Title

Effects of Tactile Massage on Mothers ofChildren with Autism Spectrum Disorder: A Pilot
Study

Author(s)上原, 佳子Citation

大阪大学, 2017, 博士論文

Version Type VoR
URL

https://doi.org/10.18910/67076

rights
Note

Osaka University Knowledge Archive : OUKA
https://ir.library.osaka-u.ac.jp/
Osaka University

Effects of Tactile Massage on Mothers of Children with
Autism Spectrum Disorder: A Pilot Study（自閉スペクトラム症児の母親へのタクティールマッサージの効果に関する予備的研究）

大阪大学大学院
大阪大学・金沢大学・浜松医科大学・千葉大学・福井大学
連合小児発達学研究科
小児発達学専攻上原2017 年 8 月

佳子

博士学位論文Effects of Tactile Massage on Mothers of Children with Autism Spectrum Disorder: A
Pilot Study1)

Yoshiko Uehara(1)(2), Hiroshi Abe(1)(3) & Tomoko Hasegawa(2)(1) United Graduate School of Child Development, Osaka University, Kanazawa
University, Hamamatsu University School of Medicine, Chiba University andUniversity of Fukui(2) Department of Fundamental Nursing, Division of Nursing, Faculty of Medical
Sciences, University of Fukui(3) Department of Behavioral Science, Division of Medicine, Faculty of Medical
Sciences, University of Fukui

Footnote
1) The present study was supported by JSPS KAKENHI Grant Number JP25350923,
and Discretionary Funds of Life Cycle Medicine Promotion Department Chief at theFaculty of Medical Sciences, University of Fukui.

1

Abstract
This study aimed to use physiological/psychological indicators to investigate theeffects of tactile massage on mothers of children with autism spectrum disorder. Under
fixed room conditions, some of the 17 participants were treated with the tactile
procedure (tactile massage) for 20 minutes on the first day and with the restingprocedure (resting in a seated position) for 20 minutes on the next day, while the others
were treated with the resting procedure on the first day and the tactile procedure on thenext day. Salivary cortisol concentration, salivary secretory immunoglobulin A
concentration, and heart rate variable frequency range analysis were used asphysiological indicators, while the State-Trait Anxiety Inventory Form JYZ and theProfile of Mood States–Brief Form were used as psychological indicators. Our results
revealed no marked differences in physiological indicators between participants treatedwith the tactile procedure and those treated with the resting procedure. However, tactile
massage treatment led to significant improvements in the anxiety and mood
psychological indicators.

Key Words: tactile massage, mothers of children with autism spectrum disorder,
complementary and alternative medicine

2抄録日本語訳
本研究は ASD 児の母親へのタクティールマッサージの効果を，生理的・心理的指標により検証することを目的とした。母親 17 名に、条件を一定に保った部
屋で，同一対象者にタクティールマッサージを実施する[タクティール]と，安静座位を保つ[安静]を 20 分間、別日に実施した。生理的指標として、唾液コル
チゾール濃度，唾液分泌型免疫グロブリン A 濃度 、心拍変動周波数解析、心理的指標として STAI と POMS を用いた。その結果、生理的指標では、〔タクティール〕〔安静〕間でそれぞれの効果に顕著な違いは見られなかったが、心理的指標
では、〔タクティール〕の方が不安の軽減とネガティブな気分の改善に有意に効果があることが明らかになった。

キーワード
タクティールマッサージ，自閉スペクトラム症児の母親，補完代替療法

掲載学術雑誌名
日本生理心理学会機関誌 『生理心理学と精神心理学』第 34 巻 3 号

3Complementary and Alternative Medicine (CAM) has recently been introduced andused together with Western medicine at medical institutions and healthcare facilities inorder to improve patients’ quality of life (QOL) and activities of daily living (ADL)(Imanishi & Imanishi, 2007). Tactile massage, a CAM treatment that was developed in
Sweden in the 1960s as a care method for promoting the development of immaturebabies, has subsequently spread throughout the world. In Japan, tactile massage has
been known as tactile care (Japan Sweden Care Institute Co., Ltd.). Tactile massage is a
mixture of touching (touching the hands of an individual, placing a hand on theindividual’s shoulder or back) and massage (rubbing, pressing, or kneading themuscles/acupoints with a specific pressure). Tactile massage is a technique involving
the “stroking” of the limbs and the back of the individual with soft and encompassing
hands with intimacy (Makino et al., 2013) (Figure 1). It is an easy procedure fortherapists to perform once the stroking force and method are mastered, as no special
instruments or expertise are required. Therapists can perform tactile massage without
concerns regarding excessive stimulation of the deep structures of the body (acupoints
or muscles) or the flow of lymph fluid or blood. Therefore, the procedure can be
performed safely without imposing any physical burden on the individual.
The effects of tactile massage have been reported in people of different ages withvarying symptoms. These effects include the promotion of growth and development inimmature babies; alleviation of stress and aggressiveness in senile elderly individuals
4

Figure 1(Suzuki et al., 2010); improvements in ADL and QOL in patients with stroke (Olsson etal., 2004); blood glucose control in patients with diabetes (Andersson et al., 2004);
improvement of QOL in patients with diabetes (Wändell et al., 2012); alleviation ofmorning sickness in pregnant women (Ågren & Berg, 2006); alleviation of symptoms inpatients under treatment for headache, sleep disorders, or motor impairment (Andersson
et al., 2009); and relaxation in adult women (Amano et al., 2012).
The skin-stroking stimulation provided by tactile massage has been reported to increaseoxytocin levels and decrease cortisol levels in blood, indicating that thestress-alleviating effects of tactile massage are related to endocrine responses(Uvnäs-Moberg, 2000). These hormonal effects are also observed in therapists while
they are engaged in tactile massage, indicating that tactile massage may lead to a
reduction in the therapists’ stress levels (Field, 2005; Uvnäs-Moberg, 2000).
Autism spectrum disorder (ASD) is characterized by deficits in personal interaction,communication, and behavior (Diagnostic and Statistical Manual of Mental Disorders,
5th Edition; American Psychiatric Association, 2013). Mothers of children with ASD
face various difficulties in raising their children. These difficulties include learning todeal with the child’s behavioral disorder and worrying about the child’s future(Matsuoka et al., 2013). These stresses can then negatively affect the mother’s healthand increase her fatigue levels (Bekku & Yoshimura, 2008). Consequently, the daily life
activities of mothers of children with ASD may be disturbed (Estes et al., 2009).
5

Furthermore, compared to mothers of typically developed children, mothers of children
with ASD tend to be more stressed or depressed and have lower QOLs (Allik et al.,2006; Dabrowska & Pisula, 2010; Hastings, et al., 2005; Mori et al., 2009; Mugno et al.,2007; Nomura et al., 2010; Sakaguchi & Beppu, 2007). Previous studies have indicatedthat, in addition to the need for support for children with ASD, there is a need to support
their mothers in order to alleviate their stress and improve their QOL.
However, no studies have ever been conducted to examine the physiological andpsychological stress-alleviating effects of intervention with tactile massage or other
CAM treatments in reducing stress in mothers of children with ASD.
Our aim is to support children with developmental disabilities by helping their mothers
using CAM therapies. This study was intended to reveal the effects of stress palliation
using tactile massage on mothers of children with ASD. In order to accomplish this goal,
we used both physiological (endocrine and autonomic nervous system) andpsychological (change in mood and anxiety) indicators.

Methods
Participants
The study participants were 17 mothers (mean age = 39.1, standard deviation [SD] =5.3) of pre-school-aged or school-aged children with ASD of any severity level residing
in prefecture A. The mean age of the participants’ children was 7.8 years (SD = 4.2).
6

Nine of the children were in pre-school, 6 were in elementary school, and 2 were injunior high school in a school for special needs education. Fifteen of the children wereboys and 2 were girls. The exclusion criteria for the study were ongoing treatments forskin diseases, cardiovascular diseases, autonomic nervous system diseases, endocrine
diseases, hyperaphia of the skin, and menopause. The mean height of the participants
was 160.4 cm (SD = 1.3), the mean weight was 60.3 kg (SD = 2.8), and the mean bodymass index was 23.3 (SD = 0.9).
Study leaflets were distributed to the parents of children with ASD at a school for
special needs education by teachers and at an outpatient clinic of a hospital byreceptionists to recruit the participants. Written and oral explanations were provided tothose who wanted to participate in the study. The potential participants were informedof the study objectives and methods, their freedom to join or refuse, and their freedom
to withdraw their consent after inclusion in the study. They were also informed of theirfreedom to suspend the experiment and of the policies regarding protection of privacy.
Those who signed the consent form were recruited as study participants.
Procedure
The experiment was initiated after approval by the Research Ethics Committee，
University of Fukui (Ethical Review Board No. 25-11), and the Conflict of Interest
Committee, University of Fukui (No. 973).
Seven participants were treated with the tactile procedure (tactile massage) on the first7

day and the resting procedure (resting in a seated position, no tactile massage) on thefollowing day, while ten participants were treated with the resting procedure on the firstday and the tactile procedure on the following day. As the menstrual cycle influences
autonomic nervous activity (Matsumoto, 2013) and the concentrations of salivary
substances (Izawa et al., 2007a), the experiment was performed during the 2-weekfollicular phase after the start of menstruation. Considering circadian changes in
endocrine system indicators, the tactile and resting experiments were started between
10:00 and 15:00, and were performed at the same time for each participant. Both tactile
and resting procedures lasted 20 minutes. In the experiment room, the temperature was
set to approximately 25C and the humidity was set to 60%. No one else was allowed
into the experimental room and the environment was kept quiet. The study took place
between June 2013 and March 2014.
The participants were asked to avoid dental treatment and alcohol consumption, and tokeep their usual sleep hours on the night before the experiment. On the day of theexperiment, the participants were instructed not to eat, drink, or brush their teeth for 1
hour prior to the start of the experiment. Immediately before the experiment, theparticipants were asked to excrete, to gargle with 50 mL of water, and to change into an
examination gown. Their blood pressures, heart rates, and body temperatures were thenmeasured. The experimenter asked the participants about the lengths of their sleep on
the previous day and their current physical condition to ensure that they had no8

problems regarding their participation in the experiment.
Prior to the tactile/resting procedure, the participants completed a questionnaire
regarding their psychological status. Their saliva samples were also collected and theirheart rates were measured over a 5-minute period. The tactile/resting procedure wasthen carried out for 20 minutes. After the procedure, the participants again completed
the questionnaire regarding their psychological status, submitted saliva samples, andhad their heart rates measured over a 5-minute period. The order of the tactile andresting procedures was randomly assigned for each participant. Heart rate measurements
and the tactile/resting procedures were carried out with the participants comfortably
sitting in a relaxing chair. Conversation was minimized during the measurements andwhile the procedure was carried out.
During the tactile procedure, the participants received tactile massage on both hands for
Table 120 minutes. In order to maintain the same level of tactile massage for all participants,
the procedure was conducted in all participants by a researcher who was certified as atherapist after attending the Level I Tactile Care Course of the Japan Sweden Care
Institute Co., Ltd., which is an organization promoting tactile massage in Japan. Tactile
massage was performed using olive oil in accordance with the method of Suzuki et al.
(2010) (Table 1). Using a slow rhythm and a weak steady pressure, the therapist
thoroughly and lightly stroked the participant’s hand repeatedly from the wrist to thefingertip in an intimate manner. Prior to the experiment, a patch test was conducted to9confirm that no participants were allergic to the olive oil used in the tactile massage.
Physiological Indicators
Endocrine and autonomic nerve indicators were used to provide physiologicalinformation. In order to obtain endocrine data, we measured the concentrations ofcortisol and secretory immunoglobulin A in saliva. Salivary secretory immunoglobulin
A, an immunological marker, changes with acute stress and is considered to be related
to chronic stress (Izawa et al., 2007a). Salivary specimens were collected using a
Salimetrics Oral Swab (Salimetrics LLC, Carlsbad, USA ) and placed in a Swab Storage
Tube (Salimetrics LLC, Carlsbad, USA). Saliva was collected according to the
Salimetrics operation manual and preserved at -30C until the time of analysis.
The concentration of cortisol in saliva was quantified using the Salivary Cortisol EIA
Kit (Salimetrics LLC, Carlsbad, USA). The concentration of secretory immunoglobulin
A was quantified using the Secretory Immunoglobulin A ELISA Kit (Immundiagnostik
AG, Bensheim, Germany).
We used a heart rate variable frequency range analyzer to obtain information on theautonomic nervous system. Heart rate measurements and analyses were carried out
using a Pulse Analyzer Plus (TAS9) (YKC, Tokyo, Japan), which used an electrodeattached to the participant’s fingertip. In order to analyze the heart rate variablefrequency range, we determined the number of low frequency heartbeats (LF, 0.04-0.15
Hz), the number of high frequency heartbeats (HF, 0.15-0.4 Hz), and the ratio of LF to10

HF heartbeats (LF/HF). HF was used as an indicator for parasympathetic nerve activity
and LF/HF was used as an indicator for sympathetic nerve activity. These values reflect
the overall balance between sympathetic and parasympathetic nerve activities (Hayashi,1999).
Psychological Indicators
Mood and anxiety tests were conducted to obtain psychological indicators. We used theProfile of Mood States–Brief Form (POMS-Brief Form) Japanese Version to assess eachparticipant’s mood, which was developed by McNair et al. (1992a, 1992b, 2003), is ascale for assessing mood. The scale can simultaneously assess 6 moods: 5 negative
moods, which include “Tension-Anxiety”, “Depression-Dejection”, “Anger-Hostility”,“Fatigue”, and “Confusion”; and the positive mood of “Vigor”. The Japanese version of
POMS was prepared by Yokoyama (1994) and it consists of 65 items. Its abridged
version (POMS-Brief Form), which consists of 30 items, was subsequently developed
as a standard version (Yokoyama, 2005). In the POMS-Brief Form, the 5-level Likert
Scale is used to respond to the questions. The total score for each mood item is thencalculated. Higher scores in the test indicate stronger moods. A standardized score(range of 30-85) of between 40 and 60 indicates that the person is healthy. As the
POMS-Brief Form can assess the participant’s mood over a short period of time
(Yokoyama, 2005), it was used in the present study to determine the participants’current moods.
11We used the State-Trait Anxiety Inventory Form JYZ (STAI-JYZ) to assess theparticipants’ anxiety levels. The STAI-JYZ is the latest Japanese version of the test
(Hidano et al., 2000), which is a modified, improved version of the anxiety scale
developed by Spielberger et al. (1970). This test incorporates Japan’s cultural factors.
The STAI-JYZ has been widely utilized in clinical and experimental studies of anxiety.
This study examined short-term changes in anxiety as a result of tactile massage byassessing “how the participant was feeling at that moment.” We only used the stateanxiety items of the STAI-JYZ. The 4-level Likert scale is used in the STAI JYZ, andscores range from 20 to 80. Higher scores indicate higher anxiety levels. In a survey offemale university students, a score of 55 or higher was considered to represent a state ofintense anxiety (Hidano et al., 2000).
Data Analysis
Each participant’s statuses (sleeping time, blood pressure, and body temperature)
during the tactile procedure and the resting procedure were compared to assess thecondition of the participants and the experimental environment on the day of study. We
also compared each participant’s status before the procedure to her status after theprocedure and analyzed the rates of change ([post level - pre level]/pre level) of thephysiological and psychological indicators obtained during both the tactile and restingprocedures. For statistical analysis, we assessed paired differences for nonparametricvariables (Wilcoxon’s signed rank test) using IBM SPSS Statistics 19 for Windows.
12Results
Conditions of Participants and Experimental Environment
On the day of study, the median systolic pressure was 118.0 mmHg in “tactile-treated”
participants and 114.0 mmHg in “resting-treated” participants. The median diastolicpressure was 73.0 mmHg in “tactile-treated” participants and 72.0 mmHg in“resting-treated” participants. Median heart rate measured over 1 minute was 74.0 in“tactile-treated” participants and 69.0 in “resting-treated” participants. The median bodytemperature was 36.4C in “tactile-treated” participants and 36.5C in “resting-treated”
participants. No significant differences were observed in any of the above items.
The median number of hours spent sleeping on the night before the study was 7.0 in“tactile-treated” participants and 6.0 in “resting-treated” participants. There were no
significant differences in this measure. None of the participants had a poor healthcondition on the day of experiment.
The median temperature and humidity of the experiment room were 26.3C and 51.0%,
respectively, during the tactile procedure and 25.9C and 58.0% during the restingprocedure. There were no significant differences in these measures.
Changes in Physiological Indicators
We were unable to analyze cortisol levels for 3 participants and secretory
immunoglobulin A levels in 4 participants owing to insufficient amounts of saliva
collected. In addition, 1 participant was eliminated from analysis owing to the detection
13

of arrhythmia, which was discovered during the study of autonomic nervous system
indicators.
Figure 2 shows the results of the comparisons between pre- and post-procedure

Figure 2

endocrine system indicators. The median Salivary cortisol levels significantly decreased
from 0.12 μg/dl prior to tactile treatment to 0.07 μg/dl after the tactile procedure (p< .05). Cortisol levels also significantly decreased from 0.13 μg/dl prior to restingtreatment to 0.09 μg/dl after the resting procedure (p < .01). The median Secretory
immunoglobulin A concentration in saliva significantly increased from 0.62 mg/ml prior
to tactile treatment to 0.73 mg/ml after the tactile procedure (p < .05). Salivary
immunoglobulin A levels also significantly increased from 0.39 mg/ml prior to theresting treatment to 0.92 mg/ml after the resting procedure (p < .05).
Figure 3 shows the results of the comparisons between pre- and post-procedure
autonomic nervous system indicators. The median HF value significantly increased
from 129.9 ms2 prior to tactile treatment to 169.0 ms2 after the tactile procedure (p< .05). Median HF was 152.2 ms2 prior to resting treatment and 194.4 ms2 after the
resting procedure. These two values were not significantly different. HF increased in 14
participants after tactile treatment (87.5%) and in 11 participants after the restingprocedure (68.8%). Median LF/HF did not significantly change following the tactile or
resting procedures: 0.50 prior to tactile treatment and 0.90 after the tactile procedure,and 0.77 prior to resting treatment and 1.02 after the resting procedure. LF/HF increased
14

Figure 3

in 9 participants after tactile treatment (56.3%) and in 12 participants after the restingprocedure (75%).
Table 2 shows the results of the comparisons of the pre-to-post change rates ofTable 2indicators in the tactile vs. resting procedures. Although salivary cortisol levels
decreased and salivary immunoglobulin A levels increased in both groups, there were no
significant differences in the post-treatment levels between the two procedures. Both of
the autonomic indicators increased following both procedures, though there were no
significant differences in any of the items measured.
Changes in Psychological Indicators
Psychological indicators from all 17 participants were included in the analysis. Figure 4
shows the results of the pre-to-post comparison of the standardized POMS-Brief Formscores. The median pre-procedure scores did not deviate from the healthy range. In the“tactile-treated” participants, post-procedure scores for all 5 of the negative moods(“Tension-Anxiety”, p < .01; “Depression-Dejection”, p < .01; “Anger-Hostility”, p< .01; “Fatigue”, p < .05; and “Confusion”, p < .01) significantly decreased compared to
pre-procedure levels. In the “resting-treated” participants, the post-procedure scores for
3 (“Tension-Anxiety”, p < .01; “Anger-Hostility”, p < .01; and “Confusion”, p < .05) of
the 5 negative moods were significantly decreased compared to pre-procedure levels.
No significant pre-to-post-procedure differences were observed in 2 of the moods(“Depression-Dejection” and “Fatigue”). No significant pre-to-post-procedure
15

Figure 4differences were observed for the positive mood of “Vigor.”
Figure 5 shows the pre-to-post comparison of the state-anxiety scores obtained using
Figure 5
the STAI-JYZ. The median pre-procedure score was lower than 55 points, which
represents intense anxiety. In “tactile-treated” participants, the median pre-procedurescore was 44.0 points and the median post-procedure score was 32.0 points, whichindicates a significant decrease following the procedure (p <.001). In the“resting-treated” participants, the median pre-procedure score was 42.0 points and the
median post-procedure score was 40.0 points, which also indicates a significant
decrease following the procedure (p < .01).
Table 2 shows the comparison between the pre-to-post changes in the indicators forparticipants undergoing tactile and resting treatments. The “tactile-treated” participants
had significantly greater rates of change in the 4 POMS-Brief Form negative moods(“Tension-Anxiety”, “Depression-Dejection”, “Fatigue”, and “Confusion”) whencompared to “resting-treated” participants (p < .05). The median pre-to-post change rate
for the STAI-JYZ state-anxiety scores was significantly greater in “tactile-treated”
participants (p < .01).

Discussion
Here we aimed to investigate the effects of stress palliation using tactile massage onmothers of children with ASD using physiological and psychological indicators. No
16significant differences were observed between “tactile-treated” and “resting-treated”
participants in the number of hours spent sleeping on the night before the experiment.
We also did not observe any significant differences in the participants’ blood pressures,
heart rates, body temperatures, or the temperature or humidity of the experimental roomon the days the procedures were performed. Therefore, we consider the experimental
conditions to be homogenous between the two days.
Pre-to-post comparisons of physiological indicators of the endocrine system indicatethat salivary cortisol decreased significantly and salivary secretory immunoglobulin A
increased significantly in both “tactile-treated” and “resting-treated” participants. There
were thus no significant differences in the rates of change of these variables between thetwo procedures. Salivary cortisol increases with acute psychological or physical stressand is related to chronic stress (Izawa et al., 2007a). Daily life events that cause
negative moods may decrease salivary secretory immunoglobulin A levels, while events
that cause positive moods may increase salivary secretory immunoglobulin A levels(Izawa et al., 2007b). Concurrent with the above observations, our results indicate that
not only tactile massage, but also the resting condition, may be effective in alleviating
physiological stress reactions.
In a study (Murata et al., 2009), the participants were treated with a relaxing stimulus
immediately after the application of a stressful stimulus and changes in theirstress-responding molecules were examined. The concentrations of salivary cortisol,17

which were increased with stress stimulation, did not return to their pre-stress level
following “sitting,” but returned to pre-stress levels after “lying” or “lying and listening
to music.” Furthermore, salivary secretory immunoglobulin A levels significantly
increased after “lying” or “lying and listening to music.” “Sitting” did not lead to any
significant changes in this variable. In another study (Takeda et al., 2008), aromatherapy,
which is well known for its CAM effects, was compared with massage without essential
oils with the participants in a lying resting position. The authors observed a decrease insalivary cortisol levels and an increase in salivary secretory immunoglobulin A levels,
although the participants were in a lying resting position. No significant differences inthese variables were observed between the lying resting position and aromatherapy ormassage. These results indicate that even resting in a lying or supine position may
alleviate physiological stress. As the relaxing chair used in the present study was able torecline and had an adjustable footrest to fit the individual’s preference, the participants
were able to rest in a relaxing position. Consequently, salivary cortisol levels decreased
and salivary secretory immunoglobulin A levels increased even after the restingprocedure.
Pre-to-post comparisons of autonomic nervous system indicators suggest that HF
significantly increases in “tactile-treated” participants. No significant differences wereobserved in “resting-treated” participants. In addition, no significant differences were
found in LF/HF in either “tactile-treated” and “resting-treated” participants. As HF
18

represents parasympathetic activity and LF/HF indicates sympathetic activity (Hayashi,1999), tactile massage was considered to promote the parasympathetic nervous systemwith no effects on the sympathetic nervous system. This was consistent with the resultsof a study on the effects of tactile massage on healthy women (Suzuki et al, 2016). In a
study on the effects of massage (other than tactile massage) on healthy individuals(Lindgren et al., 2010), the activities of both sympathetic and parasympathetic nervous
systems were shown to decline. In this case, the massage may produce a compensatory
effect to ensure balance in autonomic nervous system activities. We may have a similareffect in the present study. Another similar report (Kaneko & Koitabashi, 2006)
examined the effects of massage on healthy individuals and reported an increase inparasympathetic activity and a decrease in sympathetic activity. There is currently noconsensus among researchers concerning the effects of massage on the autonomic
nervous system. The autonomic nervous system is affected by various external andinternal factors, which may be difficult to strictly control during the experiment. The
effects of tactile massage on the autonomic nervous system should be further examinedin a follow-up to the present study.
The STAI-JYZ state-anxiety scores significantly decreased in both “tactile-treated” and“resting-treated” participants. However, the pre-to-post rate of change was significantly
greater in “tactile-treated” participants than in “resting-treated” participants. This
indicates that anxiety is reduced both by tactile massage and by resting in a seated19position, though tactile massage may be more effective in alleviating psychologicalanxiety than resting in a seated position.
The scores for all 5 negative moods in the POMS-Brief Form were significantly
decreased in “tactile-treated” participants. The scores for 3 of the moods were decreased
in “resting-treated” participants. The pre-to-post change rate was significantly greaterfor 4 of the 5 negative moods in the “tactile-treated” participants compared to“resting-treated” participants. Our results indicate that tactile massage is more effective
than resting in a seated position in reducing psychological negative moods.
In a study on the effect of tactile massage on STAI-JYZ in elderly women aged 75
years or older with mild dementia, the state anxiety scores significantly decreased
following the procedure (Kikumoto & Kono, 2014). In studies in healthy female
university students (Amano et al., 2012) and menopausal women (Kohno et al., 2013),
scores on all 5 of the negative moods on the POMS-Brief Form were decreased
following tactile massage. The results of the present study are consistent with those ofprevious studies, confirming the effects of tactile massage in positively changing moodand alleviating anxiety.
Human beings have emotionality, which is produced in crisis situations and used for
self-preservation. There are two aspects to emotionality: “feelings,” which occur at the
moment of the participant’s response, and “emotional responses,” which are expressedas physiological or behavioral reactions (Onaka, 2010). “Emotional responses” are20

expressed as reactions of the peripheral organs (facial expressions, behavior, andchanges in the autonomic nervous system and endocrine system) and the brain. The
mechanism underlying “emotional responses” is as follows: upon transmission of
sensory stimulation from the outside to the brain, “feeling” and “emotional response”
are produced, which are then transmitted back to the brain, further modifying “feelings”
and “emotional responses” (Onaka, 2010).
For example, a study examined salivary secretory immunoglobulin A levels 30 minutes
after participants were exposed to no odor, a pleasant odor, or an unpleasant odor, which
induced good or bad feelings (Kim et al., 2009). Salivary secretory immunoglobulin A
significantly increased only with exposure to a pleasant odor. The emotional responsesof the participants differed depending upon the feelings induced by the odor. In the caseof tactile massage, the somatosensory stimulation from the skin is transmitted to thebrain, blood oxytocin levels increase, and blood cortisol levels decrease. In addition, thepleasant “feeling” experienced during tactile massage may feed back to the brain andpotentially promote the reactions of the endocrine system as an “emotional response.”
In the present study, which was conducted in mothers of children with ASD, tactile
massage was more effective in alleviating anxiety and negative mood compared toresting in a seated position. Tactile massage also increased parasympathetic system
activity in the autonomic nervous system, although its effects on stress reaction
alleviation were no different from those observed in participants resting in a seated21position. Thus, we may not have been fully able to capture the effects of the procedureon physiological and endocrine reactions. In a previous study (Suzuki et al., 2012), theparticipants received tactile massage regularly (2 times per week, total of 10 times). An
endocrine system indicator (chromogranin A in saliva as an index of mental stress) was
compared before and after the tactile massage at baseline, and the 5th and 10th sessions.
A significant reduction in this endocrine system indicator was observed at the 10th
session. This result suggests that regular tactile implementation might be more effectiveon physiological-endocrine responses than pinpoint implementation.
Tactile massage has the potential to become a very useful CAM, as adequate
somatosensory stimulation of the skin can control the emotional responses of the brain
and one’s feelings. While the mothers of children with ASD were expected to have highlevels of stress, the participants’ stress levels were within a normal range as assessedusing the index in this study. Further investigations with more participants are required
to verify the effects of tactile massage. In addition, further similar studies in adultwomen and mothers of typically developing children are needed. We intend to carry out
further verification experiments to examine the effects of regular long-term
implementation of tactile massage.

22

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Figure & Table

Figure 1. Tactile massage on the hands.
Table 1. The Tactile Care Technique.
Figure 2. The comparison between pre- and post-procedure endocrine system indicators.
Figure 3.

The comparison between pre- and post-procedure autonomic nervous system
indicators.

Table 2. The comparison of the pre-to-post change rates of physiological andpsychological indicators in the “tactile” vs. “resting” procedures.
Figure 4. The pre-to-post comparison for the standardized POMS-Brief Form scores.
Figure 5. The comparison between pre- and post-procedure the state-anxiety scoresobtained using the STAI-JYZ.

31

Figure 1. Tactile massage on the hands.

32

Table 1
The Tactile Care Technique.
1.The nurse tells the subject that it is time for tactile massage and to get in a
comfortable posture.
2. The nurse wraps both hands in a towel before removing one towel to effleurage thehand and turn the palm up
3. The nurse rubs organic olive oil on the subject after warming the oil in her palm.
4. For finger effleurage, the nurse lightly strokes the side of the hand slowly.
5. The nurse wraps her hand around each finger while performing effleurage in a slow
circular motion starting from the base of the finger to the tip of the finger
6. The nurse strokes the hand making small clockwise circles on the palm and puts thehands together before stroking the sides of the fingers.
7. The nurse lets her hands slide around the wrists while performing effleurage in acircular motion.
8. The nurse carefully wraps the subject’s hand in a towel and moves to the next hand.
9. The nurse repeats the same procedure for the other hand until the end of the tactile
massage after which she thanks the subject.
（Suzuki et al.，2010）
Note. This technique is a hand technique of the Level I Tactile Care Course of the Japan
Sweden Care Institute Co., Ltd.

33

（μg/dl）**

Salivary cortisol

*

N=14

*

*

immunoglobulin A

Salivary secretory（mg/ml）

N=13

Figure 2. The comparison between pre- and post-procedure endocrine system indicators.
Note. Wilcoxon signed-rank test, * p<.05, ** p<.01.

34

2

（ms ）

HF

*

LF / HF

N=16

N=16

Figure 3. The comparison between pre- and post-procedure autonomic nervous system
indicators.
Note. HF, high frequency; LH/HF, low frequency/high frequency
Wilcoxon signed-rank test, * p<.05.

35

Table 2
The comparison of the pre-to-post change rates of physiological and psychologicalindicators in the “tactile” vs. “resting” procedures.
TactileResting

p value

Salivary cortisol

－0.34

－0.34

Salivary secretory immunoglobulin A

0.60

1.01

high frequency

0.25

0.15

low frequency/high frequency

0.69

0.64

ns
ns
ns
ns

－0.13

－0.08

“depression-dejection”

－0.07

0.00

“anger-hostility”

－0.05

－0.07

“fatigue”

－0.09

0.00

“confusion”

－0.09

－0.06

“vigor”

0.05

0.00

－0.22

－0.07

MeasurePhysiological Indicators

Psychological Indicators
POMS “tension-anxiety”

STAI state-anxiety

Note. Change rate = (post level-pre level)/pre level
Wilcoxon signed-rank test

36

p<.05
p<.05
ns
p<.05
p<.05
ns
p<.01

（T Point）

Profile of Mood States Brief Form

**

**

**

**

**

*

**

*

N=17
Figure 4. The pre-to-post comparison for the standardized POMS-Brief Form scores.
Note. Wilcoxon signed-rank test, * p<.05, ** p<.01.

37

（Point）***

State Anxiety

**

N=17
Figure 5. The comparison between pre- and post-procedure the state-anxiety scoresobtained using the STAI-JYZ.

Note. Wilcoxon signed-rank test, ** p<.01, *** p<.001.

38