The role of massage therapy in the treatment of depression and anxiety can be invaluable; it helps to integrate the individual as a whole within the treatment context and can offer both physical and emotional relief.
Often, in a clinical treatment, the focus revolves mainly around a specific presenting lesion or pathology, however psychological and emotional factors also need to be considered. Massage therapists frequently treat patients with complaints of neuromuscular dysfunction, such as muscle tension, pain and respiratory difficulties, as well as other physical manifestations with no recognizable cause; these are cases where stress and the individual’s response to stress need to be considered.
When understanding depression, a multitude of social, environmental, hormonal, chemical, physical and personal factors, all need to be considered when deciding on the best treatment for the individual. I would also like to acknowledge that within the layers of our bodies there exists the constant integration of new experiences with deeply rooted past experiences of our lives – which stay contained within our bodies. For example, many people can relate to having a massage, or being touched and find various memories are suddenly triggered into conscious thought, or feelings are evoked of a distinct emotion. As the memory or the emotion is recalled and experienced there may also have been a release in the body or easing in the breath. Massage therapy can provide a very beneficial adjunct in the treatment of anxiety and depression encouraging a subtle release of the body’s memory of both physical and emotional trauma, and with that release access to the cause of the underlying affective state, which can help to bring the physical and emotional body back into a state of balance.
When referring to the cycle of anxiety and stress, it should be noted that we are working with the body in a sympathetic state which is indicative of energy expenditure, often defined in literature as the “fight or flight” response. Massage therapy can assist in breaking this cycle by decreasing heart rate, respiratory rate, muscle tone, and muscle pain; which will in turn put the parasympathetic state in the seat of control allowing the body to function in a more restful manner. Depression and anxiety are characterized by sympathetic and parasympathetic dysregulation, the clinical characteristics of which are summarized below1. In 90% of cases, both depression and anxiety will co-exist2.
| Characteristics of Depression | Characteristics of Anxiety |
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The limbic system of the brain is responsible for the processing of our emotions; it is the emotional center of the body and in turn controls both mood and attitude. When the limbic system is less active there generally exists a more positive state of mind. Emotions excite the limbic system through its interconnections with several structures; the most important of these is the hypothalamus, which is the brain’s control center. The hypothalamus regulates levels of pleasure, anger, pulse, and breathing. It essentially provides a link between all the body systems. Another component of the body, which is important to mention in this discussion, is the reticular activating system (RAS). The RAS receives input from sensory stimulation through touch/pressure, visual and auditory and projects this input to higher brain centers – such as the hypothalamus. Increased activity in the RAS creates increased sympathetic functioning, which can express itself as muscle hypertonicity, trigger points, muscle pain, and headaches3. If it is possible to calm the emotions by reflexively providing a soothing external stimulation calming the RAS and enhancing the parasympathetic nervous system, we can hypothesize that there would be a decrease in negative stimulation being projected to the hypothalamus and communicated to the limbic system, which would in turn decrease the symptoms of depression and anxiety.
Throughout massage treatments various assessment tools are utilized such as range of motion, palpation, tissue response, vital monitoring, and a visual analogue scale (VAS)4. The VAS is traditionally utilized for patients to record subjective levels of pain; a modification of this scale incorporates a number system in which an individual would gage their levels of overall wellness, energy and subjective stress.
Example of VAS patient log:
| Day of The Week |
AM |
PM |
Daily Comments |
| Monday | 1 2 3 4 5 6 7 8 9 10 | 1 2 3 4 5 6 7 8 9 10 |
Results outlining VAS pre/post massage treatments taken from actual casework:
(Treatments for this particular case were provided weekly for the initial 3 months, and we then reassessed to every 2 weeks for 2 months, followed by monthly appointments.)
The Treatment plan would be specific to the individual and their changing needs, utilizing a variety of massage and relaxation techniques. Previously done studies provide evidence that massage can decrease levels of stress hormones and perceived anxiety, increase relaxation, address stress related physical dysfunction, help with insomnia, calm a busy mind, increase breath awareness and encourage a more restorative state in the body. Massage therapy also helps to reconnect the body with the mind.
It is important for individuals to acknowledge their role and responsibility for their own healing. Key elements to consider are maintaining a healthy activity level, journaling, nourishing the body with healthy food choices and sufficient water, and making the time to relax through a gentle stretching, yoga or meditation practice. Talking to a friend or a trained professional to help process and understand any emotional or physical responses that may occur in the massage sessions is vitally important and can also be very empowering.
In conclusion, our bodies carry within them all of our physiological and emotional experiences which carry the potential for development and transformation, therefore, by releasing physical tensions we can in turn release psychological trauma. The only real constant we can ever really rely on, is that the human organism is never in a static state of being, but rather ever evolving and changing. With this knowledge we as individuals have to be constantly re-evaluating the changes in our bodies and our minds, and accepting of whatever that may be. Massage aims to provide a positive and therapeutic experience of touch, while encouraging individuals to have a greater acceptance and respect for themselves through their own personal evolution.
References:
- Beers, Mark H., M.D., and Robert Berkow, MD, The Merck Manual of Diagnosis and Therapy, 17th edition. N.J., USA: Merck and Co., Whitehouse Station, 1999
- Leahy, Robert and Stephen Holland, Treatment Plans and interventions for Depression and Anxiety Disorders, book and CD-ROM, New York, NY: Guilford, 2000
- Tortora, Gerard J., and Sandra Reynolds Grabowski, Principles of Anatomy and Physiology, 9th edition, USA: John Wiley and Sons Inc., 2000
- Magee, David J., Orthopedic Physical Assessment, 4th edition, USA: Elsevier sciences, 2002
General:
- Andrade, Carla-Krystin, PhD, PT, and Paul Clifford, BSC, MT, Outcome Based Massage Therapy, Baltimore, Maryland: Lippincott, Williams, and Wilkins; 2001
- Borysenko, Joan, Minding the body, Mending the mind, MA, USA: Addison Wesley Publishing Company, Inc., 1987
- Kerr, Sheila and Marc White, Massage Therapy and Its Impact on the Limbic System, B.C. Massage Practitioner, 2003; 23.1: 11-12
- Pert, Candace, PhD, Molecules of Emotion, New York, NY, USA: Scribner, 1997
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