 Like many of you, I'm sure, I wear a lot of hats, not literally, but figuratively. I'm a psychologist, but I also manage a good-sized psychology department at Nebraska Medicine, which is a large teaching hospital in Omaha. I'm a consultant on human factors for the United States Air Force. I provide tele-mental health services to people in Alabama, Nebraska, and Virginia. But I'm also in school, going back to school, because academics never quit. And I'm pursuing a postdoctoral MS in clinical psychopharmacology. So I'm very busy. But much more important than all that, I'm a husband, I'm a father, I'm a so-so racquetball player, and I'm a big advocate for and proponent for flotation therapy. So my presentation today is to tell you guys the story of how I came to become an advocate for flotation. So this story starts about three years ago when my wife and I, still in the Air Force, got orders to Grand Forks Air Force Base in North Dakota. I'm from the South, I'm from Texas. I do not do cold weather very well at all. So this was kind of upsetting, but we geared ourselves up and we prepared for this move, and then about a month before we were supposed to go, the Air Force pumped the brakes on it. And they said, no, we actually, we found a better use for your talents. We want to send you to this large military intelligence organization, because they have the highest level of stress ever recorded in the history of the Air Force. You see, a year prior to this, in 2015, a number of psychologists had actually gone into one of these units and asked them questions about their stress level, their sleep, their anxiety and PTSD symptoms, their relationships, their alcohol use, all these different metrics. And it was far and above what was not just the norm for the Air Force, but for some of the other high stress career fields in the Air Force. And the commander at the time, the person in charge of all these people said, we need a psychologist to come in and fix it. Literally my first meeting with him, this is what he said, he laid all this out for me and said, I don't care what you do, how you do it, what money you need, what resources, just come to me, let me know. All I want is for this to go away, fix it. So this is that story. And I tell this story to you so that you can may pass it on and it can become a part of our collective story of what flotation therapy can do for people. Now before I go any further, I'm not trying to sell you anything. I don't have a book to hoc or a program or anything like that. I'm doing this purely out of my other goodness of my heart. I'm not standing up here trying to represent the United States Air Force, the DOD, the Secretary of the Air Force, Secretary of Defense or Donald Trump. So these are my own statements. Please don't take them as an endorsement from anybody higher than me, okay? And I am a psychologist. I love to be called Dr. Walker, but I do recognize I'm not that kind of doctor. So who are we talking about here? The highest stressed people in the United States Air Force. Well, these are intelligence personnel, people who conduct real time intel on the ground and in aircraft with special operations personnel. Now what's interesting is everybody else in that aircraft is specially trained to perform special operations missions. That's why they're super special, except our guys. Our guys don't get that kind of vetting. And so they come into the intelligence career field thinking they might be one of the eggheads who gets to sit behind a screen and watch things that are happening thousands and thousands of miles away and they're safe, but not these guys. They're in the aircraft with the special operations crew and they're getting shot at. They're protecting people who are getting shot at. They're trying to keep everybody safe, including themselves and the other people in that aircraft. High, high stress position. And because they're good at their job, the demand keeps increasing. So now they are in almost every single special operations aircraft that we have in the Middle East and all over the world. Which means because there's only so many of them, they're frequently deploying. At one point, less than a one to one deployed well time, which means they go out for three months. They come back, maybe only be back around at home side with their families for about two months or so, and then they go back out again. You can imagine how stressful and difficult that is to maintain a good social life, family life, to have stability in your sleep cycles. And so as a result, a lot of these folks developed some pre-maladaptive coping strategies, as one might expect. So when the psychologists came in and they asked all these questions, they put together a sort of causal model of what was going on. You see from the top, there's a lot of different factors playing into the overall stress level. And these are a bunch of fancy words on here. There's things like cynicism and role overload, emotional exhaustion, occupational burnout, which we kind of get. And which can be a part of a bunch of different jobs. But the reason I put them up here is cuz they were, I mean, high again, high in a way much greater in terms of frequency and severity for this population. So myself and my teammates, we looked at this and we said, okay, out of all these different factors, all the things contributing to these negative outcomes, what in the world can we actually control? What can we affect to change the outcome? And it was this increased physiological response to stress. If you guys aren't familiar, we've got this cool little thing in our bodies called the autonomic nervous system, the ANS. It's divided into two separate components, the sympathetic nervous system, which you may have heard referred to as our fight or flight response. And the parasympathetic nervous system, which is the off switch to the fire flight response. And the reason I show this slide is because it gives you an idea of which nerves are innervating which organs, where they are along the vertebral column, and you can see that's not exactly one to one. It's not a direct on switch and a direct off switch. It's this on switch is going to stimulate a lot of different actions, going to raise your heart rate, blood pressure. It's going to oxygenate your muscles, prepare you for action, make you start to sweat, tremble, dilate your pupils, get you ready to fight off or run away from whatever threat you have available. Or that's in the proximal vicinity. But the parasympathetic nervous system doesn't quit all that. It helps to relax us, but it doesn't do everything. I'll show you why this is important. Our bodies are designed to try and maintain homeostasis. So we want to get to an optimal level of physiological arousal in any given situation. And this varies depending on context. So sometimes, like when you're sitting here and you're listening to a speaker, you don't need a bunch of energy. You can be relaxed. That may be a calm kind of steady state. And that's where we are most of the day. But if you're in a high performance type situation, like say, you know, you're getting ready to play a football game or you're giving up to give a presentation to a bunch of people in the audience, maybe you want to be in more of a ready active operational state. A little bit of heightened physiological arousal, but not something that's going to dramatically impair your performance. It's the right-hand side of that Yerkes-Dotson curve I showed in the lower left-hand corner of the slide. Where it gets to be a problem is when this gets chronic. When you're up and you're elevated at this level for an extended period of time, now not only does it wear on you mentally and emotionally, but your body, your organ systems start to become less effective at what they're doing. They start to break down and they start to deteriorate. And now you're having physical ailments in addition to mental and emotional ailments. So recognizing all that, my team and I sold on flotation therapy, essentially restricted environmental stimulus therapy treatment for our folks. And you kind of have to get creative when you sell something like this to your higher-ups, people who are not as psychologically minded. So this is how I framed it. I know most of y'all are ignoring me and reading that right now, but basically if you sound smart, you can sell anything to anybody. If I went up to them and to the Wing Commander and I said, you guys are stressed out, I wanna throw them in this float pod and deprive them of all sensory input and it won't be a torture device. They'll totally love it. That would not have gone over well. So this is how we went about convincing the higher-ups to throw some money at float tanks and to give us a shot. And part of that was, prove to me that this works. Well, get some data that actually shows that we didn't just give you X amount of dollars and you threw it away on something fancy but not ultimately effective. Well, fortunately, I had a lot of research to back this up. In fact, these are some great research studies that were done actually a while ago. We've known about the benefits of float tanks for a long time to demonstrate how impactful this is, not just physically, but mentally and emotionally as well. And we're talking about reductions in adrenal corticotropin releasing hormone, which is the big hormone that's released from our brain to trigger the stress response. Reductions in that. Reductions in cortisol, which is corollary. Lowered heart rate and blood pressure, as we would expect. And as little as three to seven sessions, that's outrageous. If a lot of people take medications for this, but they take them long-term and sometimes they don't have that kind of effect until they've been taken for several weeks at a time. But if you're telling me in three to seven one-hour sessions, you can get the same kind of impact, I mean, that's a no-brainer, especially cost-wise. And so, when you're looking at the myriad of different things that our guys were experiencing, I remember I said stress, sleep problems, chronic pain, there's a hierarchical order to that. Because of stress, they're experiencing this. Because of this, they're experiencing that. Second and third order effects, and look like float tanks can help with all of those different things because it specifically targets those first order items. Stress, anxiety, burnout-related depression. These are things that we needed help with. And we knew that we couldn't do it alone. Imagine trying to have one-on-one coaching therapy, mentorship sessions with 300 different people. You can't effectively do that. You've gotta give them something else. And this is something they could do in their own time. So, for this study, we got a contract with the local LLC that provided flotation therapy. And we told our guys about it. In fact, we told them other studies, other folks, high-stress folks, where this has worked and tried to get them to buy into it. Now, because we needed a high sample, we needed a lot of folks to actually do this, we opened it up to their spouses as two who were also pretty stressed out from dealing with their spouses and everything they went through. But they didn't comprise a strong component of the sample, so I think it's still representative of these high-stress folks overall. All right? Now, I'm a big stats guy. I include some of the stats on these ladder slides. If you're interested, you can come talk to me about it afterwards, but if not, you can just take my word for it, okay? We had 91 folks do a self-selected protocol of flot therapy. I'll show you the breakdown number of sessions, but basically, we didn't say you've gotta do this, you've gotta do it on this time. We just said, hey, try this out. If you like it, keep going. And we didn't exclude anybody either in a traditional randomized controlled clinical trial. Usually, you have a weightless control group that you can use for comparison. Decide not to do that because I didn't wanna prohibit anybody from getting this kind of treatment. These guys need help right away, so I figured that was much more important than having a well-designed traditional clinical research trial. And we can still make pre-post outcome derivations because of this. This is all the demographic data that I am able to present because this is a military intelligence unit, but trust me when I say this was very representative of their entire unit, so we get generalizability here. For those of you who are interested, we did ask for mostly self-report in deceased to have people rank their sleep quantity, or sorry, to respond to their sleep quantity, rank their sleep quality, pain, stress, but before and after the sessions. But then we also had a standardized clinical outcome measure called the OQ45. Now that has five, or sorry, four different scales that align with some of the indices that we wanted to look at for outcome measures, but I also did a few nifty statistical analyses of my own to see which of these items tended to correlate together. You have somebody answered this item one way, what other items they also answer in a similar manner, and that allowed us to derive a few additional scales specific to depression, anxiety, and burnout, which were also of clinical interest for the study. And interestingly, all the items in those scales map on almost one to one with DSM-5 symptoms for each of those respective diagnostic codes. So I feel like those are really good indications for people who are feeling depressed, anxious, clinically burnout, and so on and so forth. Now out of those 91 folks who actually had, or attended one flotation session, only a handful of them went on further and further until we got to about sessions seven, eight, and nine, which is where I conducted a number of, or most of the analyses that you're gonna see, not just because I wanted to make sure that it was the effect of the flotetakes, but because these people who actually continued with floating tended to be a lot higher acuity, meaning their baseline scores in the OQ45, their level of sleep, the pain and stress they're reporting were much higher than people who maybe only did two or three sessions, which makes sense. About half of the folks involved in the study quit after the third session because they probably got what they needed, and they were good to go, or perceived themselves as good to go. And as the people who had a lot more impairment, who were struggling more, those are the ones who were benefiting, but decided to keep coming to try and get even more benefit. All right, so here's the big takeaway. What did we find? Well, because I'm here, obviously it was something good, right? So we'll start with stress. After the first session, one session of flotation, stress range decreased by 60%. You can't get that with traditional therapy. I promise you, I'm a psychologist, I can tell you this, that's unheard of, and it sustained itself. That's even cooler. We get out to seven, nine sessions, and people are saying, my stress is gone. It's something that not just when they leave the flotation session, but they come back for their next one, and they said the past two weeks, I've been feeling great. And that's why, too, I included these quotes from people, because I think the objective data is important. We wanna see the numbers, and in fact, that's what my bosses wanted to see. They said, show me objectively that people are improving. But the stories, the individual stories are also important, and you'll see that on a number of these slides as well. Pain, chronic pain is huge. There's a lot of non-pharmacological treatments for chronic pain out there, and in fact, where I work now at Nebraska Medicine, we have a whole program devoted just to non-opiate treatment of pain, of chronic pain. And you're telling me, if I get in this float tank, and I just float for an hour, you can cut my pain down by almost two thirds, unheard of, unbelievable. Now I can tell you personally, I carry a lot of stress, and as a result, have some pain in my upper shoulders, in my neck, in my first float session, because I had to try it out if I was gonna make other people do it, was a little bit painful. And I started to feel where I was holding that stress, and what it was, and what it felt like, and it allowed me to not only be better connected with my muscles, but to actually release and let it go. Second session was phenomenal. I didn't have pain for weeks after that. Now I did some additional analyses with stress and pain, because these were two of the biggest findings that we had. I mean, the most dramatic effects were for stress and pain, so I wanted to look at and see, does how frequently you go make a difference? Or the latency in time between sessions? Well, as you would probably expect, trust me, this took a lot of time and lost statistical analysis to tell you what's very common sense. The more frequently you go, the more and better effect you get from floating. Unbelievable, I know, unbelievable. I spent probably a full day trying to work on the data and code it just to be able to tell you something that's pretty common sense. But that's not all. Interestingly, the fewer sessions that you have between floating help to sustain that stress response. So it wasn't just that you felt better after the float, but you stayed better longer, the more frequently that you flooded. Also, remember I was talking about those second order effects? You know, I'm stressed out, so I'm drinking heavier and because I'm drinking heavier, I'm having problems at home and I'm not sleeping well, those kinds of things. We already knew that a lot of these guys were self-medicating with alcohol because they were so stressed out they had a lot of pain, they couldn't sleep. Very cool that the more frequently they floated, the less they used alcohol, the less they had the need to self-medicate. And this is crucial because I think this applies to a lot of other things as well. We're talking about a reduced physiological arousal that completely gets rid of the need to self-medicate with other things. Could we also be talking about opiates for pain medication? Could we be talking about some psychotropics? It's entirely possible, something to consider. This was really cool. When it came to sleep, folks told us that the more floating that they did, the more they slept. Imagine getting three and a half hours extra of sleep every week. That's a super long nap, or like two naps. But imagine how much better you would start to feel over the course of several weeks and several months. And not only that, but their sleep quality started to improve. This goes back to activation of the parasympathetic nervous system that happens in foot tanks. General male health indices showed some improvement. But again, these are secondary and third tertiary effects from some of these other things like pain and stress. As pain and stress goes down, our overall mental health, how we feel, our levels of happiness, our interest and pleasure and things that we used to enjoy starts to go up. This was big, this was huge. So for depression and anxiety, our folks are getting better. I mean, just without a doubt, so much quicker than they have been in the things that they were trying previously. A lot of guys, these guys were pretty fit. So a lot of them used exercise, which is great. Perfectly natural, quote unquote, remedy for anxiety and depression, but it wasn't doing it for them. And so by using floating, they were able to reduce not just their depression and anxiety, but also a lot of the symptomatology of PTSD. And that's something that actually, I'm in the process of investigating now, is for people who experience this combat and trauma related exposure and who have some of these symptoms of not just anxiety, but PTSD, how does that impact them? One thing I heard over and over again was this reduced the frequency and intensity of flashbacks and nightmares, which gives people huge relief. And I think a big part of that is, they don't have the stimulation, the constant stimulation to continually feed up their physiological arousal. They just get just a one hour break of this once or twice a week. It's huge for helping them reset their overall baseline arousal. And so they don't get up to that threshold where they do start to panic and they do start to have those symptoms. Another secondary effect, relationships improve. Look at that, I'm stressed out. I'm not as angry, I'm more calm at home. Now all of a sudden I'm not fighting with my spouse as much. Kids aren't aggravating me. I actually, I'm engaged. I'm not just sitting there fist balled up trying to manage this anxiety and depression I'm experiencing. I can actually get back involved with my family members. Giving people their lives back is huge. One interesting thing, we can't make people love their job more, but we can make it more bearable for them. Which is kind of what you'd expect. And this was one of my discriminatory validity factors. A lot of times when you give people in scientific trials, when you give them a treatment or a medication, they have this halo effect where everything improves and everything is sunshine and daisies and they just feel great. Even if you wouldn't necessarily think that this medication should affect other things. So for them to say, yeah, job still sucks. I was like, okay, good. You're actually responding truthfully to some of these other indices and physical health. I wish I could have done more for this. And in fact, in subsequent research studies that I've done, I'm actually doing one on meditation right now using a smartphone app. We dug into this a lot more because I think there's more to unpack when it comes to overall physical health. But for the purpose of this study and trying not to give people survey fatigue by asking them questions over and over and over, I just gave them one global question reference to their general physical health. How are they, how healthy do they feel and how bad is their most significant physical problem? So that seemed to improve somewhat. I would have really loved to have done swabs like salivary swabs to look at cortisol levels. Cortisol being one of the major neuro endocrinological factors in stress, but that was cost prohibitive. It's kind of expensive, especially at 20, 30 bucks a pop to try to do that for so many people. And so that would have been really cool, something I'm hoping to do in the future. So you're telling me these people can focus better at work. They're gonna be prone to fewer errors. They're not gonna make as many mistakes. Yeah, I'm sold on that. So here's the overview. There's a lot of positive benefits from flotation therapy. And again, we know this, but now you can see with some people who are called into high stress situations who are doing great, amazing, miraculous things sometimes performing at the highest gain, both intellectually and physically, how they can still have problems and they can still benefit from this. I think flotation is not just for the layman. I think it's even more critical for people who are called into high performance situations. Pro athletes, people who, I mean, neurosurgeons, goodness. People in those high stress career fields can definitely benefit from this. And I think there's a huge market to helping people recognize all the different benefits that this has over time. And that's tongue in cheek with, oh, did I take it out? Oh man, I think I'm so funny. I used to have a piece at the bottom of my summary that said world peace. And I guess I took it out because I didn't think it was appropriate for this venue. So. All right, so the Too Long Did Not Read version is that, and here's what we think actually happened, that we were able to reduce that sympathetic nervous system arousal while concurrently activating parasympathetic nervous system arousal and activation using the float tanks. And all it was was just giving people a break, giving them a mental and physical break. And as a result of that, their stress and anxiety went down, their pain improved, they saw their relationships improved, they're sleeping better, they can handle their jobs more, and they have better mental clarity. All these things follow one from the other just because we're able to tackle some of the biggest things on their plate. When I said I looked at the latency between sessions, interesting, we actually had a number of people deploy right when we started this study and they're constantly going in and out. So this was pretty widely variable throughout the study, but regardless of that, just seven, nine floatation sessions, doesn't matter when they were, over the course of this one year when we collected data, we cut stress and pain in half, improved sleep, improved relationships, and we're able to offer, perhaps a good adjunct to therapy, something that maybe on its own doesn't do it for everybody and probably shouldn't. If you've got mental health issues, there's obviously a lot more going on, but we can mitigate some of the physiological vulnerabilities associated with that and help people focus more fully on what is they need to address. Imagine, I'm just thinking about this from a psychological standpoint, imagine if you had a client who's heavy-handed and dealing with all these different things and they're able to get some sense of relief, they get increased mental clarity, their stress goes down. How much better are they gonna do through traditional talk therapy or be able to meditate on their own? So here's all the reasons why you can't take this to the bank. So it's important for scientists to recognize that we do have limitations, not every research program is perfect. I got some of this out before, we had people who were deploying in and out, so that's why I looked at time between sessions. We did have some spouses involved in the data collection, but again, they were also pretty high stressed too. Looking into a deep tissue massage and flotation combo, maybe one doing one before the other. Few of our folks did do that, so it wasn't just flotation and isolation. But again, I think the generalizability of this study is for anybody who's working through a high stress situation, either professionally or personally, I think they would reasonably stand to benefit and as dramatically as I described. So just so you think, I didn't pull all this stuff out of my rear end. I know it's tight and kind of crammed in there, but I've got a couple pages of references. As an aside, the personal stories that I got from this, more so than all the objective data, made all of it worth it. I had actually interviewed a guy for one of my podcasts, a master sergeant who'd been in for like 16 years, high performing guy, told me he would not be alive without flotation. He was very seriously considering suicide and it was through successive floating services or appointments that he finally was able to get some of the relief that he needed and he fully credits his survival today with flotation. And in fact, in the interim time after he moved to a new duty station and didn't even have that available to him, he's been going on his own every few weeks because he knows he's important to him. So I just wanna share that with you guys. If you have any questions, I'm gonna be just, I think, down the road here out the side door and I'd be happy to speak with you one-on-one. If you wanna know more about me or about my study, I thank you for your time.