no differences between groups at 48
and 72 h. The authors also reported that the Reiki group
showed significantly decreased STAI-rated anxiety at 72 h
compared to controls.
Two studies attempted to examine effects of biofield
therapies on physiologic as well as psychological outcomes
for hospitalized patients. Turner et al. [45]’s high quality
RCT was designed to examine the effects of five short TT
vs mock TT sessions on pain, anxiety, medication use, and
lymphocyte subsets for 99 burn patients. The authors
reported decreased VAS-rated anxiety in this study, as well
as reductions on two of three McGill Pain Indices for TT
patients vs mock TT. No differences on pain medication
were noted. In terms of lymphocyte subsets, the authors
reported that they were unable to examine blood markers
on all patients and thus, chose to describe and not analyze
results from a convenience sample of 11 patients; thus, no
conclusions could be drawn on physiologic parameters.
Within-subjects study of Cox and Hayes [46] examined
effects of TT on heart rate, blood pressure, and peripheral
oxygen saturation for critical care patients, as well as on
psychological responses (obtained via qualitative inter-
view). Patients received a mean of two sessions of
unknown duration. While no significant changes were
found in physiological variables during treatments, themes
emerging from qualitative data for patients included feel-
ings of energy and quiescence. Finally, in the study of
Shiflett et al. [47], high-quality RCT examined ten 30-min
sessions of Reiki vs mock Reiki for poststroke rehabilita-
tion patients. No significant improvements in rehabilitation
function or depression were found for Reiki patients vs
mock Reiki.
Taken together, studies suggest that for hospitalized
patients, there is moderate (level 2) evidence for biofield
therapies to reduce anxiety (as indexed by results from
high-quality RCT of Turner et al. [45], also supplemented
by the results from a lower quality RCT of Vitale and
O’Connor [44]). Regarding pain in hospitalized patients,
there is moderate (level 2) evidence for acute reductions in
rated pain as indexed by high-quality RCT of Turner [45]in
burn patients, supplemented with the study of Vitale and
O’Connor [44] on the results with postoperative surgery
patients. Results from two high-quality studies [43,45],
both with placebo controls, suggest conflicting (level 4)
evidence on the efficacy of biofield therapies for reducing
pain medication usage (notably, the populations were
different—with Meehan studying postoperative pain and
Turner et al. studying burn patients). There is insufficient
evidence for depression, as well as functional or autonomic
outcomes for hospitalized patients; each of these variables
was examined by only one study. However, it is notable
that each of these studies reported null outcomes on these
variables.
Dementia Patients
Descriptive information for dementia studies may be found
in Table 4din the electronic supplementary material. To
date, four studies have examined outcomes for dementia
patients, and two were noted as problematic studies. The
remaining two studies examined the effects of therapeutic
touch for dementia patients and were conducted by the
same lead author. The first, lower quality study [48]
examined the effects of TT using the clinician-rated
Agitated Behavior Rating Scale, as well as on salivary
and urine cortisol on a small sample (n= 10) of persons with
Alzheimer's disease. Results indicated significant pre- and
posteffects for the vocalization and pacing subscales, but no
significant changes in cortisol over time. The second study
was a high-quality RCT that examined TT in patients with
dementia utilizing the same behavioral measure Woods et
al. [49]). This partial replication study reported similar
results to the previous pilot study: the TT group showed
decreased overall behavioral symptoms as well as decreases
in manual manipulation and vocalization compared to a
control group. Thus, while data for the effects of biofield
therapies for reducing negative behavioral symptoms in
dementia is quite limited, there is moderate evidence (level
2) that suggests this to be a promising and important area
for additional research. Findings reported here are also
corroborated by a recent case study series report [50] that
suggests biofield therapies to be helpful in reducing
negative symptoms in dementia while also being well
tolerated by participants.
Cardiovascular Patients
Descriptive information for cardiovascular patient studies
may be found in Table 4ein the electronic supplementary
material. Four high-quality studies have been conducted
examining effects of biofield therapies with cardiovascular
disorders, with different outcomes examined. Three studies
examined anxiety. In her first study with hospitalized
cardiovascular patients, Quinn [51] reported significant
decreases in state anxiety for persons receiving 5 min of
TT vs mimic TT. However, in a larger subsequent study
with patients awaiting open heart surgery, Quinn [52]
reported no significant differences between 5 min of TT
vs mimic TT and controls on state anxiety. A relatively
recent study by Seskevich, Crater, Lane, and Krucoff [53]
reported that cardiovascular patients receiving 30 min of
healing touch (HT) before angioplasty reported significant
reductions in VAS-rated worry compared to standard care;
however, there was no difference between the HT and stress
management and imagery groups. In terms of physiological
variables, in the study of Quinn with persons awaiting
open-heart surgery [52], no significant differences on
Int. J. Behav. Med. (2010) 17:1–16 11
systolic blood pressure for TT vs mimic TT or the control
group; however, the TT group did show significantly
decreased diastolic blood pressure compared to the no-
treatment control group. In the study of Beutler et al. [54],
higher quality RCT examined laying on of hands (LOOH)
compared to no treatment and distance healing in hyper-
tensive patients. There were no significant group × time
effects on systolic and diastolic blood pressure, although
the LOOH and distant healing groups both showed
significant within-subject decreases in diastolic blood
pressure.
Thus, while data is particularly limited in this area, results
from the high-quality studies of Quinn [51,52] and Seskevich
et al. [53] suggest conflicting (level 4) evidence for biofield
therapies to reduce anxiety acutely for cardiovascular
patients. High-quality studies of Quinn [52] and Beutler et
al. [54] that examined blood pressure suggest there is little
evidence for biofield therapies in reducing systolic blood
pressure. There is conflicting (level 4) evidence that biofield
therapies may reduce diastolic blood pressure compared to
no treatment for cardiovascular patients, but more studies
examining this outcome in cardiovascular patients are
needed. Given that other studies with healthy populations
have noted positive outcomes for biofield therapies on
cardiovascular indices associated with the relaxation
response (i.e., [55,56]), further examination of biofield
therapies' effects on cardiovascular indices seems warranted.
Effects of Treatment Duration and Study Quality
on Outcomes
In order to determine whether treatment session duration,
number of treatment sessions, or study quality was
associated with reported outcomes, a bivariate (Pearson's
product-moment) correlation matrix for the studies was
examined. (Although it would have been interesting to
examine practitioner experience as a potential predictor
variable, heterogeneity of practitioner experience within
studies did not make this possible). The total number of
treatment sessions was significantly positively associated
with number of positive reported psychological outcomes
(r=0.321, p=0.019), suggesting the possibility of a dose–
response effect on outcomes. However, treatment session
duration was not associated with number of positive
reported outcomes. Study quality was also not associated
with number of positive outcomes.
Discussion
Biofield-based interventions, used in various cultures for
the purposes of eliciting healing responses, have enjoyed a
recent resurgence in public interest. In order to better
inform patients of the potential benefits or nonbenefits of
these modalities, clinicians and scientists within behavioral
medicine should familiarize themselves with current theory,
practice, and research of such techniques. This review
summarizes the state of the science on biofield-based
techniques as they are practiced proximally (with practi-
tioner and client in same room). Results from this evidence-
based synthesis suggest strong evidence for effects of
biofield therapies in decreasing pain intensity in pain
populations, moderate evidence for reducing pain in
hospitalized populations, and moderate evidence in reduc-
ing pain in cancer populations. There is also moderate
evidence for biofield therapies to help reduce negative
behaviors associated with dementia and moderate evidence
for decreasing anxiety in hospitalized populations. Limited
findings on biofield therapies for quality of life in pain
patients are promising. Findings in other domains (e.g.,
comprehensive pain outcomes, fatigue and quality of life in
cancer patients, and anxiety in cardiovascular populations)
are equivocal and generally reflect a paucity of studies that
have examined these outcomes. In addition, there is little
data available to evaluate the impact of biofield interven-
tions on acute physiology related to the relaxation response,
as well as insufficient data to evaluate the impact of biofield
therapies on other populations (i.e., mood disorders,
substance abuse, pediatric populations).
Findings on biofield therapies to reduce pain intensity
among patients with pain and other ailments warrant further
investigation with regard to potential mechanism. Given
that findings appeared consistent for biofield therapies'
efficacy over placebo (five of seven placebo-controlled
trials with pain patients reported reductions in pain for
biofield vs placebo controls), effects on acute pain appear to
be beyond nonspecific effects such as touch or expectation.
From a biofield theoretical perspective, acute reductions in
pain are understood as a consequence of the movement of
stagnant energy that is often associated with pain. There-
fore, from this theoretical perspective, continued use of
modalities such as biofield therapies should serve to
mitigate pain by facilitating movement and increased
regulation of vital energy, which may, for example, be
associated with decreased inflammation in certain popula-
tions. Further larger scale studies will better help elucidate
potential longer term benefits of such modalities by
including dose–response studies and carefully selected
outcomes that are specific for the clinical populations
studied. Interestingly, there is conflicting evidence for
biofield therapies' effects on more comprehensive pain
outcomes, which incorporate cognitive and affective com-
ponents of pain perception. Should this pattern of findings
persist in the literature, it will suggest that mechanisms of
action for biofield therapies may differ from more cogni-
tively oriented behavioral medicine modalities (e.g., cogni-
12 Int. J. Behav. Med. (2010) 17:1–16
tive behavioral therapy, mindfulness-based stress reduc-
tion), and that the two may serve to complement one
another in terms of providing an overall greater sense of
pain relief and increased quality of life.
The moderate evidence found for biofield therapies'
effects on reducing dementia behaviors and anxiety in
hospitalized populations is interesting and warrants further
investigation with respect to potential mechanisms and
long-term efficacy. Though these studies are relatively few
in number, the promising findings in this area, thus, far
suggest a need for further research in these specific areas.
A disappointing finding from the review was that 67% of
studies neglected to report ethnic breakdowns of the study
sample. Such information may prove to be vital in
understanding whether persons from cultures that espouse
worldviews matching the holistic principles inherent in
biofield therapies respond more positively to these inter-
ventions. Researchers in this field are encouraged to take a
more careful approach in assessing ethnic and cultural
identity as well as worldview along with other pertinent
sociodemographic variables.
It will be important for continuing studies in this area to
examine whether biofield therapies distinguish themselves
from a general relaxation effect that could be achieved by a
variety of other empirically supported modalities. Although
purported subtle energetic effects cannot be measured
directly, bioelectric signal measurement (such as the
Gaseous Discharge Visualization [57]) as well as qualitative
reports can be examined and may prove to provide
interesting comparative information on biofield interventions
vs those that are more traditionally cognitive or somatic
focused. In addition, examination of specific biomarkers
associated with stress and relaxation response systems
should be examined to determine impact of biofield therapies
vs other modalities on these systems. Examining such
comparative data may help to resolve general questions of
mechanism and inform the current debate about whether
ancient theories supposing subtle energetic effects of these
therapies are supported by data, or are better explained by
Western theories such as expectation and relaxation effects.
Finally, assessment of potential moderators or mediators
(e.g., expectation, empathic resonance) of treatment will
provide important clinical and research information on the
potential mechanisms of action of biofield techniques.
This review has noted limitations. Although systematic,
this review is not a meta-analysis. One reason for the
decision to approach the data from a systematic but not
meta-analytic approach was based on the fact that current
studies are very heterogeneous with respect to study quality,
types of treatment modalities, length of treatment sessions,
and interventions. A formal meta-analysis would have
necessitated a more narrow scope in study inclusion and
may have excluded the assessment of within-subject designs.
In addition, the research field itself is in its infancy, with many
larger scale clinical studies currently underway. Thus, a more
definitive meta-analytic approach appears to be premature at
this point of assessment. However, this review's reliance on p
values and not effect sizes is a notable limitation. It should
be noted that of 67 studies, only six reported effect sizes, and
very few reported change scores with confidence intervals.
Future studies need to include this information in order to
better understand the clinical impact of biofield interventions
in patients.
Another limitation of this review is the lack of inclusion of
studies that reported only qualitative data, as well as a relative
lack of systematic assessment of qualitative data that was
reported in the studies included. Qualitative data may prove to
be vital in understanding the uniqueness of perceived effects of
biofield vs other behavioral medicine interventions and thus,
may be an essential aspect of study design for this field of
research. However, systematic assessment of qualitative data
in this review proved difficult as many of the 13% of studies
with qualitative data only reported data for the biofield
intervention and not other groups, or failed to report specific
methods for analyzing qualitative data. It is hoped that more
researchers will follow the lead of some in the nursing field and
espouse a “triangulated approach”[58] of combining qualita-
tive with quantitative data for the purpose of providing more
completeness in the assessment of biofield vs other therapies.
In conclusion, this best evidence synthesis of proximally
practiced biofield therapies suggests that they are promising
complementary interventions for reducing pain intensity in
numerous populations, reducing anxiety for hospitalized
populations, and reducing agitated behaviors in dementia,
beyond what may be expected from standard treatment or
nonspecific effects. Effects on longer term clinical outcomes
are less clear, and more systematic research is needed to
clarify findings on fatigue and autonomic nervous system
activity. Future suggested research directions include a more
thorough assessment of cardiovascular, neuroendocrine, and
immune variables, particularly those that are clinically
relevant to the disease population. Finally, comparisons of
biofield interventions with empirically supported treatments
for particular disorders is warranted to determine whether
these therapies provide any benefits over and above those
from other relaxation-response providing interventions. It is
hoped that behavioral medicine clinicians and researchers will
continue to examine the research in the area of biofield-based
therapies, in order to determine whether these interventions
may be a helpful tool in our arsenal to alleviate suffering
within patient populations.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
Int. J. Behav. Med. (2010) 17:1–16 13
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