Sensory Modulation Approaches To Mental Health

Moore, K., Flood, M., & Ninow, P. (2021, October-November). Sensory modulation approaches to mental health interventions for adults and adolescents. Workshop presented through the Canadian Association of Occupational Therapists, Online delivery.

10/4/2021

This handout is copyrighted to Karen Moore, OTR/L (2021). Registrants of the workshop “Sensory modulation approaches to mental health interventions for adults and adolescents” are permitted to share handouts and worksheets if such copies are distributed without charge for consumer information purposes in their own clinical practice. All copies must include the copyright notice. The handout package may not be copied in its entirety. Reproduction of worksheets or handout materials for commercial use or for useby an entire institution or in-service training to a large group of students or professionals is prohibited without written permission of the author. Slide handouts are for the use of workshop participants only and shall not be copied or distributed to others. 1

CAOT Professional Development Online Workshop

Sensory Modulation Approaches to Mental HealthInterventions for Adults and Adolescents

Pre-recorded Lecture 1Presenters:

Karen Moore, OTR/L, Megan Flood, OTR/L, Peggy Ninow, OTR/L, CHTP, SEP

Tommy’s Story

❑ Tommy’s responses inspired my

lifelong commitment to the study

and use of sensory modalities.

❑ In this workshop I will share some

of the information and insights I

discovered along the way.

Copyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

This story captures the essence of the journey that brings me before you today.

Sensory Connection Program Books

Conflict disclosure

Karen Moore is the originator and owner of the Sensory Connection Program

She receives royalties as the author of the following 3 books published through Therapro:

The Sensory Connection Program: Activities for Mental Health Treatment (Manual and

Handbook) (2005)

The Sensory Connection Program: Self-Regulation Workbook (2008)

The Sensory Connection Program: Curriculum for Self-Regulation (2015)


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Contact Information

Karen Moore

The Sensory Connection Program

Email: [email protected]

Website: www.sensoryconnectionprogram.com

Facebook: https://www.facebook.com/The-Sensory-Connection-Program-138697209516359/


Sensory Connection Program Team

Angela Balzarini Leonhart

and KarenPeggy Ninow

Megan Flood

Performing and Healing Arts

Reiki Master

Global Somatics

Somatic Experiencing

Healing Touch

Biofeedback

Sensory/Trauma Consultant

Somatic Experiencing


Sensory Modulation Workshop Plan

Lecture 4.5 hours

❖ Background – sensory modulation approaches

❖ Stress response and social engagement theory

❖ External, interoceptive, and internal senses

❖ Co-creation of intervention plans

❖ Environment, sensory spaces and rooms

Homework

Interactive Webinar Lab A (1.5 hours)

Interactive Webinar Lab B (1.5 hours)

Lecture 4.5 hours

❖ Sensory processing patterns and MH

❖ Sensory issues/performance

❖ Formal/informal sensory assessments

❖ Sensory perspectives - trauma informed care

❖ Crisis Intervention plans

❖ Sensory approaches and clinical practice

Homework

Interactive Webinar Lab C (1.5 hours)

Interactive Webinar Lab D (1.5 hours)


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mailto:[email protected]

http://www.sensoryconnectionprogram.com/

https://www.facebook.com/The-Sensory-Connection-Program-138697209516359/


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Workshop Handouts

Slide handouts

References

Workshop handouts

❖ Outline/Plan for lectures and labs

❖ Sensory Defensiveness Screening

❖ Informal assessments

❖ Worksheets, posters, directions for games and other materials to support

implementation

Homework assignment package

Note that when this star appears it will reference pertinent handout materials


My Goals for You

For you to become as excited and passionate as I am about sensory

approaches

That you will become advocates for the use of sensory approaches in

mental health

That you will contribute to the body of research and understanding

of sensory approaches by doing small studies in your clinical

environment.


Occupational Therapists Unique Roles

in Sensory Modulation Approaches

Training and background in sensory integration unique to profession

Ability to perform and interpret sensory assessments and identify sensory

processing problems

Ability to identify sensory styles and preferences and to help structure

environment accordingly and develop coping strategies

Ability to develop client-centred sensory enrichment diets

Ability to support trauma-informed approaches

Ability to identify and work on self-regulation problems and sensory issues

interfering with occupational performance

(Fraser et al., 2017; Snedden, 2012; McGreevy &

Boland, 2020; Champagne et al., 2010; Champagne,

2010a)Copyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

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Sensory Modulation

Regulatory Component of

Sensory Processing

Sensory modulation is “the capacity to regulate and organize the degree,

intensity and nature of responses to sensory input in a graded and adaptive

manner. This allows the individual to achieve and maintain an optimal range of

performance and to adapt to challenges in everyday life.”

(Miller et al., 2001, p. 57)

“Sensory modulation is considered a twofold process. It originates in the central

nervous system as the neurological ability to regulate and process sensory

stimuli; this subsequently offers the individual an opportunity to respond

behaviorally to the stimulus.”

(Brown et al., 2018, p. 7)

Defining sensory modulation...for application by occupational therapists


Sensory Modulation Approaches

Facilitate self-regulation and personal control over emotions and

behaviours (Failure to self-regulate is often the barrier to discharge in

MH settings)

Modulate arousal through the sensory system and social engagement

Work pre-emptively by learning to assess and track internal states and

recognize signs, triggers and sensory sensitivities

Use the environment to support maximum success

Monitoring internal

conditions and sensations

Coping strategiesCrisis strategies

Crisis intervention plansStress reduction


Automatic referrals

Self-injury

Restraints or seclusion

Priority reasons for referral

Problems with emotional regulation/self-control

Maladaptive coping strategies

Avoidance or sensory seeking behaviours

Unexplained explosions of emotions

Severe withdrawal or emotional shutdown

Who Needs Sensory-Focused Treatment?


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Sensory Modulation is a Problem-Solving

Approach – Every Situation is Different

What are you having difficulty doing? (at home, in school,

at work, in community)

What do you think is interfering?

Are you having any problems calming yourself down or

energizing yourself?

What are you doing now that helps?

When do you feel the most comfortable and relaxed?

When do you feel most productive?


The things I want to know!

Developed to brainstorm sensory-related

behaviours, preferences and proclivities in

adults and adolescents

Questions reflect clinical experience with

typical problematic times and situations

Questionnaire for Sensory-Related

Behaviours and Experiences

See Questionnaire for Sensory-Related Behaviours and Experiences

Handouts pp. 6-7


“Self-Centred” Treatment

•Begins with self-awareness

•Moves to self-control

•Develops into self-care and effective engagement in valued roles

“Self-Centred”= Person-Centred


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Scanlon & Novak (2015) scoping review suggests that sensory approaches are thought to be non-invasive, self-directing and empowering interventions that support recovery-oriented programs and trauma-informed care and that occupational therapists are emerging as key players in this area of practice.

McGreevy & Boland (2020) review of occupational therapy literature determined that sensory interventions are an emerging and promising area of practice but review of 18 papers concludes that more research is required.

Sutton & Nicholson (2011) highlights that sensory modulation is an effective tool for inducing a calm state, it supports rapid building of trust and rapport with staff and it facilitates awareness and self-management and regulation of emotions.

Studies of Sensory Modulation Interventions

Notes on this study can be

found on the SCP website:

http://www.sensoryconnectio

nprogram.com/pdf/sutton_ni

cholson_sensory_room_study.

pdf

Studies Supporting Sensory Modulation

Approaches

Gardner (2016) Small pilot program demonstrated efficacy in reducing self-perceived arousal levels for individuals on an inpatient involuntary psychiatric unit. Participants viewed treatment as valuable to their experience on the unit as well as recovery.

Like Champagne and Sayer’s pilot program, there was a greater change in arousal levels if patients initially felt more agitated or distressed.

Individual sensory sessions demonstrated a greater change in decreasing arousal than group sessions.

Adams-Leask et al. (2018)

Study involved benefits of sensory modulation in a MH emergency setting

Self-reported distress was significantly reduced post sensory modulation use

Consumers reported it was helpful, distracting, calming and helped manage negative emotions and thoughts

Sensory modulation promotes consumer self-management

Excellent chart on when to use sensory modulation


Support for Sensory Modulation

Continued

Hitch et al. (2020)

Article provides overview of sensory modulation approaches including

benefits and challenges. Authors proport that a growing evidence base

supports the use of sensory modulation; positive outcomes reported by

service users and mental health practitioners across inpatient and community

settings.

Sensory modulation approaches support a strong therapeutic relationship,

shared decision making and consumer choice and enable people to manage

their own conditions.

Treatment can be applied using low-cost sensory items that are available in

the home and community.


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http://www.sensoryconnectionprogram.com/pdf/sutton_nicholson_sensory_room_study.pdf


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Sensory Modulation and Occupational

Performance

Sensory processing problems can have a negative impact on an adult’s ability to engage in important life skills and occupations including ADLs, work, leisure, socialization, parenting and intimate relationships.

Andersson et al. (2020)

Participants with mental illness in study reported that to protect oneself against sensory stimulation they avoided exposure by not participating in certain occupations even though they were meaningful such as going to lunch with friends, going to a party, doing shopping, participating in sports or community events and even avoiding celebrations such as Easter brunch or Christmas dinner.

The study concluded that sensory stimuli affects engagement in daily occupation and self-modulation strategies are used in order to enable participation in daily life. The study highlighted the importance of helping service users to better understand their sensory processing patterns in order to improve and expand on strategies they were already using intuitively.

(May-Benson, 2011; McCarter, 2010; Moore & Henry, 2002; Pfieffer, 2002: Oliver, 1990;

Kinnealey et al., 1995; Reisman & Feeney, 1990)


“The experience of

being human is

embedded in

sensory events of

everyday life.”

(Dunn, 2001, p. 608)

We ALL Use Sensory

Strategies!


Focus is on the present

Brings self-awareness and

environmental awareness

Regulation through physiology

Sensory Approaches


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Using the Body to Calm the Mind

Sensory input can be used to help calm

the system –

even when cognitive techniques fail!

In crisis and critical illness there is “no wise mind.”


In the experimental context cognitive emotional

regulation has been show to be effective in fostering

adaptive behaviours.

Add stress and the ability to use these strategies

becomes impaired.

Cognitive Emotion Regulation Fails the

Stress TestResearch study: Raio et al. (2013) PNAS.org


Permission & Empowerment

➢ It is ok to be good to yourself!

➢ It is a good and necessary thing

to care for yourself!

➢You deserve it!

➢You can do it!

➢You are in control!


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Therapeutic Use of Self

Our most important sensory

approach tool is the

“therapeutic use of self.”Tina Champagne

Many of the studies cited in this paper mention that one of the most valued results of the use

of sensory approaches was the improvement in therapeutic relationships and trust between

service users and staff (Baillon et al., 2002; Lee et al., 2010; Smith & Jones, 2014; Scanlan &

Novak, 2015; Sutton & Nicholson, 2011; Te Pou o te Whakaaro Nui, 2010).


Rethinking the Stress ResponsePolyvagal and Social Engagement Theory

Stephen Porges

Porges gives us a new understanding of the stress response system informs our practice and explains why many of our sensory strategies work, especially those involving the cranial nerves.

Supports work of Oetter et al. (1993) including regulation through the “suck, swallow breathe synchrony” and Therapeutic Listening.

Social engagement theory helps us identify the best ways to approach a person in crisis and supports the importance of the “therapeutic use of self” and “co-regulation.”

(Oetter et al., 1993; Frick, 2002; Porges, 2011; Porges & Carter, 2017)


Evolution of Threat Response System

Appraisal/Communication

(tend and befriend) ventral vagal

neural regulation myelinated

Flight/Fight

Sympathetic nervous system

neural regulation unmyelinated

Freeze

Old vagal system

Dorsal vagal

We use the newer circuit to promote calm states, to soothe ourselves, and to engage with others. When this doesn't work, we mobilize for fight-or-flight behaviours. And if that doesn't do it, we resort to the old vagal system and freeze.

Porges (2011) calls this evolved system

the Social Engagement System

Man’s challenges became more complex,

he became more social and his stress response system needed to be more

metabolically efficient.

Dana, D. (2020)

Polyvagal exercises for

safety and connection.


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Social Engagement System

In the brainstem the Vagus nerve

connects to the Cranial Nerves

controlling:

Eyelid opening (looking)

Facial muscles (emotional expression)

Middle ear muscles

(extracting human voice)

Muscles of mastication (ingestion)

Laryngeal and pharyngeal muscles

(prosody and intonation)

Head-turning muscles

(social gesture and orientation)

(Porges, 2007, 2011)


Polyvagal TheoryThree Organizing Principles

Autonomic hierarchy

Ventral vagal system (ability for safety through connection and social engagement; body and brain work together)

Sympathetic system adds fight or flight

Early dorsal vagal system (strategies of immobilization)

Neuroception

Detection of risk without awareness (ANS listens inside the body, outside in the environment and in relationships)

In healthy systems the nervous system evaluates risk and matches neurophysiological state with actual risk of environment – when safe defensive structures are inhibited enabling social engagement and calm

In dysregulated systems there is a mismatch – environment perceived as dangerous when it is safe – results in fight, flight or freeze behaviours

Co-regulation

Through co-regulation we connect with others and create a shared sense of safety

Reciprocity in therapeutic relationship engages therapeutic process of change

(Porges & Dana, 2018; Porges, 2004; Dana, 2020)Copyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

Polyvagal Theory Provides a Framework to

Integrate SM With Aggression Management

Sutton et al. (2013) Authors made an argument that recent advances in neurophysiology explain why “top down” cognitive strategies and verbal de-escalation have been shown to have limited effectiveness (Porges, 2001). Authors believed that deliberate use of sensory input promoted a regulation of arousal and experience of safety by accessing evolutionarily advanced neural pathways that promote adaptive social behaviour (Porges, 1995, 2008). A conclusion of the study was that the polyvagal theory of Porges provides a suitable framework to integrate sensory modulation approaches with aggression management models.

Findings of this study align with other research that found sensory interventions to have a calming effect in people experiencing distress (Chalmers et al., 2012; Novak et al., 2012).

Moore, K. (2016). Following the Evidence: Sensory Approaches in Mental Health. http://www.sensoryconnectionprogram.com/sensory_treatment.php


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Theory suggests

1. Bring person to a safe place, lower voice, encourage vocalization, playing or listening to music.

2. Stimulate neural circuits related to social engagement (muscles of ears, orienting responses, “suck, swallow, breath sequences,” head turning, and vocalization).

Face-Heart System Strategies

Based on Porges’ Polyvagal Theory

(Porges, 2007, 2009, 2011)


Sensory Ideas to Decrease Stress

Response

Find your environmental or auditory “Safe Space.”

Make a visual cue card

Hum a tune, whistle, play a kazoo

Suck a lollipop or hot cinnamon candy

Practice breathing exercises

Walk and talk

Listen

Try yoga


Signs of Regulation and a Functional

Range of Resilience

System is relaxed, yet alert

Able to stay present – in the moment

Able to process change without flooding, compensating or shutting down

Appropriately responsive to environment

Connected to body

Available to connect with others

Peggy NinowCopyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

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Signs of Dysregulation

Lack of prosody (patterns of stress and intonation in speech)

Poor eye contact

Difficulties in social communication

Blunted affect and facial expression

Difficulties in state regulation (hypervigilant, impulsive, tantrums,

anxious, unable to calm)

Difficulties listening/speech and language delays

Sound sensitivities

(Porges, 2017, 2011)


Who Could You Go To?

Game for Supports

Who could you go to if you are feeling upset?

What could they say?

How could they help?

At a party

On the unit

In the community

At school

When with friends

On an outing When visiting

Handouts pp. 9-10Copyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

Smiles or Even Fake Smiles Brighten Mood

“The most efficient stress-

reducer might just be a

smile. Engaging socially

with others triggers neural

circuits that calm the heart,

relax the gut, and switch

off fear.”

Stephen Porges Ph.D.

Director of the Brain-Body Center at the

University of Illinois


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Safety


It All Starts With Feeling Safe!

Sensory activities are a safe

place to start

Try a blanket wrap

Put something heavy on the lap

Provide a fidget tool

Create womb space

Suggest swinging or rocking


Make a Connection – Co-Regulate

Bring the person to a space that conveys safety (comfort space, sensory room)

Use your most important sensory tool: “therapeutic use of self”

Smile

Convey calm, empathy, and reassurance by your facial expression and body language

Use a quiet gentle voice

Assure safety (“You are safe, we are here to support you”)

Bring the person to the here and now (“Feel your chair beneath you, how does it feel, how does your body feel against it?”)

When the person seems ready, ask what is going on, how are they feeling, reflect back (“That must be a terrible feeling, it seems that you are very upset.”)

Draw on strengths (“What positive thing have you done in the past to help yourself when you feel like this?”)


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Where is your safe space?


Safe Practice

Respect personal space

Ask before touching

Keep yourself safe

Be aware of sensory triggers

Watch for symptoms of distress


Symptoms of Distress

❖ Anxiety

❖ Excuses

❖ Confusion

❖ Irritability

❖ Resistance to activity

❖ Defensive behaviours

❖ Paranoia

❖ Lightheadedness

❖ Increased perspiration

❖ Flushing or pallor

❖ Shortness of breath

❖ Over arousal

❖ Nausea

❖ Fearful expression

Stop!!!!

These are signs that a person is having

difficulty tolerating an activity.


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Feeling Safe Ideas

Tune in!

Use the

“POWER OF NOW”Eckhart Tolle

Lycra Hug

Auditory safe space

Aromatherapy

Share some tea

Seaweed activityCopyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

Make a Comfort and Wellness Mandala

What is your metaphor for comfort and

security?

Handouts p. 11


Our Senses

Exteroception – our sensitivity to stimuli outside the body

Olfactory, Taste, Visual, Auditory and Tactile

Interoception – our felt experience of the innerworkings of the body

Hunger, Discomfort, Internal Pain, Breathing

Movement Senses – sensory powerhouses according to Ayres,

Proprioception, Vestibular and Deep Pressure Touch,

work together to provide fundamental capacity for movement

body schema, orientation in space


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Regulating Sensory Input

➢Intensity

➢Frequency

➢Duration

➢Regularity

We need to find the right combination for the person and the situation!


The Power of the Senses

Focus is on the present

Brings self-awareness and

environmental awareness

Regulation through physiology


External Senses - Exteroception

Smell (grounding, aromatherapy, hygiene products)

Taste (exploration, grounding, comfort foods)

“When it comes to chocolate, resistance is futile”- unknown

Vision (art, bubble lamps, fiber optics)

Hearing (music, therapeutic listening, white noise)

Light touch (fidgets, tactile input)


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Sense of Smell

Primitive, protective, powerful

Feeds directly into limbic system (strong emotional connections)

Can be pleasant or obnoxious

Can signal danger

Good for grounding

We form strong associations (can be calming or triggering)

Alerting (peppermint spritz in air helped students focus) Cinnamon story


Aroma Ideas

Smell box for grounding

Fragrance activities using essential oils

Spray scents on fleece fabric square

Scented spray in air

Scented hand creams

Hot cider with cinnamon stick

Make a scented spray: 20

drops essential oil, ½ bottle

witch hazel, ½ distilled

water


The Sense of Taste

Smell and taste are linked

Linked to oral motor input

Gives pleasure to eating

Warns us if something has gone bad

Strong tastes can be used for grounding

People turn to comfort foods when upset


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Tasty Ideas for Therapy

Tea

Warm applesauce (kept in slow cooker)

Hot cinnamon candies or strong mints for

grounding

Taste game – can you guess the flavour of the

jellybean


➢Protective and informative

➢Connected to vestibular system

(earache causes dizziness)

➢Connected to Polyvagal system –

useful in sound therapies

➢Sounds can be soothing or

activating depending on beat,

volume, and personal taste

➢Loud noises can be upsetting and

some people have trouble recovering

The Sense of Hearing

Watch for disruptions in speech and language,

ringing in ears, poor environmental awareness,

over sensitivity to noise.

Sound Interventions

Sound machine (auditory safe space)

iPod

Radio/boombox/CD player

Simon game

Frame drum activity

Ear plugs

Headphones

Humming

Singing


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Sound Therapy

Modulation/Self-Regulation

* Attention and focus

* Sensory processing

* Language and communication skills

* Auditory defensiveness

* Social skills

* Postural control

* Bilateral coordination

* Motor planning

* Visual motor integration

Sheila M. Frick, OTR Vital Links

Evidenced based protocol that helps with

Hall, L. & Case-Smith, J. (2007) The effect

of sound-based intervention… AJOT

Stephen PorgesThe Safe and Sound Protocol

A non-invasive application of Polyvagal Theory, is an auditory intervention designed to reduce stress and auditory sensitivity while enhancing social engagement and resilience. By calming the physiological and emotional state, SSP can open the door for improved communication and more successful therapy.


Music in Therapy

Music facilitates:

Reorganization of mental processes

Tuning in

Vibration and synchronization

Breathing – together

Socialization

Communication and connection with others

Play – we “play music”

Self-experienceRomanowski (2007) Benefits and limitations of

music therapy with psychiatric patients in the

penitentiary system

✓ Sounds can impact muscle tone and equilibrium

✓ Music is the natural pacemaker (Don Campbell)

✓ There is a powerful affective response to music


➢ Unifying sense/protective

➢ Linked to vestibular sense

➢ Provides environmental awareness

➢ Eye movement has Polyvagal connections

➢ Eye contact

➢ Responses to visual stimulation are not universal

The Sense of Vision

Experiment with prism glasses (Held & Hein, 1963)


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Popular Ideas for Visual Input

Smile, eye contact

Constellation projectors

Lava lamps and bubble lamps

Ceiling light diffusers with clouds

Mural made of wall tiles

Oggz

Artwork

Aquarium

Glasses and mood activity

Eye mask for sleeping


External Sense of Touch

Skin is largest sense organ – receptors are found close to the surface

of the skin

Associated with light touch and tactile discrimination

Includes recognizing signals of temperature and pain (hot stove)

Usually alerting - protective

Informative of surroundings

Think of a branch touching your hair and you automatically duck

May promote avoidance

Tactile defensiveness – people have difficulty with light touch,

certain textures of clothes, feeling of sweat


The Magic of Fidget Widgets


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Our ability to notice internal conditions and sensations of

the body and to give meaning to them.

The eighth sensory system

Answers How do you feel?

InteroceptionHow do you feel?

Craig, A.D. (2015). How do you

feel? An interoceptive moment

with your neurobiological self.

Princeton, NJ: Princeton

University Press.


Feel it, Know it, Control it!

Using Sensory Feedback to Help With Difficult Emotions


“One prerequisite of successful

emotional regulation is the

awareness of emotional states, which

in turn is associated with the

awareness of body signals

(interoceptive awareness).”

Interoceptive Awareness Facilitates

Emotional Regulation

Fustos, J., Gramann, K., Hebert. B. M., & Pollatos, O. (2013). On the

embodiment of emotion regulation: Interoceptive awareness facilitates

reappraisal. Social Cognitive and Affective Neuroscience, 8(8), 911-917.


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Good awareness of body sensations linked to:

❖ Self-awareness

❖ Self-regulation

❖ Problem solving

❖ Intuition

❖ Flexibility of thought

❖ Social awareness

❖ Perspective taking

Healthy Interoceptive Awareness

Craig, A.D. (2015). How do you

feel? An interoceptive moment

with your neurobiological self.


When you are angry – where do you feel it?

How would someone else know that you are angry? What would they

see?

What goes on the body when you are really angry?

On a scale of 1 – 10, how bad is it?

We feel emotional feelings

in our body.


Where Do You Feel It?

HeadNeck/shoulders

HeartStomach

Legs

BowelsHands

Lungs

Muscles

Throat

Body Feelings Chart Handouts p. 12Copyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

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Felt Sense

Assessing the Body via Interoception:

❖ Enhances mindfulness and builds presence in the here and now

“What are you noticing in your body now?”

❖ Anchors life experience in the nervous system

“What happens inside as you talk about….?”

❖ Builds capacity for tolerating more intense feelings

“Is it okay to hang out with this feeling?”

Peggy Ninow

Payne, Levine & Crane-Godreau (2015) Somatic Experiencing: Using

interoception and proprioception as core elements of trauma treatment


Attachment problems and neglect

Dissociation

Disturbed pain responses

Mental illness symptoms (numbness, body

dysmorphic disorders, somatoform disorders,

hallucinations)

Disruptions in Body Awareness


Anxiety disorders

Depression

PTSD

Dissociative disorders

Obesity and eating disorders

Schizophrenia

Autism spectrum disorder

ADHD

Addiction

Poor Interoceptive AwarenessLinked to:

Mahler, K. (2016). Interoception: The eighth

sensory system. Lenexa, KS: AAPC Publishing.

Payne, Levine & Crane-Godreau (2015)


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Betty doesn’t recognize it when she gets angry.

Before she knows it, she just explodes.

She can’t contain it because she doesn’t know it is starting and it is always too late.

Bad things happen, Betty hurts herself and others. People tell her she has to learn to stop –to control herself but no one tells her how to begin.

Explosive Betty


When Betty is upset, she says she has a

tiger in her stomach.

She starts to recognize when the tiger is

coming.

With help from her therapist, she learns

strategies such as humming or smelling her

scent box.

After a bit she asks herself, “How upset is

the tiger?”

When the tiger calms down, Betty can

resume her activities.

Helping Betty


Difficult Emotions 10

1

Emotions Scale

Where Do You Feel

This Emotion?

Moore, K. (2015).

Sensory Connection

Program: Curriculum

for self-regulation.

Framingham, MA:

Therapro, Inc.

Handouts p. 13


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Deep pressure touch

Proprioception – Movement sense

Vestibular stimulation – Balance sense

Sensory Powerhouses: The Internal Senses

Our Strongest Sensory AlliesJean Ayres


➢ Oral motor sense is a combination of flavor, texture, temperature, and movements of lips, jaw, and facial muscles

➢ Pound for pound the jaws are the biggest proprioceptors in the body

➢ People seek oral motor stimulation to help with comfort, attention, and overall organization

➢ Input activates the vagal system through the cranial nerves and supports social engagement system

Oral Motor Sense

Activity idea

Drink cold water

through a straw with

slow, small

repetitive sucks and

swallows

Deep Pressure Touch

Our most critical sense – the largest sense organ

Touch has powerful effects on emotions (influences limbic system)

Basis of body image/boundaries (with proprioception)

Touch is crucial for normal development and attachment

Deep pressure touch receptors are deeper, responses slower, calming

effect, invites approach

Harlow’s Famous Monkey Study 1959


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The Sense of Touch

Warm touch stimulates release of the “hug and cuddle

hormone," oxytocin, which enhances a sense of trust and

attachment.

Touch is the best way to comfort – if you ask people how

they would comfort someone they tend to list pats, hugs,

and different kinds of touch more than anything else.

(Chillot, 2013)

Kraus et al. (2010) NBA research: good teams are touchier!


Massage Therapy

Causes decrease in cortisol and increase in serotonin and dopamine

Positively impacts depression and depression-related conditions,

pain syndromes, autoimmune and immune chronic illnesses, and

stress conditions

Self-massage (massaging forehead, rubbing hands, stroking neck)

slows the heart rate and lowers the level of the stress hormone

cortisol.

(Field et al., 2005)


Weighted Blankets

➢Powerful tool in crisis

➢Studies show weight up to 30 pounds is safe;

20 pounds is typical (Champagne, 2006)

➢76% of subjects reported positive influence of

weighted blanket (Champagne, 2008)

Weighted blankets and items were mentioned in many studies as

being frequently used and effective tools.

(Baillon et al., 2002; Becklund et al., 2021; Champagne, 2010b;

Cummings et al., 2010; Dorman et al., 2009; Ekholm et al., 2020;

Eron et al., 2020; Knight et al., 2010; LeBel & Champagne, 2010;

Lee et al., 2010; Novak et al., 2012; Sullivan et al., 2005; Sutton &

Nicholson, 2011)


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Taming Wild Horses

“It is my opinion that the horse pressure box is humane… It must be used by sensitive careful people

who care about horses. The pressure box is definitely more humane than some of the very rough

training methods that some people use. I have observed some very abusive training methods used on

mustangs.” Temple Grandin

Squeeze Box

Tactile – Deep Pressure Strategies


Neoprene waist trimmer belt

Shooter sleeves

Lycra “Shoulder Hug”

Medibead lab pad

Weighted Animals

Make a weighted “therapy” animal

Find a realistic stuffed animal

Buy some aquarium stones

Make a slit on the underside

Pull out some of the stuffing

Insert aquarium rocks

Sew animal back up

Have a “Stuffing Bee”

❖ Ask everyone to bring a

stuffed animal

❖ Use aquarium rocks to give

weight

❖ Donate to a long-term care

home or children’s treatment

centreCopyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

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Provides “health touch”

Gives intense input to the body – helps give body

awareness

People sit up, make eye contact, become more

engaged and interactive

Can be helpful for people struggling with self-injury

Beanbag Tapping

Directions in Handouts p. 14


Meditation Beanbag Tapping

Requires self-control

High cognitive demand

Imagines present

Invites dissociation

Works towards self

acceptance

Self-control through

thoughts

Creates self-control

Minimal cognitive

demand

Feels present

Invites integration

Starts at self-awareness

Self-control through

physiology


Case Story: Visiting the Eye Doctor

Young adult woman client at Westborough State Hospital

Extremely tactilely defensive

In modified seclusion due to self-abusive behaviours

As a sensory consultant, I taught her beanbag tapping

Staff followed through with a tapping program every two hours throughout the day.

We also used other strong sensory input activities such as Theraband rowing.

A year later a colleague asked me if I had heard the story of her going to the eye doctor.

“So, what’s with the beanbag??????”


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➢ Activated by movement or compressing or stretching a joint

➢ Receptors involved are located in skin, muscles, and joints

➢ Tells where body parts are in space and in relation to one another

➢ Includes the senses of position and movement of our limbs and trunk, the sense of effort, the sense of force, and the sense of heaviness

➢ Increases endorphins if input is strong and sustained (runner’s high)

➢ Rarely overloading to sensory system

ProprioceptionDeep Pressure & Movement Sense


➢ Keeps the body erect. Drives equilibrium responses.

➢ Gives awareness of body position and movement in space (Ayres, 1979).

➢ Internal GPS.

➢ Helps reticular activating system filter better and

screen out irrelevant stimuli (Dunn, 1997).

➢ Receptors are located in the ears and there are

strong ocular connections. (Hence dizziness with

earaches and carsickness)

The Vestibular Sense


Vestibular System – The Great Modulator

Fastest way to calm a person down is

slow linear rocking!

Easy to over do!!!!!

Watch for Autonomic Reactions

Person must be in control!!!!!!


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Vestibular Input Activities

TheraBand rowing

Vestibular Dysfunction

Hypersensitive to movement

Intolerant or avoidant to movement

Discomfort on stairs, elevators, escalators, uneven terrain

Gravitational insecurity

Dizziness or motion sickness

Hyposensitive to movement

Craves fast intense spinning, jumping, racing around

Doesn’t get dizzy

Moves a lot when seated or stationary

Associated with weak grip and shuffling gait (lack of heel-toe pattern)


Breathing Strategies

Blowing bubbles

Four deep breaths

“Voo” breathing


“Voo” Breathing (Used by Peter Levine – Somatic Experiencing)

❖ Vocalizing a “Voo” with the outbreath, like a foghorn, vibrating the belly.

❖ A powerful tool for interrupting distress, it opens up the heart, lungs, mouth and throat, stimulating the many branches of the Vagus nerve.

❖ It changes your oxygen levels and stimulates positive changes in neurochemistry calming the system, relieving anxiety and sometimes pain.

Handouts p. 8

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Abdominal Breathing

Practicing what we preach!!!!

➢ Often used as the first strategy for calming

➢ Keep it simple: 4 deep breaths

➢ Practice together

Handouts p. 15


It Is As Easy As “Tuning In”

Stop and listen

Feel the cloth on your shirt –

really feel it

Notice your feet on the ground

Give yourself a hug – feel the

pressure

Stand on one foot – tilt to one

side – feel the point at which you

will fall

Smile


Sensory Modulation Approaches

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What Input Do We Need?

Upset

Losing control

Agitated

Needing to relax

Anxious

Overwhelmed

In state of shutdown

Needs grounding

Needs reality orientation

Lacks attention

Unable to focus

Sleepy

Needs to be energized

Calming? Alerting?


Sensory Qualities that Are

Calming and Alerting

Alerting:

Fast paced

Irregular

Complex

Unexpected

Unpredictable

Intense

Strong

Irritating

Negative associations

Calming:

Soft

Rhythmic

Familiar

Soothing

Simple

Mild

Predictable

Slow

Positive associations


Calming Strategies

Use of External Senses Can Be Helpful

➢Classical music and nature sounds

➢Visually pleasing stimulation

➢Calming scents (very personal)

➢Quiet absorbing activities (puzzles, drawing, crafts, word searches)

➢Tea

➢Fidget widgets and stress balls


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Alerting Strategies

Crunchy foods

Spicy foods

Hot cinnamon or sour candies

Strobe lights

Cold/icy water

Energetic dancing

Listening to rock music

Strong scents

Activities That are Organizing

Heavy work

Exercise

Beanbag tapping

TheraBand rowing

Think Strong Sensory Input


Grounding Strategies

Smell a perfume canister

Suck on hot cinnamon balls/strong mints

Chew crushed ice

Suck on a popsicle

Stamp feet or clap hands hard

Chew a large wad of gum

Do heavy work

Pace or do vigorous exercise

Handouts p. 23Copyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

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Grounding Strategies

Situations Requiring Grounding

➢Dissociation

➢Urges to self-injure

➢ Suicidal thinking

➢Negative thinking

➢ Flashbacks

➢ Loss of touch with reality

➢ Extreme anxiety


Grounding definition:

connect you with the

present moment.

Crisis Strategies

Powerful Internal Senses Most Helpful

➢ Abdominal breathing – Voo Breathing (pleasantly stimulating the Vagus nerve)

➢ Rocking

➢ Weighted blankets, lap pads and neck pads

➢ Grounding strategies

➢ Walking (pacing)

➢ Stress balls

Core Strategies for Crisis Intervention Handouts p. 47


Decisions - DecisionsWhat Type of Stimulation Does She Need?

Is she depressed?

Is she hypersensitive and

overstimulated?

Is she agitated?


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Decisions - Decisions

Is he sedentary and have poor

environmental awareness?

Is he sensory sensitive and withdrawn to

avoid stimulation?

Is he highly over stimulated to the point of

shutdown?


Seems Overly Quiet/Withdrawn

Easy to overlook

Person may be shut down or

overwhelmed

Storm may still be raging inside

Just being with the person might help


When in Doubt:

Always Start with Calming

Emotional dysregulation can

result in two paradoxical

responses that are flip

sides of the same coin.


Low arousal can look like sensory overload and shutdown!

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Lack of Proper Training Can Lead to

Negative Experiences

Understand calming versus alerting stimuli

Honor preferences (sensory treatment is very personal)

Know when to back off

Plan sensory spaces carefully (Ex: Adolescent Unit developed a “Sensory

Room” without consultation to occupational therapists or training in sensory

modalities)


Effective Treatment

This is where co-creating comes in. Working together.

People are experts on themselves and they must be the agent of change in

their own life.

Educating people about their sensory issues is key to helping them understand

themselves and make appropriate adaptations and add helpful and organizing

sensory input into their lives.

People with sensory issues must become self-advocates. They need to understand

the rationale for their challenges and problems and be able to articulate it to

others. Self-advocacy facilitates the building of social supports and making

environmental adaptations to support function.

(May-Benson & Kinnealey, 2012; Pfeiffer, 2002)


Preferences Are Personal!!!

Always give choices!!

According to the Andersson et al. (2020) study on people with

serious mental illness, experiences of sensory input were

individual. Exposure to one type of input was pleasant for

some and unpleasant for others.

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Finding the Just-Right Balance

Arousal - Finding the right alert-calm balance to match the situation

Sleep Low arousal Just-right balance High arousal Shutdown


(Moore, 2008)

Sensory ExplorationCooperative Process to Identify Sensory Issues

and Helpful Strategies

Therapist explains sensory inputs and difficulties with sensory processing and how they might impact comfort and daily functioning.

Questions to explore sensory issues:

Are you overly sensitive to sensory input (tags on clothes, flickering lights, noises) that others might ignore?

Are you under sensitive to sensory input? (miss cues, takes strong input to get your attention, easily ignore things that might bother other people)

Do you experience pain and discomfort more, the same or less than other people?

Do you avoid sensory input? (withdraw from touch, shop at quiet times, use earphones to block out sounds)

Do you get overwhelmed by certain sensory experiences?

Do you seek sensory input? (love loud music, chaotic environments, fast carnival rides, hot spicy foods, strong smells)

Do your sensory processing patterns interfere with self-care and life roles?

What strategies do you already use to help you with your sensory patterns?


Experiences of Sensory Input in Daily Occupations

for People With Serious Mental Illness

Sensory Preferences

and Proclivities

EnvironmentOccupations

Andersson et al. (2020) Findings highlight

interactions between sensory

characteristics of person, occupation and

environment that interact to influence

arousal levels, coping strategies, and

engagement.

Study underscores the importance of

helping service users to better

understand their own processing

patterns.


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Case Story:

Army Veteran Difficulties Returning Home

Veteran from Iraq war had difficulty transitioning

home.

Despite wanting desperately to return to his family he

could not tolerate the chaos of dinnertime with all the

kids.

He would lose control and start screaming and yelling

and was re-admitted to the hospital.

With a sensory modulation treatment plan, he was

able to successfully return home.

Andersson et al. (2020) participants reported similar difficulties with multiple strong sensory

input occurring simultaneously; an example was dinner with family and friends (people

talking, children playing, background music, cutlery against plates, perfume, taste of food)


Brainstorm ideas

Keep track of preferences

Explore new options

Provide education on calming input, alerting input and organizing input

Sensory Preferences Checklist

Handout pp. 16-17


What Helps?

➢ Activity is designed to help identify and communicate

helpful strategies.

➢ Individualized poster is made using pictures of

sensory activities and coping strategies.

➢ Poster is made available in the classroom or sent

home to communicate helpful strategies to others.

When I am

angry?When I’m scared?

When I’m in a bad

mood?

What helps? Activity available on SCP Website

http://www.sensoryconnectionprogram.com/what_helps_poster_activity.pdf


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http://images.google.com/imgres?imgurl=http://4.bp.blogspot.com/_Np9ROZaky8s/SRO-8qHUAVI/AAAAAAAAAko/_dXaW6BUl4k/s400/veterans_suicide.jpg&imgrefurl=http://airmanmom.blogspot.com/2008_11_01_archive.html&usg=__izt4Fv561yYBIrfB4CAt-ki5JTk=&h=343&w=300&sz=26&hl=en&start=18&itbs=1&tbnid=yhvEXc3sne5fRM:&tbnh=120&tbnw=105&prev=/images?q=sad+veterans&hl=en&sa=G&gbv=2&tbs=isch:1

http://www.sensoryconnectionprogram.com/what_helps_poster_activity.pdf


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Sensory Diets

According to May-Benson & Kinnealey (2012), sensory diets need to include four

components:

Routine sensory activities (daily routines of nurturing activities including

strategies to support difficult times of day or situations or to re-group after

challenging activities)

Sensory snacks (develop a menu of choices or a sensory “survival” kit)

Supportive active leisure activities (walking, jogging, swimming, working

out at the gym, biking)

Recuperative/calming activities (activities to recharge such as a leisurely

bath, walk in a park, listening to music, reading)

Sensory diets are not prescriptive. Activities must be carefully chosen with

the person in accordance with their personal preferences. Diet activities

must be comfortable and found to be helpful.


Support for Sensory Diets

Moore & Henry (2002) reported positive results using the Wilbarger Protocol and a co-created sensory diet with clients with sensory defensiveness, PTSD and history of self-injurious behaviours. Participants were able to re-engage in valued roles.

Reisman & Feeney (1990) used a home-based sensory diet intervention of a student with sensory defensiveness resulting in decreased tactile sensitivity, increased attention, and improved ability to filter sounds.

Reisman & Gross (1992) documented physiological changes in electro-dermal responses with implementation of a sensory diet in an adult with sensory defensiveness.

Champagne (2010) describes a sensory diet program involving a daily plan with a menu of supportive sensory strategies that are used throughout the day to manage sensory modulation problems, related emotions and behaviours, minimize crisis escalation and promote calming for health and wellness.


Sensory Interventions and Tools

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Non-Tool Based Sensory Strategies

Chair pushups

Foot-flexes

Jumping jacks (highly activating)

Pacing/walking

Upper body joint compression

Full body joint compression

Kneel-stands

Stamp feet or loudly clap hands

Rhythmic slap/clap activity

Handout pp. 19 – 20 Can be used as a game.


Multi-Modal Activities

One young man was “saved by Suduko”


Sensory Snacks

Humming

Strong self hug

Swinging, bike ride, rocking chair

Soft or heavy blanket

Fidget, colouring, puzzles

Scented lotion and quick hand massage

Massage of shoulders or “hand hugs” up the arm

Slap-Clap on thighs (ten times, rest repeat)

Hard candies, chewy or crunchy food

Sipping from a water bottle

Music


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Using Technology

Yoga 101

Relax Melodies

How stressed are you?

Diary


Individual Sensory Kits

Developing kits teaches sensory coping strategies in a concrete

way

Taking home a kit helps with carryover of skills

Choose a theme, kit style and items

Use a game to practice ways to use kits and items (See SCP

Curriculum)


Brainstorming Kit Ideas

What will the kit be used for?

Paying attention at work or school

Staying awake in the car

Relaxing before bedtime

Dealing with anxiety

Helping with sobriety

Grounding

What items will be helpful?

Make Your Own Sensory Kit

What would be your theme?

What would your kit contain?

How would you use it?


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Sensory Kits, Toolboxes, Mobile Suitcases

➢ Selection of stress balls and Koosh balls

➢ Exercise bands for “rowing”

➢ Heavy duty dog

➢ Weighted lap pads and shoulder pads

➢ Puzzles, coloring items, handheld games

➢ Fidget widgets

➢ Items for oral motor stimulation

➢ Soft pillow➢ Warm throw➢ Items for hand and foot

and body massage➢ Scented creams for hand

massage➢ Hot or sour balls, strong

mints➢ Items for grounding

(perfume canister, hot balls)

Sutton & Nicholson (2011) describe bringing needed

tools directly to service users, sometimes in their

rooms. A mobile suitcase is another option for

making sensory equipment available for exploration

and use (Lindley & McDaniel, 2005). Copyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

Travel Toolkits

Clinical Outreach in the Community

Oral motor items

Fidget widgets

Focused activity

Strong sensory input

Grounding items

Handouts p. 24


Sensory Cart

Coloured glasses

Glitter wand or Oggz

LED spinner

Scented pillow mists

Scented lotions

Sound machine

Mini Simon game

Oral motor items

Fidget widgets

Stress balls

Bumpy ball

Beanbag

Wobble cushion

Vibrating pillow

Exercise band or flex bar

Weighted lap pad

Weighted animal

Spandex hug

Use of a Sensory Cart is explored extensively in

The Sensory Connection Program: Curriculum for

Self-Regulation (Moore, 2015)Copyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

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Environment

Let’s Get It Working For Us


New zoo design has replaced animals in cages with naturalistic habitats

and mixed species displays.

Prior to this, zoos could keep animals alive, but they couldn't make them

flourish.

Caged animals often exhibit neurotic behaviours—pacing, repetitive

motions, aggression, and withdrawal.

Environment Counts


Positive effects of environment can be reassurance of

safety, improved attention and focus, increased

interest, comfort and calm and cooperative behaviours.

Negative effects of environment can be

overstimulation, agitation, fear, confusion,

hallucination and acting-out behaviours.

Environment Impacts Safety and Function


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Environmental Interventions

➢ Unit/facility/home modifications

➢ Sensory/comfort spaces

➢ Sensory rooms


How Sensory-Friendly is Your Place?

Is it warm and inviting?

Do people feel safe and protected?

Does it promote positive behaviours?

Is the lighting comfortable?

Is it noisy?

Do you have a rocking chair or swing?

Are sensory tools available?


Dedicated space/room or corner of a room

Comfortable chair

Items chosen by the individual for nurturing and self-

regulation

Items might include CD or music, art or poetry books,

“Heavy Duty” animal, blanket, weighted lap pad,

manipulatives, tasty treats, grounding supplies, scented

lotions

Individualized Comfort/Safe Space

Handouts pp. 25-26 Learning About Comfort Space

Handouts p. 27 Wish List for Comfort Space and Sensory Solutions


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Comfort Spaces at Home

Work with family

Use Comfort Space Plan worksheets

Find a location

Make suggestions for items person seems to enjoy

Decide how the space will be used

10 minutes morning, afternoon & evening

Before or after work

Before of after appointment or stressful event

Before bedMoore, K. (2008). The sensory connection self-regulation

workbook. Framingham, MA: Therapro.

Participants in Andersson et al. (2020) study used the strategy of a “safe place”,

often a bedroom, where they could withdraw from sensory input and regroup; this

strategy was used in acute situations but also for resting and preventing reacting to

distress.


Clinic Sensory/Comfort Spaces

Dedicated space/room or corner of a room

Comfortable chair/couch

Items chosen for nurturing, sensory

exploration and self-regulation

Items might include CD or music, art or

poetry books, “Heavy Duty” animal, blanket,

weighted lap pad, manipulatives, tasty

treats, grounding supplies, scented lotions


Provide:

Safety and sanctuary

Failure free environment

Space for relaxation

Space for “time out” to calm and destress

Place of self-discovery and sensory exploration

Place to reduce aggression and anger or to learn crisis intervention

Place to learn stress management techniques and coping strategies

Opportunities to build trust and rapport with staff

Must be:

Focused on client well-being and emotional self-care

Connected to client goals

Supportive of empowerment and self-management

Sensory Rooms:

Coping, Calming and Comfort

(Costa et al., 2006; Sutton et al., 2013)Copyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

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What is a Sensory Room?

Definition of a sensory room by Costa et al. (2006) is a “failure-free environment” in which the mind can wander and the body can relax while experiencing graded stimulation of focused activities. These environments also provide an opportunity to learn how to use a ‘time out’ to reduce aggression or anger, receive crisis intervention in a safe environment, and learn stress management techniques.

According to Sutton & Nicholson (2011), sensory rooms provide a place to centralize multidisciplinary sensory modulation treatment.


Developing Sensory Rooms

❖ What will be the purpose of YOUR room?

Drop-in comfort room or supervised space

Sensory exploration

Sensory groups & DBT

Assigned time as part of Tx Plan

❖ Get everyone involved

❖ Develop rules and protocols

Adolescent Unit – Chauncy Hall

Deaf Unit – Westborough State Hospital


Successful Implementation of Sensory Room

Machingura & Lloyd (2017) describe the factors that contributed to the successful implementation of sensory modulation rooms on inpatient mental health units.

Use of implementation and reporting process (anticipated barriers and put in place strategies to avoid them)

Integrated clinical process (interventions supervised by trained staff in collaboration with service users, assessment tools needed to be simple and easy to administer)

Staff training and engagement (training staff across all shifts was a challenge; as nurses became trainers, the message was better received)

Governance (procedures and protocols to guide staff & care for equipment; support for obtaining funding and resources)


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Planning for Your Sensory Room

Who will use the room? How will they sign up?

What look are you aiming for?

Open shelves or cabinets for supplies?

Lighting? Flooring? Furniture? Swing?

Visual interest?

Major purchases – vibroacoustic items?

Sensory items and supplies? Consumables/restocking?

Protocols?

Documentation?


Sensory Room Thoughts

Make sure it is a POSITIVE place (never use of “time outs”)

Use proactively (never wait for a meltdown)

Allow time-limited opportunities to use it “when needed”

Provide a timer

Good for downtime

If needed – make it a regular part of the day

141Copyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

Sensory Exploration

Must be guided at first

May need to be supervised

Keep track of helpful modalities


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Sensory Room UMASS

Patients keep track of their information on

a form which designates which type of

sensory input was chosen along with a

self-rating form which rates their level

of stress on a scale of 1-10 before and

after using the sensory room.


Engage all staff in simple record keeping

What tools were helpful?

What was their anxiety level before and after the use of the room?

Information is useful for quality assurance and efficacy studies as well as

client records

Recording Experiences in Sensory Room

02468

Jan

(9

2)

Feb

(9

9)

Mar

(76

)

Ap

r (1

23)

May

(8

7)

Jun

e (9

5)

July

(54

)

Au

g (

78)

Sep

t (7

8)

Oct

(11

9)

No

v (9

7)

Dec

(9

1)1-10

sca

le

Average Stress/Anxiety Levels Before and After Using Sensory

Room 2007Ave ratingbefore enteringSensory Room

Charts reflecting a year of data show marked decreases in perceived levels of patient stress averaging 37% reduction.


Information on UMASS Study on the Sensory Room

http://www.sensoryconnectionprogram.com/sensory_room.php

UMASS Sensory Profile

for Sensory Room Use

Handouts p. 28


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http://www.sensoryconnectionprogram.com/sensory_room.php


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Self-Rating ScaleBefore use

1 2 3 4 5 6 7 8 9 10

Calm Crisis

After use

1 2 3 4 5 6 7 8 9 10

Calm Crisis

See Handouts p. 29 (scales for

calming and alerting)Copyrighted to Karen Moore, OTR/L (2021), author of the Sensory Connection Program

Effective – Well-Designed Sensory Rooms


UMASS Neuro Unit


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VA Hospital in PA


What Does the

Research Tell Us?


Studies Support Reduction in Consumer

Distress with Use of a Sensory Room

Dorn et al. (2020)

Findings confirmed sensory room use produced a statistically significant positive

change in consumer arousal (self-reported or observed).

Authors report that this study supports previous findings that sensory rooms offer a

viable alternative to restrictive interventions, in regard to their ability to

reduce arousal.

Article provided a table on arousal reported in 8 other studies using a 10-point

rating scale to measure distress with an average reduction of 2.99 points

attributed to sensory modulation treatment.

(Adams-Leask et al., 2012; Champagne & Sayer, 2003; Gardner, 2016; Lloyd et al.,

2014; Novak et al., 2012; Seckman et al., 2017; West et al., 2017; Wiglesworth &

Farnworth, 2016)


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Studies (Continued)

Wiglesworth & Farnworth (2016)

Study was conducted in a forensic unit. From the 50 visits recorded, most

patients experienced stress-relieving benefits. The sensory room was reported

to serve as an “escape space” and alternative calming environment. External

noise was an impacting negative factor.

Sivak (2012)

Study on the implementation of comfort rooms by nursing staff showed

decrease in use of restraints, seclusion and acting out behaviours and more

empowerment of consumer self-management. Article gives excellent

information on implementation and challenges.

Additional studies supporting use of a sensory room

Lindberg et al. (2019); Novak et al. (2012); Martin & Suane (2012); Costa et al.

(2006); Cummings et al. (2010); Lindley & McDaniel (2005)


Barbic et al. (2019) Provider and Service Users Experience

Using Sensory Modulation Rooms (SMRs):

Four Themes

• Participants & staff indicated need for further education on sensory-based interventions

• SMRs arose as alternatives to chemical restraints, medication and/or seclusion

• SMRs used to assist in managing over-aroused states

• SMRs used to direct own self care and enable control over own health

Empowermentthrough self-management

Down regulation

Need for education

Alternative to current practices


Qualitative study 2011

Collaboration of Te Pou (National center for evidence based

treatment MH), Occupational Science and Therapy Department

Auckland U.

Study of a sensory modulation approach on four units (Young

person’s unit & three adult units)

Dedicated sensory room was created.

Staff trained in the theory and practice of sensory modulation

Sutton & Nicholson (2011) StudyAuckland, New Zealand

A summary and notes on this study can be found on the SCP Website. Author Daniel Sutton gave

permission to post these notes.

https://www.sensoryconnectionprogram.com/pdf/sutton_nicholson_sensory_room_study.pdf


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Sensory modulation was perceived as an effective tool for

inducing a calm state in the majority of the people who used it.

Sensory modulation supported the rapid building of trust and

rapport for both service users and staff members.

Sensory modulation facilitated the development of service

users’ self-management, increasing their awareness and ability

to regulate their own emotional levels.

Sutton & Nicholson (2011) Study

Major Outcomes


Creating a sense of safety

Soothing through sensory input

Distracting attention from distressing thoughts, emotions and

perceptions

Stabilizing or “grounding” through sensory input

Creating positive associations

Creating a sense of control

Supporting expression and release of thoughts, emotions, and

energy


Key Factors


Staff felt it was most effective when room was used for active

discovery and not passive de-escalation.

Users felt what they learned carried over to the community.

Once sensory strategies reduced distress levels users were able to

try cognitive interventions, mindfulness and self-soothing.

As users became calmer, they were able to open up and express

emotions more freely.

Users felt better supported and cared for.


Input from Participants

Have you tried

the sensory

room??


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Dedicated room important

Users needed to be able to control environment

Large enough for storage equipment – small enough to be cozy

Homey – not clinical

Natural light

Colours, sounds and images from nature


Sensory Room SuggestionsStaff felt room provided an anchor for sensory modulation practice.

Staff experiences were similar in Bjorkdahl et al. (2016) study. 92% respondents stated rooms

had predominantly positive effects on patients and 78% stated rooms positively influenced

general ward environment. This study is very informative interms of understanding staff and

consumer experiences. It gives good support to person-centred care.


Massage chair – item most used for reducing stress

Thick blankets

Rocking chair

Beanbag chair

Weighted animals

Stress balls and manipulatives

Aromatherapy not used as much

Music varied, some brought their own MP3 Players

Coloured lights: liked by some, contraindicated for others


Popular EquipmentStaff and users agreed items were most helpful when education was provided.


A culture shift and positive staff attitude are

essential

Good orientation to room and equipment as early

as possible

Use of room as much for prevention of

escalation as for de-escalation

Staff needed to recognize signs and triggers and

to be aware of trauma and aggression histories

Staff needed to be available when needed and

have enough time to intervene appropriately


Critical Components

Users felt lack of staff availability was biggest barrier to success.

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Room is best used pre-emptively before person loses

control.

Safety training and staff competence is essential.

Staff need to make others aware when they are using

room. Someone may need to outside if needed.

Staff needs to know person and their history of trauma

or aggression and signs, triggers and symptoms and

sensory preferences.

Levels of agitation can be too high for safe use of the

room, consider other options.

Sensory Room Safety


Attitude is important: staff will find themselves in a different role because sensory rooms

decrease staff control in order to increase patient empowerment and SELF-care.

(Cummings et al., 2010)

Get Everyone Involved!

➢ Experiment – have fun!

➢ Enjoy them with your clients.

➢ Use good hygiene but remember – a

sensory room should be treated like any

other room in the hospital.

➢ Provide training so staff feel comfortable

and committed.


Sam’s Story Sam contacted me a few years ago. She had stumbled across my website.

She was intrigued by descriptions of the sensory room because her experience at the hospitals in Illinois were so different.

She said at her hospital they were very strict. All personal belongings were locked up and there was nothing comforting.

Sam is blind. She was upset that they would not allow her the simple comfort of her stuffed animals or the polished rock “she played with.” She was allowed her BrailleNote but that staff lost the cord and never replaced it.

“For a week I was lying around with nothing to do, nothing in her hands. Other clients on the unit were at least offered coloring projects or magazines.”

She believed that her meltdowns were caused by lack of stimulation. “I just didn’t have anything to focus on.” “To have nothing and to be blind with lack of visual stimulation, contributed if not caused when I went to the quiet room.”

“Quiet rooms, as in cold, empty, dirty rooms where you are pinned against the wall and given a shot in the behind. Talk about no sensory stimulation.”

Sam went on to be a volunteer peer advocate in another hospital where she is advocating for a sensory room.


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Documents

Sensory Modulation Approaches To Mental Health