Massage and relaxation therapies' effects on depressed adolescent mothers

Adolescence, Winter, 1996 by Tiffany Field, Nancy Grizzle, Frank Scafidi, Saul Schanberg

Depression is one of the most prevalent medical disorders and has been recognized as a distinct pathologic entity from early Egyptian times. Anxiety is one of the primary features of depression in adolescents (Goldman, 1988), and relaxation therapy (RT) is usually noted to decrease anxiety (Richter, 1984). Using the State-Trait Anxiety Scale, for example, anxiety levels were found to be lower in psychiatric patients following nine sessions of relaxation therapy (Hosmand, Helmes, Kazarian, & Tekatch, 1985). Even following one brief RT session, mood was elevated on the Profile of Mood States Scale (Matthew & Gelder, 1969).

In a longer term outcome study, RT was as effective as psychotherapy and pharmacotherapy in reducing anxiety (McLean & Hakistian, 1979) and even more effective than cognitive behavior therapy (Reynolds & Coats, 1986). Similarly, in a study of depressed child and adolescent psychiatric patients, both groups benefitted from as little as one hour of relaxation therapy (Platania-Solazzo, Field, Blank, Seligman, Kuhn, Schanberg, & Saab, 1992). In that study, self-reported anxiety as well as anxious behavior and fidgeting decreased, and increases were noted in positive affect.

Massage therapy (MT), in contrast, was used in only one study in the literature. In that study child and adolescent psychiatric patients had lower anxiety levels following five massage therapy sessions as well as more optimal affect and sleep patterns and lower stress hormones including cortisol and norepinephrine (Field, Morrow, Valdeon, Larson, Kuhn, & Schanberg, 1991).

The purpose of the present study was to compare the effects of massage and relaxation therapies on anxiety and depression in a sample of depressed adolescent mothers. Maternal depression ranges from 25-30% during the first three months after delivery (O'Hara, Neunaber, & Zekoski, 1984). Even mild depression and anxiety may affect the new mother's relationship with her child. For example, in one study, postpartum depressed mothers demonstrated less rocking, gaze, and positive regard toward their infants than did nondepressed mothers (Livingood, Dean, & Smith, 1983). Others have reported less frequent positive and more frequent negative states among depressed mother-infant dyads (Cohn, Campbell, Matias, & Hopkins, 1990; Field, 1992; Field, Healy, Goldstein, & Guthertz, 1990). Massage and relaxation therapy were expected to decrease the mothers' depressive and anxiety symptoms.

METHOD

The sample was comprised of 32 depressed adolescent mothers who had recently given birth at a large inner-city hospital and were recruited from the hospital's maternity ward. The subjects were randomly assigned to the massage therapy or relaxation therapy group. The groups did not differ on age (M = 18.1), years of education (M = 10.4), ethnicity (71% black, 29% Hispanic), or SES (M = 4.7 on the Hollingshead Index). To qualify for the study the mothers needed to have an elevated Beck Depression Inventory (BDI) score and to be free of current medication or other treatment for depression or related disorders. The depression classification was based on a diagnosis of dysthymia on the Diagnostic Inventory Schedule (Costello, Edelbrock, & Costello, 1985) and a score greater than 16 on the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961).

Treatment Procedures

Massage therapy. The massage therapy subjects (N = 16) received a 30-minute massage per day on two consecutive days per week for five consecutive weeks (10 massages). For the first 15 minutes the subjects were in a supine position for massage in the following four regions: (1) head/neck - slow lateral stroking of forehead, followed by long and slow stroking from the neck across the shoulders and from the shoulders to the neck; (2) arms/hands - long and slow stroking from above the shoulder to beyond the hand, followed by individual stroking of each hand; (3) torso - placing the hand gently on the solar plexus (base of chest) and adding a gentle rocking motion; and (4) legs/feet - long, slow stroking from the hip to beyond the foot, followed by stroking each foot. For the second 15 minutes the subject was in a prone position. This segment consisted of an achilles tendon (ankle) stretch (bend the knee to stretch), knee and calf shake, long and slow strokes from over the buttocks to the toes, lateral lumbar stretch (10 times) including strokes parallel to the spine from the base of the spine to the shoulders and along the arms to past the end of the hands, trapezius (shoulder blade) squeeze, friction alongside the spine with the ulnar (outside) edge of the hand from superior to inferior, posterior neck squeeze and stretch, and long, slow strokes from the head down the entire posterior surface of the body to the toes (3 times). The massage therapy was administered by trained massage therapists and performed at the same time of day (mid-afternoon) over the 5-week period.

Relaxation therapy. The relaxation therapy subjects (N = 16) spent the same amount of time in RT as the massage therapy subjects spent in MT. They attended 30-minute relaxation therapy sessions on two consecutive days a week for five consecutive weeks (10 sessions). The subjects used exercise mats, and the first 15 minutes of the session consisted of yoga exercises. The second 15-minute segment consisted of progressive muscle relaxation. For this purpose the subjects were instructed to breathe deeply for several minutes. The instructor then asked the subjects to relax and tense eight different muscle groups beginning with the feet and ending with the head. The same measures as those used in the massage/control conditions were applied in the relaxation therapy over the same time frame.