Title: Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations
Authors field T. Ironson G, Scafidi F et al
Journal: International Journal of Neuroscience 1996; 86: 197-205
Abstract: A total of 50 adults participated in this study; 26 received chair massage and 24 were directed to relax in the massage chair for 15 minutes. Sessions occurred two times per week for five weeks. Assessment tools included EEG, math computations, depression and anxiety measures, and saliva samples to be tested for cortisol. Study results showed the following in the massage group:

• Decreased frontal alpha and beta power that suggested enhanced alertness 
  
• Increased speed and accuracy on math computations
  
• Lower anxiety levels
  
• Lower depression and job stress scores

Movement Therapy Benefits Senior Citizens

Massage Improves Function, Reduces Pain and Anxiety Associated with Subacute Low-Back Pain

Adults with subacute low-back pain reported improved function, less intense pain and a decrease in the quality of pain and anxiety after six sessions of massage therapy and remedial exercise, according to a research study.

Movement Therapy Benefits Senior Citizens

Senior citizens who participated in four movement-therapy sessions showed improved balance and gait, increased leg strength, and significantly decreased leg pain, according to a recent research study.

"Senior citizens benefit from movement therapy" was conducted by Kristen Hartshorn, Jesse Delage, Tiffany Field, Ph.D., and Loren Olds of the University of Miami School of Medicine. Field is the director of the university's Touch Research Institute. The study was published in the Journal of Bodywork and Movement Therapies.

Thirty-two subjects with an average age of 86 were recruited for the study from two retirement communities and randomly assigned to either a movement-therapy group or a wait-list control group.

The movement-therapy group attended four 50-minute sessions throughout a two-week time period. Each session began with a warm-up, during which subjects typically sat in a circle and focused on breathing; raised their arms and legs; and rolled their necks. Self-massage was also performed.

After the warm-up, participants engaged in large, whole-body movements, such as swaying, pushing, stamping, twisting, turning, stepping and swinging.

This was followed by resting and sharing, when participants took a break to notice any changes in themselves, such as increased heart rate or expanded respiration.

The last portion of the movement therapy was most intensive, as subjects were encouraged to fully explore the dynamics of a movement, such as the feeling of rocking or swaying. At times they worked in pairs, mirroring each other, or used props to take the movement further. Breathwork, progressive relaxation of the entire body, imagery and visualization were also used.

Range-of-motion data and self-reports were collected from subjects in both the movement-therapy and the control group on the first and last days of the study.

Overall body pain, back pain and leg pain were rated on visual analogue scales (VITAS) ranging from 0/no pain, to 10/worst possible pain. Leg strength was rated on a 10-point scale, from very weak to very strong.

The Tinetti balance and gait evaluation was used to measure subjects' range of motion. Each item was rated from 0-2, and a higher total score was considered optimal. The balance evaluation included items such as sitting balance, arising, standing balance, turning 360 degrees and sitting down. The gait evaluation included items such as step length and height, step continuity, step symmetry and walking stance.

"Although there were trends in the reduction of back pain, only the leg pain significantly decreased over the course of the study," state the study's authors.

Results showed that those who participated in the movement therapy improved in their functional motion on the Tinetti scale, specifically in terms of gait. Leg strength increased, and leg pain was decreased significantly. The change in the means for overall pain and back pain were in a positive direction, but not significant.

"The combined effects of the movement therapy on leg strength, gait, and reduction of leg pain suggest that this may be an effective therapy for these problems in the elderly," state the study's authors. "The freer movements and lesser degree of structure and concentration required of the elderly make this a more enjoyable kind of movement therapy than the more frequently studied Tai Chi."

—Source: University of Miami School of Medicine. Authors: Kristen Hartshorn, Jesse Delage, Tiffany Field, Loren Olds. Originally published in the Journal of Bodywork and Movement Therapies, January 2002, pp. 55-58.

Anorexia Nervosa Symptoms Reduced by Massage

Multi-Sensory Stimulation Helps Infants with Brain Injuries

A combination of tactile, visual, auditory and vestibular (rocking) interventions prove beneficial for pre-term infants diagnosed with prenatal brain injury, according to the study "Developmental Intervention for Preterm Infants Diagnosed with Periventricular Leukomalacia." The multi-sensory interventions were found to increase the infants' heart and respiratory rates, and decrease their average hospital stays.

The study was conducted by researchers at the University of Illinois' College of Nursing, and was first published in the journal Research in Nursing & Health in 1999. Periventricular leukomalacia (PVL) is an injury to the immature brain, the result of an interruption in blood flow to brain tissues during or after delivery. It puts infants at risk of cerebral palsy and can lead to a delay in infant development and behavioral response changes.

Thirty infants diagnosed with PVL, at gestational ages (the age of the child from the mother’s last menstrual period) of 24 to 33 weeks, were randomly placed in either a control group or an experimental group. The control-group infants received the same developmentally supportive care that was provided for all infants.

Infants in the experimental group received twice-daily multi-sensory stimulation (tactile, auditory, visual and vestibular) for 15 minutes, five days a week for one month, or until discharge from the hospital. The first 10 minutes consisted of light massage, which was followed by five minutes of rocking. While administering the massage, a research assistant would also speak to the infant and give eye-to eye contact, thereby providing both auditory and visual stimuli. The interventions were tailored to individual infant behavior and responsiveness.

Assessments included measurements of heart and respiratory rate, body temperature and muscle tone; the Brazelton neonatal behavioral assessment scale which measures short-term behavioral responses; and the Bayley scales of infant development, which assess sensory-perceptual abilities.

Study results indicated that infants receiving the multi-sensory interventions experienced increases in heart and respiratory rate, indicating that they learned how to respond to environmental challenges more quickly, as compared with the control group. They were also more alert and active than those in the control group, and were discharged an average of nine days earlier from the hospital than control-group infants, who stayed in the hospital for 32 days. Researchers surmised that the early discharge might have been the result of infants being more alert (and thus more efficient) during feedings, which followed the interventions.

"Future research on post-intervention feeding and efficiency might further document beneficial effects" of multi-sensory interventions, the study authors concluded.

-Source: Rosemary C. White-Traut, R.N. Originally reported in Research in Nursing & Health, 1999, Vol. 22, pp. 131-143.

Anorexia Nervosa Symptoms Reduced by Massage

Massage alleviates anxiety, depression, eating disorder symptoms, poor body image and biochemical abnormalities for women diagnosed with anorexia nervosa, according to a recent research study.

"Anorexia Nervosa Symptoms are Reduced by Massage Therapy" was conducted by researchers at the Touch Research Institute at the University of Miami School of Medicine. It was originally published in Eating Disorders: The Journal of Treatment and Prevention.

Nineteen women undergoing inpatient or outpatient treatment for anorexia nervosa were randomly assigned by researchers to either a massage-therapy group or a standard-treatment group.

In addition to receiving standard care, the women in the massage-therapy group received a 30-minute Swedish massage twice a week for five weeks. Beginning in the supine position, the head and neck were massaged, followed by the arms, torso, legs and feet. In the prone position, the legs and back were massaged.

Inpatients in the standard-treatment only group participated in daily individual- and group-therapy sessions, worked with a dietician and engaged in movement therapy. The women in the outpatient program were under the care of a psychiatrist and attended group therapy.

On the first and last days of the study, researchers used the State Anxiety Inventory to evaluate the womens' anxiety levels; the Profile of Mood States to measure their moods; saliva cortisol tests to measure stress-hormone levels; the Center for Epidemiological Studies Depression Scale to determine depression levels; and urine samples to measure dopamine values. The Eating Disorder Inventory was used to measure psychological and behavioral traits associated with anorexia nervosa, such as perfectionism, drive for thinness, interpersonal distrust and body dissatisfaction.

After the five-week treatment period, the massage-therapy group had lower scores on the Eating Disorder Inventory, compared to the standard-treatment group. (Higher scores suggest more symptoms associated with anorexia nervosa.)

Although improved mood was reported by women in the massage-therapy group, no changes were found in depression scores for either the massage-therapy or standard-treatment only group. The study suggests that a longer massage treatment period may be necessary to reduce depression for women with anorexia nervosa.

"That the Eating Disorder Inventory (EDI) scores were unchanged for the participants in the control group despite receiving standard treatment … is suggestive of the difficulty of treating eating disorders with only traditional therapies," state the study's authors.

Urine samples taken on the first and last days of the study revealed an increase in dopamine values for the women who received massage therapy in addition to standard care. "Dopamine depletion has been associated with a decrease in food intake and has been implicated in anorexia nervosa and feeding behaviors," state the authors.

The results of this study, according to its authors, "suggest that massage therapy added to standard care may be effective for healing mind and body issues for individuals with eating disorders."

—Source: The Touch Research Institute. Authors: Sybil Hart, Ph.D.; Tiffany Field, Ph.D.; Maria Hernandez-Reif, Ph.D.; Graciela Nearing, Psy.D.; Seana Shaw, M.D.; Saul Schanberg, M.D., Ph.D.; Cynthia Kuhn, Ph.D. Originally published in Eating Disorders: The Journal of Treatment and Prevention, 2001, Vol. 9, pp. 217-228.

Massage Eases Lower Back Pain, Increases Range of Motion

Adults with chronic low-back pain found relief from massage therapy, according to a research study. Massage eased pain, reduced depression and anxiety, and improved sleep and range of motion.

The study, "Lower Back Pain is Reduced and Range of Motion Increased After Massage Therapy," was completed in January 2000 by the Touch Research Institute in conjunction with the University of Miami School of Medicine and Iris Burman of Educating Hands, and was first published in the International Journal of Neuroscience.

Twenty-four adults who had experienced low-back pain for at least six months were randomly assigned to either a massage therapy group or a relaxation therapy group.

The massage therapy group received twice-weekly, 30-minute massages for five weeks. Starting in the prone position, the following techniques were used: kneading and pressing the back muscles, stroking both sides of the spine and hips, gliding strokes to the legs, and kneading and pressing the thighs. Continuing in the supine position, participants received: gliding strokes to the neck and abdomen, kneading of the rectus and oblique muscles that help bend the trunk of the body forward, stroking of the legs, kneading of the anterior thighs, flexing of the thighs and knees, and gentle pulling on both legs.

Those in the relaxation group were instructed in progressive muscle relaxation techniques to tense and relax muscles in the feet, calves, thighs, hands, arms, back and face. Participants performed these exercises at home twice weekly for 30 minutes.

Assessments taken before and after the first and last sessions included: the Profile of Mood States Depression Scale to rate depression; the State Anxiety Inventory to rate feelings at the present moment; the McGill Pain Questionnaire to measure pain; the Visual Analogue Scale to measure present level of pain; the Range of Motion Measures test to rate the level of ability to bend; a Symptom Checklist-90 Revised to measure moods; a sleep scale to measure quality of sleep; and urine samples to measure levels of the stress hormone cortisol, serotonin and catecholamines (amino acid derivatives that affect the nervous system, cardiovascular system, metabolic rate, temperature and muscles).

Results showed that both groups experienced a decrease in stress and long-term pain, but only the massage group experienced less pain directly after the session, fewer depressive symptoms, better sleep, improved range of motion and an increase in serotonin and the catecholamine dopamine biochemical levels.

"The findings from the present study are compelling and if the effects can be replicated and persist, these data suggest that massage therapy effectively reduces pain, positively impacts on the biochemical system, and attenuates psychological symptoms associated with lower back pain," the study authors wrote.

The authors also wrote that future studies might "examine the impact of massage therapy on job productivity and absenteeism for individuals with chronic low back problems."

-Source: Touch Research Institute. Originally reported in International Journal of Neuroscience, 2001, Vol. 106, pp. 131-145.

The study, "Premenstrual symptoms are relieved by massage therapy," was conducted by the Touch Research Institute in conjunction with the University of Miami Medical School.

Twenty-four women, aged 19 to 45, with premenstrual dysphoric disorder (a severe form of PMS) were selected from gynecological practices. The women were randomly assigned to a massage therapy group or a relaxation group. Those in the massage therapy group received twice-weekly, 30-minute massage sessions for five weeks. The sessions started during a premenstrual week to establish a baseline measure.

Sessions began with the woman supine, and included 15 minutes of: kneading the neck; stroking the forehead; pressing down on the tops of the shoulders; stroking on the hands, arms and shoulders; circular stroking on the stomach; stroking of the feet and legs; and kneading of the thighs. The remaining 15 minutes of the session, the woman was prone while the therapist stretched her ankles; compressed her calf muscles; kneaded her thigh muscles; gave gliding strokes to her legs; and massaged her low back, shoulders and neck.

The relaxation group was given progressive muscle relaxation therapy. For 30 minutes twice a week, participants were instructed to tense and relax major muscle groups, starting with the feet and moving up.

Treatment assessments included the following self-rating scales: the Center for Epidemiological Depression Scale (CES-D) to rate depressive symptoms; the Menstrual Distress Questionnaire (MDQ) to rank premenstrual symptoms; the State Trait Anxiety Inventory (STAI) to measure anxiety; the Profile of Mood States (POMS) to rate the level of depression; and a visual analog scale (VAS) to rate perceived pain.

At the end of the study, results indicated that the massage therapy group experienced a decrease in anxiety (STAI), a decrease in depression (POMS), a reduction in perceived pain (VAS), and an overall reduction in PMS symptoms including pain and water retention (MDQ).

Researchers wrote that future studies might focus on the effects of a longer-term massage therapy program.

"Overall, the present findings suggest that massage therapy may be an effective long-term aid for pain reduction and water retention, and short-term for decreasing anxiety and improving mood for women with premenstrual dysphoric disorder. Based on these findings, massage therapy benefits would be expected to generalize to the milder PMS."

-Source: Touch Research Institute. Originally reported in the Journal of Psychosomatic Obstetrics & Gynecology, March 2000, Vol. 21, pp. 9-15.

Hypertensive adults who received regular biweekly massage sessions experienced less depression and hostility and showed a decrease in measured stress-hormone levels, according to a recent research study.

The study titled "High blood pressure and associated symptoms were reduced by massage therapy" was completed in May 1999, and was conducted in conjunction with the Touch Research Institute, the University of Miami School of Medicine and Nova Southeastern University in Florida.

Thirty adults with controlled hypertension (for at least the last six months) were randomly assigned to either a massage therapy group or a progressive relaxation group.

Those in the massage group were given twice-weekly 30-minute massage sessions in the afternoon or early evening for five weeks. Massages were given on a rotating basis by various therapists. With the subject in a supine position, the therapist would massage the head and neck, arms, torso and legs with stroking, squeezing, pressing and pulling motions. With the subject in a prone position, the therapist would massage the back of the legs, and would then massage the back.

Participants in the progressive muscle relaxation group received instructions on completing self-administered, twice-weekly 30-minute exercises for five weeks. Researchers instructed subjects to only perform their session in the afternoon or early evening on assigned days to ensure compatibility with the massage group's schedule. Relaxation sessions began with participants breathing deeply for several minutes while in a supine position with the hands alongside the body. They then followed instructions to tighten and then relax different muscles, moving upward from the feet to the head. Muscle groups included were of the feet, calves, thighs, hands, arms, back and face.

Pre- and post-treatment assessments included: a state anxiety inventory (STAI) to assess current emotions; a salivary sample to measure the levels of the stress hormone cortisol; systolic blood pressure and diastolic blood pressure measures; the Center for Epidemiological Studies Depression Scale (CES-D) questionnaire to rate depressive symptoms; Symptom Checklist-90-Revised (SCL-90-R) self-report symptom inventory of depression, anxiety and hostility; and urinary catecholamines (biologically active amines which affect the nervous and cardiovascular systems) and cortisol measurement.

Results showed that while both groups had lower anxiety levels (STAi) and lower levels of depression (CES-D), only the massage therapy group showed decreases in sitting diastolic and systolic blood pressure; decreases in salivary and urinary cortisol stress-hormone levels; and lower scores for depression, anxiety and hostility.

Researchers suggested that future studies be long-term, and examine the effects of massage on individuals who have high levels of stress.

"Longer-term follow-up might also help determine whether the results reflected short-term effects or whether the results would have persisted beyond the treatment sessions," researchers wrote. "If massage therapy can effectively reduce symptoms associated with hypertension, then it might reduce life-threatening complications, such as the risk of stroke or heart attack."

-Source: Touch Research Institute. Originally reported in the Journal of Bodywork and Movement Therapies, January 2000, Vol. 4, No. 1.

Massage lowers anxiety, improves mood and increases range of motion among dance students, according to a recent study.

Researchers at the Touch Research Institute showed that twice-weekly massage lowered the stress hormone cortisol, eased neck, shoulder and back pain, and helped range of motion, including neck extension and shoulder abduction.

Thirty female dance students were randomly assigned to a massage or relaxation therapy group. Both groups otherwise continued the same daily dance and school regime.

Those in the massage group received 30-minute sessions twice weekly for five weeks. The massage was focused on the upper body and consisted of moderate to firm pressure, stroking, stretching and rocking. With a prone dancer, the therapist began the session with firm strokes to stretch and warm the neck, back and shoulders. Next, friction and then squeezing were applied to both sides of the spine and then along the sides of the body.

This was followed with a sequence of up-and-down and side-to-side strokes along the collar bone and scapula. Firm pressure was applied, moving muscles away from vertebral column. Firm gliding motions were made down the neck, shoulder and upper back, finishing at the bottom of the scapula.

Continuing with the dancer lying on her side, massage was applied with firm pressure on the muscles along the rib cage, releasing tension before continuing. The chest muscles were then lifted, squeezed and stretched. The arms were circled up by the head and behind the back and down again while applying gentle pressure to the chest and side. The lateral neck muscles were then pressed. Lastly, the arm was circled in reverse, using its own weight to stretch the middle back and chest muscles.

In the relaxation group, dancers listened via earphones to instructions on a series of guided muscle relaxation exercises while lying on a mat. Sessions lasted 30 minutes and consisted of tensing and relaxing muscles, starting with the feet and moving up the body, ending at the face. These sessions also occurred twice weekly for five weeks.

To assess the effects of the massage and relaxation sessions, researchers used five measurements: a State Anxiety Inventory (a questionnaire that assesses anxiety levels), a Profile of Mood States questionnaire; pre- and post-session pain scales to measure perception of pain in the neck, shoulders and back; pre- and post session saliva samples to measure cortisol levels; and measurements of range of motion, including neck extension and shoulder abduction.

Results showed that both groups had less anxiety, better mood, and less pain in the neck, shoulder and back. Only the massage group experienced a decrease in cortisol and an improvement in range of motion, including neck extension and shoulder abduction.

"Perhaps massage therapy stretched the dancers more than relaxation therapy, thus leading to the improved range of motion for the massage therapy group," the study authors wrote.

The authors stated that further study should be devoted to the effects of massage therapy for preventing and treating dance injuries.

 —Source: Touch Research Institute. Originally reported in the Journal of Dance Medicine & Science, 1999, Vol. 3, No. 3, pp. 108-112.

A seminal study of massage on cancer patients has shown that the intervention reduces the level of pain and anxiety these patients experience during treatment for the disease.

The study, conducted over four years at the James Cancer Hospital in Columbus, Ohio, sought empirical evidence for the efficacy of massage on cancer patients experiencing pain in the course of treatment.

"The research on the use of massage with cancer patients has been minim[al] because massage therapy schools teach their students that massage is contraindicated with cancer patients," reported Pauline King, a mental health clinical nurse at the hospital, who led the study.

"We are always probing, sticking and doing other invasive treatments with cancer patients who are often touch deprived," King continued. "It was felt strongly that the patient needed caring touch as an antidote to the invasive procedures."

The study, which concluded in late 1999, was funded by a $10,000 grant from the AMTA Foundation. Its results have been widely reported by national media.

For the study, 52 cancer patients receiving treatment at the hospital, which is affiliated with Ohio State University, were randomly placed into either an experimental group or a control group.

On the first day of the two-day study patients in both groups had a volunteer simply sit with them for 15 minutes, but had no physical contact. On the second day patients in the experimental group received petrissage on the hands, feet, shoulders and back of the neck for 15 minutes. Patients in the control group again sat with a volunteer for 15 minutes, but had no physical contact.

Pain and anxiety levels were measured on both days before the intervention, directly following, and again 30 minutes later. Pain levels were measured by a Visual Analogue Scale in which patients rated the severity of their pain on a scale from 0-10, with 0 equaling no pain and 10 equaling the worst pain possible. Anxiety, which was defined as "tension, apprehension, nervousness and worry," was measured using the Spilberger STAIT-TRAIT Anxiety Inventory, by which patients rated their own anxiety levels.

Data analysis showed the massage had a statistically relevant impact on pain and anxiety levels of patients in the experimental group compared to those in the control group. Overall, patients who received massage showed a .9 difference (drop) in pain level, versus no change in pain level for those in the control group.

"This study is a seminal study that produced empirical evidence on the efficacy of massage on cancer pain and anxiety," the report concluded. "More hard data studies are needed in order to bring massage in the medical systems where it is most needed."

An addendum to the study findings was the positive feedback the researchers received from the hospital's medical staff, in regard to the massage protocol. "Even before the study was completed, doctors and nurses were consulting the primary investigator to give their patients a massage," King reported. "The study raised the consciousness of the medical practitioners, which was another very positive outcome of this study."

-Source: Pauline King, Ohio State University

Researchers have shown that lavender and rosemary administered through aromatherapy positively affect psychological and physiological functioning.  In a study conducted by the Touch Research Institute at the University of Miami Medical School, first published in the International Journal of Neuroscience, researchers assessed the effect of lavender and rosemary on alertness, mood and the brain's electrical activity, and on subjects' ability to perform math computations.

In the study, 40 adult faculty and staff members of the University of Miami Medical School were randomly placed into one of two groups, and were asked to inhale the scent of either lavender or rosemary essential oil for three minutes.  Those in the lavender group were expected to show an increase in alpha and beta band activity, suggesting relaxation.  Those in the rosemary group were expected to have a decrease in alpha and beta band activity, suggesting greater alertness.

Results showed that study expectations were correct: Participants in the lavender group experienced an increase in beta band activity, suggesting drowsiness; an improvement in mood; a feeling of greater relaxation; and better performance on math computations.The rosemary group showed a decrease in alpha and beta power, suggesting alertness and lower levels of anxiety; and were faster but not more accurate at performing math computations.

Subjects first took three assessment tests: an anxiety-inventory questionnaire, a profile-of-mood-states questionnaire and a series of timed math computations.   While seated in a massage chair, each subject was then given a vial containing a dental swab soaked in a grapeseed-oil base with three drops of either lavender or rosemary essential oil.  The subjects were instructed to sit quietly and breathe normally through the nose with their eyes closed.  After three minutes of aromatherapy, the subjects again took the two self-report tests and did the math computations.  For three minutes before, during and after the aromatherapy, EEG readings were taken through a cap worn on participants' heads to measure the electrical activity of their brains.

Results of the self-assessment test data indicated that both the lavender and rosemary groups experienced lower levels of anxiety and felt more relaxed after the aromatherapy.  Only the lavender group reported a significantly better mood.   The rosemary group reported feeling more alert.

Math test results showed that the lavender group experienced an increase in drowsiness, while the rosemary group showed EEG patterns that reflected a greater state of alertness.

Source: Touch Research Institute
Originally reported in the International Journal of Neuroscience, 1998, Vol. 96, pp. 217-224.