Reiki for Psychological Outcomes and Pain Relief

By Dónal P. O'Mathùna, PhD. Dr. O'Mathùna is Senior Lecturer in Ethics, Decision-Making & Evidence, School of Nursing, Dublin City University, Ireland; he reports no financial relationship to this field of study.

The term "reiki" (pronounced "ray-key") comes from two Japanese words, rei, meaning universal spirit, and ki, meaning life energy.1 Therapies based on this non-physical, vibrational life energy are known as biofield therapies, which include therapeutic touch and healing touch.2 This concept of energy arises from Eastern ideology and philosophy where a continuous and unimpeded flow of life energy is required for sustained health and wellness.3

Interest in Reiki has been growing, both among the public and in conventional health care settings. Nurses, physicians, and rehabilitation therapists now practice Reiki in hospitals, nursing homes, and other settings.2 Reiki is reported to be offered at 15% of U.S. hospitals.4 Health care professionals should be informed about Reiki to answer patients' questions about it and help them decide whether to incorporate it into their practices.

Procedure

When receiving Reiki, a person relaxes in any comfortable position. Practitioners gently rest their hands in specific ways on approximately 12 standard sites throughout the body. Reiki practitioners begin with the head and spend a few minutes at each site, with a complete session typically taking 45 to 90 minutes.

Practitioners are believed to act as passive channels for the life energy, which comes from a universal source. According to many practitioners, the energy cannot be directed by the human mind, but it guides itself to address patients' needs.1 More advanced practitioners claim they do not need to be present with patients but can bring healing by visualizing their patients (called distance Reiki).

Practitioner Training

Reiki training involves opening trainees' life energy channels (or chakras) in special training sessions called initiations, empowerments, or attunements. Only Reiki Masters (or Level III practitioners) may perform attunements, also described as "sacred ceremonies."1,5 During attunements, trainees' hands become warm, signaling they are ready to channel life energy as Level I practitioners.

Reiki Level II is attained after another attunement when the practitioner "intuitively" receives special symbols, believed to be healing gifts from personal "spirit guides."5,6 The symbols increase the practitioner's healing powers. Practitioners draw the symbols on patients' bodies, or visualize them, while silently chanting the symbol's name. Level II must be attained before distance Reiki is possible.5 Becoming a Reiki Master requires another attunement during which additional symbols are received for use in initiating trainees.

Controversy

Reiki is an ancient healing practice, believed to have originated thousands of years ago in Tibet.1 It was rediscovered in Japan by a Buddhist monk, Mikao Usui, during the mid-1800s. Usui trained others who were required to hold the initiation rites in secret. However, these practices were introduced into the Western world in the 1970s.5 Reiki is still practiced according to the "Usui System," although many variations now exist.

Reiki is based on the belief that health requires a sustained and balanced flow of life energy throughout the body. Reiki is said to correct imbalances and blockages in this energy. During Reiki, people report a variety of experiences, most commonly that of being deeply relaxed and cared for, along with sensations of energy.3 Others describe Reiki in terms of contact with "spirit guides, etheric bodies, chakras, and past lives."6 This has caused controversy as these experiences "are frequently associated with profound religious experience and have been linked to ritual healing practices across cultures."3 On the other hand, others are convinced that "Reiki is not a religion or cult."1

Clinical Studies

Some proponents claim Reiki treats many specific conditions, but research has focused primarily on promoting relaxation, healing, and wholeness. The beneficial effects claimed for Reiki are based primarily on anecdotal reports, descriptive studies, or controlled trials with small numbers of participants.7 Developing an authentic control therapy for Reiki is challenging. Most commonly, someone with no training in Reiki does the hand movements over a patient without understanding what true Reiki involves. This has been called "sham Reiki." Most studies examine psychological outcomes and pain relief. Single studies addressing various other conditions have been reviewed elsewhere.2

Psychological Outcomes. One early study involved Reiki practitioners treating 15 healthy subjects recruited from relaxation courses offered by the researchers.6 Distance Reiki was used to either induce relaxation or arouse subjects' autonomic activity at 30-second intervals in a randomly determined sequence (25 minutes altogether). A separate control group was not used nor was blinding. Relaxation responses did not differ significantly between relaxation and arousal periods.

In another single-group study, 23 healthy participants received 30 minutes of Reiki.8 Several outcomes were measured as indicators of levels of stress or relaxation. State anxiety mean scores were lower after Reiki than before (P = 0.02), as was systolic blood pressure (P < 0.01). Salivary IgA levels rose significantly (P = 0.03), but salivary cortisol, skin temperature, and electromyography did not change significantly.

In a controlled study, nursing students received either hands-on Reiki (n = 22) or mimic-Reiki (n = 20).9 Randomization and blinding were not mentioned. The mimic-Reiki was given by a research assistant who received 15 minutes of training in Reiki hand positions but no information about energy. No significant differences were found for perceptions of anxiety, personal power, or well-being.

One hundred undergraduate students were nonrandomly allocated to one of four groups.10 Each group experienced 20 minutes of either Reiki, mimic-Reiki, listening to a meditation tape, or listening to music. Relaxation was measured by a researcher-designed questionnaire, heart rate, and blood pressure. No significant differences were found between any of the groups.

A double-blind study randomized 30 inpatients at a stroke rehabilitation unit to one of three groups.11 Each patient received up to 10 treatments over 2½ weeks from either a Reiki master, a first-degree Reiki practitioner, or a sham practitioner. A historic control group consisted of records randomly selected for 20 patients at the facility. No significant differences were found using validated tools of functional independence and depression. Post-hoc analyses suggested some effects on mood and energy levels, but the researchers concluded there were no clinically useful effects. Interestingly, the sham practitioners reported feeling heat in their hands more frequently than the Reiki practitioners (P < 0.03).

A double-blind study of Reiki randomly assigned 45 patients needing treatment for depression and stress to receive hands-on Reiki, distance Reiki, or mock distance Reiki.12 Each treatment lasted 60-90 minutes, with weekly treatment for 6 weeks. Three standardized assessment tools measured depression, hopelessness, and stress at weeks 1, 6, and 52. Both treatment groups showed significant improvement on all three tests at weeks 6 and 52 compared to control (P < 0.05). The two treatment groups did not different significantly between one another.

Reiki's effect on comfort and well-being was studied in cancer patients at an outpatient clinic.7 The 189 participants were assigned to one of three interventions: standard care, 20 minutes Reiki from a Reiki Master, or 20 minutes sham Reiki. The intervention offered on each day was randomly selected and all participants that day received that intervention. Nurses and patients were blinded and validated instruments were used. The standard care group showed no changes in comfort or well-being, while both Reiki and sham Reiki groups improved significantly on both outcomes (P < 0.05). However, the two intervention groups did not differ significantly. The researchers concluded that their study affirmed the importance of personal presence with cancer outpatients.

Thirty-five psychology undergraduates participated in a single-blind randomized study.13 Participants were randomly assigned to one of six groups, with three receiving Reiki and three receiving no-Reiki. Participants also were assigned randomly to one of three relaxation/hypnosis techniques. The practitioner remained behind the blinded participants administering either Reiki or no intervention. Each received ten 30-minute treatments over 2½ to 12 weeks. The two groups differed significantly on the Illness Symptoms Questionnaire (P = 0.001), but not in measures of depression, anxiety, sleep quality, and salivary cortisol. Illness symptoms did not change in the Reiki group, but they increased in the no-Reiki group. However, the two groups also differed significantly at baseline.

The same research team conducted a related study with another 40 psychology students.14 The students were divided into two equal groups based on scoring high or low on a depression and anxiety scale. Members of each group were randomly assigned to Reiki or no-Reiki while they engaged in guided relaxation. Each participant received six 30-minute sessions over 2 to 8 weeks. For the whole group, depression, anxiety, and stress scores changed little with no significant differences between groups. Illness symptoms did not change as in the earlier study. The group that initially scored high on depression and anxiety showed a significant reduction in these scores after treatment (P = 0.09), whereas those with lower scores initially did not change significantly. The conclusion was that people with higher levels of depression and anxiety might stand to benefit more from Reiki than those with lower levels.

In another trial, 20 community-dwelling older adults were randomly assigned to Reiki or waiting list control.15 The intervention was 30 minutes of Reiki weekly for 8 weeks from a Reiki Master, accompanied by soft lighting and music. Before and after Reiki, a nurse measured pain, heart rate, and blood pressure and discussed either the past week's stressors or the upcoming week. The Reiki group compared to control had significantly improved pain, depression, and anxiety scores (all P < 0.001) on validated instruments. No significant differences in blood pressure or heart rate were noted.

A pilot study randomized 32 women undergoing breast biopsy to either Reiki plus standard care or standard care alone.16 The investigator, patients, and data collectors were blinded. Those in the Reiki group received one treatment session during the week before the biopsy and one in the week after. Treatment lasted 54 minutes on average. No significant differences were found in depression or anxiety scores between the two groups.

A randomized, crossover study involved 16 cancer patients who had recently completed chemotherapy.17 The intervention group received Reiki on 5 consecutive days, no Reiki for up to 7 days, 2 more days of Reiki, no Reiki for 7-14 days, and then the control protocol. During the control period, 45 minutes of rest at home replaced Reiki. Those undergoing Reiki had significantly improved scores for fatigue (P = 0.05), quality of life (P < 0.05), pain (P < 0.005), and anxiety (P < 0.01).

The level of evidence to support Reiki for psychological conditions is weak, although some beneficial results have been reported. Such conditions are challenging to control for, especially with a hands-on intervention like Reiki. Sham Reiki provides a way to blind patients, but those collecting outcomes also should be blinded. Researchers often provide Reiki, which confounds and potentially biases the results. Other confounding factors like music, lighting, and personal interactions should be the same between groups, but often are not.

Pain Relief. Fewer studies have examined Reiki for pain relief. An uncontrolled pilot project used Reiki with 20 subjects experiencing different types of moderate pain.18 Subjects continued to use other analgesics and received Reiki in a dimly lit room accompanied by burning candles and soft music. Pain measured with a visual analogue scale (VAS) and Likert scale was significantly lower after treatment compared to beforehand (P = 0.0001).

The pilot study led to a controlled trial of patients with advanced cancer.19 Sample size calculations indicated 100 participants were needed. Recruitment stopped after 53 patients because participants insisted on being assigned to the Reiki group. Participants were randomly assigned to either standard opioid drugs plus 90 minutes Reiki (including physical touch) or opioids with 90 minutes rest (and no physical touch). Before and after the interventions, given on days 1 and 4, a research nurse measured pain scores, blood pressure, respiration rate, and heart rate. On days 1 and 7, quality of life and analgesic usage were measured. Results were based on 24 patients who completed the study (55% dropout). On day 1, the Reiki group compared to control had significant reductions in pain levels (P = 0.035), diastolic blood pressure (P = 0.005), and heart rate (P = 0.0019). On day 4, only the pain levels were significantly different between the groups (P = 0.002). Quality of life was measured on days 1 and 7, with significant improvements in the psychological components (P = 0.002), but not the social or physical components. Analgesic usage did not differ between the groups. The researchers urged caution in interpreting the results due to the small sample size, high dropout rate, and the confounding influence of the Reiki practitioner's presence and touch in the Reiki group.

In a controlled study, 21 patients were randomized to treatment or control (no intervention) after impacted third molars were extracted.20 Three hours later the treatment group received distance Reiki and LeShan from "several" miles away, with practitioners alternating therapies every hour for 6 hours (LeShan healing is a meditative method that is believed to stimulate healing in another person). Two weeks later, the second lower third molar was removed and subjects crossed over to the other group. Pain intensity was evaluated hourly using a VAS. The treatment group had significantly lower pain intensity and significantly higher pain relief (P < 0.05).

Another study involved 120 volunteers with pain and stress for at least 1 year.21 They were randomly assigned to receive Reiki from a Reiki Master, progressive muscle relaxation, sham Reiki, or no treatment for 10 biweekly sessions. Participants completed 12 instruments at pretest, end of treatment, and 3 months follow-up. Significant improvements were noted with Reiki on 10 of the 12 scales, with the largest effects found for depression (P = 0.001) and anxiety (P = 0.0001).

Adverse Effects

Practitioners claim Reiki cannot cause harm as the energy adjusts itself as needed. A recent study claimed, "Analysis of the literature found no adverse effects reported in any study."7 However, one study found that participants had varying experiences, including positive, neutral, and negative effects.6 The latter ranged from feelings of disappointment and boredom to agitation. Several participants experienced "panic" during the study, resulting in one participant trying to "block" the healer's influence. Many reported bodily experiences unlike anything they had ever felt before, including hot flushes and muscle spasms. One study reported depression triggered by Reiki, which led to adjustments in how the therapy was administered.15 An Australian nursing journal printed a letter claiming Reiki training caused a nurse much anxiety and discomfort.22 Controversy erupted, with some nurses reporting negative effects and others defending Reiki as completely harmless.23 Unpleasant changes in states of consciousness and other negative experiences in people receiving other energy therapies are relatively uncommon occurrences, but further investigation is needed and effective communication required to ensure patients are appropriately informed.24

Conclusion

A small but growing number of controlled studies have been published on Reiki. For psychological outcomes, most studies have not found significant improvements. Studies of pain are fewer, with more showing significant improvements with Reiki. However, general conclusions cannot be reached due to the wide variety of study designs and limitations like small sample sizes and varying treatment protocols. For example, one crossover trial included a washout period of 1-2 weeks, and there were variable durations of follow-up in other studies. Proponents generally claim sessions should last 45 to 90 minutes, yet in a number of studies Reiki was provided for only 20 minutes. Confounding factors like music, soft lighting, or conversations with nurses were often present and were not taken into account.

Recommendations

Uncontrolled studies show that outcomes like anxiey, depression, and pain may improve after patients receive Reiki. However, the source of these changes cannot be definitively attributed to Reiki itself in light of confounders such as the presence of healing practitioners or the relaxing atmosphere employed. The growing popularity of Reiki at least supports the importance of meaningful, personal interactions between health care providers and patients. Improving upon and creating space for these interactions is a goal seemingly all can support, although this raises practical difficulties in today's health care settings.

Controversy regarding Reiki's spiritual roots and the range of psychological experiences triggered require further careful investigation. Such experiences may be particularly challenging for certain patients. Patients should be informed of the limited evidence supporting Reiki's effectiveness, the potential for rare adverse events, and the controversy surrounding its spiritual roots. This is essential to allow patients to make informed decisions about Reiki based on their therapeutic and spiritual goals.

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