Anxiety and therapeutic touch

Topography and relationship-specific social touching in individuals displaying body image disturbances

Interpersonal touch is intimately related to the emotional bond between the touch giver and the touch receiver. Which bodily regions we touch in those individuals in our social network is relationship specific. Perception of interpersonal touch is altered in psychiatric disorders characterised by body image disturbances (BIDs). Here, we examined whether the 'imagined' experience of social touch in individuals with BIDs is body topography- and relationship-specific. By using an interactive media mobile App, the Virtual Touch Toolkit, high versus low levels of BIDs participants completed heatmaps of full-body virtual avatars, to indicate the body regions they find soothing/unpleasant to be touched by a loved one versus an acquaintance. Self-reports of interoceptive awareness and dysmorphic concerns were also measured. Overall, imagined touch was rated as the most soothing when received from a loved one, and also when this was delivered to 'social' body regions. The importance of the social relationship for the imagined tactile interactions was particularly evident for the high levels of BIDs group, with greater problems with interoceptive awareness predicting higher soothing touch ratings when this was received by a loved one. Despite the evidence that imagined bodily contacts between meaningful people is the most pleasant for socially acceptable bodily regions, our findings may suggest a greater sensitivity to relation-specific bodily patterns of social touch particularly in the high level of BIDs group. Heightened interoceptive awareness may also play a key role in this experience of bodily affective contacts. Future research for body-oriented therapy for BIDs is encouraged to systematically probe the efficacy of imagined social touch interaction protocols which use more plausible, ecological, scenarios where touch is delivered by loved ones and to socially acceptable bodily regions.

Efficacy of Therapeutic Touch in Treating Pregnant Inpatients Who Have a Chemical Dependency

Chemical dependency is known to complicate about 3.8% of pregnancies in Vancouver, British Columbia, Canada. In this study, 54 English-speaking, hospitalized women were randomly assigned to receive either (a) daily Therapeutic Touch over a 7-day period for 20 minutes each day, (b) shared activity with a registered nurse for 20 minutes over a 7-day period, or (c) standard ward care. Anxiety was measured using Spielberger’s State-Trait Anxiety Inventory. Withdrawal symptoms were measured using a standardized Symptom Checklist. Anxiety scores were significantly less on Days 1, 2, and 3 (p < .05) for the group receiving Therapeutic Touch. Therapeutic Touch may be of value as an adjunctive measure in the treatment of chemical dependency among pregnant women.

Effects of Therapeutic Touch on Anxiety, Vital Signs, and Cardiac Dysrhythmia in a Sample of Iranian Women Undergoing Cardiac Catheterization

Purpose of the study: To investigate the effects of Therapeutic Touch (TT) on anxiety, vital signs, and cardiac dysrhythmia in women undergoing cardiac catheterization. Design: It was a quasi-experimental study. The participants had no history of hallucination, anxiety, or other psychological problems. Participants had to be conscious and have attained at least sixth-grade literacy level. Participants were randomly assigned into an intervention group ( n = 23; received 10-15 minutes TT), a placebo group ( n = 23; received 10-15 minutes simulated touch), and a control group ( n = 23; did not receive any therapy). Data were collected using Spielberger’s anxiety test, cardiac dysrhythmia checklist, and vital signs recording sheet. Statistical analyses were considered to be significant at α = .05 levels. Findings: Sixty-nine women ranging in age from 35 to 65 years participated. TT significantly decreased state anxiety p < 0.0001 but not trait anxiety ( p = .88), decreased the incidence of all cardiac dysrhythmias p < 0.0001 except premature ventricular contraction ( p = .01), and regulated vital signs p < 0.0001 in the intervention group versus placebo and control group. Conclusions: TT is an effective approach for managing state anxiety, regulating vital signs, and decreasing the incidence of cardiac dysrhythmia during stressful situations, such as cardiac catheterization, in Iranian cardiac patients.

Therapeutic touch for anxiety disorders

BACKGROUND

Anxiety disorders are a common occurrence in today's society. There is interest from the community in the use of complementary therapies for anxiety disorders. This review examined the currently available evidence supporting the use of therapeutic touch in treating anxiety disorders.

OBJECTIVES

To examine the efficacy and adverse effects of therapeutic touch for anxiety disorders.

SEARCH STRATEGY

We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References) (search date 13/01/06), the Controlled Trials website and Dissertation Abstracts International. Searches of reference lists of retrieved papers were also carried out and experts in the field were contacted.

SELECTION CRITERIA

Inclusion criteria included all published and unpublished randomised and quasi-randomised controlled trials comparing therapeutic touch with sham (mimic) TT, pharmacological therapy, psychological treatment, other treatment or no treatment /waiting list. The participants included adults with an anxiety disorder defined by the Diagnostic and Statistical Manual (DSM-IV),the International Classification of Diseases (ICD-10), validated diagnostic instruments, or other validated clinician or self-report instruments.

DATA COLLECTION AND ANALYSIS

Two review authors independently applied inclusion criteria. Further information was sought from trialists where papers contained insufficient information to make a decision about eligibility.

MAIN RESULTS

No randomised or quasi-randomised controlled trials of therapeutic touch for anxiety disorders were identified.

AUTHORS' CONCLUSIONS

Given the high prevalence of anxiety disorders and the current paucity of evidence on therapeutic touch in this population, there is a need for well conducted randomised controlled trials to examine the effectiveness of therapeutic touch for anxiety disorders.

Influences of a Relaxation Intervention on Perceived Stress and Power Spectral Analysis of Heart Rate Variability

This study was designed to determine whether power spectral analysis (PSA) of heart rate variability (HRV) can detect change in autonomic tone following a relaxation intervention called therapeutic touch (TT). Thirty healthy subjects underwent TT by one of three TT practitioners using the steps developed by Krieger and Kunz (The Therapeutic Touch, Prentice-Hall, 1979). Both subjects and TT practitioners were monitored by continuous electrocardiographic monitoring (Holter) before (15 minutes), during, and after (15 minutes) TT was administered. Subjects and TT practitioners completed a visual analogue scale (VAS) of perceived stress before and after TT. Change scores for VAS and PSA of high-frequency/low-frequency (HF/LF) ratios were compared for the 2-minute interval before TT began and the end of TT and the end of the recovery period, using t tests. VAS scores decreased (less stress) from before to after TT for both subjects (p < 0.0005) and TT practitioners (p < 0.0005). Mean HF/LF ratios increased significantly to reflect greater parasympathetic dominance from before TT to the end of treatment for subjects (p = 0.006), but not for TT practitioners. However, further analysis revealed that this change was due to an exaggerated HF/LF response from four outliers (p < 0.0005). Data collected in this study did not reveal differences between these four subjects and the rest of the sample. There were no significant changes in HF/LF ratios from the end of TT to end of recovery for either group. Further research is needed to determine why some subjects may have greater change in autonomic tone in response to relaxation in order to be able to predict who will demonstrate physiologic response to relaxation interventions.

The experience of Therapeutic Touch in the lives of five postpartum women

PURPOSE

To examine the experience of therapeutic touch in the lives of postpartum women.

METHODS

Qualitative study of five postpartum women who participated in therapeutic touch for 2 months during home visits that focused on postpartum issues and concerns. The visits were audiotaped and transcribed. Data were coded and classified; linkages between categories were sought.

RESULTS

Five themes or essences of the experience emerged: Feeling Relaxed, Feeling Open, Feeling Cared For, Feeling Connected, and Feeling Skeptical.

CLINICAL IMPLICATIONS

The women and the researcher experienced many positive emotions during the home visits. Although it is unknown whether it was the visit, the interaction, or the therapeutic touch that helped the women feel cared for, the experience of participating in therapeutic touch seemed to add a dimension of mutual caring that added a special and unique quality to the home visit.

Current strategies for prevention, detection, and treatment of ovarian cancer

OBJECTIVE

To review the prevalence, etiology, risk factors, diagnosis, and treatment of ovarian cancer.

DATA SOURCES

English-language journal articles retrieved from a MEDLINE search from 1990 to the present, and selected references retrieved from the bibliographies of those articles.

STUDY SELECTION

Clinical trials and pertinent review articles that discussed the detection, prevention, and clinical management of ovarian cancer.

DATA SYNTHESIS

Although relatively uncommon, ovarian cancer is the leading cause of mortality from gynecologic cancer. Because most ovarian cancers are not detected until the disease has metastasized beyond the ovary, the 5-year survival rate for all cases is only 50%. Pharmacists can educate women about strategies that can reduce ovarian cancer risk, especially the use of oral contraceptives. To aid in earlier detection, pharmacists also should be aware of the nonspecific symptoms that can be associated with the disease, and refer women with suggestive symptoms to their physicians for further evaluation. Treatment usually consists of hysterectomy with debulking surgery to remove as much tumor as possible, followed by chemotherapy, for which the current gold standard is cisplatin and paclitaxel.

CONCLUSION

Pharmacist-provided education can help women reduce their risk of ovarian cancer. As integral members of the health care team, pharmacists also can optimize the efficacy and tolerability of chemotherapeutic regimens; assist with palliative care for nausea, vomiting, and pain; and serve as a resource for patient information and support.

Healing as a therapy for human disease: a systematic review

OBJECTIVE

To assess, from published clinical trials, the evidence for the use of healing as a complementary medical intervention in human disease.

DESIGN

Limited to studies involving random assignment to a treatment group consisting of "healing," broadly defined, or to a concurrent control group. All randomized trials published up to the year 2000, were identified from MEDLINE, CINAHL, BIDS-EMBASE, the CISCOM complementary medicine databases and from bibliographic references of published articles. Copies of all published studies were obtained, data were extracted, and methodological quality (Jadad) scores were derived where possible.

RESULTS

Fifty-nine randomized clinical trials (RCTs) were found comparing healing with a control intervention on human participants. In 37 of these, healing was used for existing diseases or symptoms (22 existed as fully accessible published reports, 10 as dissertation abstracts only, and 5 as "preliminary" investigations with limited evidential value). The 22 full trials (10 reporting a "significant" effect of healing compared with control) constitute an extremely heterogeneous group, varying greatly in the method and duration of healing; the medical condition treated; the outcome measure employed; and the control intervention used. Many trials had a number of methodological shortcomings, including small sample sizes, and were inadequately reported. Only 8 studies (5 with a significant outcome for healing) had a maximum methodological quality score of 5, and in 10 studies this score was 3 or less. Two trials-both large scale and methodologically sound-were replicates, and each found a significant beneficial effect of intercessory prayer on the clinical progress of cardiac patients. Eleven of the 15 dissertation abstracts and pilot studies reported nonsignificant results for healing compared with control, a finding that probably reflects the relatively small sample sizes and the likelihood of type II errors. The significant heterogeneity found in this group of trials makes categorization problematic and inhibits the pooling of results by meta-analysis or similar techniques to obtain a global estimate of the "treatment effect" of healing.

CONCLUSIONS

No firm conclusions about the efficacy or inefficacy of healing can be drawn from this diverse group of RCTs. Given the current emphasis on evidence-based medicine, future investigations should be adequately powered, appropriately controlled, and properly described. These future investigations would most usefully consist of: (1) pragmatic trials of healing for undifferentiated conditions on patients based in general practice and (2) larger RCTs of distant healing on large numbers of patients with well-defined measurable illness.

A collaborative research project on Therapeutic Touch

The current shift toward granting funds for collaborative research proposals means that graduate nursing students must be prepared to participate in the collaborative research process. The authors describe how master's and doctoral students worked together with faculty to establish group norms, investigate, design, and disseminate a research proposal on Therapeutic Touch. Project goals, description of group members, and the benefits and limitations of collaborative research also are included. Evaluating the collaboration as a challenging yet enjoyable learning experience, students and faculty shared a successful scholarly endeavor that ultimately led to funding and implementation of a research proposal on Therapeutic Touch.

The surgical significance of therapeutic touch

Therapeutic touch (TT) is believed to help promote relaxation, reduce pain, accelerate the healing process, and alleviate psychosomatic illness. Patients who undergo surgery frequently experience stressors such as anxiety and pain. Although there have been limited studies on the use of TT in the surgical arena, it is a stress-reduction method that should be explored further. This article discusses studies that examined the use of TT in reducing anxiety and pain.

The effectiveness of therapeutic touch: a meta-analytic review

The purpose of this article is to explore the adequacy of published scientific evidence supporting therapeutic touch as a nursing intervention. Meta-analytic techniques were used to integrate the research-based literature published in the past decade. The results seem to indicate that therapeutic touch has a positive, medium effect on physiological and psychological variables. It is impossible to make any substantive claims at this time because there is limited published research and because many of the studies had significant methodological issues that could seriously bias the reported results. Resolving these methodological issues is imperative for therapeutic touch research to move forward.

Therapeutic touch with HIV-infected children: a pilot study

In this pilot study, 20 HIV-infected children, 6 to 12 years of age, were randomly assigned into therapeutic touch (TT) and mimic TT groups. The effectiveness of TT in reducing anxiety was evaluated. The self-report measure, the A-State Anxiety subscale of the Spielberger State-Trait Anxiety Inventory For Children, was administered before and immediately after interventions. As predicted, the TT intervention resulted in lower overall mean anxiety scores, whereas the mimic TT did not. These findings provide preliminary support for the use of TT in reducing the state anxiety of children with HIV infection.

Alternative therapies in the treatment or oral self-injurious behavior: a case report

This paper presents the case of a child with severe mental retardation and a history of oral self-injurious behavior (SIB). While the behavior was refractory to a number of dental interventions, some success was achieved through a combination of behavioral therapy techniques and therapeutic touch (a relaxation technique). Etiologies of SIB are discussed, along with descriptions of alternatives to traditional dental therapy for this difficult problem.

Reflection of a therapeutic touch experience: case study 2

The purpose of this case study was to explore the experience of both giving and receiving Therapeutic Touch. A subjective account of the Therapeutic Touch experience is given in an attempt to throw light on its unique creative and therapeutic qualities. In most instances it was shown that the experience of both giving and receiving Therapeutic Touch was a parallel experience. This case study explores the effects of Therapeutic Touch on a client experiencing pain and associated anxiety. Whilst a response to treatment was observed, the need for further case studies and research studies in this area was identified.

Quantitative research on therapeutic touch. An integrative review of the literature 1985-1995

Quantitative research on Therapeutic Touch (TT), published in referred nursing journals from 1985 to 1995, is reviewed. Therapeutic Touch is defined by Dolores Krieger, the founder of this nursing intervention. The authors of this Integrative Review examine what is known and not known to date in order to facilitate appropriate application of this modality in practice, and to offer recommendations for future research. Critical characteristics of eleven quantitative studies are identified and analyzed. These characteristics include: author/year/journal/title; study purpose (hypotheses); background/literature review/conceptual citations; sample selection method; study design/random assignment; independent variable/length of treatment/control and confounders; dependent variables/measurements; outcomes; study limitations; and implications for future research. After reviewing the studies, it is concluded that there is evidence to support the practice of Therapeutic Touch for the reduction of pain or anxiety. There is clearly a lack of congruity between the research statement, conceptual framework, operational definition of TT and the findings. This incongruity is discussed and incorporated in the recommendations for future research including outcome, theory-generating and theory-testing research.

Guided Imagery. A psychoneuroimmunological intervention in holistic nursing practice

Guided imagery is an independent nursing intervention that uses psychoneuroimmunology (PNI) principles to assist an individual in the management of distressing symptoms. The purpose of this article is to discuss the use of guided imagery in holistic nursing practice. The concepts of PNI are described and the basic steps of guided imagery are presented. PNI research and nursing research on guided imagery as an intervention are reviewed. The principles of guided imagery and PNI are applied to holistic nursing practice. Suggestions for future research methodologies, including psychological, neuroendocrine, and immunological measurements to evaluate the effectiveness of guided imagery, are offered. Rationale for using human immunodeficiency virus infection as a disease model to study the effectiveness of guided imagery is provided.

Alternative therapies and control for health in cancer and AIDS

People who are coping with AIDS and many forms of cancer have a sense of being out of control in dealing with their diseases. This stems, to a great degree, from the uncertainty that they feel relative to the accepted medical treatment for their disease. Informants in this naturalistic research study were adamant in their belief that alternative therapies helped them to regain a sense of control over their care and, thus, enhanced their health. It is important that clinical nurse specialists, who often serve as consultants to other nurses, understand and support their patients' choices of therapy. In addition, with evidence to support the benefit of stress reduction on length of survival, advanced practice nurses can play a key role in helping patients reduce stress and, hopefully, effect longevity and quality of life.