Floating Toward Recovery

By Rebecca Brumm, LPC, CEDS-S

Floatation-REST (Reduced Environmental Stimulation Therapy) is a novel, non-pharmacological intervention that is being investigated for those suffering with mental health disorders. Within the eating disorder treatment community, floating offers a unique opportunity for patients to experience greater attunement with their bodies, to habituate to programmed distressing triggers within the body, and to experience a serenity that can serve as a template for them as they learn to live with anxious temperaments. Recent eating-disorder-specific research supports Floatation-REST not only as a safe intervention, but also as one that might have a surprisingly positive effect on body image. By understanding the value of Floatation-REST as a supplement to mental health treatment, practitioners can offer it as a tool that may provide an opportunity to dig further into interventions while serving as a unique and powerful instrument to enhance well-being.

Floatation-REST dates back to the 1950s, when doctors Jay Shurley and John Lilly at the National Institute of Mental Health became interested in understanding how the brain would respond to environments completely devoid of external sensory input (Feinstein et. al, 2018). Since that time, floating has experienced periods of dormancy. Before the 2010s, research investigating Floatation-REST was sporadic, occurring widely in the 1980s and 1990s, and mostly on healthy individuals. These studies affirmed its role in the reduction of stress levels, heart rate, and blood pressure. In the past decade, research has started to explore floating as a tool for helping those suffering from mental health conditions. Initial findings offered hope, and further research was spurred. In 2015, the Laureate Institute for Brain Research (LIBR) established the first lab dedicated to researching Floatation-REST.

The Float Clinic and Research Center at LIBR was the first of its kind, with a laboratory containing floatation tanks next to a functional magnetic resonance imaging (fMRI) facility, allowing researchers to have a firsthand view of the neurological effects of floating. The initial studies from the institute have demonstrated the effects of float therapy on lowered anxiety, muscle tension, and stress-related pain in clinically anxious individuals. Ongoing research has demonstrated impressive results showing that the lack of sensory stimulation found in a float tank can “shut down” sensory cortices, leading to decreased anxiety and elevated interoception. In addition, the degree to which these effects persist over longer durations of up to six months are being investigated.

LIBR is also uniquely positioned to study eating disorder populations. The institute resides on the first two floors of the LIBR building, and the nationally renowned Laureate Eating Disorders Program operates on the third and fourth floors. This symbiotic partnership has facilitated important neurobiological findings relevant to individuals struggling with eating disorders, as well as to those who love, support, and treat these individuals.

Regarding Floatation-REST and eating disorders, a recent clinical trial found that floating was safe and well tolerated by weight-restored outpatients with a history of anorexia nervosa. Research on these subjects showed no evidence of orthostatic blood pressure changes or dizziness following the float. Evidence also demonstrated that participants experienced reduced anxiety, enhanced interoception, and improved mood.

In addition, body image distortion did not worsen; in fact, researchers found preliminary signs of reduced body dissatisfaction via improvements in the visual perception of participants’ body size. Utilizing the Photographic Figure Rating Scale pre- and post-float, researchers noted that floating acutely improved body dissatisfaction scores. These findings have prompted further research, including an ongoing randomized clinical trial looking into whether Floatation-REST can assist individuals at earlier stages of the recovery process, particularly with the challenging aspects, such as body image distortion.

Anecdotal accounts from those in recovery from eating disorders also support positive reports of this intervention. Author Emily Noren shares how floating served an integral role in her recovery from an eating disorder in her book, Unsinkable: My Story of Discovering Float Tanks and Reaching Full Recovery from Anorexia and Bulimia. Shane Stott also recounts in his book, The Float Tank Cure, how his floating experience was unmatched in aiding his recovery from crippling anxiety. Because anxiety so often precedes eating disorders, interventions aimed at these symptoms also support eating disorder recovery.

Practitioners looking to better understand this treatment should focus on several key factors. First, clinicians will want to understand the experience inside the tank and how to prepare their patients for it. It is important to equip patients with knowledge of what options they have to help them ease into the experience and to make it as comfortable as possible. Clinicians should also understand barriers for use of this intervention. In addition, therapists will want to identify skills with patients pre-float that will assist them in riding out the initial increase in anxiety that sometimes happens upon entering the tank. Finally, clinicians will want to prepare patients to thoughtfully pair talk therapies with floatation for gains in insight and self-reflection.

The Float Tank Experience

Floatation-REST is experienced through floating in a large tank of water that is heated to body temperature and saturated with 1,000 pounds of magnesium sulfate (Epsom salt). The Epsom salt allows the body to become weightless and to float effortlessly atop the water. The room is also heated to body temperature, so there is minimal distinction between the air and the water. The room has the capability to become completely dark and mostly soundproof. In this state, the brain has very little external stimulation, and the body experiences vastly reduced strain and tension compared with what it experiences throughout a normal day.

While the intentionality for a float can range from physical recovery to relaxation to fun, mindfulness, meditation, and stress-reduction benefits are among the most applicable for recovery.

Preparing Patients to Float

For some patients, simply describing the float environment elicits anxiety. The idea of being isolated with their anxious minds for an hour with not an ounce of distraction offers anything but peace and relaxation. Yet these patients are often the ones who benefit the most. Because anxiety is a disorder that often centers on control, it is important that apprehensive clients know that they do have a great deal of control in their float session.

To start, there are few rules that are steadfast, and most of them involve preserving the salt water. Regarding the experience, floaters can leave the lights on, and some float rooms are equipped with motion detection lighting so that simply raising a hand will activate the lights. Music or guided relaxation can be played during the float. Also, patients are not required to float for the entire session. They may leave and re-enter the tank as often as they choose. Going into a float experience knowing that it can be terminated at any time, or can be broken up, often lends itself to less resistance to the process. Finally, open pools are options for patients who are triggered by confined places or claustrophobic.

A general rule is that it takes two to three sessions to achieve the desired effects of floatation. The first session is often one that offers too much novelty to allow the brain and body to fully relax into the experience. The second session allows a little more familiarity, and the third session is where participants can more fully relax and focus on their intentions for floating.

It’s important for clients to understand that many floaters notice an increase in their interoceptive signals while in the water. Often the beating of the heart and respiration become especially perceptible. For anxious individuals, these sensations are often linked to panic, doom, and dread. Clinicians will want to explain the process of habituation to patients before heading into the tank, as well as review skills to ride out the initial anxiety. By detailing how the heart becomes more predominant in the session, clinicians can offer patients the opportunity to be mindful with it. Sinking into a pleasurable part of an experience facilitates reciprocal inhibition, a theory that suggests one cannot be anxious and relaxed at the same time. This experience can start to challenge the connection between bodily signals and anxiety by pairing the feeling of the heartbeat and breath with relaxation and peace instead of fear.

Barriers for Consideration

Accessibility and cost are two factors that clinicians will want to consider when evaluating this intervention for patients. Fortunately, access to commercial float tank experiences has grown exponentially. In fact, an article in a special mental health publication on Floatation-REST from Time magazine states that the number of commercial float centers nationwide has increased 300 percent since 2011, from 85 centers to 250 centers, making this intervention much more accessible.

Cost for a single experience can range from $40 to $100. Often, float facilities will bundle multiple floats together and price them at a cheaper per float cost. There has also been movement in the realm of in-home float tanks, although these are best reserved for experienced floaters who have really benefited from the practice.

Finally, patients who are actively self-cutting should wait until all wounds have healed before floating. Cuts and abrasions to the skin can become irritated and painful while in the salt water.

Floatation-REST and Psychotherapy

For those struggling with eating disorders, the body is not a peaceful place. To succeed in recovery, the relationship with the body must change, and an important aspect of that evolution is the ability to replace fear and avoidance of the body with trust and refuge. Floating facilitates that process. The combination of darkness, quiet, temperature, and floating in water produces an experience that closely mirrors that of being in the womb. Because of this, the experience is naturally calming and soothing. This is an ideal environment in which to begin repairing bodily sensations, such as heartbeat and respiration, with the tranquility that the tank offers.

Eating disorder recovery also means learning to manage the mind. Traits and tendencies of those prone to disordered eating include having ruminative thoughts, and being self-critical, anxious, and obsessive. Floating allows for an environment where one is alone with nothing to distract the mind from those tendencies. While this alone might turn a struggler away, these are often the situations that can provide immense healing.

Therapists can help to set the stage for gaining insight into the mind. Even when doing nothing but attempting to keep the mind quiet, this does not happen. The mind naturally generates thoughts, predictions, and associations, like a machine chugging along with this sole purpose. Observing this natural phenomenon, one can start to detach from being the thought, to just having a thought. Direction to return the focus to the breath when the mind wanders away without judgment can start to create the act of allowing thought, but not attaching to it.

Another tendency of those prone to eating disorders is a struggle to prioritize themselves in their lives. Carving out and honoring a designated chunk of time with the single purpose of self-care, self-reflection, and relaxation can be an exposure to the discomfort that brings for clients. Therapists might ask patients to reflect on the self-dialogue that makes taking the time to float a barrier for them. They can be encouraged to observe but not attach to those messages and to allow presence with the uncomfortable feelings, but also not allow those feelings to stop them from following through. Therapists can further process the anxious thoughts that preceded the float and contrast them with what actually came true from those thoughts.

Treating eating disorders has always required approaches that work with both the mind and the body. Floatation-REST is a novel approach that offers emotional growth, mental resilience, and body harmony. Research is just starting to show what promise this intervention may hold for facilitating healing. For those who treat eating disorders, or for those who support someone who struggles with one, this intervention may add another dimension to the recovery process.

About the author:

Rebecca K. Brumm, MA, LPC, CEDS-S serves as the Director of Operations for Laureate Eating Disorders Program.  Rebecca has a Masters in professional counseling from Central Michigan University. Though she has helped clients through a variety of challenges in her practice as a therapist since 2005, she specializes in helping people work on improving their body image and overcoming eating disorders.  Her expertise in this area comes from a variety of perspectives: she is a certified Intuitive Eating Counselor, a Health At Every Size (HAES) practitioner, and has served as a national health presenter for Cigna Health.  Additionally, Rebecca earned the Certified Eating Disorder Specialist Supervisor (CEDS-S) credential.

For over a decade, she has experienced how a strained relationship with the body can negatively affect the quality of life. Rebecca is passionate about helping people develop self- compassion, connection, and acceptance.  She believes learning to nurture a healthy relationship with one’s body can be transformative in someone’s overall quality of life.

References:

Feinstein, J. S., Khalsa, S. S., Yeh, H. W., Wohlrab, C., Simmons, W. K., Stein, M. B., & Paulus, M. P. (2018). Examining the short-term anxiolytic and antidepressant effect of Floatation-REST. PLOS One, 13(2), e0190292. https://doi.org/10.1371/journal.pone.0190292

Khalsa, S. S., MD, Moseman, S. E., MD, Yeh, H., PhD, Upshaw, V., RN, BSN, Persac, B. E., LMFT, Breese, E., . . . Feinstein, J. S., PhD. (2020). Reduced environmental stimulation in anorexia nervosa: An early phase clinical trial. Frontiers in Psychology. doi:10.3389/fpsyg.2020.567499

National Library of Medicine (U.S.). (2016, June 15-2019, August 20). Effects of Reduced Environmental Stimulation on Eating Disorders. Identifier NCT02801084. https://clinicaltrials.gov/ct2/show/NCT02801084

National Library of Medicine (U.S.). (2018, August 20). Floatation-REST and Anorexia Nervosa. Identifier NCT03610451. https://clinicaltrials.gov/ct2/show/NCT03610451

Oaklander, M. (2020). FloatHopes, Moods Lift. Time, Special Edition (Mental Health A New Understanding), 50-53. doi:https://time.com/floating/

Szypłowska, M., Kuś, A., Gładysz, K., Neścior, M., & Szpiech, K. (2019). Beneficial health effects of treatment with flotation-REST on anxiety, muscle tension pain, depression and sleep quality. Journal of Education, Health and Sport, 9(8), 829-834. doi:http://dx.doi.org/10.5281/zenodo.3370424