Depression and Anxiety: The Significance of Touch in Psychiatry—Clinical and Neuroscientific Approaches

Chronic unspecific back pain (cBP) is often associated with depressive symptoms, negative body perception, and abnormal interoception. Given the general failure of surgery in cBP, treatment guidelines focus on conservative therapies. Neurophysiological evidence indicates that C-tactile fibers associated with the oxytonergic system can be activated by slow superficial stroking of the skin in the back, shoulder, neck, and dorsal limb areas. We hypothesize that, through recruitment of C-tactile fibers, psycho-regulatory massage therapy (PRMT) can reduce pain in patients with cBP. In our study, 66 patients were randomized to PRMT or CMT (classical massage therapy) over a 12-week period and tested by questionnaires regarding pain (HSAL= Hamburger Schmerz Adjektiv Liste; Hamburg Pain adjective list), depression (BDI-II = Beck depression inventory), and disability (ODI = Oswestry Disability Index). In all outcome measures, patients receiving PRMT improved significantly more than did those receiving CMT. The mean values of the HSAL sensory subscale decreased by −51.5% in the PRMT group compared to −6.7% in the CMT group. Depressive symptoms were reduced by −55.69% (PRMT) and −3.1% (CMT), respectively. The results suggest that the superiority of PRMT over CMT may rely on its ability to activate the C-tactile fibers of superficial skin layers, recruiting the oxytonergic system. Full article

The clinical picture of depressive disorders is characterized by a plethora of somatic symptoms, psychomotor retardation, and, particularly, anhedonia. The number of patients with residual symptoms or treatment resistance is high. Touch is the basic communication among humans and animals. Its application professionally in the form of, e.g., psychoactive massage therapy, has been shown in the past to reduce the somatic and mental symptoms of depression and anxiety. Here, we investigated the effects of a specially developed affect-regulating massage therapy (ARMT) vs. individual treatment with a standardized relaxation procedure, progressive muscle relaxation (PMR), in 57 outpatients with depression. Patients were given one ARMT or PMR session weekly over 4 weeks. Changes in somatic and cognitive symptoms were assessed by standard psychiatric instruments (Hamilton Depression Scale (HAMD) and the Bech–Rafaelsen–Melancholia–Scale (BRMS)) as well as a visual analogue scale. Furthermore, oral statements from all participants were obtained in semi-structured interviews. The findings show clear and statistically significant superiority of ARMT over PMR. The results might be interpreted within various models. The concept of interoception, as well as the principles of body psychotherapy and phenomenological aspects, offers cues for understanding the mechanisms involved. Within a neurobiological context, the significance of C-tactile afferents activated by special touch techniques and humoral changes such as increased oxytocin levels open additional ways of interpreting our findings. Full article

Objectives: The aim of this study was to determine the influence of the sex of the therapist and of the athlete on the athlete’s current emotional state after a sports massage. The assumption was that the effect of a massage on the current mood was independent of the sex of the therapists or athletes. Background: Sports massages are an integral part of the support given to athletes during training or competition and are a commonly used method for promoting athletes’ physical and mental recovery. Few studies have measured the mental characteristics or even the nonspecific effects of sports massages. Sexual attraction or dislike are among the nonspecific effects of a treatment. Materials and methods: One hundred and sixty-eight high-performance male and female amateur athletes received a sports massage from 15 male and female trained therapists. The current emotional state of the athletes was measured before and after intervention using the BSKE-EA17 adjective scale, whose items can be assigned to five categories of the current emotional state. ANOVAs (analysis of covariances) were carried out to calculate the interactions between the sexes. Cohen’s d for similar group sizes and similar group variances were determined. Results: Neither the sex of the therapist nor the sex of the athlete had any influence on the mental effect of a sports massage. The only exception was when male athletes were treated by female therapists, where an increase in “elevated mood” was observed. Sports massages resulted in an increase in the responses in the categories “elevated mood” (d = 1.1) and “level of activation” (d = 0.3) and a decrease in the responses for “low mood” (d = 0.3), “level of deactivation” (d = 0.6) and “level of excitation” after the massage compared to before the massage (d = 0.9). Conclusions: Sports massages appear to increase the positive dimensions of the athletes’ current emotional state and reduce the negative dimensions. The self-reported mood changes from before the massage to after the massage were not influenced by other prognostic variables, including wait time, age of the athlete or the duration of the run. The results suggest that the specific effects of sports massages on the mental status are supported. Disregarding the aspect of the therapists’ sex, sports officials, trainers and athletes therefore can be more independent in the personnel planning of sports therapists. Full article

Social touch is important for interpersonal interaction. Gentle touch and slow brushing are typically perceived as pleasant, the degree of pleasantness is linked to the activity of the C-tactile (CT) fibers, a class of unmyelinated nerves in the skin. The inability to experience pleasure in general is called anhedonia, a common phenomenon in the chronic pain condition fibromyalgia. Here, we studied the perception and cortical processing of gentle touch in a well-characterized cohort of fibromyalgia. Patients and controls participated in functional brain imaging while receiving tactile stimuli (brushing) on the forearm. They were asked to provide ratings of pleasantness of the tactile stimulus and ongoing pain. We found high distress, pain catastrophizing, and insomnia, and a low perceived state of health in fibromyalgia. Further, patients rated both slow (CT-optimal) and fast (CT-suboptimal) brushing as less pleasant than healthy participants. While there was no difference in brain activity during touch, patients showed deactivation in the right posterior insula (contralateral to the stimulated arm) during pleasantness rating and activation during pain rating. The opposite pattern was observed in healthy participants. Voxel-based morphometry analysis revealed reduced grey matter density in patients, in the bilateral hippocampus and anterior insula. Our results suggest anhedonia to gentle touch in fibromyalgia with intact early-stage sensory processing but dysfunctional evaluative processing. These findings contribute to our understanding of the mechanisms underlying anhedonia in fibromyalgia. Full article

Physical and psychological therapy based on touch has been gradually integrated into broader mental health settings in the past two decades, evolving from a variety of psychodynamic, neurobiological and trauma-based approaches, as well as Eastern and spiritual philosophies and other integrative and converging systems. Nevertheless, with the exception of a limited number of well-known massage therapy techniques, only a few structured protocols of touch therapy have been standardized and researched to date. This article describes a well-defined protocol of touch therapy in the context of psychotherapy—the Calatonia technique—which engages the orienting reflex. The orienting reflex hypothesis is explored here as one of the elements of this technique that helps to decrease states of hypervigilance and chronic startle reactivity (startle and defensive reflexes) and restore positive motivational and appetitive states. Full article