Something in the world of floating have you stumped?
Recently, Justin Feinstein and his team at LIBR have published their first landmark study on the effects of floatation-REST on patients with extreme anxiety. After years of hearing about Justin’s research, it’s exciting for the whole industry to finally get to see some tangible results.
But what can we say about these effects? What can’t we say? Graham and Ashkahn bring in Justin Feinstein himself to answer these deceptively unsimple questions and talk in depth about this research and what it means for the industry
Justin Feinstein at the Laureate Institute of Brain Research (Link to his newsletter available on this page)
Justin Feinstein’s 2016 talk at the Float Conference (The 2017 talk will be available soon!)
FTS Product – Scientific Research List (Free)
Listen to Just the Audio
Transcription of this episode… (in case you prefer reading)
Graham: And today’s question is, “What am I allowed to brag to my customers about with the recent Feinstein anxiety research? And, and, is there anything that I absolutely should not say?”
Ashkahn: You know, I’m not sure we’re necessarily the most qualified people to answer this question.
Graham: Well who do you think, who do you think would be?
Ashkahn: You know what would be great is if Justin Feinstein himself could actually answer the questions, you know.
Graham: If only we planned ahead to have him on the show or something like that.
Ashkahn: That would be crazy.
Graham: So we did, and Justin is right here to help us answer that question for you.
Ashkahn: Hey, Justin.
Justin: That’s right. Thank you guys for having me on.
Graham: Yeah, yeah it’s our pleasure. Thanks for joining us.
So, I guess just to kind of think about the first part of that, what is some of the most impressive stuff that we can actually brag to our customers about who are coming into our float centers about some of the cool new research that you’ve been releasing?
Justin: Well, I think as as a researcher it’s always nice if someone actually reads the paper, because we we try actually put it all out there and the paper was published in the journal that is freely accessible to everybody. So, it’s there for you to read and to learn and to gain knowledge from. I tried to be as inclusive as possible and make it sort of, paint a real picture of what was happening with these patients with relatively severe anxiety as they were experiencing their first float session.
And so, I think for me the most exciting part is it actually works. When we went into this study, there wasn’t a lot of published research out there about floating with actual anxiety disordered patients. There really hasn’t been much at all. We kind of studied the whole range of patients we looked at people who had post-traumatic stress disorder, people who had panic disorder, people who had had social anxiety disorder, agoraphobia, generalized anxiety disorder. We kind of spanned the whole spectrum.
It didn’t matter what your particular type of anxiety disorder was. It didn’t matter what the specific triggers were that were causing your anxiety, floating seemed to diminish the feeling of anxiety, no matter what. I think that’s a very big take home finding for me is that if you go into the float experience suffering from some degree of anxiety, you’re going to, after the course of an hour, feel better.
All of the study was about the short term effects from a single float session. That’s important to recognize. This was an open label study and it was just trying to understand the predisposed float changes in this target population of people suffering from anxiety. So, I think to me the most exciting finding is we were seeing real significant changes from predispose float on these indicators of anxiety, and it seemed to help no matter what type of anxiety you were suffering from. So, I would say that was probably one of the biggest takeaways for me.
Ashkahn: So, I know there’s kind of some specificity when it comes to the words that you use when you talk about this research. Is it safe to say that float tanks are a treatment for severe anxiety? I know “cure” is kind of a very loaded word in the research community. In terms of the vocabulary that people would be using to say, float tanks do this with people with anxiety, what do you think is kind of the right way of presenting it?
Justin: Well, it’s premature at this early stage to call it a treatment. I think this goes into the notion of short term versus long term effects, right? In a treatment study, ideally you would want to be following patients over multiple float sessions, and then after they complete those sessions, longitudinally following them up a half year or even a year later, and trying to figure out whether or not the short term effects transcend the float environment and actually carry forward into the day to day life. Then you could have much more grounding to start talking about it as a real treatment.
In addition, when you do those longer term studies, you want to have proper control conditions to try to show that this isn’t just placebo effects, as they would say in Western medicine, but this is actually attributable to the float intervention itself. We don’t have that data yet. We’re working towards that. But those studies take many years to complete, hundreds of patients to actually go through it, and it’s not something that is going to be done any time in the near future. We’re hoping over the next three, four, five years we’re going to have some of those data to present, but right now we’re really just focusing on the short term effects.
So, basically, when I talk about short term effects, I’m talking about getting somebody well in the moment. If somebody is going into the float with a high amount of stress and anxiety, and in our case the sample also had comorbid depression, one hour of floating seemed to relieve a lot of these symptoms and actually more than just relieving the symptoms of mental illness, it actually generated a tremendous amount of wellness.
A lot of the patients reported, and I actually in the paper transcribed their debriefing interviews so you could read it firsthand, this lifting of anxiety that left them in a very peaceful and serene state afterwards in a way that they haven’t felt in many, many years, and in some cases their entire life, they said, they hadn’t felt so good. So, that was very promising because when you work with patients, oftentimes it’s the patient who knows best, right? You view them as the expert of their own condition, and a lot of these patients had tried a lot of different therapies, a lot of different medications and to no available, it hasn’t helped produce their symptoms. But for whatever reason, they found this float intervention to be tremendously helpful.
So, these short term effects are effects that we don’t know how long they last. They might last a few hours, they might last a few days, they might last even longer. We need to track that. But at least we know that this is actually making them get better, not worse. When it comes to doing clinical trial research, that’s actually really important from just a pure safety standpoint. You want to make sure that you’re doing no harm, and I think this first set of data clearly suggests that’s the case.
Graham: So would do you say, again, kind of on that center owner side if they’re talking to someone, they can say at the very least that the recent research coming out seems to show that floating can really help with anxiety, especially when people are suffering from it in the moment. Is that kind of a claim that people can make, or how would you phrase that same kind of sentiment I guess?
Justin: I think what you always have to do is until you get more and more replication, you always have to come back to the sample, and in this case we had a sample of 50 patients. Which is a decent size sample, but ultimately you would want to replicate this in even larger samples. As you start replicating it in larger samples, you could start saying, “I think this could actually generalize to the population as a whole.” But whenever you have a just a single study and, especially in this case with a single float, you want to tread cautiously. You want to wait for those replication studies to start saying anything is going to generalize to you.
But I think what you can say is if you have somebody coming and saying, “I do have a lot of anxiety. Is this something that might help me?” Point them to the study. Say, “There is some research that suggests it might help. Go and read the study and see for yourself, and if this is something that you want to try to do, we’re here to work with you.”
One thing I should mention, and I put this in the paper and I think it’s an important caveat, is all of the research that we did was in an open pool and people who have anxiety oftentimes have claustrophobia.
So, we don’t know if these findings and these really powerful effects that we were seeing are going to replicate if these patients first float was an enclosed float, but we just don’t know yet. We need to do that study. It’s a study I’m very interested in doing, and I think it’s important for the whole float industry to see that these findings are replicating in more traditional recreational float tanks. But a major caveat is all of this was done in an open pool.
The other major caveat is that all of this research was done in a medical setting with medical professionals waiting for anything that could go wrong, and that imbues a certain amount of safety to the patient, right? They feel like they’re in an environment that is ready and willing to handle anything that may arise. If they’re going out into a recreational center where you don’t have mental health professionals there to deal with things as they arise, we don’t know if that’s going to give them that same sense of safety going into the experience. All of that could be part of the effects we’re seeing. That’s part of the problem with any sort of open label study. You don’t know exactly what’s generating the effects. You know that you had an intervention, you know that they all participated in, but there’s so many variables that could be contributing to why they’re feeling better.
Graham: Yeah, yeah, that makes a lot of sense.
Graham: One thing that I’ve been kind of saying to people, and I guess this comes a little bit more from having a background in experimental psychology and having conducted my own research studies in the past, obviously on a much smaller scale. But in my studies and in my own research you just don’t see sample sizes where every single person shows a positive impact. That, to me, both when you were on stage and looking through the research paper, continues to be one of the most impressive things is that it is a relatively small sample size of 50 people that you ran through, but you know none of them showed a negative impact. It was all just kind of positive results that you were getting along this spectrum for all of them.
So, one of the things that I’ve been bragging about with your study is pretty much that. Again, that even though it was a small sample size, that it seemed pretty, within that sample size, universally beneficial. So, I’m not sure if you kind of put the same weight on that or if that’s something that you were really impressed by, but that is something I wanted to ask you about beforehand.
Justin: Yeah, no, I was impressed by that. I don’t think there’s very many interventions out there, whether it be you know antianxiety medications or psychotherapies that you’re going to get sort of across the board unanimous improvement. You oftentimes do see instances of people getting worse or instances of people who say, “I don’t feel anything whatsoever, it hasn’t helped, or made things worse. It’s just not really effective.” And that oftentimes could be not just a small group of people. Sometimes in certain types of treatments, over half of the people are getting better.
Justin: And believe it or not, that’s actually the state of affairs right now in psychiatry. A lot of our gold standard treatments for anxiety are only helping about half of the patients. So yes, absolutely, when I saw that it was really eye opening to me and it shows a level of reliability, right? That whatever is happening, is happening somewhat reflexively. These are people who have never tried floating in their lives. These are mostly individuals from the state of Oklahoma who had been suffering from anxiety for many years or even decades, and these are not the sort of people you would expect to go out to your average floats or float. And yet we were seeing these very positive effects, so I think that that was a really impressive part of the data from my perspective.
And you don’t want to ever say that this is going to generalize to everybody, but at least in this cohort of 50 people who agreed to do the float session at our clinic, they all seemed to get some degree of benefit. And that was exciting for me, absolutely.
Graham: Yeah, I was just going to say, I was sitting in the audience and I feel, I mean, it’s like I’m a bad audience member when I’m watching a movie or something. I tend to get really excited and grab the arm of the person next to me or something, but I did the exact same thing when I was in the audience of watching your talk. I don’t even know who was sitting next to me, but I was like poking him in the shoulder and like, “This is amazing. All of them are showing positive results. This is amazing.” It’s, like, “I know I know. I get it,” you know I didn’t get angry because I was one of the organizers of the conference. But I think otherwise you would have told me to shut up for something.
But yeah, I was just so excited in the audience seeing that so, yeah like you said, it’s so rare. I mean, I don’t think I’ve ever read a study where it was unambiguously positive results for anyone personally, so that one kind of blew my mind.
Justin: And I think it’s testament to the float environment. It’s such a well calibrated environment, and when you put a chronically anxious, hypervigilant, hypersensitive nervous system into that environment, it’s almost impossible for it not to finally relax, right? One of the interesting findings we found is the more severe the anxiety, the more severe the stress going into the experience, the greater the effect.
So, I think that is also giving us some hints that this is an intervention that could really help the people who need it the most. Maybe that’s often what the nervous system is craving in those cases when it is so stimulated and when it feels like it’s never able to shut off, it just needs that respite. When it’s able to do that and the float environment, there is this sort of reset or release that we were seeing with these patients where they came out of the float feeling like they were different people, and when you read the debriefing interviews, I think it becomes pretty clear that these patients weren’t just calling this a nice form of relaxation. This was bordering on the profound for some of these patients, and I think it’s testament to the power of the intervention.
Ashkahn: And how does that compare to something like actual anti-anxiety medication? When you when you look at the impact that the float is having on this group of people, I guess just some perspective on how that compares to other treatments or are the other treatments that are commonly used?
Justin: Well, we actually had all the patients rate the level of relaxation they achieved compared to all the other potential treatments and strategies they had tried over the course of their life to help them relax and feel less anxious. One of the fascinating outcomes of that was 75% of the sample thought floating was actually more relaxing than anything else they had tried in their entire life. These are people who had tried antianxiety drugs, who had tried psychotherapy, who had tried meditation, who had tried various other drugs to help them relax, and they thought this was actually better.
So, I think when when when you’re a clinician, you really want to listen hard to the patients because they are the experts, and they were telling us that we’re on to something. They didn’t tell us that this was the end all be all, they didn’t say that they were cured. I think that word “cure” is a very touchy word, and I would advise all float centers to never use it because we don’t have data to suggest this is a cure yet. But we do know that it helped them in the short term, and helping in the short term is sometimes very important when you’re suffering.
I could tell you, these patients really needed a respite because they were in acute state of anxiety and they needed to sort of break out of it and break free, and this seemed to help with that. So, despite the fact that we don’t have any evidence here whatsoever that this is curing them, we do have some very clear data that this is helping them, and doing it in a way that they felt was very advantageous for their mood and very advantageous for their well-being.
Graham: And just to clarify a little bit, too, for some of the listeners out there, so what’s kind of the more scientific definition of the word cure? Does that mean essentially that you’ve treated them for their condition to the point where it’s actually fully gone? Is that kind of what you’re implying if you say the word cure?
Justin: Yeah. In science and clinical trial research, you’ll rarely ever hear the word “cure,” and especially in the field of psychiatry where you have disorders that people have for years or decades, right? It’s very hard to say that you’ve gotten rid of all of their symptoms. In cancer, I think you have a much stronger argument to say you’ve cured the disease, right? Because cancer, you have a very objective reading where you could say here’s a cell that cancerous, and we’ve now eradicated every single one of those cancerous cells. So, no you’ve been cured, right?
You can’t really say the same thing for anxiety or depression, and a lot of the different mental health conditions. So, typically what you try to do is you try to make people’s life better and you try to make them function again, be able to have a job, be able to have relationships, be able to feel well. That feeling of wellness I think is what we were able to show with this first study. Now we have to go after the real life implications. If someone were to say, take up a practice of floating and do it regularly, would they now be able to go out and work again? Would they be able to form meaningful relationships? These were the things that were lacking in a lot of the patients in our sample.
So, what I’m really excited about is now trying to bring them back and continue to float them repeatedly and see if we could have some more real life implications. As you start seeing those things, it’s not going to necessarily mean that you’ve cured them, but they’re functioning again. They’re living life in a meaningful way again and that’s important. I think that’s the next stage of this research.
Graham: Yeah, and it’ll be really exciting to see where it goes. It’s actually just, even what you’ve published already is, I think from running a float center we see this every day on an anecdotal scale.
Graham: We just constantly see people coming into floating and coming out and telling us things like, they feel so relaxed and man, they feel like better than they have in years and all this sort of stuff. Then you know you always have to be a little hesitant in what you’re saying to other people, but actually seeing research coming out that is kind of backing up these personalized experiences that I think everyone who’s run a float tank center has noticed is definitely exciting. So, it’s very cool to see where it goes in the future, and as we go forward, being able to kind of beef up the claims we can make more and more, I think, is going to be super super exciting for everyone in the industry.
Justin: Yeah absolutely. For me, I think it floats centers should read the study and have clients who come in who do complain about you know stress or post-traumatic stress or anxiety issues or even depression issues, you could point to the study as evidence that this might be helpful. It’s important you know to make sure the patient recognizes that there’s still a lot more research that needs to be done. It’s in the early stages.
The other thing I would add to that is it’s important to make sure the patient recognizes that they have complete control over the experience. I think that’s maybe the most important take home message for float center owners, is you don’t want to force the patient to do anything they’re not ready for. If that means leaving the doors wide open on the enclosed tanks, and the light on the entire time, I would encourage them to do that. In fact we actually broke down the sample into the people who floated with the lights off versus the people that floated with the lights on, and it turns out the reduction in anxiety happened irrespective of having the lights on versus off. So, you could get a great amount of benefit even if you’re not in the full immersive experience.
So, whenever you have a patient showing up at your center I think the most important thing you could do is make sure they recognize they have complete control over the whole experience and to encourage them to take things at their own pace. Never rush them into the fully immersive float. Let them do that at their own pace.
Graham: Yeah, that makes a lot of sense. I guess just getting back to that idea of words like cure that you shouldn’t use or should at least be extremely cautious of especially at these early stages, are there any other kind of big words or even just ways that people describe your research or that you’ve heard so far that kind of irk you, or that you’re just like, “Man, I really wish they wouldn’t describe it like that yet?”
Justin: You know, it’s funny, the day the study comes out, our local newspaper decides to publish an article about it. They were very excited, and on the front page of the article, they started talking about how we demonstrated that this has long term effects for people with anxiety. I couldn’t believe that they said that after all the coaching I had given to the reporter about the fact that these were short term effects, not long term effects. But I think that’s important. You have to make people understand that all we have here in terms of data is that this is helping them in the short term over the course of a few hours, both during and after a float.
But we don’t know what the long term implications are, and we don’t want to give patients false expectations. The effects may wear off after a few hours. They may wear off after a few days. It may even wear off after a few weeks. We have to measure that, and some of our studies that we’re currently doing are looking at those questions. But at least until we have some data on that subject matter and could definitively say that these are how long the effects last, it’s important to emphasize these are just short term effects. I don’t want to discount that. Short term effects are very powerful. But please, please, please don’t start telling your clients and people with anxiety that this is going to have a long term impact. We don’t know yet.
Graham: Yeah. That also makes makes a lot of sense. That’s really funny that happened like the day afterwards.
Justin: You never know with the media, that’s for sure.
Ashkahn: Great. Well, is there an easy way to tell people where to find the study for them to read it?
Justin: Yeah. I think it’s there’s a web link through the PLOS website, and I believe you guys have it.
Justin: Feel free to post that, and it’s freely available on PLOS ONE, Public Library of Science One, which is a journal that was published in. It’s there for for the whole world to read it, and please, I encourage you to, because it is a lengthy paper, but the idea was to really just put the data out there so you guys could see it exactly how we saw it. I was quite taken by this first set of findings, and now it’s time to replicate it and dig deeper.
Graham: Perfect. Yeah, we’ll put a link to that up in the show notes, too, if you’re if you’re listening to this on your phone or something, feel free to head over to floattanksolutions.com/podcast and yeah, you can get a link directly to the people there.
Ashkahn: And Justin, you also have a newsletter, email newsletter sign up, on your site right where you kind of announce new research as it comes out?
Justin: That’s right. Yeah. If you go to the Laureate Institute’s website, I have my own web page. It’s still a work in progress, and I’ll need a lot of help when it comes to things like social media obviously, but we have an old school email Listserv that you could sign up for, and I promise there will be no spam.
We sent out our first E-mail a couple of weeks ago with the actual study, and so when new papers come out, we’ll go ahead and forge you a copy of them so you have those for your own reading.
Graham: Perfect, yeah, that’s great. Yeah, and I’ll put up a link to join your newsletter up on the site as well.
Great. Well, any last words for listeners before we let you go here, Justin?
Justin: Well, stay tuned. We have a lot more research coming out in the near future, and look forward to seeing everyone again at this year’s float conference.
Ashkahn: Excellent. Great. Thanks so much, Justin, and yeah, nice having you on board for the podcast episode.
Graham: Really nice having you, yeah. Thanks for joining us.
Justin: Take care, you guys.
Graham: All right.
And if any of you have your own questions for us, or I guess, anyone else in the world of floating, you know, we’re eager to pull them on. You can go to floattanksolutions.com/podcast and send your questions in to us there.
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