Honoring the Stress Response

Stress is a catalyst for nearly every scheduled massage session. If a client has booked a massage with you, they are likely managing some type of stress. Physical pain and injury; emotional challenges of anxiety, depression, or sadness; and mental demands of a high-pressure job or an excessively busy life are all common stressors that clients experience and that their bodies are handling behind the scenes.

Clearly every client is different. What works to reduce the effects of stress for one client may not work for another. Also, if the stress is short-term and isolated versus long-term and perpetual, then the effects on the body will be different. However, a couple of factors remain consistent. First, understanding what the stress response is and how it works will make you more capable of identifying its effects in each individual and planning an appropriate course of action. Second, listening intently with your eyes, ears, and hands, and honoring what you see, hear, and feel with intent and precision will help the body more readily respond to you. Your role in the feedback loop is greater than you may realize. The basis of your approach needs to heavily rely on these factors in order to best guide the client into calm.

Stress Defined

MedicineNet.com defines stress this way: "In a medical or biological context, stress is a physical, mental, or emotional factor that causes bodily or mental tension. Stresses can be external (from environmental, psychological, or social situations) or internal (illness or from a medical procedure). Stress can initiate the 'fight or flight' response, a complex reaction of neurologic and endocrinologic systems."¹ So, what exactly are these complex reactions?

The Stress Response in a Nutshell

The stress response begins when a real or perceived threat arises. The hypothalamus, which controls the autonomic nervous system (both sympathetic and parasympathetic divisions) and the endocrine system, receives a neural signal from the amygdala that there is a threat. In response, it releases corticotrophin-releasing hormone (CRH), which stimulates the pituitary gland to release the adrenocorticotropic hormone (ACTH). The ACTH makes its way to the adrenal glands, causing them to release epinephrine (adrenaline) and cortisol into the bloodstream. Simultaneously, the sympathetic nervous system, which originates in the spinal cord for quick response, is activated to release the neurotransmitter acetylcholine (ACh) that causes the release of norepinephrine (another form of adrenaline). The chain reaction of the release of these neurotransmitters and hormones creates responses throughout the body, such as:

• Increased heart rate and a rise in blood pressure, so plenty of blood is available for large muscle groups to take powerful action
• Tensed muscles ready to fight or flee
• Dilated pupils for clarity of vision to identify and respond to the threat
• Increased breath rate to feed oxygen to the lungs, brain, and muscles
• Breakdown of glycogen in the liver to fuel the body with glucose and increase energy
• Constriction of blood vessels to nonessential organs and systems that don't need to be used in fight or flight, such as those of the digestive and immune systems
• Increased perspiration to cool the body during these high-level metabolic processes

Now that is a big domino effect! Once the danger has passed and the body is back in balance, the hypothalamus "turns off" the process, and the whole-body responses return to homeostasis.

In contrast, when an individual is in a constant state of perceived or real danger, the process perpetuates. Something as typical as always driving in heavy traffic can fall into this category, and, in many people's lives, this is their daily reality. A high-demand job. Raising children. Overscheduling. Unhealthy relationships. There are many life experiences that can cause a perpetual, imbalanced reaction. Massage therapists and bodyworkers come into direct contact with the results.

What Might We See, Hear, and Feel?

By the time a client is in our treatment room, they are no longer in the heat of a real or perceived threatening situation. Yet, with chronic stress, the effects can remain and stress responses continue. When you think about the reactions that occur, we might see the following in our clients and feel the following under our hands:

• Quick pulse
• Tensed muscles
• Dilated pupils
• Rapid, shallow breathing and/or quickened speech
• Reports of chronic digestive issues or weak immune system (such as chronic cold and flu)
• Excessive sweating, even when inactive

When you see, feel, and hear these signs, you know the stress response is in an ongoing, repetitive loop and not appropriately turning off.

How to Support the Process

Hold and Listen

One of the most useful, connecting, and sacred skills I learned was to cradle my client's head/neck or ankles at the beginning of the session and simply listen. While this approach is commonly taught as an effective way to ground oneself and put the client at ease with your presence and touch, it is also an opportunity for deep intent and listening. Listening in this context means to feel for things like a quick pulse and subtle trembling, and to see things like shallow breathing, clenched jaw, or fidgeting. It is also a great time to close your eyes and acknowledge the repetitive stress cycle that may be occurring. It seems so simple, but it's very powerful.

Acknowledge

Within the word acknowledge is the word knowledge. When we acknowledge the stress response, it means we arrive at the body with knowledge of how stress response mechanisms function, and we envision them occurring. It's quite amazing how the body will respond to your intent without a word being spoken. The body just "knows" that you see it, and it feels soothed and safe.

Breathe

Before introducing movement to your touch, it's very helpful to take a few deep breaths. Even if you don't instruct your client to join you in those breaths, their autonomic nervous system will begin to entrain to you. You can, of course, also coach the client to breathe with you.

Coax

As you encounter tense muscles, instead of trying to force them to surrender with deep-tissue approaches, coax them. Sink to the point of resistance and wait. Give the tissue time to trust you and allow you in. Imagine if someone you didn't know well was knocking on your door, and when you didn't open it, they knocked harder. You would probably not trust the intent of their visit. Tense tissue can be thought of in the same way.

I'm not suggesting that deep-tissue approaches should never be used on people who are in a heightening, imbalanced, or inefficient stress response loop. However, it's essential not to force muscles that feel the need to be guarding and protecting. There's a reason for it. Become educated on how proprioceptors operate to add benefit to this approach.

Utilize a Broad Approach

Finally, when and if the tissues let you sink in, use broad pressure rather than pointed pressure. Pointed pressure can be another trigger to the autonomic nervous system and send it back into a stress response. In this case, think of a situation when someone was simply talking to you versus a time when someone was talking to you while pointing a finger in your face. I bet you felt a different level of comfort (or discomfort) in each situation. Remember, a threat is a threat, whether it is real or perceived, especially to a system already on high alert.

Keeping the Calm

Ideally, equip the client with knowledge of what is occurring in their own body so they can understand, envision, and honor it too. Studies have shown that envisioning a process in healthful functioning will cause the system to regulate. Do this after the session using simple terms and visuals. Clients don't need to know all the technical terms; they just need to have a basis of understanding. If you have a willing client who is open, the effects of your work will be cumulative and long-term.

Note

1. MedicineNet.com, "Medical Definition of Stress," accessed February 2019.