Sooner or later, you probably will encounter a patient who experiences anxiety related to their acupuncture treatment. You may already have encountered a patient like this. Perhaps the patient never returned due to fear or increased stress. However, an acupuncturist's primary tool (the needle) may not be the main reason that patients scurry away. Sometimes, it might have to do with the approach. A gentle approach to acupuncture treatment can significantly reduce a patient's anxiety, and incorporating massage therapy into your practice can help.

We must respect our patients' anxiety. If a patient believes their treatment experience was too harsh, they probably will not return, regardless of whether the overall impact was positive or negative. When we, as clinicians, are met with resistance, it's important to let the patient lead the way. A patient may use words such as "jitters," "apprehension" or "stress" to describe their current emotional state. These yellow flags may be your key to adjust gears before you have to go into reverse.

Physical symptoms of anxiety include twitching, muscle tension, sweating, dry mouth, difficulty swallowing and abdominal pain (which also may be the only symptom of stress, especially in children). In the treatment room, we may identify other symptoms that accompany anxiety. They include, but are not limited to: dizziness, rapid breathing, and rapid or irregular heart rate.

The approach I am outlining to help decrease anxiety includes a brief massage that is easy for anyone to perform. One does not have to be trained in massage and bodywork to significantly reduce a patient's anxiety before continuing a successful acupuncture treatment plan. An anxiety-reducing massage takes fewer than five minutes to complete. The focus, especially for an acupuncturist not a trained massage therapist, consists of a gentle soothing touch rather than a specific massage technique.

• Place the patient in the supine position during the massage. This gives patients greater comfort on the first visit because it allows them to open their eyes and assess their surroundings.
   
  
• Begin by communicating in a voice that is comforting to the patient. Be sure your tone is not patronizing. It can easily be mistaken.
  
  
• Start by applying gentle massage to the angle of the neck (mid-trapezius region).
  
  
• Gently massage the posterior aspect of the neck near the spinous processes. Then spend some time at the base of the occiput. At this point, you might notice the patient relaxing, sinking into the table and giving you their trust.
  
  
• Ascend to the tempomandibular joint and end at the temples.
  
  
• Before completing the massage treatment, assess the patient's breathing to see if it has slowed and then palpate for softening of the soft tissues.
  
  
• Once the patient is in a state of relaxation, begin the acupuncture treatment.

Massage is known to reduce cortisol levels. Therefore, it eliminates stress and anxiety. If, as an acupuncturist, you find the application of massage is too time-consuming, a constructive alternative is to add a trained massage and bodywork professional to your practice.