Reiki treatment for psychological symptoms
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To examine the effectiveness of Reiki when compared with no intervention/sham Reiki/treatment as usual/waiting list, pharmacological treatments or psychological therapies for anxiety and depression.
Background
Description of the condition
Anxiety and depression are highly prevalent disorders and are often comorbid with each other. The World Bank Burden of Disease Project reported that mental disorders account for 9.1% of the global burden of disease in the world, almost one‐half of which is accounted for by anxiety and depressive disorders (Andrews 1998).
Anxiety disorders include generalised anxiety disorder (GAD), post traumatic stress disorder (PTSD), acute stress disorder and anxiety disorders not otherwise specified, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM ‐IV). In a community sample, the one‐year prevalence for GAD was approximately 3%, with a life time prevalence of 5% (APA 1994). For acute anxiety disorder, prevalence ranged from 14% to 33% in individuals exposed to severe trauma (APA 1994). Community‐based studies suggest a life time prevalence for PTSD of 8% of the USA adult population (APA 1994).
Depressive disorders include major depressive disorder, major depressive episode, depressive disorders not otherwise specified and dysthymic disorder, as defined by DSM‐IV. According to DSM‐IV the life time prevalence for dysthymic disorder is six percent. The point prevalence of major depressive disorder in a community sample of adults has been estimated at 5 to 9% for women and from 2 to 3% for men (APA 1994).
Description of the intervention
The most frequently used treatments for anxiety and depressive disorders include antidepressant and anti‐anxiety medications, however these tend to be unpopular with people, due to uncomfortable side effects. Psychological therapies may also be used as treatments for anxiety and depression, however, a lack of trained practitioners and funding mean that many people explore self‐help options.
There is interest from the community in the use of self‐help and complementary therapies for anxiety and depression. One of these methods is Reiki. This formalised therapeutic touch modality is a 2,500‐year‐old system of healing. Practitioners describe it as a non‐verbal, gentle, sequential touch treatment, which appears to offer positive touch experiences that are safe, comforting and relaxing. Reiki is based on principles of whole‐person (mind‐body) health with similar principles to the WHO definition of health, namely, "A state of dynamic harmony between the body, mind and spirit of a person and the social and cultural influences which make up his or her environment" (www.who.int/about/en/).
How the intervention might work
Reiki is a vibrational or subtle energy therapy most commonly facilitated by light touch on or above the body. A full treatment ranges from 45 to 90 minutes and usually involves placing the hands on 12 positions in total, on the head and on the front and back of the torso. In Reiki, a number of sacred Sanscrit symbols are used to enhance the transmission of energy. These symbols are usually physically traced onto the practitioners hands by the fingers of the other hand. These symbols are said to enhance the quality of the energy transmitted to the physical, emotional, mental and spiritual levels of the person receiving the treatment ( Nield‐Anderson 2000)
The putative mechanism of action for Reiki is said to be the transfer of energy by the Reiki practitioner acting as a channel for the energy to transfer to the client (Nield‐Anderson 2000). Some authors have suggested a bio field hypothesis that understands the body as having a field of energy around and within it that is said to be responsive to various forms of healing touch (Hossi 2006; Kumar 2003; Rein 2004; Rubik 2002).
Within the literature many researchers have hypothesised that a generalised relaxation response may explain any Reiki treatment effect (Mackay 2004; Wardell 2001).There is some evidence that Reiki has an effect on depression and anxiety .Goldman 2004 found Reiki resulted in significant reductions in depressive and stress symptoms when compared to controls .These findings were maintained at a one‐year follow‐up. Wardell 2001 explored the biological correlates of a single 30 minute session of Reiki. Results showed that anxiety was significantly reduced (as measured by Spielberger's State‐Trait Anxiety Inventory (STAI)) (Speilberger 1983), salivary IgA levels rose significantly, and there was a significant reduction in systolic blood pressure. Salivary cortisol, skin temperature and electromyography (EMG) changes were not statistically significant.
Miles 2003 studied the effect of Reiki on HIV‐related pain and anxiety. There was a significant reduction in both self‐reported pain and anxiety following a 20‐minute Reiki session. There was no significant difference between self administration of Reiki and administration by another person. Olsen 2003 conducted a trial to assess the effects of two treatment conditions on pain, quality of life and analgesic use in 24 cancer patients. One group received standard opioid treatment and rest, while the other group received standard opioid treatment and Reiki. No overall reduction in analgesic use was noted for either group. However, the Reiki group experienced improved pain control and quality of life scores compared to the Rest group. All studies reviewed used small samples ranging from 14 to 45 participants.
There are several other treatments with similarities to Reiki. Therapeutic touch is a touch therapy that differs from Reiki, as it does not have an attunement process and practitioners work with conscious intent, assessing the client whilst their hands are usually, although not always, above the physical body (Potter 2003; Robinson 2007). Healing touch is a nursing technique which also uses touch and intention to create changes in the bio field. It includes placement of the hands in specific sequences on the body and use of healing intent (Wardell 2004).
Why it is important to do this review
Reiki appears to enjoy popular support by the public and in some cases hospitals are beginning to include this therapy in treatment plans. It is a therapy that intrigues but in fairness little is known about its effects and possible health benefits. Given the paucity of evidence based upon small samples, there is a place for a systematic review of Reiki treatment for anxiety and depression
Objectives
To examine the effectiveness of Reiki when compared with no intervention/sham Reiki/treatment as usual/waiting list, pharmacological treatments or psychological therapies for anxiety and depression.
Methods
Criteria for considering studies for this review
Types of studies
All randomised or quasi randomised controlled trials (where group allocation is by alternation, day of the week etc), published or unpublished.
Types of participants
Trial participants will be both males and females, aged 16 to 65, suffering from anxiety or depressive disorders, as defined by the study authors. This will include participants diagnosed with anxiety or depression according to DSM‐III(APA 1980), DSM‐IV(APA 1994), ICD‐9(WHO 1978) and ICD‐10(WHO 1992). It will also include participants with anxiety or depression as identified through use of symptomology scales (such as Hamilton 1960 and Beck 1961 scales for example).
Comorbid anxiety and depression will also be included.
Types of interventions
Reiki:
Any type of Reiki, performed by a trained Usui initiated Reiki practitioner. This is a person who has completed courses and been initiated to Reiki one, Reiki two, and Reiki three (and above) levels of Reiki. Treatment may be with hands on or off the body or a combination of these. The Reiki practitioner is to have agreed to treatment fidelity i.e., the Reiki practitioner needs to adhere to Reiki only as many Reiki practitioners have had training in a range of
energy therapies.
Control Interventions:
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No intervention or placebo Reiki (e.g., distance Reiki)
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Sham Reiki (person not attuned or initiated to Reiki placing hands on body mimicking a Reiki session)
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Standard care/ treatment as usual
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Wait list
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Pharmacological treatments (e.g., antidepressants, anti‐anxiety medication)
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Herbal medicine
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Psychological therapies (e.g., cognitive behaviour therapy, psychodynamic therapy, interpersonal therapy, supportive therapy)
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Exercise therapy
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Any other intervention
Excluded interventions:
Participants may or may not be on other treatments for anxiety and depressive disorders.
Main comparisons
Reiki versus no treatment control, to include placebo, sham Reiki, standard care, treatment as usual, wait list
Reiki versus pharmacological treatments
Reiki versus herbal medicine
Reiki versus psychological therapies
Reiki versus exercise /other therapy
Types of outcome measures
Primary outcome:
The primary outcome measure in this review will be the relief of symptoms, measured as a clinically significant improvement versus no significant improvement. This is usually measured using rating scales. Depression will be measured using self‐rating scales such as the Beck Depression Inventory (BDI) (Beck 1961) or clinician rated scales, such as the Hamilton Rating Scale for Depression (HRSD) (Hamilton 1960).
Anxiety will be measured using a self‐rating scale such as the Spielberger State Trait Anxiety Inventory (STAI) (Speilberger 1983).
Secondary outcomes:
1. Quality of life measures, such as the SF12 or SF36 (Ware 1993)
2. Self‐perceived stress, measured using self report measures such as: sleep improvements, reduced feelings of being overwhelmed or reduced tension/worry
3. Drop‐out rates
4. Side effects
5. Acceptability of treatment
Search methods for identification of studies
Electronic Searches:
1) The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR Studies and CCDANCTR‐References) will be searched
2) The Cochrane Central Register of controlled trials (CENTRAL) on The Cochrane Library
3) MEDLINE
4) EMBASE
5) Psyclit
6) Amed
CCDANCTR Studies
Intervention = Reiki or "Energy Heal*" or "Energy Channel*"
CCDANCTR References
Free‐text = Reiki or "Energy Heal*" or "Energy Channel*"
The Ovid Strategy will be:
1. Reiki.m
2. Therapeutic touch
3. Depression
4. depression.mp
5. Anxiety
6. anxiety.mp
7. Stress
8. stress.mp
9. or/1‐2
10.or/3‐8
11. and/9‐10
If this search strategy results in too many reports to screen, then it will be combined with the sensitive search for identifying reports of randomised controlled trials as found in the Cochrane Reviewers handbook. Similar searches will be carried out in the other databases.
Reference lists:
The reference lists of all identified papers will be searched for further information.
Personal Communication:
We will contact authors and experts in the field to see if they know of any unpublished studies.
Data collection and analysis
Selection of studies
Reports of all potentially eligible studies will be evaluated for appropriateness for inclusion by the two authors prior to consideration of the results. Any disagreements will be resolved by discussion, and if there is still disagreement the final decision will be reached in consultation with a third person. Excluded studies will be listed with reasons for their exclusion.
Data extraction
Data extraction will be undertaken separately by the two review authors using a form modified for this review. Data extracted will be entered into an MS‐Word document and will include details of the study, inclusion and exclusion criteria, elements of risk of bias as mentioned above, data on participants at baseline and any outcomes with the corresponding data. Any disagreements will be discussed and, if necessary, a third person will adjudicate.
Methodological quality of included studies
Assessment of methodological risk of bias will be undertaken by the review authors using : sequence generation, allocation concealment, blinding and who is blind, description of participant dropout and withdrawal, analysis by intention to treat, selective outcome reporting and topic or study specific issues. The authors will also independently assess trial quality in accordance with the Cochrane Handbook (Higgins 2005). This pays particular attention to the adequacy of the random allocation concealment and double blinding. Studies will be given a quality rating of A (adequate), B (unclear), and C (inadequate) according to these two items. Where inadequate details of allocation concealment and other characteristics of trials are provided, the trial authors will be contacted in order to obtain further information. If the raters disagree the final rating will be made by consensus with the involvement (if necessary) of a third person. Non‐congruence in quality assessment will be reported as percentage disagreement.
Missing data
If there are missing data, or details are unclear from the publication, then the authors will be contacted and asked to fill in the missing details. Forms will be stored on the computer, and also printed out and stored with the rest of the documentation for this review. If it is not possible to obtain missing data, we will calculate standard deviations (SD) from standard errors (SE) and T‐statistics where possible, or use imputed data.
Missing dichotomous data will be managed through intention to treat (ITT) analysis, in which it will be assumed that patients who dropped out after randomisation had a negative outcome, although it is acknowledged that categorising drop‐outs as treatment failures may have overestimated the number of patients with a poor outcome. Best/worse case scenarios will also be calculated for the clinical response outcome. For missing continuous data, the method of "last observation carried forward" (LOCF) will be used where possible, with due consideration of the potential bias and uncertainty introduced.
Analysis
Analysis will be carried out for both continuous and dichotomous data where the data permit. Data will be combined using relative risk (RR) for dichotomous data. Continuous data will be assessed using weighted mean difference (WMD) or if different scales have been used, a standardised mean difference (SMD). Summary effects calculation will be done by the random‐effects model. A fixed‐effect analysis will also be done to see how different this is from the random‐effects model. If there are sufficient studies then a funnel plot will be used to assess whether small sample bias (one form of which is publication bias) is present. All estimates will be calculated with 95% confidence intervals.
Heterogeneity
Heterogeneity of treatment effects between studies will be assessed by visual inspection of the forest plots, the I‐squared statistic and the test for heterogeneity, where an I2 >50% indicates a high level of heterogeneity. If heterogeneity is suspected but can be explained by plausible effect modifiers then a summary estimate of effect, both with and without the different study, will be calculated and the results discussed. If there are no plausible reasons for the heterogeneity then the studies will be re‐examined to see if pooling is appropriate at all.
Subgroup analyses
To determine whether there are any differences between study results due to factors for which there is empirical or biological evidence of effect, subgroup analysis and meta‐regression (using Stata or Comprehensive Meta Analysis) will be done if there are sufficient studies to analyse. Possible factors to be analysed that may modify treatment effect are:
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Inclusion criteria, DSM diagnosis versus other symptoms
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Severity of symptoms, mild/moderate versus severe
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Condition treated
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Scale used to measure the outcome (The SMD assumes that one standard deviation on one scale is the same as one standard deviation on other scales. This may not be so).
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Hands on versus hands off Reiki (touch may confer some additional benefit).
Sensitivity analyses
A sensitivity analysis will be conducted to assess the robustness of our results. This will include:
1. The effect of excluding low quality studies. Examining whether aspects of the quality of the studies (e.g. allocation concealment, blinding, withdrawals or dropouts) have an effect on the pooled estimate.
2. The effect of using LOCF data
3. ITT 'worst' versus 'best' case scenarios
4. Use of diagnostic interview versus self rated depression and anxiety scales
