By Ellen Feldman, MD

Altru Health System, Grand Forks, ND

Dr. Feldman reports no financial relationships relevant to this field of study.


  • Forty-one adult inpatients with cardiovascular disease were divided into three treatment groups: active intervention, sham, and control. Active intervention involved a 10-minute session with experienced Spiritist healers interacting with the patients; the sham arm used sham healers for the same period.
  • Anxiety level, depression, pain, muscle tension, feeling of well-being, heart rate, and peripheral oxyhemoglobin saturation were evaluated throughout the three-day study period.
  • Patients in the intervention group experienced a significant reduction in anxiety scores and an increase in peripheral oxyhemoglobin saturation.
  • Both the intervention and sham arm participants had significant reduction of muscle tension and improvement in well-being; these changes were more pronounced in the active intervention group.
  • Depression scores, pain, and heart rate measures did not demonstrate a significant difference among any of the groups.

SYNOPSIS: A randomized, controlled trial evaluated the effectiveness of Brazilian energy therapy — Spiritist “passé” — in multiple conditions associated with recovery in cardiovascular inpatients.

SOURCE: Carneiro EM, Barbosa LP, Marson J, et al. Effectiveness of Spiritist passé (Spiritual healing) for anxiety levels, depression, pain, muscle tension, well-being, and physiological parameters in cardiovascular inpatients: A randomized controlled trial. Complement Ther Med 2017;30:73-78.

Brazil, home to more than 1,600 Spiritism Centers,1 provides a logical setting for this investigation. Although it is not necessary to believe in the existence of spirits or the philosophy of Spiritism to evaluate and review this randomized, controlled study, it is helpful to understand the Spiritist movement to put the study into proper context.

Although popular in Brazil, Spiritism actually originated in France, where the term was coined in 1857 by Allan Kardec (pseudonym for Hippolyte Léon Denizard Rivail) after conducting a series of experiments regarding the existence of spirits. He defined the philosophy of Spiritism as “a science which deals with the nature, origin and destiny of Spirits, as well as their relationship with the corporeal world.” While he conceptualized Spiritism as a science, it is more often perceived as a religion or religious belief, with many practitioners incorporating Spiritism alongside more traditional religious practices and identities.2

The history of Spiritism in Brazil is rocky, with legal prosecution and laws banning the practice of Spiritism in the late 1800s into the early 1900s. However, as acceptance from the medical and religious communities grew, Spiritism became more integrated into Brazilian culture alongside these more traditional entities. In a 2010 census, 3.8 million Brazilians self-identified as Spiritists attending centers for healing and prayer that bridge conventional medical and religious approaches and beliefs.1,2

Spiritism therapy incorporates multiple modalities. Carneiro et al studied one such modality — Spiritism “passé,” or laying on of hands. This therapeutic technique is performed to induce healing and is thought to involve a release of good energy from the healer, from spirits, or from both. Carneiro et al did not attempt to determine the validity of the mechanism of action. They did evaluate the effectiveness of this technique in relieving cardiovascular inpatients’ level of depression, anxiety, pain, muscle tension, as well as perception of well-being, and some physiologic measures.

The study had three arms, with patients receiving either active intervention by an experienced Spiritism healer, sham intervention by a hospital worker volunteer, or no intervention (control group). Among the 41 patients, just over half identified as Catholic, 12 identified as Spiritist (four in each arm), and five claimed no religious identity.

Intervention sessions consisted of 10-minute sessions on three consecutive days. In both the sham and active intervention groups, the practitioners (or volunteers) performed identical maneuvers by sliding hands in a prescribed method over the patient’s body for five minutes and then placing hands in specific positions near (but not touching) the patient’s body for another five minutes. The Spiritist practitioners were permitted to pray prior to administering the intervention. See Table 1 for selected results.

Table 1: Selected Results of Spiritist Trials

Parameter or State

Tool of Measurement

Spiritist Passé group


Hospital Anxiety and Depression Scale3

Decrease in anxiety compared to sham: P = 0.0001

Decrease in anxiety compared to control: P = 0.003


Hospital Anxiety and Depression Scale3

Decrease in depression but no significant difference compared to sham or control

Muscle tension

Visual Analog Scale

Decrease in muscle tension compared to sham and control: P = 0.003


Visual Analog Scale

No significant difference in pain scores between any of the groups

Perception of well-being

Visual Analog Scale

Increased feelings of well-being compared to sham and control: P = 0.003

Heart rate

Direct measurement

No significant difference in heart rate between any of the groups

Peripheral oxygen saturation

Fingertip pulse oximeter

Increase in peripheral oxygen saturation compared to sham and control: P = 0.028


Energy healing, biofield therapy, and laying on of hands may be unfamiliar terms to many medical providers. Yet, the integrative practitioner certainly can benefit by learning more about these modalities, as it would not be surprising to discover patient interest and exploration in these realms.

In ongoing efforts to quantify use of complementary and alternative medicine (CAM) in the United States, the National Health Interview Survey was administered in 2002, 2007, and 2013 to more than 80,000 U.S. adults. Results are weighted to provide national estimates. Most recent data reveal that an estimated 34% of the population are using CAM therapies; dietary supplements are the most popular intervention over this period. Yoga and tai chi show an impressive linear increase in use over the specified years; energy therapy involvement in general is documented by a fairly low and consistent 1% of respondents.4

Although there are limited studies regarding Spiritist passé in medical treatment, there is more extensive evidence and studies regarding other forms of energy treatments, such as Reiki, Qigong, and healing touch. Increasingly known as biofield therapies, these have been defined as “noninvasive, practitioner-mediated therapies that explicitly work with the biofield of both the practitioner and client to stimulate a healing response in the client.”5,6

In a 2015 review paper, Jain et al summarized findings from evidence-based studies regarding these modalities. The review study concluded that there exists moderate evidence for clinical effect in symptom management (including relief of depression, fatigue, and pain) in pain and cancer, and less robust, but promising, evidence in treatment of patients with arthritis, dementia, and heart disease. Recommendations for future direction include conducting larger-scale trials, assessing the role of placebo and existing beliefs, identifying clinical biomarkers, and studying cost-effectiveness.6

The strong point of the Carneiro et al study regarding Spiritist passé is the attempt to measure results of what appears to be an abstract modality (Spiritist intervention) in a scientific, fairly rigorous method. Isolating one aspect of the therapy to a concrete step and using patients with a specific diagnosis is certainly helpful, as is the use of a sham procedure in addition to a control group.

This study was preceded by a companion investigation published one year prior looking at the effectiveness of Spiritist passé on hospitalized patients in general. In that study, using almost identical methods, similar results emerged showing a statistically significant reduction in muscle tension and anxiety level and increased perception of well-being seen after intervention with Spiritist passé. However, the study with general hospital patients also documented significant reduction of levels of depression with active treatment.7

It is difficult to know how to interpret the differences in the results from these very similar studies. Future investigations with more subjects may help develop a more complete understanding of spiritual healing.

It certainly would be useful to know if patients’ personal spiritual beliefs influenced results. Although it appears that distribution of religious affiliation was similar in each arm of the study, there was no information given regarding the response of each subject according to religion, nor was there information regarding depth of faith or spiritual life of the subjects. These areas may very well prove to be important in understanding the effect of this intervention.

As we know that depression and anxiety can affect medical recovery and course of illness in many disease states,8,9 the idea that Spiritist passé or energy therapy can affect these states has clear relevance and treatment implications. The small numbers of subjects involved in the Spiritist passé studies (72 in the initial study and 41 in this study) limits the ability to generalize the results with confidence. Additionally, to raise Spiritist passé to the level of an accepted medical intervention, multinational subjects with heterogeneous ethnicities and a wide range of religious backgrounds must be included. There may be challenges recruiting participants in regions in which Spiritist practices are regarded with suspicion and less global acceptance — this attitude alone may affect results.

Finally, it is worth noting that these are preliminary studies and are most valuable when viewed as such. The team notes that there was no follow-up after the three-day study period and no assessment of safety of the intervention (although they reported an absence of negative side effects).

Understanding the relative strengths, indications, and limitations of specific energy therapies will be useful in developing recommendations for clinical uses of these biofield interventions. For now, a widespread knowledge of the types of energy therapies available and relevant studies will serve to strengthen the armamentarium of the integrative provider. While use of Spiritist passé currently most likely is limited to areas in which trained providers are available, awareness of these preliminary, promising studies holds relevance to a more global population.


  1. Lucchetti AL, Lucchetti G, Leao FC, et al. Mental and physical health and spiritual healing: An evaluation of complementary religious therapies provided by Spiritist centers in the city of São Paulo, Brazil. Cult Med Psychiatry 2016:40:404-421.
  2. Moreira-Almeida A, Silvia de Almeida AA, Neto FL. History of ‘Spiritist madness’ in Brazil. Hist Psychiatry 2005;16(61 Pt 1):5-25
  3. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002;52:69-77.
  4. U.S. Department of Health and Human Services. National Health Statistics Reports. Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002-2012. Available at: Accessed Sept. 22, 2017.
  5. Jain S, Mills PJ. Biofield therapies: Helpful or full of hype? A best evidence synthesis. Int J Behav Med 2010;17:1-16.
  6. Jain S, Hammerschlag R, Mills P, et al. Clinical studies of biofield therapies: Summary, methodological challenges, and recommendations. Glob Adv Health Med 2015;4(Suppl):58-66.
  7. Carneiro EM, Moraes GV, Terra GA. Effectiveness of Spiritist Passe (Spiritual healing) on the psychophysiological parameters in hospitalized patients. Adv Mind Body Med 2016;30:4-10.
  8. Sherbourne CD, Wells KB, Meredith LS, et al. Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers. Arch Gen Psychiatry 1996;53:889-895.
  9. Huffman JC, Legler SR, Boehm JK. Positive psychological well-being and health in patients with heart disease: A brief review. Future Cardiol 2017; Aug 22. doi: 10.2217/fca-2017-0016. [Epub ahead of print].