Article

Physiological Effects of Deep Touch Pressure on Anxiety Alleviation: The Weighted Blanket Approach

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Abstract

The application of deep touch pressure (DTP) has been suggested to provide positive effects on anxiety modulation. However, empirical and theoretical evidence linked to the clinical effects of DTP are relatively rare. This study conducts a quantitative analysis of behavioral assessments and performs physiological measurements, including those of electrodermal activity and heart rate variability, to understand the modulation of the autonomic nervous system (ANS), and the orchestration of sympathetic (SNS) and parasympathetic nervous systems (PsNS). The results suggest that the activation of PsNS plays a critical role in ANS modulation. This study provides physiological evidence to support the positive clinical effects of DTP for reducing anxiety in dental environments.

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... Overall, participants felt more relaxed using the weighted blanket. Chen et al. (2013) evaluated the effects of weighted blankets on anxiety in 15 adults undergoing dental treatment. ...
... Results of this study showed an increase in HF HRV, demonstrating activated balanced sympathovagal responses, with weighted blanket use during wisdom tooth surgery. This finding indicates that DPS can increase the flexibility in and regulation of parasympathetic activity and autonomic nervous system modulation, which are associated with enhanced behavioral regulation and calming processes (Chen et al., 2013(Chen et al., , 2016. Losinski et al. (2017) compared the effects of two types of DPS (compression vest and 6-lb weighted blanket) with that of antecedent exercise (riding a stationary bike) on stereotypical behaviors (e.g., hand flapping, echolalia, blinking, moving fingers in front of the eyes, and rocking) of 3 students with autism spectrum disorder because stereotypical behaviors are thought to be a result of increased arousal or anxiety. ...
... Limitations of these studies include narrow sampling methodology and small sample sizes, with the largest study having only 60 participants (Chen et al., 2016). One study was limited to only women (Chen et al., 2013) and 1 study to only boys (Losinski et al., 2017). In addition, the studies varied in their approaches to the weight of the blankets. ...
Article
Importance: Sensory integration modalities, such as weighted blankets, are used in occupational therapy practice to assist with emotional and physical regulation. However, the research related to the use and effectiveness of weighted blankets is sparse. Objective: To identify, evaluate, and synthesize the current literature to help develop the impetus needed to launch a research study into the effectiveness of using weighted blankets to decrease anxiety and insomnia. Data sources: A literature search was conducted between January 23, 2018, and March 1, 2018. Databases and sites included the Cochrane Library, PubMed, PsycINFO, CINAHL, OTseeker, Web of Science, and Nursing Reference Center Plus. Search terms included weighted blanket, deep pressure, and occupational therapy as well as combinations of these terms. Study selection and data collection: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were included if the study used weighted blankets as the modality of deep pressure stimulation. Data from presentations, conference proceedings, non-peer-reviewed literature, dissertations, and theses were excluded. Findings: Only 8 studies were included: 4 Level I, 2 Level III, and 2 Level IV studies. The outcomes of these studies suggest that weighted blankets have the potential to be beneficial in limited settings and populations. Conclusion and relevance: Weighted blankets may be an appropriate therapeutic tool in reducing anxiety; however, there is not enough evidence to suggest they are helpful with insomnia. What this article adds: Evidence-based research on the effectiveness of weighted blankets in reducing anxiety and insomnia is sparse. More research is needed to define guidelines for the use of weighted blankets in clinical practice and to investigate the underlying mechanism of action. This systematic review can be used to begin an investigation of the use of weighted blankets for larger and more diverse populations.
... 28e30 Although physiological evidence is relatively scarce, the application of deep pressure input plays a role in ANS modulation under dental conditions. A few studies have reported a positive increase in HF-HRV, an indicator of emotion regulation, in dental prophylactic treatment with sustained deep pressure input in healthy individuals and patients with special needs; 31,32 however, the participants in these studies underwent dental treatment without anesthetic procedures. Although parasympathetic activity is increased, dental procedureinduced pain is still confounded by deep pressure input in psychological stress alleviation. ...
... The deep pressure apparatus, a weighted blanket (WB), was fabricated using smooth cotton fabric, 70 cm  150 cm, to prevent annoying skin sensations (e.g., scratchy or rough) as described previously. 31 The appropriate weight load for participants was approximately 10% of the body weight, 29,33 and it was adjusted to be distributed evenly over the body of the participant from the axillaries to ankles. Only those in the experimental group received deep pressure input during wisdom tooth extraction. ...
... Parasympathetic effect of deep pressure in tooth surgery 5 + MODEL practice. 31,32,37 The use of a WB, having the same conduction pathways as deep pressure massage does, may provide its benefits by shifting the ANS from a state of sympathetic response to a state of parasympathetic response. 29,38 Studies have postulated that, when the pressure receptors beneath the skin are stimulated, the vagal tone increases and the cortisol and skin conductance level decrease. ...
Article
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Background/purpose: Deep pressure input is used to normalize physiological arousal due to stress. Wisdom tooth surgery is an invasive dental procedure with high stress levels, and an alleviation strategy is rarely applied during extraction. In this study, we investigated the effects of deep pressure input on autonomic responses to wisdom tooth extraction in healthy adults. Methods: A randomized, controlled, crossover design was used for dental patients who were allocated to experimental and control groups that received treatment with or without deep pressure input, respectively. Autonomic indicators, namely the heart rate (HR), percentage of low-frequency (LF) HR variability (LF-HRV), percentage of high-frequency (HF) HRV (HF-HRV), and LF/HF HRV ratio (LF/HF-HRV), were assessed at the baseline, during wisdom tooth extraction, and in the posttreatment phase. Results: Wisdom tooth extraction caused significant autonomic parameter changes in both groups; however, differential response patterns were observed between the two groups. In particular, deep pressure input in the experimental group was associated with higher HF-HRV and lower LF/HF-HRV during extraction compared with those in the control group. Conclusion: LF/HF-HRV measurement revealed balanced sympathovagal activation in response to deep pressure application. The results suggest that the application of deep pressure alters the response of HF-HRV and facilitates maintaining sympathovagal balance during wisdom tooth extraction.
... Deep touch pressure (DTP) is a method used in sensory integration therapy, aimed at treating sensory processing difculties related to, amongst others, anxiety disorders, in particular anxiety experienced by those on the autism spectrum. [31,36,43]. The therapy involves using tools such as weighted garments and blankets to provide a comforting pressure sensation. ...
... The therapy involves using tools such as weighted garments and blankets to provide a comforting pressure sensation. Its calming efect can be attributed to increased activity of the parasympathetic nervous system, which plays a signifcant role in anxiety management [36]. In therapy practice, DTP has been applied to increase the ability to focus [24], reduce disruptive behaviour [69] and reduce anxiety symptoms [31] in patients with bipolar disorder, developmental disorders and those on the autism spectrum. ...
... It is very important to respect the patients concerns and fears because they will become increasingly agitated and physically aggressive if the alarming stimuli are not removed [9]. Having the parent squeeze the child's hand can help decrease agitation [23,24]. Methods to cope with a patient who exhibits sensory defensiveness are shown in Table 2. ...
... DTP is a form of tactile sensory input, most commonly provided by hugging, used to alleviate anxiety and appears to be especially efficacious in ASD patients though results are preliminary [23]. Possible anxiolytic effects of DTP could be useful in minimally invasive treatment however there are questions on clinical usefulness and further research is required to determine its effectiveness in the dental office [17,19,24]. ...
... The use of deep pressure for individuals with autism spectrum disorders has been widely discussed since Temple Grandin described her self-designed machine (hug machine) for giving her the pressure sensations that she craved [6]. Other types of deep pressure therapy include weighted garments, swaddling, holding, stroking, hugging, squeezing, and therapeutic brushing [7]. ...
... There seems to be agreement between the systematic reviews that weighted vests do not seem to confer any benefit on participants. However, Chen et al. [7] using a within subjects design ( = 12) found that weighted blankets reduced signs of dental anxiety in typically developing students when measured physiologically but not behaviourally. Blairs et al. [10] provided a programme of noncontingent deep pressure using bed linen (swaddling) to an adult with autism, severe anxiety, and intellectual disability. ...
Article
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Background: Deep pressure is a touch therapy technique widely used by occupational therapists for people with autism spectrum disorders. It is conceptually related to Ayres’ Sensory Integration Therapy and to the “hug” machine of Temple Grandin. There is limited research evaluating deep pressure. Objective: to evaluate the immediate effects of deep pressure on young people with autism and severe intellectual disabilities. Methods: Mood and behaviour were rated by staff working with the pupils before and after sessions of deep pressure and diary records were kept of other significant events. 13 pupils with ASD and severe ID took part in the study. Results: Sufficient data was available from 8 participants to be analysed using tau-u, a non-parametric technique that allows for serial dependence in data. Six showed benefits statistically. Five of these showed benefits across all domains, and one showed benefits on three out of five domains. Relevance to Clinical Practice: Deep pressure appears to be of immediate benefit to this population with autism and severe ID, but the heterogeneity of response suggests that careful montoring of response should be used and deep pressure discontinued when it is no longer of benefit. Limitations: This is an open label evaluation study using rating scales. Recommendations for future research: Future studies of the use of deep pressure should use physiological response measures, in addition to blinded raters for aspects of psychological health not captured in physiology.
... However, the children and the parents in the study favored the use of the weighted blanket over normal ones. However, an extensive study measuring the heart rate and electrodermal activity of the patient suffering from anxiety and covered with a weighted blanket revealed more beneficial aspects ( Chen et al. 2013). A study using similar measurement techniques but employing a 30-pound weighted blanket on adult subjects suffering acute inpatient showed an effectiveness rate of about 63% in reducing anxiety levels, and a 78% preference for inducing a calming environment ( Mullen et al. 2008). ...
... A study using similar measurement techniques but employing a 30-pound weighted blanket on adult subjects suffering acute inpatient showed an effectiveness rate of about 63% in reducing anxiety levels, and a 78% preference for inducing a calming environment ( Mullen et al. 2008). Vital sign metrics in these studies concluded the blankets to be safe for daily use (Chen et al. 2013;Mullen et al. 2008). A number of guidelines and recommendations for the use of these weighted products for clinical purposes, such as treating ASD, can be found at the National Guideline Clearinghouse database of the U.S. Department of Health and Human Services ("Use of a weighted or pressure device, " n.d.). ...
Article
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Children suffering from autism spectrum disorder are often reported to encounter sleeping disorder several causes such as hypersensitivity as result of irregular brain and muscle functions. Disturbance in sleep affects not only their health but also daytime activities including the risk of other cognitive and behavioral impairments. Such hindrance in sleep have been demonstrated to treat therapeutically by measures like application of deep pressure touch and full body vibration which can be beneficially integrated into the sleeping environment such as on the textile-based platform around the bed. With such a vision, this pilot design project aimed to develop a smart textile based sleeping bag incorporated with sensors to detect awakening stage of the child and thereby actuating stimuli for assuaging the child to fall asleep. To serve the purpose, a micro-controllable body movement detection sensor, based on conductive yarns connected to a vibrating motor was prosperously embedded at the interior of the sleeping bag along with weighted slots to exert deep touch and soothing sensation in the form of wearable technology.
... 11,15 Although physiological evidence is still relatively scarce, the application of deep pressure input plays a role in ANS modulation under dental procedures. Few studies have reported a positive increase in the parasympathetic activity, an indicator of behavioral and emotion regulation, in dental prophylactic treatment with sustained deep pressure input in healthy subjects and special need patients 12,13 ; however, the subjects in these studies underwent dental treatment without anesthetic procedures. Despite parasympathetic activity is increased, dental procedure-induced pain is still confounded by deep pressure input in psychological stress alleviation. ...
... The deep pressure apparatus, a weighted blanket (WB), was fabricated using smooth cotton fabric, 70 cm  150 cm, to prevent annoying skin sensations (e.g., scratchy or rough) as described previously. 12 The appropriate weight load for participants was approximately 10% of the body weight, 15 and it was adjusted to be distributed evenly over the body of the participant from the axillaries to ankles. Only those in the experimental group received deep pressure input during the third molar extraction. ...
Article
Full-text available
Backgroud/purpose: Deep pressure input is used to normalize physiological arousal due to stress. Third molar extraction is an invasive dental procedure with high stress for the patient, and an alleviation strategy is rarely applied during tooth extraction. In the present study, we investigated the effects of deep pressure input on autonomic responses during the procedures of third molar extraction in healthy adolescents. Methods: A randomized controlled crossover design was used for adolescents who were allocated to experimental and control groups that received intervention with or without deep pressure input, respectively. Autonomic indicators, namely the heart rate, percentage of low-frequency heart rate variability (LF-HRV), percentage of high-frequency heart rate variability (HF-HRV), and low-frequency/high-frequency heart rate variability ratio (LF/HF-HRV), were assessed at the baseline, during molar extraction, and in the posttreatment phase. Results: The results indicated that third molar extraction caused significant autonomic parameter changes in both groups; however, differential response patterns were observed between two groups. In particular, application of deep pressure input in the experimental group was associated with higher HF-HRV and lower LF/HF-HRV during third molar extraction compared with those in the control group. Conclusion: LF/HF-HRV measurement revealed balanced sympathovagal activation in response to deep pressure application. The present study suggests that the application of deep pressure alters the response of HF-HRV and facilitate maintaining sympathovagal balance during third molar extraction.
... These strategies range from providing education about sensory sensitivities and creating a sensory-friendly environment; assisting with the development and use of visual supports and social stories, and/or use of video/virtual technology. These strategies all have, at least, preliminary support for their use for children with ASD [66,[83][84][85][86][87][88][89][90][91][92][93]. ...
... Sensory-friendly environments can modify the sensory experiences encountered by children with ASD, either adding (e.g., weighted blankets, calming music) or removing (e.g., bright lights, loud noises) sensory stimuli encountered during dental care or in the waiting room to decrease stress and anxiety [66,85,86,94]. Strategies incorporating visual supports may improve cooperation and participation; these may include visual schedules, which are visual representations of a task broken down and sequenced into step-by-step directions, and visual clocks, which are particularly helpful in aiding the child to keep track of time [66,90]. ...
Article
Full-text available
Children with autism spectrum disorders (ASD) are at risk for oral health disparities. With the dramatic rise in ASD prevalence to 1 in 54 children, it is likely that an increasing number of dental practitioners will encounter or be asked to treat children with ASD. This paper reviews explanations related to the increasing prevalence of ASD, provides reasons why children with ASD are at increased risk for poor oral health, and discusses unique interprofessional collaborations between dental practitioners and occupational therapists. Occupational therapists and dentists can work together to plan modifications to the dental environment or adapt dental protocols to reduce some of the barriers encountered by those with ASD, provide desensitization strategies before the clinic visit, or help a child with emotional regulation during clinical treatments.
... It is very important to respect the patients concerns and fears because they will become increasingly agitated and physically aggressive if the alarming stimuli are not removed [9]. Having the parent squeeze the child's hand can help decrease agitation [23,24]. Methods to cope with a patient who exhibits sensory defensiveness are shown in Table 2. ...
... DTP is a form of tactile sensory input, most commonly provided by hugging, used to alleviate anxiety and appears to be especially efficacious in ASD patients though results are preliminary [23]. Possible anxiolytic effects of DTP could be useful in minimally invasive treatment however there are questions on clinical usefulness and further research is required to determine its effectiveness in the dental office [17,19,24]. ...
Article
Full-text available
Autism Spectrum Disorders (ASD) is reported to affect 1% of the world's population, with a reported increase in prevalence of 556% between 1991 and 1997. Current behavioural and medical management techniques offer both medical and dental practitioners useful options in management of patients. This study aims to review behavioural management techniques that could assist or enhance management and treatment of ASD individuals in the dental office.
... Possible mechanisms that have been proposed for how tactile stimulation may alter well-being, is through pressure to the skin that modulates the automatic nervous system, ultimately affecting central parts, resulting in a calming effect [8,9]. Although the empirical basis for this theory is still mostly anecdotal, several studies have shown physiological responses to tactile stimulation. ...
Article
Full-text available
Objective To measure rate of subscription of common sleep medication and diagnoses of substance use disorder (SUD) before and after receiving a prescribed weighted blanket (WB) among patients with psychiatric diagnoses. Materials and methods Using register-based data of health-related factors in a Swedish region, a total of 1785 adult individuals with a psychiatric diagnosis, received a WB and resided in the region during the study period were identified. Using each individual as their own control, the rate of one-year prior prescription of WB or diagnosed SUD was compared to rate after a half year wash-out after prescription of WB for a full year. Results The number of patients without prescription of sleep medication increased by 3.3% (95% confidence interval (95%CI): 0.2–6.4, p=.04). Furthermore, the proportion without a prescription of benzodiazepine receptor agonist/antihistamines sleep medication increased by 5.5% (95%CI: 2.2–8.8, p=.001). Melatonin prescription increased after WB by 3.6% (95%CI: 1.1–6.2, p=.006). Younger age and unipolar-, anxiety-, attention-deficit/hyperactivity-, and post-traumatic stress disorder was associated with decreased use while psychotic-/bipolar- and personality disorder was not associated with a decrease in the use of sleep medication. The number of alcohol SUD diagnoses did not increase while sedative SUD rate increased statistically significantly by 0.7% (odds ratio = 1.63, p=.02). In a multivariate model, only younger age predicted discontinuation of sleep medication while psychotic-/bipolar- and personality disorder had statistically less decrease. Conclusion This observational register study found a statistically significant association between WB use and decreased use of common sleep medication except melatonin that increased slightly.
... In males, a low neurological threshold was linked to a baseline state of sympathetic dominance, which suggests they may be in a resting state of hyper-arousal. Therapists working with highly sensitive young men may need to address this underlying physiological state of arousal; for example, through supporting sensory modulation strategies (Chen et al., 2013) or biofeedback (Reiner, 2008). Given that sensory sensitivity is culturally perceived as inconsistent with traditional concepts of masculinity, highly sensitive men may feel self-conscious and suppress their sensory processing needs (Gearhart, 2012). ...
Thesis
Clinicians and researchers have increasingly identified that individuals often co-present with sensory processing and attachment difficulties. To understand and support clients with difficulties related to sensory processing and/or attachment, more research is needed to understand how and why these two constructs are related, particularly in the context of contemporary research on psychophysiology and childhood adversity. The purpose of this thesis is to investigate the ways in which sensory processing and attachment patterns are related, the reasons they may be related, and to examine the implications of this relationship for areas of functioning and wellbeing. A scoping review was undertaken to examine evidence for a relationship between sensory processing and attachment patterns across the lifespan. There is emerging evidence in children that attachment security is related to better sensory modulation (i.e., self-regulation in response to sensations). In adults, there is also evidence that having a low sensory threshold (i.e., easily noticing and/or becoming overwhelmed by sensory stimuli) is related to attachment anxiety and, to a lesser extent, attachment avoidance. Findings from this review highlighted a need for further research in this area, including research: (1) examining the impact of childhood experiences on the relationship between sensory processing and attachment patterns; (2) investigating the psychophysiological underpinnings of sensory processing; and (3) exploring the implications for sensory processing and attachment on functioning and wellbeing. Based on the findings of this scoping review and a broader review of relevant research and theories, three cross-sectional studies were designed to address these gaps in the literature and lay the foundation for the proposition of a new model to understand the complex interactions between these factors. The first study was a laboratory-based study with a non-clinical young adult sample. This study aimed to determine whether different sensory processing patterns were associated with differences in autonomic functioning before, during and after a physical stressor. In the study, a low sensory threshold was related to unique patterns of autonomic activity and reactivity, which varied by gender. Previous studies have found that autonomic arousal may underpin patterns of attachment insecurity and explain the behavioural patterns of people who have experience childhood adversity. This study therefore indicates that autonomic arousal may be a potential psychophysiological factor that underpins the relationship between these constructs. The second study was an online survey with a non-clinical adult sample designed to investigate the links between sensory processing patterns, attachment patterns, and childhood experiences. In this study, it was found that childhood adversity predicted more attachment anxiety in adulthood for highly sensitive individuals. However, childhood adversity predicted more attachment avoidance for individuals with low levels of sensitivity. These findings indicate that sensory processing sensitivity interacts with childhood adversity to shape the type of attachment pattern an individual experiences in adulthood. The second study also produced a second paper that investigated the interaction effect between childhood adversity and sensory processing sensitivity on meaningful activity engagement in adulthood. Sensory processing sensitivity was not related to meaningful activity engagement and did not moderate the relationship between childhood adversity and meaningful activity engagement. Childhood adversity did, however, directly affect an individual’s level of meaningful activity engagement in adulthood. This finding supports the involvement of early intervention occupational therapists for individuals who experience childhood adversity as they are more likely to have long-term difficulties with meaningful activity engagement, which has important implications for their health and wellbeing. The third study investigated the implications of sensory processing and attachment patterns for functioning in families of children with persistent pain. Pain is a sensory experience that can trigger an individual’s threat response and activate their attachment system. Children with persistent pain often co-present with sensory processing and attachment difficulties, which impact their wellbeing and functioning. Because it was theorised that a child’s sensory processing and attachment patterns impact the child-caregiver relationship, it was expected that the child’s sensory processing and attachment patterns may also affect caregiver functioning in this context. However, it was found that the children’s sensory processing patterns were not related to parent functioning. Child and parent attachment avoidance were, however, significantly related to poorer parent functioning in a range of domains. Because the study did not investigate parent sensory processing patterns, further research is needed to understand how the interaction between child and caregiver sensory processing patterns may affect the attachment relationship and family functioning. When considering the findings of these studies alongside the contemporary literature, there is growing evidence that sensory processing, attachment patterns, and childhood experiences are interrelated factors that may be underpinned by autonomic arousal. However, it is evident that there is a need for an integrative model that conceptualises sensory processing in the context of attachment, childhood experiences, and autonomic functioning. The Dyadic Model of Sensory Modulation is therefore proposed in the fourth and final section of this thesis. Clinical implications and future areas of study are discussed that may help to further understand this emerging area of research and practice.
... The application of deep pressure, through for example weighted vests and blankets, has been reported to produce a calming and relaxing effect in clinical conditions such as autism spectrum disorders (ASD), attention-deficit hyperactivity disorder, and pervasive developmental disorders [8][9][10][11][12][13][14][15]. Applying deep pressure has been shown to be beneficial for children with high levels of anxiety or arousal [16] and deep pressure touch may also alleviate anxiety (e.g. in dental environments and bipolar disorder [17,18]). There are also anecdotal reports suggesting that the elderly who suffer from anxiety and dementia may find relief from deep pressure touch and many nursing homes are experimenting with weighted blankets. ...
Article
Full-text available
Insomnia is a common occurrence and can have a negative impact on physiological, psychological and social well-being. There is a need for simple, effective solutions to increase sleep quality. It has been suggested that weighted blankets and vests can provide a beneficial calming effect, especially in clinical disorders. Hence, we aimed to investigate the effects of a chain weighted blanket on insomnia, using objective and subjective measures. Objectively, we found that sleep bout time increased, as well as a decrease in movements of the participants, during weighted blanket use. Subjectively, the participants liked sleeping with the blanket, found it easier to settle down to sleep and had an improved sleep, where they felt more refreshed in the morning. Overall, we found that when the participants used the weighted blanket, they had a calmer night's sleep. A weighted blanket may aid in reducing insomnia through altered tactile inputs, thus may provide an innovative, non-pharmacological approach and complementary tool to improve sleep quality.
... The case also highlights the need for the development of a suitable sensory processing assessment measure for use with cognitively impaired clients who cannot participate in selfreport. Further, exploration of the use of individual sensory modalities is also recommended in HD, particularly, the use of weighted modality aides as research into deep pressure touch stimulation appears to indicate that it is effective in reducing arousal (Chen & Yang, 2012). Given the preponderance of diverse symptom profiles in HD, including psychosis, obsessive compulsive behaviours and impulse control disorder, it would also be useful to explore the potential benefits of sensory modulation interventions for alleviating other problem behaviours, in addition to aggression. ...
Article
Aggression is common in Huntington’s disease. However, at present there are no standard guidelines for managing aggression in Huntington’s sufferers due to a lack of empirical research. This paper presents a case study of the treatment of very high levels of aggression with sensory modulation and behaviour support intervention in a Huntington’s sufferer. The client exhibited a range of aggressive behaviours, including physical aggression to people, furniture and objects and verbal aggression. Following an eight week baseline phase, five weeks of sensory modulation intervention were employed. A behaviour support plan was then implemented as an adjunct to the sensory intervention, with aggressive behaviour systematically audited for a further 11 weeks. The results indicate a significant reduction in reported levels of aggression during the combined sensory modulation and behaviour support phase, compared to both the baseline and the sensory modulation therapy alone phases. This case study highlights the efficacy non-pharmacological interventions may have for reducing aggression in HD.
... Anxiety is a comorbidity for patients with AN. WB, an example of deep pressure stimulation, have been shown to reduce anxiety in adults and are a non-pharmaceutical intervention to manage anxiety (Chen et al., 2013;Mullen et al., 2008). However, not much is known regarding the effect of WB on patients with AN and ARFID. ...
Article
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Date Presented 03/27/20 An RCT that assesses the efficacy of weighted blankets on anxiety for patients with severe anorexia nervosa (AN) and avoidant restrictive food intake disorder (ARFID) in an inpatient medical setting. The results demonstrate clinical significance, advancing the field of OT as it supports the use of a sensory intervention to positively impact psychological and emotional states of a patient population with limited evidence to support best practices. Primary Author and Speaker: Rachel Ohene Additional Authors and Speakers: Christina Logan Contributing Authors: Ashlie Watters, Figaro Loresto, Kathryn Eron, Philip Mehler
... Cognitivebehavioral therapy is a therapy that uses cognitive and behavioral exercises to reduce emotional disorders, such as relaxation training, behavioral experiments, and social skills training [6]. Also, fidgeting tools are used to cope with mental health issues [5]. ...
... However, many of the studies have the same issues: small sample sizes, samples that only include children, and samples that consist only of nonnormative individuals (i.e., individuals diagnosed with autism, individuals with insomnia, or patients in a psychiatric inpatient facility; e.g., Champagne et al., 2015;Gee, Peterson, Buck, & Lloyd, 2016;Gringras et al., 2014). Although the results have been mixed, there is some agreement that weighted blankets reduce anxiety, at least in some specific populations and contexts such as inpatients at a psychiatric facility and individuals undergoing dental care (e.g., Chen, Yang, Chi, & Chen, 2013;Novak, Scanlan, McCaul, MacDonald, & Clarke, 2012). Weighted vests were chosen over weighted blankets for this study primarily due to the need for participants to be sitting up for the TSST; it is likely that a weighted blanket would have fallen off if not actively held in place for the dura tion. ...
... Weighted blankets (WBs) have been suggested as an alternative method for modulation of well-being through deep touch pressure (DTP) [17]. The effect of the WB is based on the theory that DTP contribute to a feeling of well-being and comfort, through increased levels of oxytocin, which in turn results in relaxation and promotes sleep [17][18][19]. A WB is a non-invasive intervention in the form of an assistive device [17]. ...
Article
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Background: Weighted blankets (WBs) have been suggested as a treatment option for insomnia and are commonly prescribed despite lack of evidence of efficacy. Aim: To investigate prescription pattern, return rate and cost of WBs. Material and methods: This observational cohort register-based study in western Sweden included every individual who, in a 2.5-year period, was prescribed and received at least one WB (n = 4092). A cost evaluation was made by mapping prescription processes for WBs and sleep medication. Results: Individuals diagnosed with dementia, anxiety, autism or intellectual disability (ID) retained the WB longer than others. Individuals younger than six and older than 65 years had shorter use time. The cost evaluation showed that the prescription process for WBs was longer and resulted in a higher cost than for sleep medication. Conclusions: Some individuals had longer use time, indicating a possible benefit from using a WB. Due to low risk of harm but high economic cost, a revision of the WBs prescription process could be recommended to identify those who might benefit from WB. Significance: Our result points towards a need for revision of the prescription process, to implement standardized sleep assessments, and create a more efficient prescription process to lower the cost.
... From a therapeutic perspective, touch has been suggested as an input that can potentially modify sensitization states [43,54] and may be an action mechanism for effects in manual therapy [61]. These hypotheses are supported by various experimental studies showing outcomes from craniosacral therapy [64,65], osteopathic manipulative treatment [44,[66][67][68][69] and deep touch [44,70,71] with ANS regulation, as well as studies showing links between myofascial release [72] and osteopathic HVLA thrust and mobilization techniques [44,73] with increases in interoceptive accuracy (IAc). ...
Article
Objectives Deficits in interoception have been identified in wide range of patients with complex, long-term health conditions including chronic pain, anxiety, depression and somatoform disorders. This review analysed findings from functional MRI studies illustrating the neural correlates of interoception, mindfulness and touch and aimed to identify possible areas of convergence between different neural processing pathways. Design A meta-review was conducted to appraise existing systematic reviews (SR) and to explore the potential action mechanisms, which underpin manual therapy approaches that combine touch and mindfulness interventions. Methods Five electronic databases were systematically searched from September 2017 to March 2018. SRs were evaluated for methodological quality and risk of bias using the AMSTAR 2 instrument. Results Two high quality SRs studied neural correlates of mindfulness, two moderate quality SRs studied interoceptive tasks, and one low quality SR studied touch. Mindfulness and touch showed functional convergence in the interoceptive cortices. However, neural activation in different parts of the cortex was influenced by type of task and individual functional biases in processing tactile stimuli. Conclusions These findings provide a rationale for further studies into the effects of combined touch and mindfulness-based interventions for treating conditions associated with central sensitization and interoceptive deficits.
... The utilization of other sensory-based interventions during dental care has been investigated, with most reporting preliminary success. For example, aromatherapy was found to have a calming effect for children during dental care and adults in the dental office waiting room [271][272][273][274][275]. Heart rate and physiological anxiety were reduced during dental treatments when using a weighted blanket for deep pressure sensations [276][277][278]. Lastly, a sensory adapted dental environment, designed to decrease noxious stimuli and increase calming stimuli, decreased physiological and behavioral distress in typically developing children and those with disabilities [44, [279][280][281][282][283]; this intervention is now included in the American Academy of Pediatric Dentistry's [284] list of best practices as a potential basic behavior guidance technique for use with dental patients with anxiety or special healthcare needs. ...
Article
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Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.
... Deep Touch Pressure is a type of tactile input received when firmly touching, holding, swaddling, or hugging etc. [4]. Deep touch pressure has also been shown to reduce anxiety for individuals without SPD [5] and be beneficial for babies, in the form of swaddle therapy [6]. ...
Conference Paper
Many individuals with Autism Spectrum Disorder (ASD) and ADHD often seek out deep touch pressure (DTP). Weighted blankets, vests and other wearable garments have been used to provide DTP, but each suffers from significant limitations. We designed an alternative using shape memory alloy (SMA) springs that contract when heated to create a children's deep pressure vest that can constrict on command, while being simultaneously low profile and adjustable. The garment can be controlled via wireless remote, allowing wearer self-adjustment and enabling the child's parent, guardian, or occupational therapist (OT) to give a comforting "hug" potentially from anywhere in the world.
... The reason why the OMT condition did not lead to an increase in RMSSD is perhaps because this was a mobilizing of the jaw joint intervention (rotating the jaw joint) rather than a stroking of the skin intervention such as soft tissue massage as conducted in, for example, the Toro-Velasco study (Toro-Velasco et al., 2009). As for the significant increase in the deep-touch condition, this was not surprising as other studies have found that deep touch pressure has led to a PNS response ( Lindgren et al., 2010;Chen et al., 2013). ...
Article
Background: There is paucity in the literature regarding the role of the interoceptive pathway through the insular cortex (IC), as well as heart rate variability (HRV) in relation to Osteopathic Manipulative Therapy (OMT) and deep-touch. Aims: The present study investigated whether both OMT treatment and deep-touch (a newly hypothesized treatment option) was effective at altering the interoceptive pathway and HRV, whilst OMT was only expected to be effective for increasing Range of Motion (ROM). Methods: Thirty-five healthy volunteers were randomly allocated into three conditions in a repeated measures crossover design; a control (laying supine on a plinth); deep-touch (head cradling); and an osteopathic mobilization therapeutic technique on the temporomandibular joint (TMJ). Interoceptive accuracy (IAc), HRV, as well as range of motion (ROM) for the TMJ area as well as the cervical spine (Csp) right and left measures were taken pre and post each condition setting. Results: Significant condition effects emerged from the deep-touch and mobilization interventions for IAc where increases were identified through planned comparisons. For the HRV measure (RMSSD), a significant effect emerged in the deep-touch condition (increase) but not in the mobilization or control conditions. ROM did not increase for any condition. IAc correlated with post-ROM outcomes in many cases and HRV moderated some of these relations. Conclusion: These results are discussed in the context of clinical practice, where cranial deep-touch maybe an effective treatment and modulator of the parasympathetic nervous systems, as well as the interoceptive system.
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Seclusion and restraint are commonly used by residential staff to control unsafe behaviors of youths with disabilities and complex trauma histories. This pilot study examined the effect of a nonrestraining cushion as a calming device and wellness tool in a setting that prohibits supportive physical contact, to see to what extent the cushion might help these youths to better regulate their emotional distress and unwanted behaviors. Volunteers used the cushion for 15 minutes over 24 sessions. Nine students completed the study and reported reduction in anxiety and agitation, and a soothing feeling with residual effects to their daily routines. This pilot study suggests that the use of a nonrestraining, deep-pressure cushion may simulate a secure holding effect for young people with emotional dysregulation. The cushion is a safe and healing wellness tool that empowers youths and provides programs with an alternative to seclusion and restraint.
Article
The current meta-analysis examined the use of deep touch pressure (DTP; e.g., weighted vests) with students with disabilities. DTP is a form of sensory integration therapy that is currently used extensively in schools with students with autism and other disabilities. Each study in the analysis was evaluated using the Council for Exceptional Children’s guidelines for evidence-based practices. In addition, noting the debate regarding appropriate single-case effect sizes, the current study calculated omnibus effect sizes utilizing a variety of single-case design effect sizes. Results of the current study suggest that DTP interventions are of generally poor quality and demonstrate effects that do not validate their current use for students with disabilities.
Article
Background Emergence delirium (ED) is a significant problem in the post anesthesia care unit (PACU), resulting in dislodgement of medical devices, patient and staff injury, prolonged recovery, and parent dissatisfaction. Parental requests for the use of weighted blankets in the hospital setting have increased. However, while weighted blankets have shown potential as treatment for anxiety in adults and children, no studies have demonstrated their safe use with children in the hospital setting. Purpose To explore the safety of weighted blanket use with children in the PACU as an intervention for ED, a feasibility study was conducted. Design and Methodology: A convenience sample of 93 participants, aged three to 10 years were recruited. Watcha scores, vital signs, length of wear time, and reason for blanket removal were recorded for all patients. Results Eighty-five patients completed the study. Four participants experienced vital signs outside the defined safety parameters, with only one experiencing an adverse event (1.2%). This was consistent with the historic adverse event rate of 1% for the study site. Staff did not report issues with the use or cleaning of the blankets. Of interest, there was significant correlation between ED and suspected pain. Conclusion The study demonstrated weighted blanket use is safe and feasible with children in the hospital setting, Additional studies are needed to determine the effectiveness of weighted blankets as an intervention for ED and the impact pain may have on the severity and prevalence of ED.
Article
Many medical conditions, including sensory processing disorder (SPD), employ compression therapy as a form of treatment. SPD patients often wear weighted or elastic vests to produce compression on the body, which have been shown to have a calming effect on the wearer. Recent advances in compression garment technology incorporate active materials to produce dynamic, low bulk compression garments that can be remotely controlled. In this study, an active compression vest using shape memory alloy (SMA) spring actuators was developed to produce up to 52.5 mmHg compression on a child's torso for SPD applications. The vest prototype incorporated 16 SMA spring actuators (1.25 mm diameter, spring index = 3) that constrict when heated, producing large forces and displacements that can be controlled via an applied current. When power was applied (up to 43.8 W), the prototype vest generated increasing magnitudes of pressure (up to 37.6 mmHg, spatially averaged across the front of the torso) on a representative child-sized form. The average pressure generated was measured up to 71.6% of the modeled pressure, and spatial pressure nonuniformities were observed that can be traced to specific garment architectural features. Although there is no consistent standard in magnitude or distribution of applied force in compression therapy garments, it is clear from comparative benchmarks that the compression produced by this garment exceeds the demands of the target application. This study demonstrates the viability of SMA-based compression garments as an enabling technology for enhancing SPD (and other compression-based) treatment.
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Emotional expression is an important human behavior, which enriches communication. Sensory organs play crucial role in emotional perception. Today, communication is mostly done via digital mediators, which dominantly address vision excluding other senses; therefore, communication becomes less affective. Wearable technology provides an intimate and continuous interaction with sensory organs. Hence, this technology can be used in order to make distant communication more affective by enabling multi-sensory interaction. This article presents a user-centered design practice on wearable products that simulate sensorial feedbacks (tactile, visual, and auditory) to express basic emotions. Three prototypes that transmit emotional messages were designed, built, and tested to observe user behavior. This article discusses how user experience obtained through the user test can be taken further to design new communication products, which can find solutions for different user needs.
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This study explored the use of weighted blankets as a non-pharmacological treatment for persistent vocalizations in late stage dementia. A weighted blanket was applied to three individuals with a diagnosis of dementia who had frequent and intense persistent vocalizations which were not responsive to other treatment modalities and necessitated in-patient hospitalization within a specialized behavioural unit. The evaluation found a non-statistically significant reduction in the duration of persistent vocalizations during the ten-minute application of the weighted blanket and a statistically significant reduction in the duration of persistent vocalizations during the ten minutes following the application of the weighted blanket. The use of weighted blankets may therefore be a promising non-pharmacological intervention for the treatment of persistent vocalizations in late stage dementia.
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Background: Pain, agitation, and thermal discomfort are common symptoms of older adults residing in nursing homes. Nonpharmacologic interventions are recognized as a best practice strategy for people living in nursing homes because of their low adverse effect profile and increased evidence of effectiveness. Warmed blankets have not been empirically tested for use in long-term care. Aims: The purpose of this quality improvement project was to describe the use of warmed blankets in a nursing home setting and determine if use was associated with changes in pain, agitation, mood, or analgesic use. Design: A pretest posttest design was used along with a comparison of intact groups. Settings: The setting was one 160-bed skilled long-term care facility. Participants/subjects: There were 141 residents eligible since they did not have a condition that could be worsened by superficial heat. Methods: Warmed blankets were unfolded and placed over residents with pain, agitation, or thermal discomfort. Short-term pain measures included use of the Revised FACES Pain Scale, the PAINAD (Pain Assessment in Advanced Dementia) scale, and the Brief Agitation Rating Scale. Long-term measures were taken from the electronic medical record. Results: Of the 141 eligible residents, 24.1% (n = 34) received a warmed blanket over the 1- month study period. There were statistically significant decreases in both pain level and agitation among baseline, 20 minutes after application, and the subsequent shift assessments (p < .001). There were also long-term changes in the number of pain complaints (p = .040), severity of pain complaints (p = .009), and as-needed analgesic use (p = .011). There were no statistically significant differences between the treated group and comparison group on any long-term measures. Conclusions: Warmed blankets are a low-cost intervention with a high potential for bringing comfort to nursing home residents.
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The purpose of the study was to explore the efficacy of weighted blanket applications sleep quality in children with autism spectrum disorder and behavioral manifestations of sensory processing deficits. Two 4-year-old participants diagnosed with autism spectrum disorder who also experienced sleep disturbances took part in a single-subject design study. Objective sleep measures and caregiver surveys were tracked for a baseline period of eight days, followed by a 14-day weighted blanket intervention and a seven-day withdrawal phase. Caregiver reports and objective data were evaluated using visual analysis and the percentage of non-overlapping data methods. The results suggest minimal changes in sleep patterns as a result of the weighted blanket intervention. The findings based on using a weighted blanket intervention were enhanced morning mood after night use and a significantly decreased time to fall asleep for participants, though they were not strong enough to recommend for clinical use. Future directions include single-subject and cohort-designed studies exploring the efficacy of weighted blankets with increasing sleep quality among children with autism.
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Pleasant sensation is an underexplored avenue for modulation of chronic pain. Deeper pressure is perceived as pleasant and calming, and can improve sleep. Although pressure can reduce acute pain, its effect on chronic pain is poorly characterized. The current remote, double-blind, randomized controlled trial tested the hypothesis that wearing a heavy weighted blanket – providing widespread pressure to the body – relative to a light weighted blanket would reduce ratings of chronic pain, mediated by improvements in anxiety and sleep. Ninety-four adults with chronic pain were randomized to wear a 15-lb. (heavy) or 5-lb. (light) weighted blanket during a brief trial and overnight for one week. Measures of anxiety and chronic pain were collected pre- and post-intervention, and ratings of pain intensity, anxiety, and sleep were collected daily. After controlling for expectations and trait anxiety, the heavy weighted blanket produced significantly greater reductions in broad perceptions of chronic pain than the light weighted blanket (Cohen's f = .19, CI [-1.97, -.91]). This effect was stronger in individuals with high trait anxiety (p = .02). However, weighted blankets did not alter pain intensity ratings. Pain reductions were not mediated by anxiety or sleep. Given that the heavy weighted blanket was associated with greater modulation of affective versus sensory aspects of chronic pain, we propose that the observed reductions are due to interoceptive and social/affective effects of deeper pressure. Overall, we demonstrate that widespread pressure from a weighted blanket can reduce the severity of chronic pain, offering an accessible, home-based tool for chronic. The study purpose, targeted condition, study design, and primary and secondary outcomes were pre-registered in ClinicalTrials.gov (NCT04447885: “Weighted Blankets and Chronic Pain”). Perspective: This randomized-controlled trial showed that a 15-lb weighted blanket produced significantly greater reductions in broad perceptions of chronic pain relative to a 5-lb weighted blanket, particularly in highly anxious individuals. These findings are relevant to patients and providers seeking home-based, nondrug therapies for chronic pain relief.
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We report on a soma design process, where we designed a novel shape-changing garment—the Soma Corset. The corset integrates sensing and actuation around the torso in tight interaction loops. The design process revealed how boundaries between the garment and the wearer can become blurred, leading to three flavours of cyborg relations. First, through the lens of the monster, we articulate how the wearer can adopt or reject the garment, resulting in either harmonious or disconcerting experiences of touch. Second, it can be experienced as an organic “other”-with its own agency-resulting in uncanny experiences of touch. Through mirroring the wearer’s breathing, the garment can also be experienced as a twisted version of one’s own body. We suggest that a gradual sensitisation of designers-through soma design and reflection on the emerging human-technology relations-may serve as a pathway for uncovering and articulating novel, machine-like, digital touch experiences.
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Histograms are commonly used to measure heart rate variability (HRV), particularly for measurements over a 24-hour period. In this study, a five-class density histogram (FCDH) is proposed to extend the application of histograms for short-term HRV evaluation. The cumulative density, an index derived from the FCDH, is compared with conventional time- and frequency-domain measures, namely (1) low-frequency power (LF); (2) high-frequency power (HF); (3) the power ratio (LF/HF); (4) triangular interpolation of NN intervals (TINN); and (5) the HRV triangular index (HRVi). A total of two hundred subjects participated in the HRV assessment. They came from four equal-sized groups: the healthy young (Young), the healthy old (Old), patients with coronary artery disease, and patients with congestive heart failure. After 7 days and 14 days, 46 subjects from the Young and Old groups were retested following the same protocol in order to examine the reliability of the FCDH. Results show significant differences between the four groups for the indices of cumulative density, LF, HF, TINN, and HRVi (p < 0.001), but not for LF/HF (p = 0.269). The cumulative density shows good-to-excellent interclass correlation (ICC) with an average ICC = 0.783 (95% confidence interval 0.676-0.864), which is higher than the average ICCs of LF (0.695), LF/HF (0.669), TINN (0.686), and HRVi (0.615), but lower than that of HF (0.893). The cumulative density derived from the FCDH is thus a valid and reliable method for short-term HRV assessment.
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This paper presents the results of a concurrent, nested, mixed methods exploratory study on the safety and effectiveness of the use of a 30 lb weighted blanket with a convenience sample of 32 adults. Safety is investigated measuring blood pressure, pulse rate, and pulse oximetry, and effectiveness by electrodermal activity (EDA), the State Trait Anxiety Inventory-10 and an exit survey. The results reveal that the use of the 30 lb weighted blanket, in the lying down position, is safe as evidenced by the vital sign metrics. Data obtained on effectiveness reveal 33% demonstrated lowering in EDA when using the weighted blanket, 63% reported lower anxiety after use, and 78% preferred the weighted blanket as a calming modality. The results of this study will be used to form the basis for subsequent research on the therapeutic influence of the weighted blanket with adults during an acute inpatient mental health admission.
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This paper focussed on how electrophysiological autonomic data may contribute to better understand neural substrates of emotional processing. The utility of autonomic electrophysiological markers for assessing emotional and cognitive processes is presented in the context of an important bodily arousal interface. Components of general autonomic control are reviewed and relevant neural modulations of specific autonomic variables were discussed. The role of autonomic feedback on central processes is emphasized and neural influences on autonomic activities as an index of arousal dimension, the electrodermal activity (EDA), are outlined. An overview of brain mechanisms governing generation and control of EDA is presented, and the contribution of electrodermal parameters as indices of emotional activation illustrated by data related to diurnal emotional reactivity and to non consciously subjective emotionality. Conclusions highlight the role of electrical autonomic expressions as tools to explore emotional components of mind-body-mind relationships.
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In this paper we assessed the possibility of using the pulse rate variability (PRV) extracted from the photoplethysmography signal as an alternative measurement of the HRV signal in non-stationary conditions. The study is based on analysis of the changes observed during a tilt table test in the heart rate modulation of 17 young subjects. First, the classical indices of HRV analysis were compared to the indices from PRV in intervals where stationarity was assumed. Second, the time-varying spectral properties of both signals were compared by time-frequency (TF) and TF coherence analysis. Third, the effect of replacing PRV with HRV in the assessment of the changes of the autonomic modulation of the heart rate was considered. Time-invariant HRV and PRV indices showed no statistically significant differences (p > 0.05) and high correlation (>0.97). Time-frequency analysis revealed that the TF spectra of both signals were highly correlated (0.99 +/- 0.01); the difference between the instantaneous power, in the LF and HF bands, obtained from HRV and PRV was small (<10(-3) s(-2)) and their temporal patterns were highly correlated (0.98 +/- 0.04 and 0.95 +/- 0.06 in the LF and HF bands, respectively) and TF coherence in the LF and HF bands was high (0.97 +/- 0.04 and 0.89 +/- 0.08, respectively). Finally, the instantaneous power in the LF band was observed to significantly increase during head-up tilt by both HRV and PRV analysis. These results suggest that although some differences in the time-varying spectral indices extracted from HRV and PRV exist, mainly in the HF band associated with respiration, PRV could be used as a surrogate of HRV during non-stationary conditions, at least during the tilt table test.
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The aim of this study was to test the utility of heart-rate variability (HRV) analyses as a noninvasive means of quantifying cardiac autonomic regulation during precompetitive anxiety situations in swimmers. Psychophysiological state evaluation of 10 volunteer swimmers (6 women and 4 men) was obtained by comparing baseline training condition (TC) with competition condition (CC). Self-evaluation of precompetitive somatic anxiety measured by CSAI-2 showed significant increase from the TC to CC. Analysis showed that during higher precompetitive anxiety level, a significant reduction in the timing (RMSSD), frequency (HFms2 and HFnu) and Poincaré plot (SD1) of heart-rate variability was observed, and a significant increase in the low frequency to high frequency ratio (LF/HF %). The results indicate a shift towards sympathetic predominance as a result of parasympathetic withdrawal. Our results provide an HRV analysis in a valid, useful and non-invasive way to evaluate the change of sympathovagal balance in presence of precompetitive stress.
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Measures of heart rate variability (HRV) are widely used to assess autonomic nervous system (ANS) function. The signal from which they are derived requires accurate determination of the interval between successive heartbeats; it can be recorded via electrocardiography (ECG), which is both non-invasive and widely available. However, methodological problems inherent in the recording and analysis of ECG traces have motivated a search for alternatives. Photoplethysmography (PPG) constitutes another means of determining the timing of cardiac cycles via continuous monitoring of changes in blood volume in a portion of the peripheral microvasculature. This technique measures pulse waveforms, which in some instances may prove a practical basis for HRV analysis. We investigated the feasibility of using earlobe PPG to analyse HRV by applying the same analytic process to PPG and ECG recordings made simultaneously. Comparison of 5-minute recordings demonstrated a very high degree of correlation in the temporal and frequency domains and in nonlinear dynamic analyses between HRV measures derived from PPG and ECG. Our results confirm that PPG provides accurate interpulse intervals from which HRV measures can be accurately derived in healthy subjects under ideal conditions, suggesting this technique may prove a practical alternative to ECG for HRV analysis. This finding is of particular relevance to the care of patients suffering from peripheral hyperkinesia or tremor, which make fingertip PPG recording impractical, and following clinical interventions known to introduce electrical artefacts into the electrocardiogram.
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Heart rate variability (HRV) is traditionally derived from RR interval time series of electrocardiography (ECG). Photoplethysmography (PPG) also reflects the cardiac rhythm since the mechanical activity of the heart is coupled to its electrical activity. Thus, theoretically, PPG can be used for determining the interval between successive heartbeats and heart rate variability. However, the PPG wave lags behind the ECG signal by the time required for transmission of pulse wave. In this study, finger-tip PPG and standard lead II ECG were recorded for five minutes from 10 healthy subjects at rest. The results showed a high correlation (median = 0.97) between the ECG-derived RR intervals and PPG-derived peak-to-peak (PP) intervals. PP variability was accurate (0.1 ms) as compared to RR variability. The time domain, frequency domain and Poincaré plot HRV parameters computed using RR interval method and PP interval method showed no significant differences (p < 0.05). The error analysis also showed insignificant differences between the HRV indices obtained by the two methods. Bland-Altman analysis showed high degree of agreement between the two methods for all the parameters of HRV. Thus, HRV can also be reliably estimated from the PPG based PP interval method.
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In summary, this work extends previous findings by demonstrating that anger produces a sympathetically dominated power spectrum, whereas appreciation produces a power spectral shift toward MF and HF activity. Results suggest that positive emotions lead to alterations in HRV, which may be beneficial in the treatment of hypertension and in reducing the likelihood of sudden death in patients with congestive heart failure and coronary artery disease.
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Ambulatory monitoring of cardiopulmonary parameters during wake, sleep, and activity states can expand our understanding of health and diseases. In this paper, we present a wearable cardiopulmonary monitoring system called the 'Sensing Shirt'. The Sensing Shirt consists of a T-shirt with sensors integrated for physiological monitoring, a data acquisition unit (DAQU), and a set of PC-based software. A number of vital signs such as electrocardiogram (ECG), rib cage (RC) and abdominal (AB) respiration, photoplethysmogram (PPG), SpO(2), and posture/activities can be acquired by the shirt. The physiological data are stored in a microSD memory card, and then analyzed offline to extract parameters such as heart rate (HR), breathing rate, SpO(2), tidal volume (TV), pulse wave transit time (PWTT), and respiratory sinus arrhythmia (RSA). In the Sensing Shirt system, the ECG is acquired by means of active electrodes. PPG and ECG are sampled by one high-speed 16-bit, analog-to-digital converter at 500 Hz for precise PWTT calculation. Technique of pulse amplitude modulation is used for signal conditioning both in respiratory inductive plethysmography and PPG circuits to reduce the power consumption. Powered by 2 AA batteries with 1600 mAh capacity, the whole system can work more than 48 h continuously without interruption. Basic performance tests demonstrate that prototypes of this system can capture ECG, RC and AB respiration, and PPG signals effectively, and extract parameters such as HR, breathing rate, SpO(2), and TV accurately. This advanced ambulatory monitoring system may be used in both home healthcare and scientific research.
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Few longitudinal studies have examined ethnic and sex differences, predictors and tracking stabilities of heart rate variability (HRV) at rest and in response to stress in youths and young adults. Two evaluations were performed approximately 1.5 years apart on 399 youths and young adults (189 European Americans [EAs] and 210 African Americans [AAs]; 190 males and 209 females). HRV was measured at rest and during a video game challenge. AAs showed significantly higher resting root mean square of successive differences (RMSSD) of normal R-R intervals and high-frequency (HF) power than EAs (ps<0.01). Females displayed larger decrease of RMSSD and HF during video game challenge than males (ps<0.05). These ethnic and sex differences were consistent across 1.5 years. No significant sex difference of resting HRV or ethnic difference of HRV response to stress was observed. In addition to age, ethnicity or sex, baseline resting HRV or HRV response to stress are predictors of the corresponding variables 1.5 years later (ps<0.01). Furthermore, weight gain indexed by either body mass index or waist circumference predicts declined resting HRV levels during follow up (ps<0.05). Tracking stabilities were high (>0.5) for resting HRV, but relatively low (<0.3) for HRV in response to stress. AAs show higher resting HRV than EAs, and females display greater HRV response to stress than males; and these ethnic and sex differences are consistent across 1.5 years. Resting HRV declines with weight gain.
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A number of different sets of data concerning the Corah Dental Anxiety Scale were evaluated. The data indicate that the scale is a reliable, valid, and useful measure of dental anxiety. It can be successfully used in the dental office or in research projects.
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Occupational therapists who work with hyperactive children and adults who are in an aroused state sometimes employ deep pressure touch (DPT) as a therapeutic method to achieve calmer behavior. This pilot study attempts to measure effects of DPT on objective and subjective anxiety. Twenty-three healthy college students, serving as their own controls, self-administered DPT via a specially designed apparatus. Heart rate and self-reported anxiety were compared under conditions of DPT (experimental) and confinement without DPT (control). Data on subjects' trait anxiety also were analyzed. Although the group as a whole did not relax significantly more under experimental conditions than under control conditions, the degree of subjective relaxation was greater in the experimental group. These results, coupled with a significant intragroup difference in the response of subjects with high trait anxiety, were encouraging. This study provides direction and focus to investigators interested in further research on the validation of an empirically useful treatment technique.
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Social science research has long been concerned with ethical issues, but agencies that review and fund research are increasingly attentive to assuring that ethical considerations are being fully addressed. Research on sexual behaviour, a topic that has generated much recent attention worldwide as scientists confront the epidemics of adolescent pregnancy, AIDS and STDs, raises ethical issues that are worthy of special attention. Beginning with the philosophical origin of ethical principles that guide research, this paper discusses the key ethical issues to be considered when designing and conducting social science research. Included are special precautions for research on adolescents, the purpose and properties of an informed consent procedure, and the formation and function of an ethical review committee.
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The aim of our study was to assess whether the Finapres device is able to accurately monitor not only average blood pressure values but also blood pressure variability. To examine this issue, we analyzed 30-minute recordings of finger and intra-arterial pressure simultaneously obtained at rest in 14 patients. We compared systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse interval (the reciprocal of heart rate), overall variability (standard deviation), and specific time-domain and frequency-domain components. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse interval spectral powers were computed by fast Fourier transform over three frequency bands: low frequency (0.025 to 0.07 Hz), midfrequency (0.07 to 0.14 Hz), and high frequency (0.14 to 0.35 Hz). The coherence, ie, the degree of association between blood pressure and pulse interval powers obtained by the two techniques, was also assessed. Standard deviations of diastolic blood pressure, mean arterial pressure, and pulse interval were similar when assessed from the two recordings, whereas standard deviation of systolic blood pressure was overestimated by analysis of finger pressure recordings. All powers of diastolic blood pressure and mean arterial pressure and high-frequency powers of systolic blood pressure estimated from analysis of finger blood pressure tracings were superimposable to those obtained by analyzing invasive recordings. Low-frequency and midfrequency powers of intra-arterial systolic blood pressure were significantly overestimated by the analysis of finger blood pressure tracings (+13.7 +/- 4.4 mm Hg2, P < .01, and +2.3 +/- 0.9 mm Hg2, P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)
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One symptom common to many persons with autism is a high arousal or anxiety level. This study investigated the effects of deep pressure on arousal and anxiety reduction in autism with Grandin's Hug Machine, a device that allows self-administration of lateral body pressure. Twelve children with autism were randomly assigned to either an experimental group (receiving deep pressure) or a placebo group (not receiving deep pressure but in the disengaged Hug Machine). All children received two 20-min sessions a week over a 6-week period. Arousal was measured behaviorally with the Conners Parent Rating Scale and physiologically with galvanic skin response (GSR) readings. Behavioral results indicated a significant reduction in tension and a marginally significant reduction in anxiety for children who received the deep pressure compared with the children who did not. Additionally, children in the experimental group, whose GSR measures decreased, on average, after deep pressure, were somewhat more likely to have higher GSR arousal a priori. These preliminary findings support the hypothesis that deep pressure may have a calming effect for persons with autism, especially those with high levels of arousal or anxiety.
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Power spectral analysis (PSA) of heart rate variability (HRV) offers reliable assessment of cardiovascular autonomic responses, providing a 'window' onto the interaction of peripheral sympathetic and parasympathetic tone. Alterations in HRV are associated with various physiological and pathophysiological processes, and may contribute to morbidity and mortality. Previous studies of posttraumatic stress disorder (PTSD) found lower resting HRV in patients compared to controls, suggesting increased sympathetic and decreased parasympathetic tone. This article describes the analysis of HRV at rest and after psychological stress in panic disorder (PD) patients, in an enlarged sample of PTSD patients, and in healthy control subjects. Standardized heart rate (HR) analysis was carried out in 14 PTSD patients, 11 PD patients and 25 matched controls. ECG recordings were made while subjects were resting ('rest 1'), while recalling the trauma implicated in PTSD, or the circumstances of a severe panic attack, as appropriate ('recall'), and again while resting ('rest 2'). Controls were asked to recall a stressful life event during recall. While both patient groups had elevated HR and low frequency (LF) components of HRV at baseline (suggesting increased sympathetic activity), PTSD patients, unlike PD patients and controls, failed to respond to the recall stress with increases in HR and LF. HRV analysis demonstrates significant differences in autonomic regulation of PTSD and PD patients compared to each other and to control subjects. HRV analysis may augment biochemical studies of peripheral measures in these disorders.
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Contrary to self-reports, most patients with chronic anxiety disorders exhibit increased muscle tension but not autonomic hyperarousal when at rest. Under everyday stress they tend to react with less physiological flexibility than normal controls. However, they overreact subjectively and physiologically to stimuli that are anxiety-provoking. Diminished physiological flexibility may be either a constitutional trait in anxious individuals, a partial but inadequate adaptation to prolonged stress or the result of a disregard for stressors that are not related to psychopathology. The effects of diminished physiological flexibility on general health are not known. There is only a weak relationship, and in some instances a desynchrony, between physiological changes and perception of change under stress. The inconsistencies between self-reports of physiological states and physiological recordings can be explained by alterations of body sensations through psychological factors, predominantly expectations and attention to bodily states, that lead to perceptual distortions.
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Research was conducted recently (August 14-21, 1971) in which subjects assumed the roles of 'prisoner' or 'guard' for an extended period of time within an experimentally devised mock prison setting on the Stanford University campus. The projected two- week study had to be prematurely terminated when it became apparent that many of the 'prisoners' were in serious distress and many of the 'guards' were behaving in ways which brutalized and degraded their fellow subjects. In addition, the emerging reality of this role-playing situation was sufficiently compelling to influence virtually all those who operated within it to behave in ways appropriate to its demand charac- teristics, but inappropriate to their usual life roles and values; this included the research staff, faculty observers, a priest, lawyer, ex-convict, and relatives and friends of the subjects who visited the prison on several occasions (for details see Zimbardo, Banks,
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This paper was to provide an overview of the research studies on snoezelen with people with developmental disabilities and dementia. Computerized and manual searches were carried out to identify the aforementioned studies. Within-session, post-session, and longer-term effects of snoezelen were examined. Twenty-one research studies were identified, 14 concerning people with developmental disabilities and seven people with dementia. Of those studies: 14 reported positive within-session effects; four positive post-session effects; and two positive longer-term effects. These findings were discussed in relation to: (1) methodological aspects (weaknesses) of the studies; (2) the cost of arranging a snoezelen programme and possibilities of reducing the range of stimuli available in the programme; and (3) some research issues for advancing the understanding and effectiveness of intervention programmes with people with developmental disabilities and dementia.
Article
The purpose of this study was to determine if anxiety can be measured objectively by skin conductance of a weak electric current. Three measurements were taken. First, a standardized dental-anxiety questionnaire was given to determine anxiety. Second, galvanic skin conductance was measured. Third, polygraph responses were recorded to three key questions from the questionnaire. Questionnaire scores of these key questions were used to create two groups: anxious and not-anxious. The three key questions were subjected to polygraph verification. In the first analysis patients were excluded if the polygraph test disclosed lying on any of the three key questions. The second analysis excluded liars on a question-by-question basis. The third analysis disregarded the polygraph. A statistically significant correlation was found between skin conductance and dental anxiety in all cases. Data seem to indicate that fear of injection is the most anxiety-producing aspect of modern dentistry.
Article
The purpose of this study was to identify specific practice patterns of a convenience sample of paediatric occupational therapists and the behavioural changes that they observe when they use weighted vests with children with developmental disorders. Although the practice of weighted vests is accepted clinically, there is little discussion of their use nor is there empirical evidence of their efficacy in the literature. A convenience sample of 51 occupational therapists from different geographic areas of the United States participated in a telephone survey about how they used weighted vests with specific children. This study was a follow-up to a mail survey about paediatric occupational therapists' opinions and general practice patterns with weighted vests. Although the interviewees observed some different behavioural changes in children with various developmental disorders when these children used weighted vests, their practice patterns in using the vests were similar across disabilities. The most common behavioural changes noted were increased attention and staying on task. Participants' opinions and practice patterns related to weighted vests are discussed. This study is not generalizable as it utilized a self-selected group of therapists. However, the findings from the qualitative data can provide direction for future quantitative studies by providing important data about practice patterns that may serve as independent variables examining the effectiveness of weighted vests.
Article
The aim of this study was to investigate pediatric occupational therapists' general experience and practice with weighted vests and their impressions about whether weighted vests are effective in changing specific behaviors of children with whom they have used weighted vests. A survey was mailed to a random sample of 514 pediatric occupational therapists who belonged to the School-Based Systems Special Interest Section or the Sensory Integration Special Interest Section of the American Occupational Therapy Association. The response rate was 68%. The survey included 43 items which covered therapist opinions, procedures, behavioral observations and knowledge about weighted vests, in addition to demographic information. Respondents who use weighted vests were more likely to have advanced degrees or certifications and more years of experience as pediatric therapists. They reported using weighted vests with preschool and young elementary school-aged children with the diagnoses of autism or attention deficit disorder. Staying on task, staying in seat and attention span were the most common behaviors that therapists reported improving when weighted vests were used.
Article
Ethical considerations can limit the use of traditional unconditional stimuli (US), such as electric shock and loud tones, when used in a human aversive Pavlovian conditioning procedure. The risk of the US causing pain or excessive anxiety is a particular concern when testing sensitive populations such as children, the elderly, and those with psychological or neurodevelopmental disorders. Two experiments used a differential conditioning procedure to determine whether an unpleasant sound (metal scraping on slate) could support the acquisition and extinction of conditioned responses to the same extent as either electric shock or a 100 dB(A) tone US. Experiment 1 (N=48) demonstrated equivalent or superior conditioning effects for the signal-based learning measures of US expectancy, skin conductance responses, and heart rate. Experiment 2 (N=57) yielded similar outcomes in the affective-based learning measures of startle blink modulation and pleasantness ratings. The results support the use of an unpleasant sound as a US in human Pavlovian conditioning experiments.
Article
Spectral analysis of heart rate variability (HRV) and related measures has been shown to be a reliable noninvasive technique enabling quantitative assessment of cardiovascular autonomic regulatory responses to autonomic regulatory mechanisms; it provides a dynamic probe of sympathetic and parasympathetic tone, reflecting the interactions between the two. Over 20 studies reported abnormalities of HRV in anxiety, and patients with heart disease and anxiety are at increased risk for morbidity and mortality. Psychiatric drugs partly correct abnormalities of HRV and, recently, autonomic drugs (beta-blockers) have been studied in anxiety disorders. The authors call for further studies, especially in patients with co-existing anxiety disorders and heart disease, incorporating assessment of HRV.
Article
Many symptoms of alcohol withdrawal (AW) such as tachycardia or elevated blood pressure might be explained by increased peripheral and central adrenergic activity. In contrast to many neurochemical studies of sympathetic activation during AW, only very few studies investigated autonomic balance using neurophysiological methods. We investigated heart rate variability (HRV) and sympathetic skin response (SSR) in male patients suffering from mild AW syndrome (n = 20, no treatment required) and in patients with moderate to severe AW syndrome (n = 20, clomethiazole treatment) in the acute stage. Sympathovagal influence was quantified using measures of time and frequency domain of HRV as well as modern nonlinear parameters (compression entropy). Furthermore, we obtained latencies and amplitudes of SSR to quantify isolated sympathetic influence. Measures were obtained during the climax of withdrawal symptomatology before treatment, 1 day after climax, and shortly before discharge from hospital. Alcohol withdrawal scores were obtained and correlated to autonomic measures. Ambulatory blood pressure and AW scores revealed characteristic withdrawal symptoms in both patient groups. Apart from the nonlinear parameter compression entropy, Hc, measures of HRV revealed no sign of autonomic dysfunction in contrast to the significantly increased heart rates at the time of admission. Latencies and amplitudes of SSR did not indicate any increase of sympathetic activity. A negative correlation was found between Hc and mental withdrawal symptoms. We show here that classical measures for autonomic nervous system activity such as HRV and SSR are not suitable for describing the autonomic changes seen in acute AW, although a major role for the sympathetic nervous system has been proposed. This might be due to multiple dysregulation of metabolites in AWS or to subtle alcohol-induced damage to neuronal structures, issues that should be addressed in future studies.
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This study examined whether children with attention-deficit/hyperactivity disorder (ADHD) have lower autonomic nervous system (ANS) activity and show less stress reactivity than children with an anxiety disorder. It also explored whether such a difference was accounted for by comorbid oppositional defiant disorder (ODD) or conduct disorder (CD) in some of the ADHD children. Forty-three referred children performed a stress task, during which skin conductance (SCL) and heart rate (HR) levels were measured. Results showed that the ADHD group had similar SCL responses as the anxiety disorder group, but showed less HR reactivity immediately after the stress task. The ADHD with ODD/CD group had a slightly higher HR level than the pure ADHD group, but showed similar SCL and HR reactivity and recovery. It was concluded that ADHD children have less HR reactivity immediately after stress than children with an anxiety disorder, which was not accounted for by comorbid ODD/CD symptoms, and which may be related to a stronger parasympathetic than sympathetic activation.
Article
Age differences in decision making indicate that children fail to anticipate outcomes of their decisions. Using heart rate and skin conductance analyses, we tested whether developmental changes in decision making are associated with (a) a failure to process outcomes of decisions, or (b) a failure to anticipate future outcomes of decisions. Children aged 8-10, 12-14, and 16-18 years performed the Hungry Donkey task, a child version of the Iowa Gambling Task, while heart rate and skin conductance activity were continuously recorded. Children aged 16-18 learned to make advantageous choices over task blocks faster than the two younger age groups. Age differences were present for anticipation-related autonomic activity but not outcome-related autonomic activity. The results are interpreted vis-à-vis models of prefrontal cortex maturation.
Article
Although children experience physical and behavioral consequences from anxiety in many health care settings, anxiety assessment and subsequent management is not often performed because of the lack of clinically useful subjective scales. Current state anxiety scales are either observational or multidimensional self-report measures requiring significant clinician and patient time. Because anxiety is subjective, in this pilot study, we evaluated the validity of a self-report numeric 0-10 anxiety scale that is easy to administer to children in the clinical setting. A descriptive correlation research design was used to determine the concurrent validity for a numeric 0-10 anxiety scale with the state portion of the State-Trait Anxiety Inventory for Children (STAIC). During clinic preoperative visits, 60 children, 7-13 yr, provided anxiety scores for the 0-10 scale and the STAIC pre- and posteducation. Simple linear regression and Pearson correlation were performed to determine the strength of the relationship. STAIC was associated with the anxiety scale both preeducation (beta = 1.20, SE[beta] = 0.34, F[1,58] = 12.74, P = 0.0007) and posteducation (beta = 1.97, SE[beta]) = 0.31, F[1,58] = 40.11, P < 0.0001). Correlations were moderate for pre-education (r = 0.424) and posteducation (r = 0.639). This initial study supports the validity of the numeric 0-10 anxiety self-report scale to assess state anxiety in children as young as 7 yr.
Article
Dental anxiety is a serious obstacle in conventional oral healthcare delivery. A sensory adapted dental environment (SDE) might be effective in reducing anxiety and inducing relaxation. This study aimed to assess the efficacy of a Snoezelen SDE in reducing anxiety among children undergoing scaling and polishing by a dental hygienist. The Snoezelen environment consists of a partially dimmed room with lighting effects, vibroacoustic stimuli, and deep pressure. Nineteen children, aged 6-11 yr, participated in a cross-over intervention trial. Behavioral parameters included the mean number, duration, and magnitude of anxious behaviors, as monitored by videotaped recordings. Physiological parameters reflecting arousal were monitored by changes in dermal resistance. Results, by all measures, consistently indicated that both behavioral and psychophysiological measures of relaxation improved significantly in the SDE compared with a conventional dental environment. The findings support recommending the SDE as an effective and practical alternative in oral healthcare delivery to anxious children.
Article
According to self-report and unsystematic observational data adult patients with attention-deficit/hyperactivity disorder suffer from increased vulnerability to daily life stressors. The present study examined psychological and physiological stress responses in adult ADHD subjects in comparison to healthy controls under laboratory conditions. Thirty-six subjects (18 patients with DSM-IV ADHD diagnosis, 18 sex- and age-matched healthy controls) underwent the Trier Social Stress Test (TSST; Kirschbaum, C., Pirke, K.-M., Hellhammer, D.H., 1993. The “Trier Social Stress Test”—a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology 28, 76–81), a standardized psychosocial stress protocol which contains a stress anticipation phase and a stress phase with a free speech assignment and subsequent performance of a mental arithmetic. Physiological stress measures were salivary cortisol as an indicator of the HPA axis, heart rate (HR), and time- and frequency-domain heart rate variability (HRV) parameters. Subjective stress experience was measured via self-report repeatedly throughout the experimental session. In line with previous theoretical and empirical work in the field of childhood ADHD, it was hypothesized that the ADHD and control group would exhibit comparable baseline levels in all dependent variables. For ADHD subjects, we expected attenuated responses of the physiological parameters during anticipation and presence of the standardized stressor, but elevated subjective stress ratings. Hypotheses were confirmed for the baseline condition. Consistent with our assumptions in regard to the psychological stress response, the ADHD group experienced significantly greater subjective stress. The results for the physiological variables were mixed.