Mind and body: Do music, imagery, touch, or prayer improve cardiac care?

Content provided by the Faculty of the Harvard Medical School

Mind and body: Do music, imagery, touch, or prayer improve cardiac care?

Even the most hard-nosed scientist is likely to agree that there is a strong connection between mind and body. The link between head and heart is particularly strong. Many studies have shown that stress, hostility, anger, depression, and social isolation increase the risk of heart disease and impair recovery from heart attacks. And although scientific proof is less secure, many clinicians have observed that patients who are optimistic, relaxed, and confident seem to come through illness and procedures better than those who are gloomy or anxious.

Hospitals can provide medications to help patients get through taxing tests and treatments, but can they also offer spiritual interventions that may help? It's an important question, but like many areas of alternative medicine, it has not been fully investigated. Two excellent American studies do not completely settle the question of the efficacy of spiritual interventions, but they do serve as models for rigorous scientific approaches to this complex issue.

The STEP study

To find out if prayer could assist recovery from coronary artery bypass graft (CABG) surgery, a team of scientists and pastors studied 1,800 patients at six U.S. medical centers. A third of the patients received intercessory prayer after being told that they might receive prayer; a third did not receive prayer; and a third received prayer after being told they would receive it. The prayers were performed by members of three Christian communities who were not in physical contact with the patients. The patients who received prayer were identified in the prayers by their first names and the first initial of their last names.

The prayers began the evening before each operation and continued for 14 consecutive days. Each person who offered prayer added the phrase, "for a successful surgery with a quick, healthy recovery and no complications" to their usual words.

The patients volunteered to be assigned randomly to one of the three groups, which were similar in age, gender, cardiac risk factors, severity of disease, and religious affiliations and beliefs.

The scientists monitored the patients for 30 days after each operation. A total of 1,201 patients did not know whether they had received prayers; 52% of the people who actually received prayers suffered surgical complications; 51% of the patients who did not receive prayers suffered complications. The final 601 patients knew they were receiving prayer; 59% suffered complications.

The researchers concluded that "intercessory prayer had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications." The scientists could not explain the higher complication rate, and they acknowledged that these results applied only to prayers delivered by strangers, not by relatives, friends, or patients with a strong personal faith.

The MANTRA II study

Researchers enrolled 748 cardiac patients in nine American medical centers in this trial. All the patients were evaluated and randomly assigned to one of four intervention groups before they underwent elective coronary catheterization and angiography with possible artery-opening procedures. All the patients were awake during their catheterizations. Some 563 of them required artery-opening interventions (revascularization).

The volunteers were randomly assigned to one of four groups:

• 192 patients received only standard medical care.

• 182 patients received standard care plus prayer. The prayers were delivered by established Christian, Jewish, Muslim, or Buddhist congregations at their houses of worship. Each congregation was given the name, age, and illness of the patient, but none of the patients or doctors knew which patients were being prayed for and which were not. The timing and content of the prayers were determined by each congregation according to its traditions.

• 185 patients received standard care plus music, imagery, and touch (MIT) therapy. The MIT interventions were performed by a trained practitioner at the patient's bedside before catheterization. The patients were instructed in relaxed abdominal breathing and were told to imagine the most beautiful or peaceful place they had ever experienced while listening to a soothing musical selection of their own choice. The practitioners then applied 21 "healing touch" hand positions for 45 seconds each. The single MIT session lasted 40 minutes; the patients were also allowed to listen to the same music during the cardiac catheterization.

• 189 patients received both prayer and MIT therapy.

Because the patients were randomly assigned, the members of each group had similar ages, genders, and risk factors. A similar percentage in each group had disease that warranted revascularization.

The researchers tracked each patient for six months after the catheterization. During the study period, there were no differences in the risk of major adverse cardiac events, including new heart attacks, new congestive heart failure, the need for new or additional coronary revascularization, readmission to hospital, or cardiac death.

Because these were the primary endpoints of the study, the investigators concluded that neither prayer nor MIT therapy was beneficial. But they also noted that while MIT therapy did not achieve any of the specified goals, patients who received it experienced a clear decrease in anxiety and emotional distress before the catheterization — and they were also 65% less likely to die during the subsequent six months. Distant prayer was not associated with any potential benefit.

The MANTRA II Study did not find any advantage for distant prayer, but it did not evaluate either bedside prayer or the act of praying by the patient. Some earlier studies have suggested various medical benefits from having strong religious beliefs or attending religious services. Even if these medical benefits are confirmed, scientists won't know if they result from the psychological strength of patients who are fortified by faith or from the emotional support of a caring community — or, for that matter, if compassionate prayers for the sick may actually be answered. Some 2,400 years ago, Hippocrates explained that "prayer indeed is good, but while calling on the gods, a man should himself lend a hand."

MIT therapy was also unsuccessful in improving the primary cardiac endpoints in the study, but it was associated with decreased emotional distress and possibly with improved survival. But since three interventions were used simultaneously, it's not clear which may be most useful. A "healing touch" has not been validated by rigorous scientific study, but caring human contact may certainly have positive, if nonspecific, effects on stress and anxiety. Deep breathing and imaging are common to meditation techniques that can lower blood pressure and slow the heart rate. Studies have shown a benefit of music in patients undergoing cataract surgery as well as in those recovering from heart attacks. And concertgoers seem to enjoy improved longevity similar to that of churchgoers. Interpersonal contacts and shared communal experiences may explain the apparent parallel benefits of religious services and cultural events. Or perhaps concertgoers have their own version of a religious experience as they take in what Shakespeare called "music from the spheres."

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Last updated:	December 01, 2006