limited knowledge regarding CIM and its MASSAGE THERAPY 7 efficacy to reduce symptoms and improve overall quality of life. The DNP capstone project translated the evidence supporting one form of CIM, massage therapy, in the care of individuals with depression and anxiety through the creation of an educational module for psychiatric clients and providers. Background Anxiety and Depression To better understand the importance of improving psychiatric care practices surrounding treatment of anxiety and depression, it is necessary to discuss how significant these disorders have become as health issues within our society. The World Health Organization (2016) shows that between the years 1990 and 2013, the number of individuals worldwide with symptoms of depression and/or anxiety increased by almost 50% from 416 million to 615 million with costs to the global economy of over $1 trillion yearly. Most recently these numbers have increased further due to the Coronavirus disease (COVID-19) pandemic and its global impact on patients and the healthcare system (Druss, 2020). The current health pandemic lends itself to heightened levels of worry, which can worsen current levels of depression and anxiety, and as Druss (2020) states, psychiatric patients need effective care now more than ever. Anxiety can manifest and present in a variety of ways and comprise multiple mental health diagnoses, such as Generalized Anxiety Disorder (APA, 2013). According to Perese (2012), anxiety disorders are a major source of distress and impaired functioning and are associated with heightened levels of morbidity and mortality. Those suffering from anxiety can encounter difficulties in relationships, work, school and other important areas as they often encounter difficulties in carrying out normal tasks (APA, 2013). The National Alliance on Mental Illness (2017a) indicates that 40 million or 19.1% of adults in the United States have an MASSAGE THERAPY 8 anxiety disorder. Total direct medical expenditures related to anxiety were estimated to be $33.71 billion dollars in 2013 and continue to rise (Shirneshan, 2013). Depression, the other mental health disorder addressed here, is the primary cause of disability for those aged 15 to 44 within the United States (Kessler, 2012). It can often occur concurrently with anxiety and rivals its burden with detrimental effects on society, family and the individual. These effects include impaired functioning, decreased quality of life, loss of income, detrimental marital effects, impaired child development, and increased use of medical services (Tusaie & Fitzpatrick, 2017). As of 2017 over 17 million adults in the United States had experienced at least one depressive episode in the past year (National Alliance on Mental Illness, 2017c). The American Psychological Association indicates that in 2013 the cost of treating depressive disorders within the United States totaled 71 billion dollars, making depression the 6th most costly health condition after diabetes mellitus, ischemic heart disease, low back and neck pain, hypertension, and injuries due to falls (Winerman, 2017). Complementary and Integrative Modalities Clearly, anxiety and depression are paramount issues deserving of comprehensive treatment. Lake and Turner (2017) identify the necessity of a collaborative care model that incorporates complementary modalities into the overall patient plan of care. They state that those with mental health diagnoses who use CIM "feel strongly that such nonpharmacologic treatments improve their physical, emotional, cognitive, social, and spiritual functioning; reduce the severity of their symptoms; and enhance overall wellness" (Lake & Turner, 2017, p. 19). Complementary and integrative modalities, which include laying on of hands, massage therapy, hypnosis, aromatherapy, acupuncture, reflexology, prayer, Emotional Freedom Technique (EFT), Thought Field Therapy (TFT) and guided imagery, have demonstrated benefit in the treatment of MASSAGE THERAPY 9 psychiatric symptoms and are more likely to be utilized by those with psychiatric disorders than by those with other diseases (Mamtani & Cimino, 2002). The numbers of those utilizing complementary and integrative modalities along with conventional treatment has increased over the past several years (National Alliance on Mental Illness, 2017b). Given that CIM users personally find such interventions beneficial to their mental health and overall wellness, incorporation of CIM into the care plan should be a fair consideration. However, CIM has been given little credit within allopathic medicine. This is due in part to multiple misconceptions that surround the use of CIM, such as CIM are anecdotal or lacking in evidence. Other misconceptions regarding CIM include the beliefs that not many people utilize CIM practices, that CIM practices are only utilized if conventional modalities are ineffective, and that CIM is itself largely ineffective (Tusaie & Fitzpatrick, 2017). These incorrect assumptions regarding CIM prevent their integration into the mental health care setting. In addition to these misconceptions surrounding CIM, there are additional factors that affect its utilization, such as inaccessibility. Contributing to this is lack of affordability, as many CIM treatments such as massage therapy come with a significant cost that is not covered by insurance. According to the