Massage therapy and anxiety: what the evidence shows, including the null results

Many people seek complementary approaches, such as massage therapy, for managing anxiety [1, 3]. It is important to look at what scientific research shows about how massage therapy affects anxiety symptoms and diagnosed anxiety conditions [1, 3]. This article reviews key studies, including those that found no difference between massage and other treatments [1].

The Sherman Study: Therapeutic Massage for Generalised Anxiety Disorder

One important study looked at the effectiveness of therapeutic massage for people diagnosed with Generalised Anxiety Disorder (GAD) [1]. GAD is a specific anxiety disorder. While massage is a popular complementary treatment for anxiety, its effects on a diagnosed anxiety disorder had not been thoroughly studied before this research [1].

Study Design

The study included 68 people who had GAD [1]. These participants were randomly assigned to one of three groups for treatment over 12 weeks [1]. Each group received a total of 10 sessions [1].

The three groups were: * Therapeutic massage (23 participants) [1]. * Thermotherapy (heat treatment) (22 participants) [1]. * Relaxing room therapy (23 participants) [1].

The main goal of the study was to measure the average reduction in anxiety symptoms [1]. This was done using the Hamilton Anxiety Rating Scale (HARS) [1]. The study also looked at other outcomes, such as a 50% reduction in HARS scores, whether GAD symptoms went away, changes in depressive symptoms (measured by the Patient Health Questionnaire (PHQ-8)), worry levels, and how GAD affected daily life [1]. Researchers compared these outcomes between the massage group and the control groups immediately after treatment and again at a 6-month follow-up [1].

Study Results

By the end of the 12-week treatment period, all three groups showed improvement in their anxiety symptoms [1]. The average reduction in HARS scores ranged from -10.0 to -13.0 points across the groups [1]. This level of reduction is considered a clinically important improvement [1]. The participants maintained these improvements when checked at the 26-week follow-up [1].

However, the study found no significant differences in improvement between the groups [1]. The statistical comparison showed a P-value of 0.39, meaning that massage therapy was not found to be better than thermotherapy or relaxing room therapy for reducing anxiety in people with GAD [1]. Similar patterns were seen for other measures, including symptom reduction, resolution of GAD, depressive symptoms, worry, and disability related to GAD [1].

What the Sherman Study Means

The researchers concluded that massage therapy was not superior to the control treatments [1]. All treatments led to some clinically important improvements, which the study authors suggested were likely due to a beneficial but general relaxation response [1]. Because the relaxing room treatment was much less expensive than the other treatments, the study suggested that a similar relaxation-focused approach, presented in a way that feels credible in a clinic, might be the most cost-effective choice for people with GAD who want to try complementary therapies focused on relaxation [1].

The Moyer Meta-Analysis: Understanding Different Effects of Massage

A meta-analysis combines the results of many different studies to get a broader understanding of a topic [2]. The Moyer meta-analysis reviewed 37 studies that used random assignment to test how effective massage therapy is [2]. This analysis looked at the average effect sizes for nine different outcomes [2].

Single Sessions vs. Multiple Sessions

The meta-analysis distinguished between the effects of a single application of massage therapy and the effects of multiple applications (a course of treatment) [2]. It also considered different types of anxiety: * State anxiety refers to a temporary feeling of anxiety that arises in a specific situation [2]. * Trait anxiety refers to a more stable, long-term personality characteristic where a person tends to be anxious across many situations [2].

Effects of Single Applications of Massage Therapy

A single session of massage therapy was found to reduce: * State anxiety [2]. * Blood pressure [2]. * Heart rate [2].

However, a single session did not reduce: * Negative mood [2]. * Immediate assessment of pain [2]. * Cortisol levels (a stress hormone) [2].

Effects of Multiple Applications of Massage Therapy

When massage therapy was applied over multiple sessions as a course of treatment, the meta-analysis found it reduced: * Delayed assessment of pain [2]. * Trait anxiety [2]. * Depression [2].

The reductions in trait anxiety and depression were found to be the largest effects of massage therapy [2]. The benefits seen for trait anxiety and depression from a course of massage treatment were similar in size to the benefits observed from psychotherapy [2]. The meta-analysis also noted that no specific factors consistently changed the results across studies, though further testing is needed [2]. The authors of this meta-analysis suggested that new theories and research for massage therapy could benefit from a perspective similar to that used in psychotherapy [2].

The Rapaport Review: Where the Field Stands

A review article by Rapaport and colleagues summarized the current understanding of massage therapy's role in treating common psychiatric disorders and symptoms [3]. This review highlighted the widespread occurrence of psychiatric disorders and the popularity of complementary and integrative treatments among the general public [3].

The authors discussed the growing body of research that describes the biological and neurobiological ways massage therapy might affect the body and brain [3]. The review looked at how massage can act as a therapy for major psychiatric disorders and also how it can help with psychiatric symptoms [3]. It also explored how massage therapists understand and approach the care of patients who have psychiatric concerns [3]. The review suggests that if mental health professionals, such as psychiatrists, are to work with massage therapists, they need to understand that massage therapists may have different perspectives than traditional medical practitioners [3]. The article proposed a framework for how psychiatrists and other mental health professionals can collaborate with massage therapists to care for patients [3].

Understanding Massage Therapy Regulation in Canada

It is important to know that the regulation of massage therapy varies from province to province in Canada [6]. This means that the rules and requirements for practitioners can be different depending on where you are.

Provinces with Regulated Massage Therapy

In some provinces, massage therapy is a regulated health profession. This means that a provincial regulatory college oversees the profession to protect the public [6]. These colleges set standards of practice, codes of ethics, and handle complaints [6]. Health professionals in regulated professions must be registered with their respective college to use the regulated title [6].

• Ontario: Registered Massage Therapists (RMTs) are regulated by the College of Massage Therapists of Ontario (CMTO) [4]. This college ensures that RMTs meet specific standards for education, competence, and ethical conduct [4]. You can contact the CMTO to verify a practitioner's registration or to learn about the official rules for massage therapy in Ontario [4].
• British Columbia: Massage therapy is regulated by the College of Complementary Health Professionals of British Columbia (CCHPBC) [5]. Similar to Ontario, this college is responsible for governing the profession and protecting the public [5]. You can check with the CCHPBC to verify a practitioner's registration or to find out about the rules in British Columbia [5].

Provinces Where Massage Therapy is Not Regulated

In other provinces, massage therapy is not a provincially regulated health profession. This means there is no government-mandated college overseeing the profession to protect the public in the same way as in regulated provinces [6].

• Alberta: The Government of Alberta lists the health professions that are regulated under its Health Professions Act (HPA) [6]. Massage therapy is not among the health professions regulated under that Act in Alberta [6]. In Alberta, regulatory colleges are legal bodies that are given the power to govern health professions and protect the public [6]. Registration with a regulatory college is required for health professionals who meet the requirements and provide services in a regulated profession, and it is mandatory to use the title of that regulated profession [6].

In provinces where a profession is not regulated, there may still be professional associations [6]. Professional associations are separate from regulatory colleges [6]. Their role is to promote and represent the interests of their members through education, advocacy, and other member benefits [6]. Membership in a professional association is voluntary [6]. Therefore, in Alberta, if a practitioner uses a title like 'RMT', it typically refers to a credential from a professional association rather than registration with a provincial regulatory college [6].

Understanding these differences is important when seeking a massage therapist, especially if you are looking for care related to health conditions.

What this means for you

Research suggests that massage therapy can offer relaxation and may help with symptoms of anxiety and depression [1, 2]. However, one study on Generalised Anxiety Disorder found that massage was not more effective than other relaxation methods, though all groups in that study showed clinically important improvement [1]. This suggests that the benefits might come from a general relaxation response [1]. Multiple sessions of massage therapy have been linked to larger effects on long-term anxiety (trait anxiety) and depression [2].

If you are thinking about using massage therapy for anxiety, it is important to discuss your situation with a licensed healthcare professional, such as your doctor or a mental health specialist. They can help you understand if massage therapy is a suitable option for you and how it might fit into a broader care plan.

When looking for a massage therapist, especially for health-related reasons, it can be helpful to choose a practitioner who is registered with a provincial regulatory college where applicable. This ensures they meet specific standards of practice. For example, in Ontario, you can verify registration with the College of Massage Therapists of Ontario [4]. In British Columbia, you can check with the College of Complementary Health Professionals of British Columbia [5]. In provinces like Alberta, where massage therapy is not provincially regulated, you might look for practitioners who are members of professional associations [6]. It is important to understand that membership in an association is different from provincial college registration [6]. You can learn more about what registered massage therapy is and find massage therapists in Vancouver. For more information, you can also read our patient guide to massage and anxiety.