ASMR and Massage Therapy: A Talk with Dr. Giulia Poerio

In this episode I speak with Dr. Giulia Poerio, an ASMR specialist from the University of Essex. The discussion revolves around the concept of ASMR (Autonomous Sensory Meridian Response), its triggers, physiological effects, and potential therapeutic applications, particularly in the context of manual therapy and massage. 

Some Key points discussed include: 
-Definition and explanation of ASMR, a tingling sensation triggered by certain stimuli like whispering, soft speaking, tapping, and gentle touch. 
- Comparison of ASMR with frisson (emotional chills) and the differences in their physiological responses. 
- The potential role of ASMR in pain relief and stress reduction, with some research suggesting temporary relief from chronic pain and reduced heart rate comparable to mindfulness practices.
- The tactile aspect of ASMR, which is often overlooked in research, and its relevance for manual therapists and massage practitioners. 
- The concept of ASMR as a spectrum, with varying levels of sensitivity and potential connections to conditions like ADHD, autism, and sensory processing disorders. 
- Strategies for incorporating ASMR techniques into massage sessions, such as creating a calming environment, explaining procedures, and using appropriate touch techniques. - The potential benefits of ASMR for individuals who may be touch-deprived or unable to receive physical touch, such as older adults or during the COVID-19 pandemic. 

Overall, the discussion explores the potential therapeutic applications of ASMR, particularly in the context of manual therapy and massage, while acknowledging the need for further research and empirical evidence.

The awesome as well as the awful: Heightened sensory sensitivity predicts the presence and intensity of Autonomous Sensory Meridian Response (ASMR) (Link at the bottom of the page)

Transcript

Summary

The meeting record transcript is a conversation between the host and Dr. Giulia Poerio, an ASMR specialist from the University of Essex. The discussion revolves around the concept of ASMR (Autonomous Sensory Meridian Response), its triggers, physiological effects, and potential therapeutic applications, particularly in the context of manual therapy and massage. Key points discussed include: - Definition and explanation of ASMR, a tingling sensation triggered by certain stimuli like whispering, soft speaking, tapping, and gentle touch. - Comparison of ASMR with frisson (emotional chills) and the differences in their physiological responses. - The potential role of ASMR in pain relief and stress reduction, with some research suggesting temporary relief from chronic pain and reduced heart rate comparable to mindfulness practices. - The tactile aspect of ASMR, which is often overlooked in research, and its relevance for manual therapists and massage practitioners. - The concept of ASMR as a spectrum, with varying levels of sensitivity and potential connections to conditions like ADHD, autism, and sensory processing disorders. - Strategies for incorporating ASMR techniques into massage sessions, such as creating a calming environment, explaining procedures, and using appropriate touch techniques. - The potential benefits of ASMR for individuals who may be touch-deprived or unable to receive physical touch, such as older adults or during the COVID-19 pandemic. Overall, the discussion explores the potential therapeutic applications of ASMR, particularly in the context of manual therapy and massage, while acknowledging the need for further research and empirical evidence.

Chapters

Introduction to ASMR

The conversation begins with an introduction to ASMR (Autonomous Sensory Meridian Response), a pseudoscientific term coined in 2010 to describe a tingling sensation that some people experience, often triggered by stimuli like whispering, soft speaking, tapping, and gentle touch. The sensation starts at the crown of the head and can spread throughout the body, providing a relaxing and tingly feeling similar to a head massage.

Comparison with Frisson

The discussion explores the differences between ASMR and frisson (emotional chills), which is often associated with goosebumps or piloerection (hair standing on end) in response to complex emotional experiences like listening to music or feeling strong emotions like awe or admiration. While frisson is an activating response with increased heart rate, ASMR is described as a deactivating and relaxing state with decreased heart rate.

Potential Therapeutic Applications

The conversation delves into the potential therapeutic applications of ASMR, particularly in the context of pain relief and stress reduction. Some research suggests that ASMR may provide temporary relief from chronic pain and reduced stress for up to 3-5 hours after experiencing an ASMR response. The physiological effects of ASMR, such as reduced heart rate, are compared to interventions like mindfulness and music therapy.

Tactile Aspect of ASMR

The discussion highlights the importance of the tactile aspect of ASMR, which is often overlooked in research due to the focus on auditory and visual triggers in online ASMR videos. For manual therapists and massage practitioners, the tactile component is particularly relevant, and the conversation explores strategies for incorporating ASMR techniques into massage sessions, such as using appropriate touch techniques, creating a calming environment, and explaining procedures.

ASMR as a Spectrum

The concept of ASMR as a spectrum is discussed, with varying levels of sensitivity and potential connections to conditions like ADHD, autism, and sensory processing disorders. The idea of using ASMR techniques to either calm or invigorate clients based on their individual needs is explored, as well as the potential for personalized ASMR experiences tailored to each client.

Benefits for Touch-Deprived Individuals

The conversation touches on the potential benefits of ASMR for individuals who may be touch-deprived or unable to receive physical touch, such as older adults or during the COVID-19 pandemic. The idea of using ASMR as a substitute for actual touch is discussed, with the potential to provide some of the benefits of social touch without physical contact.

Action Items

1. Explore the potential of incorporating ASMR techniques into massage sessions, such as creating a calming environment, explaining procedures, and using appropriate touch techniques.
2. Investigate the potential therapeutic applications of ASMR, particularly in the context of pain relief and stress reduction, and stay updated on emerging research in this area.
3. Consider the concept of ASMR as a spectrum and the potential connections to conditions like ADHD, autism, and sensory processing disorders, and adapt treatment approaches accordingly.
4. Examine the potential benefits of ASMR for individuals who may be touch-deprived or unable to receive physical touch, and explore ways to provide these benefits through ASMR experiences.
5. Collaborate with researchers to conduct empirical studies on the physiological and psychological effects of ASMR, particularly in therapeutic settings, to gather more evidence-based data.

Transcript

Hello, everyone, and welcome to another podcast of the sensory approach to manual therapy. Hello, I'm here with Dr. Julia Porio from whose lecture at the University of Essex in England, and who is an ASMR specialist, which is what I want to talk about. 

And I had the wonderful fortune to speak with her back in August, and we had a great two hour conversation that was literally born out of nothing that made my brain just go a million miles an hour. And so I just want to touch base again with that. 

And I had a couple more questions and highlight a few things specifically in regards to the tactile stimulus with ASMR. So the first question I would have for you is, can you explain to my listeners who don't know what ASMR, what ASMR is? 

Yeah, so it's the term stands for autonomous sensory meridian response. And it is a pseudoscientific term that was coined back in 2010 by Jennifer Allen to describe a particular kind of feeling that some people experience. 

So the feeling itself starts as a sort of tingling sensation at the crown of the head. It can spread down throughout the rest of the body. It's a little bit like getting a head massage or using one of those head massager tools. 

It's very relaxing, tingly, sparkly kind of feeling. And it is triggered or listed in some people by a common set of what are called triggers. And these include things like whispering, soft speaking, tapping and also more commonly touch or soft touch is a big trigger for ASMR. 

People often forget that touch is an ASMR trigger because they watch ASMR videos online. mine. And these videos kind of tend to simulate scenarios or sounds that would be triggering for your ASMR in real life. 

That's actually something I want to, I have it as a question to talk about later on, which is when people speak about ASMR right now, and even the research papers that we're reading, they all hyper focus on auditory and visual. 

Yeah. When, if I remember correctly from our previous talk, tactile is the number one stimulus trigger. And yet, I think possibly in research it's just that it's easier to put on a video and it's the same. 

There's no variability. Touch is never variant, different, different human things like that. But for us as manual therapists, which the majority of my listeners are, that's really what the focus is is tactile, although visual and auditory play into it as well. 

So the next question is oftentimes I read about a flow state with ASMR and there's some I don't know if it's debate or just theory on what considers a flow state and how it assists an ASMR reaction. Do you mind talking about that a little bit? 

Yes. I think, I mean, it depends how you define flow. And obviously there are different kind of experiences of flight, but often it is kind of characterizing a way of you're doing an activity or you're engaged in something and you are very immersed in it. 

You're very absorbed by the activity that seem to be kind of time distortion. So time would slow down or you're not really aware of time passing. And that seems to be common across a lot of different kinds of activities. 

So reading, for example, is something that people experience a lot of flow with. They might be reading like a novel and get very absorbed in the content. Now, one of the things that maybe differentiates the ASMR state from the flow state is that in the flow state, it's often described as being about something that is a little bit more challenging, but not so challenging that it's too difficult to do. 

So people would get really absorbed in work, let's say that is kind of within their comfort zone, maybe slightly outside in terms of intellectual cognitive challenge or similar with like horse riding or something like that, depending on your skill level. 

And that seems to be quite key to the flow state is that it's kind of sits at that boundary of being quite challenging, whereas with ASMR is actually very passive. But there are some characteristics of ASMR that make it kind of similar to flow like state. 

So the fact that it's a very absorbing experience and there does seem to be a sense in which time is passing very quickly or you lose sense of yourself because you become very immersed in it. So it was originally likened to a flow like state. 

But what I would just say is that it's actually just a very absorbing state and people become very immersed in it, almost kind of hypnotized or it's a kind of trance -like state. But that can be the same for when you're watching a really immersive film or you're playing a video game, so it's that kind of immersion in an experience and that makes it flow -like but not necessarily the same as flow because it doesn't meet some of those criteria. 

Okay and then one of the other things that I've come across a lot in the lecture and then also what we spoke about was the variant or the difference between what an ASMR response would be versus a free zone response would be and I know that many humans have experienced free zone and if you want to just talk about that for a second but then also how it differentiates is if it's simply intensity, if it's location, if it's trigger, things like that. 

Yeah, I mean, so frisson probably encompasses many different kinds of kind of complex emotional experiences and it often involves goosebumps or pyloerection so where the hairs stand on end. And it's an emotional response so normally you know, you know, animals and even in humans we usually kind of hair stand on end for things like you know fear response or to regulate temperature and things like that but as humans, we do seem to be able to experience emotional pyloerection and so things like, you know, listening to a piece of music might cause kind of the hairs on your arms to stand up or on the back of your neck. 

And similarly, there are kind of other complex emotional experiences that triggered goosebumps. So a more recent example of a very interesting emotion is something called karma mutta, which is, have you heard of this? 

Yes, I don't know that we spoke about. And it's a, it's a Sanskrit term for being moved by love and it's associated with kind of communal sharing kindness and things like that. And it's, people often will often get it they get it and they kind of might be moved to tears they might experience goosebumps is a very kind of complex social feeling. 

And so that is also associated with goosebumps or frisson. So there are lots of different kinds of emotional experiences so things like or music induced chills, karma mutta, lots of different kinds of things that will elicit this kind of goosebumps or frisson type response. 

Those wouldn't be considered ASMR. Yeah, so those wouldn't be considered ASMR for a number of reasons. I mean, first, we're not quite clear whether ASMR is associated with vital erection. Some people anecdotally have said that it is but often it's not considered to be associated with hair something at the end. 

The other thing is the location of the felt sensation. So, it's, it's different. described as a tingling sensation that's very relaxing, kind of warming. And the location of that is very specific. So it is kind of predominantly around the head spreading down throughout the rest of the body. 

Whereas things like music induced chills tend to occur mainly on the arms and the legs, at least according to some research studies. The other thing that seems to be very characteristic of ASMR and not so much of a frizzon is the fact that it's a deactivating stage. 

So it's relaxing. Whereas often in things like music induced chills, what you'll see is an increase in heart rate. So you'll get in this kind of activation. Whereas in ASMR, we see a decrease in heart rate. 

So it seems to have this kind of distinct physiological and kind of experiential profile that distinguishes it from frizzon. So it's similar, but different. Has there been any connection between people who experience ASMR and how easily or frequently they experience free song, is there an uptake in the percentage? 

Yeah, so there is a relationship, so I can't remember who did it off the top of my head, but there is a study that shows that if you are somebody that experiences ASMR you are more likely to experience free song as well. 

So these kind of aesthetic experiences tend to co -occur. I ask, because I know we mentioned this last time, but I myself experience ASMR, and I get free song very frequently, like even while you were speaking about the Karmamuta, I was experiencing it slightly on my arms, and especially when I listened to Beethoven, Ode to Joy, specifically when the choir starts, and even if I hear choirs at like Midnight Mass, they won't go anymore, or just like people singing, even sometimes Adele, like very specific music, and I'll get the free songs. 

But the ASMR stuff for me, I used to get, and it's the most common talked about tactile is lice checks, like when I was in school is when I started noticing it, and it's funny because when I mentioned that to other people who are asking me about ASMR, and I say lice check, they'll like have a light bulb go off, and then I asked them if they still experience it, and they say they no longer can remember experiencing that emotion or that sensation, even if they get a scalp massage, and the other one for me is back scratching, like if I have an option between going to get a massage versus a back scratch from my kids, even I will choose the back scratch every time because I find the benefits are actually quite lasting. 

And that that's actually one of the things I wanted to talk about, which is especially for massage therapists is ASMR and pain. So there's some research showing that ASMR has an uptake in oxytocin, and that there's temporary relief around pain from about three to five hours. 

And I think it was Haskett Allen who did that paper, I can't remember. But they were talking about how for people who have depression or anxiety, they have about a a three to five hour window post -ASMR videos where they feel a decrease in stress, and that they similarly for people who have chronic pain, not acute pain, but chronic pain, they have about a three to five hour window of diminishing discomfort. 

And I wanted to know if you've heard any more around that or any more research around that, because that's the part that really excites me as a therapist. Yeah, so it's really interesting that you talk about that. 

And I don't know how much I'm allowed to say because some research is confidential until it's published, but there will be something coming out, not from me, but from another group around ASMR and pain. 

So there is certainly research being done in this area. I think the research that you're mentioning is lacking somewhat because it's just based on self -report data, so it's not actually objective. are people, you know, they're not measuring pain through more objective methods. 

It's just a, and when you watch ASMR videos, do you experience relief from pain and how long did that last? Yeah, the paper was quite poorly done, but it was the best available at the time. Yeah, yeah, I mean, it's such a new area, but at least anecdotally, yes, I think there is, you know, an association between, you know, ASMR and lots of benefits, including pain relief, but they're probably likely to be some good research coming out, suggesting that that might be the case, which is really interesting. 

And we've also just had a paper that's just been published looking at ASMR and sensory sensitivity. So we kind of have found quite reliably that people who experience ASMR and people who experience ASMR with a greater intensity are more sensitive to sensory stimulation. 

We haven't specifically looked at the tactile modality, which is something that we're now doing. And I've got a research project that's just launched looking at tactile sensitivity in ASMR, but there is this kind of idea that maybe there might be sensory sensitivity issues. 

That might inadvertently make people who experience ASMR also more sensitive to pain. So they might have lower pain tolerance. But that's actually really interesting because like I teach a lot around chronic pain and one of the things that we teach a lot about is the sensitivity aspect and the dyskinesia and the anesthesia and things like that. 

And I myself have ADHD. And ADHD is similar to a lot of other sensitivity things as a spectrum. You can have it severely, mildly, and in different manifestations of it. And touch sensitivity or stimulus sensitivity is another one of those things that lives on a spectrum. 

You have people who can't handle fuzzy sensations. You have others who really need prickly sensations. And if ASMR, I know we talked about this later. back in August that I was going to bring it up later, but it seems like the perfect time, which is the potential idea that ASMR is a spectrum. 

And if we're getting ASMR responses in people who have this touch sensitivity, well, touch sensitivity is on a spectrum. People with hyperactivity disorders, or even people who are on the autistic spectrum, a lot of these people live in that sensitivity discomfort range. 

And so are we seeing an uptake in ASMR responses in individuals who are experiencing things like, for example, autism, or people who are bipolar, people who have ADHD, do we see a higher frequency? So we don't have data on that. 

So I don't know in terms of the numbers. at least anecdotally speaking. So I'm in contact with a few ASMR content creators who are quite famous in the fields. They've got like millions of subscribers. 

And it's really interesting because they have a greater insight into the kinds of, you know, what people are using their content for. And because people message them all the time and say, you know, I'm using this. 

And ASMR and autism comes up again and again. And people tend to say that it could be kind of a form of stimming to help with kind of, you know, repetitive type behaviors to relax and soothe and things like that. 

And that is one of the requirements for an ASMR trigger is often soothing and repetitive. Yeah. Yeah. So it is, you know, somehow is tapping into that. So, you know, a lot of people think about sensory sensitivity as being a negative thing. 

And this is one of the things that I find kind of interesting because as you say, it's related to things like autism, ADHD, you know, heightened sensory sensitivity is usually considered to be a kind of a characteristic across diagnostic kind of thing that is common to many crime crime disorders. 

But that doesn't mean that there are also positive aspects to being sensitive because actually you need, you can get benefit from it. So the paper that we just published is called the awesome as well as the awful. 

Because the idea is that heightened sensory sensitivity isn't necessarily a negative thing. And actually might mean that you can experience really positive, complex things like ASMR. I'll take a copy of that paper if ever you have a moment. 

Yeah, of course. Yeah. I just got a cruise through today. And I mean, I think there was a guy who talked about this. I think the term in psychology is neurodiversity, where a long time ago, you know, it was taking individuals who have these special needs and saying, adapt them into society. 

And now the concept is know how can they fit, what are their neurosis, what are their traits, what are their personality benefits that this quote unquote, symptom or diagnosis. gives them that would actually really enhance their abilities. 

And I think it's gotten to the point where like Starbucks and Walmart actually have a higher employment rate of people with Trismy 2100 or Down's syndromes because they find that if you engage with somebody with Down's syndromes for five minutes, you as the individual engaging with them have an uptake in oxytocin and dopamine. 

So like it puts you in a better mood. So they're doing it financially to find a way to increase customer satisfaction, but it's also employing someone and giving them the ability to live a very wonderful life. 

So I think that neurodiversity might play in here in regards to sensory sensitivity and the ASMR responses because like I'm with my ADHD, I use it as a benefit. There are downsides, which is it's hard for me to play one -on -one with my girls, my family, but the upside is I could cook, I can clean, I can take care of the house. 

Well, my wife gets to do that one -on -one stuff because I get a multitask. she gets to do the focus behavior. You know, sorry, do you experience hyper focus as well as as part of your ADHD? Right now I'm helping a friend house and I'm doing all the timing in their house. 

And I will sit down and I'll tile for for I think I did 37 hours in three days. And I didn't really even notice the time. Yeah, sure. My body was achy and sore, but hyper focus. And it's the same as like when I'm studying for ASMR, like when I spoke to you in August, and we had that talk, I had heard of ASMR on like a Tuesday. 

On the Thursday I reached out to you. And we spoke a week later. And in that meantime, I had read easily as many research papers as you could find on ASMR and become quite familiar with the concept just because the hyper focus. 

And that happens as well a lot with ADHD. But again, it's one of the perps, even though it's often just seen as a negative. But that gets me thinking about touch. And the ASMR response, because if they're sensory sensitive to things like touch, one of the courses I teach is the sensory approach to manual therapy. 

And it's about no longer using the musculoskeletal system as the primary tool to treat clients and patients, but using the sensory system as the dominant force, and as the guide. So if somebody comes in with, for example, torticalis, and I treat them like every other individual, and yet they're touch sensitive, I need to be going lighter based on their need. 

And I need to treat them for less, I can't treat them for 60 minutes, because in that, like for me, when somebody massages my neck, if they're on my neck for more than five minutes, I get very aggressive. 

And so I try to use the sensory system, which is why the ASMR stuff interests me because it's one more research tool to justify manual therapists adapting their future treatment methods to say, stop thinking about the body as a muscle system in a skeleton, think of it as a sensory system that guides muscle behavior. 

And so one of the things we talked about last time was when we get these ASMR response through tactile stimulus. There's the personalized tension. There were a few terms that you had used that I found really interesting that are almost automatically replicated in a massage therapy environment. 

And can you speak about that a little bit? Yeah, I can't remember exactly what the things were, but I can try and social touch. That is more about kind of slow velocity movement in certain directions. 

So hair stroking is often a very common ASMR trigger and in particular direction and also kind of back. as stroking or tickling and then you've also got the kind of close personal attention element which isn't necessarily tactile but it does often at least make you feel like you might anticipate being touched so often it will be people coming very close to you or paying particular attention to a part of your body or an aspect of your face or something like that so the attention isn't necessarily on you so it's not about you as a person it's about maybe some aspect of you and I think that's one of the elements that is very kind of ASMR eliciting it's somebody you know paying very particular attention to like your nail or something you know the minute detail I'm really taking a lot of care and attention and being very gentle and comforting and nurturing and that's really what ASMR kind of is I think. 

There was that and then there was the personal not personalized attention but the focus on someone without attachment the depersonalizing of the individual yeah so yeah so I think this is you know that a really common the types of scenarios that tend to elicit ASMR appear to be ones in which there is a figure of kind of authority or trust so there's an element of kind of you're in the safe hands of somebody although somebody is in an area of expertise and I think that's another thing we're exploring in research is how ASMR is related to trust so often this might happen in a situation where you know you're going to the hairdresser's and you really trust that that person is going to do a job or some a doctor is doing a kind of a cranial nerve exam you see this all over YouTube ASMR kind of illustrations of cranial nerve exams and there's this kind of idea that you know they're not they are doing their job and you're in safe hands and you trust this person and therefore you might allow a to come very close to you and in a situation where you know normally it would be very strange if somebody you didn't know was coming very close to you so there's that element of needing to trust and being able to trust because that person has expertise in a professional capacity. 

So that personalized the tension and then the ability to trust somebody but without attachment really encourage the environment for an ASMR response. But that leads us into another subject which is not everybody gets an ASMR response which I want to brush up on in one second but you've mentioned something a second ago around tactile stimulus where the direction mattered. 

And I have a theory and this is new information for me. So I'm interested in seeing if this theory is correct. Now there's a group that studied a research paper back in 2010 at the Hayes group. And it was a paper that talked about how when you stroke the skin with less than three grams of pressure from proximal to distal with the nervous system meaning from the brain weight. 

you engage a parasympathetic system response. And if you stroke towards the brain, you engage a sympathetic response. Now, my theory from what you just said would be that an ASMR response is triggered when the stroking away from the brain and not towards the brain. 

But I don't know if that's what you're, when you mentioned the direction, is that the correct direction? I think, I mean, so this is not based on evidence, although it is something that I think we really need to explore because actually when we, so if we're doing in the lab, we're trying to simulate social touch, we will do simulation at certain velocity and pressure and from proximal to distal. 

That's just the way that you do it. And we haven't, we don't normally do the other way, right? And if you think about the way that the ASMR response itself travels, it's traveling, sort of. So there seems to be that the direction is important. 

So I think that I would agree with your intuition and your hypothesis here that somehow the direction is important, but I think we should test it. It's interesting, there was the study that I was speaking about was a group of neonates who had cancer. 

So under six months old in cancer. And so they couldn't be touched. And in the first group, they found that the death rate was a hundred percent, which was obviously very unfortunate, but they realized that in the first six months of life, they were fed, they had water, they had oxygen and they had waste removal, but they were all in incubators and not touched. 

And then when this similar group happened in another country, they're like, well, we can't do the same thing. Obviously we don't want that to occur. And so they added touch, but because they were going through cancer treatment and under six months, they had no immune system. 

And so they found one parent that could only do 15 minutes of touch, just the hand in the incubator. And they found that when the parents, obviously when the baby smelled the parent, they got excited. 

And when the parents stroke the skin towards the head, the child would get even more anxious. And because they were sorry, so weak and so out of immune compromise, that they were like, yeah. have to calm your baby down with touch. 

And so then they found that if you stroked away, it calmed the baby down. Now, obviously they're not redoing these studies, you know, it's a very unethical study to be doing on a six -month -old, but it was just interesting to see that response. 

And in massage, we're often taught, you know, sometimes our strokes do go up to the brain, but if you lay down for any typical massage, the majority of treatments go down the spine and it's almost to engage that trust. 

I wonder whether, and this is maybe not so much about the direction in relation to the brain or, you know, but actually about the direction of the hair. And I think maybe this is, it's actually maybe we need to understand also more about the skin and hair. 

So for me, I have often wondered whether, and this is just speculation, but I find it really intriguing and I've just discussed it with colleagues, whether the reason why it's happening. at here is because you have a higher concentration of hair follicles and that's why you're getting it there and you know we'd have to do a survey to see if people who are hairy or have higher responses well so this is this is something that i've thought about is that you know actually is that is that the case like because i'm quite hairy and i've often you know like do i you know do i am i getting some benefit out of being really hairy in this in because i get chills a lot for example and you just you know it yeah well warm but you know in terms of emotionally i get the you know you spoke about you get goosebumps and stuff a lot of the time i do as well and i you know i wonder whether it is affected by things like let's say if you shave your legs or you somehow kind of disable the ability for your you know hairs function in a similar way but like that's interesting because evolutionary wise as well our hair has multiple purposes there's a great teacher john zwaranek in denver who talks about how you know one of the benefits of hair is not only that it's for warmth but it was a protective mechanism you felt something invading your space prior to it being a threat that's that's interesting as well yeah and then the other thing that's interesting is when you stroke children and you're trying to put them to bed it's very rare that you'll stroke a baby like this up and down their spine you almost always lift your hand off the body and stroke down to try to help them to sleep it's very rare that you see them either going up towards the brain or back and forth so that's interesting as well thanks same with animals when you think about it as well think about you you don't you know brush or maybe you do sometimes but you wouldn't brush the you wouldn't stroke a dog the opposite way to work the way their hair's going right so and if you do it to a cat they don't like you yeah um so then i did have um another interesting thought about the idea that of the spectrum because for me that to me is still real where the future of ASMR stuff is going to go. 

For those who don't receive a response, I believe it's only, is it 35% who receive ASMR? Yeah, so we don't actually have like a definitive population estimate. I think it depends on who you speak to about this. 

I think in one study that was just done on undergraduate students in the UK, there was just under half people said that they experienced ASMR. I think that's an overestimation. So around 20 to 30 probably be in the ballpark, but we don't know yet. 

And then you can experience it. Like I was talking about people who go, oh, I had an experience with a lice check and I felt it, but now I no longer get it. You can get desensitized to it. And this goes back to that sensory stimulus, sensory sensitivity you were discussing, you know. 

they're thinking just of like hot sauce challenges, like you start with a ghost pepper and you're gonna burn your tongue, but by the end they're eating Carolina Reapers without any real difficulty and they train themselves into that sensory response. 

And so with ASMR, is that what's happening? You're training yourself to expect what's happening or you're training yourself to not either get the response that you used to get. Yes, I think, I mean, it's interesting that you mentioned people who have experienced it maybe in childhood, but they don't experience it now. 

I wonder how common that is actually. And it might suggest that everybody is ASMR capable and that it might be that there is something that's going on or that stopped during development or something happened. 

Or that ASMR is too vague. Yeah, or that they haven't tapped into it, or I don't know. My sense is that ASMR is something that you've probably experienced or you don't. And that if you do experience it, it can vary, but people disagree with that view. 

That's just kind of my, that's what I believe to be the case, but I don't know for sure. But in terms of what was the first, the second part of your question, I can't remember. In regards to, is it something that we can train or sensitivity to either get used to or not? 

Yeah, so for sure there's an element of habituation which happens a lot and people often call this ASMR immunity. So there was a term for it in the community, which is ASMR immunity, how do I get my tingles back? 

And often I would get email from people saying, I used to experience this a lot and then I watched ASMR videos and then I'm no longer able to experience it. And I think as you've alluded to, there's this sense of desensitization or habituation. 

And what I normally advise people to do, although not in a clinical capacity, is just to take a break from ASMR videos and stimulus and then watch something maybe a bit different. There's a component of unexpectedness to it, correct? 

Yeah. So this is the thing that I think is often really intriguing is that now often you'll see ASMR content on YouTube that doesn't seem like it's going to be very ASMR, but actually what it's doing is because it doesn't seem like all the ASMR that you've seen, it's not something that you're expecting when you click on an ASMR video, but in itself it's still triggering. 

So things like fast ASMR is now a thing, whereas before, you know, if somebody has said to me like, oh, you know, somebody speaking very quickly and repeating words lots of times will get, you know, give you brain tingles, I'd be like, no. 

And then I watched a few videos and was like, hmm. And there is that element of, there's this kind of sense in which ASMR is triggering because it violates your expectations of what might be happening. 

Does that ruin the theory, then, that ASMR is triggered in a slow, repetitive, calming? Those are some of the qualities or the guidelines that say, in order to get an ASMR response, these boxes must be checked, and now it sounds like that's not necessarily the case. 

But is that only because these people have been experiencing ASMR for so much that they're habituated to it and they need almost like an uptake in stimulus? Yeah. I mean, that's such a good question. 

I don't know that slowness is necessarily a key property. So this is the thing is that what are kind of the necessary and sufficient conditions for experiencing an ASMR, you know, getting an ASMR experience? 

And I'm not sure the repetition or slow or any of these things in isolation are the only things that make something an ASMR response. And actually, it's so complicated because it is not just about the low level kind of conceptual qualities of ASMR triggers, but it's the combination between that and kind of higher order cognitive processing, which might explain why things like fast ASMR, you know, is somehow working because, as you say, there are these people who have got very habituated to this slowness. 

They need that kind of level up. They need the higher dose of something to get the same response. That's interesting because when we talk about chronic pain and we talk about how humans develop a sensory response to chronic pain, one of the things we often talk about is our minimum level of stimulus needed to elicit a sensory response. 

And, you know, like a good example is have a cup of hot, hot, like scorching hot bathwater thrown on you and you'll think you got burned. But sit in that bath and slowly increase the temperature and you think you're relaxing and comfortable. 

And it's one of those things where the extreme version of that sensory stimulus in a non -threatening environment done slowly elicits a calming response, but quickly and suddenly is perceived as a threat. 

And it makes me wonder if ASMR people are receiving that same thing where the minimum level is no longer perceived as threat or unexpected, and therefore their response is, and I don't really care about this anymore. 

And with chronic pain, we often see that where when they experience chronic pain and then they experience it over and over and over, they develop the opposite version. Their sensory stimulus threshold consistently diminishes so that over time, less stimulus is needed to elicit a greater response to pain. 

And we actually tried to train them out of that. We tried to train them to understand that they can elicit greater stimulus before hitting the threshold of pain. So we talked a lot about like going to the limit of grimacing, which is just below that pain threshold and things like that. 

So with ASMR, potentially being a spectrum. I want to talk about that really quickly because then I want to move that from there into the idea of how to integrate ASMR into massage sessions, which is the goal for most manual therapists who are interested in this. 

If it is a spectrum, like most spectrums, on one end we'll have the low version and on the other end we'll have the high version. Now, if I were to look at skin tone disorders, like people who have high tone or low tone, things like that, and I'm not talking muscle tone, which is something we used to talk about now what we talk about is the actual skin tone and the myotone responses neurologically. 

If I'm looking at something like cerebral palsy on one end where their skin is so tight that oftentimes it's almost like a compression sleeve. It's almost like wearing a compression sock and their skin is so tight that even their muscles are hyper reactive because the sensory receptors inside the skin are pre -triggered. 

Their minimum threshold is sitting so high that the slightest breeze elicits a response. If we go to the other end of the spectrum and we look at someone like trisomy 21 or down syndromes, their skin tone is so flaccid and low. 

This is why we don't say muscle tone because people will say they have low muscle tone, but the truth is they're actually very strong. Their muscle tone when contracted is very powerful, but their skin tone is low. 

It takes a larger response to elicit a sensory system that says your muscles. This is where children with down syndromes in schoolyards are often hurt their friends by accident because they squeeze harder to elicit a response in the tactile stimulus in their skin. 

The skin says that's enough proprioceptive input, but it takes more force to elicit the appropriate response. Whereas on the other end, people with high tone will drop objects more frequently, because they're so sensitive that they grip things lighter. 

If this spectrum exists and then somebody gets a back scratch or somebody gets a deep pressure massage, massage, or light tissue massage, whatever it is, should we be modifying the type of stimulus we're offering for these individuals? 

And would the benefit be different oxytocin -wise? We brushed over very quickly, but with the responses that ASMR is giving to the brain. So you're talking about in the therapeutic context. Yeah. As a massage therapist, so I can't delve into their psychology. 

It's out of my scope of practice, but they're coming in and let's say they have pain, low back pain, neck pain. It doesn't matter what it is. And if they're coming in a pain and they're either hyperactive state or let's say depressed state, lethargic on one end and hyperactive on the other, sensory -wise as a therapist, maybe they don't get an ASMR response. 

But if it is a spectrum where we can go from ASMR to frisson, we then have to look at what's on the other end of that response. Is it anxiety or is it stress -inducing? And where should we be trying to create these responses? 

It's interesting because in terms of tactile sensitivity, my view would be that, and we have a bit of data on this, that the people with ASMR are more sensitive to tactile stimulation, particularly if it's got a positive tone. 

So a lot of it has got to do with it's not just about, you know, how sensitive you are to tactile input, but also how sensitive you are to different tactile input that has like an emotional element to it. 

So I don't know if that kind of fits with the kinds of things that you are thinking about, but certainly, at least when I think about it, there's an emotional element to touch as well. And I think that people with ASMR are particularly sensitive to that, so they might be more sensitive to picking up on whether a touch is caring or, you know, pleasant versus, you know, something quite negative. 

So they might be better able to kind of code the negative or the positive or negative emotional components of specific kinds of touch. And I'm talking about particularly kind of that slow velocity, C -fiber activating touch. 

I frequently go back to pediatric, that's one of my specialties. But even in grownups, we have these responses. But when we talk about it in a pediatric term, people just kind of accept it as, oh, yeah, that makes more sense. 

But a good example would be children who have to go to a hospital often and get heel pricks for immunity, blood samples, things like that. Sometimes they become what we call toe walkers because their heels hurt. 

So when they come into a massage therapy environment, if they feel safe and if they know the touch is going to be nice and calm and soft, they'll let the heels get touched. Whereas if they're going into the hospital, they have this pre -anxiety and threat because they know they're about to get hurt. 

And so in that example, you know, the emotional component of touch. is very much related. Now we talk in a child and everybody goes, yeah, that makes sense. But we forget that as adults, we're just big kids and our emotions are the same. 

So we still have that long, you know, maybe we walk on our heels now as a grownup, but maybe we still don't like our heels being touched. And so without it being an ASMR response, even let's say a scalp massage, giving somebody frisson, the component of touch, how much of that really triggers either the frisson, the ASMR response in relationship to their sensitivity? 

I don't know that I understand the question. So you're asking about the kind of the relationship. I mean, are you talking about the context in which the touch occurs? The context in which it occurs, so in a massage clinic, things like that, but also in regards to your clients on the table, your patients on the table, you're treating them in a therapeutic environment, they're coming in for either stress or pain or whatever it is, our touch, we should be modifying it, which most therapists will say, yes, of course you shouldn't be modifying it. 

And yet when it comes to the actual practice of modifying it, they'll often still use a lot of pressure, they'll often still do a cookie cutter treatment, they'll often still use fast movement. And what I teach in my classes is stop, slow it down, lighter touch, like I will often treat at three to 25 grams of pressure, which is for some people, it's like almost brushing your skin, it can seem annoying. 

And if you do this and you're sliding across the skin, it can get really creepy and annoying. But if you do the same thing with a whole hand and you glide the skin, but not on the skin, it almost has a confident and soft feeling. 

And so I'm more wondering when people do that type of tactile touch, which in the ASMR videos, we don't see, we hear and we see things, but the touch is not there. So with ASMR, the type of touch that's eliciting the response, is it the gliding? 

Are we looking at more of a confident touch? It's the pressure, things like that. Yeah, so I do think it is that kind of slow velocity touch that we've spoken about in terms of what you might call social affective touch, C -fiber touch, C -fiber activating touch. 

But we don't really know. I guess I think what's interesting is that even within an ASMR population, what is pleasant for one person may not be pleasant for another. And I just think that the only reliable way that you can do is just ask. 

I know that sounds really basic, isn't it? But you see it in ASMR. It's pretty common in massage. Yeah, but you see it in ASMR videos when people are simulating these sorts of things and also in normal settings. 

There's often an element of consent. Or, and is that okay checking in and and part of that helps to create this reassuring setting and which will enable you to get the kind of positive benefits from touch or other audio visual, you know, that translates into tactile like experience. 

But I think that is one of the reasons why often you know situations where there is that implied trust and safety or say a safe threat. That is kind of kind of somehow implied so you know from the moment you walk into a doctor surgery you're getting kind of these social cues about like this is a legitimate place, you know, and then you speak to the person if they're very nice like if, if, for example, in any kind of clinical setting, you felt very uncomfortable by whoever was You wouldn't find that touch pleasant in the same ways that if you've got somebody you don't like touching you, that's really unpleasant, even if they're doing it in a pleasant way. 

So it's not just about the qualities of the touch, but it's also about like who's doing the touch and why also. So that that brings me to the second part of that previous question, which is the type of touch who's offering it is important. 

But can we then, and I doubt there's research on this, so it's more of a theory. It's more just picking your brain. Can we, should we, but can we be using touch to stabilize that spectrum? So let's say somebody is coming in depressed or lethargic and we need to wake them up because they have either a job interview or they feel like they have a commitment that they have to get done. 

They need to be a little more active or let's say vice versa. We have somebody coming in scattered and hyperactive and we need to calm them down so they can be focused for a test or something like that. 

We know that touch is often talked about in Western culture, at least as especially in the industry and massage as, oh, relax and calm down. But people don't talk about massage as a benefit of potentially waking somebody up. 

And I do this all the time. I have individuals who come in like athletes. We do it in sports massage. When I used to work with my Olympic athletes, it was, it's not always a relaxing massage. You've got an event coming up. 

Guess what? We're going to wake your system up and sometimes it's your system's perfect. Let's not touch you. And so the question is in a therapeutic environment, can we be using ASMR type touch to not only call someone down, but to bring them back up and wake them up? 

Yeah. So I mean, I think it's really interesting because if you think about kind of the senses and emotion, there's nothing about a particular sense that makes it relaxing or invigorating. Right. So if you think if you replace everything that you just said, touch the word touch with like music or sound, of course, there's like music that you might listen to that will make you feel relaxed. 

And then of course there's music that you're gonna listen to that might make you feel really excited and hyped up. So there's no reason why another modality like touch or sight or smell can not produce different emotional responses, right? 

It's just about this kind of, there's a connotation or there's a link between certain kinds of touch and a certain kind of emotional response. And in some contexts that massage is usually related to relaxation, whatever. 

But as you say, there's no reason why that same modality can't be used to produce completely different emotional response, whether or not that's ASMR is another question. By that logic though, we should all should be changing the lighting, the music, our tone and the speed with which we speak all based on our client. 

And Um, that's something that I also tried to teach and it's been, it's been a very uphill battle because the majority of times when you get treatment, it's very cookie cutter. And we have, um, yeah, we have a lot of places in North America, at least where it's very cookie cutter type treatments. 

Um, and so that was, that was one of the big questions. Um, and then the last one is where as therapists who don't have the money for research, uh, you know, we're, most of us are private practice or we work in a clinic. 

Is there a way that we can be using ASMR to enhance people's massage experience? Yeah. I mean, I think that you could certainly watch, um, ASMR content to get inspiration for the kinds of things that you could do, um, to kind of enhance that experience and whether or not people, you know, experience the tingling sensation, it might still add to the overall kind of positive experience of it. 

So for example, we know that people who don't experience ASMR, they also show kind of reductions in heart rate when they watch ASMR videos, it's just not as pronounced. So there is reason to think that you might use some elements of the ASMR, um, practice, um, to kind of as a lucky, kind of almost like an add -on to what is already happening. 

And that would probably start from the very beginning, um, particularly around how you talk to somebody, um, and making it feel intimate and comfortable. And I'm sure these are things that people do without realizing that it might produce ASMR in people. 

Um, and I think this is often why, you know, I used to get ASMR if I would go, you know, and get a treatment of sorts. And actually now there are these kind of ASMR spars, which are, um, ASMR or traditional spa treatments with the addition of ASMR to kind of ramp it up a bit more and make it more multi -sensory and, um, more relaxing. 

So yeah, there are some, you could certainly watch videos and get some inspiration. Now, for people who don't have ASMR, that type of experience, let's say you're going to this spa where they're doing the ASMR focus. 

Are we seeing that in some of them it drives them crazy? Because like my wife's watched some ASMR videos and did they annoy her? Or are we seeing that in general because they're in a spa and typically think about relaxing, that they're almost always getting a relaxing experience? 

Because if we start adding ASMR to massage therapy, our goal is not necessarily to upset. And will we be getting, I mean, obviously the thing that it was asked, but hypothetically, would it be that we're going to be enhancing said experience almost across the board if you don't experience ASMR? 

Well, I think it depends on the kinds of ASMR elements that you're incorporating, of course. So, you know, there are common things which some, you know, that are common to ASMR videos that people would find very aversive in an interpersonal situation, like ear to ear whispering. 

You probably wouldn't want to kind of include that. You wouldn't want to make it feel too intimate. You know, things like eating sounds, they are not very ASMR eliciting for many people and often they can produce very angry reactions or like breathing. 

So there would probably need to be something, things that, you know, just more mindful of the whole context of the scenario and not necessarily about making an ASMR type experience, but realising what are the component parts of ASMR that make it relaxing, that includes kind of paying attention to the voice, the quality of the voice, you know, making things feel calm, speaking in a, you know, often slow way, being very delicate with your hand movements, making somebody feel like they are an individual and that you care about them. 

I think that, I mean, it sounds really silly, but feeling like you're being cared for is a key part. So if there's any way that in a massage, you feel like the person actually cares about you or an aspect of your body, I think that's helpful. 

Because I imagine people get quite a lot of, unless they have massages quite a lot, I imagine people often think about maybe what the person who's giving them the massage is thinking about them and their body or, you know, thinking, oh, gosh, I didn't do that. 

Or, oh, what if I need to go to the toilet? What am I going to make any bodily sounds or all of those kinds of things? So to enjoy the experience, if you can diminish that kind of running mind, you know, that could be a way to help. 

But I mean, the answer is yes, everybody needs a bodily sound drink and such. So as you're speaking, I'm noticing the gestures of your hands and I'm thinking, okay, if I'm going to start incorporating ASMR or encourage others to do it, we're not going to necessarily do the ear to ear whispering because like you said, there's that thing of intimacy, which ASMR is not a sexual response. 

I understand that. And we haven't talked about that, but it's only 5% see it that way. Most individuals don't see it that massage is not a sexual experience. And yet there's a misappropriation culturally that it very much is. 

And so some people are still getting that response. And then touch in a therapeutic environment is not an arousing experience. And yet for most humans outside of their spouse or their doctor, very few humans touch you while you're either undressed or partially undressed under some sheets. 

And so there's almost a cross linking of the network where people, they find an intimate connection that can sometimes be perceived as arousal. in a massage therapy situation, simply because they are either dressed mostly, or mostly undressed or partially undressed, and they're getting touched by another human. 

And so if I'm going to use a voice that I'm not trying to encourage more intimacy, would it just be to slow my words down, to lower my tone, but not to whisper almost like this? Or is it still to keep it more engaged, but lower in tone a little quicker? 

What would you, because we're not going to do the whisper, kind of talking, things like that? I think, at least in a massage context, I could imagine it as being something that is quite professional. 

So often what you see in ASMR content, all that can be inducing is people explaining what they're going to do and why they're doing it. So it's almost like a procedural, there's an element of like instruction that is often considered to be a trigger. 

So this is why you quite often see tutorial videos and things like that, or, you know, it's like, oh, I'm just going to do this because this, or I'm going to focus on this, or, you know, so it feels very procedural. 

And there's a kind of, that I think that helps with the feeling that you're safe in some ways. Even though part of an ASMR response is getting the unexpected. Yes, but it's also telling. That's interesting. 

Yeah, I mean, there were so many contradictions within ASMR, but often you'll get, so for example, if you watch an ASMR facial, the thing that might differ from an ASMR facial compared to another facial is that the person is telling you what they're doing while they're doing it. 

So I'm just going to, you know, focus on this. Well, now we're putting on a cream that is going to do this. So there's an element of people enjoy things being explained to them. And I don't know what it is about that that is eliciting for people, but that does seem to be an element. 

Yeah, that's the last time we spoke. We talked about neural cross. working and perhaps there's a thing of trust coming along with the effect of being touched on those especially around pain because people become so protective around their pain. 

They're concerned that it's going to hurt when you touch them for the first time and oftentimes in my treatment I'll be like okay well we're about to touch your trapezius here we're going to squeeze it you let me know when it's enough pressure and there's over almost I mean I have been told by some people that there's an over communication in the way I treat but it's also something I teach because most massage therapists and manual therapy in general physio or PT I mean I see it across the board is under explained it's I'm the therapist you sit down I'll treat you and then you can leave and oftentimes we see that even in the intake an intake you know most massage therapy clinics run a five minute turnover and a 55 minute massage and then that five minute turnover therapist has either go to the bathroom change the sheets and do an intake which means the intake's lasting a minute to two minutes. 

Whereas when my clients come in, we're doing 50 minute intake and it's not high, how's the weather? It's tell me everything about your pain every day since I last saw you, the type of pain, the intensity of pain, the duration of pain, the activity that induces it, or when you feel good, what you're doing, how's it feel to feel good? 

And there's almost an overexplanation, but it seems like that might actually be something that, even if it doesn't create an ASMR type response, it may be setting up an environment where those responses would be more readily available. 

So if somebody doesn't get an ASMR response, they may still be set up an environment to get either a mild or version of it if it is a spectrum kind of thing. Does that make sense? Yeah, 100%. I mean, all the things that you've described would probably elicit ASMR for me as part of the context of just somebody taking information and asking you and be very kind of talking you through things. 

We often find this in, when we're doing research studies, people who get ASMR, they tend to experience it a lot when we're doing the study setup. So in our, you know, they will come into the lab and we say to them, okay, right, thanks very much for coming. 

We just need you to fill out this form. And then we just get this information from you, get your consent. And then now we're gonna attach the sensors to you. So I'm attaching one to this finger and then two to this finger. 

And then we're gently, is that feel okay? And people say that they're just getting really intense ASMR and we're like, no, stop, stop, stop. So that means that you have to do an unethical research study, which does not give them informed information to have them come in blind with no information, which you may not get approved, but that you might get a more accurate response. 

Yeah, it's that kind of setting up and touching and checking in with them and that procedural element and explaining things that can be very eliciting for people. So yeah, the idea of being rushed in and rushed out. 

is not very conducive to the feeling that you are kind of an individual and it's a nurturing, relaxing experience. So, I mean, the idea of getting a 15 minute, somebody sort of asking you questions about the specifics is, it sounds great to me. 

So then the last question before I let you go here would be the part that is probably the most vital and important to most of manual therapists who would be interested in, maybe not again, like I said, maybe not triggering an ASMR response, but at least creating an environment where it's available would be, what are the benefits? 

I mean, I've already mentioned the oxytocin, but there's gotta be more benefits than that because if people are gonna reevaluate how they treat or how they interact or take time out of the treatment that financially we have to inethically justify the time I'm taking away from my hands on time, I need to justify it as a benefit that they're getting something out of that, that I'm not just taking time away from them as a client. 

Yeah, I mean, in terms of the research evidence, you know, we are limited in what we can say conclusively about, you know, what ASMR does to the body, brain, you know, all of these things. The oxytocin stuff is very much hypothetical. 

There is no actual evidence measuring oxytocin or, you know, in ASMR, either just at baseline or after an ASMR experience. So that is not and actually, I think oxytocin is really misunderstood. Yeah, so that that isn't supported by evidence. 

And that's not because it's not, you know, that that doesn't happen. It's just that we haven't that hasn't been tested yet, at least to my knowledge. And what we do know physiologically is that ASMR is associated with significant reductions in heart rate. 

So the average reduction in heart rate that we found in our study, which was only on 52 ASMR responders, was 3 .41 beats per minute. And so we think, okay, well, what does that is that even like, is that meaningful? 

And so we compared it, we said we looked at other interventions that were for kind of stress reduction and things like that. And 3 .41 beats per minute is comparable to things like mindfulness and music therapy. 

So, you know, that is probably the best evidence that there is that there is this kind of physiological benefit, of course, people also report feeling very relaxed. And we know anecdotally that there are lots of benefits. 

But in terms of the hard science, that's probably the best we've got. And I still don't even think that's very good, because I think we need to replicate it. And also see if if the similar type of response occurs with people who aren't getting any ASMR response, but set up in the same environment. 

Yeah, so I mean, we do we do have that data. And there is a reduction in heart rate is just not as pronounced. I can't remember what the average reduction was. And then I think within a control group, you'll get really variable responses. 

So you might get people who, which affects the average. So you might get people who actually, you know, like your wife really actually hate it and their heart rate goes up, right? And then you might, so it's really variable depending on the content. 

So, but I would say there's definitely a lot of research to be done in therapeutic settings. I think for me, ASMR not in a, not delivered in a tactile form, but the fact that ASMR might be a substitute for actual touch is a really intriguing and fascinating avenue for me. 

Thinking about context in which people may be touch hungry or they don't experience much touch. So particularly older people. And in a pandemic when people are not supposed to be socially attracting us often. 

So it's like, can you get? the benefits of social touch, which there is now so much research out there on, you know, you know, these kinds of benefits. But can you get that not from being touched, but through experiencing something like ASMR? 

And that, for me, is like a really interesting idea. To me, that's interesting, but for almost the opposite reason. I would use it to enhance the touch. Two birds, one stone, you know, like that to me would be if I can get you out of your pain quicker, with fewer treatments and more effectiveness. 

That's my bread and butter. Yeah, but I think about my grandma, for example, since my granddad died. And, you know, whenever I give her a hug, she's like, oh, it's so nice to be touched. And I think, oh, gosh, she doesn't get to and she used to put her pillow, which I don't know if she still does it now. 

She's moving into her care home. But, you know, she'd put a pillow behind her back to feel as if somebody's there. So there's that, you know, for people who can't get touched, are there ways that we can deliver touch in accessible ways that don't necessarily involve another human touch? 

I mean, it's not the best substitute, is it? But if it's the only substitute, it is the best substitute. Yeah, yeah, exactly. So for me, that's particularly intriguing. So then the last thing would be any advice for therapists, not necessarily around the ASMR, but about everything we spoke about and mainly for creating an environment for one, either eliciting an ASMR response or if the spectrum, which I understand is still a theory and still hypothesized to at least elicit free zone or a calling response using ASMR techniques. 

Any advice for therapists? Yeah, so I mean, I think I would kind of hear sort of think about the what we might know about what makes experiences more likely to happen. So ASMR is isn't this thing that is necessarily very consistent. 

So there are kind of some suggestions around what might make an ASMR experience more likely to occur. That ranges from things like the temperature of the room. So a lot of people say that actually they need to be a little bit colder to experience ASMR, but also how you feel emotionally and maybe their time of day. 

So thinking about this kind of calming response and the conditions that might allow it to occur could help to set up an environment in a way that is more beneficial. So things like a darkened room, like not having the temperature not too hot, not too cold with a person and checking in and thinking about all those kind of little details, like ASMR is very much detail orientated. 

And also making sure the person isn't feeling... anxious. So like one of the things that I think is really interesting about ASMR is that people anecdotally say that it's harder to get ASMR when they need it the most. 

So when them stressed, they might turn to an ASMR contact, but ironically, they can't experience it. So actually, they're more able to experience it when they're calmer. So that whole kind of leading up to a session is very important. 

The whole context, it's not just about the delivery of something, but also thinking about the environment as a whole. So again, when I talk about the sensory system in my classes, we talk about touch, obviously, but I talk about the eight senses. 

We've got more than touch available to us. We've got interoception, proprioception. There's so many beyond the five traditional senses. And one of the reasons I do long intakes is exactly that, is to get them into that sense of I'm fully in someone else's care, this will go well. 

And I think for a lot of therapists, maybe it's taking more than five minutes away from a massage, knowing that the client's going to get touched a little less, but that the overall benefit is likely going to be increased because their sense of anxiety, their sense of trust is all changed. 

Yeah. And I think this is really interesting because what you're saying is so testable. Like you could do research to find out what, and you could maybe even put like a precise number on the benefit. 

So everything that you're saying is probably like really inherent in a lot of your practice, but wouldn't it be amazing if you could demonstrate that and show the benefit in an empirical way and then more people can adopt it. 

You might be getting another email from me. Yeah. Like I think that was especially if I can get that grant, if I can find that funding that we were talking about earlier, maybe it'd be easy to do simple things like, you know, I know there's been, I was talking to a GP, one of my cousins. 

my cousin's girlfriend, she's a GP, and she said that actually because of COVID, they're not allowed to just spontaneously touch. And there are studies where if you just touch somebody that improved, just a little touch on the arm, right? 

And it's these really simple things that could make a really big difference. I think the study you're referring to was there's a 30% increase in recovery rates of patients with long -term illnesses. If during the diagnosis and prognosis, their foot or hand, through clothing and a shoe, it doesn't have to be skin to skin, the doctor places their hand on their foot or their hand of the patient while giving the diagnosis and prognosis 30% chance of recovery compared to those not touched. 

Yeah, that's so significant. Unbelievable. Yeah, and yeah, I just think that they probably are kind of comparable. when you're talking about, you know, also already in a therapeutic context, how can you enhance that and, you know, with ASMR there's also kind of ideas about it personalized ASMR so wouldn't it be great if you could come up with content that is kind of personalized in a way that ensures that the person gets that experience. 

And I'm sure the same could be said for the kind of work that you're doing as well, which you probably already do intuitively anyway right. Well, that's the thing it's funny you bring up the word intuition I have a thing about that I have a whole podcast on how I'm not a fan of the word intuition but I think I think yes, a lot of therapists do this stuff naturally. 

I think one of the things about being a speaker a speaker and a teacher is that we try to find the words to the things people do naturally, because I don't think it's intuition I think it's time and experience, we just don't have the vocabulary to describe what we're doing. 

And I think if you want to teach someone else, you have to have the time the words you can't say oh intuitively I need to do this because then my student can never do it, because they don't have what I have. 

And so finding the words to do it which is why I wanted to do this again and thank you so much for taking the time to do this. I want to make sure okay this is going to go on YouTube at one point. And, and I'll be on my podcast, and I might reach out to you again. 

Yeah, only, especially when that pain research comes out around ASMR because to me that's really where we're going to see some interesting stuff coming out. Yeah, I'll let you know. Interesting that you say about the kind of the intuition it reminds me of, I don't know if you're familiar with Antonio de Masio's work on gut feeling. 

And the idea that actually intuition is is really about your previous experience and actually your gut, your gut feeling so there's some really interesting psychological research on exactly what you're saying which is it isn't intuition it's, it's experience. 

Yeah, I call it, I call it, I do a whole I did a half hour Instagram live where I essentially just ranted for half hour on how much I don't like the word, because it's usually it's used very frequently in the massage therapy industry across the board as teachers and they're teaching classes. 

And for me, it's one of the worst words you can use with a student because it's time and experience, which like when I treat some of low back pain, they come in and they're limping and they walk out pain -free. 

It's not because I'm a miracle worker. It's not because my elbow was more powerful than someone else's elbow. It's not because I saw something and did it differently. It's simply because my time and experience has shown me that if I touch you here, after 20 years of doing this, it's likely gonna cause a reaction that is within a spectrum of responses. 

That's simple. And so it's time and experience. I really think that plays into it. But that also plays into what we're talking about with ASMR. When somebody comes in and you observatory unconsciously see they're stressed, do you lower your tone? 

Do you have a longer intake? Or if you see they're depressed, do you try to engage them more and invigorate them? And yeah, it plays into it. Yeah, that's so interesting. And when you think when you talk about intuition, actually, really, what you mean is expertise, isn't it, really? 

So maybe people should use that term. There's no way to fake expertise. It comes with time. Time and experience. Yeah. Yeah. Well, thank you so much again. I really appreciate it. And if you want to send me that for that paper you were talking about that I will do badly read that. 

And then when I hear about the chronic and pain thing, I can't wait. And thanks so much. Yeah, no worries. I will definitely email you. I'll email you now before I forget that paper because I've just got the proofs through, but that pain paper as well is really good. 

Yeah. And when it comes out, for anybody who ends up following this on YouTube or the podcast, I will publish a link to it because I love that stuff. Thank you so much. Oh, pleasure. So nice to chat to you. 

Thank you so much. You as well. Enjoy your evening. You too. Take care. Bye -bye. Right. Thank you.