More than 45 million Americans, almost 20 percent of the population, have a mental illness, and 57 percent of them receive no treatment. The picture is particularly discouraging for children and adolescents—major depression in youth has increased by almost 5 percent over the last six years.1 According to a recent report by the National Advisory Mental Health Council Workgroup, 1 in 10 children and adolescents has a mental illness severe enough to result in signif-icant functional impairment.2
However, amid these grim numbers, people with mental health issues are turning to a range of wellness strategies that include massage therapy. Recent research is showing how massage therapy might work to mediate mood-influencing hormones like cortisol and how it might help mental health illnesses related to physical conditions such as heart disease and cancer. But more needs to be done. “There is a real need for more research,” says Mark Hyman Rapaport, MD, who has published several studies on the topic, including a review in 2018 on massage therapy for psychiatric disorders.3 With imaging technologies such as functional magnetic resonance imaging (fMRI), researchers hope to eventually monitor changes in the brain itself during massage therapy.
The Why and How
Anxiety disorders are the most common mental health condition in the U.S., according to the Anxiety and Depression Association of America, and generalized anxiety disorder (GAD) in particular affects 6.8 million adults (3.1 percent of the U.S. population).4 Yet less than half of people with the disorder are receiving treatment. In addition, GAD is often associated with depression. Massage therapy shows promise in helping GAD, although researchers want to understand more about why and how. According to Dr. Rapaport, “there are certain brain changes with generalized anxiety disorder and we want to know how massage can work by remediating these changes.”
In a 2016 study,5 Dr. Rapaport found that Swedish massage therapy (SMT) successfully remediated GAD. “We found profound changes associated with massage in individuals with GAD, especially against an active control condition,” he says. Interestingly, the researchers found significant changes in other symptoms, as well. “We also saw major changes in anger hostility measures and major decreases in fatigue.”
In an earlier study,6 Dr. Rapaport and colleagues found that twice-weekly Swedish massage increased the body’s natural oxytocin production and decreased cortisol levels compared to a touch control condition. The study also found that the twice-a-week “dosage” had a “distinctly different” pattern of neuroendocrine effects, particularly on all once-weekly treatment.
A group of German researchers is proposing a hypothesis on how massage therapy may work to improve impaired interoception, which is an individual’s sense of the physiological condition of their body and which may be related to depression. The researchers point out that massage therapy “applies slow, rhythmic and caress-like touch that stimulates C tactile afferents in the non-glabrous skin” and that “CT mediated touch elicits responses in interoceptive brain areas (e.g., the insular cortex) that have been associated with abnormal interoceptive representations in depressed subjects.”7
“Massage therapy increases circulation and improves the balance in terms of stress hormones,” says John Rollinson, LMT, CST-D, who practices in Northampton, Massachusetts. “It also improves overall health, and when someone is trying to get through a difficult period, they need all the resources they can get.”
Physical Health, Mental Symptoms
Studies in patients experiencing physical medical conditions such as cancer have also pointed to the beneficial effects of massage for treating anxiety and depression related to those conditions. Studies on breast cancer patients found massage helped reduce levels of depression, anxiety and insomnia.8
Other studies point to massage therapy as a way to reduce prenatal depression in pregnant women.9 A 2019 study on older female patients with acute coronary syndrome found that foot reflexology was an “efficient and safe intervention for alleviating psychological responses.”10 And a recent study on the perception of therapeutic benefits of complementary medicine in women with eating disorders showed massage as “very helpful.”11
Overall, current evidence is strong enough that the Society for Integrative Oncology and the American College of Chest Physicians revised their clinical practice guidelines to support the use of massage to help treat anxiety and mood disturbances in patients.12
Jacqueline Herbach, LMSW, LMT, who practices in New York City, has worked with people undergoing treatment for cancer since 2002. “Depression, anxiety and insomnia are common when you’re given a diagnosis,” she says. In these cases, she works to meet clients where they are emo-tionally. “Many people are so anxious that I try to work on grounding them physically,” and she may start by holding their feet or head. She also recommends treading lightly. “Many people coming in for a massage want a deep tissue massage, but if someone is very depressed, it is not always the best way to go.”
Intake and Teamwork
When working with someone with a mental health condition, a thorough screening and intake is essential. Herbach often sees her clients’ medical records prior to a session due to her work at a hospital’s integrative medicine center. Otherwise, she will conduct a thorough phone interview first. “I think screening is important,” she says. “Not everybody can work with every population.”
She adds, “Many times I’ve said I’m not the right person.” Rollinson does not hesitate to refer clients out. “I’m always looking for any signs that they might need more than we can offer,” he says. “I know a number of psychologists and psychiatrists to whom I would not hesitate to refer a client.” He says many of his clients come in purposely for help with depression or anxiety.
But sometimes, Rollinson says, “They may have come in because of a car accident, [and] a big part may be the stress of having been in an accident.” In those cases, they may need additional support from mental health professionals.“It is always good to work as part of a team,” he emphasizes. “The insights you can get from doctors or mental health providers often give helpful direction for the process, and they are often grateful for yours."
Working With Young People
Many recent studies point to the potential usefulness of massage in treating a range of psychological issues in children, such as attention disorders, aggression, anxiety, depression and post-traumatic stress disorder. In a 2019 study on eating disorders and depression, researchers “highlight the importance of assessing massage therapy effects on biochemical imbalances, such as depressed dopamine levels, as well as behavior and mood disturbances in children and adolescents with psychological problems.”13
Another 2019 study compared the effectiveness of soft tissue manipulation and a relaxation technique (Jacobson’s progressive relaxation) in reducing anxiety levels in young adults. The researchers found that the level of perceived anxiety decreased “significantly” in the group receiving soft tissue manipulation.14
John Rollinson, LMT, CST-D, in Northampton, Massachusetts, often treats children experiencing learning and emotional difficulties, including attention deficit hyperactivity disorder (ADHD). He says it is important to work with the entire family. “You always want the parent in the room with you when you are working with a child,” he says. “Treat the child like a person and ask if it’s OK to work on them.” In addition, he is mindful of the higher activity levels and shorter atten-tion spans of most children, keeping most sessions to a half hour. He is also careful to note any medical treatments. “You always want to know if achild is on medication and be aware of any side effects.”
Massage and Health
Massage Therapy for Depressed Clients
1. New MHA state of mental health report shows adults, children in crisis. Mental Health America.September 17, 2019.
2. The National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment. Blueprint for change: Research on child and adolescent mental health. Washington, D.C.: 20001.
3. Rapaport MH, Shettler PJ, Larson ER, Carroll D, Sharenko M, Nettles J, Kinkead B. "Massage therapy for psychiatric disorders." Focus. Vol. 16, No. 1, Winter 2018.
4. Facts & Statistics. Anxiety and Depression Association of America.
5. Rapaport MH, Shettler PJ, Larson ER, Edwards SA, Dunlop BW, Rakofsky JJ, Kinkead B. "Acute Swedish massage monotherapy successfully remediates symptoms of generalized anxiety disorder: A proof-of-concept, randomized controlled study." Journal of Clinical Psychiatry 77:7, July 2016.
6. Rapaport MH, Shettler PJ, Bresee C. "A preliminary study of the effects of repeated massage on hypothalamic-pituitary-adrenal and immune function in healthy individuals: A study of mechanisms of action and dosage." J Altern and Complement Med. 2012 August; 18(8): 789-797.
7. Eggart M, Queri S, Müller-Oerlinghausen B. "Are the antidepressive effects of massage therapy mediated by restoration of impaired interoceptive functioning? A novel hypothetical mechanism." Medical Hypotheses. Volume 128, July 2019, Pages 28-32.
8. Kashani F, Kashani P. "The effect of massage therapy on the quality of sleep in breast cancer patients." Iran J Nurs Midwifery Res. 2014 Mar-Apr; 19(2): 113-118; and Krohn M, Listing M, Tjahjono G, Reisshauer A, Peters E, Klapp BF, Rauchfuss M. "Depression, mood, stress, and Th1/Th2 immune balance in primary breast cancer patients undergoing classical massage therapy." Support Care Cancer. 2011 Sep: 19(9):1303-11.
9. Tiffany Field. Massage therapy research review. Complmentary Therapy in Clinical Practice. 2016 Aug; 24: 19-31.
10. Bahrami T, Rejeh N, Heravi-Karimooi M, Tadrisi SD, Vaismoradi M. "The effect of foot reflexology on hospital anxiety and depression in female older adults: A Randomized Controlled Trial." Int J Ther Massage Bodywork. 2019 Aug 30; 12(3):16-21.
11. Foroughi N, Zhu KCY, Smith C, Hay P. "The perceived therapeutic benefits of complementary medicine in eating disorders." Complement Ther Med. 2019 Apr;43:176-180.
12. Cancer symptoms and treatment side effects: What does the research show? NCCIH Clinical Digest for health professionals, December 2018.
13. Tiffany Field. "Pediatric massage therapy research: A narrative review." Children (Basel) 2019 Jun; 6(6): 78.
14. Wilczynska D, Lysak-Radomska A, Podczarska-Glowacka M, Jolanta Zajt, Dornowski M, Skonieczny P. "Evaluation of the effectiveness of relaxation in lowering the level of anxiety in young adults—a pilot study." Int J Occup Med Environ Health 2019;32(6):817-824.