The Multi-Dimensional Impact of Interpersonal Touch in Reflexology

Foot massageCentrally positioned within the art of reflexology exists a well documented multi-dimensional concept connecting all forms of professional reflexology practice – that concept relates to interpersonal touch.

Researchers have extensively examined the importance of human interpersonal touch in mother/infant bonding, child development, and adult social interactions.  The role of interpersonal touch as a counter-stimulation intervention in pain management (Gate Control Theory) has also been scientifically acknowledged.  Additionally, the study of non-verbal communication is well established – with researchers possessing a high level of understanding concerning the subtle relationship between our inner emotions and desires – and that of our external posture, body language, and facial expressions.  More recently researchers have been attempting to examine the innate human ability to non-verbally impart and decode emotional content through interpersonal touch.

“Human touch is a highly complex sensory modality, involving numerous interacting systems and exploratory capacities.  Through touch we are able to interact with the world around us, feeling a wide variety of distinct properties, including warmth, solidity, roughness and elasticity.  We use touch to conform and console each other, and touch is one of our primary conduits of pleasure and pain.” (Fulkerson, 2014)

The intention of this blog post is to provide the reader with a glimpse into the scientific world of interpersonal touch. Touch as a therapeutic intervention is a much overlooked and entirely undervalued concept in modern reflexology – despite the provision of an extensive and wholly relevant body of work, open to reference.  Developing a deeper understanding of the impact of interpersonal touch can certainly help reflexology practitioners to better understand the complexities and subtleties involved within our innately multi-dimensional modality, and to consider options for future reflexology research.

The Skin

The surface of the human body, the skin, is one enormous sheet of tactile receptors, and the skin constitutes by far the largest of our sense organs.  The first sensations to develop in human beings are tactile – with researchers demonstrating a six week old foetus is able to react to tactile stimuli (Atkinson & Braddick, 1987; Bremmer, Lewkowicz, & Spence, 2012)

“This complex system might be considered the most powerful interface ever designed between our self and the objects that surround us.” (Gallace & Spence, 2014)

The skin provides us with a means of connecting with our external environment – it provides our body with protection – and it informs us about what is occurring on its surface (Gallace & Spence, 2014).

Tactile Receptors

Different tactile receptors innervate different parts of the skin.  Glabrous skin is only found on palms of the hands, soles of the feet, and parts of the genitals. Non glabrous skin (hairy skin) covers the rest of the body.  Stimuli affecting both glabrous and hairy skin are translated into sensory neural signals by means of mechanoreceptors. Mechanoreceptors basically react to any mechanical stimulus delivered to the body surface (deformation of the skin). There are six classifications of tactile receptors:

  • imageFree Nerve Endings – Found in hairy and glabrous skin. Sensitive to touch and pressure; situated in epidermal cells, and on the corneal surface of eye.
  • Root Hair Plexus – Found in hairy skin. Monitors distortions and movements across the body surface.
  • Merkel Discs – Found in glabrous skin. Sensitive to touch and pressure.
  • Meissner’s Corpuscles – Found in glabrous skin.  Sensitive to fine touch, pressure and low frequency vibration
  • Pacinian Corpuscles – Found in hairy and glabrous skin. Sensitive to deep pressure, notably located in soles of feet, palms of hand, mammary glands, and external genitalia
  • Ruffini Corpuscles – Found in hairy and glabrous skin.  Sensitive to pressure and distortion of the skin – located in the deep dermis.

“The Pacinian corpuscles are most commonly found on the palms of the hands and soles of the feet.  The Pacinian corpuscles respond to deformation of the skin, such that the greater the deformation, the greater the generated potential.” (Gallace & Spence, 2014).  

Touch and Psychoneuroimmunology 

“People say the effect is only on the mind. It is no such thing. The effect is on the body, too.” (Florence Nightingale, 1859)

Psychoneuroimmunology is an integrative scientific discipline. The research field seeks to explore how mental and emotional  processes and events modulate the function of the immune system – and in turn how immunological activity can alter the function of the mind (Daruna, 2012).  Psychoneuroimmunology postulates that persistent stress can increase the probability of developing many diseases – including cancer, coronary disease, and autoimmune disorders.

“The induction of relaxation, by any means, is associated with decreases in negative affect and counteracts sympathetic nervous system activity via the actions of nitric oxide.  Relaxation also produces alterations of hormone levels in the circulation. Consequently, effects on immune activity would be expected.” (Daruna, 2012)

The effects of tactile contact have been documented in a variety of health-care related behaviours.  For example, researchers (Whitcher & Fisher, 1979; Wong, Ghiasuddin, Kimata, Patelesio, & Siu, 2013), demonstrated the act of receiving touch from a nurse the day prior to surgery can result in a decrease in the patients stress levels – when measured both objectively (heart rate/blood pressure), and subjectively (patient evaluation).

imageInterpersonal touch has been clinically proven to aid the release of endorphins, in addition to the neuropeptides, serotonin and dopamine.  When released into the bloodstream these chemicals serve to counteract and suppress the effects of the adrenal stress hormones cortisone and adrenaline (Field, Hernandez-Reif, & Diego, 2005).

Research also suggests interpersonal touch induces oxytocin release in humans.  Oxytocin is produced by the hypothalamus, and transported to, and secreted by the posterior adrenal gland.  Acting as both a hormone and a neurotransmitter, oxytocin has been proven to reduce stress response and feelings of anxiety (Newman, 2007, Churchland, 2011).

Oxytocin is perhaps most associated with the neuroanatomy of intimacy – specifically sexual reproduction, facilitating childbirth, maternal bonding, and, after stimulation of the nipples, lactation.  Scientific research is also beginning to discover more about oxytocin’s role in modulating social behaviour – including maternal bonding, couples bonding, sexual behaviour, social memory, and even trust (Newman, 2007).

A number of studies have investigated the role of touch between intimate partners in mediating the release of oxytocin (Bales & Carter, 2003; Bielsky & Young, 2004; Carter, 1998, 1999; Cho, De Vries, Williams, & Carter, 1999; Feldman, 2012).  Holt-Lunstad et al, (2008), for example, found that couples who engaged in an exercise involving touching each other’s necks, shoulders, and hands, displayed higher levels of oxytocin in their saliva than couples who did not engage in the touch exercise.  Another study (Light et al, 2005), demonstrated that women who report frequent partner hugs display higher levels of oxytocin in their blood than women who report fewer partner hugs. Researcher believe the release of oxytocin can help couples to form lasting relationship bonds (Gulledge, Hill, Lister, Sallion, 2007).

Touch and Pain Responses

“Now while we know the fact of pain relief, through the laying on of hands, or by kindred measures, we know only a part of its reason for operation. There are several of these. They are, first, the soothing influence of animal magnetism, experienced when we tenderly, if not lovingly, rub the bump, accumulated in the dark of the moon, by a collision with a tall brunette side-board, or a door carelessly left ajar.  It does soothe.  This we know.” (W. Fitzgerald, 1919)

The Gate Control Theory of Pain was introduced in the 1960s by Ronald Melzack and Patrick Wall.  The theory identifies the experience of pain as a complex interplay between the central and peripheral nervous systems. When physical injury occurs messages travel along the peripheral nerves to the spinal cord, and then on to the brain.

Before pain messages are able to reach the brain they encounter nerve ‘gates‘ (inhibitory neural mechanisms) in the spinal cord.  When the nerve gates are open pain messages can rapidly reach the brain – and when the gates are closed messages are hindered in reaching their destination.

“Stress causes changes in the activity of the autonomic nervous system (ANS) and, more generally, the peripheral nervous system (PNS).” (Daruna, 2012)

The underlying principle in Gate Control Theory is to introduce factors capable of closing the pain gates.  These factors can be physiologically or psychologically based and might include concentration, relaxation, distraction, mediation, exercise, and tactile counter-stimulation (reflexology, massage, TENS etc).

imageThere are two types of nerve fibres are believed to carry the majority of pain messages to the spinal cord:

  • A-delta Fibers – carry electrical messages to the spinal cord at approximately 40 mph
  • C-Fibers – carry electrical messages to the spinal cord at approximately 3 mph

“The delivery of a single painful stimulus will evoke two successive and qualitatively distinct sensations referred to as first and second pain. First pain is brief, pricking and well localised on the skin surface, and its perception results from the activation of myelinated A-delta fibers.  Second pain is longer-lasting, burning, it is associated with a burning sensation and tends to be less well localised.  It results from activation of unmyelinated C-fibers that conduct the neural signal more slowly than the A-fibers.” (Gallace & Spence, 2014)

William Fitzgerald’s loving rub after his bump into the tall brunette side-board provides us with a good example of how these respective nerve fibres operate.  The initial bump causes activation of the A-delta nerve fibers  Fitzgerald instinctively follows the event with a ‘rub’ of the area, thus activating even faster nerve fibers to send information spinal cord and brain – in turn overriding some of the pain messages carried by the A-delta and C-fibers (closing their passage to the central nervous system).  And so it soothes!

Dr Carol Samuel, a UK reflexology researcher, recently carried out a small study (Samuel & Ebenezer, 2013) examining the effects of reflexology on acute pain responses. Dr Samuel asked volunteer participants to place their hands into ice cold water and two measurements of pain were noted – threshold (first indications of pain) and tolerance (the time at which the participants could no longer tolerate any further pain). Findings demonstrated:

“Reflexology produces antinociceptive* effects in a controlled experiment and suggest the possibility that reflexology may be useful on its own or as an adjunct to medication in the treatment of pain conditions in man.”

*Antinociceptive – describes or relates to any unique factor that increases tolerance for, or reduces sensitivity to, a dangerous or harmful stimuli, for example, a stimuli that may cause pain.

Touch and Child Development

“The evidence indicates that grooming maintains social relationships between nonhuman primates of every age, sex, and rank.  It is plausible that humans’ tactile communication system may have evolved from the intricate system of tactile content evident in nonhuman primates.” (Hertenstein et al. 2009).

One of the most famous (and possibly cruel) touch related studies was carried out during the 1950s by the American psychologist Harry Harlow. The study was designed to examine how touch might influence infant coping mechanisms. Harlow raised baby Rhesus monkeys in a cage housing two surrogate ‘mothers’ – one surrogate was constructed from metal wire, and held a feeding bottle – the other surrogate was wrapped in terrycloth.  When the baby monkeys became frightened they would cling to the terrycloth surrogate – even if that meant they became dehydrated and starved. Harlow used these studies to demonstrate that intimate body contact, and not feeding, was the most important factor in mother-child bonding.

imageJohn Bowlby (1973), is the British psychiatrist responsible for the psychological/developmental concept called attachment theory. Attachment theory suggests that touch provided by primary caregivers enables infants to feel safe and secure – and thus provides the foundation for all securely attached relationships formed in later life. Many subsequent studies have gone on to confirm Bowlby’s pioneering work.

“Touch is central to human social life.  It is the most developed sensory modality at birth, and it contributes to cognitive, brain, and socioemotional development throughout infancy and childhood.” (Hertenstein et al. 2006)

One study (DeAngelis & Mwakalyelye, 1995) concluded babies stroked regularly were healthier and thrived better than those babies receiving no touch.  This study interestingly additionally concluded those mothers who received massage were less depressed and anxious than those receiving relaxation training only.  Similarly, a study carried out by Wiess et al. (2000) found that a mothers nurturing touch was able to foster more secure attachment in low birth weight infants, nine months later.

An Australian study (Paslow, Morgan, Allan, Jorm, O’Donnell, & Purcell, 2007) reviewing the effectiveness of complementary therapies for anxiety in both children and adolescents demonstrated massage had immediate and short-term effects on anxiety.

Touch into Adulthood

Researchers believe the soothing effects of interpersonal touch remain important throughout adulthood, both in a social interaction context, and within the context of interpersonal relationships. Many social psychology studies have highlighted the manner in which interpersonal touch can help to regulate social interactions and relationships.  Researchers have identified that touch can even influence the social behaviours of a person, inducing them to sign a petition (Willis & Hamm, 1980), return lost money (Kleinke, 1977), leave a bigger tip (Crusco & Wetzel, 1984), and, motivate people to work harder on shared tasks (Gueguen, 2004).

One interesting study (Eaton, Mitchell-Bonair, & Friedmann) demonstrated that when staff in a care home touched elderly patients at the same time as verbally encouraging them to eat, the patients consumed more calories and protein for five days after the touch. A study by (Grewen, Anderson, Girdler, Light, 2003) revealed individuals who received pre-stress tactile partner contact demonstrated significantly lower systolic and diastolic blood pressure and heart rate increases than the no contact group.

Similarly, Ditzen et al. (2007) investigated whether specific kinds of physical interaction between couples can reduce hypothalamic-pituitary-adrenal (HPA) and autonomic responses to psychosocial stress in women. The participants were randomly assigned to one of three control groups – no interaction with their partner – verbal interaction with their partner  – physical contact with their partner – before being exposed to a stressor event. The results revealed those women experiencing physical contact before stress demonstrated significantly lower cortisol and heart rate responses to the stressor event.

Communicating Emotion through Interpersonal Touch 

More recently researchers have been trying to understand the complex relationship between interpersonal touch and human emotions.  One fascinating study (Hertenstein et al, 2006) required pairs of participants to be seated at a table, whilst separated by a curtain, and unable to see one another. One participants (the encoder) was asked to communicate distinct emotions by touching the other participants forearm.  The person being touched (the decoder) was asked to try and identify the communicated emotion from a number of offered response options.

The results suggest human beings come readily equipped with an innate ability to send and receive emotional signals through touch.  In fact, participants in this study were able to communicate eight distinct emotions – anger, fear, disgust, love, gratitude, sympathy, happiness, and sadness.  The research team expected accuracy rates to display at around chance level (25%), however accuracy levels were in fact as high as 78%. Such remarkable findings allowed the team to suggest interpersonal touch is important to emotional communication, and potentially intimately involved in the expression of positive emotions between people.

imageA team from the same research facility latterly carried out a similar study (Hertenstein et al. 2009). In this experiment participants were required to touch an unacquainted partner on the body to communicate emotion.  The encoder entered the room to find the decoder standing blindfolded.  The encoder was then randomly shown one of eight emotions on a piece of paper and asked to first think about how they wanted to communicate the emotion – before touching the decoder on an appropriate part of the body.

The study concluded that touch communicates eight emotions: anger, fear, happiness, sadness, disgust, love, gratitude, and sympathy.  Accuracy rates in this study ranged on average from 50-70%.  Researchers additionally concluded that touch demonstrates greater differentiation (of emotion) than the voice, and perhaps the face.

“Emotional/hedonistic touch can be differentiated from perceptual touch at many different levels of neural processing.” (Gallace & Spence, 2014)

Another study (Gazzola, Spezio, Etal, Castelli, Adolphs, 2012) used fMRI scans to measure brain activity in individuals receiving interpersonal touch.  The participants – all heterosexual males – were shown a video of a man or a woman appearing to touch their leg – the videos however were fake – and the real touch was provided by a woman who remained shielded from the study participants view. In this study findings revealed the participants, perhaps unsurprisingly, rated the experience of male touch as less pleasant than that of the female touch.  Perhaps more interestingly, the fMRI scans highlighted that part of the brain called the primary somatosensory cortex showed increased activity when the participants received what they perceived as female touch.

These findings are particularly important because prior to this study researchers believed the primary somatosensory cortex was responsible for encoding only very basic qualities of touch, such as pressure, or texture. However, because brain activity was being influenced by the participants perception of who they thought was touching them – the study was able to conclude that emotional and social components of touch are absolutely intwined with tactile sensations – and thus the experience of touch is affected by the individuals social evaluation of the person providing the touch.

Therapeutic Touch (TT)

Therapeutic Touch was pioneered by Delores Kreiger, a Professor of Nursing at New York University, and is widely integrating into nursing in the USA and Canada.  Therapeutic touch can be distinguished from most other bio-energetic therapies because the modality has been demonstrated to be effective after extensive, empirical investigation (Graham, 1999).

Therapeutic Touch can be carried out using physical or non-physical contact.  In essence the practitioner is attempting to focus their attention towards achieving a relaxed and focused state in which they make an assessment of the patient’s energetic body field.  The practitioner attempts to achieve this stance by developing an awareness of sensations in their own hands and body. The patients affected area is balanced using colour imagery as a focus for directing healing energies – for example, red to warm and stimulate an area – blue to cool or sedate – yellow to energise.  When the practitioner becomes aware of the patients energetic body field starting to feel more balanced, the healing session is considered complete.

A 2009 study reviewing prior research relating to the effects of therapeutic touch on pain recommended grounds for implementing TT as a pain management intervention because of ‘a majority of statistically significant positive results’ (Monroe, 2009).

*Whilst Therapeutic Touch differs from reflexology in that it offers no direct stimulation to the tissues of the body – it does share certainly a similar focus of intention stemming from the practitioner.  The concept of transferring emotional or energetic content between the client and practitioner can also be found within a counselling and psychotherapy context (i.e. transference/counter-tranference)*  

Summary

In medieval Europe rich nobles were reported to have slept in beds large enough to accommodate their wife, children, servants, and even their knights – this close proximity sleeping arrangement offered a perfect protection against the icy chills of winter. Across the centuries, influenced by the fluctuating nature of social and cultural norms, many forms of interpersonal touch have become less common. Indeed, the idea of sleeping on mass today might be considered as unhygienic, invasive, inappropriate, or even challenging.

Sadly, gone too are the days where the empathetic nursery nurse or teacher might freely offer a kindly hug to an emotionally distressed child.  Human beings seem to be more isolated within their own personal space – and detached from instinctual acts of interpersonal touch than at any other time in history.  Perhaps this trend towards social and physical isolation provides a rationale for why human brings are so drawn towards healing modalities such as reflexology? Being touched it would seem is an innate requirement for many human beings – from the cradle to the grave.

Foot massage“Touch has the potential to trigger a catharsis, to be a catalyst for meaningful change, to provide a corrective emotional experience.” (Williams, Clarke, & Gibson, 2011)

There are many complementary modalities offering interpersonal touch to clients, however, reflexology undoubtedly stands alone in its capacity to offer a combination of interpersonal touch, focused intention, and the benefit of a emotionally supportive therapeutic relationship.  Reflexology impacts both body and mind in a complex, multi-dimensional manner.  The scientific principles of psychoneuroimmunology, and the fields close working relationship with the psychological, immunological, and cognitive neuroscience communities, are helping to highlight the underlying principles of many holistic mind/body modalities.

  • Reflexologists touch – research helps us to understand how that touch is impacting our clients neurological, endocrine, and psychological processes.
  • Reflexologists work with intention – new research is helping us to better understand how that intention within our touch can be decoded by the receiver.
  • Reflexologists listen, empathise and even educate – research is helping us to understand more about how stress and emotional states can impact physiology – and about how supportive therapeutic relationships can promote autonomy and self-directed change.

“No single science approaches completeness. A little knowledge here and a little there applied to whatever method you may already be using to help suffering humanity may prove a priceless asset to your success.” (Eunice D. Ingham)

No single field of research relies solely upon its own findings. Nor should reflexology. There is an enormous difference between personal opinion – and factual verified information.  As the modality moves forward in attempting to refine the definition of reflexology we should endeavour to embrace the findings of the wider scientific community.  There seems to be a concern present within parts of our industry that in embracing scientific or academic information we may be in danger of losing, or become detached from, the metaphysical core principles of the modality. On the contrary, as is blindingly transparent from the information presented, the scientific research community is undoubtedly only better informing our intellectual understanding of reflexology.

The language utilised may differ somewhat – the reflexologist might refer to intention or energy transfer, whilst the cognitive neuroscientist or psychologist might refer to encoded and decoded information – perhaps though in truth the only difference is in the language? Certainly, for the time-being at least, neither group can claim to truly understand the origins of such energy/information – but we are certainly becoming clearer about its potential impact.

As professional reflexologists we should embrace scientific research – embrace knowledge – and in doing so embrace a renewed understanding of the multi-dimensional impact of the reflexology package.

References:

Bowlby, J. (1973). Attachment and Loss:Vol. 2. Separation, Anxiety and Anger. Basic Books: New York.

Crusco, A., & Wetzel, C. (1984). The Midas Touch: the effects of interpersonal touch on restaurant tipping. Personality and Social Psychology Bulletin.

Daruna, J. H. (2012). Introduction to Psychoneuroimmunology. Academic Press.

DeAngelis, T., & Mwakalyelye, N. (1995). The power of touch helps vulnerable babies thrive. APA Monitor.

Ditzen, B., Neumman, L., Bodenmann, G., vonDawans, B., Turner, R., Ehlert, U., & Heinrichs, M. (2007). Effects of different kinds of couple interaction on cortisol and heart rate responses to stress in women. Psychoneuroimmunology.

Eaton, M., Mitchell-Bonair, I., & Friedmann, E. (1986) The effect of touch on nutritional intake of chronic organic brain syndrome patients.  Journal of Gerontology.

Field, T., Hernandez-Reif, M., & Diego, M. (2005). Cortisol Decreases and Serotonin and Dopamine Increase Following Massage Therapy. University of Miami School of Medicine.

Fitzgerald, W. (1919) Zone Therapy, or Relieving Pain and Disease.

Fulkerson, M. (2014). The First Sense. A philosophical Study of Human Touch.  MIT Press: Massachusetts.

Gallace, A., & Spence, C. (2014). In Touch With the Future. The Sense of Touch from Cognitive Neuroscience to Virtual Reality. Oxford University Press: Oxford.

Gazzola, V., Spezio, M., Etzel, J., Castelli, F., Adolphs, R., & Keysers, C. (2012). Primary somatosensory cortex discriminates affective significance in social touch. Proceedings of the National Academy of Sciences of the United States of America.

Grewen, K., Anderson, B., Girdler, S., & Light, K. (2003) Warm partner contact is related to lower cardiovascular reactivity.  Behavioural Medicine.

Gueguen, N. (2004). Nonverbal encouragement of participation in a course: the effect of touching. Social Psychology of Education.

Harlow, H. (1958). The Nature of Love. American Psychologist

Hertenstein, M., Holmes, R., McCullough, M., & Keltner, D. (2009). The communication of emotion via touch. Emotion.

Hertenstein, M., Keltner, D., App, B., Bulliet, B., & Jaskolka, A. (2006). Touch Communicates Distinct Emotions. Emotion.

Hold-Lunstad, J., Birmingham, W., & Light, K. (2008) Influence of a “Warm Touch” support enhancement intervention among married couples on ambulatory blood pressure, oxytocin, alpha amylase, and cortisol. Psychomatic Medicine.

Kleinke, C. (1977). Compliance to requests made by gazing and touching experiments in field settings. Journal of Experimental Social Psychology.

Monroe, C. (2009) The Effect of Therapeutic Touch on Pain. Journal of Holistic Nursing.

Paslow, R., Morgan, A. J., Allan, N. B., Jorm, A. F., O’Donnell, C. P., & Purcell, R. (2007). Effectiveness of complementary and self-help treatments for anxiety in children and adolescents. Medical Journal of Australia.

Ingham, E. (1984) Revised Edition. Stories Feet Can Tell Thru Reflexology. Stories Feet Have Told Thru Reflexology. Ingham Publishing: Saint Petersburg.

Light, K., Grewen, K., & Amico, J. (2005) More Frequent Partner Hugs and Higher Oxytocin Levels are Linked to Lower Blood Pressure and Heart Rate in Premenopausal Women. Biological Psychology.

Paslow, R., Morgan, A. J., Allan, N. B., Jorm, A. F., O’Donnell, C. P., & Purcell, R. (2007). Effectiveness of complementary and self-help treatments for anxiety in children and adolescents. Medical Journal of Australia.

Samuel. C., & Ebenezer I. (2013) Exploratory study on the efficacy of reflexology for pain threshold and tolerance using an ice-pain experiment and sham TENS control. Complementary Therapies in Clinical Practice.

Weiss, S.J., Wilson, P., Hertenstein, M.J. & Campos, R.G. (2000). The tactile context of a mother’s caregiving: Implications for attachment of low birth weight infants. Infant Behavior and Development.

Williams, S., Clarke, D., & Gibson, K. (2011). The Use of Touch in Psychotherapy, A Thematic Analysis. Germany: Lambert.

Willis, F., & Hamm, H (1980). The use of interpersonal touch in securing compliance. Journal of Nonverbal Behaviour.

Whitcher, S., & Fisher, J. (1979) Multidimensional reaction to therapeutic touch in a hospital setting.  Journal of Personality and Social Psychology.

Wong, J., Ghiasuddin, A., Kimata, C., Patelesio, B., & Siu, A. (2013). The impact of healing touch on pediatric oncology patients. Integrative Cancer Therapy.

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