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SM as reducing symptoms of stress and anxiety, insomnia and joint/muscle pain (Bost & Wallis 2006; Cowen et al. 2005). A clear large, moderate or small change from baseline was found in favour of TM, with clear differences in effect from SM. Although some outcomes were similar, MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT 23 TM treatments also resulted in more invigorating and energising response, improvement in mental focus, improved flexibility/posture and psychological stimulation outcomes. TM also had longer-lasting effects, with a contribution to carry-over effects when preceding or following SM. A secondary outcome showed three participants citing TM as either life-changing or stimulating positivity (see Figure 3 and Supplementary Materials B: 1608 Diary Codes & Themes): “I suspect we’re dealing with parts of my musculature that have been tense for years without any chance of being into any form of relaxation. There’s something amazing happening.” The literature on TM supports these findings: Keeratitanout et al. (2015) cite TM as increasing flexibility and decreasing muscle tension. One of the aims of Thai general massage is to restore energetic balance by helping to remove blockages and bring balance to the body, mind and spirit. TM induces relaxation and stress relief, although in some recipients this effect may exceed the here-and-now presenting symptoms to actually access and release longer term emotional holding patterns and blockages (Banpasirichote 1989; Chaithaouthi & Muangsiri 2007). Conclusion This study found that six weekly massages (three of TM and three of SM) addressed fatigue or low energy by releasing stress, promoting relaxation and relieving muscular aches and pains. A weekly massage allowed time for the participant to relax and recover from stressful life routines and provided physical and mental benefits - a holistic (mind/body) effect - enabling better coping with adverse life events and subsequent stress. TM actively addressed fatigue by MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT 24 inducing an energising, rejuvenating and mentally stimulating/motivating effect; SM addressed fatigue through alleviation of stress and promotion of relaxation. As the benefits of TM and SM are both biological and psychological, it is recommended that further research into massage therapy considers the psychosocialphysics perspective as important as the biomedical model. With results showing energising effects for TM, other recommendations would include an exploratory randomised trial to further consider this outcome without the confounding factor of SM in the crossover trial.

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