Sensory Processing Sensitivity and the OT

In 1991, Dr. Elaine Aron, an American clinical research psychologist, began her research on what she refers to as 'the highly sensitive person' (HSP) - or more formally and scientifically named 'sensory processing sensitivity' (SPS). Since then, there have been more than 100,000 scientific articles on this subject. In 1996, Dr. Aron developed a validated survey that is widely used for research purposes and in clinical settings, but can be accessed by the general public, as a way to determine if a person has the traits of a highly sensitive person. It is available on her website: hsperson.com.

Sensory processing sensitivity (SPS) is an innate trait and not a disorder - an important distinction. This genetically determined characteristic has been found in 20-30% of the world’s human population, equally amongst the sexes, as well as in over a hundred species of animals. The level of sensitivity in today’s population is considered to be on a continuum, with 30% of the population considered 'high', 40% moderate and the remaining 30% with low levels of sensitivity. A useful analogy used by Dr. Aron and others is that of different flowers...

People considered to have a high level of sensitivity are described as orchids, since this is a flower that needs a specific environment to flourish. Medium sensitivity levels are referred to as tulips; dandelions are considered low on the scale, since this flower can grow in almost any environment, despite the conditions.

Within this group, 70% of people self-identify as introverts and the rest as extroverts. This trait should also not be confused with shyness (the fear of negative judgment), or introversion (a preference for quiet, minimally stimulating environments). Furthermore, 'sensory processing sensitivity' is not the same as 'sensory processing disorder', or sensory integration disorder. Dr. Aron explains the difference in this article.

To further define and explain what sensory processing sensitivity is - and how it shows up in everyday behaviours and patterns - Dr. Aron has created the acronym DOES, which stands for:
 

As occupational therapists, our goal is to provide the most beneficial environment for our clients to succeed. With the understanding that 20-30% of the population has sensory processing sensitivity, it is incumbent for us as clinicians to be aware of the environment - and to accommodate as much as possible.

Environmental considerations may include:
 

• Lighting - Check that the lighting is adequate for the situation. The lights should be bright enough to accomplish the task or activity, but not too bright as to be distracting, as well as in good working order (for example, not flickering).
   

• Noise - This is a big issue for people with SPS, who are easily irritated and distracted by noise that is not always obvious to others in the room. Examples include the banging of a heating unit, or cars outside the building. When possible, work with the client in a quiet, calm setting, perhaps with the ability to close the door if there is activity outside of the treatment area.
   

• Other distractions - Phones ringing, intercoms interrupting the treatment session, different smells, or other people speaking loudly can all be easily disruptive to the HSP.

People with SPS may also have more difficulty with tasks that are overwhelming when first presented - and instead of being able to process the steps, may 'shut down'. This may also display itself in poor adherence to treatment plans, decreased participation during the treatment session, difficulty establishing trust between the clinician and the client, or dropping out of the program altogether. With this understanding, we as clinicians can more readily adapt the situation, by altering and adapting to meet the sensory needs of the highly sensitive client. This can be accomplished by limiting outside noises and breaking down the task into smaller, attainable goals, with an emphasis on positive affirmation.

Since SPS affects 20-30% of the global population, it also affects occupational therapists; one out of every 4-5 OTs will be a person with sensory processing sensitivity.

 If you think you may be someone with SPS, I encourage you to take the survey (see link above).

Those of us with even a mild form of this attribute, can benefit from a deeper understanding of the trait - and then personally utilise the same principles we offer to clients. It has been proven that healthcare professionals who are also highly sensitive people have a higher propensity for burnout, mainly due to an increased capacity for empathy and difficulty setting boundaries in the workplace. Therefore, the healthcare provider with SPS is advised to make self-care a priority. This can take different forms, such as making sure to take frequent breaks away from others and outside, away from loud noises if possible. Since 80% of all stimulation is through our eyes, closing our eyes for even 30 seconds can help mitigate sensory overload. An emphasis on good nutrition, sleep, good boundaries and participation in vocational hobbies should also be strongly encouraged.

I believe that an understanding of this unique trait of sensory processing sensitivity can help us to better serve our clients. By recognising this trait in ourselves, we can better reach our full potential and more comfortably interact and flourish in our everyday lives.

Lynn Festa, OTR, CHT, CDWF is an Occupational Therapist who lives in Lenox, MA, USA.
 She is a HSP Knowledgeable Professional, who specialises in coaching highly sensitive persons. Lynn can be reached at hpc@pobox.com.