A recent nursing journal article reported the results of a rapid evidence assessment of therapeutic touch (TT) research, concluding:
No high-quality evidence was found for any of the benefits claimed.
This is, of course, no surprise to anyone. Therapeutic touch, a form of so-called “energy medicine“, is pseudoscience. What is surprising, and frankly disturbing, is the authors’ report that therapeutic touch
remains actively taught in many North American Colleges and in contemporary nursing literature and nurse education. A diagnosis of “Imbalanced Energy Field” is also included in the current North American Nursing Diagnosis (NANDA) manual [2018 ed.] . . .
The authors, Bernie Garrett, RN, PhD, and Marliss Riou, MSN, both of the University of British Columbia School of Nursing, undertook a rapid evidence assessment, covering 2009-2020, of studies exploring therapeutic touch as an intervention.
As background, the authors include a description of the alleged mechanism of action for therapeutic touch, its foundational assumption being that all humans possess “a massless human bio-energy field” within which “there may be balance which produces good health, or there may be an imbalance which may result in illness”. Practitioners claim they can, with their hands, but without actually touching the person, detect and manipulate a person’s energy biofield to “stimulate the body’s natural ability to heal itself” and to bring the energy biofield into better balance. The authors note that this idea of a metaphysical life force is prevalent in many cultures as well as in contemporary pop-culture, the “force” in Star Wars being one example.
Obviously, the authors continue, these notions “are in direct conflict with contemporary physics and biomedical science”. As well, “no underlying anatomical structures or physiology associated with the proposed human biofield energy has been identified” and it has not yet been proven to exist. The answer to this criticism, at least from some proponents, is that “the proposed energy is spiritual in nature and said to exist outside of” contemporary scientific knowledge.
The article contains a detailed discussion of the authors’ rationale for using the rapid evidence assessment, their methods, and their assessment of the studies, but we’ll skip to the end. (The article is open-access, so feel free to dig in.) Their conclusion:
After 45 years of study, scientific evidence of the value of TT as a complementary intervention in the management of any condition still remains immature and inconclusive:
- Given the mixed result, lack of replication, overall research quality and significant issues of bias identified, there currently exists no good quality evidence that supports the implementation of TT as an evidence-based clinical intervention in any context.
- Research over the past decade exhibits the same issues as earlier work, with highly diverse poor quality unreplicated studies mainly published in alternative health media.
As the nature of human biofield energy remains undemonstrated, and that no quality scientific work has established any clinically significant effect, more plausible explanations of the reported benefits are from wishful thinking and use of an elaborate theatrical placebo.
The authors then take their fellow nurses to task:
Given the deficiency of quality research evidence, it remains somewhat puzzling why nursing organizations and textbooks continue to support TT . . . as no other faith-based interventions have gained similar traction in nursing literature. The support of poor quality and biased research is clearly problematic and could affect the wider scientific credibility of the profession.
And, in a refreshing change from the typical “further research is needed”:
Without basic research, further clinical studies will present similar issues, and given the resources expended to date with no tangible evidence, similar work would seem unjustified.
If any research is to be done, the authors say, it should be to “establish a validated theoretic framework”:
As the claims TT practitioners make for, and their ability to detect a human biofield energy field can easily be tested with well-controlled practical experiments (as Emily Rosa attempted to do in 1998), it appears at best inept, and at worst disingenuous that this has not occurred to date.
Indeed! And let’s apply this same reasoning to the entire universe of so-called alternative medicine: Before one more study is done, or one more penny is spent on research, let’s require other iterations of energy healers, acupuncturists, subluxation-based chiropractors, naturopaths, homeopaths, ayurvedic practitioners, and all the rest, to “establish a validated theoretical framework” for their particular brand of metaphysics.
“Imbalanced Energy Field”
The organization credited with creating the imbalanced energy field diagnosis cited by Garrett and Riou is NANDA International (formerly known as the North American Nursing Diagnosis Association). NANDA’s mission is, according to its website: “To facilitate the development, refinement, dissemination and use of standardized nursing diagnostic terminology”, meaning, in part, that “[w]e provide the world’s leading evidence-based nursing diagnoses for use in practice and to determine interventions and outcomes.”
NANDA publishes Nursing Diagnoses: Definitions & Classification, which it describes as “the definitive guide to nursing diagnoses”. According to NANDA, a nursing diagnosis (which is different than a medical diagnosis) is a
clinical judgment concerning a human response to health conditions/life processes, or vulnerability for that response, by an individual, family, group, or community.
As a 2013 NANDA blog post explains, “disturbed energy field” became an accepted nursing diagnosis in 1994. Upon receipt of some complaints about the diagnosis, including one from the late James Randi, NANDA undertook a review of the evidence, committing to apply its 2008 “Level of Evidence” criteria in doing so. “Disturbed energy field” was then removed from the 2015-2017 Nursing Diagnoses: Definitions & Classification (10th edition), only to reappear as the diagnosis “imbalanced energy field” in the 11th edition, covering 2018-2020. “Imbalanced energy field” is categorized under “Domain 4. Activity/rest” in the subcategory “Class 3. Energy Balance”, which includes only two other diagnoses, “Fatigue” and “Wandering”. According to the Table of Contents in the new 12th edition of Nursing Diagnoses (2021-2023), none of this has changed. (I do not have access to the publication itself.)
So much for the “Level of Evidence” criteria review and “evidence-based nursing diagnoses”.
A nursing text, Handbook of Nursing Diagnosis (14th edition 2013), which employs the NANDA taxonomy of diagnoses, uses the term “disturbed energy field”, stating what is described as the NANDA definition thusly,
Disruption of the flow of energy surrounding a person’s being that results in disharmony of the body, mind and/or spirit.
The “Defining Characteristics” of this diagnosis are a “perception of changes in patterns of the energy flow”, including temperature change, visual changes (e.g., color); “disruption of the field” (e.g., “vacant, hole, spike, bulge, obstruction, congestion”); movement (e.g., “tingling, dense”); and sounds. The diagnosis supposedly has “related factors”, characterized as “pathophysiologic”, that is, “related to slowing or blocking of energy flows secondary to” an illness, pregnancy, or injury, or “situational”, that is, related to slowing or blocking of energy flow secondary to pain, fear, grieving or anxiety. There are more, but you get the idea: illness, fear, and so on cause energy flow blockages that are detected by temperature change, tingling, and so forth.
According to the Author’s Note, “some may consider this diagnosis unconventional”.
But such considerations are waved off by the author, a nurse, who tells her fellow nurses that “there are many theories, philosophies, and frameworks of nursing practices” and “nursing diagnosis should not represent only mainstream nursing”. Nurses, rather, “should celebrate diversity” because “[f]undamentally, nurses are all connected though the quest to improve the condition of individuals, families, groups, and communities”.
This, of course, could be used as a rationale for just about any practice, no matter how implausible or lacking in evidence.
While “specialized instruction” is necessary for performing therapeutic touch, the Handbook describes some of the steps for those unfamiliar with the practice, including:
- Scan the client’s energy field for openness and symmetry.
- Sense the cues to energy imbalance . . .
- Note the energy flow over lower legs and feet.
- Briefly shake your hands to dispel congestion from the field if needed.
- When therapeutic touch is complete, place your hands over the solar plexus area . . . and focus on facilitating the flow of healing energy to the client.
- Energy Medicine Therapies: Therapeutic Touch, Healing Touch, Reiki, Reflexology, And Craniosacral Therapy
- The Biofield (Human Energy Field): Foundations For Energy Medicine
- Alternative Medicine In Rehabilitation: Energy-Based Therapies
Nurses can also get, again for CE credit, a “Certificate in Energy Medicine”. The course description begins:
Increasingly, scientific evidence shows that human beings are comprised of an energetic system that is highly integrated with the physical body, emotions, and the spirit.
“Scientific evidence” has shown no such thing.
Bernie Garrett, the lead author of our therapeutic touch review, posted this comment to the 2013 NANDA blog post:
Having a NANDA diagnostic statement of “Disturbed Energy Field” is about as much use as a diagnosis of “Feeling a bit under the weather.” Come on, this makes nurses look ridiculous. Time that NANDA got a grip on this situation.
James Randi himself, an instigator of complaints about the diagnosis, also commented on the 2013 NANDA blog post:
While accepting and agreeing with [another commenter criticizing the concept of a “human energy field”, or HEF], I’ll simplify the situation somewhat. The James Randi Educational Foundation offers our $1 million dollar prize to anyone – TTP [therapeutic touch practitioner] or not – who can simply show that they can detect the HEF. It’s that easy. No arguments, no fuss, no scientific or supernatural theories required. Do it, and walk away with the $1,000,000 prize. My experience in the quackery field tells me that NANDA-I will never come to grips with the HEF situation, but will continue to promote this attractive-but-false delusion. Please prove me wrong.
NANDA never took him up on the challenge and time has proven him right.
If nurses want to claim that “imbalanced energy field” is a valid diagnosis and therapeutic touch is effective, they must be able to defend it with a plausible mechanism of action and evidence of effectiveness. If they claim these are solely spiritual concepts, then they need to be clear that this is the basis on which they are offering their services, as it may conflict with the patient’s religion or belief system. In either case, whether lack of evidence or lack of full disclosure, it is unethical to do otherwise.