Tuesday, October 20, 2009

Treating ADHD by Floating in Salt Water?

Can Floating in Salt Water Near Body Temperature be Used as an Effective, Natural ADHD Treatment?

One of the things I enjoy most about researching and writing this blog is that I get a chance to review the literature of some pretty zany diagnostic and treatment methods for ADHD. I often wonder what is going through the minds of some of these researchers as they concoct these seemingly eccentric modes of treatment for the disorder.

This blog has covered some of these seemingly bizarre treatments, including treating ADHD with mirrors, EEG manipulated ADHD treatment, light therapy for ADHD with seasonal affective disorders, and the effectiveness of behavioral therapy measures for ADHD, and hinted at other treatments such as vestibular stimulation for ADHD.

A recent article in Cases Journal on treating a patient with ADHD and Asperger's by flotation sessions in a tank of salt water struck me as particularly bizarre, but piqued my curiosity. However, the justifications and apparent effectiveness of these measures suggests that further investigation may be warranted. Before we all decide to take a prolonged trip to the Dead Sea, we should investigate the methods of this treatment process and check for scientific evidence behind its claims. Below is a summary of the process, and some of the major points the article's authors conjured up to validate the effects of this form of ADHD treatment.
  • As the name of the journal title suggests, this was a case report on a single individual, and not a controlled clinical study. However, I have repeated given my opinion on how case studies, although statistically inferior to controlled trials, should retain a place in novel medical treatments.

  • The patient was a 36 year-old woman co-diagnosed with ADHD and Asperger's (although keep in mind that many diagnostic methods forbid the co-diagnosis of ADHD with anything along the Autistic Spectrum, including Asperger's. However, many clinicians often ignore this guideline and have no problem with diagnosing a person with these two comorbid disorders).

  • The study authors noted that a number of the alternative treatments which previously showed promise hinged on triggering arousal levels (mirrors, EEG, etc.). It is well documented that deficiencies within arousal levels are common in the ADHD population. Hence, a sensory stimulation via flotation in a water tank may possibly show promise as an alternative ADHD treatment.

  • The flotation device is essentially a covered tank (to minimize the impact of outside sources of stimulation) containing highly concentrated salt water (to enable easier floating and buoyancy) at near-body temperature (to reduce tactile stimulation due to a temperature difference between the person's body and outside environment). Keep in mind that this water is typically only 8 inches to a foot (20 to 30 centimeters) deep, and its high salt content (much higher than the ocean) allows one to float easily without touching the bottom of the tank. This method, called flotation-Restricted Environmental Stimulation Technique or flotation-REST, has been shown to be an effective stress-reliever and relaxation method. A total of 19 flotation treatment sessions were done within the span of about a year.

  • The authors found five key components (arousal control, inhibition/activity regulation, sensory integration and interpretation, cognitive abilities, and emotional abilities) of ADHD behavior to be positively affected by flotation.
  1. Arousal control: As mentioned previously, arousal levels have been shown to be a significant component of ADHD (and it can be either over or under-arousal). The flotation-REST method apparently addresses the arousal problem and normalizes this state by providing an environment which screens out most visual and tactile environmental stimulants.

  2. Activity regulation/inhibitory control of physical processes: Often a hallmark characteristic of ADHD is the difficulty with inhibition control or impulsivity with regards to physical movements, especially in younger children. Impulsively grabbing at objects or persons is a common occurrence among children with the disorder (as almost any parent of and ADHD child can attest!). The salt water/ADHD treatment case study highlights that the salt water flotation/isolation therapy may alleviate some of this behavior due to it's effect on allowing the individual to "internalize" their focus on their physical movements, which may build up more regulatory ability of motor control and enhance the ability to restrict inappropriate physical impulses.

  3. Sensory integration: We have previously alluded to the possible connection between ADHD and sensory integration (in the context of balance impairment and inner-ear dysfunction on ADHD) disorders. Additionally, numerous studies on fine motor skill deficiencies, such as handwriting and ADHD have been covered this blog and studied in the literature. It appears (at least in theory, according to the case study and journal article) that the flotation experience in a sensory restricted environment enhances the patient's sensory integration abilities by depriving external sensory stimuli, leaving room for the person in the salt water tank more time to focus and coordinate his or her senses.

  4. Improvements in cognitive abilities for ADHD patients: We have discussed cognitive abilities in ADHD (as related to pharmacological treatment strategies) in previous posts, and there are numerous studies on comorbid cognitive deficits in those with ADHD. Furthermore, some posit a cognitive energy deficiency as the underlying cause to ADHD, identified as a cognitive-energetic model of the disorder. These deficiencies are believed to be at least partially remedied or improved by the flotation in salt water treatment, mainly due to the distraction-free environment being conducive to periods of prolonged concentration and enhanced thinking without interruption. According to the article, many of these benefits continue after the individual is out of the tank even for a period of a few weeks (of which these effects then begin to taper off).

  5. Imrovements in personal emotional abilities: Emotional abilities, especially as they relate to inter-personal interactions and relationships can also be a common deficit in individuals with ADHD. The flotation technique is believed to improve this aspect as well, as it provides an environment of personal self-acceptance which can then be transferred to improved relationships with others and their emotions.
In conclusion, we should probably not go running out to buy a big shark tank (minus the shark of course!) just yet. Remember, this was just one simple case study done in Sweden of a 36-year old woman with comorbid Asperger's. Obviously further study is warranted, and there are a number of loose ends that must be tied up before this alternative treatment method is accepted and goes mainstream. Future studies on the effectiveness of this treatment for children with the disorder would be especially useful. Nevertheless, this Flotation Restricted Environment Stimulation Technique (flotation REST) has shown to be useful in other areas of psychological function, including as a relaxation/stress reduction method.

Thus, (in this blogger's personal opinion) this flotation REST technique may be especially good for ADHD'ers who suffer from high levels or irritability or have comorbid anxiety or depressive qualities (perhaps not those with claustrophobia or hydrophobia though!). Individuals with ADHD who have responded well to Wellbutrin or other antidepressant medications may be especially good candidates for this flotation treatment, at least in theory based on our current observations at the time.

Additionally, it is worth the re-mention that the woman of the case study had co-morbid (co-existing) Asperger's and was already on an antidepressant medication throughout the whole course of the study. This may be good news for those who suffer from co-morbid disorders, as well as the fact that this flotation REST technique seems to be relatively compatible with medication treatment. Thus supplemental treatment by flotation in salt water near body temperature may be a good adjunctive measure for individuals with ADHD and a wide spectrum of comorbid disorders.

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Steven said...

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08:00 6 softgels krill oil.
09:00 1 softgel phosphatidyl serine.
12:00 1 softgel phosphatidyl serine.
14:00 4 softgels krill oil
15:00 1 softgel phosphatidyl serine.
18:00 1 softgel phosphatidyl serine.
20:00 4 softgels krill oil
21:00 1 softgel phosphatidyl serine.

Total: 14 capsules krill oil and 5 softgels PS.

Sometimes I also take lecithin (which is cheaper then phosphatidyl serine, but not as calming).

People who don't have ADD might also use these supplements as a mind enhancing, concentration improving nootropic.

Remember: All these supplements are fats that originate from diet and body.

The brand krill oil is neptune krill oil (2 softgels = 1.0 g neptune krill oil/ NKO) and the brand phosphatidyl serine is Nature's Way.

After taking the phosphatidyl serine I feel the substances have concentration enhancing but also calming, relaxing properties.

How does it work:

The brain cells membrane is made of fat. One of these fats is phosphatidyl serine. Krill oil has DHA/EPA connected to phosphatidyl choline. This works as an anchor and enables more phosphatidyl serine to anchor to the cell membrane. More phosphatidyl serine improves the brain electral conduction and makes the electrical signals stronger, causing more neurotransmitters to be released. Something like that...



Anonymous said...

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Purity warning
Some brands actually sell krill oil that isn't pure krill oil. Instead it's a mix between krill oil and fish oil (or lemon oil or another kind of oil). These brands are less potent and should be avoided. Please check out the products (other) ingredients to see if the product contains fish oil, lemon oil or other oils.

The ADHD Treatment Guide said...

Please do not use my blog as a platform to promote your products. It is meant to be a free resource of unbiased information for those with ADHD and their families not a promo-site for krill oil or xanax. If you want to share a treatment method that has worked for you and do so in an unbiased manner (meaning you do not stand to profit directly from your suggestion), you are of course more than welcome to leave a response, but please do not spam this site.

I appreciate your cooperation in advance.

Nicolas Iverson aka theadhdwarrior and creator of this blog.

Nonscence said...

What I am wondering, while reading your blog post, is what kind of 'salt' was used. The Dead Sea salts are very high in magnesium, and you have elaborated extensively on the benefits of magnesium in your blog. Research evidence suggests that magnesium is most efficiently absorbed inter- and intracellularly in a topical manner. The benefits of Epsom baths or Himalyan salt or Dead Sea salt baths are easy to find by means of an internet search.

Since the article in your link only mentions 'saline' it is not clear whether they used a magnesium saline.

I would be interested to know what kind of saline solution was used. If it was magnesium saline, then the benefits of 'floating in salt water' would be logical to me.

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camobel.es said...

It cannot have effect in actual fact, that is what I think.

Anonymous said...

Thanks for the writeup and reference to the article in Cases Journal.

I am building my own floatation tank and am looking forward to the positive benefits.

For a great writeup on building your own floatation tank visit:


Anonymous said...

Build you own floatation tank:


Anonymous said...

As an adult living with ADHD and a few other things. It is obviously not going to cure ADHD (but I found your comment amusing so thank you for that). But it does decompress your mind and body. it's a gift to experience total sensory deprivation. As we are unable to "turn it off" even during sleep. This is really quite amazing!!

Ryan Hoffman said...

The profits range from mental unwinding and restoration, like the impacts of a profound contemplation, to physical relaxation. I have done the therapy at Float Therapy West Kelowna A

ObsidianJaguar said...

Most float tanks use Epsom salt, magnesium sulfate, in high concentration so that the relative density of the solution is about 1.25. (Lilly recommended 1.3 but this requires operating very close to saturation with the risk of recrystallization). The density assists floating particularly making the head buoyant so that the nose and mouth are well out of the water for breathing.

It has recently been discovered that there is a secondary effect which is important to flotation therapy. Magnesium is absorbed through the skin due to natural molecular diffusion. This tends to correct magnesium deficiency.[15] Magnesium is absorbed from the diet but in many areas of the world, over-cropping without adequate replacement of magnesium makes the normal diet low in magnesium.

The body naturally optimizes the levels of magnesium, so there is no overload effect from floating in the salts for extended periods

ObsidianJaguar said...
This comment has been removed by the author.
Anonymous said...

Ive tried floration tanks, & they are indeed wonderful, incredibly relaxing etc (I fell asleep during my sessions). You feel amazing for several hours after..but then real life (with its noises & stress) intrudes & thats it. Maybe if you did this once a week or so?
But that would be expensive..and time consuming, unless you had or could build one of your own then Id say it would be a better alternatibve to meditation. A quick google search throws up the Zen float tank (a tent, basically) for $1850 USD & Im guessing better ones would be a lot more.