Journal of Behavior Therapy And Mental Health

Journal of Behavior Therapy And Mental Health

Current Issue Volume No: 2 Issue No: 2

Review-article Article Open Access
  • Available online freely Peer Reviewed

  • The Effectiveness Of Treating Anxiety With Reiki

    1 Department of Nursing, MCPHS University Worcester, MA. 

    Abstract

    The effectiveness of treating anxiety with Reiki is explored within ten quantitative studies. Methodology utilized for a critical appraisal and systematic review of the literature is explained with inclusion and exclusion criteria. Theoretical framework for the project is grounded in the work of Hildegard Peplau, whose nursing theory based on the therapeutic use of self is foundational for Reiki implementation. A thorough critique of the literature is conducted for key components of robustness and believability. This critique is conducted using a structured guide addressing synthesized strengths and weaknesses of the body of literature. A synthesis of the literature explores the findings of the studies. This synthesis reports on Reiki s effectiveness in treating anxiety within a variety of patient settings and populations, its effect on subscales of anxiety, physiological manifestations of anxiety and pain associated with anxiety. Cultural considerations effecting Reiki s potential effectiveness are discussed. Gaps in the literature are examined, including the studies narrow sample population, lack of participant exclusionary factors for controlled outcome data, and the lack of studies across time. Implications for future research are discussed with recommendations for expanded research that includes a broader variety of settings, age groups, and patient diagnoses, including anxiety disorders, for research data that is transferable. Implications for further practice for the advanced practice registered nurse (APRN) are explored, with the potential benefits for both providers and patients, including improved patient satisfaction and expansion of provider treatment modalities.
    Author Contributions
    Received Aug 14, 2023     Accepted Aug 28, 2023     Published Sep 06, 2023

    Copyright© 2023 Humphreys PMHNP-BC Erika, et al.
    License
    Creative Commons License   This work is licensed under a Creative Commons Attribution 4.0 International License. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Funding Interests:

    Citation:

    Humphreys PMHNP-BC Erika, Emily Cabrera Dr., Susan Downey Luhrmann Dr. (2023) The Effectiveness Of Treating Anxiety With Reiki Journal of Behavior Therapy And Mental Health. - 2(2):22-34
    DOI 10.14302/issn2474-9273.jbtm-23-4712

    Introduction

    Introduction The Effectiveness of Treating Anxiety with Reiki

    Anxiety is a widespread mental health concern affecting up to one-third of the United States population at some point during an individual’s lifetime 21. Individuals with anxiety disorders often have impairments socially, professionally, and in their physical health 20. National healthcare costs for the management of anxiety disorders are estimated at $46.6 billion annually, 75% of the expenses being attributed to anxiety-related morbidity, mortality, and loss of job productivity 11.  The novel coronavirus of the 2019 (COVID-19) pandemic has increased these statistics globally, with 76 million newly diagnosed cases of anxiety disorders since its onset, with a 25% overall increase in the disorders’ prevalence 9. With the increasing rates of anxiety disorders and the associated healthcare burden, a focus on the diagnosis and treatment of anxiety disorders claims new relevance.

    Beyond the economic impact of anxiety disorders, the psychosocial impact on the quality of life is another concern. Mood disorders are often a precursor to substance use disorders. The comorbidity of the two disorders is not only predictive of their presence, but also of their severity, with a more severe mood disorder driving a more problematic or potentially fatal subsequent substance use disorder 16. It is believed that up to 90% of individuals who commit suicide have a psychiatric illness, most frequently a mood disorder 23. Suicide remains the tenth leading cause of death in the United States and the second leading cause of death among Americans ages 10-34, claiming over 47,500 American lives annually 5, and claiming over 700,000 deaths annually worldwide 28. As with any disease process and its related mortality and morbidity rates, investigating contributing risk factors is essential.

    Anxiety is assessed utilizing evidence-based standardized screening tools. The Generalized Anxiety Disorder-7 (GAD-7) screening tool assesses anxiety levels using subscale areas of anxiety on a 4-point Likert scale of seven items with scoring ranges from 0 to 21, addressing elements of anxiety including nervousness, irritability, worry, restlessness, and fear 19. Other standardized anxiety screening tools include the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS), the Anxiety Depression Stress Scale (ADSS) and the Adult Manifest Anxiety Scale (AMAS) 10. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), gives criteria for diagnosing anxiety disorders 1. Symptoms assessed in this catagory include irritability, worry, fear, restlessness, fatigue, and muscle tension, with these symptoms often causing distress in social functioning 1.

    Treatment for anxiety often includes psychopharmaceuticals, which can be effective in reducing anxiety symptoms while potentially introducing bothersome side effects, dependence, and compliance issues 3. Given the large population affected by anxiety, and the obstacles involved with psychopharmacology use, Complementary Alternative Medicine (CAM) has gained interest as a treatment for anxiety. CAM includes modalities such as yoga, meditation, mindfulness, and Reiki. Among these, Reiki is less understood and researched for the potential efficacy in the treatment of anxiety.

    Reiki is a form of biofield energy healing, aimed to balance the Chi, or universal energy, within the body 2. Reiki was originally developed in Japan in the 20th century, as a way of clearing negative energy blockages that prevent the natural flow of this healing energy within the body 12. The Reiki practitioner directs energy from the universe to the recipient in areas where energy blockages are sensed, using systematic hand movements above the recipient’s body 27. Energy imbalances within the recipient are cleared and homeostasis of mind, body and soul are restored, creating a sense of well-being 12. The purpose of this study is to explore what is known about Reiki and its efficacy in treating anxiety, and to answer the PICO question: In patients with anxiety (P), how does the administration of Reiki (I), when compared to the administration of sham Reiki or no intervention (C), affect self-assessed anxiety levels (O)?

    Discussion

    Discussion/Conclusion/Recommendations

    All articles discussed the strengths and limitations of their study design, except for one 25. Seven of the ten articles made recommendations for future research based on their study s findings, strengths, and limitations 24713152627. Three of the articles did not include recommendations for future research 212425. In the two studies with an identified hypothesis, one study s findings supported the hypothesis 7. One study s findings did not support the hypothesis 4. In the seven articles with literature reviews, five linked their findings back to the reviews 413152526.

    References

    In each article, all sources of information were accurately referenced at the end of the article 24713152124252627 .

    Synthesis of the Literature

    A synthesis of the literature reports the studies findings in a cohesive manner, identifying themes that emerged from the sum of the articles. Data are reported with levels of statistical significance of findings 8. The following themes were identified: the effect of Reiki administered in various settings, the effect of Reiki on manifestations of anxiety, Reiki s interconnectedness with pain and anxiety, and cultural considerations of the implementation of Reiki.

    Effect of Reiki on Anxiety

    Reiki was found to reduce anxiety levels in all ten studies 24713152124252627. Seven of the studies showed a statistically significant reduction in anxiety scores (p<0.001) 271315252627. The remaining three studies showed reduced scores ranging from a 0.21 to 0.6 average decrease in points, however these reductions in points lacked statistical significance (p>0.05) 42124.

    Effect of Reiki on Anxiety in Various Settings

    Five of the studies focused on a preoperative/preprocedural setting 27152124. Four of the studies were conducted in outpatient therapeutic settings 4132527. One study was conducted in an inpatient hospital setting 26. In seven studies, Reiki administration was reported to reduce anxiety levels in all settings with statistically significant scores (p<0.001), with STAI scores averaging a reduction of 4.8 to 7.0 points and other scales scores averaging a reduction of 1.9 to 5.25 points2713152521242627. Reiki sessions varied widely in duration with sessions ranging from 15 to 90 minutes in length, and in quantity, with participants receiving a single session to daily sessions for 45 days 271315252627. In the remaining three studies, Reiki administration was found to reduce anxiety levels in each setting, however, with scores that lacked statistical significance 42124. Scores ranged in reduction from 0.21 to 1.2 points 42124. Reiki sessions varied less in this group, ranging in duration from 10 to 20 minutes, with each participant receiving one or two Reiki sessions 42124.

    Preoperative/Preprocedural

    Reiki administered to preoperative/preprocedural patients resulted in statistically significant (p<0.001) reduced average scores ranging from 4.8 to 13.76 points less than baseline, utilizing the State-Trait Anxiety Inventory, Y1 (STAI-Y1), 2715 Post treatment assessments of the religious and cultural considerations were thought to have resulted in reduced assessment scores that lacked statistical significance, with p-values ranging from p>0.05 to p=0.782 2124.

    Inpatient Medical

    Reiki offered to patients on inpatient medical units as non-pharmacological intervention for anxiety demonstrated statistically significant reduced anxiety scores (p<0.05) on standardized screening scales 26. The 11-point Likert scale questionnaire resulted in scores that averaged 3.94 at baseline pretreatment and 1.73 posttreatment, with a mean change of -2.21 points 26. These patients were hospitalized for varying illnesses and conditions 26. Reiki was more effective than massage in the reduction of inpatient anxiety levels with statistically significant scores (p< 0.05) post treatment in the two groups 26. The massage intervention group showed a reduction of 1.84 points from baseline, compared to the 2.21-point reduction in the Reiki intervention group, and with a p-value of <0.001 26.

    Outpatient Clinic

    In the outpatient setting, the administration of Reiki resulted in a statistically significant reduction of self-reported anxiety levels, ranging on average a decrease of 1.9 points to 5.25 points on the various scales utilized to measure anxiety levels 132527. One study conducted in the outpatient setting showed reduced self-reported stress levels ranging from a 0.2 to 0.5 percent improvement over control group scores, however findings lacked statistical significance (p>0.05) 4. In this study the Reiki treatment group showed an average reduction of 2.5 points, while the sham Reiki and no intervention group ranged from 1.2 to 1.9 average reduction of self-reported stress levels 4.

    Effect of Reiki on Related Manifestations of Anxiety

    Seven of the ten studies assessed related manifestations of anxiety 241315212627. Three of the studies looked at vital signs in response to Reiki treatment as a physiological demonstration of anxiety 2415. Four of the studies looked at emotional subscales of anxiety, including tension, irritability, jitteriness, nervousness, fatigue, and stress and worry related to social concerns, rating them with standardized scales, such as the Positive and Negative Affect Schedule (PANAS) and the Spiritual Well-Being Scale (SWB) 7132627. The data from these related manifestations of anxiety and emotional subscales of anxiety will be discussed in detail.

    Emotional Subscales of Anxiety

    In studies of Reiki administered for the reduction of anxiety, four studies assessed specific subscales measuring facets of anxiety 7132627. These subscales measured tension, irritability, jitteriness, nervousness, fatigue, and stress and worry related to social concerns 7132627. Tension, irritability, jitteriness, nervousness, fear, fatigue, and worry and stress related to social concerns were reduced with statistically significant lower scores ranging in t-test score changes of -20.03 to -28.8, (p< 0.0001) 7132627.

    Physiological Manifestations of Anxiety

    The autonomic nervous system responds to anxiety with nonspecific physiologic changes. Reiki treatments have been shown to reduce these vital signs with statistically significant scores (p< 0.05) 2415. After the administration of Reiki, blood pressure was reduced with systolic scores reduced in range from 141 mm Hg to 116 mm Hg, and diastolic scores from 77.1 mm Hg to 59 mm Hg 2415. Heartrate was reduced in a range from 75.6 bpm to 66.3 bpm with the administration of Reiki 415. Respiratory rate was reduced in a range from 20.1 breaths per minute to 16.3 breaths per minute 215. Reiki sessions ranged in duration from 10 to 30 minutes, and in quantity, with participants receiving one to four sessions 215.

    Reiki s Interconnectedness with Pain and Anxiety

    Reiki s effect on perceived pain was assessed in four of the ten studies utilizing a ten-point scale, with ten being the worst pain and zero being an absence of pain 2131526. Findings on Reiki s effect on pain as it relates to anxiety levels will be discussed further.

    Pain reduction with Reiki Intervention

    Pain scores were shown to be reduced with statistical significance (p< 0.05) with administration of Reiki preoperatively, when compared to sham Reiki and SOC control groups 21315. Pain scores reduced from an average of 4.75 to 1.4 on a 10-point Likert pain scale 2131526. Postoperative and postprocedural patients who received Reiki also reported statistically significant reduced pain scores ranging from 1.4 to 2.71 average lower scores when compared to SOC control groups, with p-values ranging from p<0.001 to p<0.003 21526. Pain reduction associated with congruent anxiety reduction was observed with a Pearson correlation coefficient of r=0.20 in one study that measured this relationship 13. Reiki sessions ranged in duration from 20 to 90 minutes, and in quantity, with participants receiving one to four Reiki sessions 2131526.

         Cultural Considerations with Potential Effectiveness of Reiki

    Studies involving American patients showed that Reiki provided a statistically significant (p<0.001) reduction in anxiety symptoms 213152627. These studies utilized various screening tools, such as the STAI, AMAS and a 10-point Likert scale with up to 8% reduction in anxiety scores 213152627. Reiki sessions ranged in duration from 15 to 90 minutes 213152627. Italian and Indian patients studied also showed statistically significant (p< 0.001) reduction of anxiety levels, with scores 25% to 50% lower after the administration of Reiki 725. These studies ranged widely in their administration of Reiki, with sessions lasting 15 to 60 minutes, for anywhere from one to 45 sessions 725. Turkish and Brazilian patients did not show similar results with reduction of anxiety scores 2124. Turkish patients did show statistically significant different scores (p< 0.05) between the Reiki administration group and the control group due to increased self-reported anxiety levels of the control SOC group, as reflected with STAI scores decreasing from 40.03- 39.82 in one, 30-minute Reiki session 24. Brazilian patients did show statistically significant improvement in self-reported existential and spiritual well-being after two, 20-minute Reiki sessions, and the authors note that the interpretation of well-being and the absence of anxiety symptoms are filtered through a cultural lens 21. These scores were reduced on average from 2.1 points to 7.9 points on the Spiritual Well-being Scale 21.

    Gaps in the Literature

    The existing literature on Reiki s effect on anxiety is minimal and does not cover a wide range of study participants. Only two of the studies focused on the effect of Reiki on anxiety for individuals in treatment for an anxiety disorder 2527. It is important that the research answer the question of Reiki s effectiveness in the treatment of anxiety for those experiencing it on a regular basis: patients with anxiety disorders. Only three of the ten studies indicated that taking anxiolytics or other psychotropic medication for mood was an exclusionary factor for study participation, therefore, a comparison of individuals with and without preexisting anxiety conditions, and with and without psychopharmacological treatment was not conducted 21521.

    Five of the ten studies focused on the effect of Reiki on preoperative patients anxiety levels, which focused half of the literature on a narrow population 27152124 One study that conducted three or four Reiki sessions per patient, with one session preoperatively and the remaining postoperatively, did not report on the anxiety levels of participants after their first Reiki session preoperatively 2. The scores reported in this study were assessed prior to the first treatment preoperatively, then at discharge after subsequent treatments, when preoperative anxiety is naturally concluded and mood-altering pain medication is likely being given 2. Six of the ten studies utilized only a single Reiki session to assess anxiety levels, as opposed to looking at cumulative effects of the intervention over time 4713152426. Two of the studies utilized convenience sampling at Reiki centers, where the participants were biased towards open mindedness and previous knowledge of Reiki s potential benefits 413.

     Implications for Future Research

    Patient satisfaction is indicated in future research implications, as an increase in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys benefits both the hospitals and the consumers 2. These patient satisfaction scores are public and affect hospital Medicaid and Medicare reimbursement rates 6. For a broader and deeper understanding of Reiki s potential benefit in the treatment of anxiety, several different settings, diagnoses, and age groups need to be studied 215. Reiki s benefit on inpatient settings where anxiety levels are commonly high, such as on intensive care units, burn units, and inpatient substance abuse units, would broaden the research and make findings more transferrable 24. Including all age groups in various studies would indicate if the intervention is beneficial across the lifespan 15. Studies need to be conducted in a wide array of settings, both inpatient and outpatient, to show the full potential of Reiki as an intervention for patients receiving primary, secondary and tertiary care 15. Differentiating studies and study participants by whether preexisting anxiety disorders are present, and if anxiolytic or other psychopharmacological treatment is being utilized, is critical in creating studies that identify individuals who would benefit from Reiki treatments for anxiety. These studies need to be conducted over time to explore the potential long-term benefits of Reiki as a treatment for anxiety, utilizing a series of Reiki sessions to explore potential maximum efficacy 13726. Reiki practitioners work at three different skill levels, including level one, level two, and Reiki master. The skill level of the Reiki practitioners in a study should be congruent, ruling out wide variance of the treatment rendered 13.

    Implications for Further Practice

    For the advanced practice registered nurse (APRN), research on Reiki could potentially open the door to a low-cost, safe alternative intervention for treating anxiety across many patient care settings. Identifying means to treat anxiety nonpharmacologically allows the APRN to limit prescribing risks associated with anxiolytics that are controlled substances, such as dependence and diversion. Having CAM modalities offered alongside traditional therapies within the APRN practice increases patient satisfaction 26. Patients report higher levels of satisfaction with their care when they experience their provider as unhurried, present, and compassionate 15. Nurses are trained on a holistic body, mind, and soul model, which is well-tailored to the implementation of a guided energy therapy such as Reiki. Hildegard Peplau s interpersonal relations theory sets solid theoretical framework for the appropriateness of studying Reiki s potential benefit for patients of APRNs 22.

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