levels. Converging data may suggest a potential underlying mechanism for the massage therapy-weight gain relationship. Uvnas-Moberg, Widstrom, Marchini, and Windberg (1987) reported that stimulating the inside of the mouth of the newborn led to the increased release of gastrointestinal food absorption hormones, including gastrin and insulin. Field et al. (1982) reported that sucking on a pacifier during gavage feedings led to significantly greater weight gain in preterm infants. Stimulating the entire body, as in massage therapy, leads to increased vagal activity and insulin levels (Field, 1995) as well as increased weight gain (Field et al., 1986). The "vegetative" branch of the vagus is known to stimulate the release of food absorption hormones including insulin and gastrin (Uvnas-Moberg et al., 1987). The massaged infants in the above studies did not eat more food and did 1272 December 1998 • American Psychologist not sleep more, so they were not simply consuming or conserving more calories. Rather, the weight gain seems to have been mediated by an increase in vagal activity, which in turn facilitated the release of food absorption hormones (at least insulin). The superior habituation performance (an index of newborn memory) noted at the neonatal period and superior performance on the mental scale of the Bayley Scales for Infant Development at one year (also related to infant memory skills) may derive from enhanced hippocampal development. As noted earlier, Meaney et al. (1990) tracked a relationship between increased glucocorticoids, decreased dendritic arborization in the hippocampal region, and inferior maze performance, suggesting impaired memory function in the aging rats that had been deprived of tactile stimulation as rat pups. Similarly, the more elaborate dendritic arborization noted in MRIs of the hippocampal region in massaged preterm neonates by Modi and Glover (1995) may be related to the superior memory performance noted in the massaged newborns and their performance again at one year of age. Pregnancy Massage Preterm delivery may result from pregnancy anxiety, depression, and related obstetric complications. Because anxiety, depression, and related stress hormones can be decreased by massage therapy, as has been noted in many studies (see section on alleviating stress, depression, and anxiety), massage therapy was expected to have similar effects on pregnant women. In many countries pregnant women are massaged several times daily for relaxation and to reduce their anxiety levels (Older, 1982). In a recent study pregnant women who were massaged versus pregnant women who experienced relaxation therapy reported lower anxiety and depression, and had lower stress hormone levels (cortisol and norepinephrine; HernandezReif, Field, Hart, et al., in press). The massaged women experienced less sleep disturbance and less pregnancy pain (lower back and leg pains), and fewer obstetric and postnatal complications including lower prematurity rates. Pain Reduction During Painful Procedures Childbirth Labor In this study significant others of pregnant women were taught to massage the women during childbirth versus a control group, who received the standard breathing coaching throughout labor (Field, Hernandez-Reif, Taylor, et al., 1997). The massaged women had lower anxiety and depression scores, decreased cortisol levels, less need for medication, shorter labor, fewer days in the hospital, and less postpartum depression. In current research we are assessing the possibility that massage therapy stimulates oxytocin, which in turn could facilitate labor progression. Studies are needed to monitor the fetal response to the mother's reduced pain and decreased time in labor as well as the neonatal outcome. Massage Therapy Prior to Debridement for Burn Patients Massage therapy has also been used to reduce anticipatory anxiety prior to debridement (skin brushing for severe burns) and to indirectly alleviate pain during that procedure (Field, Peck, et al., 1998). After a five-day course of 30-minute massages prior to debridement, burn patients had lower anxiety levels and associated decreases in stress hormones (cortisol). Depression also decreased by Day 5, probably because of the decrease in pain. Postoperative Pain An equivalent-groups design with a treatment group of 19 patients and a control group of 20 patients was used to investigate the impact of massage therapy on patients' perceptions of postoperative pain (Nixon, Teschendorff, Finney, & Karnilowicz, 1997). Controlling for age, the results indicated that massage produced a significant reduction in patients' perception of pain over a 24-hour period. Reducing Pain in Chronic Pain Conditions Juvenile Rheumatoid Arthritis Chronic pain is a problem for children with juvenile rheumatoid arthritis. Antiinflammatory agents used for their pain have ceiling effects, and other drugs such as narcotics cannot be used due to their potentially addictive effects. Thus, massage therapy is being assessed for its usefulness for pain relief. In a study in which parents provided their children daily massages, several positive effects were noted (Field, Hernandez-Reif, Seligman, et al., 1997). The massaged children (versus the control children who received progressive muscle relaxation) experienced (a) decreased anxiety and