This article addresses the use of weighted blankets as a tool to help a person self-regulate, particularly as pertaining to treatment of symptoms of PTSD.
The most recent research to emerge in the field regarding weighted blankets is very significant in its findings regarding the potential of the blankets for reducing anxiety, which is often an issue for those suffering from PTSD. In a study headed by Tina Champagne, OTD, OTR/L in 2015 involving thirty inpatient psychiatric patients each using a thirty pound blanket, the participants rated their own anxiety levels both before and after using the weighted blankets. Sixty percent of those participating reported a significant reduction in anxiety. Moreover, while the vast majority of these adults had had previous psychiatric hospitalizations which included the use of restraints and/or seclusion to manage their outbursts, none of those participating in the study required restraints or seclusion during the period of the trial.
The results of this study are impressive, but why do the blankets work? The answer is that the blankets offer a form of deep pressure touch. Deep pressure touch is a type of tactile sensory stimulation that can have calming effect on people and is an approach based in ongoing neurophysiological research. The calming action of DPT serves to facilitate the body’s transition from a state in which the sympathetic nervous system (SNS) is dominant to one in which the parasympathetic nervous system (PSNS) prevails. SNS is the body’s alert system; it becomes dominant when we enter fight-or-flight mode, initiating a cascade of self-protection mechanisms associated with this high-alert state. PSNS is predominant when we feel a sense of calm, which enables prime functioning of the body’s systems.
The fight-or-flight mechanism is vital to us as humans, but when we remain in this state for prolonged periods of time, it can become difficult for us to return to a state of arousal that is “just right” — the natural homeostasis in which the nervous system is balanced and can attune optimally to whatever activity is at hand. When SNS is engaged for too long, we can become exhausted and irritable, eventually developing physical symptoms such as digestive issues, headaches, difficulty concentrating, memory problems, and sleep issues. Disproportionately large reactions to everyday problems are typical. This habituated fight-or-flight state is a common ongoing symptom of PTSD. At present, the two primary forms of treatment recommended by the American Psychological Association (APA) — which are considered evidence-based therapies — are several forms of psychotherapy and various types of medications.
In 2013, The National Association of State Mental Health Program Directors (NASMHPD) introduced Training Curriculum for the Reduction of Seclusion and Restraint. The Six Core Strategies for Reduction of Seclusion and Restraint (6CS) was presented in this curriculum. This is an evidence-based package of strategies — including Sensory Modulation Strategies — that focus on crisis prevention.
Although the APA notes that there is insufficient evidence to recommend for or against offering Seeking Safety (SS) or relaxation (RLX) therapies, the connection that exists between effective treatment for PTSD and 6CS is the notion of prevention and treatment when the fight-or-flight system is active. Jane Musgrave, MS OTR/L, is a national presenter of Sensory Modulation Interventions using the NASMHPD Training Curriculum. Ms. Musgrave was the Director of Rehabilitation at Taunton State Hospital for over 20 years and currently owns her own OT consulting business Just Good Sense. She states “Weighted blankets are a major tool within the Sensory Strategies. They are used for self-regulation, restraint/seclusion prevention, crisis prevention, and to increase a person with PTSD self-calming and coping abilities.” She goes on the say “The coolest thing about weight (including weighted blankets) is that if it’s going to work, it seems to work right in front of your eyes. It’s amazing and wonderful to witness a very distraught dis-regulated (and potentially assaultive) person become calm, organized and relaxed enough to be about to talk about what is upsetting them.” The blankets are, furthermore, non-invasive and shown to be totally safe, as revealed in the first study mentioned above.
In addition to their direct implications for calming the fight-or-flight response, the weighted blankets can also be a powerful sleep aid. This is because those with PTSD may be on high alert at night, as well, and because of this, it can be very difficult for them to modulate their state of arousal to one that is conducive to sleep. Also, they are often light sleepers once they fall asleep; worry, negative thoughts, and fear can make sleep elusive for those suffering from this condition. Nightmares are common, as are medical problems including chronic pain, stomach problems, and pelvic area problems in women, all of which can also make quality sleep difficult. Finally, those with PTSD tend to have higher incidence of self-medicating with drugs and alcohol, which likewise impacts quality of sleep.
It is important, though, to remember that the intention of the blankets is not to cure PTSD. Certainly, they cannot cure the syndrome, but they can empower those suffering to take control of a situation that may be causing significant stress and disruption in their relationships, their functioning at work, and their participation in and enjoyment of life. The goal of using the blankets, then, is to try and achieve a more calm, relaxed, and balanced state. This small, relatively inexpensive, and wholly natural approach/therapeutic tool can indeed have a very powerful effect on an individual’s state of arousal, which ultimately affects every area of one’s life.
As with any treatment modality, it is vital to be aware of contraindications. Recommendations that have emerged from the research are that weighted blankets should be avoided for those who have a tendency towards claustrophobia, those with broken bones or open wounds, and those who are unable to manage the blanket with sufficient strength to be in control, so that it does not inadvertently become a form of restraint.
The intention of occupational therapy is to facilitate a person’s highest level of participation in everyday life through meaningful activity encompassing the cognitive, social-emotional, and physical domains. In keeping with the typical OT approach, not only does deep pressure touch in most people help provide a more secure, grounded, comforted, and loved experience, it is useful as a vehicle through which we can exercise meaningful participation in life and take greater control of our own health. Taking this one step further, weighted blankets in particular can serve as powerful tools that enable patients suffering from PTSD to resume some measure of control over their own lives through a very simple, non-invasive approach.