Effects of The Laying On of Hands On Anxiety, Stress and Autonomic Response of Employees in A Hospital - A Double-Blind Randomized Controlled Trial

Journal Pre-proof
Effects of the laying on of hands on anxiety, stress and autonomic

response of employees of hospital A double-blind randomized controlled
trial
Élida Mara Carneiro, Livia Figueira Avezum Oliveira, Djalma

Alexandre Alves da Silva, Jéssica Beatriz Ferreira Sousa, Rodolfo
Pessato Timóteo, OctávioBarbosa Neto, Adriana de Paula Silva,
Virmondes Rodrigues Junior, Luiz Antônio Pertili Rodrigues de
Resende, Maria de Fátima Borges
PII: S0965-2299(20)30681-6
DOI: https://doi.org/10.1016/j.ctim.2020.102475
Reference: YCTIM 102475
To appear in: Complementary Therapies in Medicine
Received Date: 27 March 2020

Revised Date: 13 May 2020
Accepted Date: 8 June 2020
Please cite this article as: Carneiro ÉM, Oliveira LFA, Silva DAAd, Sousa JBF, Timóteo RP,
Neto O, de Paula Silva A, Junior VR, de Resende LAPR, de Fátima Borges M, Effects of the
laying on of hands on anxiety, stress and autonomic response of employees of hospital A
double-blind randomized controlled trial, Complementary Therapies in Medicine (2020),
doi: https://doi.org/10.1016/j.ctim.2020.102475
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Effects of the laying on of hands on anxiety, stress and autonomic response of employees of
hospital A double-blind randomized controlled trial
Élida Mara Carneiroa,b,c,1, Livia Figueira Avezum Oliveiraa,b, Djalma Alexandre Alves da Silvab,
Jéssica Beatriz Ferreira Sousab, Rodolfo Pessato Timóteob, Octávio Barbosa Netob, Adriana de Paula
Silvaa,b,c, Virmondes Rodrigues Juniorb, Luiz Antônio Pertili Rodrigues de Resendeb, Maria de Fátima
Borgesa,b,c
a
Integrative and Complementary Practices Center – NUPIC, Clinics Hospital, Uberaba, MG, Brazil.
b
Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.
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c
Medical Spiritist Association of Uberaba (AMEUBE), Uberaba, MG, Brazil.
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1. Corresponding author at:
 Author’s name: Élida Mara Carneiro: PhD in Health Sciences.

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 Postal address: 141, José Pimenta Camargo Street, Uberaba, Minas Gerais, Brazil.
 Phone number: +5534997735988.

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 Email address: elidamc16@gmail.com
Research approved by the Ethics Committee in Research of the Federal University of Triângulo
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Mineiro (UFTM), under n. 1.144.646 (CAAE: 44891115.8.0000.5154) and all the participants signed
the Free and Clarified Consent Term. This study is part of the Evaluation of the Effects of
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Complementary Spiritist Therapy on Servers and Patients. Trial registration: ClinicalTrials.gov
Identifier NCT03356691.
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 Total words of the abstract: 218
 Total tables: 2
 Total figures: 3
 Number of references: 45
Highlights
 Laying on of hands with a Spiritual connection by Spiritist “passe” treatment showed positive
effects on employees with stress/anxiety.
 5-min of laying on of hands with a Spiritual connection by Spiritist “passe” appears produce
cardiac autonomic modulation with greater parasympathetic activity.
 5-min of laying on of hands with a Spiritual connection may promote regulation of immune
responses.
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 As a quick-to-use, non-invasive technique and at no cost, laying on of hands with a Spiritual
connection by Spiritist “passe” can be a promising complementary therapeutic approach, but
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more studies are needed.
Abstract
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Mental and behavioral disorders are responsible for intense suffering, absenteeism and abandonment
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of work. The objective of this study was to evaluate the anxiety, stress, depression, negative and
positive affects, and hematological and autonomic responses of employees of a public hospital
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exposed to laying on of hands with (LHS) or without Spiritual connection (control-LHW).
Methodology
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Eighty-four employees with anxiety/stress were enrolled and randomly allocated into two groups of
intervention LHS by Spiritist “passe” and control-LHW by volunteers with healing intent. Anxiety,
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stress and depression were evaluated by Depression Anxiety and Stress Scale (DASS21). Negative
and positive affects by Subjective Well-being Scale (SWS), cardiac autonomic modulation by heart
rate variability and cytokines and blood count were assessed by blood sample.
Results
Our study showed a significant improvement in the neutrophils (p = 0.041; d = 0.70) and cardiac
parasympathetic activity, and reduction in VLF (p < 0.005) in the LHS. There was reduction in
erythrocyte parameters and interleukin 10 (p < 0.005) in the control-LHW. In both groups there was
a significant reduction in anxiety, stress, depression and negative affects after one session (p < 0.005).
Conclusion
Laying on of hands with Spiritual connection by Spiritist “passe” appears to be effective in increasing
cardiac vagal activity and regulation of immune responses of employees of a public hospital with
stress/anxiety.
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Keywords: Spiritual healing; Energy therapies; Complementary therapies; Anxiety; Stress
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1. Introduction
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The emotional, mental and physical wear and tear generated by work can produce
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discouragement, emotional hypersensitivity and irritability that can lead to the development of
anxiety, stress and depression. These problems related to mental health also cause depersonalization
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and inertia, leading to a decrease in productivity, performance and worker satisfaction.1,2
Mental and behavioral disorders represent the third-most common grounds for claiming
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sickness benefits3 in Brazil, and result in increased absenteeism and abandonment of work. They
cause intense suffering and hamper individuals’ daily activities, impairing physical and social
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functions. Thus, they increase public spending. and become a public health problem.4
In Brazil, one commonly used energy therapy involving the laying on of hands is Spiritist
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‘passe’, which has been used in clinical situations, especially with people with depression and anxiety.
This complementary and integrative practice involves exchanging energies derived from a Spiritist
healer bearing a connection to good Spirits.5 The use of such therapies has been recognised and
encouraged by the Ministry of Health.6,7
Several studies have demonstrated the effects of Spiritist ‘passe’ on the health of diverse
populations, including reducing muscle tension8-10 and anxiety8-11, increasing immune response12,
preventing elevation of salivary cortisol concentrations13, and increasing feelings of wellbeing.8-10 As
there is consistent evidence of high levels of mental illness among health workers, particularly nursing
staff, it is important to evaluate the effects of this mode of therapy on the health of this population.14,15
The current study posited the conceptual hypothesis that the laying on of hands with Spiritual
connection in Spiritist ‘passe’ (LHS) will result in greater reductions in anxiety, stress, depression,
and negative affects, and greater improvements in positive affects, and autonomic and hematologic
response, than for participants receiving laying on of hands without Spiritual connection (control-
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LWS). The study’s operative hypothesis posited that, as compared with those receiving control-LWS,
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employees receiving LHS will show lower anxiety, stress, and depression scores on the Depression
Anxiety and Stress Scale (DASS21); lower negative affect and greater perception of positive affect
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on the Subjective Well-being Scale (SWS); and better cardiac autonomic response measured by Heart
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Rate Variability (HRV) and blood tests post-treatment.The primary objective of the study was to
evaluate the effects of LHS and control-LWS on stress, anxiety, and cardiac autonomic modulation
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of employees of a public hospital. The secondary objective was to investigate their effects on
depression, positive and negative affects, and hematologic response.

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2. Methods
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2.1. Study design and Participants

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A two-arm, double-blinded, randomised controlled trial was conducted between 2016-2019 in the
Clinics Hospital of the Federal University of Triângulo Mineiro (CH-UFTM). To ensure double-
blinding, the study participants and the professionals responsible for the evaluations and analyses
were not informed of the group to which each participant was assigned. Moreover, the Spiritist and
non-Spiritist healers were chosen from similar age groups, dressed similarly, and were trained to carry
out the same sequences of techniques. Eligibility criteria for participants included consent for
participation; age between 18-64 years; mild to severe levels of stress or anxiety; and employment at
the CH/UFTM (health and administrative professionals). Subjects were not included if they were
away from work or on vacation, refused to provide informed consent, or were receiving other types
of energy therapy during the study period. The sample size was calculated based on the Spiritist
‘passe’ study by De Souza Cavalcante et al.11 A minimum sample of 54 participants was required for
a significance level (alpha) of 0.05 and test power (beta) of 0.80; proportion of anxiety reduction of
37% in the control group and in the treatment of 82.6%. Considering a 25% increase in losses, the
total sample size was calculated as 68 employees. Based on inclusion and loss criteria, the final
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sample was composed of 84 participants allocated between the intervention group involving Spiritist
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‘passe’ (LHS) (n = 42) and the control group (control-LWS) (n= 42). Employees of the hospital were
first interviewed and their fit with the inclusion criteria was assessed. Those found eligible were asked
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to provide written informed consent. In total, 91 participants were conveniently recruited to the study.
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Subsequently, the sample was reduced to 84 participants, randomly allocated to the control-LWS or
Spiritist ‘passe’ groups through a randomisation ratio of 1:1. The allocation was made using a
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computer program by a researcher who did not participate in data collection.

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2.2. Experimental procedures
Participants responses to questionnaires and blood samples were collected at baseline (one day before
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treatment), and on Day 1 after the treatment. For the LHS group,8-13 Spiritist healers applied a
longitudinal technique: they moved their hands in a longitudinal direction, starting at the top of the
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participant’s head and slowly sliding their hands along the body for 2.5 minutes. This was followed
by the laying on of hands over participants’ head and chest, at a distance of approximately 10-15 cm
for a further 2.5 minutes. For those in the control group, volunteers from the hospital were trained to
perform the same sequence of techniques for the same duration as the LHS group. These actions were
performed with the intention of healing, but without Spiritual connection. Participants were
instructed to abstain for at least 24 h prior to the visit from the use of stimulants (e.g. cafeine, tobacco,
alcoholic beverages, high-fatty food) and medicines, as well as physical activity.not to use alcohol,
coffee and cigarettes. The HRV was performed in baseline condition (supine position) in a quiet room
at ambient temperature (21-–25 °C) in the morning, between 08.00 and 12.00 hours, and in the
afternoon, between 14:00 and 17:00 hours, at CH/UFTM, after a minimum period of two hours after
the last meal. The participants were first placed in a supine position—relaxed, in silence, without
moving, and breathing normally—for a period of 10 minutes. After this, blood pressure, heart rate
(HR), and peripheral oxygen saturation (SpO2) were measured. Electrodes were installed in position
CM5 (in the manubrium and V5 position) and readings were record using a Datagraph Model 76102-
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B polygraph (Lafayette Inst. Co, Lafayette, USA) connected to a microcomputer via an analogue-to-
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digital converter A/D-DI-194, starter Kit (Dataq Instruments, Akron, USA), with a sampling
frequency of 240Hz. This was for automatic on-line acquisition and archiving of the ECG and
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calculation of series of intervals between the R waves of the electrocardiogram (RR), beat by beat.
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Then, the electrocardiogram was continuously recorded for a period of 5 minutes (rest) and during
interventions for 5 minutes, with direct observation of the tracing. Immediately after the end of the
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HRV record, the measurements of the physiological parameters (blood pressure, HR and SpO2) were
repeated. All participants were given the verbal command, ‘Direct your thoughts upon the desire for
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healing’. They kept their eyes closed or were blindfolded during interventions. In both groups,
interventions were applied without touching the participants in a single 5-minute session. The time
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was controlled by the researcher, who signalled the end of each interval with taps on the shoulders of
the Spiritist healers or volunteers. The Spiritist healers had over two years of experience in applying
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Spiritist ‘passe’, subsequent to formal training, and belonged to the Association of Volunteers or
Spiritist Chaplaincy of CH/UFTM. They prepared for each session through prayer requesting the
presence of good Spirits. In the control-LWS, members of the Volunteers' Association or health
professionals of the CH/UFTM who did not practice Spiritist ‘passe’ or other biofield therapies were
recruited. They were trained to perform techniques while wishing good health upon the participants,
i.e. with the intention of healing (compassionate mental act directed at a person's health and well-
being),16,17 without prior prayer and evocation of good Spirits (laying on of hands without Spiritual
connection therapy). All therapy providers were older than 18 years.
2.3. Instruments and data collection
Clinical outcome measures were collected via questionnaires at baseline and on Day 1 of
follow-up. The data on age, gender, race/color, marital status, education, individual wage, religion
affiliation and religiosity (Duke University Religion Index – Durel) were collected at baseline.
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2.3.1. Primary outcomes
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The DASS was developed by Lovibond and Lovibond,18 and adapted to Portuguese and
validated by Vignola and Tucci.19 In its reduced version of 21 items (DASS21), this instrument is
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excellent for assessing symptoms of depression, anxiety, and stress. A self-report measure, it contains
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3 subscales related to stress, anxiety, and depression, each containing 7 items. Responses are recorded
on a 3-point Likert scale. The results are obtained by adding together the item scores of each subscale
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and multiplying the totals by 2. This scale has been used in previous studies related to energy
medicine.20,21 To assess the cardiac autonomic modulation and explore the sympathetic and
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parasympathetic activities of the autonomic nervous system (ANS) was used for Heart Rate
Variability (HRV) exam. The computerized analysis of variability of the intervals between waves RR
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in the time domains was performed temporal analysis: SDNN - standard deviation of RR intervals
(describes a median of the variabilty. It consists of parts from sympathetic and parasympathetic
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nervous system (sympathetic predominance). The SDNN can be described as an overall variability
or total power. You can describe it to the patient as the total power of the regulation system. RMSSD
- root-mean-square of the successive normal heartbeats RR interval difference (considered the most
precise marker for the parasympathetic effector on the heart), and pNN50 - percent of normal RR
intervals of the ECG whose difference exceeds 50ms, meaning this is, number of times an hour in
which the change in successive normal sinus RR intervals transcend 50 ms (represent parasympathetic
activity and it has a correlation with component of high frequency by spectral analysis). In the
frequency domain was performed analysis calculated by the spectral densities in: VLF - very low
frequency band (0 to 0.04Hz), component, index without well-established physiological explanation;
LF - low frequency band (0.04 to 0.15Hz), reflects the joint action of the parasympathetic and
sympathetic components on the heart, with a predominance of sympathetic; HF - high frequency band
(0.15 to 0.4Hz) and corresponds to respiratory modulation, considered an indicator of the vagus nerve
acting on the heart; LF/HF - relation of LF/HF components (reflects the sympatho-vagal balance of
the heart); SD1ms - standard deviation of points perpendicular of the identity line, reflects beat-to-
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beat changes in HR, correlates with RMSSD and is considered an index of parasympathetic activity;
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and SD2ms - standard deviation along the identity line, reflects the HRV in the long-term record.22-
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2.3.2. Secondary outcomes
Negative and positive affects were examined using the SWS at baseline (on the day before
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treatment) and on Day 1 after treatment. This scale, constructed by Albuquerque and Tróccoli
(2004),25 assesses what people think and feel about their lives, either as a whole or in terms of specific
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aspects such as health, leisure or work conditions, and affective components. Components involve
satisfaction with life, positive or pleasant affection, and negative or unpleasant affection. In the
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current study, we used the evaluations of both positive and negative affects.
To evaluate haematological parameters, blood counts and blood cytokine levels were
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analyzed. The complete blood counts were performed with the help of the automated cytometer XP-
2000i SYSMEX. The parameters evaluated were total erythrocytes, hemoglobin, hematocrit,
platelets, total leukocytes and leukocyte differential (neutrophils, lymphocytes, eosinophils and
monocytes).
In addition, the innate immune responses of the cytokines interleukin 1 beta (IL-1β) and
interleukin 6 (IL-6) were evaluated. Further, the tumour necrosis factor alpha (TNF-α) and the
interleukin 10 (IL-10) cytokine were evaluated to measure adaptive immunity and obtain a regulatory
profile of immunity respectively. Subjects’ blood was collected and immediately centrifuged at
5,000rpm, the supernatant aspirated, and packed in sterile 1.5 ml plastic tubes stored at -70°C. The
cytokines TNF-α, IL-6, IL-1β and IL-10 (BD PHARMINGEN-USA) of the plasma were quantified
using the ELISA method. High-affinity 96-well plates (NUNC-DENMARK) were sensitised with
specific monoclonal antibodies for each cytokine, with 100µL per well, at a concentration of 1mg/mL
of the sensitisation buffer (pH 9.5), and then incubated overnight at 4ºC. The contents were discarded,
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and the plates blocked with phosphate buffered saline (PBS) containing 2% bovine albumin (SIGMA-
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USA), with 200µL per well, for 4 hours at room temperature. Subsequently, the PBS bovine serum
albumin (PBS-BSA) was discarded and samples were added to rows 1 to 10 and diluted at a ratio of
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1:2 in 1% PBS-BSA with a final volume of 200µL per well. In rows 11 and 12, recombinant cytokines
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were diluted at a serial dilution ratio of 1:2, in 1% PBS-BSA, with a final volume of 100µL,
maintaining the initial concentration recommended by the manufacturer of each recombinant

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cytokine. Wells H11 and H12 were used as WHITE, adding only 100 µL of 1% PBS-BSA. The plates
were incubated overnight at 4° C. Afterwards, they were washed with a PBS solution containing
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0.05% tween (SIGMA-USA), and the specific disclosure antibody for each cytokine, obtained from
the same manufacturers, was conjugated with biotin and added at a concentration of 1mg/mL to 1%
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PBS-BSA, with 80µL per well. After incubation for 4 hours at 37ºC, the plates were again washed
with 0.05% PBS tween, adding 100µL per well of streptoavidin conjugated to peroxidase, and
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incubating for a further 3 hours at 37ºC. Finally, the plates were again washed in 0.05% PBS tween,
and the development buffer containing OPD (SIGMA-USA), at 100µL per well, was added and
reacted in the dark at room temperature. The results were obtained from the absorbance measurement,
at 450nm wavelength, by an automatic ELISA reader (BIORAD 2550 READER EIA). The
concentration of cytokines was determined from linear regression with the absorbances obtained on
the curve of the recombinant cytokine and expressed in pg/mL. Finally, 100 µl/well of streptoavidin
labelled with alkaline phosphatase and diluted in the ratio of 1: 1000 in 1% PBS-BSA, was added.
These plates were incubated for 1 hour and washed 6 times with PBS tween, after which 100 µl/well
of dinitrophenyl phosphate substrate (DNP) were added. The results were determined by the
difference between the absorbances obtained at 405 and 490 nm (Abs405 - Abs 409), measured in an
automatic ELISA reader. The concentration of cytokines in the serum was determined by comparison
with the absorbances obtained in a standard curve of the respective recombinant cytokine performed
simultaneously and expressed in pg/ml. The evaluations of the physiologic parameters occurred
before and immediately after the interventions. The measurements of the physiological parameters,
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HR and SpO2, were carried out using the portable Rossmax SB220 Fingertip Pulse Oximeter
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(Rossmax InnoTec Corporation, Taipei, Taiwan) attached to the index finger of the left upper limb.
Pulse oximetry is used to verify peripheral oxygen saturation, a measure of oxygen impregnated in
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the blood. It is a non-invasive examination that uses the oximeter as an oxygenation detection
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instrument due to its practical character and the possibility of using it at the bedside, thus allowing its
use together with clinical evaluation.26 Systolic (SBP) and diastolic (DBP) blood pressures were
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measured using the automatic BPA 100 Microlife device.
The number of adverse events experienced by each participant and the total number of overall
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events were noted for each treatment group.

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2.4. Ethical considerations
The study was approved by the Ethics Committee of the Federal University of Triângulo
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Mineiro, Uberaba, Brazil, protocol no. 1.144.646 (CAAE: 44891115.8.0000.5154). This study is part
of the larger study entitled Evaluation of the Effects of Complementary Spiritist Therapy on Servers
and Patients. Trial registration: ClinicalTrials.gov Identifier NCT03356691. All the participants
signed the term of free and informed consent.
2.5. Statistical analysis
Baseline characteristics were summarized using either medians, percentiles, means, standard
deviation, frequencies or percentages as appropriate. Normal distribution of the data was checked
through the Kolmogorov-Smirnov test. The association between categorical variables was studied
using Chi-square (X2) or Fisher's exact tests. Between-group comparisons of outcomes were made
using the Mann-Whitney or t-Student tests. Within each group comparisons respecting the variations
of primary and secondary outcomes across baseline and after treatment were made using the
Wilcoxon or t-Student tests. The effect size was considered small (0.20 or 0,30), medium (0.50) or
large (> 80).27 The analysis performed was by intention to treat. Differences were considered to be
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statistically significant when p < 0.05.
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3. Results
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3.1. Characteristics of the participants
The baseline data were summarised according to the groups. Of the 91 participants enrolled
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in this study, 84 were randomized (Fig. 1).
[Insert Figure 1]
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DASS21, depression anxiety and stress scale version with 21 items; Control-LHW group, laying on of hands without
connection Spiritual group; LHS group, laying on of hands with connection Spiritual group; LHW, laying on of hands
without connection Spiritual; SP, Spiritist “passe”; HRV, heart rate variability.
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Fig. 1. Flow diagram showing the process of study.
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Most participants were women (87%); 57.1% declared themselves non-white; 50% were
married; 56% had an income above 3 minimum wages and 57.1% had a degree. Age mean in the
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Control-LHW and the LHS groups was 36.71 ± 10.77 and 40.07 ± 9.32, respectively. Body mass
indess in these groups was 25.61 ± 5.04 and 25.08 ± 4.17, respectively. Only 4.8% of employees
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smoke, 25% use alcoholic beverages and 19,6% do physical exercises. There were no significant
differences between these groups respecting participants’ age, body mass index, gender, marital
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status, educational level, religion affiliation, religiosity, smoking and use alcoholic beverages history,
and physical activity (p > 0.05; Table 1).
[Insert Table 1]
Table 1
Between-group comparisons respecting participants’ characteristics.
Group
Control-LHWa LHSa
Characteristics Category P value
% %
Gender Male 16.3 9.8 0.288b
Female 83.7 90.2
Marital status Single 41.9 26.8
Married/In union 48.8 51.2 0.268c
Separated/ 2.3 9.8

Divorced
Widow/ 7 12.2
Widower
Education level ≤12 years 35.7 50 0.135b
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>12 years 64.3 50
Catholic 46.5 40
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Religious Evangelical 0 5 0.487c
affiliation Spiritist 34.9 37.5
Umbanda 2.3 0
No religion
Over 2
Other or no reply 7.0
9.3
0
2.5
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a
LHS, laying on of hand with Spiritual connection therapy by Spiritist “passe”; control- LHW, laying on of hand
without Spiritual connection therapy.
b
The results of the Fisher's Exact test.
c
The results of the Chi-square test.
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Initially, the variables of stress, anxiety, depression, positive and negative affects,
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physiological and hematological parameters, and HRV were compared between the control-LHW
and LHS groups. No significant difference was found for all analyzes between groups at baseline (p
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> 0.05).
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3.2. Primary outcomes
The analysis of heart rate variability showed a significant increase in the variable of the RMSS
time domain (p = 0.023), and the HF (p = 0.033), HFms (p = 0.000) and SD1ms frequencies (p =
0.004), which are considered markers of the parasympathetic modulation response. Significant
reduction in VLF (p = 0.021) was seen only in the LHS group. In addition, there was a greater increase
in pNN50 scores in the intervention group than in the control group, without significant differences.
There were no significant differences between groups (p > 0.05; Fig. 2; Table 2). The increase in the
HF component gives us information on the modulation of the vagus nerve over the heart, thus
highlighting the parasympathetic tonus. These changes showed that the Spiritist “passe” can modulate
the cardiac autonomic response with significant increases in the modulation of parasympathetic tone
as compared to the moment without laying on hands (rest).
[Insert Fig. 2]
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Fig. 2. Analysis of the variables of Heart Rate Variability in the time domain: RMSSDms (A), square root of the mean of
the summed squares of successive differences between RR intervals; pNN50 (B), percent of NN intervals whose
difference exceeds 50ms; and SD1ms (C), standard deviation of points perpendicular to the identity line; and frequency
domain: VLF (A), very low frequency; HFms (B), high frequency expressed in ms; and HF (C), high frequency. The
points illustrate individuals rest (black balls) and during (black squares) interventions of Control-LWH (laying on of hand
without spiritual connection therapy) group and black triangles in the LHS, laying on of hand with Spiritual connection
by Spiritist “passe” group. Lines represent median and interquartile range. *p < 0.05, Wilcoxon test.
After the intervention, stress, anxiety, depression and negative affect all showed a significant
reduction in both groups (p < 0.05, Wilcoxon test), but without significant differences between the
study groups. There were no changes in positive affect in either group, although an increase in scores
was observed only in the group exposed to Spiritist “passe” (Table 2).
Table 2
Values (absolute and interquartile) of the respective tests for HRV and mental/emotional parameters,
baseline (pretest) and after (posttest) intervention.
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Group
Control-LHWa p LHSa p
Variable
value value
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Pretest Posttest Pretest Posttest
Heart rate variability
iRRms
804.7
(722-871.3)
74.8
818.6
(715.4-911.2)
73.4
0.354
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(793.2-913.9)
71.4
852.5
(816.7-895.8)
70.4
0.097
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HR 0.396 0.099
(69.1-82) (65.9-84) (65.7-75.7) (67.4-73.6)
32 32.3 28.9 31.5
RMSSD 0.307 0.023b
(20.2-36.2) (21.7-41.5) (20.4-40.6) (22.8-45.6)
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8.2 11.9 4.9 10.2

PNN50 0.359 0.065
(1.7-14.3) (0.9-15.7) (1.8-19.1) (2.3-21.9)
407 356.3 541.4 414.7
VLFms 0.946 0.766
(211.2-607) (189.8-779) (272-777.4) (306.1-659.1)
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361.6 348.4 456.7 433.8

LFms 0.778 0.309
(175.8-686.2) (163.6-702.4) (189.3-814.6) (242.2-1174)
48.4 46.5 48.6 45.2
LFnu 0.493 0.572
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(33.8-54.6) (37.7-58.7) (32.2-63.1) (29.1-63.6)

342.8 458.5 409.5 495.4
HFms 0.412 0.000b
(174.9-607.2) (239.6-604.5) (168.6-768.9) (286.4-832.9)
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50.5 52.7 45.1 54.7

HFnu 0.737 0.229
(45.2-63.4) (41.3-61.6) (37.4-65.1) (34.6-66.4)
0.9 0.8 1.2 0.8
LFHF 0.563 0.360
(0.5-1.2) (0.6-1.4) (0.4-1.6) (0.4-1.8)
22.7 22.8 20.5 22.3
SD1ms 0.211 0.004b
(14.3-25.6) (15.4-29.4) (14.5-28.7) (16.1-32.3)
42.6 52.3 52.7 53.2
SD2ms 0.307 0.171
(37.9-63.2) (35.9-67.5) (39.2-65.5) (41.3-76.4)
Mental/emotional parameters
68.5 67 68.5 70
Positive affects 0.690 0.163
(55-77) (60-78) (53-78) (56.5-83)
51 42 59 38.5
Negative affects 0.000b 0.004b
(38-68) (29-53) (42-75.5) (33.5-61.5)
14 6 13 4
Stress 0.000b 0.000b
(6-20) (0-14) (6-22.5) (0-12)
5 2 7 1
Anxiety 0.002b 0.000b
(2-12) (0-4) (2-15) (0-7)
6 2 5 0.5
Depression 0.000b 0.001b
(2-16) (0-8) (2-12) (0-9)
Data are expressed a median (interquartile range).

a
Control-LWH, laying on of hand without Spiritual connection therapy; LHS, laying on of hand with Spiritual connection
therapy by Spiritist “passe”; iRR(ms), intervals between the R waves; HR, heart rate; RMSSD, Root-Mean of square
successive NN interval difference; PNN50, percent of NN intervals whose difference exceeds 50ms; VLFms, very low
frequency expressed in ms; VLF, very low frequency; LFms, low frequency expressed in ms; LF, low frequency
of
component; LFnu, low frequency component expressed in standard units; HFms, high frequency expressed in ms; HF,
high frequency component; HFnu, high frequency expressed in standard units; LFHF, LF/HF ratio; SD1ms, standard
deviation of points perpendicular of the identity line; SD2ms, standard deviation along the identity line.
b
ro
Statistical significance was set at P < 0.05, Wilcoxon test.
3.3. Secondary outcomes -p

Among the secondary outcomes, on Day 1 of follow up, there was a greater increase in the
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percentage of neutrophils (p = 0.041; Cohen d = 0.70) in the LHS group as compared to the control-
LWS group. A greater reduction in eosinophils was also observed between the baseline and after
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intervention (p = 0.024, t-Student) in the Spiritist ‘passe’ group. There were significant reductions in
total erythrocytes (p = 0.033; t-Student), haemoglobin (p = 0.033), and haematocrit (p = 0.014) in the
na
control group, although there were no significant differences between the groups (p > 0.05). With
regard to cytokines, there was a significantly greater reduction in IL-10 in the control group (p <0.05,
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Wilcoxon test). For the other variables, there no differences emerged after the intervention for both
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groups (Fig. 3).
650
520
390 * P re te s t
260
130
50 P o s tte s t
IL - 1 0
40
30
20
10
C o n t r o l- L H W LHS
Fig. 3. Graphic of the interleukin (IL-10) analysis. The points illustrate individuals baseline (balls) and after (squares)
interventions of Control-LWH (laying on of hand without Spiritual connection therapy) and LHS, laying on of hand with
Spiritual connection by Spiritist “passe” groups. *p < 0.05, Wilcoxon test.
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There were no reports of unwanted effects or adverse reactions by participants.
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4. Discussion
-p
Considering the main objective of the study to measure the effects of the laying on of hand
with Spiritual connection therapy by Spiritist “passe”, and without a Spiritual connection, in single
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session, on levels of anxiety, stress, depression, negative and positive affects, hematological and
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cardiac autonomic responses, and the study hypothesis, the main findings of this investigation were
that laying on of hand with Spiritual connection therapy can influence the cardiac autonomic control
stimulating the increase of vagal modulation acutely, increased concentration of neutrophils after 1
na
day, moderate effect size, and maintained the erythrocyte and IL-10 parameters within normal values.
Corroborating the findings in this study, a previous study with newborns, the laying on of hand with
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Spiritual connection by “passe” promoted reductions in respiratory rate and HR indicating a possible
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increase in cardiac parasympathetic activity.13 The ANS has an important homeostatic role28 through
the functional regulatory and integrating mechanism and its anatomical and functional divisions:
sympathetic and parasympathetic systems. Parasympathetic modulation is important for the control
of insulin secretion and neurotransmitters.29 A study shows that individuals with anxiety disorders
have reduced SDNN, rMSSD, pNN50, LF and HF indices,30 while depression, epilepsy, post-
traumatic disorders and chronic pain exemplify situations that present low parasympathetic tonus.31-
33
Hence, Spiritist ‘passe’ can be considered an effective therapy to improve these conditions.
In agreement with our findings, studies of other therapies such as yoga34 and 40-50-minute
massages with moderate pressure33 have been shown to induce relaxation, with increased activity of
the parasympathetic nervous system by vagal stimulation. However, the laying on of hands in Spiritist
‘passe’ is extremely quick, requiring only 5 minutes of application, and without contact with the
individual.35
Psychologically stressful experiences evoke changes in cardiovascular physiology and may
influence the risk of cardiovascular disease through neurophysiological pathways. A review study on
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cardiovascular reactivity generated by stressors and risk of cardiovascular disease indicates that the
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mechanism is related to the network of cortical, limbic and brainstem areas. Further, autonomic and
physiological control through visceromotor and viscerosensory mechanisms is of fundamental

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importance to the generation and regulation of cardiovascular reactivity evoked by stressors.36 In
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addition, autonomic changes are often found in altered mood states. and depression can cause various
physical disorders. It is currently considered the second leading cause of disability and its global
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burden has increased in recent years.37 Depressive symptoms lead to low cardiac vagal activity that
predispose the individual to the risk of cardiovascular disease.38 Changes in the ANS that promote
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vagal withdrawal are reflected in reductions in HRV indices. Consequently, reduced HRV
characterizes emotional dysregulation, decreased psychological flexibility and social commitment,

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which are linked to hypoactivity of the prefrontal cortex.37
In this study, stress, anxiety, depression and negative affects significantly reduced in both
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groups after approximately 24 hours of the laying on of hands for 5 minutes.These findings are
consistent with previous studies that point to beneficial mental health effects of the laying on of hands
with a Spiritual connection and without Spirituality.9-11 However, more significant reductions were
evidenced over the applications (3 to 8 sessions), when there existed a Spiritual connection in Spiritist
‘passe’, such as a greater decrease in anxiety9-11 and depression8, and minimised increase in the stress
hormone cortisol.13 Although, the laying on of hands with the intention of healing can also be used
to help a person in times of crisis, because it can reduce stress, anxiety, and depression.
In this study, we chose cytokines to assess whether the situations of stress, anxiety and
depression experienced by employees influenced the innate and adaptive immunity of these
individuals. We observed that there were no differences in the pro-inflammatory cytokines. However,
in the control group we observed a significant reduction in the production of IL-10, which is a
cytokine with a regulatory profile of immunity, and in the levels of erythrocytes and haemoglobin. In
the ‘passe’ group, a significant increase in neutrophils and maintenance of IL-10 levels and
erythrocyte parameters was observed. In this case, we can infer that stress, anxiety, and depression
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may be causing the decrease in individuals' red cells, and a reduction in the regulatory profile of
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immunity with the reduction of IL-10. In addition, in the Spiritist ‘passe’ group we inferred that there
was an improvement in the medullary production of red cells such as erythrocytes and neutrophils,
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which are inflammatory cells of innate immunity, but a maintenance of IL-10 levels, which allows
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greater regulation of immune responses in these participants. The literature shows that the Spiritist
‘passe’ can stimulate the production of blood cells to maintain the balance in cellular functioning,
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which can generate organic homeostasis and probably prevent the development of several diseases
such as anaemia, among others.12,15 The literature shows that the Spiritist “passe” can stimulate the
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production of blood cells maintaining the balance in cellular functioning, which can generate organic
homeostasis and probably prevent the development of several diseases such as anemia, among
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others.12,15 The Spiritist “passe”, considered a therapy for the emission of psychic and vital energies
that alters the cell field40 resulting from a combination of good fluids and energies derived from the
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Spiritist healers in union with good Spirits.41 This connection between the Spirit therapists and the
Spiritual dimension is what differentiates the Spiritist “passe” from other laying on of hand therapies.
The mechanism of action of Spiritist ‘passe’ is not known by science. One possible mechanism
may be a reduction in the tone of the sympathetic nervous system or an increase in the
parasympathetic. By stimulating a parasympathetic response, this therapy can promote the reduction
of anxiety, stress, and pain,42,15 which is consistent with a state of calm. It could also contribute several
specific benefits, such as increased immune system response.43 In recent decades, the influence of the
ANS on the immune system has been verified.44
No adverse effects were reported by any participants from the laying on of hands. These
results are consistent with others studies.8-13,15 Furthermore, this therapeutic approach has no
contraindications.35 In addition, it is usually quick and economically viable, as it is conducted by
volunteers for no cost because Spiritist healers minister this therapy as charitable action (altruism).10
In Spiritism, the Spiritist healers need a preparatory course and practical training; furthermore, they
must educate their thoughts and emotions, practice healthy behaviors and charity.
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Laying on of hands therapies have been recognized in Brazil by the Ministry of Health by
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Ordinance 702 of 2018.7 These therapeutic resources need meditative effort to transfer vital energy
through the hands in order to re-establish the balance of the human energy field.7 They are focused
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on stimulating the body's ability to heal itself through an energetic rebalancing that promotes the
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restoration and normalization of cell function, and, therefore, contribute balance to the physical
organism.35 Spiritist ‘passe’ is one of the most widely used therapies in Brazil and has been the subject
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of a doctoral thesis.42 This therapy has been applied in several institutions, including in hospitals, in
combination with conventional treatments, and has had significant impacts on patient health.46
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Among the strengths of the present study are the rigorous controlled random design and the
use of valid and reliable tools for assessing the cardiac and haematological autonomic response.
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However, this study has some limitations, including a single application and short follow-up. In
addition, this study was focused on employees with stress/anxiety and aged between 20 and 64 years.
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It is suggested that future work be carried out in different age groups and clinical situations of patients.
Future studies are recommended to evaluate the effects of the laying on of hands with a Spiritual
connection with long-term follow-up, to discover if the application of this therapy in a continuous
way may have a cardioprotective effect.
Conclusion
Laying on of hands with Spiritual connection in Spiritist “passe” appears to be effective in
increasing cardiac parasympathetic activity and regulation of immune responses.
The laying on of hands with or without Spiritual connection significantly reduced anxiety,
stress, depression, and negative affects of employees of a public hospital living with stress/anxiety.
Further studies with longer follow-up period are needed.
Contributions of the authors:
Élida Mara Carneiro contributed to the conception and planning of the study, data acquisition and
manuscript preparation and review; Livia Figueira Avezum Oliveira contributed to the data
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acquisition, critical review of the intellectual content, and final approval of the manuscript. Djalma
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Alexandre Alves da Silva and Virmondes Rodrigues Junior made substantial contributions in data
acquisition and analyzed and interpreted data, worked on critical review of the intellectual content,
-p
and final approval of the manuscript. Jéssica Beatriz Ferreira Sousa and Octávio Barbosa Neto
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contributed to data acquisition and intellectual content, Rodolfo Pessato Timóteo and Adriana de
Paula Silva contributed to analyzed and interpreted data, critical review of the intellectual content,
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and final approval of the manuscript. Luiz Antônio Pertili Rodrigues de Resende and Maria de Fátima
Borges contributed to the conception, critical review of the intellectual content, and final approval of
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the manuscript.
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Conflict of interest
Authors declare that there are no conflicts of interest related to the publication of this work.
Jo
Acknowledgement
To the volunteers for their effort to make this study possible.
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Effects of The Laying On of Hands On Anxiety, Stress and Autonomic Response of Employees in A Hospital - A Double-Blind Randomized Controlled Trial

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Effects of the laying on of hands on anxiety, stress and autonomic

Élida Mara Carneiro, Livia Figueira Avezum Oliveira, Djalma

To appear in: Complementary Therapies in Medicine

Received Date: 27 March 2020

© 2020 Published by Elsevier.

hospital A double-blind randomized controlled trial

 Author’s name: Élida Mara Carneiro: PhD in Health Sciences.

 Phone number: +5534997735988.

 Email address: elidamc16@gmail.com

Complementary Spiritist Therapy on Servers and Patients. Trial registration: ClinicalTrials.gov

 Total words of the abstract: 218

effects on employees with stress/anxiety.

cardiac autonomic modulation with greater parasympathetic activity.

connection by Spiritist “passe” can be a promising complementary therapeutic approach, but

exposed to laying on of hands with (LHS) or without Spiritual connection (control-LHW).

and inertia, leading to a decrease in productivity, performance and worker satisfaction.1,2

encouraged by the Ministry of Health.6,7

preventing elevation of salivary cortisol concentrations13, and increasing feelings of wellbeing.8-10 As

depression, positive and negative affects, and hematologic response.

2.1. Study design and Participants

computer program by a researcher who did not participate in data collection.

2.2. Experimental procedures

connection therapy). All therapy providers were older than 18 years.

2.3. Instruments and data collection

frequency band (0 to 0.04Hz), component, index without well-established physiological explanation;

maintaining the initial concentration recommended by the manufacturer of each recombinant

measured using the automatic BPA 100 Microlife device.

events were noted for each treatment group.

2.4. Ethical considerations

signed the term of free and informed consent.

in this study, 84 were randomized (Fig. 1).

and physical activity (p > 0.05; Table 1).

Marital status Single 41.9 26.8

Married/In union 48.8 51.2 0.268c

Separated/ 2.3 9.8

Education level ≤12 years 35.7 50 0.135b

3.2. Primary outcomes

as compared to the moment without laying on hands (rest).

baseline (pretest) and after (posttest) intervention.

Heart rate variability

8.2 11.9 4.9 10.2

361.6 348.4 456.7 433.8

(33.8-54.6) (37.7-58.7) (32.2-63.1) (29.1-63.6)

50.5 52.7 45.1 54.7

Data are expressed a median (interquartile range).

3.3. Secondary outcomes -p

groups (Fig. 3).

Psychologically stressful experiences evoke changes in cardiovascular physiology and may

physiological control through visceromotor and viscerosensory mechanisms is of fundamental

characterizes emotional dysregulation, decreased psychological flexibility and social commitment,

which are linked to hypoactivity of the prefrontal cortex.37

ANS on the immune system has been verified.44

contraindications.35 In addition, it is usually quick and economically viable, as it is conducted by

way may have a cardioprotective effect.

Laying on of hands with Spiritual connection in Spiritist “passe” appears to be effective in

increasing cardiac parasympathetic activity and regulation of immune responses.

Further studies with longer follow-up period are needed.

Contributions of the authors:

To the volunteers for their effort to make this study possible.

enfermagem: stress, coping e burnout. Sitientibus 2006; 34: 7-24.

trabalhadores de enfermagem em um hospital da Bahia. Revista Brasileira de Enfermagem 2014; 67:

3. Silva-Júnior JS, Fischer F. M. Afastamento do trabalho por transtornos mentais e estressores