A randomized controlled safety and feasibility trial of floatation-REST in anxious and depressed individuals

BACKGROUND

Reduced Environmental Stimulation Therapy via floatation (floatation-REST) is a behavioral intervention designed to attenuate exteroceptive sensory input to the nervous system. Prior studies in anxious and depressed individuals demonstrated that single sessions of floatation-REST are safe, well-tolerated, and associated with an acute anxiolytic and antidepressant effect that persists for over 48 hours. However, the feasibility of using floatation-REST as a repeated intervention in anxious and depressed populations has not been well-investigated.

METHODS

In this single-blind safety and feasibility trial, 75 individuals with anxiety and depression were randomized to complete six sessions of floatation-REST in different formats: pool-REST (weekly 1-hour float sessions), pool-REST preferred (float sessions with flexibility of duration and frequency), or an active comparator (chair-REST; weekly 1-hour sessions in a Zero Gravity chair). Feasibility (primary outcome) was assessed via an 80% rate of adherence to the assigned intervention; tolerability via study dropout and duration/frequency of REST utilization; and safety via incidence of adverse events and ratings about the effects of REST.

RESULTS

Of 1,715 individuals initially screened, 75 participants were ultimately randomized. Six-session adherence was 85% for pool-REST (mean, M = 5.1 sessions; standard deviation, SD = 1.8), 89% for pool-REST preferred (M = 5.3 sessions; SD = 1.6), and 74% for chair-REST (M = 4.4 sessions; SD = 2.5). Dropout rates at the end of the intervention did not differ significantly between the treatment conditions. Mean session durations were 53.0 minutes (SD = 12.3) for pool-REST, 75.4 minutes (SD = 29.4) for pool-REST preferred, and 58.4 minutes (SD = 4.3) for chair-REST. There were no serious adverse events associated with any intervention. Positive experiences were endorsed more commonly than negative ones and were also rated at higher levels of intensity.

CONCLUSIONS

Six sessions of floatation-REST appear feasible, well-tolerated, and safe in anxious and depressed individuals. Floatation-REST induces positively-valenced experiences with few negative effects. Larger randomized controlled trials evaluating markers of clinical efficacy are warranted.

CLINICAL TRIAL REGISTRATION IDENTIFIER

NCT03899090.

Induction of altered states of consciousness during Floatation-REST is associated with the dissolution of body boundaries and the distortion of subjective time

Floatation-REST (Reduced Environmental Stimulation Therapy) minimizes stimulation of the nervous system by immersing subjects in an environment without sound or light while they effortlessly float in thermoneutral water supersaturated with Epsom salt. Here we investigated the relationship between altered states of consciousness (ASC) and its association with the affective changes induced by Floatation-REST. Using a within-subject crossover design, 50 healthy subjects were randomized to 60 min of Floatation-REST or 60 min of Bed-REST (an active control condition that entailed lying supine on a warm waterbed in a dark and quiet room). Following Floatation-REST, subjects felt significantly more relaxed, less anxious, and less tired than after Bed-REST. Floatation-REST also induced significantly more pronounced ASC characterized by the dissolution of body boundaries and the distortion of subjective time. The loss of body boundaries mediated the loss of anxiety, revealing a novel mechanism by which Floatation-REST exerts its anxiolytic effect.

The Effectiveness of Web-Based Psychotherapy to Treat and Prevent Burnout: Controlled Trial

Background

Burnout is a hidden productivity killer in organizations. Finding a solution to efficiently measure and proactively prevent or rehabilitate employees with burnout is a challenge. To meet this unabated demand, companies and caregivers can focus on proactive measures to prevent “Burnout as an Occupational Phenomenon.”

Objective

We aimed to address effectiveness, reliability, and validity of the empowerment for participation (EFP) batch of assessments to measure burnout risk in relation to the efficacy of web-based interventions using cognitive behavioral therapy (CBT) and floating to improve mental health and well-being. We introduced three risk assessments: risk for burnout, risk of anxiety, and risk for depression.

Methods

We used an interventional, empirical, and parallel design using raw EFP psychometric data to measure the effectiveness of web-based therapy to reduce the risk of burnout between a control group and web-based therapy group. A total of 50 participants were selected. The rehabilitation and control groups consisted of 25 normally distributed employees each. The rehabilitation group received therapy, whereas the control group had not yet received any form of therapy. IBM SPSS was used to analyze the data collected, and a repeated measures ANOVA, an analysis of covariance, a discriminant analysis, and a construct validity analysis were used to test for reliability and validity. The group was selected from a list of employees within the My-E-Health ecosystem who showed a moderate or high risk for burnout. All assessments and mixed-method CBT were web-based, and floating was conducted at designated locations. The complete EFP assessment was integrated into a digital ecosystem designed for this purpose and therapy, offering a secure and encrypted ecosystem.

Results

There was a statistically significant difference between pre- and postassessment scores for burnout. The reliability of the burnout measure was good (Cronbach α=.858; mean 1.826, SD 3.008; Cohen d=0.607; P<.001) with a high validity of 0.9420. A paired samples 2-tailed test showed a good t score of 4.292 and P<.001, with a good effect size, Cohen d=0.607. Web-based therapy reduced the risk for burnout in participants compared with the control group. Tests of between-subject effects show F=16.964, a significant difference between the control group and the web-based therapy group: P<.001, with movement between the group variables of 0.261 or 26.1% for the dependent variable.

Conclusions

This study suggests good reliability and validity of using web-based interventional mixed methods CBT to reduce the risk of burnout. The EFP batch of web-based assessments could reliably identify morbidity risk levels and successfully measure clinical interventions and rehabilitation with consistently reliable results to serve as both a diagnostic and therapeutic tool worthy of major research in the future.

Trial Registration

ClinicalTrials.gov NCT05343208; https://clinicaltrials.gov/ct2/show/NCT05343208

Acute Floatation-REST Improves Perceived Recovery After a High-Intensity Resistance Exercise Stress in Trained Men

PURPOSE

The aim of the present investigation was to determine whether a 1-h floatation-restricted environmental stimulation therapy (floatation-REST) session could augment recovery from high-intensity resistance exercise (6 × 10 back squats, 2-min rest) known to induce significant metabolic, adrenergic, and mechanical stress.

METHODS

Eleven healthy resistance-trained males (age, 22.5 ± 2.3 yr; height, 176.4 ± 6.0 cm; weight, 85.7 ± 6.2 kg; back squat one-repetition maximum, 153.1 ± 20.1 kg; strength-to-weight ratio, 1.8 ± 0.2) completed the within-subject, crossover controlled study design. Participants completed two exercise testing blocks separated by a 2-wk washout. In one block, the high-intensity resistance exercise protocol was followed by a 1-h floatation-REST session, whereas recovery in the alternate block consisted of a passive sensory-stimulating control. Markers of metabolic stress, neuroendocrine signaling, structural damage, inflammation, and perceptions of soreness, mood state, and fatigue were assessed over a 48-h recovery window.

RESULTS

Floatation-REST significantly attenuated muscle soreness across recovery ( P = 0.035) with greatest treatment difference immediately after the intervention ( P = 0.002, effect size (ES) = 1.3). Significant differences in norepinephrine ( P = 0.028, ES = 0.81) and testosterone ( P = 0.028, ES = 0.81) immediately after treatment revealed the modification of neuroendocrine signaling pathways, which were accompanied by greater improvements in mood disturbance ( P = 0.029, ES = 0.81) and fatigue ( P = 0.001, ES = 1.04).

CONCLUSIONS

Because no adverse effects and significant and meaningful benefits were observed, floatation-REST may prove a valuable intervention for managing soreness and enhancing performance readiness after exercise.

Evaluation of short-term effects of three passive aquatic interventions on chronic non-specific low back pain: Study protocol for a randomized cross-over clinical trial

Background

Low back pain (LBP) is among the most common physical ailments and its chronic manifestation is a leading cause for disability worldwide. LBP is not attributable to a known diagnosis in 85% of the cases and therefore called chronic non-specific LBP (cnLBP). Passive immersion in warm water is commonly claimed to reduce muscular tension and pain, but not yet sufficiently investigated with regard to cnLBP. The current study compares three passive aquatic interventions regarding their effects on cnLBP: floating (resting in a supine immersed position on flotation devices), WATSU (a passive hands-on treatment, in which a practitioner stands in warm water, gently moving and massaging the client), and a Spa session.

Methods

In this randomized cross-over clinical trial, all 24 adult participants with cnLBP will undergo the three interventions in balanced order with a washout-period of at least two weeks in between. Assessments will take place at baseline and follow-up of study and immediately before and after each intervention. Assessments cover the primary outcome self-reported current pain (Visual Analog Scale, range: 0–100 mm), other self-report questionnaires (addressing, e.g., personality traits or -states), and physiological parameters (e.g., measurement of spinal range of motion).

Discussion

The study adds estimates of intervention-specific effect-sizes of widespread passive aquatic interventions to cnLBP. The study also points to potential underlying pain-reducing mechanisms.

Trial registration

The protocol was approved by the Ethics Committee of the Canton Bern (ProjectID: 2018–00461). Trial registration is intended at ClinicalTrials.gov.

Flotation Restricted Environmental Stimulation Therapy for Chronic Pain: A Randomized Clinical Trial

IMPORTANCE

Flotation restricted environmental stimulation therapy (REST) is an emerging therapeutic intervention that, to our knowledge, has never been directly compared with an indistinguishable placebo in patients with chronic pain.

OBJECTIVE

To determine whether 5 flotation-REST sessions alleviate chronic pain.

DESIGN, SETTING, AND PARTICIPANTS

This single-blind, randomized clinical trial compared flotation-REST as an intervention for the treatment of chronic pain with indistinguishable placebo and wait-list control conditions at Hannover Medical School, Hannover, Germany. Men and women aged 18 to 75 years who had been diagnosed with chronic pain disorder with psychological and somatic factors (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification, code F45.41) by physicians at the study center were randomly assigned to 1 of the 3 groups. Data were collected from June 26, 2018, to June 18, 2020.

INTERVENTIONS

Patients in the intervention and placebo groups underwent 5 treatment sessions lasting 60 to 90 minutes, each session separated by 4 days. The placebo treatment was delivered in the same floating tank but controlled for effortless floating and environmental stimulus restriction. Patients in the wait-list control group did not receive any additional treatment but were asked to continue any ongoing treatments at the time of enrollment.

MAIN OUTCOMES AND MEASURES

The primary outcome was a change in pain intensity 1 week after the last treatment session. The assessment was repeated at 12 and 24 weeks. Secondary outcomes included pain-related disability, pain area, pain widespreadness (number of body regions affected by pain), anxiety, depression, and quality of life, as well as several other short-term outcomes.

RESULTS

A total of 99 patients (mean [SD] age, 51.7 [12.3] years; 80 women [81%]) were included in the study. No differences were found among the groups in the primary outcomes (mean [SD] change in maximum pain: -7.6 [19.7] for the intervention group, -5.8 [12.7] for the placebo group, and 0.4 [14.0] for the wait-list control group; mean [SD] change in mean pain: -2.1 [19.4] for the intervention group,-4.2 [16.2] for the placebo group, and 2.0 [12.6] for the wait-list control group). Long-term secondary outcomes did not show significant differences. In the short term, patients in the intervention group showed significant improvements in pain intensity (-17.0 [17.1]; P < .001), relaxation (23.9 [22.6]; P < .001), anxiety (-10.1 [8.4]; P < .001), pain area (-3.6% [7.4%]; P < .001), and widespreadness (-2.0 [3.0]; P < .001), and similar changes where observed in the placebo group.

CONCLUSIONS AND RELEVANCE

Patients with chronic pain experienced no long-term benefits from the 5 flotation-REST interventions. Clinically relevant short-term changes in pain in the placebo group suggest that improvements may not be caused by environmental stimulus restriction or effortless floating as previously thought.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03584750.

Taking the body off the mind: Decreased functional connectivity between somatomotor and default-mode networks following Floatation-REST

Floatation‐Reduced Environmental Stimulation Therapy (REST) is a procedure that reduces stimulation of the human nervous system by minimizing sensory signals from visual, auditory, olfactory, gustatory, thermal, tactile, vestibular, gravitational, and proprioceptive channels, in addition to minimizing musculoskeletal movement and speech. Initial research has found that Floatation‐REST can elicit short‐term reductions in anxiety, depression, and pain, yet little is known about the brain networks impacted by the intervention. This study represents the first functional neuroimaging investigation of Floatation‐REST, and we utilized a data‐driven exploratory analysis to determine whether the intervention leads to altered patterns of resting‐state functional connectivity (rsFC). Healthy participants underwent functional magnetic resonance imaging (fMRI) before and after 90 min of Floatation‐REST or a control condition that entailed resting supine in a zero‐gravity chair for an equivalent amount of time. Multivariate Distance Matrix Regression (MDMR), a statistically‐stringent whole‐brain searchlight approach, guided subsequent seed‐based connectivity analyses of the resting‐state fMRI data. MDMR identified peak clusters of rsFC change between the pre‐ and post‐float fMRI, revealing significant decreases in rsFC both within and between posterior hubs of the default‐mode network (DMN) and a large swath of cortical tissue encompassing the primary and secondary somatomotor cortices extending into the posterior insula. The control condition, an active form of REST, showed a similar pattern of reduced rsFC. Thus, reduced stimulation of the nervous system appears to be reflected by reduced rsFC within the brain networks most responsible for creating and mapping our sense of self.

Examining the short-term anxiolytic and antidepressant effect of Floatation-REST

Floatation-REST (Reduced Environmental Stimulation Therapy) reduces sensory input to the nervous system through the act of floating supine in a pool of water saturated with Epsom salt. The float experience is calibrated so that sensory signals from visual, auditory, olfactory, gustatory, thermal, tactile, vestibular, gravitational and proprioceptive channels are minimized, as is most movement and speech. This open-label study aimed to examine whether Floatation-REST would attenuate symptoms of anxiety, stress, and depression in a clinical sample. Fifty participants were recruited across a spectrum of anxiety and stress-related disorders (posttraumatic stress, generalized anxiety, panic, agoraphobia, and social anxiety), most (n = 46) with comorbid unipolar depression. Measures of self-reported affect were collected immediately before and after a 1-hour float session, with the primary outcome measure being the pre- to post-float change score on the Spielberger State Anxiety Inventory. Irrespective of diagnosis, Floatation-REST substantially reduced state anxiety (estimated Cohen’s d > 2). Moreover, participants reported significant reductions in stress, muscle tension, pain, depression and negative affect, accompanied by a significant improvement in mood characterized by increases in serenity, relaxation, happiness and overall well-being (p < .0001 for all variables). In reference to a group of 30 non-anxious participants, the effects were found to be more robust in the anxious sample and approaching non-anxious levels during the post-float period. Further analysis revealed that the most severely anxious participants reported the largest effects. Overall, the procedure was well-tolerated, with no major safety concerns stemming from this single session. The findings from this initial study need to be replicated in larger controlled trials, but suggest that Floatation-REST may be a promising technique for transiently reducing the suffering in those with anxiety and depression.

Trial registration: ClinicalTrials.gov NCT03051074

Case Studies on Fibromyalgia and Burn-out Depression Using Psychotherapy in Combination with Flotation-Rest: Personality Development and Increased Well-Being

The aim of the study was to examine whether and how the combination of therapy and flotation tank could be used to treat patients with severe stress problems. Two women on long-term sick-leave, aged 55 and 58, participated in the study, which was carried out over a period of one year. One of these women was diagnosed as suffering from burn out depression and the other from fibromyalgia. The therapy program had several components: flotation-REST, group therapy, conversational therapy, and picture production. The clients kept journals and were the participants of deep interviews on two occasions. “The Empirical Phenomenological Psychological Method” (Karlsson, 1995) was used in the analysis, which generated four overarching themes: a) the therapeutic work model; b) transformation of feelings; c) self-insight; and d) meaning. These together constituted a “therapeutic circle” which after a while transformed into a “therapeutic spiral” of increased meaning and enhanced well-being.

Promising effects of treatment with flotation-REST (restricted environmental stimulation technique) as an intervention for generalized anxiety disorder (GAD): a randomized controlled pilot trial

Background

During Flotation-REST a person is floating inside a quiet and dark tank, filled with heated salt saturated water. Deep relaxation and beneficial effects on e.g. stress, sleep difficulties, anxiety and depression have been documented in earlier research. Despite that treatments for generalized anxiety disorder (GAD) are effective; it is till the least successfully treated anxiety disorder, indicating that treatment protocols can be enhanced. The use of Flotation-REST as a treatment of GAD has not been researched. The aim of the present study was to conduct an initial evaluation of the effects in a self-diagnosed GAD sample.

Methods

This study was a randomized, parallel group, non-blinded trial with 1:1 allocation ratio to waiting list control group (n = 25) or to a twelve session treatment with flotation-REST (n = 25). Inclusion criteria’s were: 18–65 years and GAD (as defined by self-report measures). The primary outcome was GAD-symptomatology, and secondary outcomes were depression, sleep difficulties, emotion regulation difficulties and mindfulness. Assessments were made at three time points (baseline, four weeks in treatment, post-treatment), and at six-month follow-up. The main data analyses were conducted with a two-way MANOVA and additional t-tests. Forty-six participants (treatment, n = 24; control, n = 22) were included in the analyses.

Results

A significant Time x Group interaction effect for GAD-symptomatology [F_(2,88) = 2.93, p < .001, η_p² = .062] was found. Further analyses showed that the GAD-symptomatology was significantly reduced for the treatment group (t₍₂₃₎ = 4.47, p < .001), but not for the waiting list control group (t₍₂₁₎ = 0.98, p > .05), when comparing baseline to post-treatment scoring. Regarding clinical significant change, 37 % in the treatment group reached full remission at post-treatment. Significant beneficial effects were also found for sleep difficulties, difficulties in emotional regulation, and depression, while the treatment had ambiguous or non-existent effects on pathological worry and mindfulness. All improved outcome variables at post-treatment, except for depression, were maintained at 6-months follow. No negative effects were found.

Conclusion

The findings suggest that the method has potential as a complementary treatment alongside existing treatment for GAD. More studies are warranted to further evaluate the treatments efficacy.

Trial registration

Australian New Zealand Clinical Trial Registry: ACTRN12613001105730, Date of registration: 03/10/2013

Beneficial effects of treatment with sensory isolation in flotation-tank as a preventive health-care intervention - a randomized controlled pilot trial

BACKGROUND

Sensory isolation in a flotation tank is a method known for inducing deep relaxation and subsequent positive health effects for patients suffering from e.g. stress or muscle tensions pains. Very few studies have investigated this method as a preventive health-care intervention. The purpose of this study was to evaluate the effects in healthy participants after receiving a series of flotation tank treatment.

METHODS

Sixty-five participants (14 men and 51 women) who were all part of a cooperative-health project initiated by their individual companies, were randomized to either a wait-list control group or a flotation tank treatment group where they participated in a seven weeks flotation program with a total of twelve flotation sessions. Questionnaires measuring psychological and physiological variables such as stress and energy, depression and anxiety, optimism, pain, stress, sleep quality, mindfulness, and degree of altered states of consciousness were used. Data were analysed by two-way mixed MANOVA and repeated measures ANOVA.

RESULTS

Stress, depression, anxiety, and worst pain were significantly decreased whereas optimism and sleep quality significantly increased for the flotation-REST group. No significant results for the control group were seen. There was also a significant correlation between mindfulness in daily life and degree of altered states of consciousness during the relaxation in the flotation tank.

CONCLUSIONS

It was concluded that flotation-REST has beneficial effects on relatively healthy participants.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12613000483752.

Chronic whiplash-associated disorders and their treatment using flotation-REST (restricted environmental stimulation technique)

In this study, we investigated for the first time whether flotation-REST might be used for treating chronic whiplash-associated disorders (WAD). Six women and one man, all diagnosed by licensed physicians as having chronic whiplash-associated disorder, participated. Two of the participants were beginners with regard to flotation-REST (2 or 3 treatments), and five of them had experienced between 7 and 15 treatments. The method for data collection was the semistructured qualitative interview. The empirical phenomenological psychological method devised by Karlsson was used for the analyses. Two qualitative models explaining the participants' experiences of flotation-REST emerged. The models describe the participants' experiences of flotation-REST, as well as the short-term effects of the treatment in terms of five phases: (a) intensification, (b) vitalization, (c) transcendation, (d) defocusation, and (e) reorientation. Results indicated that flotation-REST is a meaningful alternative for treating chronic whiplash-associated disorder.

Wellness through a comprehensive yogic breathing program - a controlled pilot trial

Background

Increasing rates of psychosocial disturbances give rise to increased risks and vulnerability for a wide variety of stress-related chronic pain and other illnesses. Relaxation exercises aim at reducing stress and thereby help prevent these unwanted outcomes. One of the widely used relaxation practices is yoga and yogic breathing exercises. One specific form of these exercises is Sudarshan Kriya and related practices (SK&P) which are understood to have favourable effects on the mind-body system. The goal of this pilot study was to design a protocol that can investigate whether SK&P can lead to increased feeling of wellness in healthy volunteers.

Methods

Participants were recruited in a small university city in Sweden and were instructed in a 6-day intensive program of SK&P which they practiced daily for six weeks. The control group was instructed to relax in an armchair each day during the same period. Subjects included a total of 103 adults, 55 in the intervention (SK&P) group and 48 in the control group. Various instruments were administered before and after the intervention. Hospital Anxiety Depression Scale measured the degree of anxiety and depression, Life Orientation Test measured dispositional optimism, Stress and Energy Test measured individual's energy and stress experiences. Experienced Deviation from Normal State measured the experience of altered state of consciousness.

Results

There were no safety issues. Compliance was high (only 1 dropout in the SK&P group, and 5 in the control group). Outcome measures appeared to be appropriate for assessing the differences between the groups. Subjective reports generally correlated with the findings from the instruments. The data suggest that participants in the SK&P group, but not the control group, lowered their degree of anxiety, depression and stress, and also increased their degree of optimism (ANOVA; p < 0.001). The participants in the yoga group experienced the practices as a positive event that induced beneficial effects.

Conclusion

These data indicate that the experimental protocol that is developed here is safe, compliance level is good, and a full scale trial is feasible. The data obtained suggest that adult participants may improve their wellness by learning and applying a program based on yoga and yogic breathing exercises; this can be conclusively assessed in a large-scale trial.

Trial Registration

Australian Clinical Trial Registry ACTRN012607000175471.

EFFECTS OF FLOTATION REST (RESTRICTED ENVIRONMENTAL STIMULATION TECHNIQUE) ON STRESS RELATED MUSCLE PAIN: ARE 33 FLOTATION SESSIONS MORE EFFECTIVE THAN 12 SESSIONS?

The aim of the study was to investigate whether or not 33 flotation sessions were more effective for stress-related ailments than 12 sessions. Participants were 37 patients, 29 women and 8 men, all diagnosed as having stress-related pain of a muscle tension type. The patients were randomized to one of two conditions: 12 flotation-REST treatments or 33 flotation-REST treatments. Analyses for subjective pain typically indicated that 12 sessions were enough to get considerable improvements and no further improvements were noticed after 33 sessions. A similar pattern was observed concerning the stress-related psychological variables: experienced stress, anxiety, depression, negative affectivity, dispositional optimism, and sleep quality. For blood pressure no effects were observed after 12 sessions, but there was a significant lower level for diastolic blood pressure after 33 sessions. The present study highlighted the importance of finding suitable complementary treatments in order to make further progress after the initial 12 sessions.