The Benefits of Giving a Massage on the Mental State
of Massage Therapists: A Randomized, Controlled Trial
Anne M. Jensen, DC, ICSSD, MSc,1,2Adaikalavan Ramasamy, MSc, DPhil,3,4,5
Judith Hotek, BS,6Brian Roel, LMT,7and Drew Riffe, LMT, DC7
Objectives: The objective of this study was to determine whether giving a massage had an impact of the mental
state of the massage therapist.
Design: The design of this study was a randomized, controlled, blinded study with two parallel groups.
Settings/location: This study was conducted at an accredited school of therapeutic massage in Dallas, Texas.
Subjects: The study comprised healthy female and male final-term massage students between ages 18 and
Interventions: The participants were randomized into two groups: (1) the experimental group who gave a 1-
hour Swedish massage to a massage client (Massage group), or (2) the control group who sat in a room doing
normal, daily activities (Control group). Both these activities were a normal part of the daily routine for these
Outcome measures: The primary outcomes were the change in the Depression Anxiety and Stress Scale (DASS)
scores pre- and postparticipation.
Results: Twenty-two (22) participants were randomized in this trial. The baseline characteristics were compa-
rable between the two groups. A statistically significant advantage for the massage group was found relative to
the control group in subjective anxiety (DASS Anxiety Subscale, p=0.014). There were no significant differences
between the groups with regard to total DASS score (p=0.540), subjective depressive symptoms (DASS De-
pression Subscale, p=0.472) and subjective stress-related symptoms (DASS Stress Subscale, p=0.919). There
were no adverse events reported by any participant.
Conclusions: This study shows that massage therapists themselves may benefit from giving a therapeutic
massage by experiencing less subjective anxiety following the giving of a massage.
hanced emotional well-being, calmness, improved mood, re-
laxation, and reduced anxiety.1However, research to date has
focused on benefits to the recipient of the massage,2and has
ignored any effects on the person giving the massage, the mas-
sage therapist. In a thorough search of the literature, no peer-
that giving a massage might have on the massage therapist.
beneficial effects, including the psychologic benefits of en-
Since ancient times, touch has been used as a healing tool
in all cultures.3Yet in the mind of the rational, ocularcentric
modern Western individuals, it plays an inconsistent and
often confusing role in health and well-being, and as a result
touch is often disdained. From birth, touch promotes an in-
fant’s neuropsychologic, physiologic, and social develop-
ment.4–6In later stages as well, touch has been shown to be
associated with more satisfactory social relations.7Para-
doxically, in regard to health and well-being, it is arguably
the most important of our basic senses, yet it is least un-
1Department of Primary Care & Department of Continuing Professional Development, University of Oxford, Oxford, UK and2Research
Institute, Parker University, Dallas, TX.
3Respiratory Epidemiology and Public Health, Imperial College, London, UK.
4Department of Epidemiology and Biostatistics, Imperial College, London, UK.
5Department of Medical and Molecular Genetics, Kings College London, Guy’s Hospital, London, UK.
6Department of Information Systems, Parker University, Dallas, TX.
7School of Massage Therapy, Parker University, Dallas, TX.
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 18, Number 12, 2012, pp. 1–5
ª Mary Ann Liebert, Inc.
With touch therapies such as massage, it is impossible to
touch without being touched oneself.8,9It is precisely this
quality that makes the sense of touch unique from any other
human sense (e.g., I can see you without you seeing me).
Furthermore, as Mazzio10describes, the experience of touch
often eludes adequate verbal description: ‘‘When humans
touch, there is a reciprocity of sensation at once physical and
psychological that may be felt but not fully grasped.’’
It is speculated that through this blurred connection, the
giver of a touch therapy also receives a therapeutic benefit.
The purpose of this study is to investigate whether giving a
massage impacts the state of mind of massage therapists.
Materials and Methods
The aim of this study was to investigate whether giving a
massage impacts the mental state of a massage therapist,
including depression, anxiety, and/or stress. It was specu-
lated that the feelings of depression, anxiety, and stress
would reduce following the giving of a massage.
In this single-blinded, randomized, controlled trial, 22
participants were recruited from a population of final-
trimester therapeutic massage students. Volunteers were
included if they were healthy, mentally and physically, and
aged between 18 and 65 years. They were excluded if they
currently had any contraindications of giving a massage
(e.g., inflammatory arthritides). Of the 22 volunteers en-
rolled, 11 were randomly allocated to the experimental
group and gave one 1-hour massage. The remaining 11
participants served as controls, and sat in a room for 1 hour.
No participants in either arm delivered any form of mas-
sage or other touch therapy on the day of their participation,
nor did they participate in any practical touch training on the
day of their participation. Participants in the experimental
group gave one 1-hour Swedish massage to a massage client,
which was part of the normal routine for these participants.
In all cases, plain massage lotion, free of fragrances and other
additives, was used.11The control participants sat in a
classroom for 1 hour, with no other explicit instructions,
which is also normal routine for these participants. It is im-
portant to note that the normal routines for all participants
were kept unchanged, except for completion of question-
naires before and after the allocated 1 hour. All interventions
occurred at an accredited school of therapeutic massage.
The primary assessment measure was the Depression An-
xiety and Stress Scales (DASS). The DASS is a set of three self-
report scales measuring the affective states of depression (‘‘D’’),
anxiety (‘‘A’’) and stress (‘‘S’’).12Each of the 21 items is scored
from ‘‘0’’ (Did not apply to me at all) to ‘‘3’’ (Applied to me very
much or most of the time’’).12A template was used to score the
test, and the total score and three subscores were calculated for
each of the subcategories. Subscores can range from 0 to 28+,
with normal being at the lower end of the range.12The DASS
was found to have adequate convergent and discriminant va-
lidity12and good reliability, including test–retest reliability.12,13
Sample size estimation was performed based on the pri-
mary outcome measure, the DASS (total score). The mini-
mum change in the total DASS score of 10 points was
predicted using the results from a similar effectiveness
studies.14,15Using the DSS Research Sample Size Calculator
Software and 5% level of confidence, a total of 22 subjects (11
per group) would be required from a statistical power of
0.81. There was no anticipation of any loss-to-follow up and
thus no further adjustment for attrition was made.
Randomization and blinding
Participants meeting the eligibility criteria were pooled
and randomly allocated to a group by an independent as-
sistant. Randomization took place using sealed opaque en-
velopes containing group allocation, which was selected for
each participant upon enrollment. Only the principal inves-
tigator had prior knowledge of the contents of each of the
envelopes. Another independent assistant who was blind to
the group allocation administered the assessment question-
naires. While it is difficult to blind study participants when
hands-on therapies are allocated, in this study this was ac-
complished because the participants’ normal routines were
not disrupted. More explicitly, the normal daily activities of
these massage students (who were in the phase of their ed-
ucation in which they were actively seeing clients) involved
coming in at the start of a shift, and sitting in the student
lounge to wait for walk-in clients. Therefore, some of these
students were assigned a massage (a normal activity) and
some of these students were not assigned a massage (also a
normal activity). Due to the normality of these activities, it is
believed that all participants were blind to group allocation
for the duration of their participation in the study.
The data were analyzed using SPSS 17.0. The change in
DASS subscores pre- and postintervention between the two
groups was performed using the nonparametric Mann–
Whitney U-test statistics16,17to test whether the difference in
medians of the two groups is statistically significant. When a
difference in the direction of the test statistics is a priori an-
ticipated, a one-tail procedure is implemented. Otherwise a
two-tailed procedure is indicated.
Standard protocol approvals, registrations,
and patient consents
This protocol received ethics committee approval by the
Parker University Institutional Review Board (Approval
#R07_10). Also, this study was registered with a clinical trials
registry: ClinicalTrials.gov (Identifier #NCT01169480). Writ-
ten informed consent was obtained from all participants, and
all other tenets of the Declaration of Helsinki were upheld.
Twenty-five (25) people were screened, 22 were random-
ized, and 22 were included in the analysis (Fig. 1, Consolidated
2JENSEN ET AL.
Standards of Reporting, or CONSORT, Diagram). The most
frequent reason for exclusion was scheduling difficulties (12%).
The differences between the groups at baseline were not sta-
tistically significant (Table 1). In addition, all participants scored
in the ‘‘normal’’ range for all DASS scores.
The primary analysis was intention-to-treat and involved
all participants (N=22) who were randomly assigned to both
groups. Table 2 summarizes the changes in scores from
baseline to second assessment (before and after giving a
massage or rest). Secondary analyses identified a statistically
significant advantage for the massage group relative to the
control group in subjective anxiety (DASS Anxiety Subscale,
p=0.014). There were no significant differences between the
groups with regard to total DASS score (p=0.540), subjective
depressive symptoms (DASS Depression Subscale, p=0.472)
and subjective stress-related symptoms (DASS Stress Sub-
scale, p=0.919). See Figure 2 for a boxplot of the changes in
DASS scores (plus p-values) by DASS category and group,
and Figure 3, by group and gender. There were no adverse
events reported by any participant.
Many studies have examined the therapeutic effect of re-
ceiving a massage, and in general have found some benefit.
The results of this study suggest that the giver of a massage,
the massage therapist, also receives a therapeutic benefit
from the experience, in the form of reduced subjective anx-
iety. The difference compared with a no-intervention control
group was large and clinically relevant.
One strength of this study is its uniqueness in the litera-
ture. No study published to date has investigated the ther-
apeutic effects for the therapist of giving a massage or other
touch therapy. Another strength was its zero-dropout rate.
Other strengths are its simple and pragmatic randomized,
controlled study design, the careful and clever blinding of
assessors and study participants, and faithful adherence to
protocols. However, this study also has a number of limita-
tions that must be taken into account.
The main limitation of this study was that it might have
been underpowered. Because no prior research on this topic
Reporting Diagram). DASS, Depression Anxiety and Stress
Scales; STAI, State–Trait Anxiety Inventory.
CONSORT Diagram (Consolidated Standards of
Table 1. Participant Characteristics at Baseline
Gender (% male)
SD, standard deviation; DASS, Depression Anxiety Stress Scales.
ap-Value from two-sample test for equality of proportions with
continuity correction. Otherwise p-value was calculated using
Mann–Whitney test statistics with exact conditional distribution of
test statistics. All p-values reported in this table are based on two-
sided hypothesis testing.
Table 2. Participant’s Change in DASS Scores
Massage group (N=11)
Control group (N=11)
Changes in scores
SD, standard deviation; CI, confidence interval; DASS, Depression Anxiety Stress Scales.
aEffect size is calculated using Hedges’ adjusted g formula which gives an unbiased estimate with small samples sizes.
bp-Value from Mann–Whitney test statistics using exact conditional distribution of test statistics. The p-values were calculated under one-
sided hypothesis testing for superiority of massage.
GIVING A MASSAGE REDUCES ANXIETY IN THERAPISTS3
could be found, an adequate estimation of sample size was
difficult. It is noted that DASS subscores dropped for both
groups, with only the DASS Anxiety subscore achieving
significance. In addition, sample size was estimated using
only the total DASS score. If estimations using the individual
subscores were made and the largest sample size estimation
was used, statistical significance might have been reached in
other DASS categories as well.
Another limitation of this study is the lack of follow-up
assessment, which would have given an indication of the
durability of effect. Inclusion of longer-term data would have
strengthened the study; however, its feasibility in this or a
similar setting is questionable. In a therapeutic massage
practice, a therapist would normally massage several people
per day for days in succession, and not one in isolation,
confounding the long-term effects of giving one massage.
Future research may want to investigate the durability of
Finally, the participants were massage students in their
last term of training, and therefore, had limited practical
experience. They also may have lacked self-confidence. As a
result, for some participants, the act of giving a massage may
have been stressful, and therefore may have negatively im-
pacted the therapist’s mental state. In addition, all massages
were also assessed by the massage client, which is also part
of the normal routine. However, this may have evoked dis-
tress, or a ‘‘test anxiety’’ state. Future research should control
for these potential confounders or use experienced thera-
pists. In addition, while the measure used in the study (the
DASS) is considered sound, future research may also wish to
choose different measures of mental state, such as a different
psychometric, or even a physiologic measure, such as a
biomarker of stress.
This study may attract criticism for not monitoring or
limiting the activities of the control group. However, the
Stress Scales (DASS) scores by DASS category and group.
One value of the p-value from Mann–Whitney test statistics
between massage group and controls for each DASS cate-
gory is shown in parentheses.
Boxplot of changes in Depression Anxiety and
sion Anxiety and Stress
Scales subscores by group
Changes in Depres-
4 JENSEN ET AL.
activities assigned to both arms of this study (‘‘giving a Download full-text
massage’’ or ‘‘sitting in a room waiting’’) were normal daily
activity for all participants, and therefore, should not con-
found results. On the other hand, the addition of an active
control condition would have helped tweeze out the thera-
peutic effects of attention or a specific activity from that of
the massage, and therefore, strengthened this study. Such an
active control group could simply have observed a massage
taking place, had some other nontherapeutic interaction with
a client, or attended a lecture.
Other health professionals, such as chiropractors, osteo-
paths, nurses, and physical therapists, also offer touch ther-
apies. These results may not be generalizable to other
groups. Future research on the therapeutic effects of offering
touch therapies targeting other health professionals is also
The purpose of this study was to investigate whether
giving a massage impacts the mental state of the therapist.
Since these results support the authors’ hypothesis and also
support anecdotal evidence, speculation about the causation
of the benefits is warranted.
The skin is considered the most primitive sense organ,18
playing an important role in communication and facilitating
social relationships. The therapeutic effect of touch is unde-
niable in all stages of life and for varying conditions.4,5,19,20
Tactile sensations, as compared to the other senses, are un-
ique in two important ways: (1) They are spread throughout
the body, and (2) whoever is touched, touches back.9This
link between object and subject affords a communication that
is nonverbal, allowing each to experience the other’s dispo-
sition.9It is precisely this connection21that is speculated to
be the basis for the promising results of this trial, the bene-
ficial effect of giving a massage.
This study shows that massage therapists may themselves
benefit from giving a therapeutic massage by experiencing
less subjective anxiety following the giving of a massage.
Additional research is warranted to explore other potential
benefits for touch therapists.
The authors would like to thank Dr. Lavada Smith for her
enthusiasm and her important contributions to this study.
No competing financial interests exist.
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Address correspondence to:
Anne M. Jensen, DC, ICSSD, MSc
2000 East Irving Boulevard
Irving, TX 75060
GIVING A MASSAGE REDUCES ANXIETY IN THERAPISTS5