Post Traumatic Stress Disorder (PTSD) affects more than 24 million people in the United States at any given time. PTSD seems to be pretty resistant to most traditional forms of treatment and costs the U.S. billions of dollars in medical care that may not even be effective. There are lots of anecdotes, but very few formal studies, about floating being helpful achieving positive results on a timeline much shorter than traditional treatment. So how do we answer the question, “Does floating help those with PTSD?”
Most of the excitement around floating being used for PTSD has to do with its potential as a treatment, much more so than the efficacy of the treatment as proven by clinical research. That’s what we’re going to look at here.
Before we get too deep into this subject, I want to highlight a couple of things. PTSD is considered a Trauma- and Stressor-Related Disorder. Much of the time, when people in the mainstream talk about PTSD, they’re also talking about veterans. While many veterans suffer from PTSD, not all veterans do. Likewise, there are lots of people who suffer from PTSD that are not veterans. Anyone who is exposed to actual or threatened physical or sexual violence can develop symptoms of PTSD.
This means that threats of violence, real or perceived, as well as witnessing violent acts, can cause PTSD. So witnessing a brutal accident, being a paramedic, and experiencing sexual assault can symptoms of PTSD to manifest.
In the past few years, several people in the float industry have been making strides in showing how the practice of floating can help those with PTSD. This is a very exciting development for a lot of reasons.
For one, some of the anecdotal stories about the power of floating in treating PTSD have been eye-opening and inspiring, like when Michael Harding and Bek Houghton shared their experiences at the 2016 Float Conference.
Two, many of the benefits of floating that are well researched are exactly the kinds of benefits that generally help with PTSD, which clinical psychologist David Manfield talked about at the very first Float Conference back in 2012.
Three, there are veterans’ organizations like Pathways for Veterans that are actively using float tanks to help treat PTSD.
While I’m sure everyone enjoys getting to revisit these informative talks from the Float Conference, I’m going to avoid doing much more of that. The idea that I’m meandering towards is that for as long as most float centers have been around, people have been talking about the benefits of floating for people who suffer from PTSD. With this long tradition, there should be very solid reasons for that, right? Well, let’s take a look at that.
Very few studies have been done on clinical (i.e. not healthy) populations in float tanks, so claiming that floating is objectively helpful for those that suffer from PTSD is a stronger statement than we can make right now. To understand what we do know, we should look at research that’s been done that directly involves clinical patients who suffer from PTSD that we can extrapolate from.
Fortunately, there are three studies that we can look at right now that examine the benefits of floating and PTSD.
The first one is a case study out of Karlstad University in Sweden from 2013[¹]. This case study had a single patient, but it does provide some very strong results in this patient’s life about how floating was able to help her with her mental health and specifically her PTSD. The study followed her journey through floating for a year and a half, with very regular floats scheduled along with a series of interviews to track her progress.
She is diagnosed with attention deficit hyperactivity disorder, atypical autism, post-traumatic stress disorder, anxiety, and depression. Her trauma appears to be related to sexual assault, which affects how her condition manifests. Among the symptoms, she exhibited prior to treatment were severe social anxiety, fatigue/lethargy, and intrusive negative thoughts and feelings.
The results of the 2 years she was in treatment were noticeably dramatic. Here’s a couple of excerpts that highlight this change:
The relaxation extends into her everyday life and includes psychological relaxation as well as relief from earlier painful muscle tensions. Her quality of sleep is good; she has energy and no longer problems with fatigue. She describes being alive, alert and positive, and she no longer feels depressive or bothered with negative feelings “I can do more and I am more positive”.
The problems with lethargy and dullness are gone and she has the capacity to carry out many things and to be active. Floating has provided feelings of security, self-confidence, and the ability to handle setbacks “I have a little more confidence and floating is like an energy boost. I feel like more when I feel better”.
Her social abilities have increased, and she is not silent or shy anymore. She is no longer afraid of making mistakes and about how her behavior might be evaluated. The respondent no longer needs medications and she is happy to avoid the side effects that she previously experienced.
She was surprised by the effect since she did not believe floating would affect her in any significant way. Her friends and co-workers were also surprised about the positive effects that they saw and they asked her what she had done.
Floating made her feel like ‘a new person’ and she came back to life and felt good. She says there are no side effects and prefer floating in front of the drugs she used to take.
Her anxiety conditions by the end of the study appear to have gone into a severe remission, so much so that she’s able to go out in social situations and act in a way that she was never able to before. It was such a drastic change that people that knew her previously were asking what she had done differently. That’s pretty remarkable!
Any doctor worth his salt will tell you, however, that a single patient in a single study does not provide evidence. At best, it lays the groundwork for future studies with a larger patient population.
Fortunately, this single study has provided a useful groundwork to study anxiety conditions (like PTSD) with a larger sampling of patients and we’re finally starting to see that.
In 2018 Dr. Justin Feinstein at the LIBR Float Clinic released two studies examining how people diagnosed with anxiety disorders are affected by floating. While there has been a lot of research on the anxiety reduction and relaxation benefits in healthy populations, there’s almost no research on clinical populations. When assessing treatment options it makes a world of difference when a doctor is able to point directly to the condition a patient has and see that there have been reported benefits for them.
Dr. Feinstein spoke at the Float Conference later in the year to discuss their conclusions. He can certainly explain them better than I can, and I encourage you to listen to his Float Conference Talks from 2018.
He does an excellent job of explaining why these results are significant and what they’ve been looking for, so I highly recommend familiarizing yourself with them.
In fact, let’s stop here to discuss some of the key terms that Dr. Feinstein and his team at LIBR use in their research.
Interoception, if you’re not familiar, is the ability to notice the internal workings of your body instead of focusing on external stimuli. Increasing interoception is the primary goal for many mindfulness therapies being studied right now.
A high Anxiety State is a symptom of many chronic anxiety conditions, including PTSD. As Dr. Feinstein puts it, “Prospective studies have shown that AS [Anxiety State] is a strong predictor for the onset of mood and anxiety disorders and the development of spontaneous panic attacks.”
This means reductions in this specific symptom are likely to have positive overall effects for patients who suffer anxiety conditions as a whole and interoception is useful for doing that. That’s the goal here. What better environment to focus on your internal senses than the inside of a float tank?
The first study, published in 2017[²], the Float Clinic focused on the benefits of a single float session. So an ongoing benefit can’t be determined unlike with the Karlstadt study, which continued for over 2 years.
Of the 50 participants in the study, 17 were diagnosed with PTSD. That subgroup was looked at individually several times to observe how much they were impacted. The results indicated that the patients within the PTSD subgroup had the greatest baseline of anxiety and stress.
the PTSD subgroup had large post-float reductions in fatigue (d = -.96). On key symptom-related variables—such as reductions in state anxiety, stress, depression, and negative affect—the effect sizes were consistently large across all subgroups. Further analysis revealed that the largest effects occurred in the most severely anxious participants.
The most anxious people were the ones that found the greatest amount of relaxation. But it goes so much further than just a simple reduction in anxiety, Dr. Feinstein suggests this is a return to a baseline of non-anxiety, also known as Wolpe’s theory of reciprocal inhibition.
Beyond the immediate dissipation of anxiety, the float experience also induced a significant decrease (p < .0001) in self-reported stress, muscle tension, pain, depression, and negative affect, along with a significant increase (p < .0001) in serenity, relaxation, happiness, positive affect, overall well-being, energy levels, and feeling refreshed, content and peaceful, with estimated effect sizes ranging from large to very large across variables.
On key symptom-related variables—such as reductions in state anxiety, stress, depression, and negative affect—the effect sizes were consistently large across all tested diagnostic categories.
This result is more than just a positive effect, it’s having a measurable impact among every patient, in every measure that they were testing for. This result alone demonstrates the value of floating, at least for some people, as an effective treatment for anxiety.
So, how does floating compare to other treatments for anxiety?
[This] finding is notable given the fact that the severely anxious participants reported having the most severe impairments in life functioning, and also tended to be the most resistant to other forms of treatment; approximately two-thirds of the severely anxious participants were currently taking an SSRI or SNRI, and over three-quarters had tried psychotherapy.
Indeed, most participants in this study reported having tried a number of other techniques to help them relax and feel less anxious and stressed. Of potential clinical relevance, nearly 75% of the entire sample, and 82% of the severely anxious subgroup reported that they had achieved more relaxation with Floatation-REST than any of the other treatments or techniques they had tried in the past.“
Not only are patients seeing major benefits to floating, but these benefits are also often surpassing traditional treatment methodologies in treatment-resistant patients. That’s pretty amazing for results from a single session.
While these results were promising, results from a single session aren’t enough. It also raises questions beyond just the relatively small sample size, like “are the benefits prolonged? Does it remain effective after multiple treatments?”
Dr. Feinstein and the folks at the LIBR Float Clinic knew that there would be a healthy level of skepticism at this research, so they conducted a new study looking to see if patients with High Anxiety Sensitivity received greater benefits than a control group over a longer period of time[³]. This time, examining the benefits of 12 floats over the course of six months.
The findings regarding State Anxiety were replicated from the previous study, and over the prolonged timeline, didn’t show any sign of dissipating with the frequency of people floating.
Interestingly, the magnitude of state anxiety reduction found in the current study was commensurate with the magnitude of reduction found in the initial float study.
Initially, there was some concern that interoception could be damaging for certain anxious people, because there’s a strong negative association some people have, especially PTSD patients, with hearing their heartbeats or hearing their breath. The concern was this could trigger a Pavlovian-like response and increase anxiety. Fortunately, the opposite seemed to happen. Dr. Feinstein’s current hypothesis is that the float environment itself is what does it.
[F]indings presented here suggest that Floatation-REST may shift the nervous system into a physiologically quiescent state, one that is antagonistic to anxiety.
Floating itself removes people from the stressors of the outside world, and this could be what helps people relax in a float tank in a way that other treatments can’t replicate.
Let’s go back to looking at that case study from Karlstadt University. The report of the patient showed, specifically, a greater sense of confidence, reducing anxiety in social situations, and better emotional control. Her PTSD symptoms, symptoms that are traditionally very persistent, were all but eliminated. This study reproduces those benefits across a much larger (albeit still somewhat small) sample size.
One of the major underlying symptoms of PTSD, and anxiety conditions in general seems to be mitigated almost entirely by floating. This means that in this (extremely) limited sampling, floating appears to be incredibly helpful in treating PTSD. In fact, everything we saw in the case study from Karlstadt University seems to be consistent when applied to a larger sampling of people.
So given these amazing results, why can’t we say that floating is an effective treatment for PTSD? Well, despite this research being incredibly thorough and the benefits clearly pronounced (even being more drastic than current treatment methodologies), these are relatively small sample sizes. Between the two studies from the Float Clinic, there’s a total of 81 participants in these studies, and of those, 28 were diagnosed with PTSD. If you’re familiar with statistics, you know of things called “Confidence Intervals”, the degree of confidence for a certain conclusion. It’s largely on sample sizes as well as the consistency of result within those samples. To be comparable to other treatment methods, we need hundreds – maybe even thousands – of patients before we can say definitively that floating can be used to treat PTSD.
While it’s a step in the right direction, it’s not enough to expect doctors to draw meaningful conclusions from just yet. We need a lot more data to make a compelling case for floating as a medical treatment. Bucket loads of data. So much data that it seems overwhelming. Right now we don’t have that. Not for floating and PTSD, not for floating and depression, and not for floating and anxiety disorders.
Fortunately, The Float Clinic is doing the first long term randomized control trial on floating in a clinical population now. Beyond the great work of the team at LIBR, more researchers are developing an interest in floating. As it becomes more well known and these benefits continue to get published, replication from other researchers becomes more likely.
It’s possible that within the next couple years, we’ll see another dedicated float tank laboratory open up, more research will absolutely be published, and further down the line, we could see doctors prescribing floats for patients with anxiety conditions like PTSD. If the research continues to demonstrate such significant results, it really doesn’t seem like the question is “if” doctors will start recommending floating, but really, “when”.
[1]Kjellgren, Anette, et al. “Quality of Life with Flotation Therapy for a Person Diagnosed with Attention Deficit Disorder, Atypical Autism, PTSD, Anxiety and Depression.” Scirp.org, Scientific Research Publishing, 5 July 2013, file.scirp.org/Html/8-2250044_34022.htm.
[2]Feinstein, Justin S., et al. “Examining the Short-Term Anxiolytic and Antidepressant Effect of Floatation-REST.” PLOS ONE, Public Library of Science, 2 Feb. 2018, journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0190292.
[3]Feinstein, Justin S, et al. “The Elicitation of Relaxation and Interoceptive Awareness Using Floatation Therapy in Individuals With High Anxiety Sensitivity.” Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, Elsevier, 9 Mar. 2018, www.sciencedirect.com/science/article/pii/S2451902218300491?via%3Dihub.
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Leaving a tank unattended for a week – DSP 93
Float tanks are like giant salty babies sometimes. Between water sanitation, temperature control, and filtration…they require a lot of attention and care, and even when you do things perfectly they can still make giant salty messes everywhere. So how do you leave your baby alone for a week? How do you prepare for that? Unlike a human baby, you can take your float tank with you (or at least it’s unlikely).
Choosing a Shower Disinfectant for your float center – DSP 92
A recommendation for a shower cleaner should be a fairly straightforward answer, right? Well… maybe not. Graham and Ashkahn are very particular about the definitions of things like “sanitation” “disinfectant” and other common cleaning terms. In this episode, they take the time to explain what product labels typically mean and what you want to look for when getting a surface cleaner for your float center.
Be ready to dive in and do some extra reading when getting into this episode. There’s a lot of terminology to parse and clarify. Fortunately, it’s Graham and Ashkahn so they have lots of really clear advice, like “don’t mix bleach and ammonia (or any homemade cleaning product, really)”.
When Does a Float Start? – DSP 91
Time management and maintaining your schedule is one of the most important quality controls in a float center. If you can’t get people out on time, it can throw off your schedule for the rest of the day. So, when does a float start? How do you measure that time? And what do you do if a floater starts late? Cut off their float? The next persons?
Graham and Ashkahn have been running Float On in a particular way for a long time now, and have particular insights into the challenges of how you manage your schedule.
Tips for filling an empty service schedule – DSP 90
There are fewer things more stress inducing for a float center than seeing their schedule for the week and having it just be completely empty (Maybe watching your pump start up and spray water over your entire float room, but it’s a close call). What do you do in that situation? And how do you prevent it from happening in the future?
Well, Graham and Ashkahn have tried everything, from doing shout outs and deals on social media, to literally walking down the street trying to convince people to come in and float while the tanks were empty. Some tactics are more effective than others, but what it really comes down, at least in Float On’s case, is being prepared to give out a ton of free floats.
The guys talk about the effectiveness of each strategy they’ve tried and how they’ve reached out to contacts to form mutually beneficial business relationships and really get the ball rolling with filling up their tanks.
pH testing devices for float tank solution – DSP 89
There are lots of things you can measure when testing the quality of your water, for sanitation and comfort. Many of which aren’t specifically designed for float tanks. This is kind of an open secret in the industry, but most things simply aren’t accurate because of the incredibly high salinity of float tank solution. And pH seems to be one of them. This can cause float center owners major headaches as it’s often one of the first things that health departments/regulators will want to measure when they come and inspect your place (if they do at all).
Graham and Ashkahn try to break down this mystery of float water and try to break down some theories as to why it might be that float tank water might not have accurate pH readings, regardless of how you measure it.
Handling humidity to reduce water drops on tank ceilings – DSP 88
One of the biggest Float Mysteries in the industry is how to properly deal with condensation in a float tank. Your float tank is basically a giant humidity generating machine so clearly there’s going to be some condensation, but how much and why it forms can vary for seemingly no reason, making managing it difficult. The last thing any float center owner wants is for it to affect the floats they’re running (little water droplets falling on floaters is no fun).
Graham and Ashkahn commiserate with the industry about the difficulties in dealing with this particular hot topic, while also delving into the science of it and common solutions that should help any float center owner that’s facing this problem.
The purpose of a flow meters and the flow rate for a float tank – DSP 87
When navigating demands from health departments, it can be an absolute minefield of regulation, oftentimes with holdovers from the pool and spa industries. Many of these can be superfluous to float centers, but if you’re just starting a center, it’s difficult to know which ones to ignore, and which ones to incorporate.
Flow meters fall into this weird gray area where they’re not as important for float centers as for pools (and in some cases aren’t really needed at all), but can still be required by health departments or regulators. And to not throw the baby out with the salty bathwater, there are definitely some very practical uses for flow meters on float tanks.
Graham and Ashkahn tackle all these confusing elements and even provide specific product recommendations for flow meters for float tanks. Give it a listen!
When to contact health department – DSP 86
Contacting your health department/inspector/regulator/enforcer/supreme overlord can be stressful, to say the least. And given their general lack of understanding of floating as an industry, it makes sense why float centers may put this off. However, they have the authority to shut down your business if they feel that it’s a public safety issue, and that’s a situation no one should put themselves in.
Talking to your health department early and often can save yourself some headaches, but you don’t want to go to them unprepared. There’s a lot of nuance to regulation and existing codes that you should probably be familiar with beforehand. Fortunately, it may be something other float centers in your area have had to deal with, if there are any.
Ashkahn and Graham have a few tips for what to do to prepare and how to address common concerns they may have in this episode.
Thoughts on facilitating couples floats – DSP 85
First off, we’ll just say that Float On does not offer couples floats and never has. Graham and Ashkahn dive into their reasoning for that decision while simultaneously addressing some of the common concerns and benefits that go along with the practice. Some people say it helps get people into the tanks that wouldn’t try it otherwise. Some smaller centers rely on the added revenue per tank and increased exposure to the practice. It’s a complicated question and one that each center will likely have to consider on their own.
What are average floater return rates? – DSP 84
Getting repeat customers is integral to the health of any business. For float centers, this is especially true. It can be worrying when we see our floaters leave the center, never knowing if they’ll return. There’s a very natural inclination to start tracking this trend to see if there’s anything you need to change about your business to attract repeat customers. Memberships are a natural way to attract repeat customers and can quickly become the lifeblood of your center, too.
But how do you measure it? What time frame is acceptable to consider a repeat customer? If they don’t float within six months, does that mean you’ve lost them? If they float once and don’t return for three years, is that a success on your part or a failure?
Graham and Ashkahn tackle all of this and more this time around. Check it out!
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