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Characterizing the experiences of flotation-REST (Restricted Environmental Stimulation Technique) treatment for generalized anxiety disorder (GAD): A phenomenological study


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Among the anxiety disorders Generalized Anxiety Disorder (GAD) is currently the most treatment resistant, suggesting that treatment protocols could be enhanced. A promising treatment of GAD is flotation-REST (Restricted Environmental Stimulation Technique), which in earlier studies has been shown to alleviate symptoms in GAD. Although, research on flotation-REST as a treatment of GAD has shown promising result no study has explored how treatment is experienced. By applying a phenomenological perspective the present study aims to characterize the experiences of undergoing flotation-REST treatment while suffering from GAD.
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European Journal of Integrative Medicine
journal homepage:
Research paper
Characterizing the experiences of otation-REST (Restricted Environmental
Stimulation Technique) treatment for generalized anxiety disorder (GAD): A
phenomenological study
Kristoer Jonsson
, Anette Kjellgren
Dept. of Psychology, Karlstad University, Sweden
Generalized anxiety disorder
Sensory isolation
Flotation-tank therapy
Introduction: Among the anxiety disorders Generalized Anxiety Disorder (GAD) is currently the most treatment
resistant, suggesting that treatment protocols could be enhanced. A promising treatment of GAD is otation-
REST (Restricted Environmental Stimulation Technique), which in earlier studies has been shown to alleviate
symptoms in GAD. Although, research on otation-REST as a treatment of GAD has shown promising result no
study has explored how treatment is experienced. By applying a phenomenological perspective the present study
aims to characterize the experiences of undergoing otation-REST treatment while suering from GAD.
Method: Nine participants with GAD, as dened with self-report measures, participated. Data was collected by
semi-structured interviews that were conducted after the completion of a twelve session treatment program with
otation-REST. The Empirical Phenomenological Psychological (EPP) method was used for gathering and
analyzing the data.
Results: The analysis resulted in six themes that characterize the experience of undergoing a otation-REST
treatment while having GAD: (1) obstacles in treatment, (2) a relaxed and safe vantage point, (3) non-ordinary
states of consciousness, (4) connecting with oneself, (5) new attitudes and coping strategies, and (6) enhanced
Conclusion: The results highlights that otation-REST treatment of GAD was experienced as a comprehensive
process that were both challenging and pleasant. The results indicate that the method positively aected
symptoms and the core issue associated with GAD on an experiential level. The present study also generated
some initial understanding regarding potential mechanism that might mediate and maintain positive treatment
eects when otation-REST is applied as an intervention of GAD.
1. Introduction
Anxiety disorders are the most common psychiatric conditions in
Europe and USA [1,2]. Among the anxiety disorders, Generalized
Anxiety Disorder (GAD) is the least responsive to existing treatments
[3], which in general consists of Cognitive Behavioral Therapy (CBT)
and/or pharmacological treatment [4]. The core feature of GAD is
excessive worrying, with symptoms such as diculties concentrating,
muscle tension, irritability, fatigue and poor sleep [5]. GAD also
exhibits a high degree of comorbidity, in which panic disorder, social
phobia and major depressive disorder are the most common [6].
Several etiological risk factors for GAD has been suggested and
explored, such as negative and stressful life events [7], insecure
attachment style [8], poor problem-solving ability of real-life events
[9], inadequate interpersonal skills [10], innate emotional responsive-
ness [11], as well as low mindfulness and diculties with emotion
regulation [12]. The contemporary models of GAD are by few excep-
tions grounded in CBT, and often highlights the chronic worrying in
GAD as an avoidance strategy for unpleasant internal experiences [13].
The psychotherapeutic treatment that GAD patients receive is fairly
consistent, and the most commonly used components are relaxation
techniques, monitoring of cues and triggers for worry, exposure
(imaginal, in vivo or emotional), as well as cognitive restructuring [14].
The fact that GAD is a relatively prevalent disorder [e. g. 15], and
that most treated GAD patients only reach partial remission [16,17],
suggest that current treatment protocols could be further enhanced.
One way of doing this could be to add some new form of treatment
modality to existing treatment protocols that potentially could improve
treatment outcome, as well as increase the treatment options for
patients with GAD. A method of interest is otation-REST (Restricted
Received 9 February 2017; Received in revised form 6 April 2017; Accepted 27 April 2017
Corresponding author at: Department of Psychology, Karlstad University, SE-651 88 Karlstad, Sweden.
E-mail addresses:, (K. Jonsson).
European Journal of Integrative Medicine 12 (2017) 53–59
1876-3820/ © 2017 The Authors. Published by Elsevier GmbH. This is an open access article under the CC BY-NC-ND license (
Environmental Stimulation Technique), which in earlier studies has
shown promising results as a treatment for stress-related ailments
[18,19], chronic pain conditions [20,21], as well as been shown to
have a positive impact on symptoms associated with GAD, such as
fatigue [18], poor sleep [22,23], and muscle tensions [21]. Flotation-
REST treatment utilizes a dark and soundproof isolation tank where the
subject oats comfortably on the back in salt-saturated water main-
tained at skin temperature (34.7 °C). By spending time in an environ-
ment where sensory stimuli are reduced to a minimum, attention and
thoughts tends to be more directed towards a relaxed here and now-
state[24], and the method has been found to eectively induce
relaxation as good or better than more established stress management
interventions [25].
As a step to evaluate potential benets of otation-REST treatment
for GAD a randomized controlled pilot trial was recently conducted
[26], where the eects of a twelve session 45 min) otation
treatment program over a period of seven weeks were evaluated in a
self-diagnosed GAD sample. The results indicated for the rst time
otation-REST as a promising treatment of GAD, and the method was
found to signicantly lower GAD-symptomatology as well as issues
related to the disorder, such as sleep diculties, depression, and
diculties in emotional regulation. Many of these benecial eects
resulting from treatment were also maintained at 6-months follow-up.
In conjunction with this study additional qualitative data were col-
lected by semi-structured interviews, and the present study reports the
results from the analysis applied to this data. The main aim with the
present study was to characterize the experiences of undergoing a
seven-week treatment program of otation-REST while having GAD. A
phenomenological approach was used to gather, transcribing and
analyzing the data.
2. Method
The design of the present study was qualitative and interpretive, and
an in-depth semi-structured interview was conducted with each parti-
cipant. The data was analyzed and interpreted by applying the
Empirical Phenomenological Psychological (EPP) method developed
by Karlsson [27].
2.1. The researchers
The researchers in the present study were a professor in psychology
(Kjellgren) and a Ph. D. candidate in psychology (Jonsson). Kjellgren is
an experienced researcher on the application of otation-REST as a
treatment for various mental and physical ailments, and she has also
conducted studies on meditation, yoga, as well as on the phenomenol-
ogy resulting from ingestion of various novel psychoactive substances.
Jonsson is currently undergoing his Ph. D. education at Karlstad
University and his dissertation work comprises evaluating otation-
REST as a treatment for anxiety and insomnia.
2.2. The otation-REST intervention
Flotation-tanks measuring 270 cm × 150 cm × 130 cm were uti-
lized. The tanks contained water saturated with Epsom salt (magnesium
sulphate) 0.3 m in depth, and maintained at a temperature of 34.7 °C
(skin temperature). The temperature of the water was maintained by a
feedback system consisting of a thermometer that send data to an
internal heater in the oat tank. The tanks were insulated to minimize
sound and light, and earplugs were used during the otation sessions.
The tanks were located in quiet rooms in which toilet and shower could
be accessed. During the otation sessions stawas present nearby and
could be called upon by an alarm button located inside of the tank.
Before and after each otation session the participants had the
opportunity to sit down and relax in the otation facilities. The
otation treatment consisted of 12 otation session (á 45 min) over a
seven week period with two sessions a week, and with the fourth week
treatment free. The design of the otation-REST intervention was
chosen based on earlier otation-REST studies conducted at Karlstad
University, which have indicated it as sucient to reach desirable
therapeutic eects for various populations [18,19,21]. The fourth week
was treatment free to make possible for female participants to plan the
timing of their otation sessions according to the incidence of each
menstrual cycle. No specic instructions were given prior treatment,
except information regarding practicalities surrounding the treatment.
2.3. Participants
Interview data was obtained from nine individuals (two men and
seven women) with a mean age of 45 years (age range 2461) selected
from a sample comprising 24 individuals participating in a research
project evaluating otation-REST as an intervention for GAD [26].In
the original research project the participants were recruited from
outpatient psychiatric care, as well as by advertisement in the local
paper (Karlstad, Sweden). Upon completing the otation-REST treat-
ment, half of the participants (n = 12) who had undergone treatment
were invited for an in-depth interview session.The selection of these
participants were determined by randomization, in which twelve slips
of paper were randomly selected from a jar containing in total 24 paper
slips each corresponding to a participant in the treatment condition. In
total nine of the respondents accepted, while three declined due to
unknown reasons.
All participants met the criteria for GAD as dened by well
validated self-report measures extensively used to indicate GAD in both
clinical and non-clinical populations [28,29], and thus constituted an
analogue GAD sample in the present study. The baseline measurements
of GAD symptomatology in the sample recruited from indicated high
levels of symptom severity. Other self-report measures in addition
indicated substantial suering from depression, sleep diculties, as
well as diculties in emotional regulation, for all participants. For
descriptive and quantitative measures of symptom severity of the
sample in the original research project, as well as a detailed description
of the self-report measures used, see Jonsson and Kjellgren [26].On
average the interviewed participants had experienced issues with
anxiety for the past16 years. Two participants were on a stable dose
of anxiolytics and antidepressant medication, and three participants
used analgesic medication. In addition, two participants received
psychotherapeutic intervention (one session a week). All participants
lived at home; ve lived with a partner and four lived alone. Four
participants were employed; two worked part time and two were full
time students.
2.4. Data collection
The participant gave verbal and written consent to participate in the
study and verbal and written information about the study were given by
the rst author. The protocol for the present study was approved by the
Ethical Board on Experimentation on Human Subjects in Uppsala,
Sweden (Dnr. 2013/357).
The rst author conducted all the interviews within two weeks, but
not directly after, the participants completed the otation treatment.
Due to earlier observations that participants sometimes express need for
privacy directly after receiving otation-REST it was decided that the
interviews should be conducted at an occasion separate from a otation
session. The interviews lasted between 45 and 75 min, and took place in
a secluded room within the otation laboratory at Karlstad University,
Sweden. The interviews were semi-structured and started with the
following question: Can you tell me about your experience of the rst
otation session?From this starting point the interviewees were
encouraged to describe their experiences of undergoing the treat-
ment-program in as much detail as possible. Follow-up questions were
used to clarify the verbal accounts when needed. Two additional
K. Jonsson, A. Kjellgren European Journal of Integrative Medicine 12 (2017) 53–59
questions were used if not already answered adequately: were there any
experiences during the otation sessions, positive or negative, that have been
especially meaningful for you, and can you describe them in more detail?,
and Were your daily life aected by the treatment, and can you describe
how?Besides the three pre-formulated main questions the interview
was focused around creating a setting where a genuine dialogue could
take place, with the aim to provide a space in where the interviewees
had the opportunity to share what they felt was the most important
experiences of partaking in the treatment program. Furthermore, the
interviewing strategy was intended to help the participants to relate
and express what they actually experienced during the partaking in the
treatment, while minimizing their own interpretation of the experi-
ences held. All the interviews were captured using a digital recording
device and transcribed into a word-document for later analysis. All
information that potentially could be used to identify the interviewees
was deleted in the transcription process.
2.5. Data analysis
The EPP method [27] was used to analyze the data. The method
aims to describe the implicit meaning structure of a certain phenom-
enon under study, as it manifest itself, based upon direct world
experiences described by the participants. This implies that the
researcher(s) must maintain an open and bias free attitude to the
immediate experiences, as provided by the participants, by bracketing
(temporarily putting aside theoretical knowledge). The analysis pro-
cesses followed the 5-step guidelines of the EPP method [27].
Step 1 consisted of reading and re-reading the text until a good
comprehension of the content was reached by both authors. In step 2
division of the text into separate meaning units (MU) was performed. A
division was made each time the text changed its substantial meaning,
as is illustrated by the following example: When I oated I felt calm (MU
1), and my thinking became clear and focused (MU 2)This step resulted
in 610 MUs. In Step 3 each MUs were transformed into the language of
the researchers, with the aim of raising the implicit meaning of the
participants described experiences. The MUs presented in the example
above were thus transformed into: The subject experienced relaxation
(tMU 1) and The subject experienced enhancement of cognitive functions
(tMU 2). In step 4 the transformed MUs were organized into categories
based on their characteristics and similarities. This step resulted in 47
categories. Finally step 5 consisted of synthesizing the categories into
overarching themes based on their relation to each other at a higher
level of abstraction, and presenting them as a written analysis with
illustrative quotations from the raw data. During this step alternative
interpretations were discussed by both authors until a consensus were
reached. The researchers strived to ensure credibility by continually
compare the raw data to interpretations made, and by making adjust-
ments and renements of interpretations as the analysis processes
3. Results
The analysis resulted in six overarching themes that characterize the
experience of undergoing a otation-REST treatment while suering
from prolonged anxiety: (1) obstacles in treatment, (2) a relaxed and safe
vantage point, (3) non-ordinary states of consciousness, (4) connecting with
oneself, (5) new attitudes and coping strategies, and (6) enhanced life-
quality. These themes together with illustrative quotations gathered
from the raw data are presented below (Table 1).
3.1. Obstacles in treatment
The experiences of the otation-REST treatment comprised several
obstacles that emerged both initially and later in treatment. The time
before the rst otation session were characterized by nervousness and
anticipation. Worry regarding how one would react to treatment, as
well as anxiousness related to practicalities surrounding the treatment,
were experienced: I was stressed about that I would not hear the music
marking the end of the sessions, or that I would not get up the lid of the tank,
and what would happen then.The initial phase of treatment was also
characterized by restlessness while oating, which together with
increased awareness of stiness and pains in the body, as well as for
some, transient unpleasant reactions such as dizziness, headaches and
nausea, made it dicult to reach a relaxed state while oating. Despite
these initial frictions the subjects were motivated to continue with the
treatment: In the beginning I was stressed only by being in the tank. I really
needed to get hold of myself. I got this feeling that I needed to get into the
stress to get out of it. This kept me going. Some part of me just wanted to
leave the tank; it was all about facing my own restlessness.
Diculties to temporarily let go of the responsibilities of daily life
while oating were present, which expressed itself as feelings of guilt
and stress, as described here: I got this feeling I did not have time to just
lay there in the tank, I had more to think about. What I should do afterwards
or how they felt at home. It just felt wrong that I should have this time for
myself.Paradoxically heightened energy and gist for life were also
reported to constitute a problem, due to a sort of mild mania to change
life over a day: I got all this energy by oating and I did not understand I
needed to use it wisely. I wanted to change so many things in my life that it
actually turned out to be a sort of stress.Participants also reported
frustration over not being able to manifest certain ideas for positive life
changes that emerged during the treatment sessions, which created
feelings of being stuck in life.
Becoming more susceptible to everyday environment, as well as
increased self-awareness, was described as dicult to manage early in
treatment. Participants stated that they initially did not have the
adequate tools to handle the heightened awareness that were reported
to result from treatment, which lead to experiences of feeling vulner-
able and emotionally over-exposed: “…it was the transition that was
dicult. I became very sensitive, and could not manage my feelings. I
became angry, and did not know why. But when I got through this I felt
better. I am still sensitive, but I learned to cope with it. In the beginning [of
treatment] it was more like a bomb, and I was not prepared for it.
3.2. A relaxed and safe vantage point
As the otation-REST treatment progressed, deep and pleasurable
relaxation both physiologically and mentally were experienced.
Relaxation emerged after a sort of trust and adaptation to the treatment
method was established. The otation sessions became a way to reach a
deeply relaxed state, that seldom were naturally occurring in the
participantślife, and to fully relax were for some a novelty, as stated
here: I did not know that you could be so calm and relaxed. It feels like I
have been driven by stress all my life and somehow I thought this was
normal.Thought processes were also experienced to calm down, as
well as becoming clearer and focused during the otation sessions: “…it
is so quiet, normally I have so many thoughts in my head, but when I oat it
is just one thought at a time, not thousands. So I can think really clearly, and
Table 1
Complete list of categories and number of meaning units in each category for the rst
overarching theme: Obstacles in treatment.
Sub-themes Meaning units
Relaxation diculties in tank
Pre-treatment anxiety and anticipation
Practical hinderances
Stressful and demanding life-situation
Diculties integrating insights from treatment
Negative physical reactions
Diculties coping with heightened awareness
Emotional over-exposure
Diculties managing inrease in energy
Total 98
K. Jonsson, A. Kjellgren European Journal of Integrative Medicine 12 (2017) 53–59
I am relaxed when I think.Gradually the oat-tank were experienced as
a safe environment that oered a time outfrom the demands and
distractions of everyday life, a sought for moment to re-charge and get
time for oneself: Here I can be. This is my space. Nothing disturbs me.
Nobody can touch me, aect me, nothing. Like a parenthesis in the midst of
life. My little breathing space.At times the otation sessions were
experienced a vantage point from which daily life could be observed
and reected upon, which facilitated planning, structuring and pro-
blem-solving of everyday matters (Table 2.
3.3. Non-ordinary states of consciousness
Typically, mild deviations from normal state consciousness were
experienced during the otation sessions. Participants described that
they felt centered in the now, and experiences of states in the border-
land of sleep were reported: It felt like I was in this deep and relaxed
state. I did not really sleep, it was more like dormancy. Like being in a state
between sleep and waking state.Slight alterations in time-perception
were reported, as well as experiences of visual phenomenas, such as
seeing dots of light, or ashes. The otation-REST treatment was also
characterized by changes in body-perception. Experiences of weight-
lessness were common, and the distinction between the water and the
skin were often perceived as blurred. At times the body was experi-
enced to expand its boundaries, a process that culminated in a state free
from the usual bodily restriction, as stated here: I became totally
weightless, the little tank were like an open sea. I did not feel the boundaries
of my body. It was like I did not have a body anymore.These types of
experiences could progress into a state were also the verbal mind
chatter diminished or disappeared, accompanied with feelings of deep
peacefulness and/or enthralling euphoria with spiritual overtones, as
described here: ...I just laid there in total darkness, and then I started to
drift away from my body. My thoughts were the only thing that was left.
Then they disappeared more and more as well. At one point it felt like I
existed without my thoughts, without my body, and with this feeling of peace.
It lled me with such happiness. It just came over me.
3.4. Connecting with oneself
Increased awareness of certain tensions and pains in the body were
reported to occur during the otation sessions, which after a moment of
focused attention, tended to disappear: I felt dierent parts of my body
that were tense. The area started to throb a bit for a while, and then the
tension went away.The contents of the inner world were also perceived
as more apparent while oating, which initially in treatment was
experienced as rather unpleasant because negatively toned emotions
and thoughts were present. By coming in contact with emotions without
trying to avoid or control the experience, negative emotions tended to
diminish and make place for more positive emotional states: I felt like
the anxiety were stuck in my body, and when I oated and just stayed in the
feeling it was like it [the anxiety] were released and disappeared. It made me
feel lighter, more relaxed afterwards. Like I moved on somehow.With
time, thoughts and emotions tended to be viewed as from a distance
while oating, and this was experienced to promote observation and
acceptance of the ambient ow of inner experiences with less reactivity
(Table 3.
Autobiographical memories surfaced during the otation sessions,
especially recollections of earlier negative life episodes, which often
were accompanied by an initial increase in anxiety: “…in the beginning it
was very dicult. I got more anxiety. All my feelings were so intense. There
were all these memories and earlier experiences that have been hard for me.
It became less and less dicult to face this, and by the fourth time [otation
session] there was no anxiety at all.There were also autobiographical
recollections that were less dramatic that nonetheless were experienced
as meaningful. Insights regarding how earlier life experiences were
connected to present emotional states were reported, which for some
lead to concrete life changes: I become so aware of my emotional life, and
what I needed to feel good. My childhood was really dicult, and I
continued to have a close contact with my mother despite her being an
alcoholic. While I oated I realized how badly this aected me, which lead
me to end our relationship.Subjects also reported that the otation
treatment gave them an increased self-knowledge, in regard to more
clearly know what were good for them, what part they played in
challenging situations, and what they needed to do to move in a
positive direction: “… now I know what is good for me and what is just
taking my energy. I have become so much better at being aware of myself. I
can see myself in dierent situations, which makes everything clearer. I see
when I do wrong. Its like I got this new perspective on things. I see my part in
it and what is needed to be done.
3.5. New attitudes and coping strategies
Undergoing the otation-REST treatment was characterized by
development of several new attitudes and strategies to cope with
oneself and everyday life. Participants experienced themselves to be
more motivated to stay healthy than before treatment, and many ideas
for positive life changes arose during the oating sessions (Table 4.
Experiences of novel states of beingduring the treatment sessions, such
as being deeply relaxed, having a sound distance to psychological
processes and being less reactive, inspired to seek out activities that
induced similar eects as oating, as expressed here: “…oating has
Table 2
Complete list of categories and number of meaning units in each category for the second
overarching theme: A relaxed and safe vantage point.
Sub-themes Meaning units
Deep relaxation
Positive seclusion
Feeling safe
Increased focus and clarity
Reective mind set
Cognitive structuring and problem solving
Trusting the method
Undemanding context
Total 102
Table 3
Complete list of categories and number of meaning units in each category for the
third overarching theme: Non-ordinary states of consciousness.
Sub-themes Meaning units
Hypnagogic state
Alterations in body-perception
Visual phenomenas
Changes in time perception
Disengaging from self
Total 84
Table 4
Complete list of categories and number of meaning units in each category for the fourth
overarching theme: Connecting with oneself.
Sub-themes Meaning units
Increased awareness of psychological processes
Increased body-awareness
Emotional opening
Processing and integrating the past
Increased self-knowledge
Sound distancing to psychological processes
Observing and non-judgmental mind set
Total 108
K. Jonsson, A. Kjellgren European Journal of Integrative Medicine 12 (2017) 53–59
showed me that I can be calm, and that I dońt need to be so controlled by my
thoughts. It is really a big thing for me that is also easy to forget. I try to do
things that take me to that place.The sought after activities were
characterized by being free from performance and tended to be more
focused on just being: I try to nd other techniques for reaching the same
eects [as oating]. The best has been to go long walks in nature. Not
powerwalking, just walking along water and trees. Then I can let go of
everything at home and just be myself. I go on a walk with no strings
attached.The participants also described that the treatment had an
impact on their use of the social technologies of the modern age: ...I
have been better at shutting down. I try to not constantly being reachable on
my phone. I feel it is important to have moment in which the outer world
cannot reach me. Because I realized it is a source of stress in my life.
The felt importance to maintain a more mindful attitude in everyday
life were gradually cultivated as treatment progressed, and the parti-
cipants reported that they tended to strive for being more present in
daily life as a way to cope with stress and stay healthy: “…now I try to
take one day at the time. Each day has its challenges. I feel good by focusing
on one thing at the time, and if I do not have time for everything, then so be
it.As a way to cope with a heightened awareness of thoughts and
emotions that were perceived to result from treatment participants
tended to identify less with their psychological processes, and experi-
enced that they were more in control over when to ascribe relevance to
them: ...I am not so controlled by my emotions and thoughts anymore, I try
to look at them from a distance, and by doing so it is easier for me to know
what is crap and what is worth paying attention to.
The subjects reported that the otation treatment impacted their
social life in various ways (Table 5. Personal integrity was experienced
to increase and social relations tended to be more guided by the
subjects own needs instead of others after treatment: Before I felt this
frustration. I always said yes to meet up with friends, even if I did not have
the energy for it. Now days, if some friends want to meet up in town and I
say no and she becomes disappointed. Well, then it is her problem.
Increased courage to end relationship that were demanding or other-
wise unrewarding were also reported. The subjects tended to take less
responsibility for others reactions, and experienced a reduced need to
please others: I have been such a social chameleon before, but now I dare
to be myself more when I am with others. I let other take care of their stu;I
cannot take all that responsibility to make others feel good all the time. Not
at the expanse of my own mental health anyway…”
3.6. Enhanced life-quality
Undergoing the otation-REST treatment was experienced to result
in increased well-being and life-quality (Table 6. The subjects perceived
themselves to be less anxious and worried: Before I was worried about
everything. The kids, the family, the future. Everything. Now days I take one
day at the time. I do not need to be several steps ahead all the time.Mood
enhancing eects were also experienced both directly after a oating
session and in daily life. Depressive tendencies subsided and increase in
energy, zest for life, as well as functioning in everyday life were
experienced: I am happier and more alert [after treatment]. Everything
works better at home. I can take care of things, take care of the kids. I feel
more capable in my everyday life. I am not as tired as I used to be. I actually
feel like doing new things for a change.
The subjects also experienced that they with increased ease could
handle stress after treatment: Stuthat earlier made me tense, I have
easier to let go of faster and relate to in a calmer way. I think it is because I
have been laying here [in the oat tank] and relaxing.In addition, pains
associated with earlier injuries or medical conditions were experienced
to be alleviated for some: My body in general feels more relaxed. I also
have fewer aches in my body now. I think it is because I relax more. I got this
neck and back pain, from an old whiplash-injury, but a lot of the ache
associated with it has gone away.Increase in sleep quality was also
experienced to result from treatment, and the participants generally felt
more refreshed and rested in the morning. The participants also stated
that the treatment enhanced their ability to recall dreams, and that they
often found the dreams to be lled with content that were meaningful
for them: What I notice mostly when I oat is that I remember my dreams.
After three four times [oating sessions] I remember short dream
sequences, and it has continued after the treatment as well, but subsided a
bit. When I oated I remembered my dreams almost every night. The dreams
also meant something to me; they were not chaotic at all.
4. Discussion
The phenomenological analysis resulted in six themes that capture
the implicit meaning structure of direct experiences associated with
phases in treatment that occurred in both a chronological and parallel
order. The eects from treatment were not solely conned to experi-
ences during the otation session, but also extended to experiential
changes in daily life. To summarize, improvements in quality of life and
cultivation of new attitudes and coping strategies were reached by
spending time in a secluded environment which appeared to promote
relaxation, increased self-awareness, self-insights, and meaningful in-
tegration of past experience. However, this process also presented
several hindrances and challenges that had to be overcome to acquire
the benets of the otation treatment.
In the light of the rst theme obstacles in treatment, undergoing the
otation treatment comprised several hindrances to reach a relaxed
state while oating. Although some of these initial obstacles likely are
related to the process of adjusting and getting familiar with the
treatment, others are more likely associated with spending time in an
environment where sensory input is reduced to a minimum, potentially
highlighting existing physical and psychological issues. A conclusion
that is in line with Edebol and colleagues [20] phenomenological study
on otation-REST as a treatment of chronic pain conditions, where they
found that an intensication phasetook place early in treatment; in
which existing ailments became more apparent and therefore made it
dicult to relax. Other described issues, as for example coping with a
heightened energy level and self-awareness in daily life, as well as
diculties manifesting ideas of positive life changes, probably could be
Table 5
Complete list of categories and number of meaning units in each category for the fth
overarching theme: New attitudes and coping strategies.
Sub-themes Meaning units
Seeking out restorative environments and activities
Healthy lifestyle changes
New attitudes and changes in social life
Mindful mind set
Self-chosen seclusion
Increased feeling of control
Total 107
Table 6
Complete list of categories and number of meaning units in each category for the sixth
overarching theme: Enhanced life-quality.
Sub-themes Meaning units
Mood improvement
Easygoing attitude
Increased energy and optimism
Reduced stiness and bodily pain
Enhanced ability to relax
Increased sleep-quality
Enhanced contact with dream life
Increased functionality in daily life
Total 111
K. Jonsson, A. Kjellgren European Journal of Integrative Medicine 12 (2017) 53–59
mitigated and worked with in a fruitful manner by combining the
otation-REST treatment with psychotherapy, a combination that ear-
lier pilot studies have found to generate a positive synergy in the
treatment process [30,31]. In addition, the reported increase in dream
recall described in the theme enhanced life qualitycould be of interest
for psychotherapies involving interpretation of dreams as a therapeutic
tool. According to Steck and Steck [32] dreams is best viewed as an
important form of thinking and feeling, including many aspects such as
problem solving, creativity, self-insight into personal behavior, as well
as processing of social interactions. In the light of this, the reported
increase in dream recall might be connected to a more general tendency
of increased self-awareness and openness to experience of oneself that
were reported to result from treatment.
As described in the theme a relaxed and safe vantage pointthe
otation-REST treatment aected several issues associated with GAD.
First, the theme indicate that the otation treatment on an experiential
level succeeded to induce deep relaxation in individuals with prolonged
anxiety, and in addition that the otation sessions gradually were
experienced as a safe context from which existing issues could be
confronted. Taken together this suggest that otation-REST might be a
valid option for individuals with GAD that does not respond to more
established stress-reducing techniques, or for other reasons prefer this
type of intervention. Bodily tensions and pains were also reported to
diminish, which is an important nding when considering that chronic
pain is a medical condition commonly seen in anxiety disorders [33].
The experienced stress and pain-reducing eects reported is also in line
with earlier studies which have indicated stress reduction [25] and
alleviation of chronic pain conditions [e. g. 21] as robust eects
resulting from otation-REST treatment. It is also interesting that
problem-solving of daily-life matters occurred during the otation
sessions, especially since poor problem solving ability in daily life in
part has been suggested to maintain GAD [34], and that individuals
with GAD has been reported to have low condence in regard to solve
problems arising in life [35]. As described in the theme enhanced life
qualitythere were several other benecial eects experienced to result
from treatment that is directly relevant for GAD; especially mood
enhancement, enhanced sleep quality, as well as experienced reduction
in anxiety and time spent worrying. These results are in line with the
initial evaluation of otation-RESt as an intervention for GAD, as
studied by Jonsson and Kjellgren [26], thus triangulating the ndings.
As described in the theme connecting with oneselfthe participants
experienced a deepened connection with their emotions and life
history, which initially were experienced as challenging. The results
here suggest that the otation-REST treatment might facilitate emo-
tional processing and habituation [36] by exposure to unpleasant
emotions with or without associated autobiographical recollection.
Since negative life episodes and insecure attachment styles during
childhood has been proposed to lay the foundation for the chronic
worrying seen in GAD [8], this is a nding that motivates further
studies on the potential of otation-REST as a method providing a
therapeutic setting promoting exposure and processing of feared
stimuli, as well as meaningful integration of past experiences. In
addition, the current results indicate that the treatment promoted a
strive to maintain a more present-oriented attitude in daily life, as well
as keeping a sound distance to psychological processes, as a way to cope
with stress and stay healthy. Interestingly, these attitudes bear resem-
blance to sought after eects in mindfulness- and acceptance based
interventions [e.g. 37]. Considering that low mindfulness has been
suggested to characterize individuals with GAD [12], the results here
suggest that otation-REST in part might reach benecial treatment
eects through facilitation of mindful and accepting states of con-
As described in the theme non-ordinary states of consciousnessthe
otation treatment also comprised experiences characterized by devia-
tions from normal state consciousness, such as changes in time and
body perception. For some persons the otation-REST treatment
induced states in which bodily sensations and cognitive activity were
reduced to a minimum and these types of states were accompanied with
extraordinary feelings of peace or mood lift (euphoria). These types of
experiences have been highlighted in earlier research on otation-REST
[e.g. 24] and they appear to play an important part in the treatment
process. Earlier studies have indicated that non-ordinary states, as for
example induced by psychedelic drugs [e.g. 38,39] or by hypnosis [40],
can have therapeutic applications for mood disorders. When discussing
this it could also be of interest to consider Fuch́s[41] phenomenological
study of individuals with mood disorders, in which he highlights that a
corporealization characterize the experience of suering from these
types of ailments; a concept he denes as being trapped in a body,
which hinders a fullling life by being rigid, heavy, as well lled with
anxiety and its associated somatic expressions. In the light of this the
experienced alterations in body perception, especially the most radical
ones in which the subjects perceived to temporarily be free from bodily
constraints, can be of interest to explore further in regard to how and if
these types of experiences are connected with mood enhancement.
The results in the present study also presented some understanding
on how otation-REST might maintain eects from treatment over
time, as indicated by Jonsson and Kjellgren study [26]. As described in
the theme new attitudes and coping strategiesthe participants were
keen to seek out activates that induced similar eects as otation-REST.
Although, the participants likely succeeded in a varying degree in this
endeavor it highlights that individuals after otation-REST treatment is
open to continue with activities which promotes stress-reduction and
present moment awareness. A way to increase the likelihood of
maintaining positive treatment eects from otation-REST might then
be to provide good options for this when the treatment program is
completed, by for an example extending the treatment with mind-
fulness oriented interventions. The participantśsocial life were also
described as impacted by treatment in a positive sense, and since poor
interpersonal skills has been suggested to characterize individuals with
GAD [10], this might also be a contributing factor in staying healthy
after treatment ended. Although more research is needed to explore
how the above mentioned factors inuence the maintenance of positive
treatment outcomes from otation-REST treatment, the current results
at least provide some initial understanding in this matter.
It is important to consider the limitations of the current exploration
of the experience of otation-REST as a treatment for GAD. As with all
phenomenological research an issue is research induced biased during
the analysis processes, and the analysis has been conducted by
researchers with expertise in otation-REST can be seen both as a
strength and weakness. Bias might also have been introduced during
the interviews, for an example the participants might have been
inclined to please the interviewer by emphasized positive aspects of
the treatment, or felt the need to withhold experiences that might have
been considered to private to share. We have to our best ability tried to
counteract these possible biases by creating an open and non-judg-
mental interview climate. As the main aim with the study were to
characterize the experience of undergoing otation-REST treatment any
discussion around potential casual relationships between the interven-
tion and treatment outcomes is also best seen as speculative and
guiding for further research in the eld. Furthermore, the sample used
in the present study met the criteria of GAD by self-report measures.
This might raise questions regarding generalizability of the ndings to
clinical populations. However, preliminary analyses have demonstrated
good validity and reliability for the self-report measures used when
applied as diagnostic screeners [28,29]. The sample size of the present
study can also be considered a weakness. However, the validity of
phenomenological research does not depend on sample size, but rather
to what degree meaningful data were obtained [27,42]. In the light of
this, the data collected was considered sucient to provide an initial
characterization of the experiences of otation-REST treatment while
suering from generalized anxiety.
In conclusion, the present study is the rst to report a phenomen-
K. Jonsson, A. Kjellgren European Journal of Integrative Medicine 12 (2017) 53–59
ological perspective on otation-REST as a treatment for GAD. The
results highlights that otation-REST treatment of GAD was experi-
enced as a comprehensive process that both were challenging and
pleasant, and which encompassed relaxation, increase in self-aware-
ness, self-insights, meaningful integration of past experiences, as well as
cultivation of new attitudes and changes in daily life. The results
indicate that the method positively aected symptoms and the core
issue associated with the disorder on an experiential level, thus
triangulating results from an earlier pilot trial indicating otation-
REST as a promising treatment of GAD [26]. The present study also
generated some initial understanding regarding potential mechanism
that might mediate and maintain positive treatment eects when
otation-REST is applied as an intervention of GAD, thus guiding
further research in the eld.
Conict of interest
The authors declare that they have no conict of interests.
This study was supported by unrestricted grants from the County
Council of Värmland, Sweden.
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K. Jonsson, A. Kjellgren European Journal of Integrative Medicine 12 (2017) 53–59
... In some cases, mainly regarding inducing of relaxation (which can be measured by devices and subjective assessment), even one session can be sufficient (Feinstein et al., 2018;Fine & Borrie, 2016). However, based on the summary of relevant V. Kavková, M. Malůš / Psychologie a její kontexty 12 (1), 2021, 5-21 research, most researchers agree that ideally one should have 8-12 ca 45-minute sessions within 4 to 7 weeks (Jonsson & Kjellgren, 2017). Bood (2007) et al. also say that the optimum therapeutic benefit of floating does not necessarily improve with a higher number of sessions (i.e. more than 12 sessions). ...
... Regarding anxiety disorders, Jonsson and Kjellgren have recently studied the effect of floating on generalized anxiety disorder (Jonsson & Kjellgren, 2017;Jonsson, 2018). ...
... The results show that flotation REST is experienced by the subjects as a comprehensive process that leads to new challenges as well as enjoyment. The results show that the method has a positive effect on the symptoms connected with generalized anxiety disorder on experimental level (Jonsson & Kjellgren, 2017). In the overall evaluation, the results show that flotation V. Kavková, M. Malůš / Psychologie a její kontexty 12 (1), 2021, 5-21 REST can be a useful instrument for coping with stress, either in combination with or independently on other stress management techniques. ...
Full-text available
The study is a summary of the knowledge of the Flotation REST technique and its effects on stress, anxiety, and depression from the point of view of psychophysiology. Flotation REST is a specific form of relaxing environment invented in the 1950s which has been researched in particular in the fields of psychology and physiology. It is a hydrotherapeutic device that utilizes the effect of environmental stimulation restriction. Hence the abbreviation REST (Restricted Environmental Stimulation Technique). In our country, the technique is usually used in spa centers and wellness facilities. In foreign research, in particular, in the USA, Canada, and Sweden, Flotation Rest has proved to be a unique method in the field of applied psychophysiology. It is a technique with predictable psycho‑ physiological effects, a useful application tool that could help in the treatment of certain somatic as well as mental conditions. The goal of this article is to summarize the effects of the method both on the physiological and psychological levels regarding stress, anxiety, and depression, and to increase the awareness of this technique in view of its development and potential applications.
... There is much research into sensory deprivation tanks, which offer alternative accounts, such as those focusing on the therapeutic effects of float tanks (van Dierendonck and te Nijenhuis., 2005; Feinstein 2018) or altered states of consciousness (Kjellgren, Lindahl, and Norlander 2009). There is also some other research, similar to the author's, which is phenomenologically minded and seeks to uncover the lived experience inside the float tank (Carder 2018;Jonsson and Kjellgren, 2017). This research has found many parallels to my own, such as the radical changes to temporal perception that are reported within the tank. ...
This paper explores Henri Bergson’s understanding of time in relation to the experience of the sensory deprivation tank. In this exploration, the tank is presented as a time machine: a machine that separates time from space and takes the floater into an experience of what Bergson describes as pure time. At the same time, the tank acts as a kind of phenomenological epoché that, through the disabling of the floater’s sensory‐motor schema, literally suspends the human being outside of the world and forces them to reconsider their previous judgements and understandings of consciousness and time. The tank is tied in with contemporary scientific and philosophical discourses on consciousness, such as those of David Chalmers and what he has described as the hard problem of consciousness. As Chalmers discusses, the hard problem requires a radically new type of thinking beyond contemporary science and its inherent materialistic and mechanistic worldview. The tank is presented as a machine that could play a part in this radical rethinking of consciousness—a literal black box working through the black box problems of consciousness.
... One study applying flotation-REST as a treatment for generalized anxiety found that it decreased dysfunctional emotional regulation [20], so pointing to a beneficial effect that might contribute to improved sleep. Interviews with the participants from the same project [38] suggested that flotation-REST could improve mental health, with benefits to sleep, by promoting positive life-style changes such as seeking out seclusion (turning off mobile phones, being unreachable, walking in nature) and striving to be more relaxed and mindful (by, for instance, taking one day at time). A third suggested explanation for the effect of flotation on sleep is the induction of mildly altered states of consciousness. ...
Full-text available
Introduction Some therapies described within alternative and complementary medicine are advertised as sleep-promoting, including flotation-REST (Restricted Environmental Stimulation Technique). Flotation-REST induces deep relaxation through sensory isolation in a water-filled tank and is plausibly reported to mitigate insomnia problems, which have consistently been associated with stress, worry and arousal. However, the effects of flotation-REST have not been previously summarised. The aim of this systematic review was to investigate the efficacy of flotation-REST on sleep in clinical and non-clinical samples. Methods A systematic search for studies on flotation-REST, involving at least one sleep-related variable, was conducted in the databases PubMed, Google Scholar, Web of Science and PsychINFO. Thirteen full-text articles met the inclusion criteria and were considered for eligibility. Nine were included in the current review. The methodological quality of the studies was assessed using a structured checklist, and a standard data extraction sheet was used to summarize the ratings. Results In all included studies, flotation-REST demonstrated beneficial effects on sleep, both in clinical and non-clinical samples. In two studies, the effects were maintained 4 or 6 months post-treatment. The quality of the sleep outcome measures were, however, low in most studies, particularly regarding the participants’ nightly sleep habits, self-reported sleep problems and insomnia diagnosis. Conclusions Flotation-REST may be a promising treatment for insomnia symptoms, but more controlled studies with established sleep measures, and on populations with clinically verified insomnia, are needed.
In dieser theoretischen Arbeit soll versucht werden, das Rätsel der subjektiven Zeit in gewöhnlichen und außergewöhnlichen Bewusstseinszuständen (ABZ) mit der Selbstwahrnehmung zu erklären. Die Erfahrung der Veränderlichkeit des Zeitverlaufs ist in ABZ noch extremer ausgeprägt. Dort kommt es zu einer gemeinsamen Modulation der Zeit und des Selbst. Die veränderten Zeit- und Selbsterfahrungen von Patienten mit psychischen Erkrankungen der Depression, Angst und Substanzabhängigkeit – eine Überrepräsentation der Zeit und des Selbst – sollen in einen Kontext möglicher komplementärer Interventionen wieMeditation, Floatation-REST (Restricted Environmental Stimulation Technique) und Psychedelikaanwendungen gesetzt werden; diese basieren auf den skizzierten psychologischen und neuronalen Grundlagen der Zeit- und Selbstwahrnehmung.
Full-text available
Background: Psilocybin is a serotonin receptor agonist that occurs naturally in some mushroom species. Recent studies have assessed the therapeutic potential of psilocybin for various conditions, including end-of-life anxiety, obsessive-compulsive disorder, and smoking and alcohol dependence, with promising preliminary results. Here, we aimed to investigate the feasibility, safety, and efficacy of psilocybin in patients with unipolar treatment-resistant depression. Methods: In this open-label feasibility trial, 12 patients (six men, six women) with moderate-to-severe, unipolar, treatment-resistant major depression received two oral doses of psilocybin (10 mg and 25 mg, 7 days apart) in a supportive setting. There was no control group. Psychological support was provided before, during, and after each session. The primary outcome measure for feasibility was patient-reported intensity of psilocybin's effects. Patients were monitored for adverse reactions during the dosing sessions and subsequent clinic and remote follow-up. Depressive symptoms were assessed with standard assessments from 1 week to 3 months after treatment, with the 16-item Quick Inventory of Depressive Symptoms (QIDS) serving as the primary efficacy outcome. This trial is registered with ISRCTN, number ISRCTN14426797. Findings: Psilocybin's acute psychedelic effects typically became detectable 30-60 min after dosing, peaked 2-3 h after dosing, and subsided to negligible levels at least 6 h after dosing. Mean self-rated intensity (on a 0-1 scale) was 0·51 (SD 0·36) for the low-dose session and 0·75 (SD 0·27) for the high-dose session. Psilocybin was well tolerated by all of the patients, and no serious or unexpected adverse events occurred. The adverse reactions we noted were transient anxiety during drug onset (all patients), transient confusion or thought disorder (nine patients), mild and transient nausea (four patients), and transient headache (four patients). Relative to baseline, depressive symptoms were markedly reduced 1 week (mean QIDS difference -11·8, 95% CI -9·15 to -14·35, p=0·002, Hedges' g=3·1) and 3 months (-9·2, 95% CI -5·69 to -12·71, p=0·003, Hedges' g=2) after high-dose treatment. Marked and sustained improvements in anxiety and anhedonia were also noted. Interpretation: This study provides preliminary support for the safety and efficacy of psilocybin for treatment-resistant depression and motivates further trials, with more rigorous designs, to better examine the therapeutic potential of this approach. Funding: Medical Research Council.
Full-text available
Background: During Flotation-REST a person is floating inside a quiet and dark tank, filled with heated salt saturated water. Deep relaxation and beneficial effects on e.g. stress, sleep difficulties, anxiety and depression have been documented in earlier research. Despite that treatments for generalized anxiety disorder (GAD) are effective; it is till the least successfully treated anxiety disorder, indicating that treatment protocols can be enhanced. The use of Flotation-REST as a treatment of GAD has not been researched. The aim of the present study was to conduct an initial evaluation of the effects in a self-diagnosed GAD sample. Methods: This study was a randomized, parallel group, non-blinded trial with 1:1 allocation ratio to waiting list control group (n = 25) or to a twelve session treatment with flotation-REST (n = 25). Inclusion criteria's were: 18-65 years and GAD (as defined by self-report measures). The primary outcome was GAD-symptomatology, and secondary outcomes were depression, sleep difficulties, emotion regulation difficulties and mindfulness. Assessments were made at three time points (baseline, four weeks in treatment, post-treatment), and at six-month follow-up. The main data analyses were conducted with a two-way MANOVA and additional t-tests. Forty-six participants (treatment, n = 24; control, n = 22) were included in the analyses. Results: A significant Time x Group interaction effect for GAD-symptomatology [F (2,88) = 2.93, p < .001, η p (2) = .062] was found. Further analyses showed that the GAD-symptomatology was significantly reduced for the treatment group (t (23) = 4.47, p < .001), but not for the waiting list control group (t(21) = 0.98, p > .05), when comparing baseline to post-treatment scoring. Regarding clinical significant change, 37 % in the treatment group reached full remission at post-treatment. Significant beneficial effects were also found for sleep difficulties, difficulties in emotional regulation, and depression, while the treatment had ambiguous or non-existent effects on pathological worry and mindfulness. All improved outcome variables at post-treatment, except for depression, were maintained at 6-months follow. No negative effects were found. Conclusion: The findings suggest that the method has potential as a complementary treatment alongside existing treatment for GAD. More studies are warranted to further evaluate the treatments efficacy. Trial registration: Australian New Zealand Clinical Trial Registry: ACTRN12613001105730 , Date of registration: 03/10/2013.
Full-text available
In this study we investigated the value of flotation Restricted Environmental Stimulation Therapy (REST) as a stress-management tool. We focused on the physiological effects of REST, its influence on well-being, and on performance. Twenty-seven studies published in 25 articles or book chapters were included in a meta-analysis. The total number of participants was 449, with a mean age of 29 years (ranging between 20 and 45). Sixty-four percent was male and 36% was female. The results showed that REST has positive effects on physiology (e.g., lower levels of cortisol, lower blood pressure), well-being, and performance. The pre–post mean effect size and the overall randomized control group effect size were relatively strong. This suggests that despite some limitations of the original studies, flotation REST can be a useful stress management tool in addition to or instead of other stress management tools.
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Understanding temperament is central to our understanding of development, and temperament constructs are linked to individual differences in both personality and underlying neural function. In this article, I review findings on the structure of temperament, its relation to the Big Five traits of personality, and its links to development and psychopathology. In addition, I discuss the relation of temperament to conscience, empathy, aggression, and the development of behavior problems, and describe the relation between effortful control and neural networks of executive attention. Finally, I present research on training executive attention.
The neuroanatomy and physiology of dreams and transitional states of sleep as well as functions of dreams are described. The major types of dreams such as lucid dreaming, daydreaming, and nightmares are discussed. Modern research suggests that sleep is a well-organized activity. The sleeping brain remains active and dreaming occurs in rapid eye movement (REM) sleep periods as well as in non-REM sleep. The “dreaming machine” involves large areas of the brain, and fMRI studies reveal complex patterns of activation and inhibition of multiple cortical and subcortical brain regions. Cerebral areas producing images are turned on, which explains the visual nature of dreams. Brain areas responsible for placing objects in their physical context remain inhibited, explaining why proportions are often distorted in dreams. It is suggested that the “primary driving forces of dreaming” are found in the meso-cortico-limbic system. This circuit is implicated in emotion and reward processing. Studies show that dopaminergic modulation plays an important function in dreaming. Dreaming can be considered as an important form of feeling and thinking. In dreams the most unexpected associations happen and both logical and illogical contents are featured. Dreams offer many facets such as problem solving, creative ideas, and new insight into personal functioning. They deal with emotional regulation, represent social interactions, and lead to better self-knowledge. While dreaming the body is active, feels intensively, and has even more abilities than the awake body, for example, it can fly. In psychotherapy dream narratives allow images to be connected with emotions and a search for meaning. During or after traumatic experiences, nightmares may or may not replay the dramatic events: accompanying violent emotions may gradually change into less overwhelming feelings, a process necessary to prevent their recurrence. Dreaming can then been regarded as having a restitutive function.
The generalized anxiety disorder is a frequent psychiatric disorder mostly seen in young women. Because of disabling physical symptoms patients ask for help before all in primary care and in internal medicine. A generalized anxiety disorder is often associated with other psychiatric disorders such as depression and other anxiety disorders. After appropriate diagnosis and differential diagnosis the planning of the treatment may already be initiated by the general practitioner. The treatment of choice is a combination of cognitive behavioural therapy and psychopharmacotherapy. First line pharmacotherapy comprises certain antidepressants. By offering an evidence based treatment patients' quality of life usually can be improved and the risk of chronification of the disorder may be diminished.
The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV :Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.