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‘To give is better than to receive?’ Couples massage significantly benefits both partners’ wellbeing


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This experimental study evaluated the differential effects of 'giving' and 'receiving' massage on wellbeing in healthy but stressed couples. Forty-two volunteers started the study and of these, 38 (i.e. 19 couples) completed a 3-week massage course. Emotional stress and mental clarity were assessed before and after mutual massage between each pair of adults belonging to a couple at home. While massage benefitted both parties' wellbeing within a session, critically we found no differences in wellbeing between those 'giving' and 'receiving' massage. These novel findings suggest that home-based massage may be advocated to couples as a 'selves-care', health-promoting behaviour.
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Journal of Health Psychology
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DOI: 10.1177/1359105318763502
Massage is a form of touch that can express
care and support between givers and receivers
(Finch, 1999; Pratt and Mason, 1981).
Historically, massage has ancient roots in many
cultures not only as a therapy to restore health
but also as a natural human activity to meet the
human need for touch (Culvert, 2002; Montagu,
1986). Yet, despite this varied potential, most
research on massage has focused on its thera-
peutic usage, and there is a paucity of studies
investigating the effects of massage among
healthy adult1 populations. Furthermore, the
majority of massage studies have explored the
benefits of receiving massage from a trained
specialist. Studies of the effects of giving mas-
sage, especially by lay people, are almost
unknown. The few exceptions that do exist
include studies of husbands’ or partners’
massage of pregnant women (Field et al., 2008;
Latifses et al., 2005). In one such study, Field
et al. (1998) tested the effects of massage on
retired people by comparing their receipt of
massage from therapists with them giving mas-
sage to babies (after they had learned the mas-
sage skill). The results were interesting and
somewhat surprising. Giving massage to babies
was more beneficial to these participants than
them receiving massage from a therapist, as
indexed by both short-term and longer-term
‘To give is better than to receive?’
Couples massage significantly
benefits both partners’ wellbeing
Sayuri M Naruse , Piers L Cornelissen
and Mark Moss
This experimental study evaluated the differential effects of ‘giving’ and ‘receiving’ massage on wellbeing
in healthy but stressed couples. Forty-two volunteers started the study and of these, 38 (i.e. 19 couples)
completed a 3-week massage course. Emotional stress and mental clarity were assessed before and after
mutual massage between each pair of adults belonging to a couple at home. While massage benefitted both
parties’ wellbeing within a session, critically we found no differences in wellbeing between those ‘giving’ and
‘receiving’ massage. These novel findings suggest that home-based massage may be advocated to couples as
a ‘selves-care’, health-promoting behaviour.
couples, emotional stress, health behaviour, massage, mental clarity, wellbeing
Northumbria University, UK
Corresponding author:
Sayuri M Naruse, Department of Psychology,
Northumbria University, Newcastle upon Tyne NE1 8ST,
763502HPQ0010.1177/1359105318763502Journal of Health PsychologyNaruse et al.
2 Journal of Health Psychology 00(0)
measurements of anxiety, depression and sali-
vary cortisol.
We note that, to our knowledge, there have
been no studies, to date, comparing the effects
of giving and receiving massage in a reciprocal
setting, such as between couples. Nevertheless,
there are hints that valuable effects might be
found based on published studies of massage
administered by professional therapists. For
example, Jensen et al. (2012) found that mas-
sage therapists reported experiencing reduced
anxiety after giving a massage than those who
had simply rested for the same period. Airosa
et al. (2016) reported that the benefit of giving
tactile massage was not only restricted to
patients or ‘receivers’ but also extended to the
nursing staff, the ‘givers’. Similarly, studies
that have focused on home-based massage
given by lay masseurs have found that the ben-
efits of giving massage include heightened self-
efficacy (Kempson and Conley, 2009),
enhanced confidence and satisfaction (Collinge
et al., 2013) and promotion of a sense of close-
ness (Forchuk et al., 2004). All these studies
suggest that giving massage benefits the giver.
However, no study that we are aware of has
compared the effects on such variables of what
might be considered the most natural experi-
ment of all: lay couples both giving and receiv-
ing massage to each other, evaluating the effects
of ‘giving’ and ‘receiving’ massage on wellbe-
ing. This is therefore our focus here.
We conducted the current study as part of a
larger study. However, the data we report here
are focused on a narrow, specific question: what
effects does ‘giving’ and ‘receiving’ massage
have on the wellbeing of the individuals who
belong to a couple, both of whom report feeling
stressed, but who are otherwise healthy. Based
on the limited extant literature, our hypothesis
was that giving a massage might provide health-
related benefits for both the ‘receiver’ and the
lay ‘giver’, and that exchanging massages
might therefore be promoted as a ‘health behav-
iour’ that can benefit both parties. To this end, a
massage programme was designed to provide
training to couples in a simple brief sequence of
massage steps (Positive Massage, PM). The
participants were then encouraged to practice
massage (both giving and receiving) at home
and to keep a massage log for 3 weeks to track
their emotional and mental wellbeing. To our
knowledge, this is a novel investigation to
explore possible differentiation between giving
and receiving a massage among healthy but
stressed couples.
Participants were recruited by means of post-
ers, flyers, email and social media (Facebook).
Inclusion criteria were (a) healthy couples
where both parties are at least 18 years old and
(b) both parties had to express feelings of
stress, tension or worry. Exclusion criteria
were (a) known cardiovascular pathology such
as an aneurysm, unless the participant had
written doctor’s approval to take part in the
study; (b) major surgery within last 3 months;
(c) recent injuries such as bone fractures in
upper body; (d) being in the first trimester of
pregnancy; and (e) already receiving massage
Forty eight participants were first asked
about their availability/preference for the dates
of the PM course, and then they were allocated
randomly to one of the two PM intervention
groups depending on their response. Please
refer to the Consolidated Standards of
Reporting Diagram (CONSORT; see http:// in Supplementary
Figures S1 for further details. Group A (n = 24)
started the PM intervention immediately,
whereas group B (n = 24) delayed the start of
their PM intervention for 3 weeks. Four partici-
pants in group A dropped out of the study either
for health reasons (n = 2) or due to unexpected
circumstances (n = 2). Six participants in group
B were unable to start the PM programme after
their 3-week delay following initial recruit-
ment. The reason for including the delayed
treatment group was to control for duration of
study effects (Raudenbush and Xiao-Feng,
2001) and to facilitate the recruitment of a rea-
sonable sample size. A maximum of six cou-
ples could be taught in any one session to
Naruse et al. 3
maximize the effectiveness of the training in
addition to the constraints of room size and
trainer availability.
Ultimately, across both groups A and B, a
total of 38 participants completed the 3-week
massage course. Of these, 34 participants’ data
were used for analysis. The mean age of the
participants was 37.1 years (standard deviation
(SD) 10.63), and the mean duration of their
relationships was 8.2 years (SD 9.56). Thirty-
three out of 34 participants (97%) had some
prior experience of receiving massage: 27/34
(79%) from professional, 13/34 (38%)
from family and 9/34 (26%) from friends. By
comparison, fewer (26/34, 76%) had experi-
ence giving massage. Of these, 23/26 (88%)
had given massage to the partner, 10/26 (38%)
to family, 9/26 (35%) to friends and 1/26 (4%)
to colleagues. These proportions are possibly
higher than the general population in the United
Kingdom2 and may reflect participants’ interest
in joining the study. In addition, participants
sometimes failed to record the entire massage
log or made obvious recording errors. In such
cases, the data points were ignored. This means
that the final data matrix, while sparse in places,
contains only the most reliable data. Further
demographic details about the participants are
shown in Table 1.
Materials and apparatus
Participants’ emotional and mental wellbeing
were assessed using a modified eight-item
visual analogue scale (VAS) (Turkeltaub
et al., 2014). Data were recorded by partici-
pants at home in an online ‘massage log’
implemented in Qualtrics (Provo, UT). There
were three measurement points for each of the
nine sessions throughout the PM programme:
(a) before massage, that is, baseline; (b) after
the first massage and (c) after the second mas-
sage. The eight outcomes in the Turkeltaub
et al. inventory for which VAS scores were
obtained included energy, irritability, mental
clarity, mood, pain, self-efficacy, emotional
stress and physical uptightness. Each item
in the inventory had a horizontal line scale
starting at –50 (the most negative) and con-
tinuing through zero up to +50 (the most posi-
tive). This scaling system from negative to
positive numbers was based on the original
scoring used by Turkeltaub et al. (2014). To
illustrate the use of this scoring system, in the
case of emotional stress, for example, partici-
pants were told that –50 should correspond to
the most emotionally stressed they could
imagine being, while +50 should correspond
to the most emotionally relaxed they could
imagine being.
PM intervention. PM3 is a unique fusion of East-
ern and Western styles of massage. It was devised
by the first author who has 10 years of experi-
ence as a certified massage therapist and 20 years
of experience as an educator. The distinctive
characteristic of PM is the frequent use of mas-
sage to promote wellbeing, rather than restricting
it to a therapeutic role. The massage sequence is
intended to be simple, brief (15 minutes) and
appropriate for those who are in a close relation-
ship. It is easily applied and does not require
clothing to be removed, nor massage oil to be
applied. It is therefore ideal for frequent applica-
tion in a home setting with minimal disruption to
the daily routine. The massage techniques used
in PM include kneading, stroking, tapping,
squeezing, chopping, stretching, static and circu-
lar compression over clothes and skin with both
the hands (palms, thumbs, fingers and sides of
hands) and the arms using some acupressure
points and trigger points. The instructor taught
participants to apply different levels of pressure
for different kinds of massage movements. Some
required gentle pressure but the majority moder-
ate pressure. Similarly, the velocity of the move-
ments (i.e. stroking) was mostly slow. However,
massage givers were also encouraged to adapt
both the pressure and the velocity to the receiv-
er’s comfort and preference.
This research project was approved by the
Faculty of Health and Life Sciences
4 Journal of Health Psychology 00(0)
Research Ethics Committee at Northumbria
Once participants had given informed con-
sent and been allocated to group A or B, they
were invited to the three weekly massage
classes at Northumbria University in weeks 1–3
and weeks 4–6 of the programme, respectively.
The PM programme was run by the first author
with the help of an assistant. It consisted of
supervised classes (week 1: back massage;
week 2: arm, neck and head massage and week
3: all parts and face) and self-directed massage
practice at home to be carried out three times
per week. Participants were given handouts
each week to remind them of the massage
sequence for the week.
Over the course of the 3 weeks, each couple
was asked to take part in nine practice sessions at
home. Each session comprised (a) a set of base-
line VAS measurements from both members of a
couple before any massage took place, (b) one
member of a couple giving massage to the other
and both participants completing a second set of
VAS scores and (c) the couple then swapping
roles with the person who was giving massage
now receiving a massage and vice versa.
Following the second massage, a third set of
VAS scores were obtained from both partici-
pants. In this way, a full dataset for each of the
nine sessions comprised two baseline VAS meas-
urements, and two sets of ‘giver’ and receiver’
VAS measurements: one member of a couple
acting first as ‘giver’ then ‘receiver’, while the
other member acting as ‘receiver’ then ‘giver’.
Treatment of data. We investigated the impact
on self-report measures of wellbeing, of adults
who belong to stable couples, giving and receiv-
ing massage to and from each other. While eight
psychological outcomes were measured using
the VAS, we wanted to be sure only to report
outcomes that were statistically independent of
each other and of potential theoretical/clinical
importance. Therefore, we first examined the
correlations between all eight outcomes from
the Turkeltaub et al. (2014) inventory and used
principal components analysis to identify statis-
tically independent dimensions in the data.
Based on these results, we selected emotional
stress and mental clarity for further analysis
using multi-level modelling.
Table 2 shows the Pearson correlations between
the eight VAS scores obtained from 34 partici-
pants at the first baseline before any massage
took place.
It is clear from Table 2 that there are a num-
ber of substantial and statistically significant
correlations between outcomes. This suggests
that we could not rely on the labels for the out-
comes to represent meaningfully separate, sta-
tistically independent concepts. Therefore, we
submitted these data to a principal components
analysis to reveal how many independent,
latent dimensions there were in the data. To do
this, we used PROC FACTOR in SAS v9.4
Table 1. Demographic data.
Number of participants started
Number of participants completed
Number of participants with
useable data recorded
Mean age 37.1(SD 10.63)
Male 15
Female 19
Mean time length of relationship/
8.2 (SD 9.56)
Marital status (% within group)
Married 16 (47%)
Cohabiting 7 (21%)
Other 11 (32%)
Ethnicity (% within group)
White British 20 (59%)
Black or African 1 (3%)
White European 7 (21%)
Asian 1 (3%)
Other 2 (6%)
Prefer not to state 3 (9%)
SD: standard deviation.
Naruse et al. 5
(SAS Institute, North Carolina, USA) with
Varimax rotation. The Kaiser–Meyer–Olkin
(KMO) measure of sampling adequacy (which
indicates the degree of diffusion in the pattern
of correlations) was 0.62, suggesting a border-
line acceptable sample. Three factors had an
Eigen value greater than Kaiser’s criterion of
one which explained 77 per cent of the vari-
ance. The scree plot showed an inflexion, that
is, Cattel’s criterion which also justified retain-
ing three factors. The residuals varied between
0.1 and 0.04, and the overall root mean square
off-diagonal residual was 0.081, indicating
that the factor structure explained a large pro-
portion of the correlations. The rotated factor
loadings are shown in Table 3, and we have
highlighted values greater than 0.4 for clarity.
Principal component one (PC1) loaded pri-
marily onto mental clarity, energy, self-effi-
cacy and mood. PC2 loaded primarily onto
physical uptightness and emotional stress.
PC3 loaded primarily onto pain and irritability.
Since emotional stress and mental clarity are
both conceptually important attributes of emo-
tional and mental wellbeing, respectively, and
were shown to be statistically independent of
each other, we restricted further analysis of the
data to these two outcomes.
Multivariate analysis
We wanted to model how emotional stress and
mental clarity changed with time across
massage sessions, particularly in relation to
whether massage was given or received. To do
this, we used PROC MIXED in SAS v9.4 to
build two separate multi-level models, one for
each of the two outcome measures. The initial
model in each case included as fixed effects:
GROUP (i.e. intervention group A and delayed
intervention group B to which participants had
been assigned), SESSION (i.e. which of the
nine sessions the data were gathered and treated
as a continuous time variable), CONDITION
(i.e. (a) baseline measurement before the first
massage event, (b) whether the responder gave
massage and (c) whether the responder received
massage), ORDER (i.e. the order in which each
member of a couple gave and received mas-
sage) and finally the two-way interaction CON-
DITION × SESSION. We included participants
nested within their respective couples as a ran-
dom effect and permitted individual variation
both at the intercept level and as a function of
session by specifying a heterogeneous autore-
gressive covariance structure. CONDITION
was dummy coded, with receiving massage as
the control, baseline indexed by 1 and giving
massage indexed by 2. These models were opti-
mized according to three criteria: (a) there
needed to be a statistically significant differ-
ence in −2 log likelihood between the final and
the empty model in each case, (b) main effects
were retained if they were statistically signifi-
cant at p < 0.05 and (c) produced a statistically
significant reduction in −2 log likelihood by
Table 2. Pearson correlations between the eight VAS scores at first baseline measurement.
EN 0.58***
SE 0.59*** 0.38*
MD 0.43** 0.49** 0.54*
PU 0.02 0.32 0.31 0.48**
ES 0.25 0.32 0.64*** 0.52** 0.75***
PN –0.25 –0.002 0.23 0.19 0.19 0.35*
IR 0.29 0.25 0.40* 0.46** 0.02 0.35* 0.32
MC: mental clarity; EN: energy; SE: self-efficacy; MD: mood; PU: physical uptightness; ES: emotional stress; PN: pain; IR:
*p < 0.05; **p < 0.01; ***p < 0.001.
6 Journal of Health Psychology 00(0)
being retained. The optimized model results are
illustrated in Table 4 and graphed in the first
row of each of the Figure 1(a) and (b). For both
outcome measures, it is clear that scores
improved as a function of massage session, and
that, in general, scores as a result of giving or
receiving massage were improved compared
to baseline. In general, for each model we found
no statistically significant effects of GROUP,
ORDER or the two-way interaction
Next, we wanted to compute simple effects
pairwise comparisons of scores between (a)
baseline and giving, (b) baseline and receiving,
and (c) giving and receiving, separately for each
of the nine sessions. To do this, we re-ran the
optimized models, but this time treating session
as a class variable and allowing individual par-
ticipants’ intercepts to vary by specifying an
unstructured covariance matrix. This allowed
PROC MIXED in SAS v9.4 to test for signifi-
cant differences in the predicted means (i.e.
LSmeans) at each time point, while controlling
for multiple comparisons. These pairwise com-
parisons are illustrated in the bottom rows of
Figure 1(a) and (b). In each case, a data point
corresponds to an LSmean difference with its
accompanying 95 per cent confidence interval.
If any mean difference together with its confi-
dence interval sits either entirely above or below
the black dashed zero line, then it is statistically
Table 3. Rotated factor loadings from PCA.
MC 0.93 −0.05 −0.02
EN 0.73 0.27 −0.03
SE 0.63 0.35 0.39
MD 0.58 0.46 0.33
PU 0.08 0.96 −0.04
ES 0.28 0.81 0.34
PN −0.29 0.29 0.79
IR 0.40 −0.07 0.78
MC: mental clarity; EN: energy; SE: self-efficacy; MD:
mood; PU: physical uptightness; ES: emotional stress; PN:
pain; IR: irritability; PCA: principal component analysis.
Table 4. Outcomes for the two multi-level models, one each for emotional stress and mental clarity.
Time (i.e. session) was treated as a continuous variable to allow us control for the effect of autocorrelated
Model ParameterF-value (DF) Z-value p-value Estimate 95% CI -2Log
Emotional Stress
Empty model 3745.8
Full model
Ppt cov: INT
Ppt cov: INT × SLOPE
Ppt cov: SLOPE (AR)
8.91 (1, 20.7)
88.52 (2, 373)
1: -19.97
2: -5.36
0.32 – 1.82
-23.03 – -16.92
-8.42 – -2.31
Mental Clarity
Empty model 3487.4
Full model
Ppt cov: INT
Ppt cov: INT × SLOPE
Ppt cov: SLOPE (AR)
4.63 (1, 25.7)
44.85 (2, 375)
1: -9.66
2: 1.93
0.026 – 1.14
-12.24 – 7.08
-0.66 – 4.52
Naruse et al. 7
Figure 1. Emotional stress (a) and mental clarity (b), the upper row shows the relationship between fitted individual data points and massage session. In
the upper row, the data are plotted separately for grey as the baseline (i.e. before massage), black as giving massage and white as receiving massage. Straight
lines represent the simple regression lines in each case, the colours corresponding to the appropriate data points. The plots in the lower row show post
hoc comparisons for each session. The differences are between baseline versus giving massage (black circles), baseline versus receiving massage (white
squares), giving versus receiving massage (grey triangles). Error bars represent the 95 per cent confidence intervals for these differences. The y-axis at the
right-hand end of the lower plots represents the total number of data points that have been included into any of the pairwise comparisons (cross-hatched
8 Journal of Health Psychology 00(0)
significant at p < 0.05. If the error bars intersect
with the zero line, then this comparison is not
statistically significant at p < 0.05. The cross-
hatched bars at each time point indicate the
overall number of viable data points that con-
tributed to the computations for that time point
and are indicated by the y-axis on the right of
each graph. It is very clear that the instances
where there are no significant effects of giving
or receiving massage relative to baseline, tend to
be associated with reduced numbers of data
points for that session. Most importantly, all
nine pairwise comparisons between giving and
receiving for the emotional stress and mental
clarity (i.e. the grey triangles in the lower plots
for Figure 1(a) and (b)) were not significantly
different from zero for any sessions.
Finally, we sought evidence for improved
response scores over the course of nine sessions
by comparing baseline, receiving and giving,
respectively, in session 1 with session 9.
Accordingly, the comparisons of LSmean dif-
ferences in emotional stress showed statistically
significant improvements for both giving
(t = 3.36, p = 0.0009) and receiving (t = 2.31,
p = 0.021), and to our surprise, also for baseline
(before massage practice; t = 2.15, p = 0.032).
For mental clarity, we only found a statistically
significant improvement between sessions 1
and 9 for receiving (t = 2.31, p = .022). No sig-
nificant reductions between sessions 1 and 9
were observed for any outcome measure.
Lay couples were trained to administer a simple
massage routine which was delivered over the
course of nine sessions during the 3-week pro-
gramme. Our results showed that brief periods of
massage produced statistically significant reduc-
tions in emotional stress and improvements in
mental clarity compared to baseline, whether par-
ticipants were givers or receivers of massage.
Importantly, we also found no significant differ-
ences between giving and receiving massage on
emotional stress or mental clarity at any of the
study time points. Therefore, taken as a whole,
our results suggest that both giving and receiving
massage between lay couples is equally
beneficial with regards to their self-reported emo-
tional stress and mental clarity.
We consider it a particularly important find-
ing that givers experienced emotional and men-
tal wellbeing benefits to the same extent as that
receivers did. We speculate that the effects of
giving massage may be related to unique char-
acteristics of touch; touching someone means
that you can feel what it is you are touching.
Giving massage inevitably involves the giver
feeling the receiver’s body through his or her
fingertips and hands, which have a high density
of mechanoreceptors (Johansson and Vallbo,
1979). In turn, his or her afferent nerve fibres
will stimulate a large part of the cortical homun-
culus (Heller and Schiff, 1991). By giving a
massage, the hands are stimulated physiologi-
cally and the giver psychologically via sensitive
tactile and pressure receptors (Field, 2010).
This may be linked with evidence that touch
can create bonds and connections in inter-per-
sonal relationships through non-verbal interac-
tion (Debrot et al., 2013; Gallace and Spence,
2010), and there is evidence that relationships/
connectedness play an important role in estab-
lishing and maintaining a sense of wellbeing
(e.g. Ryan and Deci, 2000; Seligman, 2011).
The beneficial effects of PM reported here may
therefore be, in part, a consequence of the
strengthening of such bonds between couples.
Interestingly and to our surprise, we also
found beneficial effects of massage that accrued
over the nine sessions of the study, particularly
for emotional stress. Specifically, the pre-mas-
sage VAS measure of emotional stress, just
before massage began, showed a statistically
significant reduction in emotional stress
between sessions 1 and 9. This result suggests
that exchanging massages not only provides
couples with benefits within a massage session
but also that these benefits to wellbeing may
accumulate over time. Ideally, therefore, future
studies should identify (a) how long do these
effects persist for, (b) what is the minimum
number of massage sessions needed to observe
this benefit and (c) how much of an improve-
ment in the emotional stress scale rating consti-
tutes a clinically meaningful change.
Naruse et al. 9
The current study suggests that giving mas-
sage may not only support one’s partner but
also contribute to one’s own ‘self-care’. In
short, the giving and receiving of massage
between couples might be thought of as ‘selves-
care’,4 denoting activity to simultaneously care
for a loved one and oneself. Exchanging brief
massages in daily life may be a positive and
valuable ‘selves-care’ approach to the mainte-
nance of wellbeing. The concept of ‘selves-
care’ is important, since one’s wellbeing
impacts other’s wellbeing reciprocally, espe-
cially within close relationships (Martire and
Schulz, 2007). The current findings suggest
that couples massage can be promoted as a
‘health behaviour’ as it possesses the quality of
‘selves-care’ via caring touch. We further argue
that the target should not be limited to only
couples but aimed at a wider population such
as family and friends where non-verbal com-
munication would be appreciated (Pratt and
Mason, 1981). This suggestion is in line with
McFeeters et al. (2016) who recommend
involving family members to provide massage
in the care of older people. The potential impact
of promoting exchanging massages among
couples and close relationships in wider popu-
lation cannot be overestimated. However,
motivation and willingness or even awareness
of capability within oneself to be able to give
massage may not be as readily apparent as the
benefits of receiving.
The most important indication from the
results is that home-based mutual massage
such as PM can be promoted as a ‘health
behaviour’ and can be incorporated into cou-
ples’ daily life. Some of the couple-focused
health-related interventions considered else-
where (e.g. physical activity) have also been
found to be more effective than individual
approaches (Arden-Close and McGrath, 2017;
Gellert et al., 2011). It should perhaps not
therefore be surprising that we can extend that
We acknowledge that this study sample is
unlikely to be representative of modern Western
couples, in general, because the participants
were self-selected volunteers. Therefore, we
cannot know how well the current findings
might generalize to a more representative sam-
ple. The majority of participants had previous
experience in receiving and (to a lesser extent)
giving massage, and this experience may have
had some influence on the results. For example,
perhaps participants chose to take part in the
study precisely because, according to their pre-
vious experience, massage had been pleasura-
ble, and therefore these individuals could be
considered as a biased sample from a pool of
positive responders. Were it ethically possible
to impose massage on a truly random sample of
participants, the outcomes may have been, at
the very least, considerably more variable.
Moreover, assessing the specificity of our find-
ings is difficult, in part because it is hard to
imagine what an appropriate placebo treatment
might be. Future studies could help in this
regard by (a) using larger sample sizes, (b)
including measures to minimize data loss and
(c) including outcome measurements where
there are no prior reasons to suppose that mas-
sage should have an influence, and then con-
firming this to be the case.
A second caveat concerns the degree of con-
fidence that we can claim regarding the speci-
ficity of the ‘giving’ effect that we found. In the
current study design, the interaction between
couples was reciprocal. Therefore, even though
wellbeing measurements were taken from the
giver just after the first massage, each giver
knew that they were about to receive massage.
So it is possible that the apparent benefit to the
giver may, in fact, have been about his or her
expectations of what he or she was about to
receive. Expectancy effects have been demon-
strated in other domains (e.g. Ross and Olson,
1981), and if beneficial could nevertheless form
part of a successful massage intervention.
To our knowledge, this is the first study to dem-
onstrate that among healthy adult couples who
experience limited training, both ‘giving’ and
‘receiving’ brief massages produce positive
10 Journal of Health Psychology 00(0)
benefits in emotional and mental wellbeing.
Since massage can be a pleasant intervention
that may be easily incorporated into a couple’s
daily life, this pioneering study therefore pro-
vides impetus for further research on home-
based massage as part of a couple’s ‘selves-care’
for emotional and mental wellbeing.
Suggestions for further study
Suggestions for further studies include
Using larger sample sizes, including
measures to minimize data loss;
Evaluating the feasibility and efficacy of
giving and receiving brief massage in
other populations such as close relation-
ships (e.g. friends, family and carers);
A protracted exploration to test the
impact of ‘giving’ and ‘receiving’ mas-
sage on physical and psychological well-
being, and interpersonal relationship
over months and years;
The collection of qualitative data to
understand more deeply the idiographic
psychological and interpersonal effects
of exchanging brief massages between
close relationships;
Exploration of the motivations and barri-
ers for the continual practice of massage
between couples and wider population;
Including outcome measurements where
there are no prior reasons to suppose that
massage should have an influence, and
then confirming this to be the case.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of inter-
est with respect to the research, authorship, and/or
publication of this article.
The author(s) received no financial support for the
research, authorship and/or publication of this
1. There is a growing literature regarding (a)infant
massage, (b) studies of massage among children
between 4 and 12 years and (c) parents’ massag-
ing their children.
2. Although there seems to be lack of valid data
such as how many people practice massage at
home in general.
3. Originally, a systemic simple massage style
was formulated as ‘Peace Massage’ and deliv-
ered during 2010–2013 for clients at a charity
that supported welfare, health and wellbeing
for older people in the local community. It has
been developed and refined for more effective
learning and easy application, and renamed as
‘Positive Massage’ in 2015.
4. A neologism created by the first author.
Sayuri M Naruse
Supplemental Material
Supplementary material for this article is available
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... According to their survey, 60% of a sample of 260 individuals experienced low to high levels of touch deprivation during the pandemic. This is surprising because Positive Massage [28], to mitigate the impact by promoting couples' personal and relational wellbeing. The current paper aims to explore the possible effectiveness of Positive Massage for couples' wellbeing during touch deprived periods such as the Covid-19 pandemic period and beyond. ...
... Positive Massage (PM) is an innovative form of mutual massage aimed at the promotion of wellbeing in close relationships [28,38]. It is innovative, because it is not 'receiving' or 'giving' only, but involves exchanging massage in order to benefit both parties, and is based in the home setting rather than in specialised public facilities. ...
... One of findings of the first studies investigating PM effects indicated that both 'receiving' and 'giving' massages may elicit positive effects on emotional stress and mental clarity [28]. This interesting finding inspired the researcher to create the neologism 'selves-care', which refers to a health activity that cares for both a loved one and the self simultaneously [28]. ...
Full-text available
COVID-19 has brought not only fear and anxiety, but also legitimate restrictions of communication and consequential touch-deprivation in our daily lives. Couples’ relational wellbeing continues to be impacted by these COVID-19 related stressors. Protecting both personal and relational wellbeing is therefore particularly important at this time. Using a preventative intervention approach, the current paper argues the theoretical benefit of the Positive Massage programme and reports a qualitative analysis of stressed but healthy couples’ experience of engaging in the programme. Thirty-four participants completed 3 weekly classes and home-based practice of massage exchange. Data from an open text online questionnaire completed every week of the programme and again 3 weeks afterwards were analysed using thematic analysis. The identified themes included “holistic stress relief”, “relationship-promotion”, and “selves-care skill”. Couples perceived Positive Massage as an effective mutual support skill to relax and help one another by de-stressing, both emotionally and physically through verbal and nonverbal communication, creating gratitude, deeper connection and self-efficacy via quality time together and pleasurable touch. Theoretically and experientially, Positive Massage can be an effective preventative selves-care skill. Promoting the concept of selves-care and its practical application through Positive Massage would be beneficial for couples’ personal and relational wellbeing in a touch-deprived era.
... Positive Massage (PM) is a health intervention, aiming to enhance interpersonal and intrapersonal wellbeing in close relationships through mutual lay massage [40] [41]. Instead of lengthy clinical professional massage therapy, PM has been created to be a self-help technique 3 , with a short (15 min) sequence of massage to be used in a home environment 4 . ...
... A short massage course, called the "PM programme", has been developed to introduce, instruct and facilitate the implementation of PM [40] [41]. The programme provides durable skills 5 that underpin the kind act of massage, to be used anytime in the home environment. ...
... To date, only two studies [40] [41] have explicitly investigated the effect of such reciprocal massage among healthy adults. The first study to explore the effect of PM demonstrated significant improvements in mental clarity coupled with a significant reduction of emotional stress. ...
... Besides, and importantly, the safety of massage is deemed to be high, with reports of adverse consequences following massage largely limited to those resulting from the misuse of electrical massage devices (241 out of 256 cases) (Posadzki & Ernst, 2013). To the current knowledge of the authors the only paper dealing exclusively with the effects of mutual massage among couples derives from our current research (Naruse, Cornelissen, & Moss, 2018). This may be due to a lack of awareness, or the absence of an accessible massage style that might be easily incorporated into daily life among the general adult population in the UK. ...
... To this end, a simple sequence of massage for home use, called Positive Massage (PM), was devised, and a short massage course (the PM programme) set up for people to learn and practice in close relationships (Naruse et al., 2018). Throughout the rest of this article, the term massage designates PM rather than other forms of massage. ...
... Participants are also guided to be sensitive to their partner's body and feelings when giving the massage with the aid of verbal and non-verbal communications. For further details of PM intervention, please refer to Naruse et al. (2018). ...
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Objectives: Although supporting preventative self-regulation and self-care activity for daily stress is important as dyadic coping, there seems a paucity of exploration of non-verbal interventions such as tactile communication. This preliminary experimental study assessed the efficacy of a short educational massage programme for healthy but stressed couples. The study aimed to investigate if the educational mutual massage (Positive Massage) programme has any acute and sustained effects on wellbeing, perceived stress and coping, and relationship satisfaction among couples. Design: A pseudo randomised two group design employing a delayed treatment element assessed the effects of the Positive Massage programme and subsequent at-home application. Thirty-eight participants completed a three-week massage course. Main Outcome Measures: Measurements of the Warwick-Edinburgh Mental Well-being Scale, the Rhode Island Stress and Coping Inventory, and the Positive Feelings Questionnaire were collected online using Qualtrics at three time points (the start, the end, and three weeks after the course). Data were analysed with mixed ANOVAs. Results: Mental wellbeing, and perceived stress and coping significantly improved from before to after the Positive Massage programme. There was no significant decline after the cessation of the massage programme. Relationship satisfaction did not show significant changes from the initial assessment. Conclusions: The overall effects of the Positive Massage programme indicate the importance of developing further large scale studies of mutual massage as a safe and beneficial self-care activity. This innovative study has laid the groundwork for future studies into the possibility of mutual massage as a self-regulation dyadic coping strategy for home use to improve overall wellbeing.
... As well as increasing their involvement in supporting the woman's mental health, there may be some direct benefits for the partner in delivering the massage ( Naruse et al., 2018 ). We did not assess the mental health of partners however, previous research has found men who massaged their pregnant partners reported less depressed mood, anxiety and anger, compared to a control group (Field. ...
Background: Approximately one-fifth of pregnant women suffer from anxiety and/or depression. These mental health conditions are associated with increased infant and maternal morbidity. Relaxation massage has the potential to improve mental health and may provide a vaulable option for pregnant women. This paper reports on participants’ experiences of partner delivered massage as a technique to manage mild antenatal anxiety. Methods: We conducted a feasibility study with 44 pregnant women who self-assessed as mildly anxious. The women were randomised into massage therapy (14 women/partner dyads) or to an active control group (13 women). 4-6 weeks after the birth of their baby, massage group participants were invited to be interviewed about their experiences; twelve women and four partners agreed. The qualitative data was analysed using reflective thematic analysis. Results: Four themes emerged from the data; Supporting mental health, Connecting, Useful and adaptable and Making it happen. Partner delivered massage was an accessible and practical method to manage mild anxiety for pregnant women in this study. The massage program also provided useful skills for participants to apply in their lives after the birth of their child, which has the potential to continue to support maternal mental health as well as partner connection. Conclusion: Partner delivered massage offers low-cost, accessible option for pregnant women to manage their mild anxiety. These findings have particular relevance in the context of the COVID-19 pandemic, where anecdotal reports indicate that antenatal stress is increasing and women may have limited access to healthcare services.
... Partner-delivered chair massage is a nonpharmacological option that can be used alongside treatment as usual for perinatal care. (34) ...
Full-text available
Background: Women worldwide experience perinatal mood, anxiety, and pain contributing to pregnancy and birth challenges, maternal and infant bonding, and childhood development. Perinatal women seek massage therapy for relaxation, pain management, and emotional support, but may encounter socioeconomic barriers. Prior studies demonstrated improved perinatal health by teaching partners of pregnant women a side-lying massage. Purpose: This study examined health effects to perinatal mood, anxiety, and pain, by teaching partners of pregnant (PG) women a chair massage. Setting: Participant's homes in Tucson, Arizona, USA. Participants: Twelve PG women with minor mood, anxiety, and pain: 67% white, 33% Hispanic, college educated, married, aged 32 years (± 3.86 SD), 67% expecting a first child, annual incomes ≤ $50,000 (33%), > $50,000 (67%). Research design: A pre/postintervention pilot study in a single group for eight weeks. Intervention: Twice weekly partner-delivered chair massage and its relation to perinatal mood, anxiety, and pain. Main outcome measures: Pre/poststudy perinatal massage effects were measured with the Edinburgh Depression Scale (mood), the STAI-AD (anxiety), and the VAS (pain). Weekly text messaging tracked dose and frequency, follow-up surveys measured sustainability, and birth outcomes were acquired by texting. Results: Study retention was 86%, protocol compliance 94%, with couples averaging 10-minute, twice weekly chair massage over the eight-week study period. Paired-sample t tests indicated statistically significant improvements to perinatal mood and anxiety, Cohen's d, a large strength of effect size (p = .012, d = 0.87; p = .004, d = 1.03). A trend was observed for reduced pain, with a medium strength of effect size (p = .071; d = 0.58). Follow-up surveys indicated most couples were sustaining at least weekly massage. Birth outcomes showed healthy infants with no complications, mean birth weight of 7.26 pounds, and mean gestation of 39 weeks. Conclusion: This is the first evidence of partner chair massage as safe and effective complementary home management of perinatal mood, anxiety, and pain.
Full-text available
Objectives: Partners are a significant influence on individuals' health, and concordance in health behaviours increases over time in couples. Several theories suggest that couple-focused interventions for health behaviour change may therefore be more effective than individual interventions. Design: A systematic review of health behaviour change interventions for couples was conducted. Methods: Systematic search methods identified randomized controlled trials (RCTs) and non-randomized interventions of health behaviour change for couples with at least one member at risk of a chronic physical illness, published from 1990-2014. Results: We identified 14 studies, targeting the following health behaviours: cancer prevention (6), obesity (1), diet (2), smoking in pregnancy (2), physical activity (1) and multiple health behaviours (2). In four out of seven trials couple-focused interventions were more effective than usual care. Of four RCTs comparing a couple-focused intervention to an individual intervention, two found that the couple-focused intervention was more effective. Conclusions: The studies were heterogeneous, and included participants at risk of a variety of illnesses. In many cases the intervention was compared to usual care for an individual or an individual-focused intervention, which meant the impact of the couplebased content could not be isolated. Three arm studies could determine whether any added benefits of couple-focused interventions are due to adding the partner or specific content of couple-focused interventions. Statement of contribution What is already known on this subject? Health behaviours and health behaviour change are more often concordant across couples than between individuals in the general population. Couple-focused interventions for chronic conditions are more effective than individual interventions or usual care (Martire, Schulz, Helgeson, Small, & Saghafi, ). What does this study add? Identified studies targeted a variety of health behaviours, with few studies in any one area. Further assessment of the effectiveness of couple-focused versus individual interventions for those at risk is needed. Three-arm study designs are needed to determine benefits of targeting couples versus couple-focused intervention content.
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The aim of this study was to illuminate the nursing staff's lived experiences and meaning in giving tactile massage (TM) while caring for patients in short-term emergency ward. Data were collected through individual qualitative interviews with six nurses and eight assistant nurses working with TM in short-term emergency wards in two hospitals in Sweden. The narratives were analyzed using a phenomenological hermeneutical method. Nurses experienced providing TM to patients as a present awareness in connection with compassion for the patient. TM provided the nurses with a tool to ease patient suffering and pain. Three dimensions were found where touch became a tool of doing, was an aware presence as a mindful being, and was embodied in a human-to-human connection with a changed caregiver. Given the current high-tech health care system with overcrowded units and a shortage of nursing staff, TM could be included as a caring tool to improve the caring in caregiving, allowing nurses to act in aware presence by touch to encourage health and well-being for both the patient and themselves. © The Author(s) 2015.
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Background: While massage has been removed from nursing curricula, studies have reported massage as safe and effective for stress reduction, relaxation, pain relief, fatigue, and quality of life. Objective: To compare the efficacy of two intensities of touch administered during two seated massages on the attitudes of nursing students toward touch for their self-care and patient care. Participants: Nursing students who volunteered gave institutional review board-approved written informed consent to undergo massage by a licensed massage therapist. Settings/location: A private room adjacent to the nursing lab in a school of nursing. Intervention: Brief seated massages of differing intensities. Each participant received low-intensity and high-intensity touch in a two-block, randomized order, within-subjects design. Linear mixed models nested within subject and random intercept analyses were used to test hypotheses in this two-treatment, two-sequence, two-period crossover design. Outcome measures: Health questionnaires/visual analogue scales pertaining to physical/affective/and attitudinal status were completed before and after each massage. Results: Twenty-nine participants (93% female, 83% single) completed the study. Before massage, the optimal intensity of touch anticipated for self-comfort was 6.6 (0=no pressure;10=most intense pressure imaginable). The mean touch intensities were 6.7 for high-intensity massage and 0.5 for low-intensity (p<0.001). The overall percentage differences (feeling better or worse) following massage were as follows: low intensity, 37.5% better; high intensity, 62.7% better (p<0.001). Significantly more improvement was reported for energy, pain, stress, and feeling physically uptight after high-intensity compared with low-intensity (p<0.03). Participants were more likely to both receive touch for self-care and provide touch for patient care after experiencing high- versus low-intensity massage (p<0.01). Conclusions: High-intensity seated massage was more efficacious than low-intensity massage and positively influenced nursing student attitudes toward the inclusion of massage in self-care/patient care. The role of touch for self-care/patient care in the nursing curricula merits reconsideration.
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Interpersonal touch seems to promote physical health through its effects on stress-sensitive parameters. However, less is known about the psychological effects of touch. The present study investigates associations between touch and romantic partners' affective state in daily life. We hypothesized that this association is established by promoting the recipient's experience of intimacy. Both partners of 102 dating couples completed an electronic diary 4 times a day during 1 week. Multilevel analyses revealed that touch was associated with enhanced affect in the partner. This association was mediated by the partner's psychological intimacy. Touch was also associated with intimacy and positive affect in the actor. Finally, participants who were touched more often during the diary study week reported better psychological well-being 6 months later. This study provides evidence that intimate partners benefit from touch on a psychological level, conveying a sense of strengthened bonds between them that enhances affect and well-being.
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Purpose A randomized controlled trial was conducted to evaluate outcomes of a multimedia instructional program for family caregivers in simple touch-based techniques to provide comfort to cancer patients at home. Methods A multilingual 78-min DVD and 66-page manual were produced for homebased instruction. Content addresses attitudes and communication about touch in cancer, psychological preparation for giving and receiving touch, safety precautions, massage techniques for comfort and relaxation, acupressure for specific cancer-related symptoms, and practice in the home setting. Materials were produced in English, Spanish, and Chinese versions. A community-based multiethnic sample of 97 adult patient/caregiver dyads was randomized to experimental (massage) or attention control (reading) groups for 4 weeks. Massage dyads received the program and instructions to practice at least three times per week, while control caregivers read to their patients for the same frequency. Self-report instruments assessed change in symptom severity, quality of life, perceived stress, and caregiver attitudes. Results Significant reductions in all symptoms occurred for patients after both activities: 12–28 % reductions after reading vs. 29–44 % after massage. Massage caregivers showed significant gains in confidence, comfort, and self-efficacy using touch and massage as forms of caregiving. Conclusions Multimedia instruction in touch and massage methods may offer family members a viable means of enhancing self-efficacy and satisfaction in caregiving while decreasing patient pain, depression, and other symptoms. Family members may be able to learn and apply safe and simple methods that increase patient comfort and reduce distress.
Aims: To explore the potential benefits of massage within daily routine care of the older person in residential care settings. Background: Globally, the proportion of people over 65 years is rapidly rising. Increased longevity means older people may experience a rise in physiological and psychological health problems. These issues potentially place an increased demand for quality long-term care for the older person. Complementary approaches such as massage appear to be needed in quality residential care. Design: A critical literature review was undertaken. Methods: A literature review pertaining to massage in the older resident was conducted using a range of online databases. Fourteen studies dated 1993-2012 met the inclusion criteria and were critically evaluated as suitable resources for this review. Results: Evidence suggests massage may be advantageous from client and nursing perspectives. Clients' perceive massage to positively influence factors such as pain, sleep, emotional status and psychosocial health. Evidence also demonstrates massage to benefit the client and organisation by reducing the necessity for restraint and pharmacological intervention. Massage may be incorporated into care provision and adopted by care providers and family members as an additional strategy to enhance quality of life for older people. Conclusion: Massage offers a practical activity that can be used to enhance the health and well-being of the older person in residential care. Implications for practice: Massage offers benefit for promoting health and well-being of the older person along with potential increased engagement of family in care provision. Integration of massage into daily care activities of the older person requires ongoing promotion and implementation.
Interactions with close family members have consequences for the emotional and physical well-being of individuals who are dealing with a chronic physical illness. Therefore, inclusion of a close family member in psychosocial interventions for chronic illnesses is a logical treatment approach that has the potential to boost the effects of intervention on the patient and also benefit the family member. However, randomized, controlled studies indicate that such family-oriented interventions generally have small effects. The efficacy of these treatment approaches might be enhanced by targeting specific interactions that emerging research identifies as promoting or derailing healthy behaviors and by better incorporating strategies from family caregiver interventions. In addition, family-oriented interventions should be more fully evaluated, by assessing the benefits for both patients and family members. Future research in this area can tell us much about how and when to involve family in treatment of specific chronic illnesses and, in turn, may inform conceptual models of the impact of family interactions on health.
This exploratory within-subjects study compared the effects of elder retired volunteers giving massage to infants with receiving massage themselves. Three times a week for 3 weeks, 10 elder volunteers (8 females, mean age = 70 years) received Swedish massage sessions. For another 3 weeks, three times per week, the same elderly volunteers massaged infants at a nursery school. Receiving massage first versus giving massage first was counterbalanced across subjects. Immediately after the first- and last-day sessions of giving massages, the elder retired volunteers had less anxiety and depression and lower stress hormones (salivary cortisol) levels. Over the 3-week period, depression and catecholamines (norepinephrine and epinephrine) decreased and lifestyle and health improved. These effects were not as strong for the 3-week period when they received massage, possibly because the elder retired volunteers initially felt awkward about being massaged and because they derived more satisfaction massaging the infants.
This study examined the effects of fathers massaging their pregnant wives and practicing relaxation with them. Participants were married American fathers who completed the Dyadic Adjustment Scale (DAS), the State-Trait Anxiety Inventory (STAI), and the Paternal Fetal Attachment Scale. The fathers learned to massage their pregnant wives, learned relaxation techniques with their wives, or received no intervention. Massage therapy lowered the fathers' self-reported anxiety levels on the STAI and improved marital adjustment on the DAS.