The Emotional Effects of Massage

1. The Emotional Effects of Massage Richard Hill B.A. (Ling), Dip Prof Couns. Davis Health Centre AAMT Conference May 16-19, 2008

2. Principal Texts • Hill, R. 2006 How the ‘real world’ is Driving Us Crazy! Hill & Hill p/l. Sydney. • Field, T. (ed) 2004 Touch and Massage in Early Child Development Johnson & Johnson Pediatric Institute L.L.C. • Rossi, E.L. 1993 The Psychobiology of Mind-Body Healing Revised Edition. W.W. Norton & Co., New York. • Rossi, E.L. 2002 The Psychobiology of Gene Expression W.W. Norton & Co., New York. • Uvnäs-Moberg1, K. & Petersson, M. 2004 Oxytocin, a Mediator of Anti-stress, Well-being, Social Interaction, Growth and Healing Vandenhoeck & Ruprecht http://www.v-r.de/data/files/1000100/oxytocin.pdf www.richardhill.com.au

5. (LIMBIC) HYPOTHALAMIC PITUITARY ADRENAL The HPA Axis of Stress Sympathetic System

6. Corticotrophin Releasing Hormone - CRH Adrenocorticotrophin Hormone – ACTH Adrenaline – Epinephrine

7. STRESS • During acute stress ‘long-term biological well-being is sacrificed for immediate survival’ (Cozolino:2002) • Social engagement systems are shut down • Long term systems are relegated • Winner/Loser world – Creative World

8. WHAT HAPPENS DURING MASSAGE?

9. glucose receptors kinases nerves peptides nutrients blood chemicals Our entire organism is a flowing network of energy and information BDNF dopamine mRNA hormones DNA oxygen adipocytokines seratonin glutamate cytokines macrophages ATP neuropeptides synapses stem cells toxins

10. University of Miami of Medicine Touch Research Institute. Miguel Diego and Tiffany Field (2004) “Moderate Pressure Massage Increases Relaxation” • Moderate pressure showed shift towards the left frontal lobe (positive emotive & socialising aspects) and decrease in heart rate during and after massage

11. Activation of interstitial receptors triggers the autonomic nervous system to change the pressure in fascial arterioles and capillaries releasing nitric oxide.

12. Nitric Oxide • (1987) endothelial cells in blood vessels release NO, diffuses to neighbouring smooth muscle and causes relaxation

13. Oxytocin An important hormone in the action of the parasympathetic system. A mediator and stimulator of a large number of ‘wellbeing’ beneficial psychbiological actions.

14. Oxytocin, a Mediator of Anti-stress, Well-being, Social Interaction, Growth and HealingKerstin Uvnäs-Moberg, Maria Petersson The Oxytocin Factor: Tapping the Hormone of Calm, Love, and Healing (Hardcover) by Kerstin Uvnäs-Moberg (2003) Da Capo Press

15. Oxytocin can induce anti-stress-like effects such as reduction of blood pressure and cortisol levels. • It increases pain thresholds, exerts an anxiolytic-like effect. • Stimulates various types of positive social interaction. • Promotes growth and healing.

16. Released by various types of non-noxious sensory stimulation, for example by touch and warmth. • Various types of psychotherapy involving transfer of support, warmth and empathy. • Sexual activity, childbirth and breastfeding [119]. • Levels are decreased in patients with depression, stress-related disorders, anxiety and chronic pain [128-133]. • Oxytocin increases seratonin levels

17. Vagus Nerve

18. Vagal Afferents • The nerve impulses that travel from the extremities TO the brain along the Vagus Nerve. Vagal Efferents • The nerve impulses that travel FROM the brain along the Vagus Nerve.

19. 25. Windle RJ, Shanks N, Lightman SL, Ingram CD. Central oxytocin administration reduces stress-induced corticosterone release and anxiety behavior in rats. Endocrinology 1997; 138:2829-34. • 34. Lund I, Yu LC, Uvnäs-Moberg K, Wang J, Yu C, Kurosawa M, et al. Repeated massage-like stimulation induces long-term effects on nociception: contribution of oxytocinergic mechanism. Eur J Neurosci 2002;16:330-8 • 35. Uvnäs-Moberg K. Antistress pattern induced by oxytocin. News Physiol Sci (NIPS) 1998; 13:22-6. • 36. Björkstrand E, Eriksson M, Uvnäs-Moberg K. Evidence of a peripheral and a central effect of oxytocin on pancreatic hormone release in rats. Neuroendocrinology 1996;63:377-383. • 37. Björkstrand E, Ahlenius S, Smedh U, Uvnäs-Moberg K. The oxytocin receptor antagonist 1-deamino-2-D-Tyr(OEt)-4-Thr-8-Orn-oxytocin inhibits effects of the 5-HT1a receptor agonist 8-OH-DPAT on plasma levels of insulin, cholecystokinin and somatostatin. Regul Pept 996;63:47-52. • 38. Siaud P, Puech R, Assenmacher I, Alonso G. Microinjection of oxytocin into the dorsal vagal complex decreases pancreatic insulin secretion. Brain Res 1991;546:190-4. • 48. Petersson M, Alster P, Lundeberg T, Uvnäs-Moberg K. Oxytocin increases nociceptive thresholds in a long-term perspective in female and male rats. Neurosci Lett 1996;212:87-90. • 61. Petersson M, Uvnäs-Moberg K, Erhardt S, Engberg G. Oxytocin increases locus coeruleus alpha 2-adrenoceptor responsiveness in rats. Neurosci Lett 1998;255:115-8. • 67. Diaz-Cabiale Z, Olausson H, Sohström A, Narváez A, Uvnäs-Moberg K, Fuxe K. Postnatal oxytocin treatment increased the density and reduced the affinity of alfa2adrenoceptor agonist binding sites in central autonomic regions of the adult rat in a regionally selective pattern modulated by prenatal stress. Neuropsychopharmacology, in press. • 68. Kendrick KM, Keverne EB, Baldwin BA, Sharman DF. Cerebrospinal fluid levels of acetylcholinesterase, monoamines and oxytocin during labour, parturition, vaginocervical stimulation, lamb separation and suckling in sheep. Neuroendocrinololgy 1986;44:149-56. • 69. Sansone GR, Gerdes CA, Steinman JL, Winslow JT, Otenweller JE, Komisaruk BR, et • al. Vaginocervical stimulation releases oxytocin within the spinal cord in rats. Neuroendocrinology 2002;75:306-15. • 70. Stock S, Uvnäs-Moberg K. Increased plasma levels of oxytocin in response to afferent • electrical stimulation of the sciatic and vagal nerves and in response to touch and pinch in anaesthetized rats. Acta Physiol Scand 1988;132:29-34

20. 71. Vallbo AB, Olausson H, Wessberg J. Unmyelinated afferents constitute a second system coding tactile stimuli of the human hairy skin. J Neurophysiol 1999;81:2753-63. • 72. Olausson H, Lamarre Y, Backlund H, Morin C, Wallin BG, Starck G et al. Unmyelinated tactile afferents signal touch and project to insular cortex. Nature 2002;5:900-4. • 87. Holst S, Uvnäs-Moberg K, Petersson M. Postnatal oxytocin treatment and postnatal • stroking of rats reduce blood pressure in adulthood. Auton Neurosci 2002;99:85-90. • 88. van Oers, de Kloet E, Whelan T, Levine S. Maternal deprivation effect on the infant´s neural stress markers is reversed by tactile stimulation and feeding but not by suppressing corticosterone. J Neurosci 1998;18:10171-9. 22 • 89. Caldji C, Tannenbaum B, Sharma S, Francis D, Plotsky PM, Meaney MJ. Maternal care during infancy regulates the development of neural systems mediating the expression of fearfulness in the rat. Proc Natl Acad Sci (USA) 1998;95:5335-40. • 119. Carter S. Oxytocin and sexual behavior. Neurosci Biobehav Res Rev 1992;16:131-44. • 128. Frasch A, Zetzsche T, Steiger A, Jirikowski GF. Reduction of plasma oxytocin levels in patients suffering from major depression. Adv Exp Med Biol 1995;395:257-8. • 129. Beckmann H, Lang RE, Gattaz WF. Vasopressin.oxytocin in cerebrospinal fluid of schizophrenic patients and normal controls. Psychoneuroendocrinology 1985;10:187-91. • 130. Linkowski P, Geenen V, Kerkhofs M, Menlewicz J, Legros JJ. Cerebrospinal fluid • neurophysins in affective illness and in schizophrenia. Eur Arch Psychiatry Neurosci 1984; 234:162-5. • 131. Uvnäs-Moberg K, Arn I, Theorell T, Jonsson CO. Gastrin, somatostatin and oxytocin • levels in patients with functional disorders of the gastrointestinal tract and their response to feeding and interaction. J Psychosom Res 1991;35:525-3. • 132. Alfvén G, de la Torre B, Uvnäs-Moberg K. Depressd concentrations of oxytocin and • cortisol in children with recurrent abdominal pain of non-organic origin. Acta Pediatr 1994; 83:1076-80. • 133. Anderberg UM, Uvnäs-Moberg K. Plasma oxytocin levels in female fibromyalgia syndrome patients. Z Rheumatolog 2000;59:373-9. • 134. Uvnäs-Moberg K, Björkstrand E, Hillegaart V, Ahlenius S Oxytocin as a possible mediator of SSRI-induced antidepressant effects. Psychopharmacology 1999;142:95-101. • 135. Uvnäs-Moberg K., Hillegaart V, Alster P, Ahlenius S. Effects of 5-HT1a agonists, selective for different receptor subtypes, on oxytocin, CCK, gastrin and somatostatin plasma levels in the rat. Neuropharmacology 1996;35:1635-40.

22. SO, WHY ARE MY CLIENTS CRYING AND MOANING AND BITCHING? IF MASSAGE PROMOTES CALMING AND THE PARASYMPATHETIC SYSTEM, THEN WHAT GIVES?

23. S.D.M.L.B. • State Dependent Memory, Learning and Behaviour • The linking of memory to particular states of the mind/body. • The linking of particular states of the mind/body to memory (and behaviour)

24. Clients reveal emotional concerns that have sublimated as physical traumas. As massage releases physical trauma, related emotions may also be released in various ways – talk tears body movements breathing patterns

25. WHAT IS HEALING?

26. Healing is an intensely personal, subjective experience involving a reconciliation of the meaning an individual ascribes to distressing events with his or her perception of wholeness as a person http://www.medscape.com/viewarticle/506905_1 Accessed 26/04/2008

27. You are not the healer You are a mechanism in the individual’s healing process

28. H.A.R.M.O.N.Y. • Happy – the contented satisfaction of feeling you are doing what you are meant to do. • Able – having the capacity and the capability to act. • Responsive – to be empathetically aware and sensitive in your reactions • Mindful – having an awareness of the present moment, uninhibited by judgement. • Open – acting with unconditional positive regard • Nascent – sensing that something new is coming into existence. • Yes – no barrier to what is being created - Positive (Hill:2006)

29. PLACEBO RESPONSE We can now understand that any drug that alters any aspect of the body’s sensory-perceptual or physiological responsiveness on any level can disrupt the more-or-less fragile state-dependent encoding of symptoms and thereby evoke a “nonspecific” but very real healing effect that we can call the “placebo response”. Rossi (1993)

30. Techniques

31. 1. THE PROBLEM IS A MESSAGE A problem is something you have to stop for and fix. A message is something that tells you what you need and points to where you can go.

32. 2. THAT’S INTERESTING. The world is full of information and every bit of it is interesting.

33. 3. WHAT CAN I CREATE? When you give up the distracting game of winning and losing, you are left with the exciting prospects of what you can create.

34. 4. WOW! To be fascinated by the events of another person’s life makes every life worth examining

35. 5. REPETITION Repeating what has just been said with involved enthusiasm supports what was said and entreats what is yet to be said.

36. 6. SHARED PERSONAL EXPERIENCE To show empathy not just by sympathetic intent, but also by personal experience. This, however, must be very gentle and supportive. CAUTIONS: Clients can easily feel that they are not special; that you think you know everything; and you can be sorely tempted to give advice as if you know the answer.

37. Remember: everyone enjoys a little massage

38. Techniques • 1. THE PROBLEM IS A MESSAGE • 2. THAT’S INTERESTING. • 3. WHAT CAN I CREATE? • 4. WOW! • 5. REPETITION • 6. SHARED PERSONAL EXPERIENCE – self exposure

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