Balance & Mental Health

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Connecting Your Sense of Balance to Your Mental Health

If you live in the United States, then chances are that anxiety affects either you or someone you care about. Did you know that anxiety disorders are the most common health condition in our country? Over 40 million of us are diagnosed with an anxiety disorder, and that’s not including the people who face daily struggles but have not been formally identified. Anxiety affects a person’s ability to work/play/learn, make social connections, and even impacts their physical health. Anxiety not only affects our quality of life but also affects our country’s bottom dollar in healthcare. Did you know that a person with anxiety disorder is 3-5 times more likely to see a doctor and 6 times more likely to be hospitalized for psychiatric disorders? Whether you’re concerned about a friend or family member or the national healthcare budget, addressing anxiety needs our attention.

Currently, the primary treatment options for anxiety disorders are medication, psychotherapy, or a combination of the two. While these intervention approaches have helped many people, they both still have their limitations.

On the market today, several pharmaceutical medications are available including: Selective Serotonin Reuptake Inhibitors (SSRI’s), Serotonin-Norepinephrine Reuptake Inhibitors (SNRI’s), Benzodiazepines, Buspirone, and Beta-Blockers. However, these medications come with a range of side effects that cause discomfort, impact function, and wellbeing. Each medication has its own range of side effects, but collectively they include (but are not limited to):

  • Feelings of agitation, shakiness, nervousness, restlessness

  • Hyponatremia

  • Suicidal thoughts

  • Muscle pain, cramps, stiffness

  • Ringing in the ears

  • Unusual tiredness or weakness

 

  • Nausea, vomiting, diarrhea, constipation

  • Headache

  • Drowsiness

  • Insomnia

  • Dizziness

  • Sexual problems

  • Blurred vision

Psychotherapy is another common intervention for anxiety. Talk therapy can take on many facets and all involve some approach in helping a person understand their thoughts and feelings and begin to learn new cognitive strategies to manage emotion and behavior. Some approaches incorporate mindfulness techniques including meditation. Types of psychotherapy for anxiety include:

  • Cognitive Behavioral Therapy

    • Exposure Therapy

    • Dialectical Behavioral Therapy

  • Acceptance and Commitment Therapy

  • Psychoanalytic Therapy

  • Art Therapy

  • Interpersonal Therapy

While these therapies have shown to be effective in treating anxiety, they don’t help everyone, and some people will experience relapses. One problem with traditional psychotherapy is that they do not always address the root cause, especially if the anxiety stems from an issue in the body. Newer therapy approaches incorporate the body and the mind to address the physiological experience of anxiety such as heart rate, muscle tension, and breath rate. Examples of these models include: Biofeedback, Eye Movement Desensitization Resolution (EMDR), and somatic therapies. While these take a more holistic approach and have demonstrated effectiveness, there is still speculation about whether the effectiveness fades when treatment is discontinued and sometimes these therapies still do not get to the fundamental root cause.

And then there’s another approach…

In the world of sensory integration, anxiety is a common manifestation of sensory processing differences, especially differences in the vestibular system. If this seems far-fetched, let’s remind ourselves about the vestibular system’s role in our brain and body. The vestibular system develops and maintains our relationship with gravity. If we know which way is right/left, up/down, and forward/backward, we experience a sense of security in the world. We move through our environment with ease and thus we feel safe, both physically and emotionally. If the vestibular system is under-reactive or over-reactive, the world is no longer a safe place. We might get dizzy, feel nauseous, trip and get hurt, or become confused, not to mention experience secondary difficulties with our sense of sight, hearing, smell, and touch. These secondary effects are especially prevalent in people who never had sufficient vestibular processing—namely, children. Most of the current literature connecting vestibular treatment and anxiety focuses on the elderly population and vestibular RE-habilitation. But what about children and teens whose brain and body developed alongside vestibular differences?—They need vestibular habilitation and sensory integrative therapy. The literature is growing around this developmental vestibular-anxiety connection and is certainly worth our attention for today’s children and teens who will become tomorrow’s adults.

With cases of anxiety on the rise, it’s important that we address the issue from all angles. What works for one person might not be the most effective approach for another. Whether deciding between medication, psychotherapy, alternative mental health therapy, or a sensory approach, thinking about the individual as a whole person is essential. The cost of using a “one size fits all” approach will be paid in reduced work production, school success, and emotional wellbeing as well as increased healthcare dollars because of the physical ramifications. Let’s focus on treatment that gets to the root of the issue so we and our children can live happy, productive lives and reduce our healthcare spending as a whole.

 

Sensory integrative therapy is not effective for all anxiety disorders.

If your child has anxiety and any of the following signs/symptoms, a sensory approach may be beneficial:

  • Fear or avoidance of feet leaving the ground (e.g., for climbing or swinging; being picked up suddenly)

  • Limited physical exploration of the world. Tending toward sedentary play.

  • Fear or avoidance of moving platforms (e.g., escalators, skates)

  • Fear or avoidance of head moving backwards in space (e.g., for hair washing)

  • Fear of the dark

  • Difficulties reading. Reports of headaches after focused visual work.

  • Frequent motion sickness

  • Issues with secondary systems including tactile defensiveness, hyper-sensitive sense of smell or taste

Note: If these were true for you as a child or are still true for you today, a sensory approach may benefit you even as an adult.

References

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  2. Bart, O., Bar-Heim, Y., Weizman, E., Levin, M., Sadeh, A. & Mintz, M (2009). Balance treatment ameliorates anxiety and increases self-esteem in children with comorbid anxiety and balance disorder. Research in Developmental Disabilities, 30, 486-495. 

  3. Beta Blockers. (2019, August 16). Mayo Clinic. Retrieved 7/27/2020 from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522.

  4. Buspirone (Oral Route). (2020, July 1). Mayo Clinic. Retrieved 7/27/2020 from https://www.mayoclinic.org/drugs-supplements/buspirone-oral-route/side-effects/drg-20062457.

  5. Christy, J (2019). Use of Vestibular Rehabilitation in the Pediatric Population. Perspectives of the ASHA Special Interest Groups, 4(6), 1399-1405. DOI: 10.1044/2019_PERS-SIG7-2019-0002.  

  6. Clinical Practice Review for GAD (2015, July 2). Anxiety and Depression Association of America. Retrieved 7/21/2020 from https://adaa.org/resources-professionals/practice-guidelines-gad.

  7. Furman, J.M., Balaban, C.D. & Jacob, R.G. (2001). Interface between vestibular dysfunction and anxiety: more than just psychogenticity. Otology & Neurotology, 22(3), 426-427. Retrieved from https://journals.lww.com/otology-neurotology/Fulltext/2001/05000/INTERFACE_BETWEEN_VESTIBULAR_DYSFUNCTION_AND.35.aspx

  8. Jacob, R.G., Whitney, S.L., Detweiler-Shostak, G., & Furman, J.M. (2001). Vestibular rehabilitation for patients with agoraphobia and vestibular dysfunction: a pilot study. Journal of Anxiety Disorders, 15(1-2), 131-146.

  9. May-Benson, T. A., & Koomar, J. A. (2007). Identifying gravitational insecurity in children: A pilot study. American Journal of Occupational Therapy, 61(2), 142–147. Retrieved from file:///C:/Users/gwilc/Downloads/142.pdf

  10. Generalized Anxiety Disorder (2017, Oct 17). Mayo clinic. Retrieved 7/21/2020 from https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/diagnosis-treatment/drc-20361045

  11. Nagaratnam, N., Ip, J. & Bou-Haidar, P. (2005). The vestibular dysfunction and anxiety disorder interface: a descriptive study with special reference to the elderly. Archives of Gerontology & Geriatrics, 40(3), 253-264.

  12. Ottenbacher, K. (2009). Vestibular processing dysfunction in children with severe emotional and behavior disorders: A review. Physical and Occupational Therapy in Pediatrics, 2(1), 3-12. 

  13. Potegal, M., Pfaff, W.O., & Kroker, E. (2018). Gravitational Insecurity in Children: A survey of occupational therapist’s observations. Indian Journal of Physiotherapy & Occupational Therapy—An International Journal, 12(2), 30-37: DOI: 10.5958/0973-5674.2018.00033.3. 

  14. Rolf, J.G. & Furman, J.M. (2001). Psychiatric consequences of vestibular dysfunction. Current Opinion in Neurology, 14(1), 41-46.

  15. Schulten, W.D., Batelaan, N.M., van Balkom, A.J.L.M., Penninx, B.W.J.H., Smit, J.H. & van Oppen, P. (2013). Recurrence of anxiety disorders and its predictors. Journal of Affective Disorders, 147(1-3), 180-185. https://doi.org/10.1016/j.jad.2012.10.031

  16. Selective serotonin reuptake inhibitors (SSRIs). (2018, October 2). United Kingdom National Health Service. Retrieved 7/27/2020 from https://www.nhs.uk/conditions/ssri-antidepressants/side-effects/.

  17. Serotonin and norepinephrine reuptake inhibitors (SNRIs). (2019, October 5). Mayo Clinic. Retrieved 7/27/2020 from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20044970.

  18. Sleeping pills and minor tranquillisers. (2016, August). Mind for Better Mental Health. Retrieved 7/27/2020 from https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/side-effects-of-benzodiazepines/.

  19. Thomas, B. & Dieterich, M. (2020). ‘Excess anxiety’ and ‘less anxiety’: both depend on vestibular function. Current Opinion in Neurology, 33(1), 136-141. DOI: 10.1097/WCO.0000000000000771