Psychology Social Touch and Massage Therapy Research
by
Tiffany Field
  • LAST MODIFIED: 27 June 2017
  • DOI: 10.1093/obo/9780199828340-0194

Introduction

Touch has the longest definition (fourteen columns) of all definitions in the Oxford Dictionary and is defined as “the most general of the bodily senses, diffused through all parts of skin, but (in man) specially developed in the tips of the fingers and the lips.” The Dictionary of the Russian Language says, “In reality all five senses can be reduced to one—the sense of touch. The tongue and palate sense the food; the ear, sound waves; the nose, emanation; the eyes, rays of light.” In addition, the four senses that have been recently added could be grouped under touch, including pressure, itch, pain, and thermo-perception, even though different receptors are involved in these senses. As the research field on touch has evolved, all of these forms of touch have been studied as separate topics, as have the roles of touch. Different investigators have researched the roles of touch in early development, the effects of touch deprivation, touch in communication including emotions and personal relationships, physiological and biochemical effects of touch, and affective versus discriminative touch. Massage therapy research has also been included in volumes on touch inasmuch as massage is one of the most powerful forms of therapeutic touch.

Touch in Development

From the beginning of life, touch is critical for development. During fetal development, the fetus is enveloped in amniotic fluid that conveys tactile stimulation from the mother’s movements. During the newborn and infancy periods, parents and caregivers are a primary source of stimulation, although infants also touch objects with their mouth and then their hands to learn their properties. Children receive less touch given that teachers are often mandated not to touch them. In countries where children receive more touch, for example, France, the children are less aggressive. Similar data have been reported for adolescents touching each other more and being less verbally and physically aggressive than their counterparts in the United States. Although adults have been noted to reduce stress in each other by holding hands or hugging, there is a growing discomfort and avoidance of touch in general, and with aging there is a general impairment of touch perception.

Fetal Development

Several studies, such as Field 2014 and its predecessor Montagu 1971, note that the skin is the oldest, largest, and the first-to-develop sense organ and is the least researched of the five senses. Lagercrantz and Changeux 2009 notes that the fetus experiences touch by the movement of the amniotic fluid and via the mother’s massaging her abdomen. This study’s authors documented this by increased fetal activity. Diego, et al. 2002 shows that the fetus even responds to a mother’s feet being massaged as early as 20 weeks gestation. Marx and Nagy 2015 finds that arm, head, and mouth movements of 21-week-old fetuses increased when the mother touched her abdomen.

Neonatal Development

The newborn receives touch through cuddling and breastfeeding. Bellieni, et al. 2007 shows how both of these forms of touch have calmed newborns in pain and discomfort, most especially the parent holding the newborn skin to skin, as in “kangaroo care.” In kangaroo care, the newborn (typically the preterm newborn) is carried vertically inside the parents’ clothing and the parents’ temperature warms the baby. According to data from Ferber, et al. 2008, the newborn’s heart rate and respiration are slowed during kangaroo care. Meaney and Szyf 2005 identifies how maternal licking of rat pups led to greater inhibition of stress and cortisol (the stress hormone), which lasted into adulthood. This effect has also been shown for humans in Murgatroyd, et al. 2015.

Infancy

The infant discovers most of its world in the early months by mouthing and touching people and objects. Lowe, et al. 2016 is a study of infants receiving several types of touch including affectionate nurturing touch, playful touch, and attention-seeking touch. According to these authors, playful touch has been especially noted to increase positive affect in four-month-old infants, and cross-cultural differences have also been reported in Lowe, et al. 2016. Mothers have also been noted to use touch in their teaching. For example, Abu-Ahaya, et al. 2016 shows that mothers tended to touch their infants’ body parts as they read their five-month-old infants books about body parts. It is not surprising, then, that, according to Addabbo, et al. 2016, by three months of age, infants showed discrimination of videos that depicted touching versus nontouching of human body parts (e.g., a video showing a moving hand touching a face versus one where the moving hand stopped before touching the face). In addition, they preferred the video showing the hand touching the face. Infants appear to react differently to their parents’ touching during teaching. In a study on nine-month-old infants, low reactivity to overreactivity was noted as parents painted and pressed their infants’ hands and feet to paper to make designs. In Mammen, et al. 2016, the overreactive group of infants was noted to have higher activity and distress levels, suggesting a temperamental difference in infants’ responsivity to parental touching.

Childhood

As infants move into toddlerhood and the preschool years, they receive less and less touching from their teachers as noted in a nursery school study Cigales, et al. 1996. They still receive significant touching from their parents as was noted in Aznar and Tenenbaum 2016 in a study on parents touching during storytelling. At this age, cross-cultural differences have also been noted. For example, Field 1999 shows that French preschoolers received more affectionate touch from their parents on playgrounds in Paris than American preschool children, and, in turn, they were less verbally and physically aggressive with their peers. Brauer, et al. 2016 reports that kindergarten-age children who received more maternal touch have shown greater connectivity based on functional magnetic resonance imaging (fMRI) on the prefrontal cortex (part of the “social brain”). Based on a review of twenty-three studies in Taylor, et al. 2016, touch has been noted to greatly influence the development of children. Despite the positive effects of touch in early childhood, grade-school teachers are mandated (at least in the United States) not to touch children, as touch taboos have derived from child abuse. Despite the mandate against touch in public school systems, the rate of child abuse has not decreased.

  • Aznar, A., and H. R. Tenenbaum. 2016. Parent-child positive touch: Gender, age, and task differences. Journal of Nonverbal Behavior 40:317–333.

    DOI: 10.1007/s10919-016-0236-xSave Citation »Export Citation »E-mail Citation »

    In this study parents were observed for their touching behavior during play-related storytelling and a reminiscence task (conversation about past emotions) with their six-year-old children. Both the mothers and the fathers touched their children positively more frequently when reminiscing versus when storytelling.

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    • Brauer, J., Xiao, Y., Poulain, T., Friederici, A. D., and Schirmer, A. 2016. Frequency of maternal touch predicts resting activity and connectivity of the developing social brain. Cerebral Cortex 26:3544–3552.

      DOI: 10.1093/cercor/bhw137Save Citation »Export Citation »E-mail Citation »

      Brauer has documented greater connectivity in the prefrontal cortex (based on fMRIs) in children who experienced more touch from their mothers.

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      • Cigales, M., T. Field, Z. Hossain, M. Pelaez-Nogueras, and J. Gewirtz. 1996. Touch among children at nursery school. Early Child Development & Care 126:101–110.

        DOI: 10.1080/0300443961260107Save Citation »Export Citation »E-mail Citation »

        In this study preschoolers in a nursery school received less touching from teachers than toddlers, who, in turn, received less touching than infants.

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        • Field, T. 1999. Preschoolers in America are touched less and are more aggressive than preschoolers in France. Early Child Development and Care 151:11–17.

          DOI: 10.1080/0300443991510102Save Citation »Export Citation »E-mail Citation »

          Field conducted observation studies on playgrounds in Paris and in Miami to document the play behaviors of parents and preschoolers. She found that parents in Paris versus parents in Miami were more physically affectionate with their preschoolers, who, in turn, were less physically and verbally abusive with their peers on the same playgrounds.

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          • Taylor, S., B. McLean, T. Falkmer, L. Carey, and S. Girdler. 2016. Does somatosensation change with age in children and adolescents? A systematic review. Child: Care, Health and Development 42:809–824.

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            In this review of twenty-three studies, touch was noted to significantly affect the achievement of developmental milestones of children.

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            Adolescence

            Field 2014 (cited under Fetal Development) notes several observations on teenagers including that teenagers have been receiving about half the touch they did in grade school and when they touch each other, it is typically shoulder to shoulder and elbow to elbow touch Adolescents often share lots of touch with their intimate partners, but family members are treated as if they had some “terrible disease.” Further, because of touch taboos, many touch-deprived adolescents like touch-dancing and skinny-dipping, although cross-cultural differences have been noted. For example, in a field study (Field 1999), Parisian adolescents affectionately touched their peers more often than American adolescents, as has been observed in fast-food restaurants. In that study, the Parisian adolescents were also less verbally and physically aggressive with their peers than the American adolescents. Touching is occurring less frequently as adolescents increasingly use social networking sites for communication. A review paper Spies-Shapiro and Margolin 2014 suggests that adolescents’ motivations for using social networking sites are the same as traditional forms of communication to “stay in touch with friends.” For some adolescents, Internet addiction has become a problem that is in turn related to drug and alcohol use and blunted responses to pleasant touch. In Migliorini, et al. 2013 adolescents’ responses to C-afferent (soft pleasant) touch were blunted.

            • Field, T. 1999. American adolescents touch each other less and are more aggressive toward their peers as compared with French adolescents. Adolescence 34:753–758.

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              In this study adolescents were observed in fast-food restaurants in Paris and Miami. The French adolescents touched each other more frequently, and they were less verbally and physically aggressive toward each other than the American adolescents.

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              • Migliorini, R., J. L. Stewart, A. C. May, S. F. Tapert, and M. P. Paulus. 2013. What do you feel? Adolescent drug and alcohol users show altered brain response to pleasant interoceptive stimuli. Drug and Alcohol Dependence 133:661–668.

                DOI: 10.1016/j.drugalcdep.2013.08.015Save Citation »Export Citation »E-mail Citation »

                In this study adolescents who were using drugs showed blunted responses to pleasant touch (soft C-afferent touch). The direction of effects cannot be determined from this study.

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                • Spies-Shapiro, L. A., and G. Margolin. 2014. Growing up wired: Social networking sites and adolescent psychosocial development. Clinical Child and Family Psychology Review 17:1–18.

                  DOI: 10.1007/s10567-013-0135-1Save Citation »Export Citation »E-mail Citation »

                  Adolescents, according to this review, reported that they used social networking sites in a similar way to their usual forms of communication to stay in touch with their friends.

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                  Adulthood and Aging

                  Adults and the elderly have received less attention regarding the effects of touch. Jakubiak and Feeney 2016 suggests that affectionate touch in early development would be expected to promote physical, psychological, and relational well-being later in life. This would be expected via touch reducing stress and promoting well-being. Adults have been involved in studies on touch being conveyed by emotions, touch in relationships, touch affecting compliance behavior and reducing stress, and touch therapy. In a study on romantic relationships, Kashdan, et al. 2016 found that physical touch was noted to be essential for emotional intimacy. The authors also noted that women’s social anxiety had a greater effect on a man’s comfort with touch and avoidance of touch in romantic relationships than a man’s social anxiety. Touch may become less central in the lives of older adults as sensory deficits develop For example, in a population-based study, Correia, et al. 2016 found that two-thirds of the participants (age fifty-seven to eighty-five) had two or more sensory deficits with 70 percent having a touch sensory deficit. It is not clear how many of these older adults had this touch sensory deficit following touch deprivation related to the loss of a partner.

                  Negative Effects of Touch Deprivation on Development in Humans and Animals

                  Nelson 2007 reports that institutionalized children often receive minimal touch, which results in significant growth and developmental delays. Beckett, et al. 2006 shows that, unfortunately, these delays continue years after adoption. Field 2014 (cited under Fetal Development) suggests that even infants of depressed mothers experience touch deprivation. For example, in one study, infants of depressed mothers touched themselves more, as if compensating for less touch from their mothers. In animal studies the immune system has been affected. For example, Suomi 1995’s researchers separated monkeys from their mothers. The separated monkeys had lower natural killer cell activity (which wards off viral, bacterial, and cancer cells). Social grooming, typically by the mother, is noted to enhance immune activity. That improved immune function may have happened via touch lowering cortisol (stress hormone) that normally kills natural killer cells. Schanberg 1995 reports lab results that showed effects of touch on a growth gene in the rat model. In this study researchers located a growth gene that is responsible for the relationship between touch and growth. The researchers showed that the RNA from the livers of maternally deprived rat pups was missing the messenger gene that could be “turned on” to stimulate growth. The only other publication that could be found on touch deprivation was Field 2002, a review on studies showing relationships between the lack of physical affection (physical neglect) and aggression in adolescents. Unfortunately, despite the extremely negative effects of touch deprivation, it has rarely been researched.

                  • Beckett, C., B. Maughan, M. Rutter, et al. 2006. Do the effects of early severe deprivation on cognition persist into early adolescence? Findings from the English and Romanian adoptees study. Child Development 77:696–711.

                    DOI: 10.1111/j.1467-8624.2006.00898.xSave Citation »Export Citation »E-mail Citation »

                    This study showed that children who were institutionalized in Romanian orphanages and were later adopted still experienced developmental delays in early adolescence.

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                    • Field, T. 2002. Violence and touch deprivation in adolescents. Adolescence 37:735–748.

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                      This literature review reveals a disproportionate incidence of physical abuse and neglect and the lack of positive physical contact in aggressive adolescents. This supports the notion that less physical affection (or more physical neglect) can contribute to greater aggression. The adolescents’ aggressive behavior has been notably decreased following massage therapy.

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                      • Nelson, C. A. 2007. A neurobiological perspective on early human deprivation. Child Development Perspectives 1:13–18.

                        DOI: 10.1111/j.1750-8606.2007.00004.xSave Citation »Export Citation »E-mail Citation »

                        In this paper the author offers neurobiological perspectives on the effects of early deprivation including hormonal stress and neurotransmitter imbalance.

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                        • Schanberg, S. 1995. The genetic basis for touch effects. In Touch in early development. Edited by T. Field, 67–80. Skillman, NJ: Johnson & Johnson.

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                          This chapter elaborates the genetic bases for touch effects mostly based on research from the rat model, which is considered an excellent model for the human. Schanberg and his colleagues separated rat pups from their mothers and then compared the RNA from the livers of the deprived and the nondeprived rat pups and found a growth-promoting gene that was present in nondeprived but not deprived rat pups.

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                          • Suomi, S. J. 1995. Touch and the immune system in rhesus monkeys. In Touch in early development. Edited by T. Field, 89–104. Skillman, NJ: Johnson & Johnson.

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                            This chapter describes the many studies conducted by Steve Suomi and his colleagues on depriving monkeys of touch by placing a Plexiglas wall between them and their peers so they could still hear each other, see each other, and smell each other but could not touch each other. These separations resulted in increased physical aggression that resulted in death for many of the monkeys.

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                            Emotions and Touch

                            Emotions can be identified when a stranger touches a person on the arm without giving him or her any other cues. In Hertenstein, et al. 2006, participants were assigned to the role of sender and were asked to express an emotion by touching the receiver’s forearm. The sender was given different emotion words including happiness, sadness, surprise, disgust, anger, fear, sympathy, love, pride, envy, and gratitude. A curtain separated the sender and receiver to prevent any use of visual cues, and after the sender “sent the emotion,” the receiver was asked to choose the emotion that was received. Different kinds of touch were used to convey the emotions, and the receivers were able to identify the emotions, with accuracy ranging from 48 percent to 83 percent. Pushing, lifting, and tapping were used to communicate disgust, and hitting, squeezing, and trembling were used to communicate anger. In Hertenstein, et al. 2009, the senders were allowed to touch any appropriate part of the human body to show the emotion.

                            • Hertenstein, M., R. Holmes, and M. McDonough. 2009. The communication of emotions via touch. Emotion 9:566–573.

                              DOI: 10.1037/a0016108Save Citation »Export Citation »E-mail Citation »

                              In this subsequent study, Hertenstein and colleagues asked their assistants to touch the participants anywhere that was appropriate on their bodies, and the receivers of the touch were able to correctly identify even more emotions.

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                              • Hertenstein, M. J., D. Keltner, B. App, B. A. Bulleit, and A. R. Jaskolka. 2006. Touch communicates distinct emotions. Emotion 6:528–533.

                                DOI: 10.1037/1528-3542.6.3.528Save Citation »Export Citation »E-mail Citation »

                                Hertenstein and his colleagues were the first to show that emotions could be reliably communicated through touch. Someone receiving touch from a stranger researcher could identify the emotion by the researcher’s touch. In their first study, sympathy, disgust, and anger could be reliably identified.

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                                Touch and Compliance

                                A literature review of several studies, Joule and Guéguen 2003, suggests that adults are more likely to comply with a request if they are touched at the same time that the request is made. For example, Guéguen and Fischer-Lokou 2003 shows that passengers were more likely to get a free ride if they touched the bus driver. Ersceau and Guéguen 2007 reports that car dealers received more positive ratings when they touched their customers. Touch affects compliance even at younger ages. For example, in Leonard, et al. 2014, preschool children were able to delay gratification following a friendly touch, and Guéguen 2004 suggests that older students were more likely to write a solution to a math problem on a blackboard when they were touched by their teacher.

                                Physiological and Biochemical Effects of Touch

                                Heinrichs, et al. 2003 and Henricson, et al. 2008 show physiological and biochemical effects of touch including decreased blood pressure and heart rate as well as decreased cortisol levels and increased oxytocin levels. In Guéguen 2003, lower blood pressure and heart rate were reported for adults who were holding hands and received a hug from their partner before a stressful public speaking task. Ditzen, et al. 2007 demonstrates that women who received neck and shoulder massage by their partner before experiencing a stress condition had lower heart rate and cortisol levels after the stressor. Further, Shermer 2004 notes that oxytocin was released following back rubs and hugs, and Light, et al. 2005 reports that women who received more hugs from their partner showed higher oxytocin levels and lower blood pressure than women with fewer hugs. Even self-soothing touch has led to oxytocin release, according to Uvnas-Moberg, et al. 2015.

                                Pleasant or Affective Touch versus Discriminative Touch

                                Most of the research on touch over the past decade has addressed pleasant or affective touch as it is differentiated from discriminative touch. Rolls 2010 shows in an fMRI study that discriminative touch is mediated by large myelinated (insulated) fibers, while affective touch is mediated by small unmyelinated (C) fibers. McGlone, et al. 2014 reviews a body of research showing that C-tactile afferents (CTs) are found in hairy but not glaborous skin (skin on the palms of the hands and the soles of the feet). CT fibers are activated by the sensations experienced during a human caress (Loken, et al. 2009). McGlone, et al. 2014 further notes that fMRI studies have shown that the C fibers are activated by stroking the skin that encodes affective and affiliative touch. Master and Tremblay 2010 looks at self-touch versus interactive touch. In this research, adults actively stroked either their own palm or the experimenter’s palm. Evoked potentials were larger during self-touch. Ackerley, et al. 2012 shows differential fMRI on responses to self-touch versus touch from another. Self-touch elicited a stronger response than touch from the other. These results were surprising, although they could be explained by differential stroking velocity as stroking velocity is also a factor. Perini, et al. 2015, for example, noted that intermediate velocities were rated as most pleasant. Croy, et al. 2016, however, reports that stroking velocities were slower when touching a partner and a baby than when touching an artificial arm. Fairhurst, et al. 2014 documents these physiological and behavioral responses to pleasant touch as early as nine months in infancy. On the other end of the age spectrum, Sehistedt, et al. 2016 shows that the affective, but not the discriminative, aspects of touch increased with age. Some studies have explored other potential mechanisms for affective touch including Trotter, et al. 2016, which implicated serotonin in activating social touch responses. Oxytocin has also been implicated in CT-activating touch responses, as discussed in the review article Walker, et al. 2017.

                                • Ackerley, R., E. Hassan, A. Curran, J. Wessberg, H. Olausson, and F. McGlone. 2012. An fMRI study on cortical responses during active self-touch and passive touch from others. Frontiers in Behavioral Neuroscience 6:51.

                                  DOI: 10.3389/fnbeh.2012.00051Save Citation »Export Citation »E-mail Citation »

                                  Ackerley and colleagues showed that self-touch elicited stronger fMRI responses than touch by another person.

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                                  • Ackerley, R., H. B. Wasling, J. Liljencrantz, H. Olauuson, R. D. Johnson, and J. Wessberg. 2014. Human C-tactile afferents are tuned to the temperature of a skin-stroking caress. Journal of Neuroscience 34:2879–2883.

                                    DOI: 10.1523/JNEUROSCI.2847-13.2014Save Citation »Export Citation »E-mail Citation »

                                    In this study Ackerley and colleagues showed that a skin-stroking caress occurred at a skin temperature of 32 degrees Celsius.

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                                    • Croy, I., A. Luong, C. Triscoli, et al. 2016. Interpersonal stroking touch is targeted to C tactile afferent activation. Behavior and Brain Research 297:37–40.

                                      DOI: 10.1016/j.bbr.2015.09.038Save Citation »Export Citation »E-mail Citation »

                                      These researchers showed that adults stroked their partners’ and babies’ arms more slowly than an artificial arm.

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                                      • Fairhurst, M., L. Loken, and T. Grossmann. 2014. Physiological and behavioral responses reveal 9-month-old infants’ sensitivity to pleasant touch. Psychological Science 25:1124–1131.

                                        DOI: 10.1177/0956797614527114Save Citation »Export Citation »E-mail Citation »

                                        Arousal (heart rate) and attention (duration looking) were measured in nine-month-olds in response to different velocity brushing to determine whether they were responsive to pleasant touch.

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                                        • Loken, L. S., J. Wessberg, F. McGlone, and H. Olausson. 2009. Coding of pleasant touch by unmyelinated afferents in humans. Nature Neuroscience 12:547–548.

                                          DOI: 10.1038/nn.2312Save Citation »Export Citation »E-mail Citation »

                                          Human caress can activate CTs. In this study Loken and colleagues showed that a human caress occurred at stroking speeds of 1 to 10 cm/s.

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                                          • Master, S., and F. Tremblay. 2010. Selective increase in motor excitability with intra-active (self) versus interactive touch. Neuroreport 21:206–209.

                                            DOI: 10.1097/WNR.0b013e328335b530Save Citation »Export Citation »E-mail Citation »

                                            In this study self-touch elicited a stronger evoked potential response than touch by another person.

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                                            • McGlone, F., J. Wessberg, and H. Olausson. 2014. Discriminative and affective touch: Sensing and feeling. Neuron 82:737–755.

                                              DOI: 10.1016/j.neuron.2014.05.001Save Citation »Export Citation »E-mail Citation »

                                              This paper reviews the evidence for the neurological differences between discriminative and affective touch, namely that the low-threshold C fibers that innervate the hairy skin are the substrate for affective touch.

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                                              • Perini, I., Olausson, H., and Morrison, I. 2015. Seeking pleasant touch: Neural correlates of behavioral preferences for skin stroking. Frontiers Behavioral Neuroscience 9:1–9.

                                                DOI: 10.3389/fnbeh.2015.00008Save Citation »Export Citation »E-mail Citation »

                                                In this fMRI study intermediate velocity stroking by a soft brush was rated by the participants as being more pleasant than very slow or very fast velocities. The pleasantness ratings by the participants were, in turn, correlated with activation of the brain regions involved in reward-related behavior.

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                                                • Rolls, E. T. 2010. The affective and cognitive processing of touch, oral texture, and temperature in the brain. Neuroscience Biobehavioral Reviews 34:237–245.

                                                  DOI: 10.1016/j.neubiorev.2008.03.010Save Citation »Export Citation »E-mail Citation »

                                                  Rolls showed in his fMRI study that stroking the skin as in affective and affiliative touch activated C fibers that were different from the somatosensory fibers that discriminated different types of touch. But this response was only found when the stroking occurred on hairy skin as opposed to nonhairy skin.

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                                                  • Sehistedt, I., H. Ignell, H. Backlund Wasling, R. Ackerley, H. Olausson, and I. Croy. 2016. Gentle touch perception across the lifespan. Psychology of Aging 31:176–184.

                                                    DOI: 10.1037/pag0000074Save Citation »Export Citation »E-mail Citation »

                                                    Although touch intensity ratings were negatively correlated with age, pleasantness ratings of touch increased with age.

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                                                    • Trotter, P., F. McGlone, S. McKie, et al. 2016. Effects of tryptophan depletion on central processing of CT-targeted and discriminatory touch in humans. European Journal of Neuroscience 44:2072–2083.

                                                      DOI: 10.1111/ejn.13298Save Citation »Export Citation »E-mail Citation »

                                                      In this study adults did not show a differential response to affective versus discriminative touch, which implicated serotonin in this process.

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                                                      • Walker, S., P. Trotter, W. Swaney, A. Marshall, and F. Mcglone. 2017. C-tactile afferents: Cutaneous mediators of oxytocin release during affiliative tactile interactions. Neuropeptides.

                                                        DOI: 10.1016/j.npep.2017.01.001Save Citation »Export Citation »E-mail Citation »

                                                        In this review article the authors suggest that CT-activating touch responses (responses to pleasant touch) are thought to be mediated by oxytocin. This may result from pleasant touch lowering the stress hormone (cortisol) and contributing to increased oxytocin (love hormone).

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                                                        Massage Therapy

                                                        The book Field 2014 (cited under Fetal Development) notes massage therapy has been noted as one of the most effective forms of touch. In this volume studies are reviewed on massage therapy effects with examples given here on some of the conditions studied. Although many of the studies were originally conducted by Tiffany Field and her colleagues, recent paper submissions suggest replications are being added to the literature. Field, et al. 1996 (cited under Attentiveness) first showed that physical growth, as well as cognitive and motor development, could be enhanced in preterm and full-term infants. Their studies on preterm infants revealed potential underlying mechanisms for these effects including increased vagal activity (a slowing of the nervous system) which led to increased gastric motility as well as an increase in growth hormone.

                                                        Attentiveness

                                                        Massage therapy has also enhanced attentiveness, as shown in Field, et al. 1998, a study of children with attention deficit hyperactivity disorder. Escalona, et al. 2001 is a similar study on children with autism spectrum disorder. See also Field, et al. 1996. These effects may derive from increased vagal activity (which is associated with enhanced attentiveness) as well as reduced sleep disturbances. Greater attentiveness and better math performance have been similarly shown in adults following chair massage in Field, et al. 1996. In this study electroencephalographic (EEG) changes in the direction of greater relaxation and heightened alertness were also noted (increased theta and beta waves).

                                                        • Escalona, A., T. Field, R. Singer-Strunk, C. Cullen, and K. Hartshorn. 2001. Brief report: Improvements in the behavior of children with autism following massage therapy. Journal of Autism and Developmental Disorders 31:513–516.

                                                          DOI: 10.1023/A:1012273110194Save Citation »Export Citation »E-mail Citation »

                                                          In this study children with autism were given massages by their parents each night before bedtime. The parents reported that their children spent more hours sleeping, and the children were also observed to be more attentive in their classrooms following the nightly massages.

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                                                          • Field, T., G. Ironson, F. Scafidi, et al. 1996. Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations. International Journal of Neuroscience 86:197–205.

                                                            DOI: 10.3109/00207459608986710Save Citation »Export Citation »E-mail Citation »

                                                            In this study medical school faculty and staff were given fifteen-minute chair massages during their breaks at work. Before and after the massages they were given math computations to perform (a series of numbers to add in their heads). Throughout the session their EEGs were recorded. Following the massages these adults performed math computations in half the time with half the errors and their EEG pattern shifted to one of alertness.

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                                                            • Field, T., O. Quintino, M. Hernandez-Reif, and G. Koslovsky. 1998. Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Adolescence 33:103–108.

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                                                              In this study adolescents with attention deficit hyperactivity disorder were given massages in their classrooms. Classroom observations conducted before and after the massages suggested that the adolescents became more attentive and spent more time on task.

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                                                              Psychological Problems

                                                              Psychological problems including depression and anxiety have been decreased along with the stress hormone cortisol in dozens of massage therapy studies as reviewed by Field 2010. Parallel increases in serotonin and dopamine have also been reported in many studies, which have been related to the reduction in depression and anxiety (see Field, et al. 2005).

                                                              • Field, T. 2010. Touch for socioemotional and physical well-being: A review. Developmental Review 30:367–383.

                                                                DOI: 10.1016/j.dr.2011.01.001Save Citation »Export Citation »E-mail Citation »

                                                                In this paper several studies are reviewed on the reduction of depression, anxiety, and the stress hormone cortisol following massage therapy. These decreases have occurred in depressed children, aggressive adolescents, and prenatally and postpartum depressed women.

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                                                                • Field, T., M. Hernandez-Reif, M. Diego, S. Schanberg, and C. Kuhn. 2005. Cortisol decreases and serotonin and dopamine increase following massage therapy. International Journal of Neuroscience 115:1397–1413.

                                                                  DOI: 10.1080/00207450590956459Save Citation »Export Citation »E-mail Citation »

                                                                  In this review paper by Field and colleagues show cortisol decreases and serotonin and dopamine increases following massage therapy for several conditions, including depression and a number of pain syndromes. On average saliva cortisol decreased by 30 percent and serotonin and dopamine increased by 31 percent. These clinically significant changes are promising as they would have positive effects on the immune system.

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                                                                  Pain Syndromes

                                                                  Pain, which is the most common complaint expressed to massage therapists, has been reduced by massage in all chronic pain conditions we have studied, including lower back pain in pregnancy, labor pain, migraine headaches, fibromyalgia, and arthritis in several joints in the body. In a study on migraine headaches, Hernandez-Reif, et al. 1998, a 58 percent average reduction in headaches occurred after massage therapy. In a more recent study on knee arthritis, Field, et al. 2015, knee pain was reduced following massage therapy. In the fibromyalgia study Field, et al. 2002, more time spent in deep/restorative sleep and, in turn, less release of substance P (that causes pain) have been offered as models for the decrease in pain noted in many pain syndromes.

                                                                  • Field, T., M. Diego, C. Cullen, M. Hernandez-Reif, W. Sunshine, and S. Douglas. 2002. Fibromyalgia pain and substance P decrease and sleep improves after massage therapy. Journal of Clinical Rheumatology 8:72–76.

                                                                    DOI: 10.1097/00124743-200204000-00002Save Citation »Export Citation »E-mail Citation »

                                                                    Following massage sessions, adults with fibromyalgia experienced more deep sleep as measured by activity meters they wore on their wrists. Saliva samples were also assayed for substance P, which showed decreased substance P following massage and enhanced deep sleep. With greater deep sleep, less substance P is emitted, and therefore less pain is experienced as substance P causes pain.

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                                                                    • Field, T., G. Gonzalez, M. Diego, and C. G. Funk. 2015. Knee arthritis pain is reduced and range of motion increased following massage therapy. Complementary Therapies in Clinical Practice 21:233–237.

                                                                      DOI: 10.1016/j.ctcp.2015.08.002Save Citation »Export Citation »E-mail Citation »

                                                                      This study showed not only a reduction in knee pain following massage but also an increase in range of motion. The increase in range of motion was unique to this study and probably resulted from massaging not only the quadriceps muscles but also the hamstring muscles.

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                                                                      • Hernandez-Reif, M., J. Dieter, T. Field, B. Swerdlow, and M. Diego. 1998. Migraine headaches are reduced by massage therapy. International Journal of Neuroscience 96:1–11.

                                                                        DOI: 10.3109/00207459808986453Save Citation »Export Citation »E-mail Citation »

                                                                        This study involved massaging the nape of the neck, which has a tendon that responds to massage and results in a reduction in headaches.

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                                                                        Autoimmune Conditions

                                                                        The gold standard measures for autoimmune conditions like asthma (all pulmonology functions) respond to massage as documented in Field, et al. 1998; dermatitis (all skin measures) and diabetes (glucose levels) measures have improved following massage as shown in Field, et al. 1997. The changes in these gold standard measures may derive from an increased balance of the two immune systems (the Th1 system that is comprised of anti-inflammatory cytokines and the Th2 system that is associated with proinflammatory cytokines).

                                                                        • Field, T., T. Henteleff, M. Hernandez-Reif, et al. 1998. Children with asthma have improved pulmonary function after massage therapy. Journal of Pediatrics 132:854–858.

                                                                          DOI: 10.1016/S0022-3476(98)70317-8Save Citation »Export Citation »E-mail Citation »

                                                                          In this study children with asthma were given peak airflow meters to measure their peak airflow on a daily basis. Their parents massaged them for fifteen minutes before bedtime on a daily basis. Their peak airflow increased by the end of the one-month study and their other pulmonary measures also improved.

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                                                                          • Field, T., M. Hernandez-Reif, A. LaGreca, K. Shaw, S. Schanberg, and C. Kuhn. 1997. Massage therapy lowers blood glucose levels in children with diabetes. Diabetes Spectrum 10:237–239.

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                                                                            In this study parents massaged their children with diabetes for fifteen minutes before bedtime on a daily basis. Their blood glucose levels were reduced to within the normal range by the end of the month-long study.

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                                                                            Immune Conditions

                                                                            The clinical courses of immune conditions including HIV (as reported in Diego, et al. 2001) and breast cancer (as reported in Hernandez-Reif, et al. 2003) have improved with massage. These effects have been attributed to the decrease in cortisol that leads to a greater number of natural killer cells with natural killer cells, in turn warding off cancer cells as well as bacterial and viral cells.

                                                                            • Diego, M. A., M. Hernandez-Reif, T. Field, L. Friedman, and K. Shaw. 2001. HIV adolescents show improved immune function following massage therapy. International Journal of Neuroscience 106:35–45.

                                                                              DOI: 10.3109/00207450109149736Save Citation »Export Citation »E-mail Citation »

                                                                              In this research adolescents with HIV were given massages to enhance their immune function. Their natural killer cells were not only increased but also their CD4 cells (the cells killed by the HIV virus) were also saved.

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                                                                              • Hernandez-Reif, M., G. Ironson, T. Field, et al. 2003. Breast cancer patients have improved immune and neuroendocrine functions following massage therapy. Journal of Psychosomatic Research 1:1–8.

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                                                                                In this study on women with breast cancer, a month of massages led to enhanced natural killer cell number that probably resulted from their decreased cortisol levels.

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                                                                                Moderate Pressure Massage Therapy Effects

                                                                                Moderate pressure massage (moving the skin) as opposed to light pressure massage (light stroking of the skin) is critical for these effects to occur as has been suggested in Diego, et al. 2004 and Field, et al. 2006. The stimulation of pressure receptors under the skin leads to a cascade of events including increased vagal activity. The vagus nerve (one of the twelve cranial nerves) with its many branches stimulates several parts of the body including the face and the voice (e.g., resulting in less facial expressivity and vocal intonation contour in depressed individuals due to their lower vagal activity), the heart (a slowing of the heart accompanying enhanced attentiveness), and the gastrointestinal tract (increasing gastric motility and the release of food absorption and growth hormones). Increased vagal activity leads to reduced cortisol (the culprit stress hormone), increased serotonin (the body’s natural antidepressant and anti-pain neurotransmitter), and increased natural killer cells, which, as already mentioned, ward off bacterial, viral, and cancer cells.

                                                                                • Diego, M. A., T. Field, C. Sanders, and M. Hernandez-Reif. 2004. Massage therapy of moderate and light pressure and vibrator effects on EEG and heart rate. International Journal of Neuroscience 114:31–45.

                                                                                  DOI: 10.1080/00207450490249446Save Citation »Export Citation »E-mail Citation »

                                                                                  In this study adults receiving chair massage were randomly assigned to receive moderate or light pressure massage or vibrator massage. The moderate pressure massage was optimal as heart rate was reduced and EEG patterns changed in the direction of relaxation and heightened alertness.

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                                                                                  • Field, T., M. Diego, M. Hernandez-Reif, O. Deeds, B. Figueiredo, and A. Ascencio. 2006. Moderate versus light pressure massage therapy leads to greater weight gain in preterm infants. Infant Behavior and Development 29:574–578.

                                                                                    DOI: 10.1016/j.infbeh.2006.07.011Save Citation »Export Citation »E-mail Citation »

                                                                                    Moderate versus light pressure was also assessed with preterm newborns. In this study the preterm newborns who were randomly assigned to the moderate-pressure massage group showed greater weight gain following ten-minute massages twice daily for two weeks.

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