Massage and Reiki used to reduce stress and anxiety: Randomized Clinical Trial

ABTRACT Objective: to evaluate the effectiveness of massage and reiki in the reduction of stress and anxiety in clients at the Institute for Integrated and Oriental Therapy in Sao Paulo (Brazil). Method: clinical tests randomly done in parallel with an initial sample of 122 people divided into three groups: Massage + Rest (G1), Massage + Reiki (G2) and a Control group without intervention (G3). The Stress Systems list and the Trace State Anxiety Inventory were used to evaluate the groups at the start and after 8 sessions (1 month), during 2015. Results: there were statistical differences (p = 0.000) according to the ANOVA (Analysis of Variance) for the stress amongst the groups 2 and 3 (p = 0.014) with a 33% reductions and a Cohen of 0.78. In relation to anxiety-state, there was a reduction in the intervention groups compared with the control group (p < 0.01) with a 21% reduction in group 2 (Cohen of 1.18) and a 16% reduction for group 1 (Cohen of 1.14). Conclusion: Massage + Reiki produced better results amongst the groups and the conclusion is for further studies to be done with the use of a placebo group to evaluate the impact of the technique separate from other techniques. RBR-42c8wp


Introduction
Complementary and Alternative Medicine has become an integral part of health care for the population in North America for the treatment of different ailments (1) . In Brazil complementary therapies are known as Complementary and Integrative Practices (PIC) based on Official Government Notice 971 from the Ministry of Health (2006) and it is made up of group of therapies that includes: acupuncture, auriculotherapy, homeopathy, hydrotherapy, herbal medicine, eastern massage, oriental physical exercises like Tai Chi Chuan, Lian Gong, Qi Gong, amongst others (2) .
Despite the advances in conventional western medicine, the interest for the use of PIC has increased principally in developed countries. It was observed that in 2012 33.2% of adults in North America used some form of complementary health therapy. The therapies that encompass mind and body that are commonly sought after by adults have been yoga, the use of chiropractic and osteopathic practices, meditation and massage therapy (3) .
The results of a piece of research conducted in 2007 in the United States allowed us to estimate that 18 million people over the age of 18 had used massage therapy in the last 12 months (4) . The massage therapy has been offered with a preference to hospitalized patients to support the management of symptoms of pain, anxiety and tension (1) . Also, what was shown was a reduction in lower back pain, improvements in work related activities and improvements in the quality of life of the nursing teams in the general hospitals in Brazil (5) .
In the classification of complementary therapies In post-modern society, the high levels of stress have become such a problem for health that it is very common and what can be seen is that the excessive and continuous effect can compromise health having a triggering effect in the development of innumerable illnesses. They can affect the quality of life and the productivity of human beings which has been generating major interests in relation to causes and the methods for their reduction (7) .
The principal treatment for ailments that cause mental disorders due to stress and anxiety include psychiatric treatment and pharmacotherapy. Amongst the PIC that can contribute to preventing diseases and reducing the levels of stress and anxiety, one can put the spotlight on massage (8) and Reiki that has been the subject of research as a complementary energy therapy that can help to strengthen the capacity of the body to cure itself. There is a growing interest amongst nurses for the use of Reiki in assisting patients especially in relation to self-help. Research being integrative and revisionary selected investigations using Reiki to reduce stress, to relax, to treat depression, pain and the healing of injuries (9) .
Although this method of curing is widely used for a variety of psychological and physical symptoms the proof of its efficacy is not over abundant and is conflicting demanding more studies to investigate its affects (10) .

Objective
To evaluate the effectiveness of massage and reiki in the reduction of stress and anxiety in clients at the Institute for Integrated and Oriental Therapy in Sao Paulo (Brazil).

Material and Method
There was a clinically controlled test conducted in a random way that was parallel with three study Oriental Therapy (ITIO). They were students studying massage and they conducted the collection of data that was monitored by the teachers who had experience in these techniques.
The population that was studied was made up of volunteers that sought ambulatory care at the ITIO and for military personnel from the IV-Regional Area Command Force in São Paulo (IV-COMAR) located next to ITIO. The participants fulfilled the following inclusion criteria: having a score between 37 to 119 points based on Vasconcelo's Stress Symptoms List (LSS) (11) .
participants and military personnel from the IV COMAR that had holidays booked for the period of the research or who were on sick leave, those that started to use anxiolytics and antidepressants at the commencement of the research, those that stated they felt discomfort during the massage sessions or who had some sort of tissue injury in the areas that were being massaged.
In the recruitment phases 141 volunteers on 30 June 2015 were selected, by the team of teachers that were in charge and 13 student collectors from ITIO were used. Of these 141, only 122 were subject to random blocks, from the program called Research Randomizer Quick Tutorial (12) . The data was tabulated by the team on Excel spreadsheets and was subsequently analyzed

Results
The study finally settled with 101 participants.  Table 1).
The groups showed homogeneity in relation to age and the scores on the LSS and IDATE tools (Table 1). In Table 2  In Table 3 are the sizes of the effect and the percentage of the reduction for each one of the groups and the corresponding classification.
Kurebayashi LFS, Turrini RNT, Souza TPB, Takiguchi RS, Kuba G, Nagumo MT.  (3) were: the feeling that they were about to faint, a lack of energy, no will to do anything, physical exhaustion, headache and an appetite that oscillates.

The symptoms that only responded to the Massage and
Rest group (1) were: thoughts that caused anxiety, the feeling of wanting to be alone and the feeling of worries. Quantitatively the symptoms that obtained statistical differences and significant reductions were greater for the Massage and Reiki Group (2) in relation to the Control: being worn out at the end of the day, lack of appetite, tightened jaws, waking up tired in the morning, feeling tired, insomnia, anger, irritation, speechless, watery eyes and obscured vison. With reference to the symptoms "having nightmares", only Group 2 was able to improve in relation to Group 1.
No reports of undesirable effects and injuries were mentioned for each of the groups.

Discussion
The  (18) . In a study where the sessions were 20 minutes the intervention showed positive effects in the reduction of blood pressure being a complementary technique for the control of hypertension (19) . Another study evaluated the effect of 30 minutes of Reiki in the control of anxiety, pain and well-being for patients with cancer (118 patients) in chemotherapy treatment. The evaluations before and after the application of Reiki promoted improvements in well-being, the quality of sleep, relaxation, the alleviation of pain and reductions in the level of anxiety (20) .
The immediate results of Reiki were seen in relation to cardiac beats, the levels of cortisol and the body temperature of professionals with Burnout Syndrome. They suggest that Reiki has an effect on the parasympathetic nervous system when applied to health care professionals (21) . Reiki has an important advantage amongst complementary therapies as it can be selfapplied and it was used in this way in research with 20 university students for the program on the reduction of stress and relaxation based on accompanying its effects for 20 weeks (22) .
Positive symptoms were only seen for the Massage + Reiki Group (G2) relating to physical and emotional state with special attention being drawn to the reduction of nightmares and the reduction of insomnia. However, there is a long journey to be made for the scientific community to recognize the effects of Reiki on its own or as a practice that is integrated with other PIC techniques.
A systematic review of Reiki leads us to the conclusion that the evidence is insufficient to say that Reiki is an effective treatment after twenty-three random clinical sessions based on the electronic data (23) .
Also, the literature is controversial on the issue with reference to the effect of Reiki on the levels of cortisol.
In a clinical test with health psychology students no significant changes were found in the levels of cortisol after the application of Reiki (24) . The studies also suggest that one single Reiki sessions is not sufficient to immediately reduce the levels of saliva cortisol.
Also, it is not known if there would be changes in the concentrations of saliva cortisol and post-intervention Kurebayashi LFS, Turrini RNT, Souza TPB, Takiguchi RS, Kuba G, Nagumo MT.
taking place two, six or twenty-four hours on health care professionals with burnout (nurses and doctors) (21) .
In relation to the limitation of the present study,