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To cite this article: Batya Engel-Yeger , Dafna Palgy-Levin & Rachel Lev-Wiesel (2013) The Sensory
Profile of People With Post-Traumatic Stress Symptoms, Occupational Therapy in Mental Health, 29:3,
266-278, DOI: 10.1080/0164212X.2013.819466
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Occupational Therapy in Mental Health, 29:266–278, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 0164-212X print/1541-3101 online
DOI: 10.1080/0164212X.2013.819466
BATYA ENGEL-YEGER
Occupational Therapy Department, Faculty of Social Welfare & Health Sciences,
University of Haifa, Haifa, Israel
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INTRODUCTION
266
Sensory Profile and Post-Traumatic Stress 267
life events such as physical or sexual abuse and the subsequent development
of PTS symptomatology indicated that people traumatized as children or
adults are vulnerable to the development of PTS symptoms, contingent on
their coping resources and social support. This phenomenon may be caused
by changes in their neurobiological system, mainly expressed in regulation
difficulties of biological stress systems (Collin-Vézina & Hébert, 2005) that
also influence sensory-processing abilities.
Sensory Processing
Research demonstrated that each person processes sensory information in a
different way (Brown, 2001). Sensory processing refers to the ability to regis-
ter and modulate sensory information and to organize this sensory input to
respond to situational demands (Humphry, 2002).
Sensory-processing difficulties (SPD) can occur in some or all sensory
systems and are expressed by extreme behaviors in response to sensory
stimuli, ranging from hypersensitivity to hyposensitivity and sensory-seeking
behaviors (Miller, Anzalone, Lane, Cermak, & Osten, 2007).
Dunn (1997) developed a model about the relationship between the
person’s neurological thresholds and behavioral-self regulation strategies
continua (Brown, Tollefson, Dunn, Cromwell, & Filion, 2001). According to
this model, neurological thresholds exist on a continuum from low (little
stimulation to activate) to high (much stimulation for activation). In regard to
self- regulation strategies, people who use a passive strategy allow stimuli to
occur and then respond to them, while those people who use an active strat-
egy act to control the amount and type of sensory input that they receive
(Dunn, 2007). This model yielded four sensory-processing patterns:
People on the edge of the continuum and who show extreme sensory-
processing patterns may have elevated emotional burdens which negatively
influence their affective status, behavior, and adjustment to environmental
situations (Fisher, Murray, & Bundy, 1991; Kinnealey & Fuiek, 1999; Neal,
Edelmann, & Glachan, 2002; Pfeiffer, Kinnealey, Reed, & Herzberg, 2005).
Similar characteristics such as extreme responses to sensory stimuli; negative
affect, and behavioral difficulties are common among people with PTSD.
METHOD
Participants
After the study was ethically approved by the managing board of the clinic
in which the study was performed, sixty adults aged 24–62 were recruited.
The study group consisted of 30 people who suffered from PTS symptoms
following past traumatic events and who were treated in several clinics in
270 B. Engel-Yeger et al.
People without
PTS (N = 30) Controls (N = 30)
N % N % Chi-square/t-test
*p < 0.05.
Israel. The control group included 30 participants who were matched to the
study group by age, gender, and familial status but reported no history of
experiencing a traumatic event and did not have a diagnosis of PTSD or PTS
symptoms. Table 1 summarizes the socio-demographic information of the
participants in both cohorts.
An examination of Table 1 indicates no statistically significant differences
between cohorts regarding gender, age, and marital status. A significant differ-
ence was found with regard to years of education (t[43] = 2.87, p < 0.01) in that
the control group had more years of education (M = 16.37, SD = 1.94) than the
PTSD group (M = 14.32, SD = 3.28).
An examination of Table 2 shows that the participants in the PTS group
suffer from PTS symptoms following various traumatic events that occurred
at least a year ago, and more than half (56.7%) suffer from PTS symptoms
associated with traumatic events that occurred more than 10 years ago.
Variable Values N %
Measures
POST-TRAUMATIC STRESS DISORDER SYMPTOM SCALE (PSS-SR; FOA,
RIGGS, DANCU, & ROTHBAUM, 1993)
This is a 17-item interview assessing the severity of each of the DSM-IV PTSD
symptoms during the previous week. Each symptom is rated on a 4-point
scale from 0 (not at all) to 3 (5 or more times in a week). Sub-scales scores
are calculated by summing items in each of the PTSD symptom clusters: re-
experiencing, avoidance, and arousal. The scale had high internal consis-
tency (Cronbach’s alpha = 0.88) at both the 1st and 2nd waves and moderate
to high correlations with other measures of psychopathology. The PSS-SR
has high test–retest reliability (r = 0.80) and inter-rater reliability (k = 0.91).
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Internal consistency among the 17 items in the current sample was high
(Cronbach’s alpha = 0.88).
Procedure
After providing their consent to participate in the study, participants were
asked to participate in the study. Subsequent to explanation of the study’s
aims and their signing a participation consent form, the study/control group
272 B. Engel-Yeger et al.
Data Analysis
The Chi-square and t-test were used to examine the significance of differ-
ence between groups’ demographic data. A t-test was used to examine
whether significant differences exist between cohorts in AASP scores. The
relationship between AASP scores of people with PTS symptoms was exam-
ined using Pearson correlations.
A discriminant analysis was conducted in order to determine which
sensory-processing variables were the best predictors of group membership
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RESULTS
TABLE 3 Comparison of AASP Scores Between PTS Cohort (N = 30) and Healthy Controls
(N = 30)
Comparison % of participants
to the normal found above
Mean (SD) t-test df p AASP values typical range
Sensory sensitivity
PTS 48.22 (9.81) 4.69 58 <0.001 + 80.0
Controls 37.75 (7.28) = 26.7
Sensation avoiding
PTS 48.59 (10.13) 6.07 50 <0.001 + 83.3
Controls 35.19 (6.59) = 20.0
Low registration
PTS 38.65 (10.22) 3.78 48 <0.005 + 63.3
Controls 30.97 (4.44) = 20.0
Sensation seeking
PTS 40.38 (11.01) 2.98 38 <0.01 − 3.3
Controls 46.83 (4.43) = 0.0
Note. +“More than most people”: One standard deviation above AASP normal range; = “Similar to most
people”: Similar to AASP normal range; – “Less than most people”: One standard deviation below AASP
normal range
Sensory Profile and Post-Traumatic Stress 273
Controls PTS
Discriminant Analysis
One function predicted the categorization of participants with PTS symp-
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toms when compared with controls (Wilks’ Lambda = 0.59; p < 0.001). This
one function discriminated between participants with PTS symptoms while
they had higher scores (–0.8) and controls having lower scores (0.8).
The variable which made the greatest contribution to group member-
ship was Sensation Avoiding (loading = 0.98), followed by Sensory Sensitivity
(loading = 0.75) and Low Registration (loading = –0.61). The “Sensory Seeking”
loading was –0.48.
Based on this function, 77% of the participants overall, 73% of the
participants with PTS symptoms, and 80% of the controls were correctly
classified. A Kappa value of 0.53 (p < 0.001) was calculated, demonstrating
that the classification did not occur by chance.
DISCUSSION
This study characterized the sensory profiles of people with PTS symptoms
PTS symptoms.
under-sensitive. Paige, Reid, Allen, and Newton (1990) stated that, when
people with PTS symptoms face intense stimuli, they enter a state of protec-
tive inhibition in which the central nervous system responses and the intense
stimuli are dampened down to render them more tolerable. The low ten-
dency for registering and seeking sensations may support the numbness that
people with PTS symptoms may experience, and that was also reported in
brain imaging studies ( Jatzko, Schmitt, Demirakca, Weimer, & Braus, 2006).
The SPD of people with PTS symptoms, including inefficient modula-
tion and regulation of sensory input, may also explain their emotional out-
comes (Frewen & Lanius, 2006). According to the Emotional Processing
Theory (Foa & Kozak, 1986) post-traumatic symptoms express the inability
to sufficiently process the traumatic event, leading to pathological fear, which
includes: exaggerated responses, unrealistic representations and percep-
tions, negative image and stimulation avoidance. Foa, Ehlers, Clark, Tolin
and Orsillo (1999) described three cognitive schemes characterizing people
with PTS symptoms: “I am guilty,” “The world is dangerous,” and “I am
incompetent.” These schemes may cause the person to limit motivation to be
exposed to “the world,” including its sensory stimuli. These non-adaptive
cognitive responses and the greater reactivity to stimuli in participants with
PTS symptoms (McFarlane et al., 1993) coupled with the defect in early
stimulus gating (“shut down” mechanism) may be related to their impaired
perceptual evaluation of stimuli expressed via withdrawal from sensory stim-
uli or in a lower interest to meet sensory stimuli (lower seeking).Yet, when
meeting sensory stimuli, people either react with exaggerated responses
caused by hypersensitivity or reduced responses related to “shut down”
mechanisms and thus show low registration. It may be suggested that the
SPD among people with PTS symptoms contribute to pathological emotional
responses, some of which (for example, fear and higher anxiety level) were
reported to be closely related to SPD (Kinnealey & Fuiek, 1999; Meyer &
Carver, 2000; Neal et al., 2002).
These explanations are strengthened by the results of the discriminant
analysis as well as by the correlations found between sensory-processing
276 B. Engel-Yeger et al.
patterns and PTS clusters. For example, avoidance and intrusive thoughts
were mainly correlated with lower sensation seeking. The visual, auditory
and tactile modalities that were already found to be impaired in the sensory
processing of people with PTSD (Bleich, Attias, & Furman, 1996; Hendler
et al., 2003; McFarlane et al., 1993; McNamara, Lisembee, & Lifshitz, 2010)
were found to play a significant role in these correlations.
In summary, this study enriches the knowledge regarding SPD involve-
ment in the pathogenesis of PTS symptoms. The results illuminate the need
to further study the relationship between SPD and the emotional aspects of
people with PTS symptoms and also to apply this new knowledge to the
development and implementation of intervention programs and techniques.
This holistic viewpoint may increase treatment success and enhance abilities
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