The Elicitation of Relaxation and Interoceptive Awareness Using Floatation Therapy in Individuals With High Anxiety Sensitivity

Justin S Feinstein, Sahib S Khalsa, Hung Yeh, Obada Al Zoubi, Armen C Arevian, Colleen Wohlrab, Marie K Pantino, Laci J Cartmell, W Kyle Simmons, Murray B Stein, Martin P Paulus, Justin S Feinstein, Sahib S Khalsa, Hung Yeh, Obada Al Zoubi, Armen C Arevian, Colleen Wohlrab, Marie K Pantino, Laci J Cartmell, W Kyle Simmons, Murray B Stein, Martin P Paulus

Abstract

Background: Floatation-REST (Reduced Environmental Stimulation Therapy), an intervention that attenuates exteroceptive sensory input to the nervous system, has recently been found to reduce state anxiety across a diverse clinical sample with high levels of anxiety sensitivity (AS). To further examine this anxiolytic effect, the present study investigated the affective and physiological changes induced by Floatation-REST and assessed whether individuals with high AS experienced any alterations in their awareness for interoceptive sensation while immersed in an environment lacking exteroceptive sensation.

Methods: Using a within-subject crossover design, 31 participants with high AS were randomly assigned to undergo a 90-minute session of Floatation-REST or an exteroceptive comparison condition. Measures of self-reported affect and interoceptive awareness were collected before and after each session, and blood pressure was measured during each session.

Results: Relative to the comparison condition, Floatation-REST generated a significant anxiolytic effect characterized by reductions in state anxiety and muscle tension and increases in feelings of relaxation and serenity (p < .001 for all variables). Significant blood pressure reductions were evident throughout the float session and reached the lowest point during the diastole phase (average reduction >12 mm Hg). The float environment also significantly enhanced awareness and attention for cardiorespiratory sensations.

Conclusions: Floatation-REST induced a state of relaxation and heightened interoceptive awareness in a clinical sample with high AS. The paradoxical nature of the anxiolytic effect in this sample is discussed in relation to Wolpe's theory of reciprocal inhibition and the regulation of distress via sustained attention to present moment visceral sensations such as the breath.

Keywords: Anxiety; Blood pressure; Floatation-REST; Floating; Interoception; Mindfulness; Novel intervention; Relaxation response.

Copyright © 2018 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Anxiolytic effect of floatation therapy. **p < .001. Error bars represent SEM. PANAS-X, Positive and Negative Affect Schedule–Expanded Form; POMP, percent of maximum possible; STAI, State-Trait Anxiety Inventory; VAS, visual analog scale.
Figure 2
Figure 2
Muscle tension tracings. Participants traced any regions where they felt muscle tension. The color scale is filtered to show areas of overlap ranging from 3 to 16 participants.
Figure 3
Figure 3
Average (A) systolic and (B) diastolic blood pressure over time in the float and film conditions. Time 0 is baseline. Shaded regions represent the pointwise 95% confidence interval.
Figure 4
Figure 4
Interoception ratings during the float (solid bars) and film (hatched bars) conditions. Error bars represent SEM. Ratings of (A) intensity, (B) attention, and (C) valence are shown for three different visceral systems. *p < .05; **p < .001. POMP, percent of maximum possible.
Figure 5
Figure 5
Heartbeat sensation tracings. Participants traced any regions where they felt their heartbeat. The color scale is filtered to show areas of overlap ranging from 3 to 16 participants.
Figure 6
Figure 6
Average score (range, 0–5) on the attention regulation and self-regulation subscales of the Multidimensional Assessment of Interoceptive Awareness. Error bars represent SEM. **p < .001.

References

    1. Taylor S. Anxiety Sensitivity: Theory, Research, and Treatment of the Fear of Anxiety. New York: Routledge; 2014.
    1. McNally RJ. Anxiety sensitivity and panic disorder. Biol Psychiatry. 2002;52:938–946.
    1. Naragon-Gainey K. Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychol Bull. 2010;136:128–150.
    1. Olatunji BO, Wolitzky-Taylor KB. Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychol Bull. 2009;135:974–999.
    1. Maller RG, Reiss S. Anxiety sensitivity in 1984 and panic attacks in 1987. J Anxiety Disord. 1992;6:241–247.
    1. Telch MJ, Rosenfield D, Lee HJ, Pai A. Emotional reactivity to a single inhalation of 35% carbon dioxide and its association with later symptoms of posttraumatic stress disorder and anxiety in soldiers deployed to Iraq. Arch Gen Psychiatry. 2012;69:1161–1168.
    1. Schmidt NB, Zvolensky MJ, Maner JK. Anxiety sensitivity: Prospective prediction of panic attacks and Axis I pathology. J Psychiatr Res. 2006;40:691–699.
    1. Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, et al. Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychol Assess. 2007;19:176–188.
    1. Smits JA, Berry AC, Tart CD, Powers MB. The efficacy of cognitive-behavioral interventions for reducing anxiety sensitivity: A meta-analytic review. Behav Res Ther. 2008;46:1047–1054.
    1. Simon NM, Otto MW, Smits JA, Nicolaou DC, Reese HE, Pollack MH. Changes in anxiety sensitivity with pharmacotherapy for panic disorder. J Psychiatr Res. 2004;38:491–495.
    1. Boswell JF, Farchione TJ, Sauer-Zavala S, Murray HW, Fortune MR, Barlow DH. Anxiety sensitivity and interoceptive exposure: a transdiagnostic construct and change strategy. Behav Ther. 2013;44:417–431.
    1. Deacon BJ, Lickel JJ, Possis EA, Abramowitz JS, Mahaffey BG, Wolitzky-Taylor K. Do cognitive reappraisal and diaphragmatic breathing augment interoceptive exposure for anxiety sensitivity? J Cogn Psychother. 2012;26:257–269.
    1. Smits JA, Berry AC, Rosenfield D, Powers MB, Behar E, Otto MW. Reducing anxiety sensitivity with exercise. Depress Anxiety. 2008;25:689–699.
    1. Worden BL, Davis E, Genova M, Tolin DF. Development of an anxiety sensitivity (AS) intervention for high-AS individuals in substance use disorders treatment. Cogn Ther Res. 2015;39:343–355.
    1. van Dierendonck D, Te Nijenhuis J. Flotation restricted environmental stimulation therapy (REST) as a stress-management tool: A meta-analysis. Psychol Health. 2005;20:405–412.
    1. Suedfeld P, Ballard EJ, Murphy M. Water immersion and flotation: From stress experiment to stress treatment. J Environ Psychol. 1983;3:147–155.
    1. Jonsson K, Kjellgren A. Promising effects of treatment with flotation-REST (restricted environmental stimulation technique) as an intervention for generalized anxiety disorder (GAD): A randomized controlled pilot trial. BMC Complement Altern Med. 2016;16:108.
    1. Feinstein JS, Khalsa SS, Yeh H, Wohlrab C, Simmons WK, Stein MB, et al. Examining the short-term anxiolytic and antidepressant effect of Floatation-REST. PLoS One. 2018;13:e0190292.
    1. Benson H. The relaxation response. In: Goleman D, Gurin J, editors. Mind Body Medicine: How to Use Your Mind for Better Health. New York: Consumer Reports; 1993. pp. 233–257.
    1. Shurley JT. Profound experimental sensory isolation. Am J Psychiatry. 1960;117:539–545.
    1. Turner J, Fine T. Effects of restricted environmental stimulation therapy (REST) on self-control of heart rate. In: Sanchez-Sosa JJ, editor. Health and Clinical Psychology. New York: Elsevier; 1985. pp. 477–490.
    1. Attenborough D, Fothergill A. Planet Earth: Complete BBC Series [DVD] London: British Broadcasting Corporation; 2006.
    1. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs G. State-trait anxiety inventory for adults. Menlo, CA: Mind Garden; 1983.
    1. Cohen P, Cohen J, Aiken LS, West SG. The problem of units and the circumstance for POMP. Multivariate Behav Res. 1999;34:315–346.
    1. Mehling WE, Price C, Daubenmier JJ, Acree M, Bartmess E, Stewart A. The multidimensional assessment of interoceptive awareness (MAIA) PloS One. 2012;7:e48230.
    1. Jacobs GD, Heilbronner RL, Stanley JM. The effects of short term flotation REST on relaxation: A controlled study. Health Psychol. 1984;3:99–112.
    1. Fine TH, Turner JW. The effect of brief restricted environmental stimulation therapy in the treatment of essential hypertension. Behav Res Ther. 1982;20:567–570.
    1. Turner JW, Fine T, Ewy G, Sershon P, Freundlich T. The presence or absence of light during flotation restricted environmental stimulation: Effects on plasma cortisol, blood pressure, and mood. Appl Psychophysiol Biofeedback. 1989;14:291–300.
    1. Turner JW, Jr, Fine TH, McGrady A, Higgins JT. Effects of bio-behaviorally assisted relaxation training on blood pressure and hormone levels and their variation in normotensives and essential hypertensives. In: Suedfeld P, Turner JW, Fine TH, editors. Restricted Environmental Stimulation. Recent Research in Psychology. New York: Springer; 1990. pp. 184–201.
    1. Bekhuis E, Boschloo L, Rosmalen JG, Schoevers RA. Differential associations of specific depressive and anxiety disorders with somatic symptoms. J Psychosom Res. 2015;78:116–122.
    1. Khalsa SS, Rudrauf D, Damasio AR, Davidson RJ, Lutz A, Tranel D. Interoceptive awareness in experienced meditators. Psycho-physiology. 2008;45:671–677.
    1. Khalsa SS, Lapidus RC. Can interoception improve the pragmatic search for biomarkers in psychiatry? Front Psychiatry. 2016;7:121.
    1. Domschke K, Stevens S, Pfleiderer B, Gerlach AL. Interoceptive sensitivity in anxiety and anxiety disorders: An overview and integration of neurobiological findings. Clin Psychol Rev. 2010;30:1–11.
    1. Stewart SH, Buffett-Jerrott SE, Kokaram R. Heartbeat awareness and heart rate reactivity in anxiety sensitivity: A further investigation. J Anxiety Disord. 2001;15:535–553.
    1. Paulus MP, Stein MB. An insular view of anxiety. Biol Psychiatry. 2006;60:383–387.
    1. Paulus MP. The breathing conundrum—interoceptive sensitivity and anxiety. Depress Anxiety. 2013;30:315–320.
    1. Wolpe J. Psychotherapy by Reciprocal Inhibition. Stanford: Stanford University Press; 1958.
    1. Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci. 2011;6:537–559.
    1. Van Dam NT, van Vugt MK, Vago DR, Schmalzl L, Saron CD, Olendzki A, et al. Mind the hype: A critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspect Psychol Sci. 2018;13:36–61.
    1. Miller JJ, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry. 1995;17:192–200.
    1. Goyal M, Singh S, Sibinga EM, Gould NF, Rowland-Seymour A, Sharma R, et al. Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Intern Med. 2014;174:357–368.
    1. Goldberg SB, Tucker RP, Greene PA, Davidson RJ, Wampold BE, Kearney DJ, et al. Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clin Psy-chol Rev. 2018;59:52–60.
    1. Strauss C, Cavanagh K, Oliver A, Pettman D. Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: A meta-analysis of randomised controlled trials. PLoS One. 2014;9:e96110.
    1. Bornemann B, Herbert BM, Mehling WE, Singer T. Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training. Front Psychol. 2015;5:1504.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere