Research: Mental Health & Massage

Research on Mental Health & Massage – A Deep Dive

Research on Massage, Mental Health and Sedentary Lifestyles: When considering supportive complementary treatment for mental health issues such as depression, anxiety, panic attacks or stress, massage therapy is not one of the first therapies to consider, it’s not usually even the fourth or the fifth. When I ask new clients if they have had a massage before the vast majority talk about booking one on holiday, or on a beach, in a hotel, beauty studio or at a spa.

As an unregulated profession a massage therapist can have as little training as a few weekends or as much as 3 years. Most people are unaware that a 3-year degree in advanced clinical massage exists which can treat and support those with acute injuries, chronic conditions – and also offer support for those struggling with their mental health.

Currently the highest qualification, and the only degree-level course in the UK, is offered by the Jing Institute of Advanced Clinical Massage and Complementary Medicine based in Brighton. I qualified on this degree level 6 BTEC in Advanced Clinical and Sports Massage Diploma earlier this year. A requirement was to undertake research and produce a dissertation thesis based on the results. As such in August 2023 I recruited a group of 22 people to participate in a 16-week research study into the effects of Jing Method™ of clinical massage on mental health and sedentary lifestyles.

---

Research on Massage and Mental Health in the Future – A Different Approach

I am thrilled to let you know that I have been invited to speak on my research into massage and mental health at the World Congress on Mental Health and Psychiatry in Amsterdam, Netherlands next March.

As a conference predominantly focussing on psychiatry and psychology as well as mental health, I feel incredibly privileged to be asked to speak on complementary therapies as an alternative treatment that can be used as an adjunct and support to work alongside more conventional treatment and medication.

It’s also a fantastic opportunity to let my colleagues know about this somewhat neglected area of mental health treatment, much in need of further research. Writing this blog is also a small part of publishing my results and getting them out into the wider community of social prescribing, magazines and support information for mental health conditions.

I have been asked to speak and give a lecture to experts in their field and my peers, as well as participate in a poster presentation. The congress also provides an excellent opportunity to exchange ideas, knowledge and expertise with fellow professionals, associations, institutions, public authorities and companies. With speakers already confirmed from as far afield as the United States, Australia, Spain, France and the Netherlands it promises to be an exciting event and I am extremely excited to be a part of it.

That may be enough information for you – however, if you’d like to hear more about how my participants reduced their mental health conditions by 74% overall in just a few months please do read on!

STUDY RESULTS

Depression: decreased by 77%

Anxiety: decreased by 85%

Stress: Decreased by 66%

Overall Levels: decreased by 74%

---

Mental Health – Why Research On Depression, Anxiety & Stress?

“Overall, around 1 in 6 adults (17%) surveyed in England met the criteria for a common mental disorder (CMD) in 2014.”
(McManus S, 2016)

With a loss of work linked to higher rates of suicide, employment plays a crucial role in mental health disorders (Borges et al., 2010; Battams et al., 2014). The most recent MIND Workplace Wellbeing Index highlights a lack of openness, mental health support, and a decline in work satisfaction, with 57% experiencing mental health disorders with their current employer and 21% working +45 hours/week (MIND, 2022).

“The World Health Organization reports that the single biggest risk factor for occupational illness is overwork, with those working +55 hours/week having a 17% increased risk of heart disease and 35% increased risk of stroke”
(Beheshti, 2021; Johnson and Jasarevic, 2021)

The World Health Organization reports that the single biggest risk factor for occupational illness is overwork, with those working +55 hours/week having a 17% increased risk of heart disease and 35% increased risk of stroke (Beheshti, 2021; Johnson and Jasarevic, 2021). Even before COVID-19 UK employees were working more than other EU countries (Trade Union Congress, 2019). By 2021 workload and hours in the UK had increased further, with employees working when sick, on annual leave, through their lunchbreaks and into the evenings, with a blurring between home and work life (Osborne, 2021; Stevens, 2021).

“The COVID-19 pandemic has significantly changed the way many people work…blurring the boundaries between home and work. Many businesses have been forced to scale back or shut down operations to save money, and people who are still on the payroll end up working longer hours.”
(Johnson and Jasarevic, 2021)

In 2021 a Hays survey reported 40% working during their holidays and 52% working longer hours than pre-COVID-19, with 41% of these employees working +5-10 hours/week and a concerning 25% working +10 hours/week (Churchill, 2021).

“the COVID-19 pandemic has created a global crisis for mental health, fuelling short- and long-term stresses and undermining the mental health of millions.”
(World Health Organization, 2022c)

---

Mental Health & Sedentary Lifestyles – The Research Study

This upward trend in mental health disorders and longer working hours in the UK by the year 2020 (Trade Union Congress, 2019) was greatly exacerbated by the unprecedented programme of COVID pandemic lockdowns, shielding, and home working in 2020 & 2021. With a further report outlining the increased risk of stroke and heart disease with longer working hours (Johnson and Jasarevic, 2021) and the NHS stating baldly that a seated lifestyle can lead to early death (NHS, 2022b) my research study aims were to assess the effects of a six-week course of Jing Method™ massage chronic stress protocols on those with a desk-based job or lifestyle who have levels of stress, anxiety, depression, or low-mood.

“Studies have linked being inactive with being overweight and obese, type 2 diabetes, some types of cancer, and early death.”
(NHS 2022b – Why We Should Sit Less)

The Research Study

A mixed group of 22 adults in desk-based lifestyles with differing levels of these mental health disorders agreed to join the 16-week study, with initial levels for eligibility assessed using the Depression, Anxiety and Stress Scale 42 (DASS-42) questionnaire. One person left before commencement due to commitments, another at week 1 due to caring responsibilities and two at week 9, due to work and childcare issues respectively, with 18 participants finishing.

• 6-week Control Period: establishing a baseline of mental health, with participants completing a DASS-42 questionnaire weekly.
• 6-week Treatment Phase: a weekly massage session using the Jing Method™ chronic stress protocols. Involving a multi-modal approach, this included grounding, myofascial release, hot stones massage and placement, effleurage and massage, acupressure points and gentle stretching. There was also a 5-minute daily self-care routine of stretches and breathing techniques which varied every 2 weeks.
• Post-Treatment Phase: 4 weeks post-treatment a last DASS-42 questionnaire was used to assess any longer-term effects of the study.

---

Research Results – Significant Improvements in Mental Health

Percentages

The results were significant and really do speak for themselves. All participants showed a marked improvement in levels of depression, anxiety and stress with group average scores decreasing by 77%, 85% and 66% respectively for each area. Overall DASS-42 scores decreased by 68% during the treatment phase and continued to decrease by 9% in the post-treatment phase. The overall group scores fell by 74% during the course of the full study.

• Full Study: all mental health levels decreased by 74%
• Treatment Phase: levels decreased by 74%
• Post-Treatment Phase: levels continued to decrease by 9%
• Depression: levels decreased by 77%
• Anxiety: levels decreased by 85%
• Stress: levels decreased by 66%

Severity Labels

I love the way these pie charts really show the depth and scope of the results of my study.

The DASS-42 questionnaire not only scored participants mental health but also rated it using 5 severity labels:
normal, mild, moderate, severe and extremely severe.

Again, the results are striking, particularly as a visual.

• Overall: all mental health conditions – 65% rated as mild to extremely severe in week 1 decreased to 4%, with 96% of participants rating as normal by week 16
• Depression: 56% rated mild to extremely severe at week 1 decreased to 11%, with 89% of participants rating as normal by week 16
• Anxiety: 56% rated mild to extremely severe in week 1 decreased to 0%, with 100% of participants rating as normal by week 16
• Stress: 78% rated mild to extremely severe in week 1 decreased to 0%, with 100% of participants rating as normal by week 16

Unexpected Results

As the study progressed there were some unexpected results which I had not anticipated. Whilst these could not be officially included I did record them for any future research projects and for interest.

Sleep and Mental Health

As can be seen below a significant number of participants recorded improved sleep throughout the study and of the three who recorded worse sleep two were due to having young children. As a massage therapist clients do often report improved sleep, particularly on the night of treatment, so these results were really interesting – not least because good quality and quantity of sleep is closely related to good mental health and vice versa as in this report by MIND: How does sleep relate to mental health?

Although massage is generally under-researched, its relationship to sleep is one area that has been better examined (Field et al, 2007; Hatchul et al, 2014; Samuel et al, 2021). Sleep and massage has also been investigated by other Jing Institute students either directly (Stanyon, 2015; Ward, 2015; Reif, 2018; Meyer, 2021) or indirectly when investigating such diverse areas as the menopause, whiplash and PTSD (Gant, 2015; Babbs, 2019; Hyde, 2021; Hurworth, 2023). My hope would be that my study can augment these studies and encourage future research to improve sleep in general – so crucial for many areas of healthcare (for a really good read I recommend Professor Matthew Walkers – Why We Sleep: The New Science of Sleep and Dreams) and mental health.

Decrease in Procrastination

This is much harder to quantify but enough participants commented upon it for it to be noticeable. More to the point, it was something I noticed in myself as well. This is perhaps not to be wondered at. A lack of motivation is an extremely common symptom of depression, stress or anxiety, and an increased ability to complete tasks could be a potential consequence of an improvement in mental health levels.

Therapist Improvements

As I was giving rather than receiving the treatment I can honestly say that I wasn’t expecting an improvement in my own mental health, sleep and ability to get on with things. Indeed, the difficulties, challenges and long hours resulting from juggling and treating 22 people with a 6-7 day working week rather made me assume it might be the complete opposite. My own mental health is thankfully excellent and I barely registered a score when I experimentally tested myself with the DASS-42 questionnaire. Nevertheless, I was pleasantly surprised to find myself calmer, relaxed, more content and happily engaging in tasks that had been on my ‘to-do list’ for months. The Jing Method™ worked for me, even as a therapist, as the chronic stress and pain protocols are truly designed to promote calm and engage the parasympathetic or ‘rest and digest’ nervous system so effectively.

Longer-Term Results

Jing recommends a 6-weekly treatment course for chronic conditions (Fairweather and Mari, 2015), and this study investigated effects 4 weeks post-treatment. Between weeks 12 and 16 depression, anxiety and stress scores continued to fall by 20%, 11% and 1.5% respectively or 9% overall. With the latest NHS report confirming that the 18-week target for all referrals has not been met since 2016 (Baker, 2023) the potential for an effective longer-term treatment has some considerable significance.

---

Why & How Does It Work?

HFMAST & The Biopsychosocial Model: A Multi-Modal Approach

What distinguishes and sets the Jing Method™ apart is its multi-modal approach under the acronym HFMAST and truly holistic approach using the Biopsychosocial model – which also looks at psychological factors such as emotional well-being, mental health and self-esteem, social circumstances like peers, family and support network as well as the biological elements like their physical health, medication and genetics. 

Using the Biopsychosocial model as the basis for the Jing Method™, Rachel Fairweather and Meghan Mari (2015) at the Jing Institute created a fusion of soft tissue/massage techniques under the acronym HFMAST.

An outcome-based holistic approach to treat conditions, acute and chronic pain, the Jing Method™ builds upon and improves current methods of massage therapy using heat and cold and hot stones, fascial techniques, muscle massage and trigger point therapy, acupressure point treatment, stretching and teaching self-care.

Cumulative Treatments and Self-Care

As clients spend 95% of their time away from their therapist self-care is a crucial element of treatment that can really aid and speed recovery, and this is as true of mental as of physical health with the two going hand-in-hand.

 “It is now generally accepted that illness and health are the result of an interaction between biological, psychological, and social factors”
(Wade and Halligan, 2017)

Making self-care easy to manage and fit into life as a daily and habitual pattern was an important part of the study, and I created 3 different 5-minute daily routines of stretching, movement and breathing techniques. 60-78% of people used the self-care routines offered, but due to more awareness many participators devised their own, with 89% engaged in some form of self-care, and 55% of people restarting an exercise regime – particularly helpful for those with sedentary/desk-based lifestyles.

Therapeutic Alliance – Time for You as an Individual

It’s may be harder to quantify, but I feel that the alliance that I can form as a therapist with my clients really is key, and both Jing and other medical research studies have clearly demonstrated this is not just a belief on my part (Gillingham, 2017; Sheppard, 2018; Leysen et al, 2019; Harrison, 2021)

Taking the time to listen and acknowledge the feelings of someone as an individual and fellow human being, and simply show care and compassion can have a huge effect on treatment in general and I truly believe it enables my clients to get better results, this is all the more so on levels of mental health.

Alternative, Adjunct & Support for Conventional Treatment

Even during the writing-up of my study dissertation, the latest NHS key statistics have revealed a shocking increase in all treatment waiting times, rising to a record 7.8 million in September 2023 (Baker, 2023). Treatments like these can help support a struggling NHS, potentially lessening the need for further treatment and empowering people to help themselves.

There may be potential cost benefits for complementary medicine in comparison to prescription of long-term conventional medication or treatment. Estimated at an overall cost of £117.9 billion (NHS England, 2022), individual costs are harder to assess (Ride et al., 2020). Despite an overall lack of research (Herman, Craig and Caspi, 2005; Polley et al., 2017) there is a growing scientific interest in and recommendations for CAM interventions to prevent mental health disorders (Helha and Wang, 2022; McDaid et al., 2022) and plenty of compelling evidence of potential cost-savings of worthwhile consideration (Herman, Craig and Caspi, 2005; Kutch, 2010; Wemrell, Olsson and Landgren, 2020).

---

Participant Inspiration – From Sedentary To Movement

Inspiring stories from my study participants!

Participant 2 had a fully-sedentary lifestyle, overweight with diabetes and high levels of cholesterol and blood pressure. Inspired by her self-care routine, she started a daily 10-minute lunchtime walking habit.

3 months after finishing the study she was walking 25-28 miles a week, had lost over a stone in weight, had less joint pain and hugely reduced her levels of cholesterol and blood pressure, going back to pre-diabetic levels. Her son joined her and also lost 2 stone making a huge difference to both of their health

Paying it forward in action! ♡

 

Participant 22 has a lifelong autoimmune condition and, as a direct result of this, had low levels of mental health and struggled with motivation to do movement and exercise, not doing any for a number of years.

On my advice he devised his own self-care plan carefully doing squats to improve his proprioception (sense of his body position in space), balance and strength.

One year post-study he’s now doing a special exercise programme designed for his condition 4-5 times a week ♡

Research Feedback – What Did Participants Say?

A picture really does speak a thousand words – here are some from my participants – with huge gratitude from me for their time in putting down their thoughts to say why it worked so well for them.

---

Research Conclusions

The results of this study, demonstrating the successful and continued reduction of depression, anxiety, and stress levels in those with desk-based and sedentary lifestyles with the Jing Method™ approach, are extremely promising. This offers great potential for future research and treatment for people with poor mental health.

Jing methodology offers a viable alternative to conventional treatment and is an efficacious and achievable treatment approach for mental health disorders. Given the results, participants feedback, and “the full-scale emergency in mental healthcare” reported by Care Quality Commission and MIND in October 2023 (MIND, 2023) this multi-modal massage treatment surely warrants further research. Potential collaboration and funding could be sought with mental health charities and social prescribing initiatives such as Community Living Well (Kensington and Chelsea Social Council, 2018).

It is to be hoped that research studies on massage therapy and the multi-modal approach will expand further, not only within the complementary, but also conventional sector. As we progress into the twenty-first century there is recognition that medical treatment needs to be holistic, treating the individual and whole human rather than just one aspect of them such as the physical or mental, and this should surely expand to include the holism and combining of conventional and complementary treatment approaches as well.