Motivation and emotion/Book/2013/Massage and emotion

Overview
As you begin reading this article, take a moment to reflect on what you are feeling physically, mentally and emotionally. You may feel physical strain – in your eyes from looking into a computer monitor, laptop, tablet or phone screen. This strain in your eyes may be the precursor to a headache. There may be an ache in your back, shoulders and neck from sitting for a prolonged time or in an uncomfortable posture, maybe even in your legs as they hang off a chair. Take a moment to realise how this physical strain is making you feel mentally. A few words which come to mind may be: stressed, tensed, fatigued. So, how is your current mental and physical state affecting your emotions? You may feel irritable, difficulty concentrating, anxious, exhausted and the list goes on!

Now, let’s take a moment to think of one heavenly word… MASSAGE. Doesn't just mentioning the word give you a sense of relief? You may feel refreshed, invigorated, maybe even tempted to jump straight out of your chair and onto a massage bed! Just out of curiosity, where did all this energy come from suddenly? How did this word relax the muscles in your face and create a smile? How did a word affect you physically, mentally and emotionally?

Massage has many effects on one’s well-being and lifestyle. Known as an alternative to medical treatment, there are endless types of massages. In this chapter of Motivation and Emotion: Improve your Life, you will learn about massage, explore its effects on your body and mind, and choose which modality would suit you best in order to improve your life!



What is massage?
Massage, as defined by Moyer, Rounds and Hannum (2004), is the earliest form of medicinal practice to enhance health and well-being by means of manipulation of soft tissues and muscles over the body. Etymology of the word helps gain understanding of the practice to be the act of kneading through touch.

History
Massage is often referred to as an ancient practice. Written evidence proves massage techniques were practiced in 2000 B.C., prominently in the Asian and Middle Eastern cultures (Elton, Stanley, & Burrows (1983), as cited in Moyer, Rounds & Hannum, 2004).

In the 17th century it was found that over 60 different essential oils were common ingredients in medicines and perfumes (Edge, 2003). The 1960s saw a revived use of essential oils following the discovery, by French chemist, Gattefossé, that lavender oil was extremely effective in the treatment of external injuries such as burns and many other oils were found to have exceptional antiseptic qualities.

Massage as an alternative treatment
Although much research has not been conducted regarding massage as an alternative to psychotherapy, Moyer, Rounds and Hannum (2004) found many structural similarities between both forms of therapy. An analysis of psychotherapy indicated the effectiveness of the practice is not due to special elements which different therapists may throw in, but is the result of shared factors which are required as a standard form of the sessions (Wampold (2001), as cited in Moyer, et al.). Factors involved in psychotherapy may be the client having a positive expectation that this session will prove beneficial, the therapist providing empathy and positive regard and the development of a safe and secure rapport (Moyer, et al.). These factors can be further associated with factors involved in massage therapy, when a recipient enters a massage clinic they may feel positive and expect feelings of relaxation, the therapist must create a rapport to assure the recipient they will be safe and secure by displaying positive regard, interpersonal contact, verbally and through touch, which will form the foundations of the alliance (Moyer, et al.). Other similarities involve the need for repeated sessions to improve and maintain the desired results and lengths of sessions depending on the requirement or intensity of the condition.

Massage therapy for cancer patients
Cancer patients experience many stages of physical, mental and emotional discomfort. One excruciating period is in the advanced stage of cancer where the disease spreads to the bones causing intolerable pain. Jane, Wilkie, Gallucci, Beaton and Huang (2009) conducted a study examining the effects of comfortable massage pressure on the intensity of pain, anxiety and physiological relaxation compared at various time points. The experiment was conducted over three days with 30 patients (Jane, et al.). The results indicated decreased pain and anxiety in immediate, short, intermediate and long term assessments (Jane, et al.). Jane, et al. stated that the results found were hopeful however not significant, therefore it is suggested to consider massage therapy be used in conjunction with pharmacological treatments to improve the management of pain during the tender stages.

Aromatherapy
An extended eight month study was conducted by Edge (2003) investigating the effects of massage involving aromatherapy on mental health in adults. The study consisted of eight individuals who were recommended to receive aromatherapy massage. Participants received therapy once a week for six weeks (Edge). Levels of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HAD) as pre-test and post-test measures (Edge). Other measures included a recording of mood, anxiety and relaxation through a visual analogue scale (VAS) before, after and six weeks after the therapeutic sessions. These assessments were compared with the results obtained from the HAD scale (Edge). Edge observed improvements in six out of the eight HAD scales and significant improvements in all areas assessed by the VAS.

Yoga
Yoga, a form of self-massage, involves the act of applying pressure through rubbing and pushing limbs against limbs and the floor (Field, 2011). Yoga, similar to massage therapy, involves the stimulation of pressure points, the underlying mechanisms also reflect massage therapy. The gate control theory, deep sleep theory and increased serotonin levels are considered to be the factors involved in incurring the benefits of massage and yoga (Field). Field combined the vast effects of yoga into a review, effects of yoga on individuals mind, pain, cardiovascular health, autoimmune and immune conditions, pregnancy, physiology and physical well-being were collated. There is extensive research and evidence supporting yoga and its beneficial effects on the well-being from a variety of aspects (Field).

For more details on the benefits and effects of yoga on emotions, see Yoga and emotion

The emotional and psychological influence
Massage therapy has shown to significantly improve mood and anxiety related emotions. Assessments conducted immediately after a massage session compared to assessments completed prior to the massage session were noted and found significant improvements (Cowen et al., 2005). Cowen et al. (2005) conducted single Thai massage and Swedish massage on participants to examine the effects on physiological and psychological measures. Significant improvements in tension anxiety and confusion bewilderment were found immediately after the massage session, a 48-hour follow up assessment indicated continued improvement in disorientated behaviour (Cowen, et al.).

Cho and Tsay (2004) examined how the fatigue and depression of patients with end-stage renal disease would be affected by a combination of acupressure with massage in comparison to routine care. The 10 minute acupressure massage sessions were performed for three days over a span of four weeks, assessments of fatigue and depression were conducted in the initial and final sessions (Cho & Tsay). Cho and Tsay reported a significant improvement in depression in patients receiving acupressure massage in comparison to the control group. The findings may prove beneficial for enhancing care of patients suffering from renal diseases.

Moyer, Rounds and Hannum (2004) conducted a meta-analysis to investigate the effects of single and multiple applications of massage therapy and compared the efficacy to data obtained from results which made use of other or usual treatment options. The results presented supported that massage therapy improves blood circulation. Significant improvements in immediate assessments and single applications of massage on anxiety, blood pressure and heart rate were observed and no significant improvements in pain, mood or cortisol level (Moyer, et al.). Moyer, et al. found that anxiety was reduced in over 64% of participants and 60-66% participants experienced lowered blood pressure and heart rate. In multiple applications of massage therapy 62% participants pain levels showed significant decline and depression and anxiety were further reduced (Moyer, et al.). The results of this study present alternatives for patients with depression or anxiety disorders to consider massage as a treatment option to attempt in conjunction with or without psychotherapy (Moyer, et al.).

The physical influence
The physical benefits obtained from massage sessions are quite noticeable. Applying pressure to tense muscles is an act we may do unconsciously, when done deliberately by massage therapists recipients experience reduced tension. Western massage techniques are largely considered to be mechanical, meaning the basis of therapy lie in the anatomy of the human body; certain pushing, pulling or pressures release certain muscles (Cowen, et al., 2005).

Moyer, Rounds and Hannum (2004) stated that massage therapy may speed up the healing process and reduce pain through mechanical means. Various manipulations of pressure help the breaking down of subcutaneous adhesions and prevent fibrosis (Donnelly & Wilton, 2002, as cited in Moyer, et al.). The manipulations induce the release of endorphins into the blood stream which in turn provide relief from pain and stimulate the feelings of well-being (Moyer, et al.). Cowen, et al. (2005) found significant improvements in range of motion and blood pressure compared to baseline assessments.

Gate control theory
The gate control theory of pain was developed by Ronald Melzack and Patrick Wall in the 1960s. It is proposed that the experience of pain is a result of an interplay between the central and peripheral nervous system (Moyer, Rounds & Hannum, 2004). When injured, damaged tissue sends signals to the brain, through the peripheral nervous system. This message then encounters permeable ‘nerve gates’ which allow entry regarding the number of factors, if a message is accepted the pain is experienced, on the other hand, if a message is declined the pain may remain unnoticed. In technical terms, electrical messages accepted by the nerve gates are called A-delta fibres. These travel at speeds of 40 mph. Messages declined are called C-delta fibres and these travel at a speed of 3 mph (Deardoff, 2003). The act of applying pressure and heat or cold sends an electrical impulse quicker than A-delta fibres which override the pain messages (Deardoff).

To understand this theory, let’s remember back to a moment when we hit our elbow, knee or toe against a piece of furniture. What was your first reaction? You may have cursed the stationary object for magically appearing in your way! More importantly, you would have applied pressure to the area hurt. This pressure provides comfort and warmth or chill by applying ice, and sends a message to your brain which is faster and much stronger than the intensity of the pain message. The pressure message tells your brain the pain has been taken care of so it can be forgotten and you can stop cursing now.

Deep sleep theory
The deep sleep theory suggests sleep is restorative and healthy for the body and deprivation of deep sleep results in changes in chemicals. The change in chemicals may be the precursor to increased or stable pain in areas which may be tensed (Moyer, Rounds and Hannum, 2004). Sunshine (1996, as cited in Moyer, et al.) found performing massage on participants had promoted deep sleep which resulted in decreased experience of pain, this was caused by an increase in substance P which reduced levels of somatostatin, a hormone which inhibits the growth hormone, which is linked with the experience of pain.

Parasympathetic activity
Moyer, Rounds and Hannum (2004) presented a review of a theory suggesting that massage promotes parasympathetic activity. Our nervous systems contain two different types of reactions, one of which is commonly known as the fight or flight response. These responses are sympathetic which refers to a defensive state in which the body may be alert or tense. The second, and opposite, response or state is parasympathetic which refers to a state in which we are calm and relaxed. The theory suggests that massage therapy switches the body from a sympathetic to parasympathetic state as the process of applying pressure may increase levels of serotonin and stimulate vagal activity, concerning the vagus nerve, one of the nerves which send impulses to the brain (Field, 1998, as cited in Moyer, et al.).

Acupressure massage
Acupressure is a technique in which physical pressure, by hand, elbow or specific devices, is applied to certain ‘acupoints’ located over the body which clear blockages which may be present. The techniques within acupressure are supposed to regulate and balance the body’s ‘energy’ which results in enhanced health and a stronger immune system (Cho & Tsay, 2004). Chen, Li, Wu, and Lin (1996, as cited by Moyer, Rounds & Hannum, 2004) found, in their study investigating the effects of acupressure on sleep quality, that stimulation of acupressure points enhanced the quality of sleep and the massage indirectly reduced pain intensity.

Aromatherapy massage
Aromatherapy massage involves the use of essential oils, such as lavender oil, to enhance well-being (Edge, 2003). Essential oils may also be used in infusers, candles and clothing to obtain the relevant benefits, lavender oil, for example, may be used for relaxation purposes for yourself after a long day at work or lightly dabbed onto a hyperactive child’s clothing to induce calmness.

For more details on how smells can affect our emotions, see Smell and emotion

Swedish massage
Swedish massage is the most popular form of massage practiced in Western countries (Cowen, et al., 2005). It was founded through performing dissections of the human anatomy and discovering which muscles may become tense and how to relieve them, thus has a mechanical emphasis (Cowen, et al.). This modality usually requires undressing to obtain the maximum benefit.

Thai massage
Thai massage has originated from oriental medicine and yoga, practiced typically in the Eastern countries, and gradually becoming prevalent in Western countries (Cowen, et al., 2005). Cowen, et al. found no significant differences between Swedish and Thai massage, with both yielding similar effects. As Thai massage focusses more on the reflexive and flexibility aspects, this modality may be a common choice for individuals who may not be comfortable with the thought of undressing for a massage session.

Yoga
Yoga is an exercise in which we can obtain many benefits as with massage. There are various forms of yoga which are practiced to achieve different results. Field (2011) presented the more prominent forms and their respective results:
 * Hatha yoga – a relaxing and restoring form of yoga (Field)
 * Ashtanga yoga – involving positions which initially cause strain in order to achieve relief, this form of yoga may also be known as power yoga (Field)
 * Anusara yoga – involving more light and flowing movements and postures, this form of yoga may also be known as Vinyasa (Field)
 * Iyengar yoga – a form of yoga to improve strength, postures may include headstands which are to be held for a proposed length of time (Field)
 * Bikram yoga – a form of yoga which is practiced in a room with high temperatures (Field)

Conclusion
Massage benefits a variety of functions in emotion and psychology, physiology and physical activity. Single applications of massage and multiple applications are able to provide many benefits. If there are certain reasons visiting a massage clinic is not possible, yoga is a recommended, self-massage alternative.

In light of the research presented, it is not recommended to diagnose and determine a form of treatment without consulting a professional in the medical field.

Other motivation and emotion book chapters

 * Being touched
 * Smell and emotion
 * Yoga and emotion