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80 m a s s a g e & b o d y wo r k j u l y/a u g u s t 2 0 2 2 80 m a s s a g e & b o d y wo r k j u l y/a u g u s t 2 0 2 2 it is now easy to point to good evidence for therapies that have become incorporated into interdisciplinary health-care programs at the highest levels of health care. Even so, among many clinicians, and especially in the massage therapy community, debates about the relative validity, or indeed respectability, of many modalities continue, and perhaps most surprisingly, even when the weighty evidence base is pointed out, a certain denial seems to set in. For some, the acknowledgment of the body-mind connection oen seems to extend only as far as the apparently "comforting" nature of massage, while denying outright the potential mechanisms of mechanotransduction— for others, the power of the connection is overstated and results overpromised. Acupuncture is frequently waved away as pseudoscience even though it is recommended as an effective method for many conditions— particularly chronic pain—by major health care centers and systems on the basis of the evidence. 11 Laboratory and clinical findings on the role of therapeutic loading of fascia and the subsequent behavior of fibroblasts should leave no doubt as to the beneficial effects of skilled manual therapy on several levels, 12 yet some insist that massage can only ever be skin deep and that to claim otherwise is pseudoscience. All these examples (and there are many more) illustrate a big gap between the actual evidence and the cherry-picking that seems to be the norm in current debates. BAD COMPANY OR BAD LANGUAGE? ere are many reasons why so-called "alternative therapies" continue to provoke debate, and, in some cases, (that I have written about previously) 13 it is unfortunately because of own-goals. "Keeping bad company" is oen touted as a key reason why the word "holistic" still meets with raised eyebrows; yet, these reasons are buried so deep in history that it is difficult to accept this is really the case—at least among trained professionals. However, the way we learn, think, teach, and speak about these ideas is in fact the root of the problem. In the numerous cases in which evidence does demonstrate the safety, effectiveness, and measurable beneficial effects (with or without a full understanding of mechanisms of action) of certain modalities, it seems difficult to grasp why controversies persist. One key reason is down to what is called "discursive dissonance"—a fancy term for when an idea means different things to different people and results in them talking past each other. Sometimes this can be resolved with friendly dialogue, but all too oen, and especially on social media, we don't understand each other because we're primed not to want to. e reason for this is that discursive dissonance can oen result in cognitive dissonance— another fancy term that describes the mental stress we feel when confronted with two conflicting beliefs or attitudes and the emotional response that results from having a deeply held belief challenged. We are wired to see ourselves as rational and to justify our behaviors, so while scientific and professional matters are best handled without an emotional response, it is a very human reaction that can stem from four key sources: 1. Forced compliance: Acting against one's beliefs. 2. Loss of choice: Feeling upset at the loss of option B once we choose option A. 3. Contradicting beliefs: Being exposed to new information that forces us to reevaluate what we believed. 4. Effort: Making a great effort to achieve something (e.g., learn a technique), only to find that it was not as valuable as we thought, or coming to see it negatively. In all four cases, there are two possible reactions: a change in behavior or seeking new information to either strengthen or weaken the concept that has challenged our original position. 14 In the context of professional practice and the kinds of debates outlined above, if we have been taught throughout our professional lives to think a certain way, sometimes the mental challenge is such that it forces us to rethink our professional identity and public image. If the internal contradiction produces a sense of shame or exposure, it can provoke confusion at best, and possibly stronger emotions and conflicts with the ideas—or people—we see as being responsible for challenging us. Yet, if we are supposed to manage patients' expectations and practice ethically, then it is also critical that we are able to manage these responses in ourselves. 15 Anthropological research suggests that because this kind of contradiction is social, we are likely to try to avoid it through some kind of shared communication strategy, rather than actually changing our beliefs. ough this strategy is best developed either through civilized dialogue or working groups and formal exchanges in scientific journals, all too oen it descends into rude exchanges on social media that do nothing other than highlight the problem (while damaging the profile of one's profession a whole lot more). TOWARD SOLUTIONS One powerful answer to these issues currently taking shape is the International Consortium on Manual erapies (ICMT) and its conference that took place in May 2022. For the past two years, the ICMT has formed interprofessional working groups representing the main manual therapy professions, looking to establish a common vocabulary and frame of communication and to collect the theories and evidence that will allow the diverse manual therapy professions to understand and enrich each other while maintaining their unique features, while also raising their scientific and professional profiles. With open discussion sessions in the form of roundtables and an upcoming virtual conference, this is a highly significant step toward breaking down some of the

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