Restricted Environmental Stimulation Therapy Research Articles

A study of flotation-REST (restricted environmental stimulation therapy) as an insomnia treatment.

ObjectivesFlotation-REST is a treatment for deep relaxation, where a person is contained in a stimuli-restricted environment and floats in water with high salt content. The aim was to investigate the effects from flotation-REST on people with insomnia diagnosis, as previous studies of flotation-REST have demonstrated some effects on sleep but have limitations regarding sample selections and sleep measures.Material and MethodsSix participants were recruited through an outpatient psychiatry clinic and posters on a university campus. All participants fulfilled criteria for insomnia diagnosis and four fulfilled criteria for major depressive disorder. Using a single case experimental design, daily changes were investigated on sleep logs regarding sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency over the course of 12 sessions consisting of 45 min of flotation-REST. No other treatments were offered simultaneously. Questionnaire data on insomnia severity (the ISI) and depressive severity (the MADRS) were also collected.ResultsThree participants improved on their most salient insomnia symptom (long SOL or WASO), and two improved on sleep efficiency. The improvements were maintained 2 months after treatment. Insomnia severity decreased for three patients, whereas depressive severity decreased for five. No changes in TST were found and two patients did not improve on any sleep measure. The two participants who benefitted the most were students in their 20s.DiscussionThe results were mixed. Flotation-REST may be beneficial for young adults with sleep-onset insomnia but more research is warranted.

Floatation Therapy for Mental Health Conditions


 Limited evidence from 2 randomized controlled trials suggested that floatation with restricted environmental stimulation therapy may provide some potential benefits in reducing anxiety and improving many of the symptoms associated with anxiety, including muscle tension, blood pressure, difficulties in emotion regulation, sleep difficulties, and depression, in individuals with anxiety disorders.
 Both trials reported no serious adverse events or negative side effects associated with the floatation therapy.
 No evidence was found on the cost-effectiveness of floatation therapy for the treatment of mental health conditions.
 No evidence-based guidelines with recommendations regarding the use of floatation therapy for the treatment of mental health conditions were identified.

Flotation Restricted Environmental Stimulation Therapy for Chronic Pain

Flotation restricted environmental stimulation therapy (REST) is an emerging therapeutic intervention that, to our knowledge, has never been directly compared with an indistinguishable placebo in patients with chronic pain. To determine whether 5 flotation-REST sessions alleviate chronic pain. This single-blind, randomized clinical trial compared flotation-REST as an intervention for the treatment of chronic pain with indistinguishable placebo and wait-list control conditions at Hannover Medical School, Hannover, Germany. Men and women aged 18 to 75 years who had been diagnosed with chronic pain disorder with psychological and somatic factors (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification, code F45.41) by physicians at the study center were randomly assigned to 1 of the 3 groups. Data were collected from June 26, 2018, to June 18, 2020. Patients in the intervention and placebo groups underwent 5 treatment sessions lasting 60 to 90 minutes, each session separated by 4 days. The placebo treatment was delivered in the same floating tank but controlled for effortless floating and environmental stimulus restriction. Patients in the wait-list control group did not receive any additional treatment but were asked to continue any ongoing treatments at the time of enrollment. The primary outcome was a change in pain intensity 1 week after the last treatment session. The assessment was repeated at 12 and 24 weeks. Secondary outcomes included pain-related disability, pain area, pain widespreadness (number of body regions affected by pain), anxiety, depression, and quality of life, as well as several other short-term outcomes. A total of 99 patients (mean [SD] age, 51.7 [12.3] years; 80 women [81%]) were included in the study. No differences were found among the groups in the primary outcomes (mean [SD] change in maximum pain: -7.6 [19.7] for the intervention group, -5.8 [12.7] for the placebo group, and 0.4 [14.0] for the wait-list control group; mean [SD] change in mean pain: -2.1 [19.4] for the intervention group,-4.2 [16.2] for the placebo group, and 2.0 [12.6] for the wait-list control group). Long-term secondary outcomes did not show significant differences. In the short term, patients in the intervention group showed significant improvements in pain intensity (-17.0 [17.1]; P < .001), relaxation (23.9 [22.6]; P < .001), anxiety (-10.1 [8.4]; P < .001), pain area (-3.6% [7.4%]; P < .001), and widespreadness (-2.0 [3.0]; P < .001), and similar changes where observed in the placebo group. Patients with chronic pain experienced no long-term benefits from the 5 flotation-REST interventions. Clinically relevant short-term changes in pain in the placebo group suggest that improvements may not be caused by environmental stimulus restriction or effortless floating as previously thought. ClinicalTrials.gov Identifier: NCT03584750.

The Influence Of Flotation Restricted Environmental Stimulation Therapy On Recovery From High Intensity Resistance Exercise

Flotation-restricted environmental stimulation therapy (flotation-REST) attenuates afferent nervous system signaling to promote relaxation of the body and mind. Despite limited research, the intervention has become increasingly popular among high performance populations (e.g., athletes, military) seeking to accelerate recovery and enhance performance readiness. PURPOSE: to determine whether flotation-REST augments recovery from high intensity resistance exercise known to induce significant metabolic, adrenergic and mechanical stress. METHODS: Eleven resistance trained males (age: 22.5± 2.3 years; height: 176.4±6.0 cm; weight: 85.7±6.2 kg; back squat 1RM: 153.1±20.1 kg; strength to weight ratio: 1.8±0.2) participated in a randomized, crossover-controlled research study. In one testing block high intensity resistance exercise (6 x 10 back squats at 80% 1RM, 2 min rest) was followed by a one-hour flotation-REST session, while recovery in the remaining block consisted of a sensory stimulating control. Markers of neuroendocrine signaling (catecholamines, cortisol, testosterone), structural damage (myoglobin, creatine kinase), inflammation (IL-6, TNF-alpha) and psychological perception (soreness, mood, fatigue) were measured before exercise (PRE), immediately post exercise (IP), post 1-hour recovery (1R), twenty-four hours post exercise (+24) and forty-eight hours post exercise (+48). Mean differences were assessed using repeated measures ANOVA with pairwise post-hoc comparisons (p ≤ .05). Effect sizes (ES) were calculated to evaluate magnitude of significant treatment differences. RESULTS: Flotation-REST significantly decreased soreness across the 48-hour recovery period (ES, IR: 0.68, +24: 0.47, +48: 0.28). Immediate improvements in positive affect (ES, IR: 0.74), negative affect (ES, IR: 1.03) and fatigue (ES, 1R: 1.13) were accompanied by differences in neuroendocrine signaling. Norepinephrine was significantly reduced (ES, 1R: 0.99) and testosterone significantly increased (ES, 1R: 0.32) in flotation-REST compared to control. No treatment differences were displayed for structural damage or inflammation. CONCLUSION: The data suggest a positive impact of flotation-REST in the first 48 hours of recovery, particularly where psychological appraisal is involved.

Flotation restricted environmental stimulation therapy and napping on mood state and muscle soreness in elite athletes: A novel recovery strategy?

Relaxation techniques and napping are very popular strategies amongst elite athletes recovering from the psychophysiological demands of training and competition. The current study examined a novel relaxation technique using restricted environmental stimulation therapy in a flotation tank (FLOAT). FLOAT involves reducing the level of environmental stimulation while achieving a sense of near weightlessness through floating in an enclosed, warm, saline-dense water tank. Sixty elite, international-level athletes (28 male, 32 female) across a range of 9 sports, completed a ∼45min FLOAT session following exercise training for their sport. Pre and post FLOAT, athletes filled out a multidimensional mood-state questionnaire (MDMQ) containing 16 mood-state variables as well as a question on perceived muscle soreness. Group data were analysed for pre to post FLOAT for all measured variables. Further analyses were performed on all variables for athletes that napped during FLOAT (n=27) and compared to those that did not nap (n=33). A single FLOAT session significantly enhanced 15 of the 16 mood-state variables (p<0.05) and also lowered perceived muscle soreness (p<0.01). Small (n=3) to moderate (n=6) effect sizes in favour of napping for 9 of the 16 mood-state variables were found when compared to the no nap group. FLOAT may be an effective tool for both physical and psychological recovery following training in elite athletes. Furthermore, napping in combination with FLOAT may provide additional benefits to enhance certain mood-state variables. This study serves as a pilot study for future research into the performance recovery of elite athletes following FLOAT.

Effects of modified Restricted Environmental Stimulation Therapy on relaxation, heart rate, blood pressure and flexibility

Background: Restricted Environmental Stimulation Therapy (REST) promotes physiological and behavioral changes that reduce the deleterious effects of stress. However, it requires expensive equipment and is accessible to a limited number of professionals and patients. We aimed to evaluate the physiological and behavioral effects of modified REST (mREST) in healthy young women. Method: Twenty-one healthy young women (20-25 yrs) participated. mREST consists of positioning the patient floating in the pool with 32oC for about 15 minutes, for twelve sessions, with blindfolded and wearing earplugs. The evaluation was performed before and after the intervention. The analysis of the state of relaxation was investigated by a questionnaire and the self-reports were categorized. Measures of heart rate and blood pressure were used as indicators of the cardiovascular response. Flexibility, measured by the finger-to-floor test, was used as an indicator of muscle relaxation. Results: Heart rate and blood pressure significantly decreased while flexibility and relaxation increased after the sessions (p&lt;0.001 for all comparisons). Self-reports of relaxation were consistent with the blood pressure measures and indicated that the participants showed states of relaxation associated with the decrease of blood pressure and the increase of flexibility (p&lt;0.001 for all comparisons). Conclusion: Healthy women undergoing mREST reported relaxation, with effects on muscular and cardiovascular systems. mREST is a simple, practical and affordable option for therapy in the aquatic environment.

Flotation restricted environmental stimulation therapy (REST) as a stress-management tool: A meta-analysis

In this study we investigated the value of flotation Restricted Environmental Stimulation Therapy (REST) as a stress-management tool. We focused on the physiological effects of REST, its influence on well-being, and on performance. Twenty-seven studies published in 25 articles or book chapters were included in a meta-analysis. The total number of participants was 449, with a mean age of 29 years (ranging between 20 and 45). Sixty-four percent was male and 36% was female. The results showed that REST has positive effects on physiology (e.g., lower levels of cortisol, lower blood pressure), well-being, and performance. The pre–post mean effect size and the overall randomized control group effect size were relatively strong. This suggests that despite some limitations of the original studies, flotation REST can be a useful stress management tool in addition to or instead of other stress management tools.

Health and thxrapeutic applications of chamber and flotation restricted environmental stimulation thxrapy (REST)

Basic research has documented reliable changes in emotional. cognitive, behavioral, and psychophysiological functioning as the effects of two related techniques that drastically reduce the level of environmental stimulation: chamber and flotation restricted environmental stimulation therapy (REST). Studies applying these findings in medical. psychotherapeutic, and behavioral health contexts have shown reductions in stress and inappropriate behavior among patients suffering from drug-induced mania. agitation, autism, and Alzheimer's syndrome; reduced phobic symptoms; Significantly lower relapse in habit modification interventions (e.g., smoking, alcohol intake, and weight loss); improved stress management and the amelioration of tension headaches, insomnia, and other stress-related symptoms; reduction of chronic pain; and better muscle control among cerebral palsy patients and others. The broad benefits of chamber and flotation REST. used alone or in combination with other intervention techniques, warrant further investigation and clinical use.

The Use of Restricted Environmental Stimulation Therapy in Treating Addictive Behaviors

Successful treatment of addictive behaviors is difficult because of the complexity of relevant contributing variables. Restricted environmental stimulation therapy (REST) is offered as a useful, flexible tool that can facilitate change in addictive variables at each level of complexity, from habitual acts through attitudes to self-concept and spirituality. The nature of REST is discussed in terms of processes and effects. Basically two processes, refocusing and rebalancing, contribute to the various physical and mental effects of restricted environmental stimulation. These effects include profound relaxation, relief from pain, and a shift in consciousness to a state that is more introspective, less defensive, and more receptive. Research in treating addictive behaviors with REST is reviewed with smoking, overeating, alcohol consumption, and drug misuse. There is a substantial body of literature demonstrating the effectiveness of REST in modifying smoking behavior. Very little research has been done on REST and drug misuse. Each of the other areas has a small number of preliminary studies that suggest REST as a promising treatment. In general, chamber REST proves to be effective in facilitating attitudinal and behavioral change, and maintaining those changes. The scant research with flotation REST show it to be less effective in modifying behavior but more relaxing and pain alleviating than chamber REST. The characteristics of the REST experience that make it effective in treating addictions are discussed as follows: (1) the induction of a general relaxation response, (2) substance misusers find serenity and relief by nonchemical means, (3) internal refocusing to concentrate on personal problems, (4) disruption of habits through removal of trigger cues and response possibilities, (5) increased feelings of control over addictive behaviors, and (6) enhanced learning processes. REST is a versatile, cost-effective treatment modality with demonstrated effectiveness in modifying some addictive behaviors and promising applications with others.

Restricted Environmental Stimulation and Smoking Cessation: A 15-Year Progress Report

The first successful use of restricted environmental stimulation therapy (REST) as a method of smoking cessation was reported in this journal in 1972. Since then, close to 20 papers and articles have further investigated this application. The results have been consistently positive and have further shown that--unlike most techniques--REST combines synergistically with other effective treatment modalities. The effect of REST seems to target primarily the major problem with other known treatments in this area: It substantially reduces the relapse rate among clients who quit smoking at the end of treatment. Furthermore, REST is safe, has no known adverse side effects, and is easily tolerated by most participants. Nevertheless, the method has not found wide acceptance among practitioners. This paper explores and answers some of the concerns that may be involved in its relative lack of popularity.

The presence or absence of light during flotation restricted environmental stimulation: effects on plasma cortisol, blood pressure, and mood.

This study examined the effect of light on relaxation associated with flotation restricted environmental stimulation therapy (REST), as measured by plasma cortisol, mean arterial pressure, and psychometric parameters. Twenty-one subjects were paired by baseline cortisol levels into two groups: one experiencing flotation REST in the presence of light (REST-L) and one experiencing flotation REST in the absence of light (REST-D). Subjects were 15 male and 6 female students aged 22-28 in normal health who had not experienced REST. Repeated flotation REST (8 sessions) either with light or without light was associated with a decrease in plasma cortisol and a decrease in mean arterial pressure, with no differences in effectiveness between groups. The psychometric assessment of mood, using the POMS scale, before and after sessions 1 and 8 revealed mood state improvement in both REST-L and REST-D groups. These data suggest that the presence of light did not compromise the flotation REST experience, as evidenced by the lack of difference between REST-L and REST-D groups.

Effects of restricted environmental stimulation: enhancement of hypnotizability for experimental and chronic pain control.

Enhancement of hypnotizability and pain tolerance has been demonstrated using restricted environmental stimulation therapy (REST) with university students as Ss (A. F. Barabasz, 1982). The purpose of the present study was to determine whether or not similar results could be obtained with chronic pain patients. Ss consisted of outpatients in treatment for conditions in which pain is prominent who also demonstrated low hypnotizability after repeated hypnosis plateau sessions. 2 groups of Ss were exposed to REST. Situational demand characteristics (Orne, 1962) favored an increase in hypnotizability for REST Group 1 (high demand). REST Group 2 (low demand) was exposed to situational demand characteristics designed to disguise the experimental hypothesis. 2 groups of control Ss were exposed to the same alternative demand characteristic manipulations as the experimental groups, but environmental stimulation was maintained. The Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) of Weitzenhoffer and E. R. Hilgard (1962), including a posthypnotic suggestion for an anesthetic reaction, and an ischemic pain test were administered prior to treatment and again immediately following treatment. After 6 hours of REST, significant increases in SHSS:C scores were found for high-demand and low-demand experimental Ss, as well as for high-demand control Ss. No such increase was found for low-demand controls. Significant decreases in pain scores were found for both high- and low-demand experimental groups. No significant pain score decreases were found for either control group, suggesting a relatively weak effect of demand characteristics. An independent postexperimental inquiry suggested all Ss believed they received active treatments. The inquiry, conducted 10-15 days after the experiment, also revealed a majority of experimental Ss were using hypnosis on a daily basis to reduce pain with a substantial decrease in pain medication. Only 2 control Ss (highest in hypnotizability) reported similar success. Anecdotal reports of pain reduction experiences using hypnosis after REST intervention were supportive of E. R. Hilgard's (1977) neodissociation theory.

Restricted environmental stimulation therapy of smoking: A parametric study

Restricted environmental stimulation therapy (REST) has been shown in several studies to be an effective technique in smoking intervention. The most common procedure has been 24 hours in a dark, silent chamber; in several cases, messages designed to facilitate smoking cessation have been presented every few hours over an intercom. This study parametrically varied 12 versus 24 hour chamber REST sessions and four message presentation schedules (massed, distributed, or self-demand presentation of five messages, and a no message condition). A ninth group of volunteer subjects spent five one hour sessions in a flotation REST tank. In this condition, no message was presented during the first session; one message was given during each of the next three sessions; and two messages were given in the last session. Previous findings of therapeutic efficacy were confirmed for chamber REST, with 3- and 12-month follow-ups showing means of 51% and 35% reduction, and 34% and 21% abstinence, respectively. The 24-hour distributed message group, representing the modal technique, showed a mean reduction rate of 51% and an abstinence rate of 36% one year after treatment. There were no significant differences as a function of the two main factors nor the interaction. Most chamber REST groups showed significant smoking reductions on both follow-ups. Flotation REST led to a significant decrease three months after the treatment, but not at one year. The data have theoretical as well as practical implications for future uses of REST.

Memory effects of restricted environmental stimulation therapy (REST) and possible applications to ECT

Restricted environmental stimulation (REST) has been shown to facilitate learning and memory in both human and animal experimental subjects. This paper reports early data from a test of the usefulness of REST in reducing post-ECT amnesia in depressive patients. Two such patients were placed in a quiet, dimly illuminated room for 2–4 hrs. after recovering from each ECT administration in a series of treatments; three others, following standard practice, were returned to their normal hospital rooms. Measures of memory (verbal, numerical, nonverbal, life event, and self-rating) were given prior to the first ECT treatment; after the first post-recovery session; after the last post-recovery session; and one week after the last ECT administration. The major difference found was that the REST group showed an improvement in self-rated memory functioning from the first to the last ECT administration that was 15 times as great as that reported by the control group. This finding is interesting because of the major role played by self-reported memory disturbances in the scientific, clinical, and popular evaluation of ECT. The sample size is being increased, as it must be for any reliable conclusions to be drawn from this study.

A three-year follow-up of hypnosis and restricted environmental stimulation therapy for smoking.

Abstract Clinical follow-up data were obtained from 307 clients. Clinicians' experience level, contact time, and procedural thoroughness varied in 6 interventions for smoking cessation. An additional intervention combined hypnosis with restricted environmental stimulation therapy (REST). The major results suggest positive treatment outcomes to be related to greater hypnotizability, absorption, hypnotist experience level, procedural thoroughness, and client-therapist contact time. The least effective intervention (4% abstinence at 4-month follow-up) involved intern trainees using a short, single-session approach. The most effective procedure (47% abstinence at 19-month follow-up) involved the combination of hypnosis and REST. Data interpretation limitations are discussed.

Restricted environmental stimulation therapy and aversive conditioning in smoking cessation: active and placebo effects

An aversive smoking treatment, either alone or followed by 24 hr of restricted environmental stimulation therapy (REST, lying on a bed in a dark, silent chamber with occasional smoking-related messages presented over an intercom), was administered to 74 smokers. The subtractive expectancy placebo technique, where an active treatment is described as inert, was used to evaluate the role of the expectancy placebo component. The combined treatments were more effective than aversive conditioning alone, but less so than REST by itself. Expectancy contributed substantially to the success of the aversion treatment through the 6-month follow-up, and less so to the early success of REST. These components faded by the end of 12 months. The implications for designing follow-up periods for studies in this area are obvious. The results also supported hypotheses that Ss who undergo REST are less likely to relapse once they have quit smoking, and that other REST Ss who do not quit show success in controlled (reduced) smoking. For the first time, REST did not potentiate another treatment with which it was combined, perhaps because this particular other treatment is not in itself of proven effectiveness. The results also show that the impact of REST does not depend on the client's expectations concerning its effects. Data concerning smoking behavior and attitudes, some of which predicted treatment success, are also presented.

Restricted environmental stimulation therapy (REST) as a treatment for autistic children.

This study explored the usefulness of 48 hours of Restricted Environmental Stimulation Therapy (REST) as a treatment for autistic children. In order to provide quantified objective measures for evaluating the effects of this treatment, a battery of psychological tests was developed which would be useful and practical for the assessment of these children in regular diagnostic settings. Several positive changes in learning, social and play behavior, and cognitive functioning were noted.

Effects of relaxation associated with brief restricted environmental stimulation therapy (REST) on plasma cortisol, ACTH, and LH.

Restricted Environmental Stimulation Therapy (REST), which involves placing an individual into an environment of severely reduced stimulation for brief periods, has been subjectively reported to produce deep relaxation. The present study determines the effects of REST-assisted relaxation on plasma cortisol, ACTH, and luteinizing hormone (LH). These parameters were also measured in a group exposed to a similar relaxation paradigm, but without REST (non-REST). Each subject experienced two baseline sessions (1 and 2), four REST (or non-REST) relaxation sessions (3, 4, 5, 6), and two follow-up sessions (7 and 8). Pre- and postsession plasma hormone levels were measured in sessions 1, 2, 5, and 8. Both REST and non-REST subjects reported that the experience was relaxing. During the treatment period (session 5) pre- to postsession changes in cortisol and ACTH, but not in LH, were significantly greater for the REST group than for the non-REST group. Plasma cortisol level also decreased across sessions in the REST group, with levels in sessions 5 and 8 significantly lower than the baseline (sessions 1 and 2). Non-Rest subjects showed no change in plasma cortisol across sessions. No significant change in plasma ACTH or LH occurred across sessions in the REST or non-REST groups, although ACTH showed a decreasing trend. These data demonstrate that repeated brief REST-assisted relaxation produces a relaxation state associated with specific decreases in pituitary-adrenal axis activity.

Restricted Environmental Stimulation Therapy and Behavioral Self‐Management in Smoking Cessation1

The relative impacts on smoking behavior of restricted environmental stimulation therapy (REST), behavioral self‐management, and the combination were compared. Fifteen smokers from the community were treated in each of the three conditions and followed over a 12‐month period. The combined treatment was very successful compared to standard smoking interventions (a mean of 66% reduction from baseline smoking rate and 53% of subjects completely abstinent on the 1‐year follow‐up), and subjects in this group smoked significantly less than those in either the REST or behavioral self‐management only condition. Furthermore, subjects receiving REST, alone or in combination, were significantly less likely to relapse following treatment. The results were taken to support the importance of addressing multiple change objectives in smoking cessation programs.

Restricted environmental stimulation therapy in the treatment of essential hypertension

Restricted Environmental Stimulation Therapy (REST) has been useful in treating a variety of health-related problems, including obesity and cigarette smoking. The pilot project described in this paper used 24 hr of REST (darkness and silence) with four patients suffering from essential hypertension. Long-term changes have included lower blood pressure, a reduced need for medication, and improved coping with stressful life events.