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Humans have evolved over time to automatically react, at a neurological level, to environmental sensory stimulation. Increased sensitivity and orientation to the light touch of a disease-spreading mosquito or the low growl of a hungry predator supported early humans in reacting quickly to fight or flee from environmental dangers, thus increasing chances of survival. This primitive sensory processing ability is still present in humans today, however, some people experience challenges in processing sensory stimulation that is associated with maladaptive coping strategies, mental health diagnoses, and decreased quality of life. These sensory processing challenges often go undiagnosed and untreated, however occupational therapy provides a lens with which to treat individual sensory processing challenges and support recovery in mental health settings.
Sensory defensiveness is a disorder of sensory processing in which the central nervous system has difficulty modulating sensory input, and is characterized by hypersensitivity, over-orienting, and aversion to everyday environmental stimulation (Kinnealey & Fuiek, 1999). Sensory defensiveness may result in the development of coping strategies that are time-consuming, emotionally exhausting, and/or socially unacceptable (Abernathy, 2010). “Individuals with overresponsivity to sensation may withdraw from certain types of touch, cover their ears in response to everyday sounds, and/or avoid movement activities that are typically enjoyable or non-noxious to others. These individuals may also have limited diets due to sensitivity to the taste, smell or texture of certain foods. They may also get easily overwhelmed in certain environments, demonstrate strong emotional reactions to sensory stimuli, and engage in disruptive behaviors when demands become too great” (Reynolds & Lane, 2008, p.517).
There is evidence that sensory defensiveness is co-morbid with various diagnoses of mental illness and results in decreased quality of life. Kinnealey & Fuiek (1999) reviewed a study that reported significantly higher levels of anxiety and depression in a group of people who were also found to display sensory-defensiveness. Abernathy (2010) reported on a study in which all participants were diagnosed with depression and either post-traumatic stress disorder, dissociative disorder, or borderline personality disorder; had a history of serious self-harming behavior, and were found to experience sensory defensiveness. A study by Kinnealey, Koenig, & Smith (2011) found that sensory avoiding (a sensory processing pattern characterized by low thresholds for sensory stimulation combined with actively avoiding sensory input) was significantly correlated with decreased quality of life indicators, such as role emotional (participation), mental health, social functioning, general health, and increased bodily pain (Kinnealey, Koenig, & Smith, 2011).
Despite the negative effects on behavior and quality of life for individuals with sensory defensiveness, this sensory processing challenge is often undiagnosed and untreated in adults labeled with serious mental illness. Abernathy (2010) describes that sensory defensiveness is potentially misdiagnosed due to lack of knowledge surrounding its existence and the similarities between sensory defensiveness and various diagnoses of mental illness. “In her book, Heller (2003) described many case studies where individuals had been given a mental health diagnosis when the underlying problem was actually sensory defensiveness. The diagnoses that individuals were given varied and included anxiety disorder, borderline personality disorder, dissociative disorder and alcohol abuse (Abernathy, 2010, p.211). Regardless of the diagnosis, lack of treatment for sensory defensiveness can influence the effectiveness of other mental health treatment methods. “Sensory defensiveness is brainstem based and thus refers to reflexes and primitive, instinctive reactions that have their origin in bodily sensation, triggered by internal or external stimuli (Heller, 2003). For example, a person experiencing anxiety would not benefit fully from cognitive behavioral therapy if some of his or her anxiety is caused by sensory defensiveness, because his or her anxiety or panic does not have its origin with a negative thought but starts due to a primitive bodily reaction. If the sensory defensiveness is treated then the person will be able to address problems with anxiety that are cortex based and thus involve higher cognitive functioning” (Abernathy, 2010, p.211).
Treatment of sensory defensiveness can be provided by occupational therapists, which can support the treatment of individuals labeled with mental illness by other providers in mental health settings. “Hale and Coy (1997) describe a sensory-based treatment intervention for sexually abused adolescents who were responding poorly to counseling alone…They describe improved success in the treatment of these adolescents when there is a collaboration between counselors who focus on social and emotional issues and occupational therapists who address underlying sensory processing problems” (Moore & Henry, 2002, p.46-7). Pfeiffer and Kinnealey (2003) conducted a study with 15 adults who displayed co-morbid anxiety and sensory defensiveness to determine the efficacy of treatment by occupational therapists. The treatment protocol included increasing client insight into sensory defensiveness, development of an individualized and regulated routine of exposure to sensory input, and engagement in daily physical activities of the individual’s choice. Following four weeks of treatment, levels of sensory defensiveness and anxiety in these individuals were significantly decreased. Despite the small sample sizes of these studies, the significance of these results supports continued efforts to identify individuals who experience sensory defensiveness and provide interventions to support their everyday functioning and success in recovery from mental illness.
Due to the abnormal distress that results from exposure to everyday sensory stimulation, individuals with sensory defensiveness develop learned patterns of avoidance to or display strong emotional and behavioral reactions in certain environments and activities. This negatively impacts one’s social connections, community participation, the overall quality of life, and may act as a barrier to making progress in traditional mental health treatments. While the evidence is still emerging, results of treatment for sensory defensiveness by occupational therapists is positive and provides a rationale for mental health providers to engage in interprofessional collaboration with occupational therapists to effectively support the recovery of individuals labeled with mental illness.
Sharon Vincuilla, OTR/L
Occupational Therapy Doctoral Resident