In many ways, massage therapy (MT) research is still in its early stages. By the early 1990s, only a handful of researchers had conducted well-designed MT research studies. Some of these went unpublished (for example: Levin SR. Acute effects of massage on the stress response. Master's thesis, University of North Carolina, Greensboro, 1990; Hemenway CB. The effects of massage on pain in labor. Master's thesis, University of Florida, Gainesville, 1993), probably because there were fewer places to publish MT research then, but a few other studies concerned with specific conditions such as low back pain(1), or specific populations such as cancer patients(2), did appear in scientific and professional journals. However, to the best of my knowledge, no one had an ongoing program of MT research during this period.
The situation changed, of course, in 1992, with the founding of the Touch Research Institute (TRI). Tiffany Field and her colleagues established a program of scientific MT research that continues today. As a result, both the quantity and the quality of MT research show an improvement beginning in that year, and by 1998, TRI had conducted enough MT research for Field to publish a narrative review of MT research in the widely-read journal American Psychologist(3). That review highlighted TRI's empirical approach to MT research, in which MT was applied to all manner of specific clinical conditions and populations to see what worked. Individual studies examined the effects of MT on infant growth and development, postoperative pain, juvenile rheumatoid arthritis, fibromyalgia, back pain, migraine headache, multiple sclerosis, spinal cord injury, autism, attention-deficit/hyperactivity disorder, posttraumatic stress disorder, eating disorders, chronic fatigue, depression, diabetes, asthma, HIV, and breast cancer. In addition to several condition- and population-specific effects, Field's review asserts the existence of a set of more general MT effects that were consistently observed across the individual studies. These effects were reductions of anxiety, depression, and stress hormones.
From a research standpoint, those general effects are potentially more illuminating than are any condition- or population-specific effects, because their more basic, fundamental nature makes them a useful foundation for theories that attempt to explain how a treatment works, as opposed to merely determining if it works. Theories rooted in these general effects could both guide and accelerate the research process by suggesting the most fruitful areas and strategies for further research. To better understand the general effects of MT would be very valuable; therefore, let us examine what is already known about them more carefully.
One MT effectthe stress hormone reduction effectis contentious. Although this effect is widely reported upon as if it were already a scientific fact, quantitative reviews of MT research fail to support a stress hormone reduction effect in either adult(4) or pediatric(5) MT recipients. In actuality, the confident but erroneous assertions that such an effect is already well established are likely attributable to an analytical erroran emphasis on within-group analyses even when a study's design demands between-groups analysesthat is frequently committed in MT research(6). More research concerned with MT and stress hormones is definitely needed, but at present, the effect of MT on stress hormones is not a scientific fact on which theories can be built.
However, the other two general effects are well-supported by scientific data and widely agreed-upon by MT researchers. Quantitative research reviews show that a series of MT treatments consistently produces sizable reductions of depression in adult recipients(4). The effects of MT on anxiety are even better understood. Single sessions of MT significantly reduce state anxiety, the momentary emotional experiences of apprehension, tension, and worry in both adults(4) and in children(5), and multiple sessions of MT, performed over a period of days or weeks, significantly reduce trait anxiety, the normally stable individual tendency to experience anxiety states, to an impressive degree in adults(4).
Together, these effects on anxiety and depression are the most well-established effects in the MT research literature. They are especially important for us to understand not only for their own sake, but also because anxiety and depression exacerbate many other specific health problems(7). In other words, it is reasonable to theorize that quite a few specific health benefits associated with MT may actually be "second-order" effects that are a consequence of MT's "first-order" effects on anxiety and depression. For all these reasons, the anxiety- and depression-reducing effects of MT can form the basis of new testable theories that will guide future research and help to determine how, when, and for whom MT works.
Having spent much time thinking about MT's strong and consistent effects on anxiety and depression, I believe that the time is right to name a new subfield for MT research and practice: affective massage therapy (AMT). Building on what is already known about the effects of MT on anxiety and depression, everything possible should now be done to better understand and to optimize the ways that MT influences affect, the observable components of an individual's feelings, moods and emotions. The recognition of AMT as a distinct subfield leads naturally to a host of basic questions that need to be answered, and to theories that can be tested to ensure that our scientific understanding of MT progresses to the greatest possible degree.
Basic questions pertaining to AMT for which no evidence-based answers yet exist include these:
Theories of AMT to be tested include these:
The ramifications for AMT should be obvious. Undoubtedly, MT temporarily changes the recipient's bodily state, but how the recipient interprets that change must depend on their attitudes, expectations, and knowledge of MT, and on their perception of the affective state and presentation of the therapist.
I hope that some of you find the idea of AMT as inspiring and as interesting as I do, and I look forward to future IJTMB articles that address some of the questions and theories that I have suggested here, as well as others that I have undoubtedly overlooked.
Christopher A. Moyer, PhD
Research Section Editor, IJTMB
Department of Psychology
University of Wisconsin–Stout
Menomonie, WI, USA
The author declares that there are no competing interests.
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International Journal of Therapeutic Massage and BodyworkVolume 1, Number 2