Study of the Therapeutic Effects of Proximal
Intercessory Prayer (STEPP) on Auditory and
Visual Impairments in Rural Mozambique
Candy Gunther Brown, PhD, Stephen C. Mory, MD, Rebecca Williams, MB BChir,DTM&H,
and Michael J. McClymond, PhD
Background: Proximal intercessory prayer (PIP) is a common com-
plementary and alternative medicine (CAM) therapy, but clinical
effects are poorly understood, partly because studies have focused
on distant intercessory prayer (DIP).
Methods: This prospective study used an audiometer (Earscan
vision charts (40 cm, 6 m “Illiterate E”) to evaluate 24 consecutive
Mozambican subjects (19 males/5 females) reporting impaired hearing
(14) and/or vision (11) who subsequently received PIP interventions.
Results: We measured significant improvements in auditory
(P⬍0.003) and visual (P⬍0.02) function across both tested
Conclusions: Rural Mozambican subjects exhibited improved au-
dition and/or visual acuity subsequent to PIP. The magnitude of
measured effects exceeds that reported in previous suggestion and
hypnosis studies. Future study seems warranted to assess whether
PIP may be a useful adjunct to standard medical care for certain
patients with auditory and/or visual impairments, especially in con-
texts where access to conventional treatment is limited.
Key Words: audition, complementary and alternative medicine
(CAM), intercessory prayer, spirituality, vision
Proximal intercessory prayer (PIP), a term we coined to
refer to direct-contact prayer, frequently involving touch,
by one or more persons on behalf of another—is one of the
commonest complementary and alternative medicine (CAM)
therapies. Pentecostals and Charismatics—the fastest grow-
ing subgroups of Christianity— often pray for their own heal-
ing and request distant intercessory prayer (DIP), but they
consider PIP to be particularly efficacious. Pentecostals model
PIP on New Testament accounts of Jesus and his disciples
laying hands on the sick. Pentecostals conceptualize the Holy
Spirit’s “anointing,” sometimes represented by oil, as a tan-
gible, transferable substance, or love energy, communicated
through human touch. Comparing anointing with electricity
or radiation therapy, Pentecostals believe efficacy correlates
with frequency and length of exposure, types of prayers, and
From the Department of Religious Studies, Indiana University, Bloomington,
IN; Nashville, TN; Johannesburg, South Africa; and Department of Theo-
logical Studies, Saint Louis University, St. Louis, MO.
Reprint requests to Candy Gunther Brown, PhD, Department of Religious
Studies, Indiana University, 1033 E 3rd St., Bloomington, IN 47405-
7005. Email: firstname.lastname@example.org
Supported by the John Templeton Foundation (West Conshohocken, PA),
Flame of Love Project/University of Akron (Akron, OH), $150,000; and
the Lilly Endowment (Indianapolis, IN), Indiana University (Blooming-
ton, IN), $50,000. The findings and conclusions do not necessarily rep-
resent the views of the funding agencies.
Supplemental digital content is available for this article. Direct URL citations
appear in the printed text, and links to the digital files are provided in the
HTML text of this article on the journal’s Web site (http://journals.lww.com/
None of the authors have any commercial, proprietary, or other financial
interest in any device, equipment, or other item mentioned in the sub-
This research received IRB approval from Indiana University (October 2006;
Accepted March 4, 2010.
Copyright © 2010 by The Southern Medical Association
• Although commonly employed as a complementary
and alternative medicine (CAM) therapy, the clinical
effects of proximal intercessory prayer (PIP) are
poorly understood, partly because most research has
focused on distant intercessory prayer (DIP).
• This study found a significant effect of PIP on audi-
tory function across the tested population (P⬍0.003).
• This study found a significant effect of PIP on visual
function across the tested population (P⬍0.02).
• Further study seems warranted to assess whether PIP
may be a useful adjunct to standard medical care for
certain patients with auditory and/or visual impair-
ments, especially in contexts where access to conven-
tional treatment is limited.
864 © 2010 Southern Medical Association
“faith” and anointing levels of those receiving and offering
prayer. Some persons are considered more anointed than oth-
ers or as “specialists” in praying for specific conditions.
Scholarly research on the therapeutic effects of intercessory
prayer and other forms of “distant” healing has flourished in the
past two decades. However, most studies have focused on DIP
rather than PIP and/or failed to differentiate PIP from healing
techniques such as Therapeutic Touch and external qigong that
posit a different healing mechanism (eg, prana,qi vs Holy Spirit,
Jesus) and may engender correspondingly different levels of
anticipated efficacy. There is an inadequate evidential basis for
generalizing findings from studies of one class of healing tech-
nique to another, yet researchers persist in making such gener-
The resultant literature has yielded uncertainty as to
whether prayer and/or distant healing is therapeutically benefi-
cial, neutral, or detrimental.
Of particular concern are findings like those of a well-
publicized “STEPP” (Study of the Therapeutic Effects of
Intercessory Prayer) paper, which concludes that “interces-
sory prayer itself had no effect on complication-free recovery
from CABG (coronary artery bypass graft), but certainty of
receiving intercessory prayer was associated with a higher
incidence of complications.”
Notably, one of the three groups
of intercessors, the only Protestant group, included in the
study, Silent Unity, Lee’s Summit, MO, has a theology and
practice of intercessory prayer that differs so widely from
Pentecostal prayer that the study analyzed an essentially dif-
ferent phenomenon: ie, Unity is a New Thought group that
understands prayer not as supplication to a deity outside the
self, but as an exercise of the divine/human power of mind.
Unity cofounder Myrtle Fillmore taught: “We do not promise to
say a prayer of words and have the saying work a miracle in
another individual. Our work is to call attention to the true way
of living and to inspire others to want to live in that true way.”
Most studies have, moreover, in seeking to avoid confounds
resulting from patients’ knowledge that they are receiving prayer,
focused on DIP. Although several prospective, double-blind, ran-
domized, controlled clinical trials concluded that DIP has posi-
tive therapeutic effects,
interestingly, Matthews et al
no significant effect for patients receiving DIP, but found a
significant benefit for patients receiving PIP. Although acknowl-
edging possible confounds of Hawthorne and placebo effects,
Matthews’s study design better corresponds with pentecostal
PIP. Unfortunately, the condition isolated for study, rheumatoid
arthritis, is relatively susceptible to psychosomatic improve-
Notably, Matthews et al
reported that improvements in
swollen and tender joints and reduction in pain and functional
disability was not accompanied by a parallel reduction in serum
inflammatory markers, suggesting that “clinical improvement
might be attributable more to alteration of patients’ perceptions
regarding their illness than to changes in inflammatory pathways
affecting their joints.”
Our study follows Matthews in focusing on PIP, but
diverges by isolating two conditions, auditory and visual im-
pairments, that are relatively less sensitive to, although not
unaffected by, psychosomatic factors.
ers have investigated effects of suggestion and hypnosis on
vision and hearing and claimed significant effects.
pursued two research questions: 1) Does PIP result in mea-
surable effects? If so, 2) how does the magnitude of effects
compare with suggestion and hypnosis findings?
Materials and Methods
Subjects were recruited prospectively at Charismatic Prot-
estant meetings cosponsored by Iris Ministries (headquartered in
Pemba, Cabo Delgado, Mozambique) and Global Awakening
(headquartered in Mechanicsburg, PA), at four locations in
Mozambique. The site was selected because Iris leaders are
widely reputed among Pentecostals globally as “specialists” in
praying for those with hearing and vision impairments— espe-
cially during village outreaches in rural Mozambique.
During evangelistic meetings (4 –12 June 2009, in Im-
piri, Namuno, and Chiu´re villages and Pemba city) Iris lead-
ers invited the “deaf” and “blind” to designated areas to re-
ceive prayer for healing by themselves and other Western and
Mozambican affiliates. Every consecutive subject was in-
cluded in the study who received prayer for vision or hearing
loss and assented to diagnostic tests (all subjects assented).
We provided study information sheets in Portuguese and of-
fered Makua (local language) translation. Measurements were
taken immediately before and after PIP.
Western and Mozambican Iris and Global Awakening
leaders and affiliates who administered PIP all used a similar
protocol. They typically spent 1–15 minutes (sometimes an
hour or more, circumstances permitting) administering PIP.
They placed their hands on the recipient’s head and some-
times embraced the person in a hug, keeping their eyes open
to observe results. In soft tones, they petitioned God to heal,
invited the Holy Spirit’s anointing, and commanded healing
and the departure of any evil spirits in Jesus’ name. Those
who prayed then asked recipients whether they were healed.
If recipients responded negatively or stated that the healing
was partial, PIP was continued. If they answered in the af-
firmative, informal tests were conducted, such as asking re-
cipients to repeat words or sounds (eg, hand claps) intoned
from behind or to count fingers from roughly 30 cm away. If
recipients were unable or partially able to perform tasks, PIP
was continued for as long as circumstances permitted.
We prospectively evaluated a consecutive series of 24
Mozambican subjects (19 males/5 females) reporting audi-
tory (14 subjects) and/or visual (11 subjects) impairments
who received PIP. One subject reported both hearing and
vision impairment. Three subjects (eg, Subject A in Supple-
Southern Medical Journal • Volume 103, Number 9, September 2010 865
mental Digital Content, http://links.lww.com/SMJ/A1) were
excluded from analysis because of false positive responses dur-
ing audiometric testing. Due to field-imposed time constraints,
those subjects who self-reported improvements were given pri-
ority for retesting after PIP; we lacked time to re-test two sub-
jects, so we reported them as unimproved. Also because of time
constraints, some subjects reporting problems only in one ear
were only tested (pre- and post-PIP) in that ear. No subject
ordinarily wore hearing aids or corrective lenses.
For hearing assessment, a handheld audiometer (Earscan
ES3, Micro Audiometrics Corp, Murphy, N.C., calibrated 3
months prior to the study, with calibration valid for 12 months)
was used to measure hearing thresholds. Measurements could
not be conducted in an acoustically isolated room due to the
remote field location, and the high ambient noise (AN) from
the nearby crowd of people presented a considerable chal-
lenge to measurement accuracy. AN was measured with a
sound meter (Tenma model 72–935) in dB SPL in order to
investigate whether its fluctuations presented a potential con-
found in the before vs after PIP measurements; maximum and
minimum AN was tested for each subject during both pre-
Due to time constraints, hearing thresholds were mea-
sured for all subjects only at 3 kHz in each ear separately
instead of across the whole frequency spectrum; we took
additional measurements as time allowed. A total of 18 ears
in 11 individuals with hearing impairments were analyzed.
The maximum intensity that could be generated by the audi-
ometer was 100 dB HL. Subjects responded by button press
or verbally. Subjects whose pre-PIP hearing thresholds ex-
ceeded 100 dB HL were assigned a conservative 105 dB HL
threshold for subsequent analysis. The measurement protocol
followed the standard Carhart-Jerger method.
mental Digital Content, http://links.lww.com/SMJ/A1.)
Eleven visually impaired subjects were tested using 40
cm (6 subjects) and/or 6 m (5 subjects: this chart was used for
elderly subjects reporting distant vision problems) logarith-
mic, “Illiterate E” visual acuity charts (Precision Vision, La
Salle, Ill.), using both eyes together, or with each eye sepa-
rately as time allowed. The minimum measurable acuity was
6/120 on the 40-cm chart and 6/30 on the 6-m chart. A pre-
measured string was used to hold charts at the appropriate
distance. As researchers pointed to each letter, subjects
pointed or verbally indicated which direction it faced; re-
searchers did not indicate whether responses were correct,
making it less likely that subjects memorized the chart.
There was a highly significant improvement in hearing
across the 18 ears of 11 subjects (t(10) ⫽3.93, P⬍0.003,
two-tailed) (Fig. 1). Two subjects showed hearing thresholds
reduced by over 50 dB HL. AN was very high during testing
(50 –100 dB SPL), but AN (85 dB SPL), calculated for each
subject individually as the average of the minimum and max-
imum noise during measurement was unchanged between
pre- and post-PIP tests (t(10) ⫽-0.48, P⫽0.64, two-tailed),
indicating that AN was not likely to be a confound (Fig. 1, A).
The average 3 kHz threshold after PIP was 49.4 dB HL,
which was slightly high, perhaps due to high AN.
Significant visual improvements (both difference and ra-
tio of before vs after) were seen across the tested population
(Wilcoxon signed rank test z ⫽2.49, P⬍0.02, two-tailed)
(Fig. 2, A). Three of eleven subjects improved from 6/120 or
Fig. 1 Auditory results. A, Hearing thresholds at 3 kHz were significantly improved across the population. Improvements cannot be
accounted for by reductions in AN (dB SPL). B, Hearing threshold changes ranged from a 10 dB HL increase to over 60 dB HL
Brown et al • Effects of Proximal Intercessory Prayer (STEPP)
866 © 2010 Southern Medical Association
worse to 6/24 or better, and one subject improved from un-
able to count fingers at 30 cm (6/2400) to 6/38 (Fig. 2, B).
All but one vision subject was tested in broad daylight; the
remaining subject was tested after dark, with electricity
provided by generator-powered stage lights and a flash-
light (See Subject E in Supplemental Digital Content,
http://links.lww.com/SMJ/A1); the lighting level did not
appear improved between the pre- and post-test (conducted
less than one minute later), making it unlikely that variable
lighting was a confound.
Both auditory (P⬍0.003) and visual (P⬍0.02) im-
provements were statistically significant across the tested pop-
ulations. Generally, the greater the hearing or vision impair-
ment pre-PIP, the greater the post-PIP improvement.
There are several limitations of the study. First, field
conditions were challenging. There were no modern clinical
facilities available, and we were unable to diagnose the eti-
ology of auditory or visual impairments or to assess whether
structural changes occurred. There is no way of knowing
whether hearing changed at untested frequencies, or whether
subjects tested only with 40 cm or 6 m charts would have
exhibited change with the other chart. Second, although the
study was prospective and controlled for some potential con-
founds such as AN, there was no control group, only a null
hypothesis of no significant effect. Third, the study was not
double-blinded. In support of experimenter reliability, several
audition subjects showed no measurable improvement, de-
spite self-reported improvement.
Studies of PIP by nature expose subjects to suggestions
that their conditions will improve. Could observed effects be
attributable to suggestion or hypnosis?
Sheehan et al
showed that a few minutes of suggestion led to statistically
significant visual acuity improvement, but the effect was so
small that a subject would not be able to read one line smaller
on the Snellen chart. Several studies of hypnotic suggestion
showed an average 2
times increase in visual acu-
ity, with the largest reported improvement from 6/60 to 6/6,
despite no measurable changes in ocular refraction. Other
studies reported no improvement in vision or auditory thresh-
olds after hypnotic suggestion.
A 2004 review article sum-
marizes the results of suggestion and hypnosis studies as
failing to demonstrate significant improvements in vision or
The average visual acuity improvement measured
here was over tenfold, significantly higher than in suggestion
or hypnosis studies (Fig. 3). It seems reasonable, however,
placebo, hold-back effects,
may have contributed to improved function. Conversely,
may also account for some cases in which
subjects reported improved hearing (but not vision) despite
no measurable improvement. It should be noted, however,
that in the Mozambican cultural context, traditional healers
typically charge clients more when healing occurs; thus, sub-
jects may have been predisposed to minimize reporting post-
might also have contributed to some
observed improvement, but these would also be present in
hypnosis studies to similar degrees and therefore may not
fully account for the larger effects observed here. Further-
more, the amount of practice was minimal at best. Subjects
with measurable hearing thresholds experienced the test tones
of a given frequency only a few times in each ear, following
the Carhart-Jerger protocol. In some cases, the threshold ver-
ification pass of the Carhart-Jerger protocol revealed a lower
pre-PIP threshold than the initial pass, apparently due to prac-
tice effects, and so the protocol continued until the measured
pre-PIP psychophysical hearing threshold was stable. In this
way, any existing practice effects were largely accounted for
already in the pre-PIP test. Subjects with no measurable hear-
ing threshold pre-PIP were deemed deaf in the corresponding
ear(s) if they both self-identified as deaf and exhibited no
tone response or visible startle response even to tones of 100
dB HL, in which case it is unclear how such an experience
might constitute practice. Likewise, visually impaired sub-
jects were allowed minimal experience with the eye chart
Fig. 2 Vision results. A, Binocular vi-
sual acuity increased significantly
across the population. B, Individual im-
provements ranged from no change to
an improvement from >6/120 to 6/7.5.
Southern Medical Journal • Volume 103, Number 9, September 2010 867
during the pre-PIP test. They were asked to read as far down the
eye chart as they were able to a single time, and care was taken
not to reveal the smaller lines below their pre-PIP acuity thresh-
old prior to the post-PIP test. It seems reasonable that subjects
whose pre- and post-PIP visual thresholds differed by only one
or two lines on the eye chart may have been exhibiting practice
effects. It seems much less likely that subjects who went from
being unable to read a single line (in which case it is unclear that
this experience constituted practice) to reading far down the
chart were exhibiting practice effects.
This study leaves unanswered the question of to what
extent PIP by different individuals would have resulted in
further improvements (or diminishments) in function. One
particular Iris leader was involved in administering PIP in 13
out of 25 interventions.
This research, which focused on clinical effects of PIP,
did not attempt to explain mechanisms by which functional
improvements occurred. Future studies might be designed to
test whether impairments with certain etiologies are more
susceptible to improvement through PIP, to probe the mech-
anisms by which PIP produces effects, and to assess whether
improvements are long term. It would be desirable to fol-
low-up with subjects several days or weeks after PIP, al-
though systematic follow up would be extremely difficult under
similar field conditions (we tried but could only locate one sub-
ject for retesting the following day—see Subject B in Supple-
mentary Digital Content, http://links.lww.com/SMJ/A1). Con-
ducting similar studies under controlled clinical conditions in
North America would be desirable, yet neither Iris nor Global
Awakening claims comparable results in industrialized coun-
tries (arguing that “anointing” and “faith” are lower where
medical therapies are available)—see Supplemental Digital
Content (http://links.lww.com/SMJ/A1) for our unsuccessful
attempts to collect data in the US. Possible control groups
for future investigations might include subjects receiving
“sham” PIP or Therapeutic Touch. The researchers might
use themselves as controls by testing their own hearing in
conditions of low and high AN. Effects of AN and subject-
subjectivity might be mitigated by using earbuds instead of
supra-aural headphones and by utilizing otoacoustic emis-
Our study has three main findings. First, Mozambican
subjects did exhibit improved auditory and/or visual acuity
subsequent to PIP interventions. Second, the magnitude of
measured effects exceeds that reported in previous studies of
suggestion and hypnosis. Although it would be unwise to
overgeneralize from these preliminary findings for a small
number of PIP practitioners and subjects collected in far-
from-ideal field conditions, future study seems warranted to
assess whether PIP may be a useful adjunct to standard med-
ical care for certain patients with auditory and/or visual im-
pairments, especially in contexts where access to conven-
tional treatment is limited. The implications are potentially
vast given World Health Organization estimates that 278 mil-
lion people, 80% of whom live in developing countries, have
moderate to profound hearing loss in both ears, and 314 mil-
lion people are visually impaired, 87% of whom live in de-
veloping countries, and only a tiny fraction of these popula-
tions currently receive any treatment.
The authors thank Indiana University’s Statistical Con-
sulting Center for assistance with data analysis, Indiana Uni-
versity’s Department of Speech & Hearing Sciences for equip-
ment consultation, Joshua W. Brown, PhD (Dept.
Psychological & Brain Sciences, Indiana University) for as-
sistance with data collection and analysis; Mark Reinke, MD
(otolaryngologist), Kenneth Scott, MD (otolaryngologist),
Harry Cohen, MD (ophthalmologist), Clifford W. Brooks,
OD (School of Optometry, Indiana University), and Paul
Cooke, PhD (Dept. Communicative Sciences & Disorders,
Michigan State University) for critical feedback on the manu-
Fig. 3 Comparison with suggestion and hypnosis. A, Studies of
hypnotic suggestion and suggestion without hypnosis have found
small but statistically significant improvements in visual acuity.
The magnitude of effects across the population was significantly
larger in PIP than in suggestion and hypnosis. B, The maximum
improvement in visual acuity for PIP was larger than the max-
imum improvement reported for suggestion and hypnosis.
Brown et al • Effects of Proximal Intercessory Prayer (STEPP)
868 © 2010 Southern Medical Association
1. Astin JA, Harkness E, Ernst E. The efficacy of “distant healing”: a
systematic review of randomized trials. Ann Intern Med 2000;132:903–
2. Roberts L, Ahmed II, Hall S, et al. Intercessory prayer for ill health: a
systematic review. Forsch Komplementarmed 1998;(5 Suppl):82– 86.
3. Roberts L, Ahmed I, Hall S, et al. Intercessory prayer for the alleviation
of ill health. Cochrane Database of Syst Rev 2009;(2):CD000368. DOI:
4. Benson H, Dusek JA, Sherwood JB, et al. Study of the therapeutic
effects of intercessory prayer (STEP) in cardiac bypass patients: a mul-
ticenter randomized trial of uncertainty and certainty of receiving inter-
cessory prayer. Am Heart J 2006;151:934 –942.
5. Fillmore M. Myrtle Fillmore’s Healing Letters. Unity Village, MO,
Unity, 1988, pp 106.
6. Byrd RC. Positive therapeutic effects of intercessory prayer in a coro-
nary care unit population. South Med J 1988;81:826 – 829.
7. Harris WS, Gowda M, Kolb JW, et al. A randomized, controlled trial of
the effects of remote, intercessory prayer on outcomes in patients ad-
mitted to the coronary care unit. Arch Intern Med 1990;159:2273–2278.
8. Cha KY, Wirth DP. Does prayer influence the success of in vitro fer-
tilization-embryo transfer? Report of a masked, randomized trial. J Re-
prod Med 2001;46:781–787.
9. Matthews DA, Marlowe SM, MacNutt FS. Effects of intercessory prayer
on patients with rheumatoid arthritis. South Med J 2000;93:1177–1186.
10. Lerman CE. Rheumatoid arthritis: psychological factors in the etiology,
course, and treatment. Clin Psychol Rev 1987;7:413– 425.
11. Knapp PH. Emotional aspects of hearing loss. Psychosom Med 1948;
12. Raz A, Zephrani ZR, Schweizer HR, et al. Critique of claims of im-
proved visual acuity after hypnotic suggestion. Optom Vis Sci 2004;81:
13. Sheehan EP, Smith HV, Forrest DW. A signal detection study of the
effects of suggested improvement on the monocular visual acuity of
myopes. Int J Clin Exp Hypn 1982;30:138 –146.
14. Graham C, Leibowitz HW. The effect of suggestion on visual acuity. Int
J Clin Exp Hypn 1972;20:169 –186.
15. Kelley CR. Psychological factors in myopia. J Am Optom Assoc 1962;
16. Kantel DR. The “Toronto Blessing” revival and its continuing impact on
mission in Mozambique [dissertation]. Virginia Beach, VA, Regent Uni-
17. Hall JW, Mueller HG. Audiologists’ Desk Reference Volume 1: Diag-
nostic Audiology Principles, Procedures, and Practices. San Diego, Sin-
gular, 1996, pp 82.
18. Sterling K, Miller JG. The effect of hypnosis upon visual and auditory
acuity. Am J Psychol 1940;53:269 –276.
19. McCarney R, Warner J, Iliffe S, et al. The Hawthorne Effect: a random-
ized controlled trial. BMC Med Res Methodol 2007;7:30.
20. Zamansky HS, Scharf B, Brightbill R. The effect of expectancy for
hypnosis on prehypnotic performance. J Pers 1964;32:236 –248.
21. Di Lillo M, Cicchetti A, Lo Scalzo, et al. The Jefferson scale of physi-
cian empathy: preliminary psychometrics and group comparisons in Ital-
ian physicians. Acad Med 2009;84:1198 –1202.
22. Taylor JH. Practice effects in a simple visual detection task. Nature
23. World Health Organization, Fact Sheets Nos. 282 (May 2009) and 300
(March 2006). Available at: http://www.who.int/mediacentre/factsheets/
en/. Accessed December 3, 2009.
Southern Medical Journal • Volume 103, Number 9, September 2010 869