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

<div><p>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.</p><p><b>Trial registration:</b> ClinicalTrials.gov <a href="https://clinicaltrials.gov/show/NCT03051074" target="_blank">NCT03051074</a></p></div

Floatation-REST in an open circular float pool.

<p>The circular fiberglass pool is 8 feet in diameter and contains 11 inches of reverse osmosis water saturated with ~1,800 pounds of USP grade Epsom salt (magnesium sulfate), creating a dense salt water solution that is maintained at a specific gravity of ~1.26, allowing participants to effortlessly float on their back while the water hovers just above the ears. A small blue LED light remains illuminated throughout the float session, and can be turned off by the participant through a round air switch (both of which can be seen in the picture, located immediately adjacent to the participant’s right foot). Unlike the picture, clothing is usually not worn while floating since anything touching the body can generate somatosensory stimulation, potentially detracting from the float experience.</p

Impact of Floatation-REST on mood and affect.

<p>Change scores from pre- to post-float are shown for all 16 measures. To facilitate comparisons across measures the score for each measure was converted to POMP units representing the percent of maximum possible on each scale. All measures showed a significant pre- to post-float change with the significance level denoted with asterisks. Error bars represent the SEM.</p

Estimated effect size of a single float session in patients with anxiety and depression.

<p>The estimated Cohen’s d is shown for each pre- to post-float change score, with grey lines representing the 95% confidence interval. The dashed black line demarcates the starting point (d = 0.8) for what is considered a “large effect size” [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0190292#pone.0190292.ref073" target="_blank">73</a>].</p

Impact of Floatation-REST on state anxiety.

<p>(A) The float experience caused a reduction in state anxiety that was evident across all 50 participants, leading to a significant pre- to post-float change on the Spielberger State Anxiety Inventory (STAI) at the group level [t(49) = -15.16, p < .0001, d = 2.15]. (B) Despite a large baseline difference, the anxious group’s average post-float anxiety had reached levels slightly lower than the pre-float anxiety reported by the non-anxious reference sample. Error bars represent the SEM.</p

Flow diagram for study recruitment.

<p>Flow diagram for study recruitment.</p

Participant demographics and baseline functioning on the day of Floatation-REST.

<p>Participant demographics and baseline functioning on the day of Floatation-REST.</p

Side effect checklist.

<p>After the float session, participants completed a 43-item side effect checklist. For each item participants selected one of four choices (None, Mild, Moderate, or Extreme) and each choice was automatically scored as a number (0, 1, 2, or 3). Shown here is the average score across the group of 50 anxious and depressed participants, with error bars representing the standard error of the mean (SEM).</p

Inclusion and exclusion criteria.

<p>Inclusion and exclusion criteria.</p

Data_Sheet_1_Exploring the acute cardiovascular effects of Floatation-REST.docx

The central nervous system (CNS) exerts a strong regulatory influence over the cardiovascular system in response to environmental demands. Floatation-REST (Reduced Environmental Stimulation Therapy) is an intervention that minimizes stimulation from the environment, yet little is known about the autonomic consequences of reducing external sensory input to the CNS. We recently found that Floatation-REST induces a strong anxiolytic effect in anxious patients while paradoxically enhancing their interoceptive awareness for cardiorespiratory sensations. To further investigate the physiologic nature of this anxiolytic effect, the present study measured acute cardiovascular changes during Floatation-REST using wireless and waterproof equipment that allowed for concurrent measurement of heart rate, heart rate variability (HRV), breathing rate, and blood pressure. Using a within-subjects crossover design, 37 clinically anxious participants with high levels of anxiety sensitivity and 20 non-anxious comparison participants were randomly assigned to undergo a 90-min session of either Floatation-REST or an exteroceptive comparison condition that entailed watching a relaxing nature film. Measures of state anxiety and serenity were collected before and after each session, while indices of autonomic activity were measured throughout each session. HRV was calculated using both time-series and frequency domain analyses. Linear mixed-effects modeling revealed a significant main effect of condition such that relative to the film condition, Floatation-REST elicited significant decreases (p Clinical trial registration[https://clinicaltrials.gov/show/NCT03051074], identifier [NCT03051074].</p