Contributed By Sandra K. Anderson, BA, LMT, ABT, Jolie Haun, PhD EdS LMT, April Neufeld, BS, LMT

Massage therapists are aware of the mind-body connection and its important role in maintaining health and wellness. This mind-body connection can be particularly influential when a client is recovering from substance abuse. In 2011, Price and colleagues published study results in the Journal of Substance Abuse Treatment, documenting the impact of the mind-body connection in a sample of adult females. Their work examined the effects of mindful awareness in body-oriented therapy (MABT) for women enrolled in a substance use disorder (SUD) treatment facility. MABT combines massage and mind–body approaches to develop interoception (the processing of internal sensations to create awareness integral to sense of self) and emotional self-care skills.

Massage is thought to be clinically useful for increasing self-awareness about tension, stress and habitual response patterns that may help prevent relapse. However, Price and colleagues were unique in their examination of mind–body therapy using massage as part of treatment.

Women in addiction treatment often report experiencing sexual and physical abuse in both childhood and adulthood. Further, the rate of eating disorders in women with SUD are nearly double that of those without a SUD. Having a trauma history and/or an eating disorder can increase vulnerability to relapse post-treatment. However, mind–body therapies, such as MABT, may provide women with self-care skills to prevent relapse. In particular, MABT can provide women with the ability to identify and cope with emotions without using drugs.

This study was a pilot project at a women's only treatment clinic in the Pacific North West. Forty-six women enrolled in the study; the median age was 39 years. Participants reported using alcohol, opiates and multiple addictive substances before treatment. Most participants were Caucasian; one was Asian American, and two identified as mixed ethnicity. More than half the participants reported experiencing sexual or physical trauma in either childhood or adulthood and PTSD, while 30 percent had an eating disorder. Most participants had previously sought substance abuse treatment and had minimal exposure to massage.

Participants were randomized to receive the 8-week MABT intervention plus treatment as usual (TAU) or to TAU alone. TAU was a 12-step abstinence-based approach involving group sessions using psycho-education and cognitive–behavioral therapy. All participants completed a 3-week inpatient program and then continued in an outpatient, 12-to-24 week program that met 2 to 3 times per week for three hours.

MABT sessions were offered weekly during the outpatient program, each lasting 1.5 hours. Each participant randomized to MABT was assigned to one of four licensed massage therapists who had clinical experience addressing mental health concerns. The MABT protocol involved asking participants about their emotional and physical well-being to guide the session. Particular attention was given to body awareness in relation to experiences associated with substance use and treatment. The hands-on component of the session was 45-minutes and included massage over clothes. Touch was also used to teach interoception and body-based self-care skills such as learning to feel the sensation of breath, bring conscious attention to specific areas of the body, attend to physical and emotional tension and develop mindful body awareness. To integrate the skills they were learning, participants had individualized inner body awareness homework to do each week.

Data collection time points included baseline, post-intervention (three months from baseline), and six and nine month follow-up. The data included assessments that measured substance use, psychological and physical indicators of distress, perceived stress and other mind-body indicators such as ability regulate emotions, body awareness and bodily dissociation. A satisfaction survey and written questionnaire about participant perception of the MABT experience was administered at post-test. A questionnaire about use of any practice focused on connection to the body, such as daily or weekly yoga classes or bodywork treatments, during the follow-up period was administered to both groups at six and nine months. In addition, MABT participants were asked if the practice involved skills learned in MABT sessions.

Findings indicated moderate to large effects including significantly fewer days of substance use at post-test for participants in MABT, compared to those in TAU. Other outcomes showed improved eating disorder symptoms, depression, anxiety, dissociation, perceived stress, physical symptom frequency and bodily dissociation for MABT compared with TAU at the 9-month follow-up. The high level of continued use of MABT skills after the study was considerable, suggesting that participants perceived much benefit from MABT.

Though findings are significant and compelling, Price et al. indicate study limitations for consideration when interpreting outcomes. One limitation is that MABT participants were given a greater amount of time and attention than those in TAU. However, the high level MABT skills used during follow-up shows this was not the only reason for the effects of the study. Another limitation was the small sample size, and allocation of subjects to TAU and MABT differed. Also, only part of the assessment for emotion regulation was used; the findings or interpretation may not be valid without the use of the entire measure. The study sample was likely to have higher socioeconomic status and functional abilities than those found in community clinics. Finally, the sample was restricted to women. The effect of MABT with samples representing both men and women, with individuals in methadone-assisted treatment warrants further study.

Overall, this study demonstrates a mind-body oriented intervention with massage therapy can have positive effects on people in SUD treatment. The authors suggest MABT may be particularly relevant to women, given the high rates of eating disorders, depression, anxiety and trauma found among those with SUDs. It also appears that the self-care and other coping skills acquired during the study carried over beyond treatment and were incorporated into daily life.

Massage therapists who work with individuals recovering from substance abuse have confirmation that what they experience and know intuitively is being proven scientifically – compassionate, therapeutic touch facilitates the mind-body connection and can help in substance use recovery.

Resource:

• Cynthia J. Price, (Ph.D.), Elizabeth A. Wells, (Ph.D.), Dennis M. Donovan, (Ph.D.), Tessa Rue, (M.S.). Mindful awareness in body-oriented therapy as an adjunct to women's substance use disorder treatment: A pilot feasibility study. Journal of Substance Abuse Treatment. September 26, 2011.

Editor's Note: If you are interested in learning more about the evidence supporting the use and integration of massage therapy in clinical and medical practice with different patient populations, visit The Massage Therapy Foundation at: www.massagetherapyfoundation.org/ and tap into the Foundation's Research Resources.