THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 7, Number 1, 2001, pp. 45–51

Mary Ann Liebert, Inc.

Chronically Ill Patients Treated by Spiritual Healing

Improve in Quality of Life: Results of a Randomized
Waiting-List Controlled Study

HARALD WIESENDANGER, Ph.D.,1 LUCIUS WERTHMÜLLER,2

KATJA REUTER, Dipl.Psych.,3 and HARALD WALACH Ph.D.3

ABSTRACT

Objective: Little is known about the effects of distant healing in chronically ill patients, the
population most likely to see a healer in practice. This study investigated whether distant heal-
ing as found in normal practice with patients representative of those seeking treatment from
healers changes patients’ quality of life substantially.
Method: Randomized, waiting-list controlled study of distant healing (anonymous, amulet,
and allowing for personal contact) in chronically ill patients.
Outcome measure: Patient-reported quality of life as expressed by the sum of all MOS SF-36
health survey items.
Results: Sixty patients were treated by various methods of distant healing over 5 months; 59
patients were put on a waiting list (control). Quality of life improved significantly (p , 0.0005)
in the treated group (10 points), while it remained stable in the control group. Positive expecta-
tion was significantly correlated with outcome.
Conclusion: Chronically ill patients who want to be treated by distant healing and know that
they are treated improve in quality of life.

INTRODUCTION in Iceland (Haraldsson, 1994) reported that 41%

of the population had seen a healer, and ac-

S
piritual healing is a method of treating pa-
tients by positive mental intentions only.
Practitioners frequently claim to “send healing
energies,” “influence subtle material pro-
cesses,” or simply pray for the well being of the
recipient. Personal contact is no prerequisite,
and in practice many healers treat over large
distances. There is little epidemiologic knowl-
edge about how many people seek the advice
of paramedical healers. But a national survey
cording to our experience in Germany (Wiesen-
danger, 1994; Binder and Wolf-Braun, 1995) it
is an increasingly used modality of unconven-
tional treatment methods. Although spiritual
healing is part and parcel of the medical sys-
tem in almost all but the Western countries
(Glik, 1988; Hahn, 1995; Al-Krenawi et al., 1996)
as testified by the World Health Organization’s
call for respecting traditional healing systems,
little is known about its effects. Some studies

1
Schönbrunn, Germany.
2 Basel,
Switzerland.
3University Hospital Freiburg, Institute of Environmental Medicine and Hospital Epidemiology, Freiburg, Ger-
many.

45
46
suggest positive effects of prayer and spiritual
healing (Byrd, 1988; Brown, 1995; Dixon, 1998),
others report either negative or inconclusive re-
sults (Beutler et al., 1987; Castronova and Ole-
son, 1991; Greyson, 1996; O’Laoire, 1997). A re-
cent review of the Cochrane collaboration
reported no effects for intercessory prayer over
control (Roberts et al., 1998). Two recent re-
views (Abbot, 2000; Astin et al., 2000) both con-
cluded that there are enough interesting find-
ings to warrant further study but not enough
conclusive evidence.
Because the situation is rather confusing, we
decided to study distant healing, in which the
patient is not in direct personal contact with his
or her healer, in a setting akin to what can be
found in practice. We studied healers who used
various distant healing modalities on patients
with chronic illnesses of various kinds, as they
usually present to a healer. We sought to imi-
tate the variety of healing practices that can be
found and that patients seeking healing treat-
ment are likely to encounter. We wanted to as-
sess healing as close as possible to normal prac-
tice, as Brown (2000) recently called for.
Therefore we deliberately did not define “heal-
ing” or “healing practice” in a specific way but
used an operational definition: healing in the
context of this study means the practice of dis-
tant healing that is used by different profes-
sional healers, who normally use distant heal-
ing, to benefit patients. The only prerequisite
was that healers were prepared to practice
mainly at a distance. Although healing fre-
quently takes place in a personal encounter, we
wanted to study mainly distant healing. There-
fore, in the healing modalities used in this
study, the main healing practice was distant
healing, even though in some subgroups initial
encounters were allowed for. Our question
was: “Does distant healing as found in normal
practice with patients representative of those
seeking treatment from healers change pa-
tients’ quality of life substantially?” In this pa-
per we describe the most important findings.
METHOD
Via a publicity campaign in print media we
recruited patients suffering from chronic dis-
eases who knew from their physicians that
WIESENDANGER ET AL.
nothing much more could be done by conven-
tional treatment to alleviate their illness. The
disease had to be a clearly diagnosed entity, to
have been present for at least 1 year, and to be
resistant to medical treatment up to now. Pa-
tients had to agree to the procedures, be will-
ing to wait for 6 months for their treatment, and
had given written informed consent. Exclusion
criteria were psychiatric diagnoses and life-
threatening diseases. Patients sent in their med-
ical histories and diagnostic documents from
their general practitioners for eligibility screen-
ing and were subsequently randomly assigned
to either the waiting-list control group or the
treatment group. A list of all eligible patients
was sequentially numbered, and randomiza-
tion was done using a list of random numbers
split at the median. Patients with sequential
numbers below the median of the random
number list were allotted to treatment; those
above were allotted to waiting. Thus, all pa-
tients were completely randomized and allo-
cation was concealed. Furthermore, random-
ization was stratified according to country
(Germany and Switzerland). Patients who
dropped out of the study after randomization
were not just replaced by new patients, but
every new patient taken into the study was
again randomly assigned.
Patients randomly assigned to the treatment
group were distributed in a quasirandom fash-
ion into one of three treatment modalities,
which were meant to reflect different types of
distant healing:
• Anonymous distant healing (n 5 30), in
which patients did not know who was treat-
ing them and when and were treated simul-
taneously by three to four healers who did
not have contact with the patients
• Amulet distant healing (n 5 10), in which
patients were given an amulet “laden with
healing energy,” which had to be worn at
night, by one healer who specialized in this
technique (patients knew the healer but did
otherwise not have contact)
• Contact distant healing (n 5 20), in which pa-
tients knew who was treating them and were
able to make telephone contact or see the
healer if necessary, but personal contacts were
restricted to an initial meeting and the main
part of the healing took place at a distance.
SPIRITUAL HEALING
These three modalities are representative of
important types of distant healing used in
practice. Contact and noncontact distant heal-
ing practices were represented in equal pro-
portion. Altogether, 50 healers from seven Eu-
ropean countries—most from Germany and
Switzerland, but also from Italy, Luxembourg,
France, Spain, and the United Kingdom—vol-
unteered to participate, answering campaigns
in national healer newsletters. They were all in
contact with some national healer communities
and in this study practiced the type of healing
they would normally use for distant healing.
Distant healing sessions lasted 23 minutes on
average, with a range of 5 minutes to 2 hours.
Seventy percent of the participating healers
thought that distant healing was equally effec-
tive as direct healing, 13% thought distant heal-
ing was even more effective, and 17% pre-
sumed distant healing to be less effective than
direct healing.
Patients in the contact group were treated by
a single healer, as were those in the amulet
group; patients in the anonymous group were
treated by four to six healers simultaneously.
For the anonymous and contact groups, treat-
ment consisted of two weekly healing sessions
over the course of 5 months; it was at the heal-
ers’ disposition to decide about the length and
the techniques. In the contact group, the pa-
tients additionally knew their healer, and had,
on average, four personal contacts, with one
third of the patients not making use of this pos-
sibility. Patients in the amulet group were to
wear the amulet on the body as much as pos-
sible and from time to time to focus their at-
tention on the amulet.
Those patients who were randomly assigned
to the treatment group were seen at an initial
information meeting and instructed as to the
treatment modalities. They were either given
the name of the healer to contact, given their
amulet, or told that they would be treated
anonymously. They were then seen by a physi-
cian who ascertained eligibility. Patients were
asked to keep a weekly journal of their experi-
ences and to come back for the concluding visit
5 months later, when they were again seen by
a physician and filled out the final patient ques-
tionnaire. Patients allotted to the waiting-list
group were told that their first interview would
be in 5 months’ time and were sent the patient
47
questionnaire. Their healing treatment started
after the treated group was finished.
In a preformulated, dated, and signed pro-
tocol it was agreed that the main test should be
between all patients in the treatment group,
with subgroup analysis as exploratory, and
that the main outcome criterion was generic
health status or quality of life as measured by
the MOS-SF36 health survey with a single sum
score (Bullinger et al., 1995). Because patients
in this study were expected to have heteroge-
neous diseases and because we wanted a prac-
tically relevant measure of therapeutic success,
we opted for a sum score of all SF36 scales as
the main and single outcome criterion, which
is psychometrically sound, as an analysis of a
large data set collected by us has shown
(Walach and Güthlin, 2000). We agreed to use
the difference between post-treatment and pre-
treatment scores of the SF36 sum of all items as
the main outcome parameter and to test this
difference score between the group with one
single t test.
SF36 data, together with items asking for ex-
pectations and health locus-of-control items,
were filled in by the patients while waiting to
see the physician (patients of the treatment
group) or at home (waiting-list group). Patients
were encouraged not to change any medica-
tions or conventional treatments given to them
by their general practitioners during the study
without consulting with their doctor. After the
study all patients were sent a small question-
naire gathering information about other thera-
peutic actions during their trial.
We set the number of patients to be included
in the study at 60 per group. This study size
was able to detect an improvement in quality
of life in the treated group of half a standard
deviation superior to the control group (d 5
0.50) at a power of beta equal to 0.86 (Cohen,
1987), which is clinically relevant and statisti-
cally reasonable.
RESULTS
A detailed report in German is available
from the first author (Wiesendanger, 1999). Of
281 patients who applied, 120 were randomly
assigned, because resources within the study
were limited. From among patients fulfilling
48 WIESENDANGER ET AL.

TABLE 1. QUALITY OF LIFE, INITIAL VALUESa

Control
Group Treated Group All

Scale m sd m sd m sd
Physical functioning 64.15 28.99 51.77 34.24 57.91 32.22
Role functioning, physical 36.59 36.62 32.65 41.24 34.61 38.90
Role functioning, emotional 54.23 43.72 41.36 42.24 47.75 43.28
Social functioning 50.21 29.22 56.46 26.79 53.36 28.08
Bodily pain 52.92 29.42 45.34 26.49 49.10 28.12
Mental health 51.20 19.25 51.22 18.03 51.21 18.56
Vitality 36.21 19.55 37.66 18.82 36.94 19.12
General health perception 41.90 21.41 42.75 20.86 42.33 21.05
Sum score of all items (not transformed) 88.65 18.17 85.84 17.87 87.23 18.00
a
SF36 scales and sum score (main outcome parameter), mean (m) and standard deviations (sd) for the groups and
the whole sample; 0 5 lowest possible score; 100 5 highest possible score (except sum score); multivariate difference
between groups nonsignificant.

inclusion criteria, those patients were chosen
whose illnesses were comparatively more se-
vere and chronic. Among the randomized pa-
tients, nine withdrew their consent shortly be-
fore or after randomization; these patients were
replaced by newly randomized ones. One pa-
tient in the waiting-list group dropped out
rather late and never handed in any data.
Therefore, the final study size was 119, with 60
patients in the treated group and 59 in the con-
trol group. Two patients in the treated group
and three in the control group gave insufficient
data. These patients were evaluated according
to intention-to-treat. Missing data at the first
measurement were interpolated by grand-
mean estimations; missing data at the second
measurement were interpolated with data from
the first measurement. Patients had a mean age
of 44.6 years, 68% were female, 22% had higher
education (A-level with or without a university
degree), 51% were married, 60% were living to-
gether with a partner, 83% were religious, and
60% were regularly or at least sometimes prac-
ticing their religion. Patients were very open
toward spiritual healing (mean of 4.33 on a 5-
point Likert scale), were confident (4.45), and
were faithful (4.35). They rated the chance of
being substantially helped at 63%. Patients suf-
fered from a variety of diseases such as com-
plicated migraines and headaches (35 patients),
inflammatory bowel diseases (3), pain syn-
dromes (29), psoriasis (8), and congenital
anomalies (4), to name only the larger cate-
gories. The mean duration of illness was 11
years, with a range of 1 to 37 years.
Randomization resulted in roughly compa-
rable groups. Although there was a slight dif-
ference between groups in some scales (Table
1), this difference was not significant in a
multivariate analysis of variance (Wilks’
Lambda1/110 5 0.882; p 5 0.077). Quality-of-
life data are presented in Tables 1 and 2. Posi-
tive difference scores indicated improvement.
The treated group experienced improvement
on all scales. In some the improvement was
substantial (emotional role-functioning, pain,
mental health) whereas the control group re-
ported either only slight improvements or ag-
gravations. The main outcome criterion, which
was defined as such a priori in a protocol, the
pretreatment-posttreatment difference of the
sum of all SF36 items, showed an improvement
of 10.18 in the treated group, while the control
group stayed virtually the same. This differ-
ence was highly significant (t 5 2 3.61; df 117;
p 5 0.00045). There was no statistically signifi-
cant difference among the treatment modalities
(anonymous, amulet, and contact distant heal-
ing), although patients of the contact group
showed the greatest improvement (12 points
difference), patients in the amulet group
medium improvement (10 points), and the
anonymous group the least improvement (8
points). The effect size of the difference be-
tween treated and untreated groups was d 5
0.66 standard deviations.
We tried to explain some of the variance by
regressing theoretically interesting expectancy
and attribution variables on the outcome crite-
rion. In order to avoid capitalization of chance,
SPIRITUAL HEALING 49

TABLE 2. QUALITY OF LIFE, DIFFERENCE A FTER 5 MONTHS OF TREATMENT a

Control Group Treated Group Difference
(C) (T) (T-C)

Scale m sd m sd m

Physical functioning 22.20 20.92 8.98 18.47 11.18

Role functioning, physical 23.97 29.30 8.60 40.82 12.57
Role functioning, emotional 2.82 30.51 25.31 46.70 22.49
Social functioning 2.12 23.35 5.00 31.49 2.88
Bodily pain 24.50 25.23 10.28 25.74 14.78
Mental health 1.75 14.98 9.89 20.90 8.14
Vitality 2.03 15.26 9.51 20.96 7.48
General health perception 20.29 17.93 7.38 17.11 7.67
Sum score of all items (not transformed) 20.01 14.47 10.18 16.22 10.19*
a
Post-treatment minus pretreatment score for control (C) and treated (T) groups; mean value (m) and standard de-
viations (sd); negative values indicate aggravation, positive values indicate improvement; SF 36 single scales and sum
of items (main outcome parameter); *, p 5 0.00045 by t test.

we first inspected first-order correlations of de-
scriptive variables with the outcome criterion
and used only theoretically interesting ones.
For the treated group, this yielded a significant
multiple regression coefficient of an adjusted
R2 5 0.22 (F 5 6.08; p , 0.002) with two vari-
ables: “expectation of improvement” (beta 5
0.32) and “others have an influence on my ill-
ness” (beta 5 20.27). That is to say, the higher
the expectation of improvement and the less
others were believed to influence the disease,
the more improvement could be seen. Regres-
sion coefficients and the regression equation
were significant, with 22% variance explained.
Other therapeutic activities during the trial
(e.g., changing the general practitioner, starting
psychotherapy, spa treatment) were not differ-
ent between the groups.
DISCUSSION
This nonblinded, randomized, waiting-list
controlled study of distant healing showed that
patients suffering from various types of chronic
diseases can experience a statistically signifi-
cant and clinically relevant improvement in
quality of life as measured by the SF36 ques-
tionnaire after a 5-month treatment period with
distant healing. A few words of comment are
appropriate.
First, we tried to assess distant healing as it
is practiced normally. Therefore, we did not in-
corporate blinding procedures, because treat-
ment in practice is done openly. Patients knew
when they were treated or not treated. This is
exactly what happens in practice: People who
are willing to be treated by healing and who
think or know that they have not much to ex-
pect from the medical system any more seek
out this form of treatment. We have not tested
any theoretical components of distant healing
(such as the effectiveness of “healing energies,”
let alone any supernatural powers), but rather
the complex of expectancy, knowledge of be-
ing treated, and treatment. Our results suggest
that this combination is a powerful treatment
modality when seen against the background of
relatively severe and stable chronic diseases. It
is more powerful than spontaneous remissions
or the change of time, as controlled for by the
waiting group. The effect-size of d 5 0.66 stan-
dard deviations is comparable to the efficacy of
psychotherapy (which ranges from d 5 0.5 to
d 5 1.2) (Smith et al., 1980; Matt, Wittmann,
1985; Barker et al., 1998; Crits-Cristoph, 1992)
and can be considered clinically relevant.
Second, we do not and cannot make any
judgments about the specific or nonspecific na-
ture of these effects. We do not know whether
the effects were due solely to the expectations
of patients or also to some healing specifically
induced by the healers. There are two indica-
tions in our data that point to the first expla-
nation as the more likely one. The expectation
of being cured correlated positively with im-
provement—that is, the more people expect
healing to improve them, the more they im-
50
prove. Furthermore, there was a quasi dose-
response relationship between contact and
improvement, albeit not a significant one:
Patients, who had the possibility of contacting
the healer, and who knew the healer, experi-
enced more improvement than those receiving
either an amulet or anonymous distant healing,
although the differences were smaller than an-
ticipated. Therefore, it is likely that part of the
improvement was a result of expectancy ef-
fects, which probably make up a substantial
part of what is normally called placebo effects
(Kirsch, 1997). This hypothesis needs to be sub-
mitted to a further test in another trial with ap-
propriate controls. This could be achieved
without dummy interventions by conducting a
four-armed trial with two waiting and two
treated groups, one of each knowing about the
assignment, and one of each masked. There-
fore, without any other control or sham proce-
dure, just by having patients treated or waiting
but knowing or not knowing about the assign-
ment, specific effects could be disentangled
from nonspecific ones. This would be the next
step, which we are currently planning to do.
Third, we only assessed subjective reports
from patients as outcome criteria. This is stan-
dard procedure in many clinical trials (Staquet
et al., 1998). It would have been impractical
for this study to gather disease-specific infor-
mation because it had to be based on the vol-
unteer collaboration of medical doctors in
their free time. The information that was
gleaned by general practitioners at the final in-
terview substantiated the findings from pa-
tient data. Therefore we think it is valid in-
formation.
Four, only patients of the treated group were
seen by doctors. We did this to ascertain that
no patient in the treated group would suffer
from a life-threatening illness and to gain some
more information apart from patients’ self-
reports. One might argue that this in itself
could have been a treatment that explains the
difference between the groups. Theoretically
this is possible, but it is highly implausible, be-
cause patients were seen by a panel of com-
pletely different persons and furthermore had
a lot of experience with doctors checking and
diagnosing them. There is no reason to expect
that this check-up would have brought about
WIESENDANGER ET AL.
the changes that were missing after other oc-
casions.
Finally, the optimal trial of healing, in our
view, would test the effects of healing in both
a blind and an open setting, ideally in one sin-
gle randomized trial. This would enable re-
searchers to disentangle the nonspecific effects
brought about by expectancies and any specific
effects of healing. Measures of expectancy
should be introduced, because this is an im-
portant moderator.
We conclude from our data that chronically
ill patients whose medical condition is stable
and who have not much to expect from further
conventional treatment can experience a clini-
cally significant improvement in their quality
of life if they decide to have a healing treat-
ment. If patients are open to healing and have
a positive expectation, the addition of distant
healing to conventional treatment can be a
good way of improving patients’ quality of life.
We do not know at present whether this effect
is specific or nonspecific.
ACKNOWLEDGMENT
Harald Wiesendanger and Lucius Werth-
müller received limited financial funds for ad-
ministrative expenses from “Messe Basel.”
Harlad Walach is funded by the Institut für
Grenzgebiete der Psychologie, Freiburg, Ger-
many. There was no other private, commercial
or public funding involved. We are grateful to
all healers and doctors involved in the study,
who gave their time for free, and to the patients
who collaborated.
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Address reprint requests to:
Harald Walach, Ph.D.
University Hospital Freiburg
Institute of Environmental Medicine and
Hospital Epidemiology
Hugstetterstraße 55
D79106, Freiburg
Germany
E-mail: walach@ukl.uni-freiberg.de