Mental Health is a very serious global concern! As a health care provider, I have seen my patients anxious, scared, confused, tearful, depressed, and sometimes in sheer panic with debilitating anxiety and pain. As they express these emotions, they look for a glimmer of hope and look up to me with the trust that I as their provider will be able to “fix” all their concerns. I have felt the immense burden they carry and many times their emotions cross over and affect me too.

At that moment, the only thought racing through my mind was how could I decrease their physical and psychological distress to help them “feel better.” How could I decrease the burden they carry not just physically, but mentally and emotionally, and how could I empower them with the tools and strategies to build both physical and mental resilience?

The American Physical Therapy Association (APTA) supports interprofessional collaboration at the organizational and individual levels to promote research, education, policy, and practice in behavioral and mental health to enhance the overall health and well-being of society consistent with APTA’s vision. Physical, behavioral, and mental health are inseparably interconnected with overall health and well-being. It is within the professional scope of physical therapist practice to screen for and address behavioral and mental health conditions in patients, clients, and populations. This includes appropriate consultation, referral, or co-management with licensed health services providers in the prevention and management of behavioral and mental health conditions (1) through its position statement HOD P06-20-40-10.

The APTA also endorses evidence-based complementary and integrative interventions (HOD P06-18-17-47) underscores the importance of incorporating Integrative medicine practices within physical therapy. At the State level, as a member of the American Physical Therapy Association of New Jersey (2), I have been actively involved in Co-Charing the new Integrative Physical Therapy (IPT) Special Interest Group. IPT blends traditional physical therapy methods with holistic practices that address the whole person—physically, mentally, emotionally, and spiritually. This initiative aims to enrich therapists' capabilities in delivering Integrative Physical Therapy by leveraging a variety of methodologies, including Yoga, Mindfulness, Tai Chi, Hydrotherapy, Acupuncture, Acupressure, Zero Balancing, Reiki, Nutrition and Energy medicine to name a few.

According to the National Center of Complementary & Integrative Health (NCCIH), a branch of the National Institutes of Health (NIH), Mental health problems are common. In the United States, they affect about one-fourth of adults in any given year. According to the World Health Organization, mental illnesses account for more disability in developed countries than any other group of illnesses. Anxiety and mood disorders are the most common mental health problems. Researchers are investigating complementary and integrative health approaches for a variety of mental health problems, including anxiety & depression (3).

Anxiety disorders are one of the most common mental health concerns with a major contribution to the global burden of disease. Pharmacology and psychotherapy stand for the conventional treatment for anxiety disorders but these present limited efficacy, especially in the case of chronic anxiety, with high relapse rates often causing adverse side effects (4).

Anxiety is a natural part of the human experience, often serving as a protective mechanism in response to potential threats. However, when symptoms become chronic, disproportionate, or uncontrollable, anxiety can escalate into a clinical disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), anxiety disorders vary in presenting symptoms and may include excessive worry, panic attacks, restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances. Beyond these distressing psychological and emotional disturbances, the sequelae of anxiety extend into the realm of physical health. Research has pointed to a correlation between anxiety and increased pain responses, as well as the exacerbation of musculoskeletal disorders (5).

Anxiety disorders have profound implications on both mental and physical health.
There is growing interest in manual therapy modalities, with emerging research to alleviate related symptoms (5). A systematic review by West et al (2024) found that individuals receiving manual therapy interventions displayed a statistically significant reduction in anxiety intensity. The use of Acupressure for Anxiety is a common practice in Integrative Medicine, and the literature supports Acupressure as an effective and feasible alternative treatment for decreasing anxiety. A systematic review and meta-analysis published by He et al. (2019) found moderate evidence that Acupuncture and/or Acupressure was significantly associated with reduced cancer pain and decreased use of analgesics.

Acupressure is part of Traditional Chinese medicine (TCM), which is a comprehensive science that studies human health and disease. A central relational element of TCM is Yin and Yang, which refer to opposites, mutually exclusive yet complementary substances within the human body and the outside world. Based on the theory of the balance of Yin and Yang and the interaction of five elements (五行) (metal, wood, water, fire, and earth), TCM analyzes changes in the five Zang organs (五脏) (liver, heart, spleen, lung, and kidney), six Fu organs (六腑) (gallbladder, stomach, large intestine, small intestine, bladder, and triple energizer), extraordinary Fu-organs (奇恒之腑) (brain, marrow, bone, pulse, gallbladder, uterus, and ovary), meridians (the channels of basic substances transportation and connecting inside and outside of the human body), and qi-blood-body fluid (the basic substances constituting and maintaining the human life activities) (6).

A recent study by Yang et al (2021) cited several key Acupressure points that can help with Anxiety & fatigue (Heart 7, Spleen 6), chemotherapy-induced nausea, vomiting and anxiety in women with breast cancer ( Pericardium 6), primary dysmenorrhea ( Liver 3 ), anxiety & pain in cancer patients (Large Intestine 4, Heart 7), pre-operative cesarean section anxiety (Yintang EX-HN 3 and Heart 7), anxiety from the anticipation of surgery or treatment (Yintang EX-HN3, Heart 7 & Pericardium 6).

The literature also provides robust scientific evidence supporting Acupressure as an effective non-pharmacological therapy for the management of a host of conditions such as insomnia, chronic pelvic pain, dysmenorrhea, infertility, constipation, digestive disturbances, and urinary dysfunctions to name a few.

Case Study
Clinically, our ability to target the nervous system to make a change in a patient’s pain and anxiety is extremely valuable from a pain neuroscience perspective. Recently a patient in her early 60s walked into the clinic with high anxiety and rectal pain rated 15/10. She reported that she spoke to her best friend and her friend who had found relief for anxiety with urinary retention with Acupressure had urged her to see me. She said, “I have tried everything, and you are my last hope!”

This patient had been to the ER twice over a span of 3 months and had undergone extensive testing with no diagnostic pathology. The only position she could find relief was in a side-lying but she was so distressed at the thought of “spending the rest of my life on the couch” that she refused to lie down in that position during the day, even if it meant relief from her excruciating pain.

The first thing I taught her was to notice how shallow her breath was, and how to use her breath deeply and actively to decrease her pain and anxiety by using two key Acupressure points Central Vessel 17 (CV 17), located at the center of her chest and Yintang EX-HN3, located between the eyebrows. CV17 is known to be a point for emotional healing while Yintang (EX-HN 3) is known to have a mentally stabilizing effect in Traditional Chinese Medicine (TCM). Within a few minutes, the patient felt very calm and relaxed and felt that she now had some control over her symptoms.

She was now able to focus and actively listen to me as I explained to her that we needed to work not just on the physical body, but also the mental, emotional, and energy body. I guided her to accept the “positional preference” of her body and “align” herself mentally and physically with what makes her “feel better.” So instead of feeling bad every time she thought about lying down to decrease her pain, I taught her to feel empowered that she had one position that she could use to break the cycle of her pain. This shift in how she approached her pain, as well as the potent Acupressure points to alleviate pain and anxiety, were a tremendous relief to her. I sent her home with a breathwork practice, a pelvic girdle stretching program, and an Acupressure program that targeted key Acupoints for self-regulation. The patient returned the next visit and reported that her pain was down from 15/10 to 5/10.

Over the course of the next few visits, using a combination of Acupressure as a self-regulation tool, targeted stretching of the lower back & pelvic girdle musculature, manual therapy, self-care, and breath work and awareness, this patient gained complete control over her anxiety and pain. She felt much calmer and empowered to have a physical self-regulation Acupressure practice which she could use to improve both her physical and mental health.

As a holistic pelvic health practitioner, who is psychologically informed with an Integrative physical therapy clinical practice, I recognize the deep-rooted mind-body connections and the need to address the “whole” person. In all the ancient and modern Energy healing practices, the breath is the key to working with the physical, mental, emotional, and the energy body. Acupressure is a powerful evidence-based energy healing practice that can be combined with breathing to heal the body in multiple dimensions. When a patient can “breathe better” and “feel better,” they can be steered easily towards building both physical and mental resilience.

As healthcare providers, we share this mental and emotional burden with our patients, and we must empower them with the tools and strategies to live healthy pain-free and anxiety-free lives.

To learn more about Acupressure, please join us for the upcoming remote course Acupressure for Optimal Pelvic Health scheduled for Feb 1st & 2nd. The course will introduce course participants to the basics of Traditional Chinese Medicine (TCM), Acupuncture & Acupressure. Of the 12 major Meridians or energy channels, this course will focus on the Bladder, Kidney, Stomach, and Spleen meridians. In addition, there are other important Meridian points that stimulate the nervous system and can be used for self-regulation to manage Anxiety, pain, and a host of other symptoms. The course also offers two potent Acupressure home exercise and wellness programs.

This course explores Yin yoga as a powerful holistic practice with Acupressure and will offer an evidence-based perspective on how Yin poses within each meridian can channelize energy through neurodynamic pathways with powerful integrative applications to facilitate healing in multiple dimensions.

References

1. The Role of the Physical Therapist and the American Physical Therapy Association in Behavioral and Mental Health: Position statement https://www.apta.org/apta-and-you/leadership-and-governance/policies/role-pt-apta-behavioral-mental-health
2. American Physical Therapy Association of New Jersey: Integrative Physical Therapy Special Interest Group https://aptanj.org/page/IPTSIG
3. National Center of Complementary & Integrative Health (NCCIH) https://www.nccih.nih.gov/health/anxiety-and-complementary-health-approaches
4. Amorim D, Amado J, Brito I, et al. Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research. Complement Ther Clin Pract. 2018;31:31-37. doi:10.1016/j.ctcp.2018.01.008
5. West KL, Huzij T. A systematic review of manual therapy modalities and anxiety. J Osteopath Med. 2024;124(11):487-497. Published 2024 Jun 24. doi:10.1515/jom-2024-0001
6. Yang J, Do A, Mallory MJ, Wahner-Roedler DL, Chon TY, Bauer BA. Acupressure: An Effective and Feasible Alternative Treatment for Anxiety During the COVID-19 Pandemic. Glob Adv Health Med. 2021;10:21649561211058076. Published 2021 Dec 12. doi:10.1177/21649561211058076
7. He Y, Guo X, May BH, et al. Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain: A Systematic Review and Meta-Analysis. JAMA Oncol. 2020;6(2):271-278. doi:10.1001/jamaoncol.2019.5233
8. Zhang SQ, Li JC. An introduction to traditional Chinese medicine, including acupuncture Anat Rec (Hoboken). 2021;304(11):2359-2364. doi:10.1002/ar.24782
9. Abbott R, Hui EK, Kao L, et al. Randomized Controlled Trial of Acupressure for Perception of Stress and Health-Related Quality of Life Among Health Care Providers During the COVID-19 Pandemic: The Self-Acupressure for Stress (SAS) Trial. Am J Med Open. 2023;10:100056. doi:10.1016/j.ajmo.2023.100056
10. Chen SR, Hou WH, Lai JN, Kwong JSW, Lin PC. Effects of Acupressure on Anxiety: A Systematic Review and Meta-Analysis. J Integr Complement Med. 2022;28(1):25-35. doi:10.1089/jicm.2020.0256
11. Monson E, Arney D, Benham B, et al. Beyond Pills: Acupressure Impact on Self-Rated Pain and Anxiety Scores. J Altern Complement Med. 2019;25(5):517-521.

Author Bio
Rachna Mehta PT, DPT, CIMT, OCS, PRPC, RYT 200

Rachna Mehta PT, DPT, CIMT, OCS, PRPC, RYT 200 (she/her) graduated from Columbia University, New York with a Doctor of Physical Therapy degree. Rachna has since been working in outpatient hospital and private practice settings with a dual focus on Orthopedics and Pelvic Health. She was instrumental in starting one of the first Women’s Health Programs in an outpatient orthopedic clinic setting in Mercer County, New Jersey in 2009. She has authored articles on pelvic health for many publications. She is a Certified Integrated Manual Therapist through Great Lakes Seminars, is Board-certified in Orthopedics, is a certified Pelvic Rehab Practitioner, and is also a registered yoga teacher through Yoga Alliance. Rachna has trained in both Hatha Yoga and Yin Yoga traditions and brings the essence of Yoga to her clinical practice.

Rachna currently practices in an outpatient setting. Her clinical practice has focused on an Integrative physical therapy approach blending traditional physical therapy methods with holistic practices that address the whole person - physically, mentally, emotionally, and spiritually. She specializes in working with pelvic health patients who have bowel and bladder issues with high pelvic pain which sparked her interest in Eastern holistic healing traditions and complementary medicine. She has spent many hours training in holistic healing workshops with teachers based worldwide. She is a member of the American Physical Therapy Association and a member of APTA’s Academy of Orthopaedic Physical Therapy and the Academy of Pelvic Health Physical Therapy.

Rachna also owns TeachPhysio, a PT education and management consulting company. Her course Acupressure for Optimal Pelvic Health brings a unique evidence-based approach and explores complementary medicine as a powerful tool for holistic management of the individual as a whole focusing on the physical, emotional, and energy body.

This week The Pelvic Rehab Report sat down with faculty member Ken McGee, PT, DPT. Ken (they/he) is a queer transmasculine pelvic health physical therapist based in Seattle whose mission is to bring greater awareness to the pelvic health needs of the LGBTQIA2S community. Their practice, B3 Physical Therapy, centers on transgender and perinatal rehabilitation. Ken also provides peer bodyfeeding support and doula care, and can be found on Instagram at @b3ptcob3ptco.

You can join Ken in their remote course, Perinatal Mental Health: The Role of the Pelvic Rehab Therapist, scheduled for October 22, 2022.

Who are you? Describe your clinical practice.
Experiencing inadequate care for my own pelvic health conditions as a teenager motivated me to become a pelvic health physical therapist. Being a member of the queer community further drove me to offer trauma-informed care and develop better access to care through home visits. Currently, I split my time between providing gender-affirming physical therapy and serving as a birth doula.

What lesson have you learned (in a course, from an instructor, or from a colleague or mentor) that has stayed with you?
Very few clients will remember detailed biomechanical explanations or every exercise you teach them. However, each client will remember how you treated them and how you made them feel. Asking clients about their preferences for care and following up go a long way in establishing rapport.

What do you find is the most useful resource for your practice?
One of my favorite resources is Decolonizing Fitness. It is an educational platform by Ilya Parker, PTA, (he/they). It provides a catalog of exercises and trainings for people looking to improve their care of gender-diverse people and People of Global Majority.

What books or articles have impacted you as a clinician?
The healthcare field regularly puts people in boxes to determine care. For example, many providers might determine care based on whether someone is a transgender woman or man. However, gender is actually someone’s individual experience rather than a category. Kate Bornstein’s My New Gender Workbook is a good starting point for understanding gender as uniquely one’s own, rather than part of a treatment algorithm.

What made you want to create this course, Perinatal Mental Health?
I wanted to create this course because, as a parent and physical therapist, I see both the challenges that the perinatal period presents, as well as the ways that rehabilitation providers can support mental health. In developing the content, I drew upon my background as a volunteer for a perinatal mental health warm line.

What need does your course fill in the field of pelvic rehabilitation?
Pelvic rehabilitation providers regularly interact with people who have mental health challenges. However, there are very few courses that specifically address the needs of the pelvic health providers serving folks in the perinatal period. This course looks at perinatal mental health from the perspective of pelvic rehabilitation providers, while offering specific actions providers can take to support their clients.

Who, what demographic, would benefit from your course?
Rehabilitation providers of any experience level would benefit from taking this course. Providers who are new parents or considering becoming pregnant may also find the content personally enriching. While the research discussed in this course focused on the perinatal period, much of it can be extrapolated to other populations.

What is your message to course participants who are just starting their journey?
For people just starting in pelvic rehabilitation, I would recommend focusing on patient education. For me, I find that the greatest amount of client improvement comes through reviewing the basics. It’s okay to still be developing skills in manual therapy.

Perinatal Mental Health: The Role of the Pelvic Rehab Therapist

Price: $150

Contact Hours: 5.75

Course Date: October 22, 2022

Description: This one-day remote course covers mental health considerations in pregnancy and postpartum and is targeted to the pelvic rehab clinician treating patients in the peripartum period. Topics include common mental health concerns in the postpartum period including depression, anxiety, OCD, and PTSD, as well as the connectedness between mental health and physical dysfunction. The course will introduce useful screening tools and how to connect patients to resources and diagnosing professionals. Labs will include partnered breakout sessions to practice listening and dialogue skills. The course also includes a review of coping techniques to support mental health and physical symptoms.

Katie McGee, PT, DPT, (they/them) is a pelvic health physical therapist based in Seattle. Katie received their Doctor of Physical Therapy from the University of Washington in 2014 and their board certification as a Women’s Health Clinic Specialist (WCS) in 2018. Their practice, B3 Physical Therapy, centers on transgender care and perinatal rehabilitation. Join H&W and Katie to learn about perinatal mental health in Perinatal Mental Health: The Role of Pelvic Rehab Therapist - Remote Course scheduled for February 5, 2022. 

Due to the COVID-19 pandemic, rates of perinatal mental health conditions—such as anxiety and posttraumatic stress disorder—have risen sharply1. Around 70% of pregnant people are now reporting psychological distress1. With many families under increased stress and financial worry, the odds of developing postpartum depression have jumped from one in seven to one in five(1)!

Fortunately, pelvic rehabilitation therapists can make a difference in the mental health of their perinatal clients. In fact, many pelvic rehab therapists are reducing the risk of perinatal mental health issues without even knowing it! Simply supporting clients in keeping up with physical activity and reducing bodily pain are proven strategies for lowering the risk of perinatal mental health issues (2,3). Pelvic rehab providers can go even further in supporting their perinatal clients’ mental health with some simple actions:

1. Ask – Many birthing people feel shame around negative feelings and thoughts related to pregnancy and postpartum. Asking perinatal clients about their emotional challenges can help break through that shame. A good ice breaker for talking about perinatal mental health is letting your clients know that a mood disorder is the number one complication of pregnancy. Be sure to listen attentively and avoid interruption whenever someone discloses their mental health challenges.

2.Screen – Screening for mental health conditions can guide pelvic rehab therapists to know when it’s time to refer clients to specialized care, such as medication and/or therapy. Pelvic rehab therapists are qualified to use several screening tools in the perinatal period, including the Edinburgh Postnatal Depression Scale, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7. Best of all, these tests are free to use and easy to administer.

3. Gather resources – When a client discloses that they have thoughts of self-harm or are experiencing violence in their home, you want to be prepared with the next steps to help. Collecting resources ahead of time can go a long way in turning what would have been a fumbling offer to help into a confident action plan. Looking to grow your resource list? Check out these three links:

• Perinatal Mental Health Resources: https://www.postpartum.net/
• Intimate Partner Violence Resources: https://www.rainn.org/
• Substance Use Resources: https://www.samhsa.gov/

4. Connect – Racism leads to People of the Global Majority birthing in the United States to experience increased rates of preterm birth and low infant birth weights (4). Both these outcomes have been tied to worse postpartum mental health (5). Research shows that when People of the Global Majority are connected to culturally congruent birth doulas, rates of preterm birth and low infant birth weights fall (6). Other research similarly supports the concept that when people are paired with culturally congruent providers, health outcomes improve (7). Whenever possible, think about how you can offer your clients resources/referrals that match their identity and background to support their mental wellbeing.

5. Learn – Join Katie McGee, PT, DPT (they/them) for the Herman & Wallace course, Perinatal Mental Health: The Role of Pelvic Rehab Therapist - Remote Course scheduled for February 5, 2022. By participating in this remote learning class, you will:

• Develop a basic understanding of perinatal mood and anxiety disorders
• Bolster your listening skills for working with perinatal clients
• Gain additional tips for screening for perinatal mental health issues
• Learn how to help clients create perinatal wellness plans
• Expand your toolbox of coping skills to teach clients

Don’t miss this opportunity to truly change the lives of your perinatal clients!

References

1. Yan H, Ding Y, Guo W. Mental Health of Pregnant and Postpartum Women During the Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis. Front Psychol. 2020;11:617001.
2. Mathur VA, Nyman T, Nanavaty N, George N, Brooker RJ. Trajectories of pain during pregnancy predict symptoms of postpartum depression. Pain Rep. 2021;6(2):e933.
3. Marconcin P, Peralta M, Gouveia ÉR, et al. Effects of Exercise during Pregnancy on Postpartum Depression: A Systematic Review of Meta-Analyses. Biology (Basel). 2021;10(12):1331.
4. Andrasfay T, Goldman N. Intergenerational Change in Birthweight: Effects of Foreign-born Status and Race/Ethnicity. Epidemiology. 2020;31(5):649-58.
5. Anderson C, Cacola P. Implications of Preterm Birth for Maternal Mental Health and Infant Development. MCN Am J Matern Child Nurs. 2017;42(2):108-14.
6. Thomas MP, Ammann G, Brazier E, Noyes P, Maybank A. Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population. Matern Child Health J. 2017;21(Suppl 1):59-64.
7. Towning EJ, Purohit A. Black babies cared for by black doctors less likely to die in the US: revolutionize medical education to tackle the problem in the UK. BMJ. 2020;370:m3783.