This article describes a brief history of sensory modalities in mental health and substance abuse treatment, the purpose and current use of a sensory comfort cart at NewYork-Presbyterian Westchester Division (NYPWD), early patient outcomes, and implications for discharge and recovery.
Brief History of Sensory Modalities in Psychiatric Treatment
Ever since the mid-1800s, when the reforms of Dorothea Dix and discoveries of Florence Nightingale were introduced, cleanliness, fresh air, and natural light remain key elements in treating those suffering from mental distress and alcohol abuse. In the late 1800’s, NYPWD (an all-psychiatric hospital, then known as Bloomingdale Hospital) was relocated from New York City to White Plains. Hospital trustees purposely chose rolling farmland for its beauty to provide a healing environment for patients. The hospital was built on a hilltop with expansive views of the valley below, and over 200 acres of park-like lawns with deciduous and evergreen trees and plants. Inside the stately buildings, tall windows and hallways invited light. The high ceilings exuded openness, grandeur, and respect for the dignity of the patients.
Influenced by the Wellness Movement of the late 1800s and early 1900s, and before most psychotropic medications were introduced, treatment for those with mental illness and alcohol addiction included physical exercise, warm and cold hydrotherapy, occupational therapy and diet prescriptions. In society, various abstinence/temperance societies were formed to help those with addictions. The late 1930s brought more scientific research to the study of alcoholism as well as the founding of Alcoholics Anonymous (AA).
“Integrated” medical and addiction recovery treatment for co-occurring disorders (formerly called dual disorders or MICA (Mental Illness/Chemical Abuse), officially began in the mid-1980s (Sciacca, K, American Journal of Orthopsychiatry, 1996). After the first multi-sensory treatment room was introduced in the Netherlands in 1975 (Champagne and Stromberg, Journal of Psychosocial Nursing, 2004) alternative modalities were gradually added to the treatment of those with co-occurring disorders.
Based on research and evidence-based practice, NYPWD integrated the healing and sensory arts more intentionally into treatment in the 1990s. The therapeutic milieu was transformed to be both less restrictive and more engaging for patients. NYPWD was named as an official Planetree Hospital in 2004 because of the healing environment for patients and their families. An Integrative Medicine Committee was established in 2012 to look at evidence-based ways to integrate traditional and alternative treatment for patient care.
In addition to the therapeutic milieu and individual, group, and family therapy, the hospital provides healing arts programs and integrative treatment modalities. Units offer patients comfort rooms for relaxation and decreased stimulation, aromatherapy, and a cornucopia of alternative offerings for stress reduction. There are opportunities for yoga, meditation, psychosocial rehabilitation, and healthy lifestyle and spirituality groups. Outdoor spaces include a courtyard with a meditation labyrinth, walking trails, tennis courts, and a swimming pool for patient and family use.
The Purpose and Use of a Sensory Comfort-Cart at NYPWD
The Addiction Recovery Unit (8N) at NYPWD is a 14-bed open unit where patients with both substance abuse and psychiatric conditions are treated using evidence-based clinical approaches. An interprofessional team of MDs, psychologists, social workers, psychosocial rehabilitation specialists, nurses, and nursing support staff partner with patients and families to develop treatment goals and plans. Among various treatment approaches is the use of sensory modulation resources to provide healthy alternatives to the unhealthy coping mechanisms patients may have used outside the hospital for distress caused by anxiety, pain, and insomnia.
Over a year ago, nurses and psychosocial rehabilitation specialists on the Addiction Recovery Unit began to search the literature to identify additional innovative approaches in helping patients self-manage their distress. During the summer of 2017, a Family Nurse Practitioner joined the team to participate in a meta-analysis comprised of 17 studies. Evidence-based findings within mental health settings demonstrated “the usefulness of sensory approaches in supporting consumers’ self-management of distress” (Scanlon and Novak, Australian Occupational Therapy Journal, 2015).
Sparked by the effectiveness of many forms of alternative therapies already in use and comfort carts at other hospitals, the possibility of a sensory comfort cart became an intriguing concept for the staff members on the Addiction Recovery Unit. The team chose a rolling cart with numerous drawers for its portability and convenience to store varied resources. After nurses and psychosocial rehabilitation specialists educated all of the staff members, the sensory comfort cart was officially launched in October 2017.
The cart is designed as a resource to help patients identify and learn to cope with the distress they may experience related to recovery from symptoms of substance abuse and/or mental illness. The cart is docked in the nursing station. When patients request help with their feelings of distress, the resources on the comfort cart are offered to patients, in addition to a prescribed medication, if indicated.
The comfort cart has resources that tap into the healing properties of the five senses. Patients and family members are given a fact sheet about the cart and the purpose of each item. A few examples of the resources are:
Sound: Music and Tabletop Chimes to Soothe and Relax
- Smell: herbal teas and aromatherapy oils specifically geared to calm various emotions
- Taste: herbal teas, peppermint candy, chewing gum, etc. to reduce cravings and help focus attention
- Touch: weighted gel lap pads, beanbags, stress balls, clay/putty, aromatherapy lotions, and coloring books for adults to comfort and reduce anxiety
- Sight: various colored glasses to help with different emotions
Using a feedback form on the cart, patients identify and document feelings associated with their distress as they choose a healthy sensory modality to help relieve their discomfort or anxiety. Nurses recommend the resource be used for at least thirty minutes to an hour to determine efficacy. Each time the sensory comfort cart is used, patients are asked to fill out the brief feedback form and then rank the level of distress before and after applying the sensory modality, using a Likert scale. Staff members describe and/or bring the comfort cart into patient groups at least weekly to discuss the resources, the evidence behind sensory alternatives, and to allow patients to practice using the alternative modalities. Nursing staff members replenish the contents of the cart as often as needed.
Practicing various sensory modalities in the inpatient setting allows for patients to discover what works for them. Patients are learning that healthy sensory modalities, along with prescribed medication, are effective in modulating feelings of distress. Staff members partner with patients as to how best to incorporate the resources into their daily lives after discharge, either at home or in a residential treatment setting.
In the first few months of use, the sensory comfort cart was primarily used either in the group setting with staff guidance or when a patient asked for a PRN (as needed) medication to help with anxiety, insomnia, cravings for nicotine, etc. While expressing interest in the sensory cart’s modalities, actual patient use is lower than expected. Patients seem reluctant to fill out the feedback form, so staff members are encouraging and assisting as needed. Since the sensory cart was introduced, approximately 56 feedback forms were completed. Patients noted on 86% of the completed forms that the sensory modalities were effective for them.
Aromatherapy (sense of smell) in the form of an essential oil, alone or with putty (touch), was the highest ranked modality for distress reduction by patients. Of the oils, lavender was ranked most effective in distress reduction, followed by bergamot with lavender, orange, peppermint, and lemon. Taste ranked 2nd highest for relieving distress and included gum, followed by chamomile tea, and candy. Obtaining more ways for patients to listen to music or to view relaxation videos may add to a potential increase in the use of the senses of sight and sound for relaxation. Continuing data collection, along with staff and patient evaluation, will prompt changes to the use and processes of the sensory comfort cart.
Implications for Discharge and Recovery
Patients are encouraged to create a “toolbox” of healthy coping strategies to take with them when they leave the hospital for both their psychiatric and substance abuse struggles. These might include calling their sponsor, attending daily AA or NA meetings, taking prescribed medications for their psychiatric illness, as well as using some of the effective sensory comfort cart resources. Recently a patient stated, “I find working with the clay/putty really helps my distress and I plan to use it when I get home.” These resources are widely available to the public through retail stores or online.
According to Champagne and Stromberg (Journal of Psychosocial Nursing, 2004), “Sensory approaches strengthen the therapeutic relationships, promote collaboration and recovery, and are fully applicable across age groups, mental health settings, and consumer populations.” A future survey of the usage of the sensory comfort cart resources by patients after discharge will add knowledge that staff can use to better equip patients with co-occurring disorders to achieve a more sustainable recovery.
A resource for both patients and practitioners can be found on the internet at www.sensoryconnectionprogram.com. For more information about NYPWD’s Addiction Recovery program contact: NYPWD Access Department at 1-888-694-5700.