[Shiatsu: A complementary medicine for the relief and verbalization of trauma]

Abstract

Objectives: In child and adolescent psychiatry, symptoms such as aggressive behaviors directed against others or self, anxiety, impulsivity, oppositional behaviors, sleep disorders, and impairments in emotional regulation or social interaction can resist conventional therapies, particularly in children with autism spectrum disorder and/or intellectual disability, early childhood trauma, or attachment disorders. Among complementary medicine, yoga and mindfulness meditation, which are relatively well documented, provide interesting avenues especially for emotional control in adolescents or any individuals with oppositional behaviors, anxiety, impulsivity or hyperactivity in males with attention deficit/hyperactivity disorder. Less well known is shiatsu, a Japanese medicine based on traditional Chinese medicine using deep pressure on the paths of the acupuncture meridians. Clinical observations and rare studies on this topic were encouraging, especially for the treatment of sleep and conduct disorders, but there is a lack of empirical data. The objective of this study was to examine better the possible therapeutic effects of shiatsu in a clinical population of children treated in child and adolescent psychiatry.

Methods: The present research, a qualitative descriptive and non-interventional study, was conducted on children treated in daycare hospital units and outpatient clinical settings. Shiatsu was administered, at least during 3 sessions, to children with autism spectrum disorder or other disorders according to ICD-11 criteria (such as conduct disorders with impulsivity or attention deficit). The evaluation was performed by two independent researchers (a child psychiatrist and a psychologist who were not the caregivers) based on a direct observation of children during the shiatsu sessions, combined with semi-structured non-inductive interviews with their parents, and data collected from focus groups conducted with the children's caregivers. A phenomenological interpretive analysis (IPA) approach with Nvivo coding software was used to analyze the data.

Results: Based on semi-structured interviews with 13 parents cross-referenced with data from 2 focus groups and direct observations of 7 children during 2 full shiatsu sessions for each observation, the results show that shiatsu has positive effects on internal tension (a relief effect, notably on aggressive behaviors directed against others or self), sleep (including improvement of sleep quality), social interaction, attention, verbalization of affects and verbalization of traumatic memories of early childhood, as well as on the perception of bodily limits. As these children benefit from several treatments, it cannot be proved that the positive effects observed in this study are related specifically to shiatsu practice in a effect-cause relationship. Shiatsu may participate and facilitate the effects of other treatments. It is noteworthy that most of the children came willingly to the shiatsu sessions, ask their parents to repeat the shiatsu sessions at home, and indicate to the practitioner, from one session to the next, their elective body points where they wish to receive the application of shiatsu.

Conclusions: The findings suggest therapeutic benefits of shiatsu, especially on externalize violence with a relief of aggressive behavior directed against others or self (knowing, moreover, that internal tension, sleep disorders and non-verbalization of affects or traumatic memories, all improved by shiatsu, are also all risk factors for externalize violence). These results highlight, therefore, the need to develop a daily practice of shiatsu in child and adolescent psychiatry. Further research is required to clarify the effects of shiatsu and ascertain better its underlying mechanisms based on this exploratory pilot study.

Keywords: Apaisement; Child; Conduite auto-/hétéro-agressive; Enfant; Relief; Self-/other aggressive behavior; Shiatsu; Violence.