Sensory Modulation Challenges: One Missing Piece in the Diagnosis and Treatment of Veterans with PTSD

Figures & data

Table 1. Summary of the 7-Page Handout on Sensory Diet Treatment for Sensory Modulation Challenges Discussed with Each Veteran Research Participant.

Topic	Content
What type of sensations alert us to danger post deployment putting us in fight/flight mode?	Many more than before deployment because the first priority of your nervous system is to keep you alive. Since your brain worked overtime for you in combat, it is now having trouble differentiating which sensations to react to as dangerous, so it stays in hyperarousal mode interpreting too many things as dangerous. You might react to “little things” that never bothered you before: light touch, slight sounds, environmental sounds, visual distractions, smells, combined small distractions.
What can you do to reduce hyperarousal (hypervigilance)?	Occupational Therapists (OTs) have contributed to the understanding of how to keep our nervous system out of fight/flight mode and in that “just right place” needed for good daily functioning. One of the key concepts is called “sensory diet” (Wilbarger, 1991, 1995). It is the amount and type of sensory input a person needs to keep their nervous system “modulated” or in the midrange. In stress related reactions, our nervous system spends more time in fight/flight survival mode. OTs have found that providing opportunities for certain types of modulating activities helps the nervous system stay more even, not hyper-aroused and not depressed.
The sensory qualities of modulating activities	What types of activities help you stay in this calm alert centered space? Rhythmic movement of head through space for a sort time, for example running, jumping on a rebounder, jumping jacks, bouncing on a yoga ball, can modulate you for several hours. Heavy work with joints and muscles: any type of resistance activity with joints and muscles can last up to two hours. Firm pressure on the skin (message, weighted blanket). Certain auditory input: classical music, drumming, or light popular music. Be careful as some popular music can be stimulating because of the mastering it goes through to be electronically available. A full range of sound is necessary for modulation. Deep breathing “Mouth” activities: resistive chewing (gum, jerky) and some tastes (sour, spicy, sharp). Portable activities: exercise bands are used for many types of exercise and fit anywhere. Try a chair push up or pull up anywhere (sit in chair and pull yourself into the seat or push ourself off the seat with both hands).
The difference between sensory diet activities and “regular” activities	You need change from your “usual” activities involving one or more of the following: Increased intensity: for example, heavier weights, biking or running faster. Increased frequency: you don’t need long workouts. Several 5-minute sessions spaced through the day works well. It takes at least 5 minutes of the same activity for the brain to register change. Increased duration: if you want to work longer, try a body moving game with others like basketball, tennis, pickleball, Zumba. Rhythm changes are about whether you prefer sameness or novelty in your activities.
It’s individual	Using activities you like to do and modifying them will work well because you might actually do them. Ask a friend to be our “sensory diet” buddy and share activity ideas with each other.
It’s all in the Timing	When do you most need modulating activities? Analyze your days and add modulating activities before stressful events.
Examples	Several pages of examples of sensory diet activities appropriate for veterans and active-duty military listed by type and strength of the activity.

Table 2. Group Characteristics.

Group 1 (with PTSD diagnosis)	Group 2 (without PTSD diagnosis)
Number: 35	7
Females: 7	1
Males: 28	6
Age range: 27–73	32–75
Independent samples t-tests for equality of means between males and females (equal variances not assumed).
Variable	Significance (2-tailed)
Age	.499
Sensory Sensitivity	.460
Low Registration	.366
Sensation Avoiding	.751
Sensation Seeking	.222
Sensory Over Responsivity	.206
Sensory Under Responsivity	.865
Sensation Seeking	.810

Table 3. Reliability and Validity of Assessments Used.

Adolescent/Adult sensory profile (Brown & Dunn, 2002)
AASP reliability	Low registration	Sensory sensitivity	Sensation seeking	Sensation avoiding
Internal consistency	.692	.639	.657	.699
SEM (adults)	3.58	4.10	4.47	4.03
Basic Personality Inventory (Jackson, 1986)
Internal consistency	Test-retest reliability
Adults 19+	Adults 19+
10 groups	2 samples, n = 391
.6–.90	.63–.87

Clinical validity: The clinical validity of the Basic Personality Inventory correlated with the New York State Adult Temperament Questionnaire and nine other temperament scales. Validity: numerous studies.

Allen Cognitive Level Screen (Allen et al., 2007). The Allen is a test of functional cognition, a person’s capacity to learn. The manual as of 2007 reports numerous studies showing evidence of reliability and validity, but no psychometric data.

Table 4. Independent Samples t-Tests: Veterans with and without a Medical PTSD Diagnosis.

Factor/test	t-Value	Significance (2-tailed)
Age	−.174	.862
AASP Sensory Sensitivity	5.077	.000**
AASP Low Registration	3.219	.003**
AASP Sensation Avoiding	3.973	.000**
AASP Sensation Seeking	−1.259	.215
Sensory Over Responsivity (SensOR)	3.195	.003**
Sensory Under Responsivity (SensUR)	1.477	.148
Sensation Seeking (SensS)	1.919	.062
Allen Cognitive Level Screen	.043	.966

**p ≤ .01.

Table 5. Comparison of AASP* Standardization Means with AASP Means of Veterans with and without PTSD Diagnosis (Brown & Dunn, 2002).

Test	Study means	Standardization means (18–64)	Difference	Standardization standard deviations	Difference shown in standard deviations
AASP with PTSD diagnosis
Sensory Sensitivity	48.09	33.71	+14.38	7.63	+1.88
Low Registration	39.29	30.29	+9.00	6.25	+1.38
Sensation Avoiding	51.40	34.57	+16.83	5.34	+2.29
Sensation Seeking	42.66	49.91	−7.5	6.83	–1.10
AASP without PTSD diagnosis
Sensory Sensitivity	31.00	33.71	−2.71	7.63	−0.36
Low Registration	26.66	30.29	−3.63	6.25	−0.58
Sensation Avoiding	35.86	34.57	+1.29	7.34	+0.17
Sensation Seeking	47.14	49.91	−2.77	6.83	−0.41

Table 6. Veterans with PTSD: Correlations Among BPI and AASP Factors.

BPI/AASP	Sensory sensitivity	Low registration	Sensation avoiding	Sensation seeking
Hypochondriasis (B)	.659**		.519**	−.442
Depression (B)	.516**		.584**	−.418*
Denial (F)
Interpersonal problems (A)	.467**		.403*
Alienation (A)			.340*	−.408*
Persecutory ideas (C)	.424*	.370	.427*
Anxiety (B)	.648**	.389*	.561**	−.379
Thinking disorder (C)	.411**	.430*	.398*
Impulse expression (A)	.519**	.536**	.447**
Social introversion(D)	.603**	.350*	.663**	−.371*
Self-depreciation (D)	.376*		.382*	−.384*
Deviation (E)	.583**	.442**	.515**	−.364*

**p ≤ .01, *p ≤ .05. The Basic Personality Inventory (BPI) (Jackson, 1986) shows indications of possible areas of concern (p. 7).

Code: See codes on chart for further information on what is being measured. A: Inadequate or deviant socialization and impulse control. B: Mood and personal/emotional adjustment. C: Cognitive functioning. D: Self-depreciation and sociability. E: Critical deviant behavior. F: Test taking style. (Parts of this chart were published previously in Kimball, 2021, p. 234.)

Brown, C. E., & Dunn, W. (2002). Adolescent/adult sensory profile user’s manual. https://www.pearsonassessments.com.

 Google Scholar

Jackson, D. N. (1986). Basic Personality Inventory. SIGMA Assessment Systems, Inc. http://www.sigmaassessmentsystems.com/assessments/bpi.asp

 Google Scholar

Allen, C. K., Austin, S. L., David, S. K., Eathart, C. A., McCraith, D. B., & Riska-Williams, L. (2007). The Allen Cognitive Level Screen-5 (ACLS-5) and Large Allen Cognitive Level Screen-5 (LACLS-5) manual. ACLS and LACLS Committee.

 Google Scholar

Kimball, J. G. (2021). DIAL IT DOWN: A wellness approach for addressing post-traumatic stress in veterans, first responders, healthcare workers, and others in this uncertain world. Book Baby.

 Google Scholar