So Your Massage Client Has an Anxiety Disorder

Clients have many different goals when it comes to bodywork, and a perfectly valid one is the management of their stress/anxiety. What are the different types of psychological disorders you might encounter? What do you need to know about anxiety as a massage therapist?

Credit: Jon Rawlinson, CC BY 2.0
Credit: Jon Rawlinson, CC BY 2.0

This article, “Worrying About Worrying” by Ruth Werner, is a good primer on anxiety disorders and how they affect clients. (If you’re an ABMP member, you can see the full magazine version here).

It addresses what you can do as a massage therapist. You’re not a psychologist, but you can create a supportive, nonjudgmental space for your client to finally just unwind. Massage has pretty robust support in the scientific literature for reducing anxiety in the short- and long-term!

Anxiety vs. Stress

Something interesting about anxiety is that it’s very difficult to disentangle from a concept that we’re all familiar with: stress. “I’m so stressed out from work/school. I’m so stressed I can’t sleep. I’m so stressed that it seems like I can’t ever relax.” “Stress” is just a word that we use as a proxy for that fluttery, clenching feeling in our chest that pops up whenever we expect something to require a lot of mental or emotional resources.

This can actually be a useful feeling. If you have a presentation in an hour, stress can drive you to be on your A-game and spend that extra effort to prepare. It can give you a slightly euphoric feeling as you power through a research paper, or get ready to run a 5k. This is a phenomenon called eustress, which is that useful kick of nervous energy that’s enough to motivate, but not enough to overwhelm.

Then there’s plain old stress, also called distress in the psychological literature. This is the kind that haunts you while you’re preparing for something big, or involved in a project that’s draining the life out of you. This flavor of stress robs you of motivation, often causing people to turn away from the distressing project to less anxiety-provoking activities (often a big factor in procrastination). It leads to all sorts of maladaptive behaviors, like avoidance, aggression, and self-sabotage. It can morph into new things, like compulsive behavior, paranoia, and panic.

I have obsessive-compulsive disorder (OCD). Always have, probably always will. These days it’s just a little gremlin that rides in my hair and tells me not to touch anything in a public bathroom, but it used to be much bigger, and much more insistent. Time, counseling, and medication has put it in its place, and now I can choose to ignore it most of the time. When I’m stressed, however, it can suddenly get supersized again.

This is something that you can affect as a massage therapist. By providing me with an hour where you allow me to be myself in all my naked me-ness, you help me feel safe in my own skin. You help me feel like it’s okay to drop those recycling, negative thoughts for a short while. By applying knowledgable contact for an hour, you draw my attention to my body, allowing me to finally get out of my head. That new focus is like a vacation, and it shows me that I always have somewhere to escape to—myself.

It also promotes activation of the parasympathetic half of the autonomic nervous system. By applying kind, considerate touch, you’re “hacking” the brain manually, causing it to consider stimuli other than fear, worry, and pain. Studies show that massage regimens are useful for both “state” anxiety (how nervous you’re feeling right now) and “trait” anxiety (how nervous you tend to feel). That’s powerful stuff.

Y’all, the overlap between massage and psychology is real, and it’s something that we should embrace, because we can’t ignore it. By touching the body, you’re touching the mind. By creating a therapeutic environment, you’re allowing people to lower their shields and just be themselves. That can be a little scary for you and your client, but it can also be exciting. It’s a place for healing, even if you don’t know what to say, or what questions to ask, or how to respond to them divulging something intense. My advice is to just listen, and to let massage be your medicine.

Is stress something that you focus on in your practice? How do you react when a client tells you about their past experiences of trauma, or their current mental illness (be vague here)? If a client starts going through some serious stuff on the table, how do you proceed? Thanks for reading and participating!

8 thoughts on “So Your Massage Client Has an Anxiety Disorder

  1. I work with hospice patients and their families. Anxiety, fear, anger, depression and confusion are front and center in their lives. I use my time with them as a safe space where they can give voice to things that they are afraid to say out loud to loved ones. I listen and don’t interject any opinions which can sometimes be hard to do. I give people the space to forget if only for an hour what they are going through. I find that after the massage, most people are in a better, more positive frame of mind. That goes a long way in improving quality and outlook on life.

    1. That’s beautiful, thanks Jen. Our work with people experiencing mental/emotional pain is similar to our work with physical pain: Even if we can’t “fix,” we can create a space for healing. Less effort is usually better.

  2. Hi Ian,
    I am a new massage Therapist that loves your myofascial – Swedish approach to massage. I also am a certified facilitator of Transformational Breathing and have come to realize that we humans bury our emotional hurts, pain, and drama in our bodies. These buried feelings show up as tight spots or little balls of tension. When a facilitator or a massage therapist applies pressure to these areas the client may have an emotional release. It is my experience that anxiety and stress are some of those feelings we bury, and it is also one of the releases that we have when touch is sustained during a massage.

    The most productive response I have experienced is to let the client know that this is normal and that if they are crying that this is a normal response and encourage them to surrender to what ever feeling is coming up and not try to suppress or change it. Encourage them to take deep breaths and allow the feelings to run their course. This is the clients healing time. I always ask the client if they are comfortable with me slowly continuing light effleurage strokes
    while they are processing. if not ,I just be quite until they are ready to take the next step,
    whatever that may be.

    1. Absolutely, emphasizing the safe space they’re in can make all the difference. I’m going to look into that Transformational Breathing, I’m a big believer in breath work as a lever for accessing deeper resources. Thanks, Mark!

  3. When a client tells me they are stressed, or if they are more specific and tell me about a mental health struggle, I ask them very directly if they would like their massage session to be a time to rest and relax.

    If they say yes, a good amount of what I do is about inducing dreamy spaced out feelings for them, while giving appropriate attention to any areas of the body where the client might be feeling tension due to their stress. (Swedish techniques for the win!)

    I find that having the right pacing is extra important for these clients, so I check in about the speed of my work as well as the pressure I’m applying. Often, pretty deep and quite slow works well.

    Also, my personal experience suggests that these clients are often sensitive to conditions in the treatment room. My best example is a client who was having a hypomanic episode. They needed extremely dim lighting to be still, and felt calmed by the weight of an extra blanket and warm packs. Another client of mine listens to their own music with earbuds on an iPod during their massage because they are stressed by the tiniest noise from the HVAC, and they don’t trust the piped in music to cover it up.

    So, like we already know…customizing to the client and tuning in to the little things makes or breaks the massage.

  4. Hey Ian, what an awesome article! Just writing to say thanks for the reminder of why I do this amazing work: to provide a safe space where one can just be, let go.
    So glad I discovered you on youtube. You are a cool dude, helpful too.
    Karen, LMT and fellow sloth, the lazier the better 🙂

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