Post-traumatic Stress Disorder (PTSD) is not normally mentioned or discussed day to day, let alone on our massage table. Mostly associated with veterans, there are many different traumatic events which can bring on PTSD. There are many actions we can take as LMTs to help care and comfort our clients with PSTD, from reassuring privacy to teaching loved ones how to perform massage.
Post-traumatic stress disorder (PTSD) is characterized by feelings of intense fear, helplessness, or horror from experiencing or witnessing a traumatic event. Examples of past traumatic events include war or terrorist acts, serious accident or injury, natural disaster, sudden death of a loved one, violent personal assault such as physical abuse and rape or other life-threatening events.
The affected person re-experiences the traumatic event, often avoids stimuli associated with the event, and/or detached emotionally from the event, the latter can produce a generalized numbing effect and subsequent lack of emotional responsiveness. The person may experience a flash-back or a sudden and disturbing vivid memory of a past event that produces extreme anxiety or a panic attack. PTSD is often accompanied by depression and substance abuse. PTSD is different from other anxiety disorders in that the cause of anxiety is a past traumatic event.
According to NIMH, approximately 7.7 million people in the United States have PTSD (3.5% of people 18 years or older). While PTSD can develop at any age, research indicates that the average age of onset is 23 years. The disorder also frequently occurs after violent personal assaults such as rape, mugging, or domestic violence, acts of terrorism, natural or human-caused disasters, and accidents.
Some characteristics of PTSD that suffers might have are:
- Dissociation – protective mechanism that allows a person to continue functioning after an inescapable traumatic experience. Research clearly associates dissociation with PTSD. One type of dissociation is detachment in which the person experiences symptoms of depersonalization and derealization.
- Depersonalization – disconnection from one’s own body, thoughts, or emotions. During depersonalization, the person reports they are detached from their body and mental/emotional processes or they have lost control over them.
- Derealization – disconnection from one’s surroundings. During derealization, the person reports that the world around them is surreal, dreamlike, foggy, or distorted. The person who derealizes feels that the posttraumatic event did not occur; it was a dream.
The person may experience flashbacks, insomnia, or have nightmares related to the post-traumatic event. Some persons report feeling irritable, have trouble concentrating, become startled by loud noises or when surprised, or sit or stand with their back to the wall while in public place such as restaurants. The treatments most often used are prescription drugs such as anti-anxiety medications, antidepressants, and sedatives; psychotherapy (CBT and exposure therapy); and support groups composed of people with similar experiences.
Massage Therapy and Post-traumatic Stress Disorder:
Schachter (1) recommend nine principles of sensitive practice as “standards of care” for health care providers working with clients with PTSD resulting from sexual abuse. These same principles may be useful when working with all cases of PTSD and include (1) respect, (2) taking time, (3) developing rapport, (4) sharing information, (5) sharing control, (6) respecting boundaries, (7) fostering mutual learning, (8) understanding nonlinear healing, and (9) demonstrating awareness of interpersonal violence. While these principles are appropriate for all clients, it is vital that clients feel they are in control of certain aspects of the massage including how much clothing is removed before lying on the table and covering with a drape, how they are positioned on the table, aspects of the treatment such as areas worked on, areas avoided, & depth of pressure. Offer the client a choice of gender of the therapist, especially if the client has a history of abuse.
Remind clients that their body will be draped during the entire session & that you will not be in the room while they undress and re-dress. Consider using a technique that does not require disrobing. Be sure to drape a client who remains completely clothed. Consider using a heavier-weight draping material as this may help your client feel more safe and secure.
If your client indicates that she would rather you not touch a certain area of her body, honor this request even if prior consent was given. For example, if your client initially requests deep massage on her lower back but suddenly becomes uncomfortable and asks you to move on to another area, comply without asking for explanation. Additionally, your client may feel more relaxed & in control if she can see what you are doing; this may require additional lighting & possible re-positioning of the face rest to expand his or her peripheral vision.
Partners of Veterans were taught massage to help reduce stress and promote interpersonal connectedness after returning from their tours of duty in Iraq and Afghanistan (2). They found significant reductions in PTSD, depression, and increased self-compassion in both veterans and their partners. Veterans reported significant reductions in physical pain, physical tension, irritability, and anxiety/worry. Their partners reported a reduction in stress associated with giving massages.
Articles & Journals Referenced:
- Schachter, C., Stalker, C., Teram, E., et al. (2009). Handbook on sensitive practice for health professionals: Lessons from adult survivors of childhood sexual abuse. 2nd ed. Ottawa: Public Health Agency of Canada. Retrieved from http://www.integration.samhsa.gov/clinical-practice/handbook-sensitivve-practices4healthcare.pdf on June 21, 2016
2. Collinge, W., Kahn, J., Soltysik, R. (2012). Promoting reintegration of National Guard veterans and their partners using a self-directed program of integrative therapies: A pilot study. Mil Med. 177(12).1477-85.
Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at firstname.lastname@example.org.