organization Associated Bodywork and Massage Professionals (2019), a national consumer survey conducted by Harstad Strategic Research (a leading public survey firm), found that in 2018 only 18% of American adults used CIM in the form of massage therapy. The primary reason offered by 38% of respondents for not utilizing massage services was the expense (ABMP National Consumer Survey, 2019). With numerous barriers to its success, assimilating CIM into behavioral healthcare can be challenging. Doing so involves significant research demonstrating its efficacy and contribution to positive patient outcomes. Successful integration also involves education of the mental health MASSAGE THERAPY 10 practitioner regarding CIM, networking with local CIM providers, making appropriate referrals, and client education (Tusaie & Fitzpatrick, 2017). Massage Therapy The form of CIM known as massage therapy, which falls under the umbrella term of touch therapy, is a promising addition to patient care as there has been research showing positive patient outcomes through its implementation including stress reduction, pain relief, increased relaxation and reduction of anxiety and depression (Tusaie & Fitzpatrick, 2017). Massage therapy can either be taught to healthcare staff through the institution of a training program, or it can be offered through the employment of licensed massage therapy providers. Massage therapy can also be taught to clients who can learn to perform self-massage in situations where they are unable to access such treatments from a licensed professional. In a 2018 national survey of massage therapy providers, it was found that self-massage was the most commonly shared health promotion topic between massage therapists and clients. In addition, the highest proportion of referrals made by massage therapists was for mental health services (Munk, 2019). The survey findings highlight the pertinence of self-massage education for mental health clients due to the direct correlation between those seeking massage services and high referral rate to mental healthcare providers. Organizational "Gap" Analysis of Project Site In order to screen for the above mentioned gaps in clinical practice, a NEEDS assessment was performed within a psychiatric private practice in Massachusetts (see Appendix A for gap analysis). The client population ranged across the lifespan, but for the purpose of this DNP Project, the adult population was the focus. A PROCEED approach was utilized. The first stage of this approach was in assessing the wants and needs of this particular community for MASSAGE THERAPY 11 improving overall quality of life. These wants and needs were examined retrospectively through anecdotal evidence ascertained by the practice psychiatrist and through discussions by the psychiatrist with clients on the topic (K. Mallory, personal communication, November 14, 2019). Through these interactions it was determined that significant numbers of clients within the practice feel that complementary and integrative modalities would be a beneficial component of their psychiatric care. Of particular interest were the modalities of energy work and body work (including massage therapy). Clients were largely drawn to CIM due to the high levels of stress that they continuously face. Understanding that stress is a major risk factor in the development of illness, both physical and mental, and that the evidence supports the stress-reducing benefits of CIM (Tusaie & Fitzpatrick, 2016), we see how CIM can help to fulfill the gap in clients' care. In addition, outside findings have shown that 43% of those with anxiety disorders and 53% of those with depression already utilize one or more forms of CIM treatment (Lake & Turner, 2017), and it would therefore be prudent to incorporate such treatments into the psychiatric care setting. Through this assessment, objectives for care were outlined as follows: 1) address the gap in care by incorporating CIM into the psychiatric clinical setting through client/provider education; 2) increase massage therapy accessibility and utilization in the outpatient psychiatric setting by providing education on performing self-massage. Review of the Literature A search of the literature regarding the use of CIM to address mental health conditions was conducted using the following databases: CINAHL Complete, APA PsychInfo, and Academic Search Premier. The following term combinations were used within all three databases: "massage" and "anxiety," "massage" and "depression," "touch" and "anxiety" and "touch" and "depression." Inclusion criteria included full text, peer reviewed journals only, MASSAGE THERAPY 12 published in English, and those that were published between the years 2000 and 2020." The searches amongst all three databases yielded a total of 886 results. These results were reviewed for their subject matter as a variety of research was yielded, including much on the use of massage therapy for pain and for cancer patients. Articles that most clearly focused on anxiety and depression as primarily psychological issues and not as a symptom of a physiological condition were selected. Articles reflecting the results on outcomes for specific diagnoses such as cancer, heart disease, and end stage renal disease were excluded, as were those that focused on a modality for a