Floating

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The Seven Theories of Floating
by Michael Hutchinson, author of "The Book of Floating" There's no doubt that floating works - as a therapeutic, educational and entertainment tool it has powerful effects on a number of levels, including the physical, emotional, intellectual and spiritual. But why is the floatation environment so effective? What can be so actively beneficial in an essentially passive device? This is a question that has intrigued scientists, and today there is floatation research going on in laboratories around the world. The evidence accumulated so far falls into a number of distinct, though interrelated explanations. Among the most important are as follows:

1 The Antigravity Explanation.
The buoyancy afforded by the dense Epsom salt solution eliminates the body's specific gravity, bringing the floater close to an experience of total weightlessness. Gravity, which has been estimated to occupy 90 percent of all central nervous system activity, is probably the single largest cause of human health problems - the bad backs, sagging abdomens, aching feet, painful joints, and muscular tension that result from our unique but unnatural upright posture. This theory asserts that, by freeing our brain and skeletal system from gravity, floating liberates vast amounts of energies and large areas of the brain to deal with matter of mind, spirit, and enhanced awareness of internal states.

2 The Brain Wave Explanation.
More interesting than the well known alpha waves generated by the brain in moments of relaxation, are the slower theta waves, which are accompanied by vivid memories, free association, sudden insights, creative inspiration, feeling of serenity and oneness with the universe. It is a mysterious, elusive state, potentially highly productive and enlightening; but experimenters have had a difficult time studying it, and it is hard to maintain, since people tend to fall asleep once they begin generate theta waves. One way of learning to produce theta waves is to perfect the art of meditation. A study of Zen monks conducted by Akira Kazamatsu and Tomio Hirai, in which the monks' brain-waves were charted as they entered the meditative states, indicated that the four meditative plateau's (from alpha to the more sublime theta) "were parallel to the disciples' mental states, and their years spent in Zen training." Those monks with over twenty years of meditative experience generated the greatest amount of theta, the monks were not asleep but mentally alert. However, since many of us are unwilling to spend twenty years of mediation to learn to generate theta waves, it's helpful to know that several recent studies (at Texas A&M and the University at Colorado) have shown that floating increases production of theta waves. Floaters quickly enter the theta state while remaining awake, consciously aware of all the vivid imagery and creative thoughts that pass through their minds, and after getting out of the floatation environment, floaters continue to generate larger amounts of creativity-promoting theta waves for up to three weeks.

3 The Left-Brain Right-Brain Explanation.
The two hemispheres or the neocortex operate in fundamentally different modes. The left hemisphere excels at detail, processing information that is small-scale, requiring fine resolution: it operates analytically, by splitting or dissection. The right hemisphere on the other hand, is good at putting all the pieces together. It operates by pattern recognition - visually, intuitively rapidly absorbing large scale information. Just as in the sunshine of a bright day it is impossible to see the

stars, so are the subtle contents of the right hemisphere usually drowned out by the noisy chattering of the dominant verbal/analytical left brain, whose qualities are the more cultivated and valued in our culture. But recent research indicates that floating increases right-brain (or minor hemisphere) function. Floating turns off the external stimuli, plunges us into literal and figurative darkness - then suddenly the entire universe of stars and galaxies is spread out before our eyes. Or as brain researcher Dr. Thomas Budzynski of the University of Colorado put it, "In a floatation environment, the right hemisphere comes out and says, 'Whoopee".

4 The Three Brain Explanation.
In a series of seminal studies produced over the last twenty-five years, Paul MacLean, chief brain researcher at the National Institute for Mental Health (US), has produced convincing evidence that the human brain has three separate physiological layers, each corresponding to a stage in our evolutionary history. In this "Triune Brain Theory," the most ancient layer is called the reptile brain, and it controls basic self-preservative, reproductive and life sustaining functions. Sitting atop the reptile, brain is the iambic system, which MacLean had dubbed the visceral brain, because generates all our emotions. The most recent part of the brain to develop is the "thinking cap" of convoluted gray matter called neocortex, seat of our abstract, cognitive functions; memory, intellect, language, and consciousness. While many of these three separate brains have overlapping functions they are all quite different in chemistry, structure, action, and style. Three brains should be better than one, but unfortunately, due to a ruinous design error, there is insufficient communication and coordination between the neocortex and the two older levels. This lack of communication results in a chronic dissociation between the higher and lower brains, which MacLean calls schizaphysiology, and which we experience in the form of conflicting drives - unconscious and conscious, savage and civilized, lusty and loving, ritualistic and symbolic, rational and verbal. There are times when the levels do act in harmony, as in peak experiences when body and mind unite in exhilarating moments of vitality, when our actions come effortlessly, spontaneously. But it's hard to predict when these perfect moments will occur. Now there is evidence that suggests that, due to heightened internal awareness and decreased physical arousal, floating increases the vertical organisation of the brain, enhancing communication and harmony between the separate levels. Floating, it has been hypothesised, can provide us with peak experiences almost at will.

5 The Neurochemical Explanation.
Neuroscientists have recently discovered the brain is an endocrine organ that secretes numerous neurochemicals which influence our behavior. Our brains secrete hormones that make us happy, anxious, depressed, shy, sleepy, sexy. Each of us creates different amounts of these various neurochemicals, and those who create, for example, more endorphins - natural opiates - experience more pleasure as a result of a given experience than those who create fewer endorphins. Tests indicate that floating increased the secretion of endorphins at the same time as it reduces the levels of a number of stress-related neurochemicals, such as adrenaline, nordpinephrine, ACTH, and cortisol - substances that can cause tension, anxiety, irritability, and are related to ailments such as heart disease, hypertension and high levels of cholesterol. One other neurochemical theory is the "return of the womb" explanation. Since pregnant women produce up to eight times the normal endorphin levels, the foetus experiences true prenatal bliss. When a floater is suspended in the dense, warm solution, enclosed in darkness, body pulsing rhythmically and brain pumping out endorphins, it's possible that subconscious memories are stirred and profoundly deep associations called up. It is no coincidence that at least one commercial float centre is named "The Womb Room."

6 The Biofeedback Explanation.
Because of biofeedback research (including Johns Hopkin's researcher John Basmajian's conclusive study of subjects consciously firing off single motor-unit neurons), we now know that humans can learn to exercise conscious control over virtually every cell in their bodies. Processes long thought to be involuntary, such as the rhythm and amplitude of our brain waves, healing, blood pressure, the rate or force of heart contractions, respiratory rate, smooth-muscle tension, and the secretion of hormones and neurotransmitters are now thought to be controllable. The way biofeedback machines work is by enhancing concentration', by focusing on a single, subtle change in the body, which is being amplified by the machine, we are able to shut off our awareness of the external environment. This shutting-off of external stimuli is exactly what the floatation environment does best - almost as if in an "organic" biofeedback machine, in the tank every physical sensation is magnified, and because there is no possibility of outside distraction, we are able to relax deeply and focus at will upon any part or system of the body.

7 The Homeostasis Explanation.
The human body has an exquisitely sensitive self-monitoring and self-regulating system that is constantly working to maintain the body in homeostasis - an optimal state of balance, harmony, equilibrium and stability. Considered in these terms, we can define stress as a disruption of our internal equilibrium, a disturbance of our natural homeostasis. Research now indicates that many of floating's most powerful effects come from its tendency to return the body to a state of homeostasis. When we view the mind and body as a single system, it becomes clear that external stimuli are constantly militating against the system's equilibrium, every noise, every degree of temperature above or below the body's optimal level, every encounter with other people, everything we see and feel can disrupt our homeostasis. But when we enter the tank, we abruptly stop making constant adjustments to outer stimuli. Since there are no external threats, no pressures to adapt to outside events, the system can devote all its energies to restoring itself./ The normal state, of course, is health, vigour, enthusiasm, and immense pleasure in being alive. ©Michael Hutchinson

Floating Alleviates Chronic Stress-related Pain
Treatment in the form of floating in huge tanks of saltwater, so-called 'floating,' is effective for chronic stress-related pain. This is shown in a study at Karlstad University, Sweden, led by Professor Torsten Norlander. The research study shows that individuals suffering from stress-related health problems such as chronic pain, depression, or anxiety are often helped a great deal by floating. The effect remains four months after the treatment period. A control group, which did not participate in floating, experienced no improvement in their health. The study is part of a series at the Human Performance Laboratory and is research project run in collaboration with the Vormland County Council. The patients who were treated with floating had had health problems for a long time. Several of them had been diagnosed with 'burn-out.' They had various stress-related symptoms like pain, exhaustion, depression, and anxiety.

"These are individuals who often have tried many different forms of treatment before. They are individuals who are in the greatest possible need of relaxation but who have the hardest time adopting methods of relaxation. They are so tightly wound up that the methods don't work," says Professor Torsten Norlander. What happens, then, when these patients are allowed to float? It appears that floating is an effective way to trigger the body's relaxation response. The level of stress hormones goes down during and after floating. Moreover, it seems as if the treatment has an even greater effect since prolactin, a kind of 'life-force hormone,' is released in larger amounts. After a period of treatment totaling seven weeks, 22 percent of the participants in the floating group were entirely free of pain, and 56 percent experience a clear improvement; 19 percent noticed no difference, and 3 percent grew worse. In terms of symptoms, the findings were as follows: 23 percent slept better; 31 percent experienced less stress; 27 percent felt less anxiety; and 24 percent were less depressed or came out of their depression completely. What the researchers find particularly gratifying is that the positive effects were still in evidence four months after the floating treatment ended. To ensure that the good results can be ascribed to floating as such, the researchers set up, on the one hand, a control group that did not take part in floating and, on the other hand, a subdivision within the floating group. One of these subgroups received normal attention and encouragement, while the other subgroup was given extra attention and encouragement. "It might be suspected that it was the attention and encouragement that yielded results, so we wanted to try treating the two floating groups differently. But it turned out that there was no difference between the two subgroups of floaters: their results were equally good. On the other hand, the control group, which did not take part in floating, registered no improvement whatsoever," says Sven-Oke Bood, a doctoral student in psychology and a registered nurse. This research on floating is part of his coming doctoral dissertation. Stress is largely about how we worry about things that have happened and are going to happen. When an individual, instead, manages to reach a sort of 'here-and-now' state, the brain can rest. These researchers believe that floating is a way of achieving just such a state. In a dark and silent floating tank, the patient is cut off from many sense impressions. Besides the rest the brain gets, the muscles also become relaxed. In one study the researchers found that about 12 floating treatments are sufficient to achieve results. The group that received 33 floating treatments attained only slightly better pain relief and blood pressure levels. It seems as if 12 treatments are enough to alleviate anxiety, depression, and other stress-related symptoms.

In another study the researchers examined whether floating can be combined with conversational therapy. Thus far it seems that patients who float achieve positive results more quickly during conversational therapy. Floating enhances the effect.

The research project, which has been underway since 2003, is being funded by the Vormland County Council and the Center for Clinical Research. These research findings are being presented in the prestigious American scientific journal International Journal of Stress Management in May and in a specialist journal for pain research. Peer reviewed publication and references International Journal of Stress Management, May issue

Vetenskapsrodet (The Swedish Research Council) The Swedish Research Council bears national responsibility for developing the country's basic research towards attainment of a strong international position. The Council has three main tasks: research funding, science communication and research policy. Research is the foundation for the development of knowledge in society, and the basis of high-quality education. Research is also crucial as a means of enhancing welfare through economic, social and cultural development.

A BRIEF OVERVIEW OF RESEARCH REGARDING THE EFFECTIVENESS OF RESTRICTED ENVIRONMENTAL STIMULATION THERAPY AS A COMPLEMENTARY TREATMENT FOR A RANGE OF BEHAVIORAL DISORDERS
Baylah David, Ph.D. Neurobehavioral Health Services, 5363 E. Pima, Suite 100, Tucson, Arizona 85712, (520) 321-0373

Introduction
The use of sensory restriction as an intervention which alters human consciousness began in 1951 with the opening of the McGill University Perceptual Isolation Laboratory, mandated, primarily, to study the mind-altering effects of monotonous environments. By 1960 or 1961 systematic exploration of sensory restriction as a therapeutic modality in the treatment of psychological disorders began, with the study of its effect on various types of mental illness among people inpatient in psychiatric hospitals. Research into the use of such an environment as a therapeutic

intervention has evolved considerably in the intervening forty years, and has focused primarily on its use in the treatment of addictive disorders. This paper reviews the research bases and effectiveness of Restricted Environmental Stimulation Therapy (REST). REST is a psychotherapeutic practice that places the client in an environment with a drastically reduced level of external stimulation. Research evidence indicates that REST consistently has beneficial effects on medical, psychological, and behavioral health outcomes, particularly when used in conjunction with other therapies.

Smoking cessation
For thirty years research has been conducted on the use of "sensory restriction" as a smoking cessation intervention. About twenty research studies have been conducted. The findings have been consistent: when used by itself, in studies with follow-up periods ranging from 12 months to 5 years, 25% of REST subjects achieved long term abstinence . When REST was combined with other effective smoking cessation treatments (e.g. behavior modification , hypnotherapy ) in studies with follow-up periods ranging from 18 months to 5 years, 50% achieved long term abstinence. In a few clinical studies, one to two years in duration, REST has been combined with weekly support groups. In those instances 75-80% have maintained abstinence for the length of the study . Success rates for REST as an adjunct or complementary therapy are dramatically better than most other available treatments. For example, at the end of one year the success rate of the nicotine patch alone is 5% and combined with behavior modification 20%. Studies of the use of anti-depressants such as Zyban/Wellbutrin for smoking cessation, which show a 40-50% success rate, have not included follow-up data longer than one year and are contra-indicated for a large segment of the crossaddicted population, specifically those with eating disorders. In addition to the non-invasive and brief nature of the REST treatment, two factors distinguish it from others with regard to smoking cessation: its notably low relapse rate and the remarkable characteristic that it lifts physical craving for nicotine, thereby removing the aversive factor of physical withdrawal.

Eating disorders & alcoholism
Additional studies have shown REST to be effective in treating various eating disorders, in decreasing heavy drinking, and in treating a variety of other behavioral and mental health disorders. In three studies of REST as a treatment for obesity, REST was followed by slow continuous weight loss over the 6 month follow up period . Another study examined REST as a treatment for bulimia , and have found the success rate equivalent to that with smoking cessation 50%. REST has been found effective in decreasing the alcohol consumption of heavy drinkers, in some cases resulting in total cessation. Heavy social drinkers treated with 2 hours of REST and anti-alcohol educational messages during the treatment, reduced their alcohol consumption 56% in the first two weeks after the treatment. That reduction was maintained at 3 and 6 month follow-ups . A Washington State University study (1990) found that, for heavy drinkers, after exposure to one 12 hour or 24 hour REST session, the average daily onsumption of alcohol continued to drop over 6 months of followup. The 24-hour group's average consumption before REST was 42.7 ounces per day, immediately post REST was 23.3 per day, 16.0 per day at 3 months and 12.7 at 6 months.

Drug abuse
A University of Arizona study examined chamber REST as a complementary relapse prevention technique with substance abusers enrolled in traditional outpatient substance abuse treatment programs. At the end of 4 years of follow-up 43% remain continuously sober and drug free. None of the control group did so for eight months of follow-up .

Summary
Addiction in its various manifestations, and smoking cessation in particular, have been the focus of the largest body of chamber REST research; about three-fourths of all subjects were exposed to REST as treatment for an addiction/"behavioral disorder". In addition, however, a meaningful body of research has been conducted, over several decades, on the effect of chamber REST in treating a variety of more traditional psychiatric and psychological disorders (e.g., phobias, obsessive compulsive behaviors, anxiety, depression, autism and schizophrenia), as well as chronic pain, stuttering and hypertension. (references available) The "side effects" of REST treatment are often even more dramatic than its effectiveness in achieving explicit behavioral goals. In a group of patients undergoing REST as part of a smoking cessation program, several of the participants reported that their time in the chamber was used to think more deeply than usual about other life problems, and that solutions found as a result of this experience were applied successfully afterward. The list of benefits included an increase in exercise and/or a decrease in caffeine or "fattening food" consumption, and a solution of interpersonal problems, with family members (constant arguments, withdrawal, perceived rejection) and at work (insufficient recognition, failure to assert oneself). A British psychiatrist published a case of unexplained muscular tension, hypertension, neck pain, and generalized anxiety which was positively impacted by a 24-hour chamber REST session. Not only did the patient achieve normal blood pressure and a relief from the somatic symptoms that made medication no longer necessary, he also reported a significant change in his outlook on life. The history of REST research seems to have revealed what traditional cultures knew for thousands of years that solitude and sensory reduction facilitate healing of many disorders. Because REST requires a minimal investment of time, has a paucity of contra-indications, augments the effectiveness of existing treatments and potentiates the effectiveness of other therapeutic interventions, we owe it to those we serve to utilize it as a tool.

REST-Assisted Relaxation and Chronic Pain
Health and Clinical Psychology magazine (1985) By Thomas H. Fine & John W. Turner, Jr., Medical College of Ohio, Toledo, Ohio, USA

In the past decade relaxation training has been one of a number of behavioral approaches to the treatment of chronic pain. Recently, flotation REST (Restricted Environmental Stimulation Therapy), which consists of floating in buoyant liquid kept at skin surface temperature in a soundproof, light-free enclosure, has been used to induce deep states of relaxation and assist in the relaxation training process. This report presents data on patients receiving multimodal treatment for chronic pain, including REST-assisted relaxation training. The patients received individual stressoriented psychotherapy, biofeedback-assisted relaxation training and REST-assisted relaxation training. The use of flotation REST will be discussed through a comparison of the subjective effects of REST relaxation of biofeedback assisted relaxation specifically regarding the perception of pain.

Introduction
Treatment of pain disorders has undergone a refocusing of efforts in recent years. The movement has generally been away from the external management of pain perception through medication or surgery; towards the internal regulation of pain experience through behavioral management,

(Fordyce & Steger, 1979) relaxation training (Turk, Meichenbaum and Genest, 1983) and cognitivebehavioral approaches (Turk, et.el., 1983). These approaches have been used extensively with various pain disorders including chronic, recurrent pain and chronic intractable, benign pain (Turk, et.al., 1983). As mentioned, one component of this treatment approach has been relaxation training. Often the relaxation training is assisted through the use of EMG or thermal biofeedback. The rationale for this is simply that biofeedback provides specific training for physiological processes enhancing the generalized relaxation instructions. In addition biofeedback may provide motivational factors not available in relaxation training alone. The goal of relaxation training is for an individual to be able, through the use of an internalized set of cues, commands, images, phrases or kinesthetic sensations, to alter his or her physiology to a state of reduced output. Any process that assists an individual in experiencing that state may prove useful in a behaviorally oriented chronic pain therapy. Flotation Restricted Environmental Stimulation Therapy (Flotation REST) has been shown to create powerful physiological and subjective relaxation states (Turner & Fine, 1983, Suedfeld, 1983, Jacobs, Heilbronner & Stanley, 1984). This technique involves flotation in a lightproof, sound attenuated chamber containing a thermally constant (94.5 degrees) buoyant (1.28 s.g.) solution of epsom salts and water. Flotation REST in combination with relaxation training, stress management and biofeedback has been used experimentally and clinically for stress related disorders (Jacobs, Kemp, Belden, 1983, Fine & Turner, 1983). This report describes the use of flotation REST as part of a multimodal program for chronic pain.

Methods
Fifteen patients (ten males and five females) were referred to the Behavioral Medicine Clinic of the Medical College of Ohio for a chronic pain disorder by their current attending physician. Eight patients were treated in an outpatient program, seven patients were treated on an inpatient unit. Ten patients had daily, chronic low back pain, three patients had daily chronic shoulder pain, and two patients had chronic headaches at least once per week. The number of years with pain ranged from . 25 to 16 with a mean of 7.3. Patients were treated on the inpatient unit if a) a psychiatric condition (i.e. depression) was considered significant to warrant admission or b) environmental conditions made outpatient treatment unfeasible (length of drive for treatment). Each patient's treatment began with a thorough interview. This interview covers the patient's pain disorder and psychosocial information about the patient. Throughout the treatment process the therapist worked with the patient on significant psychosocial factors as well as relaxation oriented interventions. Treatment consisted of relaxation training (autogenic phrases and/or progressive relaxation) EMG and/or thermal biofeedback, stress oriented psychotherapy and flotation REST. In addition inpatients participated in a milieu therapy program including occupational therapy, group therapy and exercise therapy. After the initial interview session, each patient's psychophysiological baseline was recorded using frontal and/or neck EMG and peripheral temperature measurements. The therapist then instructed the patients how to use a modified autogenic training relaxation exercise for regular home use. Patients then use EMG frontal and/or neck biofeedback during one hour sessions in the clinic. The number of feedback sessions ranged from 6 to 36 with a mean of 13. Actual feedback training is for 25 minutes and the other time is used for psychotherapy. REST was introduced to the patient after the patient maximized the effects of the biofeedback training. REST was introduced to a) increase the depth of the subjective experience of relaxation and b) increase the subjective sense of reduction of pain during relaxation. Procedures for flotation REST involved flotation in the REST chamber either nude or in a bathing suit. During flotation, and after an initial period of silence ranging from 10-25 minutes, a tape recording of the autogenic phrases was played. As treatment sessions progressed some patients were asked to use the phrases without the tape, and some were also given imagery suggestions specific to

their situation. REST sessions were between 40 and 60 minutes long, the length chosen by the patient. The number of REST sessions varied from 2 to 18 with a mean of 7. Patients rated their pain experience using a scale of 0-6 on pain log sheets. Patients rated the depth of relaxation achieved on a scale of 0-10 in a follow-up interview.

Results
The results presented here are taken from the patients' clinical records at the end of treatment and a follow-up conducted at least three months post treatment except for two patients still in long term treatment. For the 13 patients with chronic intractable benign pain there was a difference in intensity but no differences in frequency or duration of pain after treatment. For the two patients with chronic recurrent pain, all three subjective pain rating measures changes. (See Table 1). Twelve patients stated that they regularly used relaxation to affect their pain, and were able to reduce it. Patients subjectively rated the REST relaxation as more relaxing and more pain relieving than the Biofeedback Assisted Relaxation (Fig. 1). Patients were asked to rate whether or not they became pain free during biofeedback or REST. Eight patients rated themselves as pain free after REST, one patient rated himself as pain free after biofeedback and 2 patients did not become pain free (Table 2). Twelve patients were not able to work because of their pain. Three of these patients are now working and one is being retrained for a less physically stressful career. Table 1: Subjective Reports of Pain Pre/Post Treatment Intensity Pre 1 Post 1 CIBP + CRP* N = 15 4.3 3.57 P<.10 SIG (F=4.15,dF1,14) Frequency CIBP N = 13 Daily Daily CRP N = 2 3/Week 2/Month Duration CIBP N = 13 Constant Constant CRP N = 2 18 Hours 6 Hours *Chronic Intractable Benign Pain & Chronic Recurrent Pain Table 2: Patients Experiencing Total Remission of Pain During Relaxation REST Biofeedback Both 812

Discussion
This clinical, preliminary report examined the efficacy of REST in a multimodal program for chronic pain. Numerous reports have already established the use of relaxation training as an appropriate component of this treatment (reviewed Turk, et. al., 1983). Previous reports have show REST to be more physiologically and subjectively relaxing than relaxation training alone (Turner and Fine, 1983, Jacobs, et.al., 1984). In this report relaxation was assisted by both EMG biofeedback and flotation REST. Both were reported as effective in assisting the patients in relaxation, with patients reporting that REST was significantly more relaxing than Biofeedback. In addition, more patients were able to experience periods of complete remission of pain with REST than with biofeedback. Patients in this treatment program reported a small but significant decrease in average subjective pain experience during follow-up. Although the chronic intractable benign pain patients did not report a decrease in the frequency or duration of pain, they did regularly use relaxation as an intervention of the pain. The patients stated that they felt that their relaxation skill was important in their ability to live with their pain.

The mechanism through which flotation REST reduces pain experience is unknown. The buoyancy of the solution may provide a more supportive environment than the typical relaxation chair, allowing deeper muscle relaxation. The reduction of environmental stimulation may allow the person to better attent to previously ignored tension in the muscles, further enhancing relaxation. The lack of environmental stimulation may disrupt a cognitive component of pain by eliminating environmental cues normally associated with pain. A recent preliminary report (Turner & Fine, 1984) has indicated that the subjective effects of flotation REST can be affected by the narcotic antagonist Naloxone. This suggests that REST either increases endogenous opiod production or heightens sensitivity to existing opiod levels. This may be biochemical aspect of the subjective pain reduction. Many of the pain patients treated expressed a desire to have a flotation REST chamber at home. For patients with chronic intractable benign pain secondary to injury, this may be a cost effective alternative that would increase their overall level of functioning, and help reduce or eliminate pain medication. In summary, this report demonstrates that relaxation training was an effective tool for reducing the subjective intensity of pain for all of the patients studied. Both Biofeedback and REST were perceived as helpful in the relaxation process, although REST was seen as significantly more powerful in affecting relaxation than Biofeedback. More pain free periods followed REST relaxation than Biofeedback assisted relaxation. Despite some methodological weakness, this report is strongly suggestive of an important role for REST in the treatment of chronic pain. Jacobs, G., Heilbronner, R., and Stanley, J. The Effects of Short-Term Flotation REST on Relaxation: A Controlled Study. Health Psychology, 1984, 3, 99-112. Jacobs, G., Kemp, J., and Belden, A. A Preliminary Clinical Outcome Study On A Hospital-Based Stress Management Program Utilizing Flotation REST and Biofeedback. Unpublished manuscript. Fine, T.H. and Turner, J.W., Jr. The Effects of Brief Restricted Environmental Stimulation Therapy in the Treatment of Essential Hypertension. Behavior Research and Therapy, 20, 567-70, 1982. Fordyce, W. and Steger, J. Chronic Pain in Pomerleau, O.F., and Brady, J.P. Behavioral Medicine: Theory and Practice, Baltimore: Williams and Wilkins, 1980. Turk, D., Meichenbaum, D., Genest, M. Pain and Behavioral Medicine. New York, Guilford, 1983. Turner, J.W., Jr. and Fine, T.H. Effects of Relaxation Associated with Brief Restricted Environmental Stimulation Therapy (REST) on Plasma Cortisol, ACTH, and LH. Biofeedback and Self-Regulation, 1983, 8, 115-126. Turner, J.W. and Fine, T.H. Naloxone and Restricted Environmental Stimulation Therapy. Presented at the 15th Annual Meeting of the Biofeedback Society of America, Albuquerque, 1984.

Epsom Salt
Many years ago Epsom Salt was the most popular medical drug in England. The people who used it didn't know exactly why it was so beneficial. They knew nothing of its antiseptic and restorative qualities, but they did understand that in some way it was good for health and promoted longevity. They found by experience that not only did it keep away sclerosis, kidney diseases and rheumatism, but that it was also very useful in correcting any tendency to put on too much weight. Epsom Salt is now made from a rock substance called Dolomite, which is found abundantly in, and derives its name from, a mountainous district in the South Tyrolean Alps called "The Dolomites". This Dolomite rock belongs to a very large group of substances known as 'salts', in which an alkaline base is combined with an acid radical to form a neutral substance (the 'salt'). It consists of two metals, calcium and magnesium, combined with two non-metallic elements, carbon and oxygen, and takes the form of a neutral double salt known as carbonate of calcium and magnesium. Epsom Salt is also a 'salt' but instead of being made of magnesium, oxygen and carbon, as is the case with the carbon salt, its constituents are magnesium, oxygen and sulphur. Chemically it is known as magnesium sulphate. Magnesium sulphate is not found in a natural state, so it has to be made artificially from some suitable magnesium containing substance. The substance best suited for

this purpose is Dolomite, mentioned above.

The Secret of its Value
As mentioned earlier, in the process of manufacture the carbon ingredient of the magnesium carbonate has been replaced by another non-metallic element, namely sulphur, forming magnesium sulphate. The magnesium prefers carbon to sulphur and this sulphate readily gives up its sulphur and seizes upon carbon whenever a favourable opportunity for making the exchange presents itself. This strong affinity for carbon is the secret of its great value for medical purposes. Carbon, in one form or another, is the main constituent of the building materials which go to form our vegetation and so, in turn, to provide our foodstuffs, and it is in the crude form of carbon that the waste products of the human body are excreted. The magnesium draws out the carbon and renders the now inert residue soluble, thereby facilitating excretion.

The Remedial Action of Epsom Salt
It has already been pointed out that the distinguishing feature of the action of Epsom Salt is that it is constantly trying to revert to its original carbon state and that because of this affinity for carbon and carbon compounds it renders valuable aid in dealing with diseased conditions of the body. As far as its medical action is concerned, the human body survives entirely on foods which contain carbon ingredients, and that the waste emanating from this food takes the form of carbon. This is the daily routine of a person in robust health. The greater part of this carbon waste passes out of the human body through the lungs or bronchial tubes in the form of carbon dioxide. The process whereby the carbon waste matter is converted into carbon dioxide is a form of combustion known as oxidation. In order that the unused carbon of the food material should be disposed of in this way, it is necessary that the blood and the tissues should be supplied with sufficient oxygen to bring about this oxidation. If the required quantity of oxygen is not forthcoming to complete the process, retarded combustion ensues, and this results in the formation of partially oxidised forms of carbonaceous waste, such as uric acid, and other acids and toxins, which are the outcome of putrefaction. The partially oxidised carbon compounds are apt to accumulate in the blood and in the tissues, thereby giving rise to ill-health and disease. It is here that Epsom Salt, rightly administered, proves great value. By its strong affinity for carbon and carbon compounds, it absorbs and nullifies this harmful waste in the manner already described, and acts as a beneficent remedial agent. Taken internally in small doses, Epsom Salt acts on the kidneys, and by increasing the action of these organs, brings about a greater elimination of waste matter solution through these channels. Its chief value, however, lies in external application, because of its power of drawing stored tissuewastes from the body through the skin. Magnesium sulphate paste is still widely recommended by doctors today to aid in drawing out impurities and poisons from the body. Excerpted and adapted from "Epsom Salt, Its Value and Use." By Dr. I L Valentine Knaggs.

Restricting environmental stimulation influences levels and variability of plasma cortisol
JOHN W. TURNER, JR., AND THOMAS H. FINE Department of Physiology and Biophysics and Department of Psychiatry, Medical College of Ohio, Toledo, Ohio 43699-0008 TURNER, JOHN W., JR., AND THOMAS H. FINE. Restricting environmental stimulation influences levels and variability of plasma cortisol. J. Appl. Physiol. 70(5): 2010-2013, 1991.-

Summary
Restricting stimulation from the environment has been shown to alter psychological and physiological states. The present study of 27 healthy subjects examines the effects of restricted environmental stimulation technique (REST) on plasma levels of cortisol and variability in plasma cortisol levels across repeated REST sessions.

The REST environment consisted of a 1.2 X 1.2 X 2.4-m ovoid chamber containing 25 cm of saturated MgSO, solution (sp gr 1.28) maintained at 34.5OF. The buoyant supinely floating subject experienced a minimum of light, sound, and temperature awareness and spatial orientation. The non-REST environment was a cushioned reclining chair in a quiet dimly lit room. The 5wk protocol consisted of four visits for blood sampling during a 2-wk baseline followed by eight REST or non-REST sessions, 40 min each, with blood samples taken on four nonsession days between sessions 5 and 8. Variability in plasma cortisol was expressed in terms of standard deviation. REST was associated with across-session decreases of 21.6% in plasma cortisol and 50.5% in plasma cortisol variability, whereas no changes in these measures occurred in non-REST. It is concluded that REST influences both static and dynamic aspects of adrenocortical function, possibly altering the feedback monitoring of plasma cortisol.

Introduction
Increased levels of plasma cortisol in humans have been reported in association with a variety of psychological and physiological stress conditions (13, 16). Conversely, decreases in blood pressure (BP) (3, 7) and plasma levels of several hormones, including cortisol(22) and aldosterone and renin activity (12), have been reported in association with repeated brief exposure to a sensorily restricted environment. One version of this condition is flotation REST (restricted environmental stimulation technique), in which the individual lies supinely in thermoneutral buoyant fluid with minimized photic, auditory, and tactile stimulation (9, 19).

To date, studies of the relationship of restricted sensory input to physiological activity have been limited to point-in-time measurements of given parameters, which give little information on the dynamics of the system. One possible dynamic measure of a system is the variability of its measured parameters (6, 15), and standard deviation (SD) around mean values for a given parameter is a statistic that describes such variability. The involvement of central nervous mechanisms in the dynamic regulation of physiological systems has been evidenced in several studies of BP regulation. Increased variability in mean arterial BP has been demonstrated in several species after disconnection of baroreceptor input to BP regulation (2, 11, 21). Because flotation REST (henceforth, REST) greatly attenuates the input of sensory information about light, sound, kinesthetics, and temperature, it was of interest to assess the possible impact of REST on dynamic aspects of physiological regulation. Plasma cortisol was chosen as the monitored parameter for the present study on the bases that REST effects on the activity of this hormone have been previously demonstrated (8,15) and feedback regulation of plasma cortisol has been well researched. In this study the effect of brief repeated REST on plasma levels of cortisol and their variability is examined. The study is designed to minimize the amount of protocol-related disruption that subjects experienced in their normal daily life.

MATERIALS AND METHODS
Twenty-seven healthy subjects (18 males, 9 females) ranging in age from 21 to 32 yr were recruited. A brief medical history was taken, and subjects were screened for normalcy of sleep-wake cycles and diet and for absence of adrenal-stimulating medications. Three subjects dropped out during the study for personal reasons unrelated to the study. The subjects were pair-matched on the basis of initial midday values of the measured end point, plasma cortisol, and were split into a REST group (n = 15, 5 females) and a non-REST group (n = 12, 4 females). The REST condition consisted of a 1.2 X 1.2 X 2.4-m ovoid chamber (Enrichment Enterprises, Huntington, NY) completely enclosed and filled to a 25-cm depth with saturated MgSO, solution (sp gr 1.28) maintained at 34.5OC. The buoyant supinely floating subject experienced the absence of light and a minimum of sound (~10 dB), temperature awareness, and spatial orientation. The non-REST condition consisted of a cushioned reclining chair, fully reclined in a warm (29°C) quiet (~30 dB) dimly lit (~1 ft cd) room. The 5-wk protocol was identical for each subject and consisted of four visits for blood sampling during a 2-wk baseline followed by eight REST (or non-REST) sessions, one every 3rd day for 3 wk. Blood samples were taken on the day before sessions 5-8. Samples were taken by an experienced phlebotomist via forearm venipuncture into heparinized tubes and were immediately centrifuged. The plasma was frozen and stored at -6OOC until assayed for cortisol by radioimmunoassay (kit code KCOD2, Diagnostic Products, Los Angeles, CA). The blood sampling protocol was designed in consideration of the diurnal variation and episodic secretion patterns of cortisol (25) such that, for each blood sampling visit, 1) the subject arrived and sat quietly for 5 min before sampling, 2) blood was drawn between 1200 and 1400 h, and 3) each blood sampling event consisted of two samples, 10 ml each, taken 20 min apart. Thus for each subject there were four sampling sessions in baseline and four in treatment, with a and b samples in each session. Determination of the reproducibility of values in the paired a and b samples provided a means to assess reliability of the cortisol measure in each session, because significant changes in

plasma cortisol over 20 min were unlikely under these conditions (1,27). The overall difference between a and b samples was 7.8%, and a and b samples for each session were pooled. Because of potential effects of meals on cortisol release, all subjects were instructed to eat their regular breakfast and not to eat lunch until after the blood sampling session on sampling days. For each treatment session the subject undressed, showered briefly, experienced REST or non-REST for 40 min, showered again (REST only), dressed, and departed. Average total session time was 70 min. Subjects were encouraged to discuss a given session when it was over and were requested to report any unusually stressful experience during the study. A brief subjective report questionnaire was completed by each subject after each treatment phase session.

RESULTS
Plasma cortisol data are presented in Fig. 1. These data were subjected to two-way repeatedmeasures analysis of variance. Hypothesis testing for cortisol data was accomplished with the parametric Tukey’s test and F test (18). There were no differences among sessions within baseline or among monitored sessions within treatment in either the REST or non-REST groups. In other words, plasma cortisol levels did not change significantly during baseline or during the portion of treatment that was monitored in either REST or non-REST. Plasma cortisol values in REST treatment were lower (P < 0.05, Tukey’s test) than in REST baseline, non- REST baseline, and nonREST treatment. Cortisol values in the latter three were not different. The mean cortisol level (across sessions and subjects) was 11.29 t 0.37 (SE) pgldl in REST treatment and 14.21 t 0.82 in REST baseline. As a dependent variable in this study, variability refers to the classical statistical definition of measures of dispersion and is reported as SD, which is the square root of the variance iN SD= \/C (Xi-X)2/N-i V i=l For each subject, SD was calculated across samples for baseline (4 cortisol values) and treatment (4 cortisol values). These individual SD values were then averaged across subjects in baseline or in treatment to yield SD values as follows: REST baseline, REST treatment, non- REST baseline, and non-REST treatment. To account for the possibility that lower SD values in a given condition were simply the consequence of plasma cortisol values being lower, the coefficient of variation (SD/Z 100) was determined for each SD. Plasma cortisol variability, reported as SD and as coefficient of variation (Table l), was subjected to statistical analysis. Although parametric statistics are normally more robust than nonparametric statistics, the latter do not require normalcy of distribution and equal variances in the sample populations to be compared. Because it was hypothesized that variability could be influenced by TABLE 1. Effect of repeated brief REST on variability of plasma cortisol values REST (n = 15) Non-REST (n = 12) Baseline Treatment Baseline Treatment Plasma cortisol, cLg/dl SD CV 14.21 11.29 13.77 14.14 3.86 1.91* 3.51 3.77 29.86 18.56* 26.85 30.06 n, No. of subjs. Values were calculated for 4 samples from each subject and then averaged across subjects in each group. REST, restricted environmental stimulation technique; SD, standard deviation; CV, coeff of variation [(SD of cortisol value/cortisol value) X 1001. * Different from Baseline (P < 0.005, Wilcoxon matched pairs test). 2012 RESTRICTED ENVIRONMENTAL STIMULI AND PLASMA CORTISOL treatment in this study, data were tested for significant differences by a nonparametric test. The SD and coefficient of variation were 50.5 and 37.9%, respectively, lower in REST treatment than in REST baseline, and the changes in both parameters were significant (P < 0.005, Wilcoxon matched pairs test). In the non-REST group there was no difference in either SD or coefficient of variation between baseline and treatment. Eighty-seven percent of the REST subjects showed decreased plasma cortisol across sessions, and 93% showed decreased SD for cortisol. A Pearson correlation was performed on REST group data, comparing acrosssession percent change in plasma cortisol with acrosssession percent change in the SD of plasma cortisol. These changes were not correlated (r = 0.12; NS, P > 0.05, df = 13). DISCUSSION Both the concentration and the variability in concentration of cortisol in plasma were decreased across sessions in the REST group, whereas no changes occurred in the non-REST group. These data suggest a RESTspecific effect on the activity of the adrenal cortex or the clearance of cortisol or both. The present study does not differentiate between these possibilities. Although the

metabolic clearance rate (MCR) for cortisol has been shown to increase 19-30% after exogenous pharmacological- dose ACTH administration (27), it appears unlikely that cortisol clearance changes significantly in unstressed individuals (1, 20). In the present study of unstressed healthy subjects, mean plasma cortisol decreased 21.6%. The decrease in plasma cortisol levels was not surprising, because previous studies have demonstrated decreased plasma cortisol across REST sessions in normal subjects (22). The decrease in variability around the mean value of plasma cortisol from baseline to treatment in the REST group, but not in the non-REST controls, suggests that the conditions of REST can influence the dynamic state of cortisol regulation. The coefficient of variation data demonstrate that the decrease in variability is not due simply to smaller SD values accompanying smaller absolute cortisol values. In fact, the results of the Pearson correlation show that changes in plasma cortisol and changes in the SD of mean plasma cortisol were not significantly correlated. This suggests that the effects of REST on absolute cortisol levels can occur independently of the REST effects on the variability of cortisol levels. It is known that cortisol exhibits episodic pulsatile release (8), with considerable variation occurring within and between individuals (10,25). Also, it has been shown that there is a cortisol peak associated with mealtimes (4). These factors may have contributed a significant “noise” component to the variance data. However, it appears that the REST effect was robust enough to have a discernible impact on variability, because SD values were decreased across treatment in REST but not in non- REST. Sampling was too infrequent in the present study to determine whether changes in pulse frequency or pulse height were associated with REST. A large number of blood samples taken 15-20 min apart would be necessary for analysis of pulsatile release characteristics (23, 24). Such analysis would require the use of an in-line venous catheter. This approach was not chosen for this study, because it precluded assessment of the effect under “normal” circumstances. The present study was designed to minimize the amount of disruption that subjects experienced in their normal daily life. This was done to monitor the dynamic physiological system across time under “natural” everyday conditions. A more radical monitoring such as in-line blood sampling over many hours might confound the interpretation of the treatment effect. Although the control condition could potentially obviate this problem, there is the possibility that the stress associated with extended intravenous monitoring would wash out the REST effect. The present study is, to our knowledge, the first report of external environmental conditions influencing the variability of plasma cortisol levels. In the conceptual framework of cybernetic theory, variability is one measure of the dynamic state of a negative feedback loop (15, 26). Plasma cortisol is one component of an integrated negative feedback loop. Thus plasma cortisol variability is one reflective measure of the dynamics of physiological regulation. In the present controlled study, the intervention (REST) was associated with a change in plasma cortisol levels and variability over time; i.e., REST influenced both the total output and the dynamics of the physiological system. This result is consistent with other studies in which variability in a measured parameter was influenced by a central nervous systemmediatedintervention. For example, Cowley et al. (2) observed increased variability in mean arterial pressure after BP baroreceptor disconnection in dogs, various mental and physical stressors have been shown to influence BP variability in humans (5,17), and Porges (14) reported decreased variability in heart rate in association with increased attention to a reactiontime task. It should be noted that these studies examined immediate response dynamics, whereas the present study examined longer-term dynamics. It has previously been reported that repeated REST can be associated with cortisol changes that persist for days beyond the REST sessions (22). Likewise, REST effectiveness in BP reduction in essential hypertensives may continue for weeks to months beyond cessation of treatment (3, 12). This raises the possibility that REST may contribute to reorganization of set points for the operation of physiological feedback loops. The cortisol variability data in the present study are consistent with such a hypothesis, although they do not address either the mechanism by which REST affects plasma cortisol levels or whether REST specifically facilitates or improves feedback regulation of plasma cortisol levels. Address for reprint requests: J. W. Turner, Jr., Dept. of Physiology and Biophysics, Medical College of Ohio, 3000 Arlington Ave., Toledo, OH 43699-0008. Received 21 February 1990; accepted in

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Flotation REST in Applied Psychophysiology
Thomas H. Fine, M.A. and Roderick Borrie, Ph.D.

Thomas H. Fine is an Associate Professor in the Department of Psychiatry of the Medical College of Ohio. He began his research and clinical work with Biofeedback in 1975, and, with John Turner, initiated the Restricted Environmental Stimulation Therapy research program at MCO in 1978. Roderick A Borrie, Ph.D. is a Clinical Psychologist at South Oaks Hospital, Amityville, New York. He began his exploration of therapeutic uses of Restricted Environmental Stimulation Therapy at the University of British Columbia with Dr. Peter Suedfeld, and continues to use it in current work with patients suffering chronic pain and illness.

Introduction
Restricted Environmental Stimulation Therapy (REST) has fascinated many researchers, clinicians, and explorers of consciousness, promising something special - a powerful transformation, a mystical peak experience, an intense change in biochemicals, improved performance, or a healing of our ills. Beyond the fascination, Flotation REST has established itself as a unique method in the field of applied psychophysiology. Flotation REST has proven to be a technique with predictable psychophysiological effects and powerful clinical and performance applications. This article will provide the reader with an introduction to the basic research into Flotation REST's psychophysiological effects, and a brief overview of the clinical and performance applications currently in use by REST clinicians and researchers. The article will examine in greater detail the use of Flotation REST as an intervention for chronic pain. REST is an acronym for Restricted Environmental Stimulation Technique, a name developed in the late 1970s by Peter Suedfeld and Roderick Borrie for a technique that had previously been called Sensory Deprivation (SD) or Sensory Isolation. Since much of the early SD research had been misinterpreted, especially by writers of introductory psychology texts, a widely accepted myth developed that SD environments were highly stressful, even models for producing psychotic like experiences. This led to difficulties with the Sensory Deprivation concept. Ultimately Suedfeld and Borrie proposed that, since the process involves restricting the environmental stimulation that the patient or subject experiences, REST would be a more accurate and less provocative acronym. Flotation REST is a special type of REST popularized by John C. Lilly, M.D. Lilly developed an immersion system in the late 1950s at that was used in early SD experiments. In the 1960s he developed a flotation system in which a person floats in a light free, sound reduced chamber in a highly concentrated solution of Epsom Salt and water maintained at a constant temperature of 9,4.5 F (Lilly, 1977, p. 118). Both Wet and Dry REST systems have been utilized in research and practice. Wet-REST systems utilize flotation in salt water, and Dry-REST systems utilize a modified REST environment in which a pliable 15 mm. polymer membrane separated the floater from the fluid (Turner, Gerard, Hyland, Neilands, & Fine, 1993). At the Medical College of Ohio, John Turner and I conducted a series of studies investigating the psychophysiological effects of brief sessions of Flotation REST. The REST environment used in all of these studies was a plastic or fiberglass chamber, approximately 1.1 m. x 1.3 m. x 2.5 m. filled to a 25 cm. depth with saturated epsom salts (Mg SO) solution having a specific gravity of 1.28 and

temperature maintained at 34.5 C. The chamber was light-free and the sound level was less than 10 decibels, with further attenuation due to submersion of the ears in the solution. The general protocol consisted of 30-40 minute sessions repeated approximately every third day with a total number ranging from 4 to 20 sessions per study. The first parameter we addressed was the subjective report of the REST experience. We utilized several indices of subjective reports including the Spielberger state anxiety scale, Zuckerman multiple affect adjective checklist (Turner & Fine, 1990a), profile of mood states (POMS) (Turner, Fine, Ewy, Sershon, & Frelich, 1989), and subjective rating scales of emotion and relaxation. All of the initial studies found marked pre-post and across-session changes indicating relaxation, an increase in positive emotion and a decrease in negative emotions. In addition, an analysis of well over 1,000 descriptions of the REST experience indicated that more than 90% of subjects found REST deeply relaxing.

Psychophysiological Effects of Flotation Rest
In choosing physiological parameters of the REST effect on relaxation, we examined the basic physiological and biochemical hormonal changes associated with stress responding. Physiological parameters measured included blood pressure (BP), muscle tension (EMG), and heart rate (HR). Hormonal parameters included both adrenal axis hormones such as ACTH, epinephrine, norepinephrine, cortisol and aldosterone, and hormones not mediating stress responding (luteinizing hormone and testosterone). Both within and across-session decreases have been observed in various hormones. Hormones directly associated with the stress response. Cortisol, ACTH and epinephrine showed decreases during REST sessions, whereas luteinizing hormone, which is not associated with the stress response, showed no change (Turner & Fine 1983). Likewise, across-session decreases were observed in adrenal-associated hormones (cortisol, aldosterone, renin activity), while a hormone unrelated to stress response (testosterone) did not shown across-session changes (Turner & Fine, 1990a). In a separate study, we examined the across-session effect on both mean cortisol values and their variability, observing a decrease in both parameters (Turner and Fine, 1991). This suggests the possibility of a resetting of the regulatory mechanism of cortisol across sessions. Furthermore, cortisol, which has received more attention than the other hormones, and Blood Pressure, have been shown to maintain the REST effect after cessation of repeated REST sessions (Turner & Fine, 1983). This phenomenon suggests that the REST effect may be more than a simple, immediately reversible response. Interestingly, in comparing hormonal and BP changes in REST with these changes in another relaxation condition (biofeedback), REST consistently showed greater hormonal effects but similar BP effects to biofeedback assisted relaxation (McGrady, Turner, Fine, & Higgins. 1987). These results led us to consider that REST affects different mechanisms than the biofeedback (since it affected cortisol levels when other methods did not) or was simply more powerful (i.e. REST reached the threshold for cortisol change but biofeedback did not).

Clinical Applications of Flotation REST
These results provide strong support for the hypothesis that Flotation REST serves as a powerful relaxation inducer and has clinical potential in working with patients who have stress-related disorders. There have been several clinical studies that have employed REST as a treatment. The disorders treated include essential hypertension, muscle tension headache, anxiety disorders, chronic pain, psychophysiological insomnia, PMS, and rheumatoid arthritis (Fine and Turner, 1985; Rzewnicki, Alistair, Wallbaum, Steel, Suedfeld, 1990; Fine and Tumer, 1985; Goldstein and Jessen, 1990; Turner, DeLeon, Gibson, & Fine, 1993). The treatment paradigms used in these studies were similar, with REST serving as the primary method of relaxation induction and training. All of these studies demonstrated positive results from the use of REST. One of the unique effects of REST demonstrated in these studies was that chronic pain patients frequently experienced an absence of

all pain during flotation, and that this spontaneous anesthesia could remain for up to several hours after the session. Unfortunately, as with many bio-behavioral treatment approaches, the large scale controlled trials have yet to be undertaken.

Flotation REST and Performance Enhancement
A separate, exciting area is the use of Flotation REST in the enhancement of human performance. Several studies, carried out primarily in the research programs of Peter Suedfeld at the University of British Columbia and Arreed Barabasz at Washington State University, have demonstrated enhancement of scientific creativity, instrument flight performance, and piano performance. Several studies of sports performance have had positive results including studies of basketball, tennis, skiing, rifle marksmanship, and dart throwing. In several of the studies the Flotation REST condition was varied with relaxation, or imagery training and always had a more powerful effect. Often, Flotation REST was used with imagery or without imagery, and no difference was, found. Flotation REST, either wet or dry, was sufficiently powerful to affect a change in performance. Barabasz suggests that because REST potentiates imagery while disrupting over learned psychological processes, the technique is especially suited not only for the acquisition of new improved skills but the unlearning of less adaptive ones.

Flotation Rest and Pain Management
An in depth examination of the role of Flotation REST in the management of pain can provide us with a clear picture of the psychophysiological nature of the treatment. Pain programs are generally used as a last referral resort for patients whose intractable pain has not responded to the traditional medical treatments. Biobehaviorally based pain management utilizes counseling and behavioral medicine techniques such as relaxation training, meditation. biofeedback, guided imagery, and selfhypnosis. The goals of such treatment are the development of pain avoidance skills, the establishment of routines for optimal fitness within the limitations of a disability, the reduction or elimination of pain, when possible, and/or the patients acceptance of some level of pain. Flotation REST can have an important role at several stages of the pain management process. By reducing both muscle tension and pain in a relatively short time and without effort on the part of the patient, flotation provides a dramatic demonstration of the benefits of relaxation. Relief is immediate and, although temporary, offers promise of further relief from REST and other relaxation-based strategies. Symptom reduction gained from flotation can increase a patient's motivation and interest in the remainder of the therapy plan. Pain patients generally come into treatment feeling suspicious and skeptical, requiring a clear demonstration that they can be helped. Flotation can be the vehicle for that demonstration. The relaxation following flotation can be used to facilitate relaxation training. In the treatment reported here, training in relaxation and other psychological pain control strategies occurred during the flotation REST sessions as well as in counseling sessions. Specially prepared audio programs introduced patients to breathing techniques, progressive muscle relaxation, autogenic training, guided imagery and hypnotic suggestions for pain reduction while they floated. Training and practice in those same techniques followed in counseling sessions and at home. The most common etiologies of pain in this group of patients were from motor vehicle accidents, work accidents, or chronic illness. Most had endured their pain for longer than six months and had also suffered various levels of anxiety, anger, and depression. These emotional problems must be considered in the treatment of chronic pain patients. The first data are pre-post pain ratings from 16 patients who floated from one to 16 flotation sessions. Each patient reported on up to four body areas, providing a total of 253 pre-post , measures. The average percentage of relief, as measured in decrease from the pre-session value, was 31.3% for all sessions and all measures. To determine whether flotation REST provides more pain relief to some parts of the body as opposed to others, these measurements were examined by body area. Pain reduction in most body areas was close to

the overall mean of 31%, except the upper back, which showed a 63.6% pain reduction, the arms which showed a 48.2% reduction, and the legs, which showed a 15.3% pain reduction. The duration of relief varied from two hours to seven days. A second set of data came from a survey mailed to patients who had completed the program. The questionnaire asked patients to assess how much pain relief they received from the various components of the pain program (Flotation, relaxation training, and counseling) and from other treatments they had received medication (pills and shots), physical therapy, chiropractic, and surgery. Short-term pain relief, long-term pain relief, relief from anxiety or stress, and relief from depression were indicated separately. Additionally, they were asked whether each treatment improved their outlook and/or helped them cope with their pain. All 27 respondents had received treatments other than those from this pain program: 81% had used pain medications; 56% had had some form of pain injections; 70% had received physical therapy; 59% had received chiropractic treatment; 22% had undergone surgery. These patients reported more short-term and long-term pain relief from flotation than from the other therapeutic modalities. For non-pain symptoms, the comparisons were even more striking. Patients reported far more relief from anxiety and stress from flotation than any other modality. For depression, flotation was equal to counseling at near 70%, with relaxation training at 53% and physical therapy and medication at 20%. Patients also claimed to have reaped a variety of other benefits from flotation, reporting improvements in sleep (65%), mental concentration (77%), energy (46%), interpersonal relationships (54%), ability to work (35%), ability to cope with pain (88%), ability to cope with stress (92%), and feelings of well-being (65%) resulting from flotation REST. In answering the question, "Did this treatment improve your outlook toward your pain?" 96% responded positively for flotation, 100% for counseling, 100% for relaxation training, 50% for physical therapy, 24% for pain pills, 17% for pain shots, 15% for chiropractic. To the question, "Did this treatment help you cope effectively with your pain?" 96% responded positively for flotation, 92% for both relaxation training and counseling, 50% for pain shots, 44% for pain injections, 38% for physical therapy, and 17% for chiropractic. It is clear that flotation was rated on average as more effective than other treatments with respect to pain, anxiety and depression relief.

Flotation REST and Chronic Illness
Summing up thus far, the data are supportive of flotation REST being useful in pain reduction, stress and tension abatement, and mood enhancement. Besides chronic pain, other patients treated at our facility were those with chronic physical illnesses, those with cancer, those with trauma to the nervous system, those with depression or bipolar mood disorder. anxiety disorders, and those suffering overwhelming stress. Uniquely, Flotation REST provides an effortless introduction to deep mental and physical relaxation. The majority of our chronic illness patients suffered from autoimmune diseases, including rheumatoid arthritis, lupus, scleroderma, and Reiters syndrome. For these patients, discovering relaxation meant a dramatic reduction in symptoms, such as joint pain, headache, fatigue and depression. Several patients with lupus reported that regular flotation permitted them to reduce their dosage of prednisone while experiencing less frequency and severity of symptoms. Two patients with scleroderma reported relief from flotation. One reported relief from pain and stiffness that lasted almost a week after her third flotation session. As this patient continued she also experienced relief from her depression about the illness, a dramatic reduction in her use of steroids and other medications, a reduction in joint pain and swelling, and less frequent heartburn and headaches. After a three month course of treatment with flotation and counseling she was able to return to her job.

Flotation REST and Depression
When depression is in reaction to the circumstances of a physical injury or illness, Flotation REST

can produce an immediate elevation in mood, probably due to the mood enhancing effects of deep relaxation as well as the optimism that occurs with the experience of physical relief. When depression is the primary diagnosis, flotation is best used as an adjunct to counseling and then only after the patient has gained a modicum of feeling in control. Caution is necessary in administering REST with depressed patients due to the often obsessive nature of negative thinking that will continue during the REST session. Once these patients have developed a better understanding of their disorder, flotation REST can be a mood elevator that speeds the course of therapy, especially when combined with positive guided imagery during the sessions.

REST and Applied Psychophysiology
The REST environment can be viewed, from a biofeedback perspective, as a system that enhances the connection between consciousness and physiology by reducing external information rather than amplifying internal information. We describe biofeedback as a process of amplifying and displaying information about processes that we normally do not attend to or are unable to discriminate from the wealth of informational noise always present. REST reduces environmental noise, and in a flotation environment one is able to be aware of all sorts of physiological information, (i.e. muscle tension, heart rate, etc.) that we are often not aware of in normal quiet environments. REST is an ideal environment for the acquisition of biofeedback based learning. Many years ago Lloyd and Shurley published a paper demonstrating its effect on the acquisition of single motor unit control. Acquisition of single motor unit control was superior in the REST chamber (Lloyd & Shurley, 1976). Our investigations found the same advantage with heart rate control. Similarly DryREST environments might be exceptional environments for neurofeedback training. While we have learned much about REST in the last twenty years, its potential in applied psychophysiology has barely been exploited. In this age of cyberspeak, we might begin to think of expanding the clinical bandwidth of applied psychophysiology by taking another look at REST.

References
Fine, T.H., & Turner, J.W., Jr. (1983). The Use of Restricted Environmental Stimulation Therapy (REST) in the Treatment of Essential Hypertension, First International Conference on REST and Self-Regulation, 136-143. Fine, T.H. & Turner, J.W., Jr. (1985). Rest-assisted relaxation and chronic pain. Health and Clinical Psychology, 4, 511-518. Goldstein, D.D. & Jessen, W.E. (1987). Flotation Effect on Premenstrual Syndrome. Restricted Environmenntal Stimulation: Research and Commentary, 260-273. Lilly, J.C. (1977). The deep self. New York: Simon & Schuster. McGrady, A.V. Turner, J.W. Jr. Fine, T.H. & Higgins, J.T. (1987). Effects of biobehaviorallyassisted relaxation training on blood pressure, plasma renin, cortisol, and aldosterone levels in borderline essential hypertension. Clinical Biofeedback & Health, 10(1), 16-25. Rzewnicki, R. Alistair, B.C. Wallbaum, Steel, H. & Suedfeld, P, (1990). REST for muscle contraction headaches: A comparison of two REST environments combined with progressive muscle relaxation training. Restricted Environmental Stimulation: Research and Commentary, 245254. Turner, J.W. Jr. DeLeon, A. Gibson, C. & Fine, T. (1993). Effects of Flotation REST on range of motion, grip strength and pain in rheumatoid arthritics. In A. Barabasz & M, Barabasz (Ed.), Clinical and experimental restricted environmental stimulation (pp. 297- 336). New York: SpringerVerlag. Turner, J.W. Jr. Fine, T.H. (1983). Effects of relaxation associated with brief restricted environmental stimulation therapy (REST) on plasma cortisol, ACTH, and LH. Biofeedback and Self-Regulation, 9, 115-126.

Turner, J.W. Jr. & Fine, T.H. (1990a). Hormonal changes associated with restricted environmental stimulation therapy. In P. Suedfeld, J. Turner, & T. Fine (Eds.), Restricted environmental stimulation theoretical and empirical development in flotation REST (pp. 71-92). New York, NY: SpringerVerlag. Turner, J.W. Jr. & Fine, T.H. (1991). Restricting environmental stimulation influences variability and levels of plasma cortisol. Journal of Applied Physiology, 70(5), 2010-2013. Turner, J.W. Jr. Fine, T. Ewy, G. Sershon, P. & Frelich, T. (1989). The presence or absence of light during flotation restricted environmental stimulation: Effects on plasma cortisol, blood pressure and mood. Biofeedback and Self-Regulation, 14, 291-300. Turner, J.W. Jr. Gerard, W. Hyland, J. Neilands, P. & Fine, T.H. (1993). Effects of wet and dry flotation REST on blood pressure and plasma cortisol, In A. Barabasz & M. Barabasz (Ed,), Clinical and experimental restricted environmental stimulation (pp. 239-248). New York: Springer-Verlag.

Author's address for information:
Thomas H. Fine, M.A. Department of Psychiatry Medical College of Ohio Richard D. Ruppert Health Center 3120 Glendale Ave. Toledo, OH 43614-5809 [email protected]

Stress: Unhealthy response to the pressures of life
Letting stress get the best of you may be doing more harm than you think. Take control by understanding the stress response and how your body reacts. Today's news includes round-the-clock coverage of natural and man-made disasters. Earthquakes and floods. Wars and terrorist attacks. Just 10 minutes of watching the news can make your stress level soar. Compounding matters, you've got a big presentation in an hour, and you've hardly had a chance to prepare. Urgent e-mails keep popping onto your display screen, each one sending a stab of anxiety through your chest. As you frantically scribble notes for the presentation, your heart races, your palms sweat and your head pounds. Physical reactions you experience when you're stressed are no accident. The human body developed these defense mechanisms to deal with the threat of predators and aggressors. But modern life is full of new threats. Your body's well-adapted defenses against physical dangers may not be as effective at dealing with the stress you feel while managing a huge workload, making ends meet, or taking care of an ill parent or child. Instead of protecting you, your body's response to stress, if constantly activated, may make you more vulnerable to life-threatening health problems.

What is the stress response?
Stress response, often referred to as the "fight-or-flight" reaction, is your body's rapid and automatic switch into "high gear." It's easy to imagine how this reaction helps you deal with a physical threat. You need the energy, speed, concentration and agility either to protect yourself or to run as fast as possible. When you encounter such a threat, the hypothalamus, a tiny region at the base of your brain, sets off an alarm system in your body. Through a combination of nerve and hormonal signals, this system prompts your adrenal glands, situated atop your kidneys, to release a surge of hormones — the most abundant being adrenaline and cortisol. Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances the brain's use of glucose and increases the availability of substances that repair tissues. Cortisol also curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. The complex alarm system also communicates with regions of the brain that control mood, motivation and fear.

Stress response working overtime
The stress-response system is self-regulating. It decreases hormone levels and enables your body to return to normal once a crisis has passed. As levels of the hormones in your bloodstream decline, your heart rate and blood pressure return to normal, and other systems resume their regular activities. But physical threats aren't the only events that trigger the stress response. Psychological "threats" — such as the stress associated with work, interpersonal relationships, major life changes, illness or the death of a loved one — can set off the same alarm system. The less control you have over these potentially stress-inducing events and the more uncertainty they create, the more likely you are to feel stressed. Even the typical day-to-day demands of living can contribute to your body's stress response. Also, many of our modern stressful circumstances, unlike most physical threats, tend to be prolonged. Consequently, you may be running on the fight-or-flight reaction longer than it's intended to operate. What's good for your body in a short-term crisis can be very harmful over long periods. The long-term activation of the stress-response system — and the subsequent overexposure to cortisol and other stress hormones — can disrupt almost all your body's processes, increasing your risk of obesity, insomnia, digestive problems, heart disease, depression, memory impairment, physical illnesses and other complications.

Digestive system
It's common to have a stomachache or diarrhea when you're stressed. This happens because stress hormones slow the release of stomach acid and the emptying of the stomach. The same hormones also stimulate the colon, which speeds the passage of its contents. Chronic hormone-induced changes can increase your appetite and put you at risk of weight gain.

Immune system
Your immune system is a complex balancing act between components that operate as an all-purpose emergency crew and more specialized components that deal with specific disease agents. The immune system, like the hormone system, evolved so that it could quickly deal with physical threats. Indeed, cortisol is one factor that prompts the system to reprioritize its tasks. These shifting priorities are essential for priming the immune system to respond quickly to injuries, like creating inflammation around a bite or puncture wound, but these changes are not beneficial in the long run. When you experience chronic stress, some features of your immune system may remain suppressed, making you susceptible to infections. Other features of the immune system may be permitted to run unchecked, increasing your risk of autoimmune diseases, in which your immune system attacks your body's own healthy cells. Stress may also worsen the symptoms of an autoimmune disease. For example, stress can trigger lupus flare-ups.

Nervous system
Certain byproducts of cortisol act as sedatives, which can contribute to an overall feeling of depression. If your fight-or-flight response never shuts off, the stress hormones may contribute to persistent and severe depression, as well as feelings of anxiety, helplessness and impending doom. Such stress-induced depression often results in sleep disturbances, loss of sex drive and loss of appetite. It also may make you more vulnerable to developing certain personality or behavioral disorders. Studies also suggest that chronic activation of stress hormones may alter the operation and structure of brain cells that are critical for memory formation and function.

Cardiovascular system
Chronic activation of stress hormones can raise your heart rate and increase your blood pressure and blood lipid (cholesterol and triglyceride) levels. These are risk factors for both heart disease and stroke. Cortisol levels also appear to play a role in the accumulation of abdominal fat, which gives some people an "apple" shape. People with apple body shapes have a higher risk of heart disease and diabetes than do people with "pear" body shapes, in which weight is more concentrated in the hips.

Other systems
Stress worsens many skin conditions — such as psoriasis, eczema, hives and acne — and can trigger asthma attacks.

Individual reactions to stress
Your reaction to a potentially stressful event is different from anyone else's. Some people are naturally laid-back about almost everything, while others react strongly at the slightest hint of stress — but most fall somewhere between those extremes. Genetic variations may partly explain the differences. The genes that control the stress response keep most people on a fairly even keel, only occasionally priming the body for fight or flight. Overactive or underactive stress responses may stem from slight differences in these genes.

Life experiences may increase your sensitivity to stress as well. Strong stress reactions sometimes can be traced to early environmental factors. People who were exposed to extremely stressful events as children, such as neglect or abuse, tend to be particularly vulnerable to stress as adults.

Managing stress
Stressful events are a fact of life, but you can take steps to manage the impact these events have on you. You can learn to identify what stresses you out, how to take control of some stress-inducing circumstances, and how to take care of yourself physically and emotionally when you face events you can't control. These strategies can include exercise, relaxation techniques, healthy nutritional choices, social support networks and professional psychotherapy. The payoff of managing stress is peace of mind and — perhaps — a longer, healthier life. © www.mayoclinic.com

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