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Emotional and physiological responses to touch massage
Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
2012 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Clinical findings indicate that touch massage has the ability to induce positive emotions and influence stress responses. However, little is known about mechanisms that can explain observed responses.

Aim: To understand mechanisms behind observed emotional and physiological responses during and after touch massage.

Methods: This thesis is based upon healthy volunteers in Studies I, II, IV and patients undergone aortic surgery in Study III. Study I had a crossover design, participants served as their own controls. After randomization they received TM on one occasion and the other occasion served as control. Heart rate variability (HRV), heart rate (HR) saliva cortisol concentration, glucose, insulin in serum and extracellular (ECV) levels of glucose, lactate, glycerol and pyruvat were measured before, during and after TM/control. In study II, functional magnetic resonance imaging (fMRI) was used in order to measure brain activity during TM movement. The study design included four different touch stimulations, human touch with movement (TM movement) human stationary touch and rubber glove with or without movement. Force (2.5 N) and velocity (1.5 cm/s) were held constant across conditions. The pleasantness of the four different touch stimulations was rated on a visual analog scale (VAS-scale). Study III had a randomized controlled design. The intervention group received TM and the control group rested. HRV, cortisol, glucose, insulin in serum, blood pressure, oxygen saturation, respiratory frequency and anxiety levels were measured before, during and after TM/control. In study IV participants were interviewed about experiences after TM and the text was analyzed in by qualitative content analyze.

Results:

Study I. TM reduced the stress response as indicated by decreased heart rate and decreased activity in the sympathetic nervous system, followed by a compensatory decrease in parasympathetic nervous activity in order to maintain balance. Cortisol and insulin levels decreased significantly after intervention, while serum glucose levels remained stable. A similar, though less prominent, pattern was seen during the control session. There were no significant differences in ECV concentrations of analyzed substances.

Study II. Human moving touch (TM movement) was significantly rated as the most pleasant touch stimulation. The fMRI results revealed that human moving touch (TM movement) most strongly activated the pregenual anterior cingulate cortex (pgACC).

Study III. Selfrated anxiety levels significantly decreased in the patient group that received TM compared with control group. There were no significant differences in physiological stress-related outcome parameters between patients who received touch massage and controls.

Study IV. In this study participants talked about the experience of TM in terms of rewards. Expressions like need, desire, pleasure and conditioning could be linked with a theoretical model of reward. Four different categories were identified as wanting, liking, learning and responding.

In conclusion: Results from these studies indicate that receiving TM is experienced as rewarding. Touch massage movement activates a brain area involved in coding of rewarding pleasant stimulations. TM decreases anxiety and dampens the stress response by a decreased activation of the sympathetic nervous activity. Our results indicate that TM is a caring intervention that can be used to induce pleasure, decrease anxiety and stress in the receiver.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå Universitet , 2012. , s. 60
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1531
Nyckelord [en]
Touch, touch massage, emotion, anxiety, autonomic nervous sytem, brain, stress
Nationell ämneskategori
Annan medicin och hälsovetenskap
Forskningsämne
omvårdnadsforskning med medicinsk inriktning
Identifikatorer
URN: urn:nbn:se:umu:diva-61492ISBN: 978-91-7459-524-6 (tryckt)OAI: oai:DiVA.org:umu-61492DiVA, id: diva2:568111
Disputation
2012-12-07, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2012-11-16 Skapad: 2012-11-15 Senast uppdaterad: 2023-05-02Bibliografiskt granskad
Delarbeten
1. Physiological responses to touch massage in healthy volunteers
Öppna denna publikation i ny flik eller fönster >>Physiological responses to touch massage in healthy volunteers
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2010 (Engelska)Ingår i: Autonomic Neuroscience: Basic and Clinical, ISSN 1566-0702, Vol. 158, nr 1-2, s. 105-110Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVES: To evaluate effects of touch massage (TM) on stress responses in healthy volunteers.

METHODS: A crossover design including twenty-two (mean age=28.2) healthy volunteers (11 male and 11 female) cardiac autonomic tone was measured by heart rate (HR) and heart rate variability (HRV). Stress hormone levels (cortisol) were followed in saliva. We also measured blood glucose and serum insulin. Extracellular (ECV) levels of glucose, lactate, pyruvate and glycerol were followed using the microdialysis technique (MD). TM was performed on hands and feet for 80min, during control, participants rested in the same setting. Data were collected before, during, and after TM and at rest. Saliva cortisol, serum glucose, and serum insulin were collected before, immediately following, and 1h after intervention or control, respectively.

RESULTS: After 5min TM, HR decreased significantly, indicating a reduced stress response. Total HRV and all HRV components decreased during intervention. Saliva cortisol and insulin levels decreased significantly after intervention, while serum glucose levels remained stable. A similar, though less prominent, pattern was seen during the control situation. Only minor changes were observed in ECV levels of glucose (a decrease) and lactate (an increase). No significant alterations were observed in glycerol or pyruvate levels throughout the study. There were no significant differences between groups in ECV concentrations of analyzed substances.

CONCLUSIONS: In healthy volunteers, TM decreased sympathetic nervous activity, leading to decreased overall autonomic activity where parasympathetic nervous activity also decreased, thereby maintaining the autonomic balance.

Ort, förlag, år, upplaga, sidor
Elsevier, 2010
Nyckelord
Touch, Massage, Autonomic nervous system, Heart rate variability, Saliva cortisol, Glucose, Insulin, Microdialysis
Nationell ämneskategori
Medicin och hälsovetenskap Arbetsmedicin och miljömedicin
Identifikatorer
urn:nbn:se:umu:diva-37167 (URN)10.1016/j.autneu.2010.06.011 (DOI)000284926900017 ()20638912 (PubMedID)2-s2.0-78149407534 (Scopus ID)
Tillgänglig från: 2010-10-25 Skapad: 2010-10-21 Senast uppdaterad: 2023-05-02Bibliografiskt granskad
2. Pleasant human touch is represented in pregenual anterior cingulate cortex
Öppna denna publikation i ny flik eller fönster >>Pleasant human touch is represented in pregenual anterior cingulate cortex
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2012 (Engelska)Ingår i: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 59, nr 4, s. 3427-3432Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Touch massage (TM) is a form of pleasant touch stimulation used as treatment in clinical settings and found to improve well-being and decrease anxiety, stress, and pain. Emotional responses reported during and after TM have been studied, but the underlying mechanisms are still largely unexplored. In this study, we used functional magnetic resonance (fMRI) to test the hypothesis that the combination of human touch (i.e. skin-to-skin contact) with movement is eliciting a specific response in brain areas coding for pleasant sensations. The design included four different touch conditions; human touch with or without movement and rubber glove with or without movement. Force (2.5N) and velocity (1.5cm/s) were held constant across conditions. The pleasantness of the four different touch stimulations was rated on a visual analog scale (VAS-scale) and human touch was rated as most pleasant, particularly in combination with movement. The fMRI results revealed that TM stimulation most strongly activated the pregenual anterior cingulate cortex (pgACC). These results are consistent with findings showing pgACC activation during various rewarding pleasant stimulations. This area is also known to be activated by both opioid analgesia and placebo. Together with these prior results, our finding furthers the understanding of the basis for positive TM treatment effects.

Ort, förlag, år, upplaga, sidor
Elsevier, 2012
Nyckelord
Brain, Human touch, Massage, Pregenual anterior cingulate cortex, fMRI, Pleasantness
Nationell ämneskategori
Neurologi
Identifikatorer
urn:nbn:se:umu:diva-51173 (URN)10.1016/j.neuroimage.2011.11.013 (DOI)22100768 (PubMedID)2-s2.0-84855166130 (Scopus ID)
Tillgänglig från: 2012-01-12 Skapad: 2012-01-12 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
3. Touch massage: a pilot study of a complex intervention
Öppna denna publikation i ny flik eller fönster >>Touch massage: a pilot study of a complex intervention
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2013 (Engelska)Ingår i: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 18, nr 6, s. 269-277Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objectives: To report and evaluate a complex touch massage intervention according to the British Medical Research Council framework. This study aimed to evaluate the effects of touch massage on levels of anxiety and physiological stress in patients scheduled for elective aortic surgery.

Background: The use of touch massage has increased during the past decade but no systematic studies have been implemented to investigate the effectiveness of such treatment. It is important to conduct multidisciplinary investigations into the effects of complex interventions such as touch massage. For this, the British Medical Research Council has provided a useful framework to guide the development, piloting, evaluation and reporting of complex intervention studies.

Method: A pilot study with a randomized controlled design including 20 patients (10 + 10) scheduled for elective aortic surgery. Selected outcome parameters included; self-reported anxiety, measured by the State-Trait Anxiety Inventory Form Y instrument, and physiological stress, measured by heart rate variability, blood pressure, respiratory frequency, oxygen saturation and concentrations of cortisol, insulin and glucose in serum.

Results: There were significant differences in self-reported anxiety levels before and after touch massage (p = 0·007), this was not observed in the control group (p = 0·833). There was a significant difference in self-reported anxiety levels between the touch massage group and the control group after touch massage and rest (p = 0·001). There were no significant differences in physiological stress-related outcome parameters between patients who received touch massage and controls.

Conclusion: In our study, touch massage decreased anxiety levels in patients scheduled for elective aortic surgery, and the British Medical Research Council framework was a useful guideline for the development, evaluation and reporting of a touch massage intervention.

Relevance to clinical practice: Touch massage can reduce patients' anxiety levels and is thus an important nursing intervention in intensive and post-operative care.

Ort, förlag, år, upplaga, sidor
Wiley-Blackwell, 2013
Nyckelord
Adult intensive care, Care nursing, Clinical research, Complex interventions, Intensive, Psychological care of patients, Research
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:umu:diva-61495 (URN)10.1111/nicc.12017 (DOI)000326030800004 ()2-s2.0-84886421315 (Scopus ID)
Tillgänglig från: 2012-11-15 Skapad: 2012-11-15 Senast uppdaterad: 2023-05-02Bibliografiskt granskad
4. Touch massage, a rewarding experience
Öppna denna publikation i ny flik eller fönster >>Touch massage, a rewarding experience
2014 (Engelska)Ingår i: Journal of Holistic Nursing, ISSN 0898-0101, E-ISSN 1552-5724, Vol. 32, nr 4, s. 261-268Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

This study aims to describe and analyze healthy individuals’ expressed experiences of touch massage (TM). Fifteen healthy participants received whole body touch massage during 60 minutes for two separate occasions. Interviews were analyzed by narrative analysis. Four identifiable storyline was found, Touch massage as an essential need, in this storyline the participants talked about a desire and need for human touch and TM. Another storyline was about, Touch massage as a pleasurable experience and the participants talked about the pleasure of having had TM. In the third storyline Touch massage as a dynamic experience, the informants talked about things that could modulate the experience of receiving TM. In the last storyline, Touch massage influences self-awareness, the participants described how TM affected some of their psychological and physical experiences. Experiences of touch massage was in general described as pleasant sensations and the different storylines could be seen in the light of rewarding experiences.

Ort, förlag, år, upplaga, sidor
Sage Publications, 2014
Nyckelord
touch, massage, reward system, health, qualitative content analysis
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:umu:diva-61496 (URN)10.1177/0898010114531855 (DOI)000439015400003 ()24771663 (PubMedID)2-s2.0-84909583292 (Scopus ID)
Anmärkning

Originally included in thesis in manuscript form, with title "Touch massage in relation to the reward system". 

Tillgänglig från: 2012-11-15 Skapad: 2012-11-15 Senast uppdaterad: 2022-06-28Bibliografiskt granskad

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