To mark World Occupational Therapy Day (27 October), our kaimahi Karen and Jennifer both Occupational Therapists, hosted a sensory modulation information session for staff at HQ.
The theme for this year’s World OT Day was “Occupational Therapy in Action”, and the session highlighted sensory modulation as an evidence-based therapeutic approach offered by Equip’s OT team. It was a fantastic opportunity to raise awareness of how sensory modulation supports tangata whaiora in managing distress and enhancing wellbeing.
For more on sensory modulation as an evidence-based practice, check out https://www.tepou.co.nz/initiatives/least-restrictive-practice-2/sensory-modulation and the following excerpts from their presentation.
What is sensory modulation?
Sensory Modulation is using our body’s senses to change our emotional state. We all use it automatically:
- when someone is stressed we make them a cup of tea and sit down for a chat
- when we are angry or agitated, we may feel like getting outside and going for a walk or a run to release stress
There is no short and easy explanation to understanding how Sensory Modulation can help us. So first, we need to talk about our senses, what they do and how we can use them to help us feel calmer or more alert.
Sensory modulation is all about using these activities intentionally to improve our state of wellbeing and the best thing is that anyone and everyone can use sensory modulation.
The senses
Our senses gather around 11 million bits of information each second from the environment and send it to our brain for processing – though most of the information comes from our eyes.
We can only consciously process around 50 bits of information per second, so all this information gets compressed down to what the brain can handle. This compression process causes a half second delay between the senses receiving that input and us being aware of it.
Most of this information about the world around us is happening below our consciousness or awareness. This shows that we are intimately connected with the world around us, the people and things in it, and it can have a big impact on how we go through our day.
How does all this information about our environment affect us?
As we process all of this information about the world around us, our brain is on the lookout for anything that has changed or could be a threat.
For example, if we hear a loud bang, which travels from our ears to our brain for processing – the amygdala in the temporal lobe of the brain signals danger!, automatically triggering the Fight, Fright or Freeze response.
Chemical messages (hormones such as adrenaline) are sent throughout the body to prepare it to respond to the danger. Adrenaline changes your breathing from deep belly breaths to shallow chest breaths, to increase the amount of available oxygen. At the same time, adrenaline also increases your heart rate so that oxygen rich blood is pumped around your muscles to prepare them to either fight back or run.
As you can see from the diagram of the highly anxious person, other body sensations you may notice from the FFF response include jelly legs, sweating, etc. And all of this occurs in less than 1/20th of a second.
The Fight, Flight or Freeze Response
Processing the information from our senses
So, the amygdala triggered this response in the body. In the meantime, your hippocampus and cerebral cortex have continued to process the sound and you recognise it as a door slamming and remember that it’s a windy day and you didn’t hook the door open. Once you understand what the noise was and that it’s not a threat, your body starts the process of calming down.
This doesn’t happen straight away because if you think back to cave man times, if there was a wild animal prowling around you need to maintain a state of alertness for a while in case it comes back again. With the threat of danger over, it can take between 20-60 minutes for your body to return to a calm state.
This hand model also explain this in more depth https://www.psychalive.org/minding-the-brain-by-daniel-siegel-m-d-2/
The cerebral cortex is responsible for processing our thoughts and emotions, movement, language and integrating the sensory inputs from all of our senses so that it can be made sense of.
The hippocampus is involved in the formation of new memories and is also associated with learning and emotions.
But I have anxiety, not a FFF response
The amygdala is in the primitive part of your brain and doesn’t know the difference between real and perceived threat. It has not evolved to keep up with modern society and can only respond in the same way each time. Your amygdala is trying to help you by keeping you safe, but it can be over reactive.
It can only respond in the same way each time, whether you narrowly miss having a car accident, for example, or are having an anxiety attack. There are many modern day stressors that cause us anxiety, such as worrying about things like whether you fit in, look ok or if you’ll say something stupid and embarrassing. Tragic news stories or social media pressures can also create psychological stress causing our amygdala to react as if it is a physical threat to us.
Evolution moves slowly and the amygdala has not evolved to differentiate between real and perceived threats and so triggers the FFF response unnecessarily.
The take home message is that your amygdala is trying to help you by keeping you safe, but it can be over reactive – so this is why sometimes we may be feeling in a state of stress but are unable to link it directly to a specific event.
Understanding this enables us to see that the amygdala has triggered a stress response, but that we are actually safe.
Sensory modulation as a calming strategy
When you notice the fight-fright-or-flight response has been activated, your goal is to calm down and take control. Remind yourself that what you’re feeling is an automatic response, not necessarily the best or most logical one.
Deep breaths:
Remember how adrenaline changed your breathing to be rapid and shallow? If the oxygen rich blood was not used to fight or run away, people may hyperventilate or have a panic attack and think they are going to faint. Once you have become aware that your amygdala triggered the FFF response incorrectly and that you aren’t in physical danger, focus on your breathing and take a few deep belly breaths to help calm down. It’s important to practise deep breathing on a daily basis and when in a calm state as your brain has difficulty trying to think clearly when you are in a stressed state.
A deep breathing exercise – breathing through your nose into belly, breathe out with mouth. As you breathe, repeat these words to yourself: I breathe in deeply. I breathe out s-l-o-w-l-y. Breathe slowly and evenly. Think about the speed and rhythm of your breaths, and focus on what’s going on in your body as you inhale and exhale.
Weighted blankets and pressure:
Weighted animals/blankets/lap pads/vests, wrapping up in a blanket, having a massage – people often find these to be grounding.
Movement:
Another helpful tip to speed up the process of restoring a calmer feeling, is to use our proprioceptive sense (movement using our big muscles, ligaments and tendons) as it helps break down the stress hormones which flooded your body at the start of the FFF response. This can include activities such as walking, running, dancing, going to the gym.
Mindfulness and yoga:
Mindfulness practise is also very helpful as it develops the skill of being present and an impartial observer of our body. This helps you to recognise your stress symptoms and that your amygdala has incorrectly triggered the FFF response. Yoga can also be helpful as it focuses on breathing and increasing your body awareness.
Examples of calming strategies
Calming activities are soft, slow, rhythmic, simple, familiar, expected/predictable, soothing, low demand and have positive associations.
- Sight – soft colours, natural/dim lighting, scenery, fish in an aquarium
- Smell – soothing, pleasant, positive associations
- Taste – sweet, sucking hard sweets, sweet fruit or juice, oatmeal
- Hearing – slow/soft music/singing/humming, gentle waves, meditation
- Touch – hugs, warmth, massage, hand lotion, squeezing a stress ball, rubbing smooth stones
- Vestibular – walking, riding in a car, rocking chair, swinging, chess
- Proprioceptive – walking, weight-lifting, yoga, pushups, heavy work
Characteristics of alerting strategies
Alerting input is pronounced, quick-paced, non-rthymic, complex or unexpected. Alerting sensations can be unpleasant and annoying at times, especially if we are nervous or upset though they can be useful for grounding – when disassociating, having flashbacks, or losing touch with reality – strong sensory input helps bring them back to the present moment.
Examples include – Strong fragrances, sour lollies, chilli, crunching popcorn, raw vegies or ice, bright colours or lighting, video games, offbeat or loud music, tickling, something prickly, walking on grass, a cold room, snapping a rubber band on your wrist, running, swinging.
When to use Sensory Modulation
2 ways to use Sensory Modulation:
- As distress is starting to build, try and calm down. Once an incident is over, sensory modulation can help a person to calm down faster but this may not be useful at the height of their distress!
- On a daily basis, as part of a sensory diet, to maximise self-care and help with overall levels of wellbeing and stress management. A sensory diet can help map out helpful strategies for the week so that your overall level of well-being increases, e.g.,walk on the beach on Saturday, then have coffee with a friend. Take a long bubble bath on Sunday afternoon. Gym on Monday, yoga on Tuesday, reading a book each bedtime, spin class Wednesday, dance class on Thursday, make dinner for friends on Friday night.
Sensory modulation is offered by OTs to tangata whaiora accessing Equip Services.