 great to be back you guys you know I was looking down at my my badge and it had five stars on it I said boy that's a lot of stars and then I realized I'd been here for five years now and this entire five years I've been sort of barking about the same thing what have I been telling you guys about anxiety right floating and anxiety and it's it's a real special treat to be able to come here and present to you as my first audience actually our first set of data with floating and people who suffer from clinical anxiety and I set it up in kind of a different way I'm gonna take you guys into the depth of the research you're gonna see the data exactly as it was presented to me and we're gonna dig into it I'm gonna dig into the theory I'm gonna dig into the the findings at the individual level at the group level and I want you guys to come away from this talk with a richer understanding of what's happening in the short term okay we're talking about the short term effects of a single float in somebody who suffers from anxiety so let's begin one note here as I call it flotation rest which is some a term that some of you probably know very well but I I changed the word just a little bit and refer to it instead of restricted environmental stimulation therapy reduced environmental stimulation therapy I think it's a more accurate name in fact for what we're doing so for those who don't know I work at Laureate Institute for Brand Research we're located in Tulsa, Oklahoma it's a very unique place where we're really given the the grandiose goal of thinking outside the box to come up with new ways of helping people with mental illness and I think we're we're achieving that goal so everyone knows what this is hopefully everyone has one and if this is your brain or the cortical surface of your brain then this is your brain inside of a float tank all forms of external sensory processing are dramatically reduced vision hearing proprioception tactile sensation not on here is thermal sensation olfaction gustation and also cortical functions like movement and speech they're all reduced very naturally inside the float environment so when you first look at this you say well that's a lot of cortical real estate this is a very tremendous intervention in terms of affecting a broad swath of brain tissue but what's left and this is the part that's always fascinated me about floating there's a very rich stream of sensory processing that's coming into the brain at every moment of the day and it really blossoms inside of the float tank it's referred to as interception and it's the brain's ability to sense the inside of your body this is what comes to front and center in the moment of a float and I think this is the mechanism by which it's helping people who suffer from anxiety so I'm going to tell you a quick story my first float I realized this because I normally would try meditating outside of a float tank for many years and I just do simple breath meditation and you're just focusing your attention on the movement of the breath inside and out in and out and you might get a glimmer of you know like 30 seconds to a minute in a sitting meditation session where you're just zoned in on the sensation of the breath and I'm sitting there in the float tank and I'm realizing right away I can not only feel the air but I feel it actually going down my wind pipe into the trachea which I've never been able to track with that level of acuity and I realized I could actually feel the temperature difference it was coming in a little bit cooler and then as it heats up it would come back out a little bit warmer and I said this is incredible this whole area of sensation was just basically a spotlight shown right onto it and I didn't have to do any work and so I started thinking what could we do to use this as a tool to help people who actually are having trouble with their heart brain or inner body brain connection so I started thinking of floating instead of as a form of sensory deprivation actually as a form of sensory enhancement really for the internal body and I wanted to actually measure this so I'm going to show you data from 50 patients with different forms of anxiety and depression and they're rating very simply over the past hour how intensely did you feel your breath your heartbeat and your stomach and digestive system and it's a simple scale from not at all to extremely 0 to 100 and we have them rated before their float begins and then we have them rated at the end very clear effects and the interesting thing is it's not all internal sensations that are intensifying inside the float environment it's very specific to cardiac and respiratory sensations and as I had felt my own first float experience sure enough the breath is oftentimes front and center so I think this is a very important finding this idea that floating could actually enhance certain sensations and the degree to which they enhance those sensations could be very important for the clinical benefit so let's take an aside for a moment given this new information some of you may wonder why do we still call floating sensory deprivation and I wonder the same thing honestly I think we should really reconsider as a whole field whether this is a term we want to be associated with an experience that is actually very different than deprivation let's talk about why I feel that way so this is the brain again as I mentioned it is a form of sensory reduction we're reducing the input to the brain but we're not depriving it right take movement for example if you want to move inside of a float tank just move your arms you could swim around you're floating if you want to feel tactile sensation again just move a little bit and all of a sudden you could feel all the water around you right if you want to have visual input given back to your brain in the pool that Colin created that float away all you have to do is wave your arm and an infrared wave detector will turn the lights on and off the lights come back on you're not deprived of any sensation right so keep that in mind I don't think it's fair to call this sensory deprivation because it's not depriving the brain of anything that sensory deprivation that's actually Donald Hebb who's a Canadian neuropsychologist a very prominent neuropsychologist who is paved by the CIA back in the 40s and 50s to do this line of research where you basically mummify people and they're totally sort of trapped in that situation for hours or sometimes days they can't move they can't see they can't change the dynamics of that situation right that's sensory deprivation and that drives people nuts as you could imagine okay not sensory deprivation totally different night and day sensory deprivation yes not sensory deprivation so I want you to think about this carefully because what you don't realize is when you call something sensory deprivation all of these stereotypes come rushing back in right and when I work with patients guess what they're anxious and they look up everything and the first thing they see when they look up floating is sensory deprivation I think it's something that we should just be conscious about and really reconsider whether we want to be associated with that history and you know my own take on this is let's refer to this as a form of sensory enhancement that's what's actually happening but it wasn't just me I didn't come up with this in fact one of the inventors of the float tank dr. Jay Shirley was the first one to really write about this there's Jay he built the first fully immersive float tank it was a vertical float tank in 1957 in the state I'm currently at which is very bizarre you don't hear much about Oklahoma in terms of being progressive on these sorts of things but it was extremely progressive on floating and in his first paper that he published in 1960 he just started describing what was going on and this is exactly what he said he got a couple doctor friends of his to try this out he said under the extreme conditions of our experiment clear limits of what might be expected were non-existent two physician subjects independently reported having been startled to hear without benefit of stethoscope their own heart sounds at ear-feeling intensity one of them reported having heard repeatedly the sat snapping sound of his own aortic cuss closing at the end of each systole such reports if verified raised the interesting question of whether they are to be regarded as instances of enhanced sensory acuity lowering of sensory thresholds or enhanced ability to fix attention there it is so I think what we're really discovering is that we got associated I think oftentimes maybe unfairly with the whole notion of sensory deprivation but in fact from the very beginning days this was viewed as a form of internal sensory enhancement so let's talk a little bit about anxiety disorders for those who don't know what they are much about what anxiety is but I would say if you're human you probably know what anxiety is it comes with the experience but anxiety disorders are a little different than just typical anxiety right when we talk about disorders we're talking about things that really impair your life your ability to function and this is the most common of all the psychiatric conditions about twice as common as depression and often comorbid and when I say comorbid I mean depression and anxiety often go hand-in-hand in fact rarely do you have one without the other and that's interesting twice as common in women than men and a lifetime prevalence of about 25% which means when you look around this room at least a quarter of you at some point in life are going to have a full-blown anxiety disorder it's also the sixth leading cause of worldwide disability people with anxiety have trouble working they have trouble functioning they have trouble maintaining relationships turns out depression just got ranked by the World Health Organization as the number one cause of disability worldwide so the combination of these two are having a tremendous impact on society here's where it becomes a little bit more dire they've done a lot of big studies on all the top-notch treatments they have out there all the SSRIs and SNRIs the cognitive behavioral therapies the different drugs and the meta-analyses and really large-scale clinical trials suggest that only about half of the patients are actually getting better and the truth is when you have comorbid anxiety and depression the outcome is substantially poor and you have trouble adhering to the treatment so there's a major gap right we have millions of people suffering from anxiety and depression and we have treatments that are only working in half the people that's not very good for a medical discipline right when you have to flip a coin and say well I think you might get better or not we should have something more reliable don't you think so 40 million people currently have an anxiety disorder in the country and it's broken up into a whole spectrum of disorders generalized anxiety social anxiety post-traumatic stress or PTSD specific phobias panic the gorophobia each one kind of has a different flavor a different set of triggers right but at its root all of them share that common feature of anxious distress for whatever the myriad number of triggers might produce and the other sort of sad part is only about a third of the patients are receiving treatment and the real reason is the other thing that all these disorders share is this feature of avoidance when you suffer from anxiety you void whatever could cause that anxiety whatever could remind you of that anxiety and oftentimes treatments could fall into that and so I think this is a key thing we have to recognize as a barrier to entry a tremendous amount of avoidance of life experience so what do we know about floating and anxiety and depression when I first got into this five years ago I thought we had a lot more information but it turns out there's only been a few studies and I'll take you through those the first one was actually done in 1990 it was a retrospective study so they've been collecting data at a hospital in Wisconsin and they were doing a stress management program that involved flotation among other things and they just sort of tested a panoply of patients of different clinical conditions and about 23 of them suffered what they called generalized anxiety which is a condition where almost everything could create worry and anxious apprehension and they reported that after about seven float sessions it was uncontrolled people did report some benefit when they measured their anxiety levels about seven months later so as the first indication maybe something is happening more recently in fact last year the Swedish group published a very interesting study it was a pilot trial with a control group at 50 participants they were self diagnosed with generalized anxiety so they just took a questionnaire and they were randomized to a weightless control group and the other half had 12 float sessions in Sweden for whatever reason they only do 45 minute float sessions I could never figure that out that's right maybe the heating is not quite quite up to par for the water but what they found was a significant reduction in symptoms of anxiety both at the end of treatment about a medium effect size but a maintenance six months later that's exciting and much more so than the control group so I think this was the first clear indication that we're getting some long-term benefit with repeated practice of floating the same Swedish group also looked at a different population that kind of a heterogeneous group of people with stress related pain and what they called burnout depression which is really people who have tremendous stress at work workaholics or just a bad boss and they reached that sort of brink and they gave them 12 float sessions and they showed that sure enough you do decrease the level of stress and anxiety and it maintains for four months post float so another study indicating some long-term changes but we really don't know anything about the short-term changes yet either none of these studies actually looked at it and then when you scour the literature for any other studies on depression or any of those different anxiety disorders that we mentioned it turns out there's nothing out there so when it comes to conditions that we all think should have a very powerful effect inside the float tank we really have no empirical data to back that up for example PTSD not a single published study on it panic disorder gorophobia social anxiety major depressive disorder is really shocked that there hadn't been more float research and major depression and so I think this is a big hole that we have to start filling and what I'm hoping to do is begin to fill that void in today because what we decided to do is rather than try to study any single one of these disorders we took the whole group of them before I could get you there though to the meat of this let's talk about a very important construct and I I apologize you guys are going to get theoretical information that most graduate students don't even have to get so bear with me here this I want to take you through these theories because they're important in terms of how I view floating and the mechanism by which it works and I think anxiety sensitivity is a very important construct it's defined as a fear of anxiety related sensations especially those arising from within the body such as dyspnea difficulty breathing or palpitations of the heart and individuals with high anxiety sensitivity often believe these sensations can lead to adverse consequences including their own death okay and I'll give you a case example of that shortly so when I talk about anxiety sensitivity I'm really referring to all of these interoceptive signals that are coming in every moment of the day and every moment of our life and they could be aroused in a number of different ways there's so many reasons why you might get perturbations of your internal body right and it's oftentimes totally unrelated to the events that are happening in the world around you but this is a recipe for disaster right because anxiety sensitivity could be a very fundamental fear such that any time you feel these sensations they could provide a motivation to avoid whatever is happening at that moment in time and it could quickly cascade a conditioning process gone awry where suddenly everything is causing your anxiety you can't discriminate anymore think about that if every time you feel your heart flutter or feel a little bit of difficulty breathing and the first thing your brain does is that what could be causing that and it just looks to latch on to something that something that it latches on to is something that you're now going to avoid and so your life becomes more and more limited as you make these associations and because of this they refer to this as a trans diagnostic concept essentially what that means is high levels of anxiety sensitivity are found across the whole spectrum of anxiety disorders it doesn't differentiate all of them have this core feature and as a virtue of this relationship this has become a core construct underlying the initiation and maintenance of pathological anxiety so let me give you a case of anxiety sensitivity gone wrong I'll tell you a story about a patient of mine this was a patient who was a veteran who had pretty bad PTSD following the Iraq war and will refer to him as Freddie and I really enjoyed working with Freddie because he wanted to get better so desperately yet the anxiety sensitivity kept hijacking the process so when I met Freddie he was in pretty dire straits he was having panic attacks several times a week and this goes back to this notion right here it would always be the same thing no matter where the panic attacks started he'd feel his heart starting to pound it would get faster and faster and then all of a sudden he'd think he's having a heart attack and it didn't matter how many times he'd had the panic attack the thought that he was having a heart attack was reflexive it was like a doctor hitting his knee with a little tool and there it was he thought he was dying of a heart attack and inevitably Freddie would flee to the emergency room and they do the whole battery of tasks and a full EKG a full workup and several hours later the doctor would come back into the room and say Freddie there's nothing wrong with your heart you're fine and he go thank God I thought I was dying this time doc I thought it was the real time and then a few days later there it came again and this is a guy who has totally intact cognition think about that he knows that he keeps having these occurrences he knows that the doctors keep telling him there's nothing wrong with you but at the moment of panic it's so profound that he knows he's dying and no one could tell him otherwise so this is the beginning of anxiety sensitivity it starts with that profound sort of reaction to any perturbation of the internal body but then it cascades so after my first week of therapy with with Freddie comes back and I said how did your week go he goes well it was okay but I had a panic attack on my way to visit my mother I said oh that's too bad did you pull over to the side he goes yeah I did and then I drove right back home I go that's too bad guys Freddie didn't visit his mom for another year you see what I'm saying you misattribute the anxiety that's sort of cascading out of control inside your body to something out here in the world but that relationship is illusory it's arbitrary and Freddie for him thought it was real he thought well maybe my mom induced that panic attack and so maybe I just need to stop seeing her and he sure enough he totally did a few weeks after that he had a panic attack while he was at work that was the last time he was at his job he quit his job after that so you see how it could spiral and you could see the the vicious nature of anxiety sensitivity so why on earth then do I think floating is going to help this think about everything I've told you about the float environment today it enhances sensations from your heart from your breath the very sensations that people with anxiety sensitivity are exquisitely sensitive to this sounds like a recipe for disaster as well if I tell my doctor friends that I want to start with a population of people with extremely severe levels of anxiety sensitivity and then I tell them about the floating environment they think I'm nuts why would you mix those ingredients together when these people are so afraid of those sensations but that is why I think it's so effective you're teaching them a whole new relationship with those sensations but instead of a relationship that is reflexively inducing anxiety it's a very different association it's one of relaxation and that is a learning process that I think is why this is so helpful but to understand this better you need to understand this theory and I apologize this is getting into the weeds a little bit but this is the theory that originally got me excited about floating if I didn't know about this theory I may not have had as much excitement and I certainly wouldn't have thought about doing this in a therapeutic context but Joseph Wolpe who's a psychiatrist he's passed away from South Africa came up with a theory of reciprocal inhibition and if there's one way to sort of summarize this just to you know consolidated in your own head the basic notion is you physiologically cannot be anxious and relaxed at the same time that's the basic notion they're they're sort of polar opposite constructs in terms of how our nervous system is designed and so he came up with his thesis based on this notion and I'm gonna show you this a lot but I'll read it to you here if a response antagonistic to anxiety can be made to occur in the presence of anxiety evoking stimuli so that it's accompanied by a complete or partial suppression of the anxiety responses the bond between these stimuli and the anxiety responses will be weakened this is not a new theory he wrote this in 1958 in his book psychotherapy by reciprocal inhibition and out of this theory he developed behavioral interventions like progressive muscle relaxation or systematic desensitization but he had never heard of floating but I think you could apply this theory perfectly well to the float environment and I think we have the first set of data putting it to the test and I'm gonna take you through it okay here's the first part of the theory if a response antagonistic to anxiety can be made to occur well what's the float environment doing the first hypothesis is that just by going into the float environment reflexively you're shifting the nervous system into a physiologically quiescent state one that's an antagonistic to anxiety the next part says in the presence of anxiety evoking stimuli what would this be in the case of someone with really profound anxiety sensitivity like Freddie floating is going to enhance the cardiorespiratory sensations the very sensations that have been associated over the course of life with the experience of anxiety so now let's move to the third part so that it's accompanied by a complete or partial suppression of the anxiety responses so then you could hypothesize that through a process of reciprocal inhibition floating will suppress the anxiety responses leading to an acute reduction in the experience of anxiety this is just based on his theory so let's put it to the test let's start off with the first one I think this is gonna be one of the simplest ones to address because it's almost impossible not to be relaxed inside the float environment right does all the work for you but the problem is we don't have a lot of research to actually say what's happening during the float experience the equipment didn't even exist if I try to do the study five years ago the wireless sensors weren't even around so here's how we did this we set up a condition where you were randomized to float and either a control condition which we referred to as earth and it literally is you sitting for 90 minutes watching the BBC documentary earth but you're grounded you're sitting down it's kind of a typical sort of audio visual stimulation it's relaxing it's not meant to be anxiety provoking in fact we had to edit out all the scenes where the animals are killing each other but the other condition you're not grounded you're in the float pool for a full 90 minutes and we did this with the people who have anxiety disorders and we had to set them up with physiological sensors so this is what that looks like it was not easy I could tell you since I'm in charge of the budget we have gone through a lot of money breaking equipment it's almost a deli occurrence and it's because salt and water don't get along with electrical physiological sensors period but we figured out how to do it and we could do a lot in fact Ricardo mentioned this morning that we're now able to measure brain waves while people float using his very novel and innovative brain station system on top of it you could see over here and you could see over here as well a small wireless EKG that we've waterproofed as well giving real-time heart signals and you might be able to see this it's a little dark is a waterproof cuff covering the wireless blood pressure monitor so we could get real-time blood pressure data as well so when you're floating this is what you're wearing but it turns out when you're doing the earth condition you're wearing the same exact thing we made them do the whole setup again and so the idea is can we actually see what's happening physiologically during that float experience versus sort of a typical day-to-day life form of stimulation just sort of relaxing watching a show on TV basically and on top of it the time of day was controlled so if you floated at three o'clock on a Monday you would do your earth condition three o'clock the following Monday so let's take you through a little bit of the the data from this physiologically and let's see what floating is doing to the relaxation response so let's start out with systolic blood pressure and you'll see two different lines here and red is the earth condition and blue is the pool condition and sure enough over the course of about 25 minutes you're dropping your systolic blood pressure by about five or so points and in the earth condition it generally stays where you started maybe goes down a little bit like right here but not as much as the pool and you'll see these shadings the shadings are a 95% confidence interval basically saying that within this sort of interval you you feel with about 95% certainty you've covered all the possible range of responses so there's a lot of overlap there systolic is going down but it's not really going down a whole lot compared to other things but let's take a look at diastolic blood pressure very different pattern and I should point out you guys this is not in a small sample this is 30 patients with anxiety and depression and the confidence intervals in fact don't overlap at all you could feel very certain that this is a genuine difference and what you see is pretty rapidly right actually in the first five minutes you're getting almost a 10 point drop and by the time you hit the 15 minute mark you're already going down by about 15 points in fact you can compute a different score from baseline and that's what this graph shows and it's very clear in the earth condition your diastolic blood pressure really isn't moving much but in the pool condition boy is it dropping and this is a very reliable effect we saw this in almost every patient so that's pretty neat diastolic blood pressure certainly is an index of the relaxation response it's actually the level of sort of contraction of your entire cardiovascular system level of tension within it you can think of it as a tension marker during the moments of relaxation so in between heartbeats that's why they call it diastole so it's when you already had the oxygen and it's already been delivered to the tissue through the systole and now you get to relax for a little bit before the next heartbeat that's when the tension in that whole system begins to plummet let's take a look at another measure that I'm very excited about tomorrow my graduate student obata alzubi is going to discuss how the heck we were able to measure heart rate variability inside the pool it was not trivial that little wireless EKG spits out hundreds and hundreds of minutes of real-time EKG data but it's not always the cleanest data like a typical EKG and so you have to manually go through minute by minute by minute to make sure you're marking every single r-wave of the heartbeat and that's how you compute heart rate variability and the notion of heart rate variability is it's complex but the basic ideas you want variability of your heart rate in fact we all have something called a respiratory sinus arrhythmia as we breathe in oxygen the heart starts beating faster in order to make sure that oxygen gets delivered to the cells in the body and as you exhale you no longer have oxygen coming in the heart rate decelerates because you don't really need to be delivering it it's an efficiency built into our whole cardiovascular system and it turns out when you have depression and anxiety your heart rate variability is extremely poor under these states of chronic stress you really lose that variability factor so keep that in mind the other thing I want you to keep in mind is it's kind of the Wild West in the field of HRV there's a like I'd say at least a dozen different metrics of HRV and no one could agree what any metric means some people say this metric is measuring sympathetic nervous system activation others say it's oh it's some ratio between these two things it turns out there's only one thing that the field could agree upon which is high frequency heart rate variability is a very pure metric of the parasympathetic nervous system okay so here's what the pool and the earth condition looks like for high frequency heart rate variability so once again this is a change from baseline and what you see pretty quickly is within the first five minutes of the float your variability goes up your parasympathetic drive goes up your vagal tone goes up and this is really the relaxation response unfolding and in fact what you see is it kind of keeps going for about an hour and then starts to slowly come back to baseline whereas the people who are in the earth condition watching the movie have the exact opposite pattern where their variability gets worse over time and you can imagine that's probably their baseline state that's where they live their life in this aspect of adaptation that really doesn't adapt to the surroundings so this is exciting I think it took us a lot of time and tomorrow when a body gives us talk you'll you'll get a sense of how hard it was to calculate this but we're finally able to extract these data from the EKG signal so let's go back to that hypothesis one right I think we have some real concrete physiological data to support that hypothesis so now we know we've set up the the core ingredients a response antagonistic to anxiety let's go to this next hypothesis we spoke about that earlier now you have to enhance the signals that create anxiety and in this case it's the heartbeat and the breath and I showed you that data earlier so that leaves us with one very important hypothesis to test if this theory is correct that means floating in this environment should help actually lead to an acute reduction in the experience of anxiety in patients with high levels of anxiety sensitivity so let's put it to the test we set up a study that we started I would say about Christmas time I remember I was floating patients in Christmas Eve and even New Year's and it was always great to see them come out of the float and then go off to the holidays and in that case it meant seeing family which was very anxiety inducing now all procedures were approved through our institutional review board Western and we had very sort of documented clearly laid out inclusion exclusion criteria but it cast a wide net basically if you had a DSM for diagnosis on a standardized sort of psychiatric exam of any anxiety disorder generalized anxiety social anxiety panic disorder agoraphobia or even a stress related disorder like PTSD you could be included you had to have an oasis score greater than or equal to eight which is basically a score saying how severe is your anxiety over the past week and any score over eight means it was clinically severe and then your anxiety sensitivity had to be off the charts a score of 30 is extremely severe on this index we allowed people who took medication because it turns out a lot of people take medication I didn't want to exclude them and they were free to take the medication during the study as long as they were stably medicated for six weeks or longer this was an adult sample and then the other aspect is they couldn't have no experience floating before and in Oklahoma that wasn't very hard to find if I came to Portland it may have been harder to do this study now I wanted to exclude certain things to make sure we were you know treading cautiously keep in mind you know we were doing this research with healthy brains for about a year and a half before I ever studied somebody with a clinical issue and we really wanted to get our feet wet excuse the pun on how to do this research before we would ever study a patient population but nevertheless we excluded relatively severe forms of mental illness so there's no bipolar disorder of schizophrenia we didn't have any active suicidality and by active I mean the person had an actual plan and they were ready to carry it out we had a lot of people who had suicidal ideation which is very common but no one was currently reporting active suicidality they couldn't be receiving inpatient treatment at the time of study we didn't want anyone with serious drug addiction any history of neurological conditions our skin conditions are open wounds that could hurt or could cause pain during the experience and then the last one we actually had to create because we learned the hard way if you don't ask people if they ever swam before they might not tell you and we had what I call a hangar we referred to her as the hangar because for about 45 minutes of her float she was holding on to the edge for dear life because she had never swam before so she didn't trust the water at all so we needed to make sure people had at least some water exposure just because we didn't want that added aspect so this is the inclusion exclusion criteria and we recruited people through a very unique database that the Lloyd Institute has been building called the Tulsa 1000 it's it's a highly resource intensive project because we're trying to recruit a thousand people from the local Tulsa community who suffer from mood and anxiety disorders and follow them for a year but at baseline we do a 24-hour battery of different tests you have different neuro imaging tests different genetic tests different neuropsych tests and computer tests so it's a very rich database and that's how I recruited these people and 121 of them actually met our criteria for eligibility but not everyone wanted to come in and in fact you'll see here we had 15 no shows people who said they would come in we scheduled the appointment we booked the room I booked off my schedule to see them and they never showed a lot of anticipatory anxiety for the first float experience and in this sample I think it was even exasperated further and in fact we had another 15 people who no showed but then they called us like a day later I think I want to come back and could I reschedule and then we brought them back in so there is a barrier to entry and out of the 121 we had 51 people who actually came in signed their informed consent and were in the study and one of those we lost because my gosh she did not want to get her hair wet she didn't know it involved getting the hair wet and it's funny I'm starting to learn what a big deal this is because my own mother who flew all the way out to visit me in Oklahoma had a horrible amount of back pain I know she would have benefited greatly from floating looks at the tank looks at her hair and says it's too much work I can't do it my own mom said floating is too much work that doesn't sound good if that's too much work we're all in trouble so anyways we had a sample of 50 and I think 50 is a really decent sized sample for anxiety disorders remember these patients are highly avoidant so getting them to try anything new is an accomplishment and if you look at most anxiety studies they usually have you know a dozen maybe two dozen patients so this is actually a moderately sized sample it's not bad in terms of the basic diagnostic breakdown remember it could span all the diagnoses so we had about 26 people with generalized anxiety 16 with social anxiety 12 with panic disorder 8 with agoraphobia 16 or 17 with PTSD including some veterans and keep in mind comorbidity was the rule rather than the exception a lot of people had multiple diagnoses and another aspect that you don't see here is 46 out of the 50 had major depressive disorder comorbid so this was a highly depressed sample and what you see here is some basic demographics about the age and gender breakdown but you would also see a little bit about the level of severity that they came in with during the float experience the level of disability and typically just to give you a flavor for disability any score greater than five is going to signify impairment when you're getting into the range of 20 which are severely anxious subgroup these are people who were unemployed didn't have jobs because of their anxiety oftentimes were divorced oftentimes couldn't leave their house sometimes we had a few people who were homeless even so you get extremely severe levels of anxiety in this anxious subgroup but the whole group of 50 actually had a whole range of anxiety some on the mild some on the moderate and some on the more severe so we span the spectrum and these are very stressed out and unhappy individuals just to give you a sense this net time happiness has people rank on average how often are you happy versus unhappy and if you look at healthy people about 60 percent of the time when you look at the severely anxious sample they're unhappy 30 percent of the time more than they are happy so it goes in the exact opposite direction so this is a sample of people with a lot of distress to give you a sense of the clinical cutoff scores anything higher than an 8 is considered clinically severe anxiety and anything higher than a 10 is considered clinically severe depression and all of these patients came into our open flow room and this is a really important part of the study I don't think we would have gotten that many patients to even do the study if we weren't texting them this very picture before we even called them on the phone to schedule an appointment and it reduced a lot of the barriers to entry what you have to recognize is the whole notion of claustrophobia is ubiquitous among people with anxiety and any enclosure whatsoever even if it's 20 feet tall is like getting into a box for them and so I think having the open pool design is a key aspect of getting patients with anxiety to actually engage in treatment and you need to keep that in mind the other thing you need to keep in mind is you got to give the patient complete control over the experience you don't dictate anything if they want to get out after five minutes no problem the showers right behind you if you want to have the lights on or off just wave your arm it's up to you if you want to have them on or off and so the notion here is when the patient sees this sort of large circular pool and realizes they could just get in and out whenever they want and realizes they could have the lights on or off whenever they want all of those stereotypes that are going through their mind just get erased immediately and now it's not so hard now floating becomes a lot easier and I think this is a key part to keep in mind if you're going to be floating people with any forms of anxiety now the experience itself was extremely well calibrated we have about 2000 pounds of salt in here the entire room is soundproof and light proof we actually have 48 butyl rubber springs underneath the pool to absorb any vibrations that are coming through the ground and the temperature is calibrated to skin temperature so the water is about 95 degrees and the air runs about 93.5 with our current humidity level and one of the nice things that that Colin built is the ability to know precisely when the lights are on versus off and precisely how long people are floating for so I'm going to show you a graph now of everybody's behavior during a one hour float session so in blue is the total time in the pool out of 60 minutes and essentially all we told them is you could float up to 60 minutes we didn't say how long you had to stay in and only two people got out early this woman got out after 22 minutes and she really didn't want to get out but she had some cuts on her back that she was not aware of beforehand and they were stinging and one other person got out I think after 48 minutes but 48 out of the 50 people stayed in the whole hour I was surprised by that to be honest the other interesting aspect is it breaks down almost in half for who decided to turn the lights on or keep the lights on versus who decided to turn the lights off and you could see this group on average about 20 what is that 26 people kind of floated most of the session with the light off about an average of 53 minutes with the light off whereas this group on average really didn't shut the lights off much at all maybe I think two minutes on average so you have this interesting comparison I'll show you a little bit of data where we could compare the people who have the lights on versus off to see if that has any effect on the anxiety response so so far so good we've got a good chunk of people with pretty severe anxiety to last a whole hour inside the pool let's see what they thought about that time afterwards when they got out we asked them and about half of them said they wish they could have stayed in longer than the hour 30% thought it was the perfect amount of time and a little less than a quarter said they were pretty much ready to get out a little before the hour had elapsed so I think this gives us a sense a little bit of preference right and in general the preference is to either you know keep it at the hour or go even longer and we definitely had some people who are kind of pissed that we turn the music on we'll talk about those people in a second the next thing I wanted to do is I wanted to fully characterize the safety of the intervention you know we're dealing with people who have very severe issues people like Freddie right I don't want to induce panic attacks or if you have people with PTSD I don't want to cause potential flashbacks while you're inside of a float environment but these are things that could happen because you're working with people with very fragile brains right people who've been through a lot who suffered a lot and so you always want to ask yourself are you causing harm and if you don't ask the question you're never going to know and so we decided to ask the question in fact we had 43 questions and after the float they had to answer whether they had an increase in any of these different effects during or shortly after the float and two-thirds of the effects were negative items for example a desire or wanting to hurt or kill yourself or even sort of more subtle items like diarrhea or heart palpitations we didn't want to bias them though and just give negative items so about a third of the items were very positive effects maybe peak life experiences where you say things like a feeling of total serenity and peacefulness or a feeling of flow with the world around you and as a forced choice after the float they'd have to rank where this was in terms of non-mild moderate or extreme and this is the average score if you sort of make mild a 1, moderate a 2, and extreme a 3 for the entire group of 50 patients this is the side effect profile of floating and the first thing you should notice unless you're colorblind is there's a disproportionate number of side effects in the positive domain in fact the top 10 are all positive so when people are experiencing an effect undoubtedly it's going to be very positive in fact the top three were a feeling completely refreshed like the reset button was hit total relaxation of body without any muscle tension and a feeling of total serenity and peacefulness and this was at the moderate level we had many people who rated this as extreme the other thing to keep in mind is the two highest negative effects were dry mouth and itchiness which isn't so bad when you look at the typical side effects of the current medications these people are taking if we have to have a black label before people get into a float tank that you may have feelings of total serenity and peacefulness we apologize that's a lot better than the typical warning which is you may have an increase in suicidal thoughts if especially if you're a teenager it's on all the SSRIs so keep this in mind I think one of the things that was very interesting for me is I didn't know what we would get in terms of adverse events in fact I was there for every float I was worried about it these people had never been put through a float environment there's no papers on PTSD or panic disorder I didn't know what the reaction would be but the reaction was positive very positive and we really didn't see any serious adverse events I'll tell you about maybe one what I would call mild to moderate adverse experience but that was about it for the most part it was overwhelmingly positive the other thing I wanted to point out actually you might not have noticed this but take a look at this one right here a strong feeling of appreciation that you are alive I actually went back into that data set and the people who ranked that the highest were the ones who had the most suicidality they weren't actively suicidal but they were thinking about it a lot that's pretty powerful if you could shift that these are the subjective effects of floating and to be honest I don't think there's a graph that I've seen that more clearly describes the variety of responses that you get with the float intervention now take a look at the x-axis these are called pump units pump stands for percentage of maximum possible on the scale in other words what I've done is I have you know 16 different measures here they might be on different scales I've put them on to that same set of units so you could compare so when you see something moving up to 50 pump units or down 50 pump units that means their ratings changed about half of the possible rating scale and I think it it's kind of interesting so for example one of the first things you might notice is floating is not inducing an extremely euphoric state if it were these things would be up here right it's inducing happiness and positive affect but not nearly as much as feelings of serenity and relaxation right so I think it nicely characterizes that distinction on top of it people did feel energized afterwards a lot of the patients would come in and you would see them sitting in the waiting room and they just look lethargic it's like you couldn't get them to move at all and they would come out and you would see this sort of very interesting change in the way their body was positioned and the way their facial expression was sort of emoting and it was clearly one of energy which was interesting to see in terms of reductions you see very strong reductions across the board and negative affect pain fatigue sleepiness depression state anxiety stress and look what's the biggest reduction of them all muscle tension so people definitely experience that reduction in muscle tension and it's starting to make me wonder how much the whole field of psychiatry has missed this aspect of anxiety how much of us hold or harbor the stress inside of our muscles and that tension builds up and unconsciously influences our anxiety levels and so I think this could be a key part of what is happening in the float experience so one thing to keep in mind these are statistically significant you could see the p values here typically p values are about point oh five meaning you have about a five percent chance for a false positive we're going down to point oh oh one or oh oh one for most of them these are highly significant effects they're not subtle changes and let me take you through a couple of them this was our primary outcome measure the Spielberger state anxiety inventory this is an inventory that's been used for decades it's been used in other clinical trials it's been used in other relaxation type studies and it's really measuring how much anxiety do you feel right now at the present moment and we measure this before the float pre and also immediately after post and we also did this in a non-anxious sample these were 30 people who had no history of anxiety no history of any psychiatric illness and it was also their first float session as well so you could kind of see the differences as a reference and clearly this is an anxious sample they have a lot of state anxiety at the beginning by the end of the float their state anxiety levels have dropped basically to the levels that the non-anxious sample were at before their float began in fact even a little bit lower so we're taking an anxious sample and getting them closer to what you may call a healthy level right of anxiety let's take a look at the entire sample of 50 patients on this measure red is their pre-float state anxiety score blue is their post-float and you could see you have some people who had really high state anxiety at baseline it's some people who had pretty low state anxiety but across all 50 patients it dropped from pre to post-float that blew me away guys you never see that in other types of interventions that level of reliability and it didn't drop you know as much for everyone look at this person he barely dropped but then you had some people who you know were way up here and then so you had this level of variability but it was very consistent take a look at serenity same thing the sample came in with very low levels of serenity but by the time the float was over their serenity was just as high as the healthy sample and you could look at each one of those individual serenity changes in the 50 anxious patients and it's the same exact thing all 50 showed a pre to post-float increase in serenity no matter how low they started at baseline so I think you know this in some ways really categorizes what are the core features that are changing with the float experience well it's reducing your level of state anxiety it's enhancing your level of serenity that's important don't forget there's a yin and a yang there and you can't just say we're we're reducing symptoms of mental illness we're also increasing symptoms of mental wellness and this is a very important aspect of the float experience that a lot of other treatments don't offer let's compare the anxious sample to that non anxious reference sample of 30 naive healthy floaters this is an important graph I think what do you guys notice the pre to post changes are a lot higher in the people with anxiety right think about that take something like state anxiety right they're dropping over two-fold higher than the non anxious sample they're coming in with a lot more as well I think what this graph should illuminate for you is that floating is having a much bigger effect on the people who are suffering than the average day-to-day floater and it's all in the right direction another thing we could do is we could parse out the anxiety sample and say well maybe the people who are you know mildly or moderately anxious were getting better but the severe people the ones who who came in with you know horrible levels of anxiety at baseline who normally don't get better with treatment maybe they're not doing as well with this so you could actually separate the most severe subset of the sample from everybody else graph it out and that's what that looks like in fact you guys what this suggests to me is the more distress the more anxiety that you bring into the experience the more you get out of it in fact it's huge look at that negative affect which is really one of the core indicators of negative mood goes way down in the severe sample it's not moving much in the less severe same thing with all of these measures depression state anxiety even seed and unmeasures of relaxation so I think this is a fascinating part of the float experiences you could actually based on what you come in with know that you're going to have a bigger effect the more you bring into the experience now another thing we could do with the data is we could calculate effect sizes an effect size is how you compare across studies when you do clinical trials you always want to know what's the effect size the p-value just tells you whether something significant the effect size tells you how large of an effect it is and typically in the Cohen's d effect size point eight is considered a large effect so if you take a look at all of the pre-deposed changes in the 50 patients with anxiety and depression what do you notice about the size of the effect there's actually a word for this when an effect gets to the level of a Cohen's d of 2.0 it's called huge but given our current context I don't use that word anymore so two of the biggest variables that I showed you state anxiety and serenity have very large effects the sort of effects that you know will be reproducible if you were to do this study again and I think that's an important aspect of this graph here one other thing we could do is we could parse out the effect sizes based on the different diagnostic categories right that this help people with PTSD maybe more than people with panic disorder if you had the lights on versus off did it make a difference on any of these effect sizes so we could kind of do a comparison of effect sizes across all the different subgroups and that's what this shows you you see down here you have a color code of effect sizes ranging from strong reductions in light red or strong increases in in blue but really any form of red and any form of blue is past that point eight threshold those are considered large effects and here it's kind of hard to see we have all the different subgroups we had the people who were severely anxious we had the lights on versus off females or males people who were taking medications versus not the different anxiety disorder categories one of the first things that jumped out to me when I looked at this graph is there's a very obvious red line our primary outcome measure of anxiety the very thing that Wolpe's theory of reciprocal inhibition says should go down in this heterogeneous sample of people with anxiety sensitivity it certainly does across every single subgroup at a very large effect size so that's interesting it means irrespective of what condition you have irrespective of what causes your anxiety if you come in to float you're going to see a drop in your state anxiety levels that to me is maybe the most important finding of the whole study but on top of it you see in general large effect sizes across all of the variables for things like stress muscle tension depression negative mood even things like serenity one interesting thing people who had the lights on did not have as big of a drop in serenity that was maybe one of the only differences between the lights on and lights off group for the most part there were much more similarities than differences across all of these categories the one thing that was really kind of different across different groups and categories was fatigue and sleepiness some people would come in they'd float they'd feel energized they'd feel awake and some people would kind of come out a little bit lethargic a little bit tired there was a lot of variability there and that could have to do with the time of day we're not sure but on these other measures I would say it was consistently large effects irrespective of the different type of diagnosis you may have had I wanted to get a sense of what other treatments this group of 50 patients had tried and it turns out as most people with anxiety they tried a lot of things about three-quarters of the sample had tried different anti-anxiety drugs exercise and massage and breathing techniques about half the sample had tried psychotherapy or counseling other people were self-medicating with alcohol cigarettes marijuana small sample of yoga compared to what it's probably like on the west coast so these people I wouldn't say were inexperienced they tried other forms of treatment other types of relaxation techniques so then I wanted to know tell me how did the relaxation you experienced during and after today's float session compare to the other relaxation techniques you've tried in the past and they had to answer one of three options either you experience more relaxation with floating than any other technique they've tried it was equally as good as the other techniques or you actually experience more relaxation with one or more of the other techniques and so here's the data for the entire sample of 50 patients and this is you know not the sort of data that you're ever going to get a paper published on I would say it's more anecdotal type data right but it's important anecdotal data because these are the patients who are suffering right they're the ones trying all these treatments desperately to get themselves better and then they came in one day to this weird laboratory in the middle of Tulsa, Oklahoma and suddenly they find themselves experiencing greater states of relaxation greater drops in anxiety than anything they tried in the past that's very important you guys always listen to the patient because they know best this is exciting I wanted to present you some notes from the float and it was hard to actually put this together because we did a debriefing interview after every float session and we just asked them very open-ended questions like how was your float experience and I was going through this morning saying you know what quotes could I show you from the different patient groups to illuminate the types of experiences that these patients had and truth is it's impossible there's too many so in the first paper that we publish I'm just going to publish the entire set of debriefing interviews so you could read them but let me give you just a couple different examples subject nine it was nice I mean I wouldn't say it totally took my mind off all my stress but it helps slow down my thoughts and I got to thinking about them like one at a time instead of just jumbling everything up and getting so stressed out about everything at once I can't change I was able to like sit there and think on it and I don't know I liked it so that's one type of response subject to it was great it was wonderful it was the kind of like taking clonopin or Xanax without the side effects just like feeling alert not that fogginess you know feeling sluggish or just like I want to withdraw it was just great yeah yeah it was like anything I've ever felt so it was good and one thing you should keep in mind is I was doing the debriefing interviews for these patients I was there the entire float session monitoring that there was nothing that went wrong and when you meet these people before they came into the float some of them were miserable like you didn't have to even have a conversation with them you walk in the room and it's like the energy just gets taken from your body and you're just sitting there in a depressed state with them and then suddenly you come into that same lounge area post float I didn't recognize some of these patients they were like different people I'd never seen anything quite like it and you could see they were surprised themselves here's another person it was awesome I feel so relaxed I just loved it it was so awesome it really was I've never been so relaxed I felt a little tension like you said in there before but I just let it go I just let it go it was awesome I'm so amazed by how my body's feeling still it's lasting too longer than a massage one time I've never felt this blows it away I mean I feel so relaxed I mean my mind is just like hey it's so relaxing you know I don't know how to explain it any other way it's my whole body and my mind I feel so good right now I'm not in pain my new knees usually some my back usually hurts I don't feel anything right now I don't feel any pain or anything nothing I mean I feel I've never been this relaxed I feel so awesome I really do it's better than a pain bill it's better oh my god I can't believe it it's really freaking me out I mean somebody could come in here jump on me and I wouldn't get mad I wouldn't I would not get mad so these are great you know I could read these all day because they're there's so much you could learn one of the questions in the survey was like how do you feel right now and I'm kind of like man I'm just kind of like I either just had an hour and a half massage not the hour the hour and a half or I had a really nice snap because I'm just not I'm not foggy I'm pretty neutral I'm really relaxed you know I was gonna write in there like butter but then I thought no I normally don't but it was saying like describe what it was like and I said I feel like butter that's something my mom would say so I had to put that quote in there but that's pretty much you know very comfortable the water temperature was perfect I mean there was times where I couldn't tell the difference between the water and not the water so that things great seriously you ought to hire it out I mean the break from external stimuli is necessary and I think that's what meditation is trying to achieve when you've got all this crap going on around you will stick them in a flow pool she could be your sales person subject 8 you know what I was talking about you know with that little anxiety that kind of popped up you know I would like to somehow figure out like how I defeated that in there and twisted and somehow try to figure out how to apply it to you know my life outside here you know because like I said normally I would get stuck in it and sometimes when I realized that I'm you know in in that anxiety where everything you know I don't know I would like to figure out how to I mean as small as it might sound like to me that's a big thing like in a way think it's just because you know people don't know how to relax but I did notice and you know I think that's just my body's storing those are all the places that it stores that stress that maybe I don't even realize and I definitely have a lot more energy now because I think like I don't know how everybody else is as normal people but with me and my stress in my mind constantly going like it just takes away my energy like I know what it what it is why I'm just physically drained all the time and mentally you know it's because my brain and I just can't slow it down so I kind of feel like I just slept for three days you know so you get this range of responses right and people perplexed you know what happened there did I just relax did I really just do that you also could get some adverse experiences these are people who have a lot of suffering a lot of stress a lot of memories here's one of them the last 15 minutes I think we're good but the first half was unexpectedly anxiety inducing like when I was taking a shower it was fine but when I first got in the panic set in and I had a hard time making it go away my heart was racing I felt a little bit tense then I asked how long did you feel like that sensation of panic lasted she said about 20 minutes then it's subsided but I had to put some effort into calming down I tried to figure out what it was like was it just the floating or the light or the size of the room or if it was darker like I didn't turn the light off at all the blue one I didn't turn it off I think one of my fears was that when I was floating I kept splashing around and trying to control my environment because I didn't want to let go I didn't want to slip into that feeling you get when you're in sensory deprivation there's an association she had to that word right like I meditate and I enjoy that but I can always move my arms and wake up and do other things around my house and I think this was a little different but when I was finally like in the last 10 15 20 minutes when I was finally enjoying the float that felt very much like I was meditating so this is a very interesting case I remember her because she was so relaxed going into the pre-float normally these patients are very strong up she was totally relaxed she's like yeah I meditate this is going to be fun I've been looking forward to this so I had none of the warning signs that she was going to have a panic attack but she did I think it took her by surprise now the thing is she didn't get out when someone has a really full-blown panic attack the first thing they're going to do is get out of the tank and they might just flee your center so she had enough sort of resources enough regulatory power to quell the panic attack but yet it was still there that experience is still there so keep that in mind you guys it's you know floating is safe I think we at least with this first session have seen clear data that we're not getting a lot of adverse experiences but it's not perfectly safe there could be a lot of anticipatory anxiety there could be people who come into that first session and have a panic attack so your job as a float center operator is to notice that to train them to coach them and make them aware of that fact but it's a very small minority that's one out of 50 people here's another person a little less severe it was good I had a lot of anxious thoughts and worries constantly and I had to constantly remind myself to calm down and relax it was difficult at first but then I kind of just relaxed and then I felt like I lost track of time and I was like well how long have I been here so not the greatest experience they had a lot of mind chatter a lot of rumination I think that's very common in this population in general at baseline and some of them still had that mind chatter while they were floating so here's the last one this one really took me by surprise because I've for many years done psychotherapy and I want you to read that in the context of a patient who would say come in every week sitting in the couch in front of you okay this is her response I asked what did you learn about yourself during this experience and she responded that a part of me is still in there that I always feel so disconnected by my circumstances because they're so abnormal and there's always this sense of dread that it's like this is it you know those thoughts of death we were talking about earlier right then every now and then you have the opportunity to experience a part of yourself and it's reassuring to know that it's still there it's not destroyed by brain damage or anxiety or just living with PTSD that was a really good opportunity to alleviate so many different things and just get a nice quick opportunity to get closer to yourself to know that you're still there I could sit with patients for six months every day and I can't get them to tell me that I threw in a float tank for an hour and she was reconnecting with the side of herself that she she thought had passed away actually she'd been suffering for that long so there's something very profound there this isn't just a relaxation experience when you read the briefing interviews you realize these aren't people saying yeah I felt relaxed they were actually accessing parts of themselves that they didn't even know existed it's a very important part I think of what I learned from this experience that the effects of floating in these very severe clinical populations are bordering on the profound and it only took one float for them to access that that's very powerful clinically so let's go back to the theory let's go back to Joseph Wolpe and reciprocal inhibition for response antagonistic to anxiety can be made to occur in the presence of anxiety evoking stimuli so that it's accompanied by a complete or partial suppression of the anxiety responses the bond between these stimuli and the anxiety responses will be weakened I think we have data to support this if a response antagonistic to anxiety can be made to occur what did we learn we learned that the single biggest self-reported change in terms of reduction was muscle tension we learned that we lowered blood pressure especially diastolic blood pressure we learned that we improved heart rate variability on the high frequency domain and on top of that we decreased their exposure to all of the external triggers of anxiety that their brains had been sensitized to over the years that's a very important part of this experience you have to realize when you have high anxiety sensitivity everything makes you nervous everything makes you anxious for the first time they didn't have all that visual and auditory information pouring into the brain and their brain got to just relax okay next hypothesis in the presence of an but anxiety evoking stimuli we took the very people who are exquisitely sensitive to any perturbation any feeling of cardiorespiratory sensations and put them in an environment that brings these out naturally to the forefront of your consciousness okay then hypothesis three so that it's accompanied by a complete or partial suppression of the anxiety response and so the theory goes that you will suppress the anxiety response and have an acute reduction in anxiety and that was the single biggest effect if you remember that effect size graph state anxiety dropped across every condition every subgroup so for the first time I think we have data to support that floating creates a short-term reduction in anxiety and it does it through a process of reciprocal inhibition but we left out something we left out the very last phrase here and this could be the most important phrase the bond between these stimuli and the anxiety responses will be weakened what does that mean that means this was just one float session over time and with repeated exposure to floating if this theory is true if our data is supportive of it that means you should have long-term reductions not just in the experience of anxiety but in the anxiety sensitivity itself think about that that's really powerful that means the next time these people are out experiencing the world and their heart starts fluttering the next time Freddy's on his way to drive to his mom's house and he starts having a panic attack suddenly the feeling of his heartbeat isn't so aversive he might have this remembered association that it was linked to one of relaxation instead of anxiety so you weaken that bond and you form a whole new competing association one that links the experience of all of these cardiorespiratory sensations with relaxation and that's really important because that means the work that occurs inside the float tank has the opportunity to transcend the environment and if that happens then this becomes a therapy it's not just a short-term treatment but actually something that you could bring forward to the world and actually encounter things in life that maybe you've been avoiding because of your anxiety so this is really where we want to go next we want to test this hypothesis this data only showed us the first three hypotheses but this one is really the long-term one so where do we go from here I think there's a couple points to really think about here one is we found a very strong short-term reduction in anxiety from pre to post float in this group of people with severe anxiety and depression okay we also found an increase in their mood remember they're also very depressed and serenity levels went up happiness levels went up relaxation levels went up it was a real enhancement in their mood but one thing this does not indicate is whether this is going to help them in the long run this was a short-term reduction we have no idea how long these changes last for by no means is this a float tank cure and I hope none of you would ever use this data to support that we have a ways to go if we're going to get to the stage where this becomes a viable treatment and I think that's really the next step that hypothesis for right where you look at long-term reductions in anxiety and anxiety sensitivity requires you to do what's called an RCT a randomized controlled trial that means you have to have a very good control group more or less a placebo condition or an active control group like another type of treatment you have to randomize people to go into one of the other and you have to follow them up longitudinally many months later so I applied for a grant this year it's going to be reviewed at the end of the year and it's the first NIH float grant that I've submitted and we'll see I think you know this is going to be a real test to see whether the federal government is going to take this therapy seriously and until I figure out whether or not I got a score I can't tell you so fingers crossed December 1st I think is the review so you know think positive thoughts that day but if that doesn't work you know we're gonna have to get clever here and think of other fundraising options and if any of you have ideas I'd love to hear about them later on because an RCT is not cheap some of them could cost upwards into the millions of dollars and the idea is that you're not just floating 50 people but you're floating hundreds of people many times and you're following them for you know sometimes over a year afterwards and so you need a lot of personnel a lot of resources and it's not easy to do but to me it's necessary because if you're gonna get Western medicine to take floating seriously they need to see that it works here the study I just showed you is not gonna make them take this seriously as an intervention but an RCT will that's the same thing that any other drug maker uses for say an anti-anxiety drug or different types of psychotherapy as well it's the same design and we have to see if floating stands that test we also need to figure out how long do these effects last one of the projects that myself in in collaboration with Dr. Kalsa who's who's about to give a talk we set up what's known as an experience sampling method where we'll text people every couple hours after the float for several days and we're trying to figure out how long do these benefits actually extend we don't know there's never been a systematic study on this in floating and if it extends more than even a few hours that could be impressive but anecdotally I'm hearing stories of patients calling my phone a week later and still feeling some remnants of the experience so we need to document how long does this actually last and I think we need to determine how these effects compared to other treatments maybe gold standard treatments like benzodiazepines typically when you go to your doctor and say doc I'm on edge I can't sleep all over the place I need something take off the edge they'll give you a benzo right well what happens in terms of state anxiety reduction with a benzo compared to say floating and where the two of them 12 hours later 24 hours later we could do that study we could actually do a head-on-head comparison and see where we're at and I think we got to keep characterizing the relaxation response what we saw today was just a taste we saw some drops in blood pressure we saw some improvement in heart rate variability but I think the response extends well beyond that we're looking at things like magnesium changes cortisol changes we're even looking at blood markers of inflammation and whether those change we have all of these different physiological variables and you heard this morning from Ricardo about some of the exciting eG data we're collecting and we also have many fmr and eG projects last year I actually presented one of our first fmr I studies and tomorrow about is going to give you an update where we're digging into that data deeply we're trying to figure out what's happening in the brain from pre to post float and finally we have several papers that have been submitted or in the process of being submitted in fact all the results I just told you today are being reviewed as we speak and I purposely submitted them to an open access journal because I think it's going to be the easiest way to disseminate this and in fact if any of you ever want a copy of the study when it comes out just go ahead and sign up on our email list this is the website and we'll email you a copy of the study and in that study we'll have all the debriefing interviews all the different graphs you just saw and it will really try to highlight what we think are the short term effects of floating in this clinical sample so I want to thank you guys it's been a long hour here and I know you just had lunch but I I'm really excited to present these results to you this is for me an eye opening experience because five years ago was just a dream right so here we are five years later and we have some real data and this is exciting so I want to thank my collaborators none of this would be possible without them you guys saw Ricardo and Jim this morning but on top of it we have my colleagues at Liber Martin Paulus the scientific director Dr. Saib Khalsa who's about to present the first float eating disorder results in another hour very exciting Kyle Simmons who was here a few years ago and then also Dr. Henry Ye who was our bio statistician that helped with all the analyses and none of this would be possible without the float lab themselves these are the people behind the scenes doing the work and and honestly they deserve just as much as I do so stay tuned this is just the beginning but it's a very promising beginning thank you guys