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Treating anxious clients

What RMTs should be aware of


January 17, 2020
By Kelly Martin

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Anxiety encompasses multiple health issues, including panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder, according to the Canadian Mental Health Association. Women are more likely to have anxiety (in Canada), and I have found in my experience that some clients with a long-term condition; especially chronic pain, are prone to it. Both anxiety and depression can be seen in the same person.

I hear many RMT’s comments like “everyone has anxiety,” like it’s so common that it’s not worth looking into. I find that this is a very important condition to treat, almost like a sidebar to your regular work. It’s very common, but it’s not something that should be ignored.

So many of my massage clients suffer from anxiety that I ask about it on intake. Being a very direct person, if I see any medications for anxiety or if “mental illness” is checked on the health history, I ask, and I don’t find that people try to hide it, even with the stigma that is sometimes found. I usually mention that I like to ask since many people have it – plus it helps guide me to check certain muscles (intercostals, scalenes). I find it an important piece of the client health puzzle, as these issues usually affect the muscles of inspiration due to the increased rate of breathing and can affect the efficacy of treatment. If the client is anxious, they will not relax.

Clients with obsessive-compulsive disorder and post-traumatic stress disorder are more likely to seek treatment elsewhere first, since they often require medication. Therefore, the three types of disorders that I will refer to are the ones that RMT’s see the most. These are also the ones that affect breathing the most: generalized anxiety disorder, panic disorder and social anxiety disorder. All three of these can come and go; sometimes without warning and they can cause a great deal of stress to the client, creating a cycle of symptoms. One gets anxiety, which can then lead to stress about the anxiety, which can increase the original symptoms.

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Of course, a client should always discuss the condition with his or her general practictioner first. Increased cortisol can be a factor in keeping the sympathetic nervous system on alert, if it remains high. Sometimes, when someone is under stress for long periods of time, cortisol will remain high and the body will feel like it’s in fight-or-flight, without coming down. If high cortisol is a possibility, the client’s doctor will know, but one can discuss treatments to decrease cortisol with a nutritionist or naturopath as well.

I have found that treating my anxious clients regularly helps with ongoing muscle tension and stress. Especially, anterior/middle scalenes and intercostals are very important to treat slowly and will usually show hypertonicity – especially with panicked clients.

There are things that clients can do to help themselves as well. Deep diaphragmatic breathing is helpful for people with anxiety. This can be explained to the client but can be difficult to achieve during a panic episode. A good trick to teach is to tell the client to breathe in for three seconds and out for five seconds. It is to be repeated as many times as needed. This is a simple way to slow the panicked breathing down and calm a panic attack.

Another way to help is to try progressive muscle relaxation, a type of guided meditation that can help relax many muscle groups in the body at the same time. As I was taught in college, one must find a quiet place to lay down and go through the muscle groups in an orderly fashion, contracting then relaxing each group. Overall it’s great for general relaxation, great for anxious clients.

Cognitive behavioural therapy may also help those with anxiety. I learned it a long time ago, after a motor vehicle accident, to help relieve pain. It requires the client to write down their answers to specific questions at specific times. There are many available forms, called “automatic thought records” that can be helpful to change a person’s irrational thoughts. These records are great for people who stay in their head and tend to overthink things. Irrational thoughts can lead to depression, so working on a sheet like this can redirect harmful thoughts. It takes a bit of practice but can halt the thinking patterns that can cause anxiety. This is one of the most direct and powerful forms of therapy for anxiety.

It is imperative that one takes care online to be sure that information is correct. For this reason, I rarely recommend my clients search the internet for health-related information, but the above examples are instances where I find the information to be helpful and correct.

Before I became an RMT, I spent many years as a pharmacy technician, so I’m aware of the medications available for anxiety. There are many conditions that require prescriptions, and many cases where medication is needed for anxiety. I find, however, that most people don’t want to go the “drug route” and want alternatives.


Kelly Martin is a Registered Massage Therapist in London, Ontario. She uses her experiences having had many injuries to help her clients.


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