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What Does the Research Really Show?

Donal P. O'Mathuna

{This article was published in the Journal of Christian Nursing, vol. 15 (Winter 1998) pp. 9-10, to supplement a longer article entitled The Subtle Allure of Therapeutic Touch. This journal is a publication of Nurses Christian Fellowship, and this issue included a number of related shorter pieces. Another one written by me can be read by clicking on its title: What Can Be the Harm? If you'd like to return to my home page and see some of the other papers I've written, my interests, or get in contact with me, click on my name above.}

Proponents of Therapeutic Touch (TT) claim it has significant research support. To persuade me of this, a member of a Christian college's nursing faculty sent me an article by Pamela Potter Hughes and others.1 I will use this to demonstrate some of the significant problems in TT research and how that research is misused to promote TT.

This qualitative study's only findings were that TT recipients enjoyed the experience. Seven adolescents were interviewed after receiving TT. Each was to receive three treatments per week for two weeks, but only one person followed the protocol. Two refused to return after their first treatment; one was treated for four weeks; and three missed various numbers of treatments.

Inconsistency also occurred because some nurses included physical contact in their treatments, while others did not. Physical contact alone can have a beneficial effect. Because of poor methodology, the significance of this research is best summarized by the authors themselves: "It is possible that just being in a quiet place with a nurse therapist may have been sufficient to provide a unique experience for the patients as opposed to any changes occurring because of an energy exchange." More rigorous research than this is needed to support the claims of TT.

However, Hughes's article has more problems. Its literature review makes grossly exaggerated claims about earlier research and in places is blatantly false. Unfortunately, this is not an isolated example. Many TT articles, especially those in popular nursing journals, misrepresent the conclusions of the original researchers. Hughes states: "For example, Therapeutic Touch has been found to be an effective adjunct to medical treatment for decreasing anxiety (Heidt, 1981; Olson, Sneed, Bondonna, Ratliff & Dias, 1992; Parkes, 1985; Quinn, 1984)."2

This is not an accurate picture of the status of TT research on anxiety. Olson's study found that TT recipients self-reported significantly reduced anxiety scores. However, physiological measurements of relaxation in the same subjects revealed no significant changes. The same individuals received the no-treatment control after receiving TT and thus knew they were not receiving treatment. This could explain why they reported feeling more relaxed while physiological measurements did not confirm this. Also, only eight of the twenty-three subjects did a control session, raising concerns of selection biasing.

Heidt's and Quinn's studies similarly had positive findings and methodological problems. Parkes, mentioned by Hughes, evaluated these: "It appears that even though Quinn (1984) and Heidt (1981) found statistically significant results when measuring reduction in anxiety, the problems inherent in the research designs of each of their studies suggest that the findings be interpreted with caution. Even though an energy exchange might be occurring, it has not been documented that it reduces anxiety in studies with more controls."3 Hughes never mentions this ambiguity.

Quinn herself addressed these problems in later studies but then got different results. Her data "reveals that there were no significant differences among the groups on post-test or retention anxiety, systolic blood pressure or heart rate."4 Failed replications of earlier studies must be acknowledged. The research has not clearly shown that TT reduces anxiety.

I have found thirteen studies (mostly unpublished dissertations and theses) where TT did not significantly reduce anxiety compared to controls. One is Parkes's dissertation, the same one cited by Hughes as reducing anxiety! After studying three groups (receiving either TT or one of two types of sham-TT), Parkes stated: "It must be concluded that Therapeutic Touch did not reduce anxiety in this instance, and that the process of the research itself slightly increased anxiety levels in all three groups."

Analysis of the other claims made for TT's effectiveness reveals a similar pattern. Researchers make tentative claims, acknowledge the limitations of their studies and then see their findings blown out of proportion by those using their studies. Survey articles on TT must be read closely and their claims investigated. Unfortunately this takes time, which many do not have. As a result, the myth spreads that TT is research-supported. It gains credibility, and more people get drawn into its underlying belief system.

To reverse this trend, we should be familiar with some of this research. We should show that we are open enough to investigate TT's claims and that we care enough about those attracted to it to understand what they are involved with. We must seek opportunities to show Christ's love to those with whom we disagree. But for the sake of those in our care and to maintain nursing's professional image, we must insist on high standards in research and accuracy in the use of its findings.

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1 Pamela Potter Hughes, Robin Meize-Grochowski and Catherine Neighbor Duncan-Harris, "Therapeutic Touch with Adolescent Psychiatric Patients," Journal of Holistic Nursing 14, no. 1 (March 1996): 6-23.

2 Ibid., p. 7, referencing Patricia Heidt, "Effect of Therapeutic Touch on Anxiety Levels of Hospitalized Patients," Nursing Research 30, no. 1 (January/February 1981): 32-37; Melodie Olson et al., "Therapeutic Touch and Post-Hurricane Hugo Stress," Journal of Holistic Nursing 10, no.2 (June 1992): 120-36; Brenda Sue Parkes, "Therapeutic Touch As an Intervention to Reduce Anxiety in Elderly Hospitalized Patients" (PhD diss., University of Texas at Austin, 1985); Janet F. Quinn, "Therapeutic Touch As Energy Exchange: Testing the Theory," Advances in Nursing Science 6, no. 1 (January 1984): 42-49.

3 Parkes, "Therapeutic Touch," p. 87.

4 Janet F. Quinn, "Therapeutic Touch As Energy Exchange: Replication and Extension," Nursing Science Quarterly 2, no. 2 (Summer 1989): 79-87.