February 23, 2015

Trauma and Sensory Interventions – A view from the Occupational Therapist’s mat

This article was authored by Jennifer Gay,
Occupational Therapist and Therapeutic Specialist,
Therapeutic Care Program at The Australian Childhood Foundation.

Sensory interventions are becoming widely used in the areas of trauma and mental health to assist clients with emotional regulation.

Many of the clients have difficulty self-regulating and have a limited ‘Window of Tolerance’ as Dan Siegel calls it. This describes the optimal zone for processing and integrating experiences where the “width” of the window is directly related to the degree to which a client can manage emotional and physiological arousal. Often those who have experienced trauma have a very narrow window and are operating outside this optimal zone.

Most of us can unconsciously utilise strategies to assist us to feel better when we are upset and return us to our optimal zone. These strategies are usually sensory based, because as Winnie Dunn, an Occupational Therapist said; “The experience of being human is embedded into the sensory events of our everyday lives”. Whether it be listening to music, talking to a friend, doing exercise or any other sensation based activity, we seek this sensory input as a way of changing our emotional and physiological state to soothe us. Many of our clients have not learnt to self soothe as part of their normal childhood development and often require co-regulation from an adult initially. It is important that we assist them in firstly being aware of how their body is feeling during times of distress and then secondly identifying what sensory strategies they can use to change how they are feeling.

In the Occupational Therapy literature, this concept of optimal arousal is discussed through sensory modulation, which is the nervous system’s ability to organise sensations received and make adaptive and graded responses without over or under reacting. Sensory modulation is a complex neurological process and people have different limits for noticing, responding to and being overwhelmed by sensations. For instance, some people like the sensation of deep pressure from a weighted blanket and others find it noxious. Some people are drawn to shops with incense whilst I personally cannot stand the smell of them. On my desk I have a variety of different sensory toys to fidget with and a postcard of a special place that I look at to calm me before I have to make any difficult phone calls! If you think consciously about it you will notice that you have your own sensory preferences and either might seek or avoid certain sensations. Sensory modulation relates to the brain’s ability to pay attention to ‘relevant’ while shutting out the ‘irrelevant’ stimuli and thereby function within an ‘optimal’ range of arousal and performance. Trial and error of different sensory input when a person is in a calm state is the best way to discover a person’s preferences.

The use of sensory approaches as a way to modulate the emotional and physiological arousal can also form the basis of safety plans for clients. They may include the use of sensory stimulation (music; scents; foods/drinks), sensory motor activities (exercise; movement; rocking), environmental modifications (heating; lighting; busyness) and assistance in learning how to self-regulate. (Champagne 2007).

There are also specific neurological sensory processing disorders that people can have and if the person appears to have issues with processing sensory input that impacts on their functioning (for example a person becomes angry and irritated by the tags and seams on their clothing and you believe that their behaviours are related to the particular sensory input), an Occupational Therapy assessment of an individual’s sensory processing patterns can recommend sensory interventions to assist in widening their window of tolerance and in arousal regulation to stay within the window of tolerance.

There are five main senses that most people are aware of; sight, sound, taste, touch, smell and then two other senses that people are less familiar with; vestibular-balance, proprioception – body awareness through muscles and joints. There are three powerhouse senses; touch, proprioception and vestibular. Activities that use touch and movement against resistance are referred to as heavy work activities and may have a powerful calming and grounding effect on the nervous system .These can include:

• Whole body actions of pushing, pulling, lifting, playing, and moving

• Oral actions such as chewing, sucking, and blowing

• Use of hands for squeezing or pinching with resistive materials, or “fidgeting”

• Deep pressure touch e.g. weighted items or heavy blankets

A few examples of sensory interventions that I have personally used with children who have experienced trauma are bubble wrap, sour lollies, and using a large swiss exercise ball and crashmats.

Currently I am working with a 9 year old boy who has experienced early childhood trauma. He was noted to seek the deep pressure from jumping into a pile of bean bags (a homemade crashmat!) and this appeared to assist to regulate him. As it is not realistic to carry a pile of beanbags everywhere you go we tried some different sensory items that also provided deep pressure input and found that he also responded well to bubble wrap. We cut up some small squares and he took them home. Previously his carers had been struggling with his behaviour of constantly jumping on their couch. The next week they reported that he had placed pieces of bubble wrap around the house to use and had stopped jumping on the couch. Another boy that I worked with had been escalating and becoming physically aggressive which was then taking him a long time (up to an hour or more) to calm his body. During calm times we tried different sensory inputs to see which ones he enjoyed and he found that he liked the sensation of sour lollies. The next time he escalated we gave him a sour lolly and he calmed within 5 minutes. For yet other children it was the physical activity of kicking or throwing the large swiss exercise ball against a bare wall that helped their arousal system to calm. What these examples have in common is that we looked for the kind of sensory input that they identified as liking and/or finding helpful when they were in a calm state. This is crucial, as if you try something when they are escalated and it isn’t helpful to them they might escalate even further.

Below is a publication about the use of sensory focused activities written for the Disability field which has relevant information on this topic. The most important thing to remember when suggesting sensory activities to clients is that responses to sensory input are individual; it is not a one size fits all approach and you must involve the client in putting together appropriate sensory activities for each person.

To finish, let me pose a few questions to hopefully stimulate some responses and sharing of ideas on the blog.

  1. What other sensory strategies have you found work with your clients?
  2. What are your top 3 strategies for regulating yourself?
  3. Do you work with carers/parents to assist them to identify their own strategies?

Acknowledgements: Toni Heron and Chris Tanti, Occupational Therapists and co-authors of an article yet to be published expanding on the content of this blog.

References:

http://www.dhs.vic.gov.au/about-the-department/our-organisation/organisational-structure/our-groups/office-of-professional-practice/practice-resources-opp/practice-resources-disability/positive-solutions-in-practice,-guides-and-advice

Champagne, T. (2007). Sensory Approaches. In, J. LeBel & N. Stromberg (Eds.) Developing Positive Cultures of Care: Resource Guide. Boston, MA:Massachusetts Department of Mental Health.

Champagne, T. & Stromberg, N. (2004). Sensory Approaches in Inpatient Psychiatric Settings Innovative Alternatives to Seclusion and Restraint. Journal of Psychosocial Nursing, 42(9), 1-8.

Dunn, W (2001) The Sensations of Everyday Life: Empirical, Theoretical and Pragmatic Considerations. American Journal of Occupational Therapy, Vol. 55, 608-620.

Siegal,D. (1999). The Developing Mind. New York: Guilford Press

ACF Smart Discussion paper 15 – working with the Window of Tolerance in the Classroom, ACF website, http://www.childhood.org.au/for-professionals/smart-online-training