Photo provided by Northwestern Health Sciences University: https://www.nwhealth.edu/blog/expanding-access-to-massage-therapy/

Massage presents an ideal time to learn about pain management techniques, especially for survivors of torture who often experience complex and chronic pain. We learn and retain information worse when stressed and better when relaxed. 

This is especially important for survivors of torture, who often experience a chronic state of fight, flight or freeze – a heightened physiological state of stress and anxiety – due to past trauma and ongoing stressors. 

Massage offers a unique opportunity for survivors to experience the relaxation response, calming the nervous system and reducing feelings of threat. This creates an ideal environment for both learning and healing. 

CVT has developed an approach called TCI-Massage (Trauma-Informed and Culturally-Responsive Integrated Massage Therapy) that integrates massage with pain education. Melding a hands-on approach and the mindfulness-based pain education ultimately creates the environment for a progressive and cumulative learning experience. 

This approach not only provides physical relief from massage, but also provides survivors knowledge and strategies to better manage their pain.

How we integrate mindfulness into education and therapy

CVT’s 10-week TCI-Massage Therapy program includes components of Mindful Awareness and Body-Oriented Therapy (MABT), developed by Cynthia Price, a University of Washington research professor.

“Massage therapists help clients learn to [bring the client’s] awareness into their body and to support self awareness,” Cynthia said. 

Each session builds upon the last, deepening the client’s understanding of pain and equipping them with practical self-management strategies. The curriculum focuses on three core components:

• Noticing Sensation
• Awareness of Breathing
• Self-compassion

In this article, we’ll start at the beginning and provide an insider-look at the Noticing Sensation component of the TCI-Massage model.

What does noticing sensation mean?

Can you feel the ground beneath your feet? The touch of your clothes on your skin? This awareness of bodily sensations is a potential tool for healing. It is a skill we can develop and it is called noticing sensation. 

Because noticing sensation leads to positive outcomes for chronic pain, we incorporate this into the pain education components of the TCI-Massage model. 

In many ways, noticing sensation is a mindfulness skill. TCI-massage integrates the idea of noticing and mindfulness to help shift how one relates to and responds to pain.

“Mindfulness is very helpful for moving people out of automatic patterns, like constantly thinking, trying to figure things out, ruminating about things that are uncomfortable,” Cynthia explains. 

What does this look like?

Diane Long, CVT massage therapist, shared a common example of noticing sensation where the client identifies a point of tension in their body.

“I might notice a place of tension, and a person might say, ‘Yes, right there where you’re working, that’s where it’s tight.’ Then, I might describe what I’m feeling and ask them to notice what they’re feeling,” they said.

After spending time providing massage to the identified area, Diane will ask the client what they notice or if there are any changes in how it feels. Many report during the massage – and especially after – feeling lighter, relief or release in that area.

“We’re noticing the discomfort and the tension and giving it some attention, and then noticing how it changes in real time…The noticing sensation is helping someone start to put words to some of the things that they’re feeling in their body,” Diane said.

According to Cynthia, finding and using new words to describe those sensations is a step towards building a new relationship with your pain and your body. 

“Part of what we’re getting at is empowering people. They can realize a new sense of self efficacy as they interface with what they feel in their body in a new way that can be positive and different from what they’re used to,” she said.

What are the benefits?

Developing the skill of noticing sensation is valuable because it strengthens body awareness. This is a critical skill for recognizing and managing pain, and introduces the powerful tool of embodied learning. 

Noticing sensation can help survivors recognize early signs of pain, prompting them to better tend to it. By guiding survivors to notice and describe their sensations, they are more equipped to manage pain and connect more deeply with their bodies. 

This work of noticing sensation happens in the context of a safe and therapeutic relationship with the massage therapist and with the support of the care team at CVT.  Reconnecting with the physical body is a foundational component of healing from trauma and managing chronic pain.

Massage can be a powerful tool for learning and healing 

This is largely due to the impact physical touch can have, especially for survivors of torture. It allows the massage therapist to directly connect pain education content to the client’s physical experience. Ultimately, this leads them to begin the journey of redefining their relationship with their body after hurt.

The hope is that learning concepts like noticing sensation through trauma-informed and culturally sensitive programs like CVT’s TCI-Massage will have an exceptionally positive impact on this population, both through massage and pain education.