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AnandaOm conducts research on Reiki. If you are a research center, hospital or would like to take part in scientific research studies, please contact  This e-mail address is being protected from spambots. You need JavaScript enabled to view it.  

Scientific Research Studies:

Integr Cancer Ther. 2013 Oct 7

Integrative Reiki for Cancer Patients: A Program Evaluation
Fleisher KA, Mackenzie ER, Frankel ES, Seluzicki C, Casarett D, Mao JJ. 
University of Pennsylvania, Philadelphia, PA, USA
Abstract 
OBJECTIVE: This mixed methods study sought to evaluate the outcomes of an integrative Reiki volunteer program in an academic medical oncology center setting. 
METHOD. We used de-identified program evaluation data to perform both quantitative and qualitative analyses of participants' experiences of Reiki sessions. The quantitative data were collected pre- and postsession using a modified version of the distress thermometer. The pre- and postsession data from the distress assessment were analyzed using a paired Student's : test. The qualitative data were derived from written responses to open-ended questions asked after each Reiki session and were analyzed for key words and recurring themes. 
RESULTS. Of the 213 pre-post surveys of first-time sessions in the evaluation period, we observed a more than 50% decrease in self-reported distress (from 3.80 to 1.55), anxiety (from 4.05 to 1.44), depression (from 2.54 to 1.10), pain (from 2.58 to 1.21), and fatigue (from 4.80 to 2.30) with : .001 for all. Using conservative estimates that treat missing data as not endorsing Reiki, we found 176 (82.6%) of participants liked the Reiki session, 176 (82.6%) found the Reiki session helpful, 157 (73.7%) plan to continue using Reiki, and 175 (82.2%) would recommend Reiki to others. Qualiative analyses found that individuals reported that Reiki induced relaxation and enhanced spiritual well-being.
Reference: http://www.ncbi.nlm.nih.gov/pubmed/24105356


AM J HOSP PALLIAT CARE March 2013
Symptomatic Improvement Reported After Receiving Reiki at a Cancer Infusion Center 
Dawn A. Marcus, MD1 Betsy Blazek-O'Neill, MD2 Jennifer L. Kopar, CAVS3
Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA
Department of Integrated Medicine, West Penn Allegheny Health System, Pittsburgh, PA, USA
Volunteer Services, West Penn Allegheny Health System, Pittsburgh, PA, USA Dawn A. Marcus, MD, Suite 400, Pain Medicine Centre Commons Building, 5750 Centre Avenue Pittsburgh, PA 15206, USA. 
Abstract Objective: To evaluate patient-perceived benefits from receiving Reiki at a cancer infusion center. 
Methods: During a 6-month period, adults at a university hospital receiving Reiki through volunteer services were invited to complete a survey asking about perceived changes after Reiki. Changes in pain, mood, distress, sleep, and appetite were rated on a 5-point scale from no benefit to great benefit. Surveys were distributed after completing treatment and were returned in postage-paid envelops. 
Results: A total of 145 surveys were completed (34.5% response rate), with 47 participants seen in the cancer infusion center and 98 in other areas of the hospital. Reiki was rated as a positive experience by 94% at the cancer center and 93% of others, with 92% at the cancer center and 86% of others interested in receiving additional Reiki sessions. Symptomatic improvement was similar for people at the cancer center and others, respectively, with much to great improvement for 89% and 86% for relaxation, 75% and 75% for anxiety/worry, 81% and 78% for improved mood, 43% and 35% for improved sleep, 45% and 49% for reduced pain, 38% and 43% for reduced isolation/loneliness, 75% and 63% for improved attitude, and 30% and 30% for improved appetite. Response was unaffected by previous exposure to Reiki, massage, or other touch therapy.
Conclusion: Reiki results in a broad range of symptomatic benefits, including improvements in common cancer-related symptoms.
Reference: http://ajh.sagepub.com/content/30/2/216.abstract


Complement Ther Clin Pract. 2013 February 19 
Reiki training for caregivers of hospitalized pediatric patients: a pilot program
Kundu A, Dolan-Oves R, Dimmers MA, Towle CB, Doorenbos AZ. 
Source Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, WA, United States.
Abstract 
To explore the feasibility of a Reiki therapy-training program for the caregivers of pediatric medical or oncology inpatients, at a large pediatric hospital, a series of Reiki training classes were offered by a Reiki Master. At completion of the training, an interview was conducted to elicit participant's feedback regarding the effectiveness and feasibility of the training program. Seventeen of the 18 families agreed to participate. Most families (65%) attended three Reiki training sessions, reporting that Reiki benefitted their child by improving their comfort (76%), providing relaxation (88%), and pain relief (41%). All caregivers identified becoming an active participant in their child's care as a major gain from participation in the Reiki training. A hospital-based Reiki training program for caregivers of hospitalized pediatric patients is feasible and can positively impact patients and their families. More rigorous research regarding the benefits of Reiki in the pediatric population is needed.
Reference: http://www.ncbi.nlm.nih.gov/pubmed/23337565

Asian Pacific Journal of Cancer Prevention, Vol 14, 2013 
Effect of Reiki on Symptom Management in Oncology 
Melike Demir, Gulbeyaz Can, Enis Celek 
School of Health, Namık Kemal University, Tekirdag, Nursing Faculty, Istanbul University, Reiki Gelişim, Istanbul, Turkey 
Abstract 
Reiki is a form of energy therapy in which the therapist, with or without light touch, is believed to access universal energy sources that can strengthen the body’s ability to heal itself, reduce inflammation, and relieve pain and stress. There is currently no licensing for Reiki nor, given its apparent low risk, is there likely to be. Reiki appears to be generally safe, and serious adverse effects have not been reported. So in this article provides coverage of how to use Reiki in oncology services. Reference: http://www.ncbi.nlm.nih.gov/pubmed/24083770 

Am J Hosp Palliat Care. 2012 June 29
The effects of Reiki therapy on pain and anxiety in patients attending a day oncology and infusion services unit. 
Birocco N, Guillame C, Storto S, Ritorto G, Catino C, Gir N, Balestra L, Tealdi G, Orecchia C, Vito GD, Giaretto L, Donadio M, Bertetto O, Schena M, Ciuffreda L. 
Source SC Oncologia Medica, San Giovanni Battista Hospital, Turin, Italy.
Abstract 
Reiki is a system of natural healing techniques administered by laying of hands and transferring energy from the Reiki practitioner to the recipient. We investigated the role of Reiki in the management of anxiety, pain and global wellness in cancer patients. Building on the results of a pilot project conducted between 2003 and 2005 by a volunteer association at our hospital, a wider, 3-year study was conducted at the same center. The volunteer Reiki practitioners received 2 years of theory and practical training. The study population was 118 patients (67 women and 51 men; mean age, 55 years) with cancer at any stage and receiving any kind of chemotherapy. Before each session, the nurses collected the patient's personal data and clinical history. Pain and anxiety were evaluated according to a numeric rating scale by the Reiki practitioners. Each session lasted about 30 min; pain and anxiety scores were recorded using a Visual Analog Scale (VAS), together with a description of the physical feelings the patients perceived during the session. All 118 patients received at least 1 Reiki treatment (total number, 238). In the subgroup of 22 patients who underwent the full cycle of 4 treatments, the mean VAS anxiety score decreased from 6.77 to 2.28 (P <.000001) and the mean VAS pain score from 4.4 to 2.32 (P = .091). Overall, the sessions were felt helpful in improving well-being, relaxation, pain relief, sleep quality and reducing anxiety. Offering Reiki therapy in hospitals could respond to patients' physical and emotional needs.
Reference: http://www.ncbi.nlm.nih.gov/pubmed/21998438

Holist Nurs Pract. 2011 Sep-Oct 25 
Reiki and its journey into a hospital setting. 
Kryak E, Vitale A. 
Source Department of Nursing Informatics, Abington Health, Pennsylvania 19001, USA. 
Abstract 
There is a growing interest among health care providers, especially professional nurses to promote caring-healing approaches in patient care and self-care. Health care environments are places of human caring and holistic nurses are helping to lead the way that contemporary health care institutions must become holistic places of healing. The practice of Reiki as well as other practices can assist in the creation of this transformative process. Abington Memorial Hospital (AMH) in Abington, Pennsylvania is a Magnet-designated health care facility with an Integrative Medicine Services Department. AMH's Integrative Medicine staff focuses on the integration of holistic practices, such as Reiki into traditional patient care. Reiki services at AMH were initiated about 10 years ago through the efforts of a Reiki practitioner/nurse and the vision that healing is facilitated through the nurturing of the mind, body, and spirit for healing and self-healing. AMHs-sustained Reiki program includes Reiki treatments and classes for patients, health care providers, and community members. This program has evolved to include a policy and annual competency for any Reiki-trained nurse and other employees to administer Reiki treatments at the bedside. 
Reference: http://www.ncbi.nlm.nih.gov/pubmed/21832928

Rev Lat Am Enfermagem. 2011 Sep-Oct 19 
The application of Reiki in nurses diagnosed with Burnout Syndrome has beneficial effects on concentration of salivary IgA and blood pressure. 
Díaz-Rodríguez L, Arroyo-Morales M, Cantarero-Villanueva I, Férnandez-Lao C, Polley M, Fernández-de-las-Peñas C. 
Source Departamento de Enfermería, Universidad de Granada, Spain. 
Abstract 
This study aimed to investigate the immediate effects of the secretory immunoglobulin A (sIgA), α-amylase activity and blood pressure levels after the application of a Reiki session in nurses with Burnout Syndrome. A randomized, double-blind, placebo-controlled, crossover design was conducted to compare the immediate effects of Reiki versus control intervention (Hand-off sham intervention) in nurses with Burnout Syndrome. Sample was composed of eighteen nurses (aged 34-56 years) with burnout syndrome. Participants were randomly assigned to receive either a Reiki treatment or a placebo (sham Reiki) treatment, according to the established order in two different days. The ANOVA showed a significant interaction time x intervention for diastolic blood pressure (F=4.92, P=0.04) and sIgA concentration (F=4.71, P=0.04). A Reiki session can produce an immediate and statistically significant improvement in sIgA concentration and diastolic blood pressure in nurses with Burnout Syndrome.
Reference: http://www.ncbi.nlm.nih.gov/pubmed/22030577


Biol Res Nurs. 2011 October 13
Immediate effects of reiki on heart rate variability, cortisol levels, and body temperature in health care professionals with burnout.
Díaz-Rodríguez L, Arroyo-Morales M, Fernández-de-las-Peñas C, García-Lafuente F, García-Royo C, Tomás-Rojas I. 
Source Nursing, University of Granada, Avda.Madrid s/n, Granada, Spain. 
Abstract 
Burnout is a work-related mental health impairment comprising three dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. Reiki aims to help replenish and rebalance the body's energetic system, thus stimulating the healing process. The objective of this placebo-controlled, repeated measures, crossover, single-blind, randomized trial was to analyze the immediate effects of Reiki on heart rate variability (HRV), body temperature, and salivary flow rate and cortisol level in health care professionals with burnout syndrome (BS). Participants included 21 health care professionals with BS, who were asked to complete two visits to the laboratory with a 1-week interval between sessions. They were randomly assigned the order in which they would receive a Reiki session applied by an experienced therapist and a placebo treatment applied by a therapist with no knowledge of Reiki, who mimicked the Reiki treatment. Temperature, Holter ECG recordings (standard deviation of the normal-to-normal interval [SDNN], square root of mean squared differences of successive NN intervals [RMSSD], HRV index, low frequency component [LF], and high frequency component [HF]), salivary flow rate and cortisol levels were measured at baseline 
and postintervention by an assessor blinded to allocation group. SDNN and body temperature were significantly higher after the Reiki treatment than after the placebo. LF was significantly lower after the Reiki treatment. The decrease in the LF domain was associated with the increase in body temperature. These results suggest that Reiki has an effect on the parasympathetic nervous system when applied to health care professionals with BS.
Reference:http://www.ncbi.nlm.nih.gov/pubmed/21821642

Gastroenterol Nurs. 2010 Jan-Feb 3
Endoscopic procedure with a modified Reiki intervention: a pilot study. 
Hulse RS, Stuart-Shor EM, Russo J. 
Source University of Massachusetts, Boston, MA, USA.
Abstract
This pilot study examined the use of Reiki prior to colonoscopy to reduce anxiety and minimize intraprocedure medications compared with usual care. A prospective, nonblinded, partially randomized patient preference design was employed using 21 subjects undergoing colonoscopy for the first time. Symptoms of anxiety and pain were assessed using a Likert-type scale. Between-group differences were assessed using chi-square analyses and analysis of variance. There were no differences between the control (n = 10) and experimental (n = 11) groups on age (mean = 58 years, SD = 8.5) and gender (53% women). The experimental group had higher anxiety (4.5 vs. 2.6, p = .03) and pain (0.8 vs. 0.2, p = .42) scores prior to colonoscopy. The Reiki intervention reduced mean heart rate (-9 beats/minute), systolic blood pressure (-10 mmHg), diastolic blood pressure (-4 mmHg), and respirations (-3 breaths/minute). There were no between-group differences on intraprocedure medication use or postprocedure physiologic measures. Although the experimental group patients had more symptoms, they did not require additional pain medication during the procedure, suggesting that (1) anxious people may benefit from an adjunctive therapy; (2) anxiety and pain are decreased by Reiki therapy for patients undergoing colonoscopy, and (3) additional intraprocedure pain medication may not be needed for colonoscopy patients receiving Reiki therapy. This pilot study provided important insights in preparation for a rigorous, randomized, controlled clinical trial.
Referece: http://www.ncbi.nlm.nih.gov/pubmed/20145447 

Brain Res Bull. 2010 Jan 15
A randomised controlled single-blind trial of the effects of Reiki and positive imagery on well-being and salivary cortisol. 
Bowden D, Goddard L, Gruzelier J. 
Source Psychology Department, Goldsmiths, University of London, ITC Building, New Cross, London SE14 6NW, United Kingdom. 
Abstract 
The study investigated whether participants who received Reiki would show greater health and well-being benefits than a group who received no Reiki. A method of blinding participants to Reiki was also tested, where non-contact Reiki or No-Reiki with random assignment was given to 35 healthy psychology undergraduates whose attention was absorbed in one of three tasks involving self-hypnosis/relaxation. Participants experienced ten 20-min intervention sessions over a period of two and a half to 12 weeks. Reiki was directed by the experimenter who sat behind the participants as they were absorbed in the tasks. Self-report measures of illness symptoms, mood and sleep were assessed pre-post-intervention as was salivary cortisol. While the Reiki group had a tendency towards a reduction in illness symptoms, a substantive increase was seen in the No-Reiki. The Reiki group also had a near-significant comparative reduction in stress, although they also had significantly higher baseline illness symptoms and stress scores. The Reiki blinding was successful - the groups did not differ statistically in their beliefs regarding group membership. The results are suggestive that the Reiki buffered the substantive decline in health in the course of the academic year seen in the No-Reiki group. 
Reference: http://www.ncbi.nlm.nih.gov/pubmed/19819311 

Clin J Oncol Nurs. 2008 June 12  
Reiki as a clinical intervention in oncology nursing practice. 
Bossi LM, Ott MJ, DeCristofaro S. 
Source Children's Hospital Boston, MA, USA.  
Abstract 
Oncology nurses and their patients are frequently on the cutting edge of new therapies and interventions that support coping, health, and healing. Reiki is a practice that is requested with increasing frequency, is easy to learn, does not require expensive equipment, and in preliminary research, elicits a relaxation response and helps patients to feel more peaceful and experience less pain. Those who practice Reiki report that it supports them in self-care and a healthy lifestyle. This article will describe the process of Reiki, review current literature, present vignettes of patient responses to the intervention, and make recommendations for future study.
Reference: http://www.ncbi.nlm.nih.gov/pubmed/18515247 

J Altern Complement Med. 2008 May 14
Reiki improves heart rate homeostasis in laboratory rats. 
Baldwin AL, Wagers C, Schwartz GE. 
Source Laboratory for the Advances in Consciousness and Health, Department of Psychology, University of Arizona, Tucson, AZ 85721-0068, USA.  
Abstract 
OBJECTIVES: To determine whether application of Reiki to noise-stressed rats can reduce their heart rates (HRs) and blood pressures. 
RATIONALE: In a previous study, we showed that exposure of rats to 90 dB white noise for 15 minutes caused their HRs and blood pressures to significantly increase. Reiki has been shown to significantly decrease HR and blood pressure in a small group of healthy human subjects. However, use of humans in such studies has the disadvantage that experimental interpretations are encumbered by the variable of belief or skepticism regarding Reiki. For that reason, noise-stressed rats were used as an animal model to test the efficacy of Reiki in reducing elevated HR and blood pressure. DESIGN: Three unrestrained, male Sprague-Dawley rats implanted with radiotelemetric transducers were exposed daily for 8 days to a 15-minute white noise regimen (90 dB). For the last 5 days, the rats received 15 minutes of Reiki immediately before the noise and during the noise period. The experiment was repeated on the same animals but using sham Reiki. 
SETTING/LOCATION: The animals were housed in a quiet room in University of Arizona Animal Facility. 
OUTCOME MEASURES: Mean HRs and blood pressure were determined before Reiki/sham Reiki, during Reiki/sham Reiki, and during the noise in each case. 
RESULTS: Reiki, but not sham Reiki, significantly reduced HR compared to initial values. With Reiki, there was a high correlation between change in HR and initial HR, suggesting a homeostatic effect. Reiki, but not sham Reiki, significantly reduced the rise in HR produced by exposure of the rats to loud noise. Neither Reiki nor sham Reiki significantly affected blood pressure. CONCLUSION: Reiki is effective in modulating HR in stressed and unstressed rats, supporting its use as a stress-reducer in humans.
Reference: http://www.ncbi.nlm.nih.gov/pubmed/18435597

Integr Cancer Ther. 2007 March 6
Pilot crossover trial of Reiki versus rest for treating cancer-related fatigue. 
Tsang KL, Carlson LE, Olson K. 
Source Department of Psychology, University of Calgary, Alberta, Canada. 
Abstract 
Fatigue is an extremely common side effect experienced during cancer treatment and recovery. Limited research has investigated strategies stemming from complementary and alternative medicine to reduce cancer-related fatigue. This research examined the effects of Reiki, a type of energy touch therapy, on fatigue, pain, anxiety, and overall quality of life. This study was a counterbalanced crossover trial of 2 conditions: (1) in the Reiki condition, participants received Reiki for 5 consecutive daily sessions, followed by a 1-week washout monitoring period of no treatments, then 2 additional Reiki sessions, and finally 2 weeks of no treatments, and (2) in the rest condition, participants rested for approximately 1 hour each day for 5 consecutive days, followed by a 1-week washout monitoring period of no scheduled resting and an additional week of no treatments. In both conditions, participants completed questionnaires investigating cancer-related fatigue (Functional Assessment of Cancer Therapy Fatigue subscale [FACT-F]) and overall quality of life (Functional Assessment of Cancer Therapy, General Version [FACT-G]) before and after all Reiki or resting sessions. They also completed a visual analog scale (Edmonton Symptom Assessment System [ESAS]) assessing daily tiredness, pain, and anxiety before and after each session of Reiki or rest. Sixteen patients (13 women) participated in the trial: 8 were randomized to each order of conditions (Reiki then rest; rest then Reiki). They were screened for fatigue on the ESAS tiredness item, and those scoring greater than 3 on the 0 to 10 scale were eligible for the study. They were diagnosed with a variety of cancers, most commonly colorectal (62.5%) cancer, and had a median age of 59 years. Fatigue on the FACT-F decreased within the Reiki condition (P=.05) over the course of all 7 treatments. In addition, participants in the Reiki condition experienced significant improvements in quality of life (FACT-G) compared to those in the resting condition (P <.05). On daily assessments (ESAS) in the Reiki condition, presession 1 versus postsession 5 scores indicated significant decreases in tiredness (P .001), pain (P .005), and anxety (P.01), which were no seen in the resting condition. Future research should further investigate the impact of Reiki using more highly controlled designs that include a sham Reiki condition and larger sample sizes.
Reference: http://www.ncbi.nlm.nih.gov/pubmed/17351024


Cancer Prev Control. 1997 June 1
Using Reiki to manage pain: a preliminary report. 
Olson K, Hanson J. 
Source Cross Cancer Institute, Edmonton, Alta. 
Abstract 
The purpose of this study was to explore the usefulness of Reiki as an adjuvant to opioid therapy in the management of pain. Since no studies in this area could be found, a pilot study was carried out involving 20 volunteers experiencing pain at 55 sites for a variety of reasons, including cancer. All Reiki treatments were provided by a certified second-degree Reiki therapist. Pain was measured using both a visual analogue scale (VAS) and a Likert scale immediately before and after the Reiki treatment. Both instruments showed a highly significant (p < 0.0001) reduction in pain following the Reiki treatment.
Reference: http://www.ncbi.nlm.nih.gov/pubmed/9765732

J Altern Complement Med. 2006 Nov 12 
Using Reiki to decrease memory and behavior problems in mild cognitive impairment and mild Alzheimer's disease.
Crawford SE, Leaver VW, Mahoney SD. Source Passamaquoddy Tribe at Pleasant Point, Perry, ME, USA. 
Abstract 
OBJECTIVES: This empirical study explored the efficacy of using Reiki treatment to improve memory and behavior deficiencies in patients with mild cognitive impairment or mild Alzheimer's disease. Reiki is an ancient hands-on healing technique reputedly developed in Tibet 2500 years ago. 
DESIGN: This study was a quasi-experimental study comparing pre- and post-test scores of the Annotated Mini-Mental State Examination (AMMSE) and Revised Memory and Behavior Problems Checklist (RMBPC) after four weekly treatments of Reiki to a control group. 
SETTINGS/LOCATION: The participants were treated at a facility provided by the Pleasant Point Health Center on the Passamaquoddy Indian Reservation. 
SUBJECTS: The sample included 24 participants scoring between 20 and 24 on the AMMSE. Demographic characteristics of the sample included an age range from 60 to 80, with 67% female, 46% American Indian, and the remainder white. 
INTERVENTIONS: Twelve participants were exposed to 4 weeks of weekly treatments of Reiki from two Reiki Master-level practitioners; 12 participants served as controls and received no treatment. 
OUTCOME MEASURES: The two groups were compared on pre- and post-treatment scores on the AMMSE and the Revised Memory and Behavior Problems Checklist (RMBPC). 
RESULTS: Results indicated statistically significant increases in mental functioning (as demonstrated by improved scores of the AMMSE) and memory and behavior problems (as measured by the RMBPC) after Reiki treatment. This research adds to a very sparse database from empirical studies on Reiki results. 
CONCLUSION: The results indicate that Reiki treatments show promise for improving certain behavior and memory problems in patients with mild cognitive impairment or mild Alzheimer's disease. Caregivers can administer Reiki at little or no cost, resulting in significant societal value by potentially reducing the needs for medication and hospitalization.
Reference: http://www.ncbi.nlm.nih.gov/pubmed/17109583 

J Altern Complement Med. 2006 Jan-Feb 12
Personal interaction with a Reiki practitioner decreases noise-induced microvascular damage in an animal model. 
Baldwin AL, Schwartz GE. Source Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ 85724-5051, USA. 
Abstract 
OBJECTIVE: To determine whether Reiki, a process of transmission of healing energy, can significantly reduce microvascular leakage caused by exposure to excessive noise using an animal model. 
RATIONALE: Reiki is beginning to be used in hospitals to accelerate recovery. Despite many anecdotes describing Reiki's success, few scientific studies are reported and none of those use animals. Animal models have the advantage over human subjects in that they provide well-controlled, easily interpretable experiments. The use of noise is relevant to hospital patients because of the excessive ambient noise in hospitals in the United Kingdom and United States. Loud noise can lead to several nonauditory disorders in humans and animals that impair recovery. In the rat, stress from noise damages the mesenteric microvasculature, leading to leakage of plasma into the surrounding tissue. 
DESIGN: One group of four rats simultaneously received daily noise and Reiki, while two other groups received "sham" Reiki or noise alone. A fourth group did not receive noise or additional treatment. The experiment was performed three times to test for reproducibility.
OUTCOME MEASURES: Average number and area of microvascular leaks to fluorescent albumin per unit length of venule. 
RESULTS: In all three experiments, Reiki significantly reduced the outcome measures compared to the other noise groups (sham Reiki and noise alone) (p < 0.01). 
CONCLUSIONS: Application of Reiki significantly reduces noise-induced microvascular leakage in an animal model. Whether or not these effects are caused by Reiki itself, or the relaxing effect of the Reiki practitioner, this procedure could be useful for minimizing effects of environmental stress on research animals and hospital patients. 
Reference: http://www.ncbi.nlm.nih.gov/pubmed/16494564 

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