Improving Mental and Emotional Health

Originally published on Helpguide.org:

People who are emotionally healthy are in control of their emotions and their behavior. They are able to handle life’s challenges, build strong relationships, and recover from setbacks. But just as it requires effort to build or maintain physical health, so it is with mental and emotional health. Improving your emotional health can be a rewarding experience, benefiting all aspects of your life, including boosting your mood, building resilience, and adding to your overall enjoyment of life.

What is mental health or emotional health?

Mental or emotional health refers to your overall psychological well-being. It includes the way you feel about yourself, the quality of your relationships, and your ability to manage your feelings and deal with difficulties.
Good mental health isn't just the absence of mental health problems. Being mentally or emotionally healthy is much more than being free of depression, anxiety, or other psychological issues. Rather than the absence of mental illness, mental and emotional health refers to the presence of positive characteristics. Similarly, not feeling bad is not the same as feeling good. While some people may not have negative feelings, they still need to do things that make them feel positive in order to achieve mental and emotional health.

People who are mentally and emotionally healthy have:

• A sense of contentment.
• A zest for living and the ability to laugh and have fun.
• The ability to deal with stress and bounce back from adversity.
• A sense of meaning and purpose, in both their activities and their relationships.
• The flexibility to learn new things and adapt to change.
• A balance between work and play, rest and activity, etc.
• The ability to build and maintain fulfilling relationships.
• Self-confidence and high self-esteem.

These positive characteristics of mental and emotional health allow you to participate in life to the fullest extent possible through productive, meaningful activities and strong relationships. These positive characteristics also help you cope when faced with life's challenges and stresses.

The role of resilience in mental and emotional health

Being emotionally and mentally healthy doesn’t mean never going through bad times or experiencing emotional problems. We all go through disappointments, loss, and change. And while these are normal parts of life, they can still cause sadness, anxiety, and stress.
The difference is that people with good emotional health have an ability to bounce back from adversity, trauma, and stress. This ability is called resilience. People who are emotionally and mentally healthy have the tools for coping with difficult situations and maintaining a positive outlook. They remain focused, flexible, and creative in bad times as well as good.
One of the key factors in resilience is the ability to balance stress and your emotions. The capacity to recognize your emotions and express them appropriately helps you avoid getting stuck in depression, anxiety, or other negative mood states. Another key factor is having a strong support network. Having trusted people you can turn to for encouragement and support will boost your resilience in tough times.

Physical health is connected to mental and emotional health

Taking care of your body is a powerful first step towards mental and emotional health. The mind and the body are linked. When you improve your physical health, you’ll automatically experience greater mental and emotional well-being. For example, exercise not only strengthens our heart and lungs, but also releases endorphins, powerful chemicals that energize us and lift our mood.
The activities you engage in and the daily choices you make affect the way you feel physically and emotionally.

• Get enough rest. To have good mental and emotional health, it’s important to take care of your body. That includes getting enough sleep. Most people need seven to eight hours of sleep each night in order to function optimally.
• Learn about good nutrition and practice it. The subject of nutrition is complicated and not always easy to put into practice. But the more you learn about what you eat and how it affects your energy and mood, the better you can feel.
• Exercise to relieve stress and lift your mood. Exercise is a powerful antidote to stress, anxiety, and depression. Look for small ways to add activity to your day, like taking the stairs instead of the elevator or going on a short walk. To get the most mental health benefits, aim for 30 minutes or more of exercise per day.
• Get a dose of sunlight every day. Sunlight lifts your mood, so try to get at least 10 to 15 minutes of sun per day. This can be done while exercising, gardening, or socializing.
• Limit alcohol and avoid cigarettes and other drugs. These are stimulants that may unnaturally make you feel good in the short term, but have long-term negative consequences for mood and emotional health.

Improve mental and emotional health by taking care of yourself

In order to maintain and strengthen your mental and emotional health, it’s important to pay attention to your own needs and feelings. Don’t let stress and negative emotions build up. Try to maintain a balance between your daily responsibilities and the things you enjoy. If you take care of yourself, you’ll be better prepared to deal with challenges if and when they arise.
Taking care of yourself includes pursuing activities that naturally release endorphins and contribute to feeling good. In addition to physical exercise, endorphins are also naturally released when we:

• Do things that positively impact others. Being useful to others and being valued for what you do can help build self-esteem.
• Practice self-discipline. Self-control naturally leads to a sense of hopefulness and can help you overcome despair, helplessness, and other negative thoughts.
• Learn or discover new things. Think of it as “intellectual candy.” Try taking an adult education class, join a book club, visit a museum, learn a new language, or simply travel somewhere new.
• Enjoy the beauty of nature or art. Studies show that simply walking through a garden can lower blood pressure and reduce stress. The same goes for strolling through a park or an art gallery, hiking, admiring architecture, or sitting on a beach.
• Manage your stress levels. Stress takes a heavy toll on mental and emotional health, so it’s important to keep it under control. While not all stressors can be avoided, stress management strategies can help you bring things back into balance.
• Limit unhealthy mental habits like worrying. Try to avoid becoming absorbed by repetitive mental habits—negative thoughts about yourself and the world that suck up time, drain your energy, and trigger feelings of anxiety, fear, and depression.

More tips and strategies for taking care of yourself:

• Appeal to your senses. Stay calm and energized by appealing to the five senses: sight, sound, touch, smell, and taste. Listen to music that lifts your mood, place flowers where you will see and smell them, massage your hands and feet, or sip a warm drink.
• Engage in meaningful, creative work. Do things that challenge your creativity and make you feel productive, whether or not you get paid for it—things like gardening, drawing, writing, playing an instrument, or building something in your workshop.
• Get a pet. Yes, pets are a responsibility, but caring for one makes you feel needed and loved. There is no love quite as unconditional as the love a pet can give. Animals can also get you out of the house for exercise and expose you to new people and places.
• Make leisure time a priority. Do things for no other reason than that it feels good to do them. Go to a funny movie, take a walk on the beach, listen to music, read a good book, or talk to a friend. Doing things just because they are fun is no indulgence. Play is an emotional and mental health necessity.
• Make time for contemplation and appreciation. Think about the things you’re grateful for. Mediate, pray, enjoy the sunset, or simply take a moment to pay attention to what is good, positive, and beautiful as you go about your day.

Everyone is different; not all things will be equally beneficial to all people. Some people feel better relaxing and slowing down while others need more activity and more excitement or stimulation to feel better. The important thing is to find activities that you enjoy and that give you a boost.

Supportive relationships: The foundation of emotional health

No matter how much time you devote to improving your mental and emotional health, you will still need the company of others to feel and be your best. Humans are social creatures with an emotional need for relationships and positive connections to others. We’re not meant to survive, let alone thrive, in isolation. Our social brains crave companionship—even when experience has made us shy and distrustful of others.
Social interaction—specifically talking to someone else about your problems—can also help to reduce stress. The key is to find a supportive relationship with someone who is a “good listener”—someone you can talk to regularly, preferably face-to-face, who will listen to you without a pre-existing agenda for how you should think or feel. A good listener will listen to the feelings behind your words, and won’t interrupt or judge or criticize you. The best way to find a good listener? Be a good listener yourself. Develop a friendship with someone you can talk to regularly, and then listen and support each other.

Tips and strategies for connecting to others:

• Get out from behind your TV or computer screen. Screens have their place but they will never have the same effect as an expression of interest or a reassuring touch. Communication is a largely nonverbal experience that requires you to be in direct contact with other people, so don’t neglect your real-world relationships in favor of virtual interaction. 
• Spend time daily, face-to-face, with people you like. Make spending time with people you enjoy a priority. Choose friends, neighbors, colleagues, and family members who are upbeat, positive, and interested in you. Take time to inquire about people you meet during the day that you like.
• Volunteer. Doing something that helps others has a beneficial effect on how you feel about yourself. The meaning and purpose you find in helping others will enrich and expand your life. There is no limit to the individual and group volunteer opportunities you can explore. Schools, churches, nonprofits, and charitable organization of all sorts depend on volunteers for their survival.
• Be a joiner. Join networking, social action, conservation, and special interest groups that meet on a regular basis. These groups offer wonderful opportunities for finding people with common interests—people you like being with who are potential friends.

Risk factors for mental and emotional problems

Your mental and emotional health has been and will continue to be shaped by your experiences. Early childhood experiences are especially significant. Genetic and biological factors can also play a role, but these too can be changed by experience. 

Risk factors that can compromise mental and emotional health:

• Poor connection or attachment to your primary caretaker early in life. Feeling lonely, isolated, unsafe, confused, or abused as an infant or young child.
• Traumas or serious losses, especially early in life. Death of a parent or other traumatic experiences such as war or hospitalization.
• Learned helplessness. Negative experiences that lead to a belief that you’re helpless and that you have little control over the situations in your life.
• Illness, especially when it’s chronic, disabling, or isolates you from others.
• Side effects of medications, especially in older people who may be taking a variety of medications.
• Substance abuse. Alcohol and drug abuse can both cause mental health problems and make preexisting mental or emotional problems worse.

Whatever internal or external factors have shaped your mental and emotional health, it’s never too late to make changes that will improve your psychological well-being. Risk factors can be counteracted with protective factors, like strong relationships, a healthy lifestyle, and coping strategies for managing stress and negative emotions.

When to seek professional help for emotional problems

If you’ve made consistent efforts to improve your mental and emotional health and you still don’t feel good—then it’s time to seek professional help. Because we are so socially attuned, input from a knowledgeable, caring professional can motivate us to do things for ourselves that we were not able to do on our own.

Red flag feelings and behaviors that may require immediate attention

• Inability to sleep
• Feeling down, hopeless, or helpless most of the time
• Concentration problems that are interfering with your work or home life
• Using nicotine, food, drugs, or alcohol to cope with difficult emotions
• Negative or self-destructive thoughts or fears that you can’t control
• Thoughts of death or suicide

If you identify with any of these red flag symptoms, consider making an appointment with a mental health professional.

Adding Massage To Help With Anxiety Disorder

If you suffer from anxiety disorders, you’re not alone. Thirteen percent of the population lives everyday with persistent anxiety. Massage therapy is a great addition to anxiety treatments.
This anxiety is more than the fear you feel when you have to speak in public. Panic attacks can seem to happen for no reason at all. Anxiety symptoms can be as mild as a general feeling of uneasiness or as severe as paralyzing terror.
Let’s take a look at the various types of anxiety conditions you can have and some natural ways to treat them.
Types of Disorders
There are several different kinds of disorders.
Generalized anxiety disorder (GAD) is characterized by chronic worry that lasts 6 months or more. The worry is not in proportion to the problem and is sometimes accompanied by physical anxiety symptoms.
trouble sleeping
restlessness
sweating
muscle tension and twitching
headaches
Obsessive-compulsive disorder (OCD) is characterized by repetitive thoughts that occupy your mind and cause you to do repetitive behaviors. People with obsessive-compulsive disorder have persistent anxiety and develop a behavior, like hand washing or hoarding, to relieve that anxiety. The behavior is like a ritual to ensure that whatever the person is anxious about won’t happen.
Panic disorder is characterized by crippling fear for no reason. People who have this disorder usually can’t predict when or where it will strike. When someone has a panic attack they may feel these physical anxiety symptoms:
chest pains
increased heartbeat
shortness of breath
light-headedness or dizziness
nausea
sudden change in temperature (hot flashes or chills)
choking
Post-traumatic Stress Disorder (PTSD) occurs as a result of a traumatic experience. We often hear about this condition in reference to war veterans, but it can be experience by anyone who has lived through a terrifying experience. People with PTSD constantly relive these traumatic events in there heads to the point that it interferes with their ability to lead a normal life.
Phobias are irrational fears. These irrational fears often trigger panic attacks.
Many people who suffer from anxiety disorders never seek anxiety treatments. They are highly treatable though with methods like biofeedback, cognitive behavior therapy, medications, relaxation techniques, and massage.
Massage for Anxiety
When you experience anxiety, your body produces a lot of the stress hormone cortisol. Massage lowers cortisol levels. It also gets rid of the muscle tension caused by anxiety disorders.
In 1996 the Touch Research Institute did a study with 26 adults. For the study half the adults were given chair massages two times a week for 15 minutes and the control group sat in a massage chair but didn’t receive a massage 2 times a week for 15 minutes. You have to feel sorry for the poor control group.
Before and after the 5 week period their anxiety and depression levels were measured. They were also given saliva tests for cortisol. Then they were given math problems to solve. At the end of the study the people who received massage had lower anxiety and depression levels. Their cortisol levels were lower and they had increased speed and accuracy on the math problems.
Relaxation massages are best for treating anxiety, but you can try just about any type of massage to help calm your nerves. You might want to stay away from deeper more intense bodywork when you’re trying to relieve anxiety.
Other Natural Treatment Methods
There are a few herbal remedies that have been effective in treating anxiety disorders. Passion flower, valerian, chamomile and kava. These herbs all have calming effects, but like medications they can have negative side effects. If you’re interested in learning more about treating common ailments with herbal remedies click here.
Meditation can help ward off anxiety when you feel it coming on. Close your eyes and breathe deeply. Focus your attention on your breath. This will help slow your heart rate and calm your nerves. When you’re first starting out meditating on your own can be tricky. These meditation MP3′s can help you achieve the mindset required for meditation more easily.
Aromatherapy is soothing and helps calm nervous tension. Essential oils can easily be added to massage oil to calm you down even more than just a plain massage will.
Taking calcium, magnesium, and B vitamins can also help ease anxiety symptoms.
Some Books You Might
Read more: http://www.massage-therapy-benefits.net

When Should Runners Get a Deep Tissue Massage?

By Jason Fitzgerald | For Active.com


Runners have long known that a good massage can boost their recovery after a tough race or hard workout. Besides the obvious "it hurts so good," massages can also reduce stress and help you relax before an important race.
But when are the best times to schedule your massage? And how can you maximize its value, because, let's face, they're not cheap.
There are specific times to get deep tissue massages if you want to boost the benefits of the massage. First, it's important to understand what those benefits are because they'll help you schedule your massage session for the optimal time. Most critically, deep tissue massages improve blood flow to your muscles by stimulating the circulatory system. You'll get an influx of oxygen-rich blood, which helps flush out the byproducts of hard exercise, and delivers fresh nutrients.

 While the circulatory benefits of massage are profound, other benefits of regular sessions include: reduced existing muscle soreness, improved range of motion, and the break up of scar tissue or adhesions that can restrict the movement of your muscles.
More: Massage for Runners: The Low Down

When to Schedule Your Massage

Because deep tissue work releases waste products at the cellular level—and may even leave you slightly sore—it's best to consider them a type of workout. Framing massages as workouts helps you schedule your massages more strategically.
You should always get a massage after your run and preferably with an easy run planned for the following day. This helps your body along with the recovery process and ensures you're not negating the benefits by doing a hard workout 12 to 24 hours later.
If you do run a strenuous interval session or long run the day after a massage, you're simply contracting your muscles, introducing more waste products, and further dehydrating muscles—which won't boost the benefits of massage.
If possible, it's also helpful to schedule your massage after an easy run, not a hard workout or long run. Ideally, you want your muscles to be relatively relaxed and not in a very fatigued state.
More: 3 Reasons to Include Recovery Runs in Your Training
This is also why it's never recommended to get a massage the day of a marathon or the day after. There's a substantial amount of muscular damage after a race of this distance, including inflammation, so it's wise to let your body heal itself for the first one to two days. Later in the week after about three to five days, you can schedule a massage after your body has dealt with the acute symptoms of post-marathon soreness and muscle damage.
More: 5 Golden Rules of Marathon Recovery
And just like it's beneficial to wait three to five days after a race to schedule a massage, make sure you give your body three to five days after a massage before you race. This gives you enough time to flush out the byproducts that massage has released, and for any residual soreness to go away.
Remember that massage can be more helpful during periods of heavy training. If you're reaching new weekly mileage records, preparing for your first marathon, or doing faster workouts than ever before, your training is at a new peak. Recover accordingly and use massage to help prevent injuries.
To further extend the benefits of massage, you can help the waste product removal process by staying hydrated and drinking lots of water. Combined with a clean diet of whole foods and light foam rolling, you'll get the most out of your deep tissue massage sessions, and will recover much more quickly—so you can train harder and race faster.

About the Author

Jason Fitzgerald

Jason Fitzgerald is a USATF-certified running coach, 2:39 marathoner, and the founder of Strength Running. Have a question about running? Download the free Strength Running PR Guide to get 35+ answers to the most commonly asked questions about running.

Grief & Loss Providing a Safe Haven for Clients

By Mary Kathleen Rose

Originally published in Massage Bodywork magazine, July/August 2011. Copyright 2011. Associated Bodywork and Massage Professionals. All rights reserved.



 "Your touch was so reassuring. It helped me know I could survive this loss. Being touched helped me stay with my feelings. It helped me so much just to know you were there."

These words, spoken by a client dealing with death are typical of statements I have heard over the years in my work as a certified massage therapist. Oftentimes people come to us for massage when they are experiencing the stress of loss in their lives. Whether the loss is through death, divorce, or other significant life changes, we find ourselves in the role of supporting them through these challenging times. We can be most helpful by understanding some of the basics of the normal grieving process, as we allow our clients a safe haven in their time of need.

Beginning in 1990, I facilitated hospice bereavement support groups for 12 years. What I learned in that time, as I listened to people of all ages and backgrounds share their stories, has personally enriched my life and significantly informed my practice of massage. I grew to appreciate the perspective, fostered by the hospice movement, that bereavement is a natural, normal process--an integral part of life. With education to help people understand the process, along with social and emotional support, we can all become wiser, more compassionate, and happier individuals.

This study of bereavement has strengthened my understanding of losses associated with acute and chronic illnesses, aging, and other physical and psychosocial life changes. I've found that human beings are amazingly resilient and adaptable, all the more so with support from friends, family, and conscientious health-care professionals, including massage and bodywork practitioners.

Understanding Grief As A Response To Loss
Bereavement is most often thought of as the mourning of a death. But the process of grieving can be applied to many other life-changing events, including disability, divorce, job loss, financial loss, or other changes in physical circumstances or relationships. Aging, itself, is a process involving many changes, including losses for which a person may grieve. A person living with chronic illness or disability may undergo an extensive process of grieving over the loss of health or function.

Whether a loss is sudden and specific, as with a death, or prolonged, as with a gradual loss of function owing to illness, it is normal for the individual to move through a range of responses and reactions. While Sigmund Freud pioneered the study of bereavement in his essay "Mourning and Melancholia,"1 written in 1917, it was psychiatrist Elizabeth Kubler-Ross who advanced the study of bereavement in relation to the dying process. In her groundbreaking book On Death and Dying,2 published in 1969, she proposed five psychological stages of dying: denial, anger, bargaining, depression, and, finally, acceptance. Her passionate commitment to ease the psychological as well as physical suffering of the ill and dying compelled her to work to bring about awareness of these issues within mainstream medicine and psychology. Her work paralleled the growing hospice movement, which sought to bring compassion and dignity to the terminally ill.

British psychiatrist John Bowlby's study of attachment behavior in children contributed to the understanding of bereavement.3 His theory of attachment, presented in the 1960s, provided an explanation for the common human tendency to develop strong, affectional bonds. Grief is an instinctive universal response to separation. In their study of adult grieving, Bowlby and fellow psychiatrist Colin Parkes described four phases of grief: numbness with intermittent anger; yearning; disorganization and despair; and organization.4

An understanding of the grieving process has continued to expand as it applies not only to death and dying, but also to the broader range of human experience. Grieving is not a simple linear process. It applies not only to losses incurred as a result of death or the anticipation of death, but also to other kinds of loss. For example, grief can be experienced when someone is diagnosed with a life-threatening and/or debilitating disease. The physical and psychosocial issues involved with aging and illness also contribute to the complexity of the bereavement process for many individuals.

More recent advances in the understanding of grief theory include the dual-process model developed by Margaret Stroebe and Henk Schut.5 While previous models focused on stages and phases of grieving, the dual-process model recognizes a dynamic in which the bereaved individual alternates between focusing on the loss--with all the associated reactions and responses--and avoiding focusing on the loss in order to cope with the stresses and practical requirements of everyday life.

In the dual-process model, it is recognized that both expressing and controlling emotion have value for the individual who is dealing with loss. The bereaved person is able to "take time off" from the intensity of emotional response to the loss in order to deal with the life changes brought about by the loss. For example, someone who has lost a loved one might still need to care for young children in the family, so will set aside her or his own feelings in order to attend to the needs of others. This person may also take a break from the intensity of emotion through other self-care measures that can include nutrition, rest, exercise, massage, and/or social interaction.

The Cycle of Grief
How individuals respond to loss depends on many factors, including their personal belief systems, their social and cultural conditioning, and the personal coping skills and support systems they have in place at the time of the loss. While people experience grief in many individual ways, there are general patterns of physical and emotional responses that frequently occur after a loss. The Cycle of Grief, at left, is a useful image for individuals to understand their own responses to loss. For massage therapists and those supporting people in times of bereavement, it is also a helpful way to understand the psychosocial experiences of their clients, as they move from the initial reactions to loss through a myriad of possible reactions and emotions, toward a healthy adaptation to change.

Shock and Protest
The first phase following a loss is characterized by shock and protest. In the initial hours, days, or weeks following a loss, the individual may experience numbness or actively protest the reality of the loss. Some people may be cheerfully present at the funeral of a loved one, only to be hit emotionally by the awareness of the loss later. It is common to function out of habit or act automatically just to get through this unfamiliar and often difficult time. Denial is a way that many people protect themselves from the painful reality of their new circumstance.

The bereaved may feel anxiety and fear. They may be afraid of the unknown in their lives now as a result of the loss, and feel confused about the next steps to take. Sadness, loneliness, and intense yearning for whom or what was lost are common experiences. The bereaved individual may also experience relief if, for example, the death of a loved one occurred after a long and painful illness. Joy may be felt where death is believed to be a release into a freer or happier state of being. Other kinds of loss can bring a feeling of relief, because the uncertainty of waiting has ended.

Another common reaction is anger, which may be a feeling of frustration directed toward oneself or others. Guilt may be present for some, as often occurs when death is by accident or suicide, and the survivors wonder what they could have done to prevent it. Regret is another feeling that surfaces when the bereaved individual wishes she or he had made different choices earlier in her or his life.

Physical reactions and symptoms may include insomnia, crying, muscle weakness, nausea, and/or loss of appetite. Some people experience difficulty breathing. Grief can be experienced as physical pain and has been described in many ways: dull, aching, stinging, biting, sharp, pressure, contracted, or constricted. Any or all of these reactions are normal parts of grieving. Just as people are individual in how they respond to everyday stresses and challenges of life, so will they respond in different ways to loss. Some feelings or reactions may be fleeting. Others will be of persistent intensity.

The helpful massage therapist or bodyworker best serves grieving individuals by allowing them to be present with their feelings. It is not necessary to diagnose bereaved people or judge their process; it is most respectful to simply be present and listen, acknowledging the significance of their experiences. If the client seems to be exhibiting reactions or behaviors outside of a normal range, it is wise to refer her or him for further evaluation and/or counseling with a mental health professional.

Disorganization
The next stage in the cycle of grief is characterized by disorganization. The loss has occurred and the initial shock has begun to wear off, but now the individual is left to cope with a reality that is different. Life is not organized the way it was
before. The sense of disorganization occurs on different levels.

Disorganization often involves practical concerns, which may include financial and legal issues. Mentally, the individual can feel disoriented and overwhelmed with decisions to make. Sometimes even the simplest decision seems to take an inordinate amount of energy. Individuals may experience forgetfulness, or in some cases, become obsessive in their behavior, thinking, or feeling. Emotionally, some feelings may persist or intensify from the first phase; others shift and change. The range of emotions that might be felt during this time includes anger, sadness, depression, despair, anguish, and low self-esteem. Physical exhaustion tends to intensify many of these feelings.

Socially, the person who is grieving may feel detached, withdrawn, apathetic, or antisocial. Some people may feel needy and afraid to be alone. Disorganization also occurs within the family or social network of the bereaved individual. Differences in the way people communicate and deal with loss within their social groups may vary, contributing added pressures and distress to the individual.

Periods of grief are difficult times for people. In its intensity, grieving may last for several weeks or months, sometimes years. Whereas people often have the support of family and friends soon after a loss, they are often alone in their grief as time goes on. Typically, our culture does not give people time to grieve. Furthermore, it is not customary to talk about our most significant losses or share our feelings with the people we work with or interact with socially. Without adequate support during this time, bereaved people feel further alienation and the added burden of suffering their grief alone. In this time, nurturing massage and bodywork can provide much needed support, providing a steady and nurturing presence.

Reorganization
With time, the acute pain of loss begins to subside, and the bereaved individual begins to reorganize her or his life. Painful emotions carry over into this phase, but the intensity or duration of the feeling is usually less than in the previous phases. One begins to accept or understand that the loss is permanent, and begins to adapt to a new life, integrating the reality of the changes into present life.

The process of reorganization involves changes and adaptations on many levels. When the loss involves the death of a loved one, the survivor learns to reorganize her or his life physically, emotionally, and mentally without the presence of that special person. When the loss involves illness or disability, the person learns to adjust their physical surroundings, lifestyle, and health care to the current situation.

Loss of one kind--either of person, place, or quality of life--involves changes in other activities and relationships. For example, persons who are injured in a debilitating accident may find it difficult or impossible to participate in once-enjoyable activities such as hiking or skiing. As they reorganize their lives, they might find other activities they enjoy that are less physically demanding. Or if they regularly participated in activities with a loved one who has now left or died, they can adapt by finding other people with whom to enjoy social activities.

Reorganization and adaptation also involve an appreciation of the pleasant and/or valued memories of the past, while accepting the reality of the present circumstance. It becomes easier to celebrate and remember the past without feeling intense sadness. Many people learn the value of compassion, while opening to new possibilities for social connection with others who have suffered similar losses.

As bereaved individuals adapt to the change, they may begin to feel improved self-esteem and mental clarity. It becomes easier to make decisions and engage with others socially. Physical exhaustion gives way to renewed energy and confidence. During this time, therapeutic massage can continue to support the individual who is adapting to change. As a massage therapist, you can appreciate and validate the client for the steps she or he is taking to reorganize their lives.

Variables In The Expression Of Grief
While the grief cycle is portrayed here as one phase that occurs after another, it is not really a fixed process, either in length of time, intensity, or sequence of emotional expression. The cycle shows the range of experience of people going through the normal process of grieving. Not only do people vary in their responses to loss, they may respond differently to different losses. Multiple losses complicate the picture. A person may be in one phase with one loss and in another phase with another loss. Or the experience of one loss may trigger unresolved feelings from a prior loss. Individuals may think they have come through the cycle only to experience an upsurge of anguished feelings, sometimes around an anniversary, birthday, or holiday.

Adaptation To Change
As the individual moves through the process of grieving, she or he may realize that loss is neither good nor bad, right nor wrong. Change and loss are inevitable aspects of the human experience. The pain of loss may never fully go away, but individuals are empowered as they learn to adapt to change. Helen Keller said, "What we have once enjoyed we can never lose. All we love deeply becomes a part of us." Her words illustrate the concept of healthy adaptation to change and loss. It is our role and privilege as massage and bodywork professionals to provide a safe, open-hearted, nonjudgmental, and reassuring atmosphere to the bereaved individual.

Mary Kathleen Rose, BA, CMT, is an authority in holistic health education and is internationally known as the developer of Comfort Touch nurturing acupressure. An ardent advocate for the needs of the elderly and the ill, she provides training and support for massage in medical settings. Her understanding of the bereavement process developed as she facilitated hospice grief and loss support groups. She can be reached at 303-651-9375 and www.comforttouch.com.

Notes
1. Sigmund Freud, Mourning and Melancholia, The Complete Psychological Works of Sigmund Freud, 8th ed. (London: Vintage, 2001).

2. Elizabeth Kubler-Ross, On Death and Dying (New York: Touchstone, 1969).

3. J. Bowlby, Attachment and Loss: Loss, Sadness, and Depression, vol. 3. (New York: Basic Books, 1980).

4. C.M. Parkes, Bereavement: Studies of Grief in Adult Life (New York: International University Press, 1972).

5. M. Stroebe and H. Schut, "The Dual Process Model of Coping with Bereavement: Rationale and Description." Death Studies (April-May 1999): 197-224.