Trusting touch

Exploring massage therapy’s role in mental health promotion
Marites Sison
April 11, 2017
By Marites Sison
For more than 16 years, registered massage therapist (RMT) Chris O’Connor worked with people going through various mental health issues, including post-traumatic stress disorder (PTSD) and eating disorders.

He says he has seen firsthand the benefits of massage therapy as part of a holistic, complementary approach to addressing mental health challenges.

People struggling with mental health problems often battle with anxiety and an inability to relax, says O’Connor, who has worked at the Homewood Health Centre, a mental health and addiction facility in Guelph, Ont. O’Connor now has a private practice, aside from being a public speaker and an educator. When patients at the facility received a massage therapy, he says, they often told him they felt very relaxed and that “it was the first time, in a long time, they had forgotten their problems.”

O’Connor’s first exposure to the value of massage therapy for mental health came while he was a student trying to fulfill a massage therapy school requirement for community service.

Volunteering at a mental health centre in Toronto, he was assigned to provide massage therapy to outpatients, most of whom had suffered physical and psychological abuse. “They had lived on the streets but they came in and started to trust what we were doing,” he says. “I didn’t see how profound it was at the time because I was… new to it all.”

But over time, he says, he realized what massage therapy had meant to these outpatients. RMTs had “literally welcomed patients with open arms and [gave] them therapeutic versus abusive touch they have suffered,” he says. It was like “having someone who actually cares, who actually steps up and doesn’t abuse you, doesn’t feel like you’re a burden to them.”  

Over the years, there have been studies assessing the effectiveness of massage therapy in easing mental health symptoms. Early this year, researchers at Beaumont Health System in Royal Oak, Mich., reported that inpatients at a progressive care unit who were given clinical massage or guided imagery to supplement traditional care noted “a significant reduction” in pain, anxiety, and sleep disorders.

For three months, 288 inpatients had been offered either a daily 15-minute complimentary clinical massage or a 30-minute guided image recording and asked to rate their pain and anxiety levels before and after the sessions.

“Patients in the progressive care unit typically experience high levels of pain and anxiety and exhibit difficulty sleeping,” explains the study, Beneficial Effects of Guided Imagery or Clinical Massage on the Status of Patients in a Progressive Care Unit, which was published in the February 2017 issue of the Critical Care Nurse journal.

In 2005, researchers from the University of Miami School of Medicine in Florida, and Duke University Medical School in North Carolina, gathered several studies conducted over the years that have documented the positive effects of massage therapy on biochemistry, including decreased levels of cortisol (“the primary stress hormone,” high levels of which can hamper one’s immune function) and increased levels of serotonin and dopamine – neurotransmitters that help regulate mood, emotions and other neurological processes.

Cortisol reduction following massage therapy was noted both “immediately following massage sessions and over the course of massage therapy treatment periods” in conditions ranging from job stress to depression and depression-related disorders and auto-immune conditions, note the researchers in the article, Cortisol Decreases and Serotonin and Dopamine Increase Following Massage Therapy, published by Taylor & Francis, a U.K.-based company that publishes books and academic journals. (Cortisol level was measured either in saliva or urine, and serotonin and dopamine, in urine.)

As more and more patients turn to complementary approaches and look beyond traditional medicine to help them deal with health issues, the question about whether massage therapy can be part of the mental health toolbox is increasingly being asked.

Pamela Fitch, a RMT and faculty member of the massage therapy program at Alqonquin College, notes that more and more, RMTs are being invited to participate in studies on mental health issues and in teams handling trauma issues. “One of the more significant findings in the meta-analysis of massage therapy and its benefits was in fact the degree [in which it] improves mood, reduces fatigues and reduces anxiety and depression,” she says when asked whether massage therapy can indeed help ease symptoms related to mental health issues.

She notes that RMTs often think of the therapy’s effect on their client’s bodies. “We look for outcomes or physiological determinants – lowering pain, improving and reducing adhesions.”

Clients, however, perceive their experience psychologically, she says. “‘Can I trust this person? Yes. Do I feel comfortable in this circumstance? Yes.’”

What a RMT invariably does is help patients “self-regulate,” Fitch says. “We encourage clients to feel comfortable in the treatment room, to be able to have choice about what happens in their care.”

Craig Currah, a recreationist and case worker at the Centre for Addiction and Mental Health (CAMH) in Toronto, says discussions about whether massage therapy can help manage mental health issues “should be prefaced with comparing and contrasting how we think about mental health versus mental illness.”

Everyone experiences mental health, “which can be affected by issues such as stress, anxiety, overall life satisfaction,” he says. “Wellness is an important contributor to mental health as it is to coping with issues around mental illness.”

Currah says that while medication “can address symptoms of the illness and promote stability,” in people who experience mental illness, wellness “is still an important consideration in one’s overall recovery.”

Massage therapy, and other modalities involving touch, fall within the ambit of wellness, says Currah. “Massage and therapeutic touch can help all people, whether or not they have a psychiatric diagnosis, because it promotes relaxation and stress reduction,” he says. “…It can be a preventative tool to maintain wellness and combat the negative physical, and sometimes emotional, effects of stress on people.”

Currah maintains, however, that “there is no evidence that massage can help with symptoms related to any particular mental illness, such as anxiety or psychosis.” Still, he adds, because massage therapy “acknowledges the whole person,” it can benefit the mind and nourish the soul.

Team effort
Therapeutic touch “may help some people who have experienced trauma and or violence to feel more comfortable receiving touch in a measured and controlled environment as they build trust with their massage therapist,”Currah says. “For some, massage therapy can involve a vulnerability and a letting go, especially for those who may have struggled with issues around self-image or body-shaming. This can be a very therapeutic moment which can allow an individual to work through deeply embedded issues.”

Fitch agrees that touch “can be a sanctuary” for a client. But, she hastens to add, there are also clients who don’t feel safe being touched.

Touch, she says, “is like a lightning rod.” For people with mental health issues, touch can be soothing – “it can facilitate self-regulation and encourage integration of some experience.” Or, “it can feel threatening.”

Fitch underscores that massage therapy alone is not the answer.  “You need to have other supports in place. You can’t have it without psychotherapy, [or] psychologist or physician support because the reality is when someone has trauma in their history, [massage therapy] may inadvertently trigger a cascade of emotions or remind a client of a traumatic incident,” she says. “I know from experience that massage therapy is a great and effective treatment, as long as it comes at the end, near the end, of the person’s recovery.”

Cross-discipline type of work, she adds, “is very effective” for people suffering from PTSD and depression.

Both Fitch and O’Connor say RMTs do not necessarily have to apply a different protocol when dealing with clients with mental health issues. Nonetheless, they stress the importance of making sure RMTs are well-informed of their client’s condition so that they can respond appropriately.

“We may take a little more care in understanding what triggers might exist for the person that could make them feel worse,” Fitch says, adding that it would require a “more complex, more subtle type of treatment.”

While a massage therapist would do the same type of work in terms of releasing an adhesion and facilitating flexibility, she would also need to pay attention to “making sure the client feels safe at all times.”

O’Connor says it’s important for RMTs to educate themselves and not be worried about treating people with mental health issues.

“If you understand the condition a little more, you can see the person behind the condition,” he says. “You have to pay attention to what their needs are. With most therapeutic relationships there’s trust involved. People with mental health issues, I find, have a harder time relinquishing that trust. You really need to establish trust, otherwise the treatments are going to be very limited.”

Fitch emphasizes the importance of peer supervision. “Within the first few years of work, new massage therapists would really benefit from consulting with experienced therapists… Other professions do it. There’s no reason we can’t do it. It would make us safer with our clients.”

Access to touch
In terms of how often a patient should go to reap the full benefits of massage therapy, Fitch and Currah say that while there are no hard and fast rules, money is often a major factor.

“Massage is privately funded, so unless they have extended health plans, they’re going to be funding their own care. That is a very big factor in how frequently they can come (for massage therapy care),” she says. “If money was not an issue, you might look forward to seeing someone once a week for a month so that the patient could appreciate how massage therapy fits into their existing condition. Once those four weeks are finished the client can determine the frequency.”

In order to establish trust, O’Connor recommends patients get massage therapy once a week for the first few weeks. “Once you’ve established rapport, it’s very good to have them on a regular routine – at least twice a month.”

Aside from the fact that the cost of massage therapy is often prohibitive, Currah says, time can be a barrier. “In our 21st century lives, we can find ourselves juggling many demands at once to the point of multi-tasking throughout our days.”

Fitch believes that “the public intuitively senses” how they can benefit from massage therapy. But, she adds, “having said that, there’s a gap between what clients intuitively wish and what massage therapists believe they can do.”

Massage therapy, as a profession, “still associates itself with orthopedic change,” she says, “but we do so much more than that, even if therapists aren’t even aware of having an impact on clients.”

O’Connor says touch has never been more vital than this current era of information technology, where people are glued to devices such as smart phones and iPads. “We [RMTs] have such a huge role to play in this new era because so many people are being removed from touch at an earlier age.”

There is that other reality that “we also live in a society that by its very nature does not promote touch, and sometimes discourages physical contact,” Currah says. Many people “have very little positive physical contact throughout their daily goings-on,” he says. “This can make it hard for people to slow down and engage in things like mindfulness, massage or breathing exercises: the demands of everyday life can make it a struggle to self-actualize and work on our wellness.”


Marites Sison is a freelance writer based in Toronto.


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