Research-Based Stress Conditions
The earliest studies on stress were performed by Hans Selye, who measured the physiological responses of animals to external pressures, such as heat and cold, prolonged restraint, and surgical procedures, then extrapolated from these studies to human beings.(3)  Subsequent studies of stress in humans established the view that stress is caused by distinct, measureable life stressors, and further, that these life stressors can be ranked by the median degree of stress they produce.  This led to the Holmes and Rahe Stress Scale below.(4)

Social Readjustment Rating Scale by Holmes and Rahe

Life Stressor

Rank

Death of spouse

100

Divorce

73

Imprisonment

63

Death of a close family member

63

Personal injury or illness

53

Dismissal from work

47

Retirement

45

How does stress affect us?
When we are under stress, our body goes into a “fight or flight” response and the sympathetic nervous system releases hormones.  Increased amounts of cortisol in the blood causes suppression of our immune system and can be indirectly linked to HBP, heart disease and stroke.  Stress has been associated with anxiety and depression, sleep disorders, irritable bowel syndrome and many other diseases.  When stress becomes chronic the suppressed immune system can allow infections and cancer to invade our body, which can lead to disease and death.
More recently, it has been argued that external circumstances do not have any intrinsic capacity to produce stress, but instead their effect is mediated by the individual's perceptions, capacities, and understanding.  The health realization/innate health model of stress is founded on the idea that stress does not necessarily follow the presence of a potential stressor.  This model focuses on the nature of thought, stating that it is ultimately a person's thought processes that determine the response to potentially stressful external circumstances.  In this model, stress results from appraising oneself and one's circumstances through a mental filter of insecurity and negativity, whereas a feeling of well-being results from approaching the world with a "quiet mind," "inner wisdom," and "common sense".(5)

Research-Based Implications for Massage Therapists
In a pilot Randomized Controlled Trial conducted on Registered Nurses, researchers showed that Chinese massage techniques reduced occupational stress. (14)  A study conducted on 147 patients suffering from anxiety, depression and chronic stress showed that therapeutic touch reduced symptoms of pain, panic, anger, fear and sleep disorders. (14)  In a recent study massage was reported to have a positive effect on cancer patients suffering from stress associated with their illness. (11)  Participants included 1290 cancer patients and 12 licensed massage therapists. Three variations of massage (selected mainly by the patients) were used:  Swedish, light touch, and foot massage. The main outcome measures were data from symptom cards collected by independent observers that were recorded before and after the first session of massage.  The largest effect of massage therapy may be on the reduction of trait anxiety and depression, with a course of treatment providing benefits similar in magnitude to those of psychotherapy.  Symptom scores declined in severity by approximately 50%.  Swedish and light touch massage were found to be superior to foot massage. According to the article, practitioners need to be aware of the following special situations with cancer patients:

  • Coagulation disorders, complicated by bruising and internal hemorrhage including Low platelet count and medications like coumadin, acetylsalicylic acid, and heparin.
  • Metastases to bone, complicated by fracture.
  • Open wounds or radiation dermatitis, complicated by pain and infection.

In these situations, therapists should avoid massaging over bone fractures and open wounds and lighten up the pressure so that bruising will not occur in patients with coagulation disorders.  There is no evidence to suggest that massage can spread cancer, but avoiding direct pressure over a tumor is a sensible precaution. (11) A recent prospective randomized trial completed by the department of radiation oncology and the Canadian Touch Research Centre in Montreal evaluated the effects of massage therapy on anxiety levels in patients undergoing radiation therapy.  In a 6-month period, 100 patients undergoing radiation therapy were randomly assigned to either massage sessions or control sessions. The massage group received a 15-minute massage session before radiotherapy over 10 consecutive days. The control group did not receive massage.  The State–Trait Anxiety Inventory and a Visual Analog Scale were used to evaluate both groups.  Following massage, anxiety scores in the patients were significantly reduced (by 43%) as compared with pre-massage scores.  In both groups, patients experienced an average 20% reduction in anxiety between the first and the last radiotherapy session, but that result did not reach statistical significance.  The massage therapy was associated with an immediate significant decrease in anxiety scores before radiotherapy (procedural anxiety). (16)  The most recent publication of a randomized controlled trial of massage for cancer patients is a multicentre study from four U.K. cancer centers and a hospice 15. A total of 288 cancer patients, referred to complementary therapy services for clinical anxiety or depression, or both, were allocated randomly to a course of aromatherapy massage or to usual supportive care alone. Reduction in anxiety and depression was significant at 2 weeks after the intervention, but not at 6 weeks. The authors concluded that aromatherapy massage is an effective therapeutic option for the short-term management of mild-to-moderate anxiety and depression in patients with cancer. (15)

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