Sensory Modulation for People with Anxiety in a Community Mental Health Setting

'It provided me with a sense of safety that I hadn't felt in weeks.' A qualitative case study of service users' experiences with sensory rooms in psychiatric inpatient units

INTRODUCTION

Sensory rooms are environments designed to provide sensory input to help service users regulate arousal and manage distress. Sensory rooms are widely implemented in psychiatric inpatient units, but limited knowledge exists on how the sensory rooms are perceived by those who use them. This study investigated service users' experiences with sensory rooms during admission.

METHODS

A qualitative case study using semi-structured interviews conducted with 20 participants, admitted in acute, intensive, and open inpatient psychiatric units in Copenhagen, Denmark. Participants used the sensory rooms under guidance from occupational therapists or physiotherapists and were subsequently interviewed about their experiences. Interviews were transcribed and subjected to thematic analysis.

RESULTS

Participants reported that being in the sensory rooms helped them to reconnect to their body and to experience peace of mind. Over time, participants used the sensory approaches to develop self-management strategies and enable participation in activities.

CONCLUSION

This study concludes that most of the participants had a positive experience in the sensory room under guidance from one of the unit's physio or occupational therapists. Participants experienced increased physical and mental calmness in the sensory room and an increased sense of safety which made a difference during their admission and, for several of them, also in terms of their expectations for everyday life following their discharge.

Sensory processing across eating disorders: A systematic review and meta-analysis of self-report inventories

OBJECTIVE

This review investigated the extant literature regarding the relationship between eating disorder diagnoses and sensory processing as measured by validated and reliable self-report inventories. Increasing evidence highlights the role of sensory processing in cognitive functions. Sensory processing is implicated in mental-ill health, including eating disorders (ED) and body image disturbances. However, the pathophysiological underpinnings of sensory processing, encompassing exteroception and interoception, in relation to ED remain underexplored.

METHOD

We included studies involving participants aged 15 years or older with an eating disorder diagnosis confirmed by semi-structured or structured interviews. We further limited inclusion to articles using validated and reliable self-report instruments to measure sensory processing. Our meta-analysis focused on studies using the interoceptive awareness subscale from the second version of the Eating Disorder Inventory. We used the Critical Appraisal checklist for quasi-experimental studies to assess the quality of included articles.

RESULTS

There were 19 studies that met our inclusion criteria. Most studies showed moderate-to-high quality. Anorexia nervosa (AN) and bulimia nervosa (BN) were associated with heightened exteroception. Moreover, people with AN reported a heightened sense of taste compared to those with BN. Our meta-analysis comprising 10 studies, 19 samples, and 6382 participants revealed that AN (binge-purge subtype) and BN were associated with increased interoceptive difficulties compared to AN (restrictive subtype) or binge-eating disorder.

DISCUSSION

Overall, this review emphasizes the need for a deeper investigation into sensory processing, spanning both exteroception and interoception, in relation to ED. This may prove important for individualizing person-centered care.

PUBLIC SIGNIFICANCE

How people process internal, for example, hunger, and external, for example, taste and sensations is known to influence cognition and mental-ill health, including ED and body image disturbances. However, the ways in which sensory processing may contribute to ED are incompletely understood. We found that individuals with AN or BN experienced heightened exteroception, while people with an eating disorder characterized by purging reported increased interoceptive difficulties. These patterns could inform the development of more personalized treatments.

User Experiences of Ball Blankets in Adults with Depression-Related Insomnia: A Qualitative Content Analysis Study

Insomnia is prevalent in patients suffering from depression and may itself exacerbate the disability associated with depression and impede the path to recovery. Although crucial in ensuring meaningful interactions and interventions for patients, research on patients' experiences of depression-related insomnia and its treatment is limited. The purpose of this study was therefore to investigate how adult patients with depression-related insomnia experience sleeping with a weighted Protac Ball Blanket®, focusing on how the blanket feels and works and contributes to their subjective sleep quality experience. An inductive content analysis approach was adopted. Semi-structured interviews were conducted with 13 patients. Four categories were identified: 1) Deep and dynamic touch pressure from the plastic balls induced calmness; 2) Changing sensory impressions from the rolling balls distracted attention from distressing thoughts and emotions; 3) The ball blanket improved the quality and quantity of sleep, which increased daily well-being; 4) Sleeping with the ball blanket was associated with positive as well as negative experiences depending on personal preferences for sensory stimulation. This study explains how the Protac Ball Blanket® as a potential non-pharmacological sleep-intervention improved the sleep of adult patients with depression-related insomnia. The blanket was found meaningful for coping with sleeplessness and with mental and physical unrest.

Nocturnal exposure to a preferred ambient scent does not affect dream emotionality or post-sleep core affect valence in young adults

Emotions experienced within sleep mentation (dreaming) affect mental functioning in waking life. There have been attempts at enhancing dream emotions using olfactory stimulation. Odors readily acquire affective value, but to profoundly influence emotional processing, they should bear personal significance for the perceiver rather than be generally pleasant. The main objective of the present sleep laboratory study was to examine whether prolonged nocturnal exposure to self-selected, preferred ambient room odor while asleep influences emotional aspects of sleep mentation and valence of post-sleep core affect. We asked twenty healthy participants (12 males, mean age 25 ± 4 years) to pick a commercially available scented room diffuser cartridge that most readily evoked positively valenced mental associations. In weekly intervals, the participants attended three sessions. After the adaptation visit, they were administered the odor exposure and odorless control condition in a balanced order. Participants were awakened five minutes into the first rapid eye movement (REM) stage that took place after 2:30 a.m. and, if they had been dreaming, they were asked to rate their mental sleep experience for pleasantness, emotional charge, and magnitude of positive and negative emotions and also to evaluate their post-sleep core affect valence. With rs < 0.20, no practically or statistically significant differences existed between exposure and control in any outcome measures. We conclude that in young, healthy participants, the practical value of olfactory stimulation with self-selected preferred scents for enhancement of dream emotions and post-sleep core affect valence is very limited.

Experiences of participating in a group-based sensory modulation intervention for mental health service users

BACKGROUND

People with mental health issues often experience difficulties with sensory modulation affecting occupational engagement. Research conducted in inpatient units has shown positive effects of individual sensory modulation interventions, however, research on experiences of group-based interventions in outpatient units is limited. Hence, a group-based sensory modulation intervention was adapted and tested within Swedish mental health outpatient units.

AIM

To explore the experiences of participating in a group-based sensory modulation intervention for service users in mental health outpatient units.

MATERIAL AND METHODS

This qualitative study involved interviews with 25 informants who had participated in the intervention. The interview data were analysed using reflexive thematic analysis.

RESULTS

Synthesis of the interviews resulted in one overarching theme of 'Embodied awareness facilitates improved coping and sense of self' organised into four themes: (1) 'Developing embodied awareness and strategies', (2) 'Taking control of everyday life', (3) 'Creating a stronger sense of self', and (4) 'From alienation to belonging'.

CONCLUSION AND SIGNIFICANCE

The informants experienced the intervention to provide new embodied coping strategies that had previously been neglected. This understanding may enrich occupational therapy practice in new ways to support service users' engagement in occupations.

Sensory modulation interventions for adults with mental illness: A scoping review

Introduction

Sensory Modulation Interventions (SMI) assist people with mental illnesses to regulate emotional and physiological arousal. We aimed to conduct a scoping review to identify the study designs, geographical distribution, modality/regimen, barriers and facilitators in using SMI for individuals with mental illnesses.

Methods

A systematic search was conducted using Arksey and O'Malley's framework with studies published on SMI from January 2010 to November 2020.

Results

17 articles were found to be relevant. One was a case-control study, qualitative (N = 3), mixed-method (N = 3), and case studies (N = 3), and the rest were pilot interventional studies (N = 8). The duration of sessions ranged from 2 to 30 minutes for 2 days to 3 years. The facilitators in using SMI were of being cost-effective and easily adaptable. Barriers were in terms of maintenance of sensory items. Sensory modulation based items related to proprioception, vestibular and tactile were the frequently used in the SMI based interventions used in the included studies.

Conclusions

SMI as an occupational therapy intervention for individuals with mental illnesses is evolving and more robust studies in the future are recommended.

Respite and connection: Autistic adults' reflections upon nature and well-being during the Covid-19 pandemic

LAY ABSTRACT

The Covid-19 pandemic and associated lockdowns provided opportunities to spend time in nature, with many people reporting that this benefitted their well-being. However, existing research from the pandemic period has focused on the way general populations experienced nature; less is known about how autistic people used nature to support their well-being during the pandemic. We created a survey that invited autistic adults living in the United Kingdom to reply to text box questions. A total of 127 people responded to our survey; we analysed their responses using a method called reflexive thematic analysis and developed themes based on patterns among all the responses. We developed two themes: respite in nature and connecting amid widespread disconnection. For some autistic adults during the pandemic, nature provided physical distance from others or from crowded homes, which helped them reduce their stress. In addition, some participants felt more psychologically connected to nature itself during the pandemic, while for others, nature served as a way of connecting with others during a potentially isolating time. These findings are important for autistic people and their families and carers who may want to seek out nature-based activities to support well-being in the wake of the pandemic.

Polysensoriality and Aesthetics: The Lived Sensory Experiences of Adults with Mental Illness

Background. Research in neuroscience shows that adults with schizophrenia or related psychotic disorders experience atypical sensory processing (e.g., deficits in sensory gating and mismatch negativity). Despite significant evidence proving these biomarkers are common among adults with serious mental illness, it is unclear how their sensory experiences impact their occupations in daily life (i.e., real-world implications of atypical sensory processing). Purpose. To explore how the lived sensory experiences of adults with psychotic disorders affect their occupations. Method. We used Walking with Video, photo-elicitation, and semi-structured interviews to study how the lived sensory experiences of adults with psychotic disorders (N  =  6) relate to their occupations. Informed by a phenomenological perspective, we analysed data from semistructured interviews, and undertook analyses through iterative rounds of coding to develop themes and two cycles of group reflective practices to identify researcher biases and assumptions. Findings. Analyses revealed the following themes: polysensoriality, embodied aesthetics of everyday life, habits of sensing and sensory anchors, and active sensory beings. Implications. In clinical contexts, occupational therapists should carefully consider the situatedness of sensory experiences while avoiding assumptions that sensory preferences and aversions mechanistically generalize across contexts and occupations.

Imputation of missing values within WHODAS 2.0 data collected from low back pain patients using the response function approach

PURPOSE

To investigate the impact of missing data and imputation with the response function (RF) approach on bias and precision of disability estimates as well as reliability of scale of WHO Disability Assessment Schedule 2.0.

MATERIAL AND METHODS

Data were collected by face-to-face interviews and self-report surveys from 284 respondents with low back pain. Hypothetical datasets were created by using person and item parameters of real data. A simulation study was devised to assess the ability parameters and reliability measures on incomplete and imputed datasets. Rasch model was used to evaluate latent trait levels. Imputation was carried out using the response function method.

RESULTS

Almost the same level of bias and MSE was reached. While the missing rate increases, the Person separation index slightly reduced, still exceeded 0.94 and Cronbach alpha values have similar mean values of 0.99 with larger variations. After deletion of four items of "work or school activities" in domain 5, reliability measures reduced the lowest.

CONCLUSION

Construct validity is preserved. Problems regarding the compliance of the items with the target group still persist. When researchers encounter missingness in data collected with WHODAS 2.0, the response function can be usefully implemented to impute missing values to improve the reliability of disability level estimates.Implications for rehabilitationThe Turkish version of the 36-item WHODAS is reliable and valid for assessing health and disability status in patients with low back pain.A critical issue is a systematic nonresponse was highly observed in items related to "work/school life activities" which are allowed to be skipped and excluded from the scoring according to WHODAS 2.0 training manual.Imputation of missing values within four items of "work or school activities" in domain 5 using the response function approach showed satisfactory reliability for the estimation of disability in adults with low back pain.This study showed missing data imputations with response function can be implemented by a statistician as contribute to a missing data management process better tailored to clinicians' interpretations.

Can Sensory- and Attachment-Informed Approaches Modify the Perception of Pain? An Experimental Study

Accumulating evidence linking pain with both attachment and sensory processing variables introduces the possibility that attachment- and sensory-informed strategies may modify pain experiences. The aim of this study was to investigate this proposition using an experimentally induced pain procedure. Pain perceptions of individuals using either a sensory-informed (weighted modality) or an attachment-informed (secure base priming) coping strategy were compared with those of individuals using no designated coping strategy. An independent measures experimental study design was used with a convenience sample of 272 pain-free adults. Experimental participants (n = 156) were randomly allocated to either an attachment (n = 75) or a sensory (n = 81) intervention group. Data from these participants were compared to those of 116 participants involved in an earlier cold pressor study in which no coping strategy was used. All participants completed the same sensory, attachment, and distress questionnaires and participated in the same cold pressor pain test. ANCOVAs revealed that participants in the sensory- and attachment-informed intervention groups reported significantly higher pain thresholds than the control group. Participants allocated to the sensory group also reported higher pain intensity scores than the control group. There were no significant differences in pain tolerance between the three groups after controlling for covariates. While further research is required, findings encourage further consideration of sensory- and attachment-informed strategies for people anticipating a painful experience.

Sensory processing and detection thresholds of burn-injured patients: A comparison to normative data

OBJECTIVE

Emerging evidence suggests that individual levels of sensory sensitivity may impact treatment outcomes for people recovering from burn injuries. For example, individuals with higher levels of sensory sensitivity were less adherent with compression garment wear, often used for scar management. The purpose of this study was to characterise sensory patterns for a sample of burn-injured patients as a cohort, using normative data as the reference. As different patterns of sensory processing can have implications clinically, understanding this at the cohort level may provide valuable insight for therapy.

METHOD

This was a secondary analysis of data collected during a cross-sectional study. Adults (N = 117) attending the Professor Stuart Pegg Adult Burns Unit outpatient clinic completed the Adolescent/Adult Sensory Profile and the following quantitative sensory tests: two-point discrimination; mechanical detection threshold; and pressure pain threshold.

RESULTS

Compared to matched normative data, burn-injured patients reported higher levels of sensory sensitive and avoiding patterns, and experienced lower detection thresholds for touch and pain.

CONCLUSIONS

Higher reports of sensory sensitivity and sensory avoiding, and lower thresholds for touch and pain, have been correlated with tactile defensiveness. Tactile defensiveness has been associated with social withdrawal and isolation, all of which could contribute to decreased engagement in therapy. The ways in which these sensory characteristics impact on burn-related treatments, such as compression garment adherence, warrant further investigation.

Effectiveness of anxiety reduction interventions on test anxiety: A comparison of four techniques incorporating sensory modulation

Introduction

Anxiety is one of the most commonly diagnosed mental health disorders on post-secondary campuses, often brought on by stressors unique to the college environment. Traditional psychological approaches to manage anxiety might focus on breathing techniques and progressive muscle relaxation. However, additional techniques that use specific sensory input to reduce anxiety have not received the same attention in the literature.

Method

This longitudinal study compared four interventions for state anxiety (deep breathing, progressive muscle relaxation, an adapted dive reflex, and use of a weighted lap object) in a cohort of professional occupational therapy students.

Results

This study found that all four interventions significantly reduced state anxiety. The sensory-based interventions of adapted dive reflex and weighted lap object appeared to have a longer duration of impact than the traditional interventions of deep breathing and PMR.

Conclusion

These results suggest that both traditional and sensory-based approaches may be effective in reducing anxiety before a testing situation.

Making sense of it together: Youth & families co-create sensory modulation assessment and intervention in community mental health settings to optimise daily life

INTRODUCTION

Occupational therapists work collaboratively with young people experiencing mental ill-health to enable meaningful occupational participation in daily life. Sensory modulation is used as a means of developing self-regulation and enabling occupational participation. Published literature on sensory modulation in mental health settings is primarily located within acute inpatient settings and focuses on self-regulation. Little is known about the use of sensory modulation within community settings to enhance occupational participation in daily lives of people with mental-ill health. This study investigated the experiences of young people and their families who engaged in sensory modulation assessment (Adolescent/Adult Sensory Profile) and intervention (between one and twelve sessions) as part of community mental health care at a large area mental health service in Melbourne, Australia.

METHODS

The qualitative study used naturalistic inquiry methodology involving semi-structured interviews with six young people and three families. Nine interview transcripts were thematically analysed to elicit the experiences of sensory modulation assessment and intervention, and how this may influence daily life.

RESULTS

Thematic analysis revealed that young people and their families' positive experiences of sensory modulation were underpinned by processes of co-creation: (a) knowing yourself; (b) understanding 'the why': developing shared reasons for engaging in sensory modulation; (c) creating comfort; (d) creating connection; and (e) constantly learning. Sensory modulation supported occupational participation in young peoples' daily lives in the areas of sleep, study, relationships, self-care, independent living, being in the world, and doing new things.

CONCLUSION

Young people and their families valued the process of co-creating sensory modulation assessment and intervention to enhance occupational participation. Results revealed that sensory modulation assessment and intervention was optimised when it was a process of co-creation. Future research should investigate the effectiveness of sensory modulation in enhancing occupational participation in these domains that influence daily life.

Psychophysiological Arousal and Auditory Sensitivity in a Cross-Clinical Sample of Autistic and Non-autistic Anxious Adults

Many autistic people report overwhelming sensory experiences and also elevated levels of anxiety. Understanding how these experiences are linked to each other can contribute to improved support and intervention for reducing sensory overload and anxiety. This study included 95 young adult participants including autistic adults, non-autistic adults reporting to a psychotherapy clinic with high levels of anxiety, and neurotypical adults with no psychiatric concerns. We measured pupil size using including a baseline task with no auditory stimulus followed by two blocks of simple auditory habituation. In a subset of 80 participants we also measured self-report levels of sensory processing, anxious apprehension, and intolerance of uncertainty. The autism group showed atypical sensory processing on all four measured domains of the Adolescent and Adult Sensory Profile including sensory sensitivity, sensory seeking, sensory avoidance, and low registration subscales. Dimensional analyses across all participants showed significant positive correlations between sensory sensitivity, sensory seeking, and sensory avoidance domains with scores from the Intolerance of Uncertainty Scale-Short Form and Penn State Worry Questionnaire. The autism group showed significantly larger pupil size than other groups at baseline, before any auditory stimulation. There were no group differences in the rate of auditory habituation, nonetheless the overall, absolute larger pupil size remained in the autism group throughout the experiment. We suggest that this and other findings could indicate chronic hyperarousal in many autistic people. Treatment for anxiety in autism should be informed by knowledge of unique aspects of anxiety in autism and consider the role of sensory experience and everyday psychophysiological arousal.