Weighted blankets for anxiety are one of the most commonly searched terms when it comes to weighted blanket research. No one is immune from the wrath of anxiety (especially during a worldwide pandemic). People from all over are desperate to find holistic remedies to the unpleasant sensation that is anxiety, which is why we have compiled the data from three research articles that support the notion of weighted blankets alleviating anxiety symptoms. All three of these studies have a common theme: The dentist’s office.
Raise your hand if you have anxiety associated with the dentist. ✋. I don’t know what it is, but those noises and not being able to see what they’re doing freaks me out. I’m not alone; it freaks out a lot of people. Unfortunately, regular dental check-ups and various other dental procedures are essential to not only keep those pearly whites clean but also to avoid other health problems.
As older readers will know, the technology to make oral care less unpleasant has improved a lot over the years. In some cases, sharp tools have been replaced with somewhat-less-uncomfortable narrow streams of high-pressure water. The stuff they use to polish your teeth has a somewhat-less-horrible flavor added to it. And, while the kids won’t remember this, it used to be that you had to wait anxiously for the x-rays to be developed before you knew if all was well. Now the waiting in most dentist offices is down to the time it takes for the technician to get the images up on the computer screen.
But what about the anxiety that you feel during the procedure itself? Have any technologies come along to help with that? The good news is there may be an easy solution to help alleviate some of that dreaded anxiety: Weighted blankets.
The Autonomic Nervous System & Anxiety
Before we dive into the research on weighted blankets for anxiety and dental procedures, let us first discuss the autonomic nervous system. The autonomic nervous system plays a large role in anxiety and the study we will be dissecting today, so it’s important to have some base knowledge, and also it’s fun to learn new things.
The autonomic nervous system is responsible for controlling our unconscious bodily functions such as our heartbeat and breathing. Now, there are two subgroups associated with the autonomic nervous system: the sympathetic nervous system (fight or flight response) and the parasympathetic nervous system (bringing the body to rest after the stress has occurred). These two systems oppose each other to keep our bodily functions in balance. How does this relate to anxiety?
The output from the autonomic nervous system can be used to measure symptoms of anxiety. One can measure anxiety levels through electrodermal activity, or the amount of sweat a person’s body is producing (more sweat = anxiety). Anxiety can also be determined by measuring the frequency of shifts between one’s sympathetic nervous system (remember that’s the flight or fight response) and parasympathetic nervous system (the part that attempts to restore your body back to a calm state). Someone whose body stays within a sympathetic state longer is experiencing longer bouts of anxiety, which puts a lot of stress on the body.
Learn more about the autonomic nervous system on YouTube.
How The Two Parts Of The Autonomic Nervous System Work Together
Let’s go through an example. Imagine you are about to take a math test, which is pretty stressful for most people. Your sympathetic nervous system would kick in, the fight or flight response. You start the test, and as you get into it, your parasympathetic nervous system kicks in to balance out the sympathetic response. This calms you down and allows you to focus.
We don’t want our sympathetic nervous system to work too long. Why? Think about how you feel in that fight or flight state: increased heart rate, sick to your stomach, etc. Now imagine feeling those symptoms all the time. It would suck for sure, but it also takes a huge toll on your health and can even shorten your lifespan.
3 Studies on How Weighted Blankets for Anxiety Can Alleviate Symptoms
Now that we have established a base understanding of the autonomic nervous system, let’s dive back into today’s research. Physicians in Taiwan were interested in asking, based on prior research, if Deep Pressure Stimulation (DPS) reduces the symptoms of anxiety in various dental procedure situations. DPS is exactly what it sounds like: pressure applied to the body, along the lines of what you experience when you get a good, satisfying hug, for instance. They couldn’t hug the patients during dental procedures, so they used other sources of DPS, including a weighted blanket and papoose board.
1. Weighted Blanket Use in Regular Dental Check-ups
Does having a weighted blanket reduce the anxiety that patients experience during a checkup? Chen et al. (2013) decided to find out.
First, let’s look at the method. The researchers recruited 15 women at a University in Taiwan, all of whom underwent a normal dental checkup.
Fifteen might not seem like a lot, but the authors present an analysis that shows that this is enough participants to get sufficient data to run the statistical analyses required for the research.
In addition, it’s important to bear in mind that there were a number of requirements that participants had to meet in order to be included. You can have a look at the paper for all of them but, to give you a sense, participants 1) could not have used a weighted blanket before, 2) had to be able to understand the instructions, 3) could not have had caffeine or taken medication on the day their treatment took place and, importantly, 4) had to have had a normal night’s sleep before the study took place.
All of these patients first spent five minutes in the dentist chair, with nothing being done to them, and a number of “baseline” measurements were taken before their procedure to gauge anxiety levels before entering the dentist’s office. These measurements are crucial to see if there is a change from the beginning of the procedure compared to later. We return to this measure below.
After that, the dental treatment began, and participants were assigned randomly to one of two conditions. Roughly half of the participants had the weighted blanket placed over them, and it was kept there for five minutes. After those five minutes were up, the blanket was removed. For the rest of the participants, the first five minutes were spent without the blanket on them. Then the blanket was placed on them for five minutes after that.
For the scientifically-minded readers, it’s worth explaining why this is important. Suppose that the researchers ran this study and didn’t use this procedure. Instead, suppose everyone had the blanket placed on them for five minutes and then went five minutes without it. Now, if it were found that anxiety was lower with the blanket than without it, could you conclude that this was because of the blanket?
No. It could be that people get more anxious over time, which isn’t that hard to imagine. In that case, it wasn’t the blanket that made them less anxious; it was just that less time had passed. By having some participants have the blanket on them first, and some have it on them second – what is called counterbalancing – the researchers can eliminate that possibility.
Before continuing, it’s worth a word or two about the blanket. First, the researchers were sensitive to the comfort of the patients: the side facing the participant was soft cotton, so no one would have to have an irritating texture against any exposed skin. Next, it’s important that the weight of the blanket could be adjusted for each patient. Weights could be added to various compartments in the blanket so that it was distributed around the blanket instead of being focused all in one place. Weights were adjusted so that the blanket was, in total, just under ten percent of the participant’s total body weight. This ratio was chosen based on prior research investigating the effects of weighted blankets.
To make this study better in terms of methodology, participants should have been given an unweighted blanket. Especially if the weights of these blankets were adjustable, they could have simply removed the weights in each condition. By doing this, both conditions would have had a blanket, and there would be better insight on if the weight aspect of the blanket was effective, rather than just having a blanket against the skin.
Measures Used
They used two different kinds of measurements, physiological and self-report. The physiological measures were, first, electrodermal activity (EDA) – essentially how sweaty one’s hand gets – and, second, heart rate variability (HRV) – roughly, how rapidly participants’ heart rate changes. (The intuition that helps here is to consider someone whose heart rate jumps, but then returns quickly to normal after the danger passes. Someone who is cool-headed would show high HRV, whereas someone who is under physical (exercise) or psychological stress would show a low HRV. In terms of the autonomic nervous system the HRV is measured with high-frequency and low-frequency percentages. A higher high-frequency percentage indicates a larger presence of parasympathetic nervous system activity (the balancing response); a higher low-frequency percentage sympathetic nervous system activity (fight or flight response).
In addition, there were self-report measures, the Numeric State Anxiety Scale (NSAS) – basically, a zero to ten scale asking the patient how anxious they are – and the Dental Anxiety Scale (DAS) – a questionnaire with four items specifically asking participants their anxiety relating to their dental anxiety.
It’s important to get objective and subjective data (quantitative and qualitative data), a process often called mixed methods, because they compliment each other and provide a full picture of the effectiveness of weighted blankets.
Results & Interpretations
Changes in Self-Perceived Anxiety
Changes in Heartrate
- When the sympathetic nervous system (fight or flight) is activated, people experience the physical sensations of anxiety including increased heart rate, more sweating, an uneasy stomach, etc. Sound familiar?
- At that point, the parasympathetic nervous system would kick in to help regulate undesirable body responses that the sympathetic nervous system generated so we could perform in the situation better (or sleep!). For example, the parasympathetic nervous system would lower the heart rate.
- Again, remember, we don’t want our sympathetic nervous system to be engaged for a long time because it keeps our heart rate up longer and could lead to a shorter life, and we want to live FOREVER. [Or as long as possible ;)].
- The participants with the weighted blanket had lower anxiety physically and mentally while the parasympathetic nervous system (calming, healing, and digestion) was not active. The control participants had lower anxiety from parasympathetic activation. Both control and weighted blanket users had similar lowered anxiety during treatment. The only difference was that the weighted blanket people had a reduction of anxiety while still being in “fight or flight” mode with sympathetic nervous system dominance.
- This is amazing! Basically, with the weighted blanket people, the body controlled the mind. Whereas in the control, the mind controlled the body per usual.
The results for the physiological measures were all similar, so let’s just look at one of them, heart rate. As you can see in the accompanying Figure, patients’ heart rates were high, around 90 beats per minute, while they were awaiting treatment. Their heart rate decreased a little bit during treatment without the blanket but, crucially, their heart rate went down, even more, when they were being treated while they were under the weighted blanket. Recall from the discussion above that this isn’t due to an order effect – the data here include both participants who had the blanket on them first as well as those who had it on them second. In short, the blanket caused a reduction in heart rate, one measure of anxiety. Other measures showed similar effects, and for those who want to study the original paper, you can read it here.
In terms of the questionnaires, while the researchers did not report any significant differences across time during the patients’ visit, one provocative finding is that during the treatment phase with the blanket, all but one participant indicated no anxiety at all on the NSAS scale! Of course, this is why physiological data are gathered: questionnaires, which are cruder measurement tools, aren’t always sensitive enough.
- Basically, the authors found that with a weighted blanket, you may not experience the physical consequences associated with stressful situations because your sympathetic nervous system has not been activated, even if you are stressed for a long time. (:
- Despite being aware of a stressful situation, enhancing your parasympathetic response with a weighted blanket can calm your symptoms and may allow you to perform at your best.
2. Papoose Board Use with Dental Patients who had Special Needs
The following year, the same group published another paper concerning deep pressure stimulation and anxiety during dental procedures (Chen et al., 2014). The physicians sought to determine if a papoose board (similar to a weighted blanket for anxiety) would be an effective mechanism to alleviate anxiety in dental patients who had special needs, and thus make appointments more attainable to this population.
Nineteen participants were recruited from a special care clinic and needed to meet the following criteria to participate in the study:
- No injuries to their hands (to allow for the measurements to adhere to their fingers).
- Familiarity/ comfortability with a Papoose Board.
- No other prior participation within a rehabilitation or drug study.
- Needed to require dental treatment that did not include the need for anesthesia or sedation.
- No medication or caffeine use the day of the study.
- No history of physical ailments such as asthma, seizures, or circulation restrictions.
- The participants could not have so much agitation and behavioral concerns that they would not be able to participate appropriately.
Level of Disability Breakdown for Participants
Measures
Physiological Measures: Electrodermal activity and Heart Rate Variability (see the above study for an explanation on these measures).
Behavioral Measures:
- Numeric State Anxiety Scale: Caretakers scored their patient’s perceived anxiety prior to and after the dental treatment; the higher the score = the more perceived anxiety.
Children’s fear survey schedule-dental subscale: Caretaker also scored their patient’s perceived “fear” as another way to test anxiety, as at the time there were no reliable surveys to assess people who are disabled. This survey included 15 questions and a higher score also denoted more anxiety.
Procedure
Breakdown of Dental Procedures Being Completed for Participants
dGiven that papoose boards are not easily taken on and off as (compared to a weighted blanket), the experimental design was performed as follows:Prior to coming into their dental appointment, their caregivers filled out a quality of sleep checklist and an anxiety questionnaire based on what they knew about their patient. These data acted as psychological baselines.
The participants laid on their back in the dental chair for five-minutes → The participants utilized the Papoose Board for five minutes without any dental procedure → The dental procedure occurred with the participant still utilizing the Papoose board and lasted approximately 5-20 minutes dependant upon the participants individual needs → The participants utilized the Papoose Board for five minutes post-dental procedure while their caregivers filled out another anxiety questionnaire to determine anxiety shifts between treatment and post-treatment.
Results
- Data were split into two groups based on autonomic nervous system response trends: Some participants had a positive trend and others had a negative trend in terms of autonomic nervous system activity.
- *Data normalization takes place to reduce repeated/ redundant data (which can skew results or give inaccurate readings) or to bring data into alignment so that they can be compared against each other.*
Positive Trend Data Results
- The raw data (not normalized to baseline) showed no significant shifts in heart rate variance and skin conductance with the Papoose Board.
- However, after the data were normalized to baseline, there was a noticeable difference noted with a Papoose Board in place.
High-Frequency Percentage shifts between the Phases
Low-Frequency Percentage/ High-Frequency Percentage Ratio Shifts Between the Phases
- The low-frequency percentage for HRV indicates the presence of sympathetic nervous system activity. (Ex: more stress = higher percentage of HRV percentage). There is speculation that the low-frequency percentage may be linked to both parasympathetic and sympathetic, however.
- The high-frequency percentage for HRV presence of parasympathetic nervous system activity.
- The ratio of high frequency and low-frequency percentages are thought of as an indication of parasympathetic/ sympathetic balance, however, there is some controversy surrounding these data accuracies.
Negative Trend Data
- The raw data (not normalized to baseline) showed no significant shifts in heart rate variance and skin conductance with the Papoose Board.
- However, after the data were normalized to baseline, there was a noticeable difference noted with a Papoose Board in place.
- It is interesting to note that skin conductance values increased for each condition, which marks for an increase in sympathetic nervous system activity (more stress).
Skin Conductance Data Shifts Between the Phases
Low-Frequency Percentage/ High-Frequency Percentage Ratio Shifts Between the Phases
- Essentially, there was some evidence to suggest that the Papoose Board regulated the autonomic nervous and increases parasympathetic activity response.
- The Negative Trend group appeared to have a more sympathetic nervous system dominance. It would have been interesting for the authors to include more of a breakdown on the different demographics between the positive trend and negative trend group so that we could see what differences led to the different results.
Notes about methodology: Due to the special nature of this population, the papoose board was used throughout the duration of the procedures, so it is difficult to determine if there would have been a difference had the Papoose board not been used. This creates a flaw in the validity of these results, and although there are changes noted, we cannot be sure the Papoose board is the cause due to the lack of information had a deep pressure stimulation mechanism not been used.
3. Weighted Blanket Use in Wisdom Teeth Surgery Patients
The most recent study by this group, Chen et al., (2016), sought to determine if weighted blankets would provide an element of relief for patients undergoing wisdom teeth surgery. Personally, I have had my wisdom teeth out, and it was by far one of the most anxiety-provoking experiences of my life, so I know this research is highly applicable to many, many individuals, as wisdom teeth surgery is becoming more of a requirement.
Sixty participants, who needed wisdom teeth surgery, were recruited for this study. They needed to meet the following criteria to be eligible:
- No history of disease that may complicate surgery.
- Not currently pregnant.
- Smoking at least less than 10 cigarettes a day.
- Did not have any sleep disturbances.
- Could not refuse to sign informed consent (which is something all participants for every single study need to sign in order to participate, so this isn’t exclusive to this study’s design).
Physiological Outcome Measure
Heart Rate Variance: See the first study dissected above for a description
Procedure
In a single-blind crossover study, the participants were assigned to either a treatment or control group. (A crossover study is where every participant is exposed to each condition. A single-blind occurs when participants are not made aware of which condition they are receiving at each time.) In both groups, the participants laid down in the dental chair and baseline measurements were performed (T0). Physiological data were then obtained at two-time points after the procedure began (Tx1 and Tx2) – the switch occurred during a brief pause approximately half-way through the procedure. In the control group, participants did not receive a weighted blanket and underwent wisdom tooth extraction. The treatment group did not receive a weighted blanket during Tx1 but did receive one during Tx2.
Unlike the other studies, the amount of time for each phase was not mentioned in the research article due to varying lengths of each unique extraction. Also, you may have noticed that the only measurement used was a physiological measure, my best guess for this is because anesthesia was used, so participants would not be coherent enough to complete an exit survey after completing a survey and having data from merely a pretreatment survey would not serve any use, as there would be nothing to compare it to.
Results
- As expected, during Tx1, no differences were observed between the control and treatment groups.
- However, the researchers reported a significant increase in patients High Frequency-HRV, upon application of the weighted blanket during Tx2 compared to the control group. Meaning, parasympathetic activity significantly increased when the weighted blanket was applied (stress decreased).
- They also reported a significant intragroup increase in High-Frequency-HRV, in the treatment group between Tx1 and Tx2, demonstrating the application of the blanket part way through the procedure produced an immediate effect on the patient.
TX2 High-Frequency Percentage Data Between Phases
Values Represent Mean DataTX1 and TX2 Data Between Phases
Thus, it can be concluded based on the heart rate variance data that the weighted blanket may have increased the parasympathetic nervous system’s activity.
- Their data showed that the wisdom teeth procedure did increase sympathetic nervous system activity, despite anesthesia being given. Not surprising, as it was a stressful experience.
How Does All The Information From The 3 Studies Relate To Me?
By conducting similar studies across various procedures and populations, the researchers were able to build credibility for weighted blankets as an intervention for dental anxiety. Average healthy adults (male and female) benefitted from the deep pressure stimulation and those who were cognitively challenged also experienced benefits.
These particular studies cannot speak for anxiety experienced in other settings, but it could offer insight into experiences people will have with other medical appointments. Deep pressure stimulation in the form of weighted blankets and a papoose board worked pretty quickly with reducing anxiety. Someone who has a fear of the doctor could obtain alleviation by utilizing a weighted blanket that is fitted appropriately to them.
More importantly, for those of you that just can’t get to sleep at night because of all those pesky symptoms of anxiety, the weighted blanket could eliminate those symptoms allowing you to restfully fall asleep quicker because you’ve tricked your brain into thinking that everything is chill.
Thoughts From Our Authors on Weighted Blankets for Anxiety
Veronica’s Notes:
The three studies addressed dental appointments and anxiety utilizing the autonomic nervous system; however, they all had differing methodologies which makes it difficult to compare all three.
The first study dissected (anxiety with a sample of only females during a routine dental check-up) only included females. While it may be safe to assume the results are generalizable to males, there is anecdotal evidence that females are generally more anxious compared to males so we cannot generalize for sure without more research.
Within the study addressing patients with special needs, as reported earlier, the control for deep pressure stimulation was not adequate, in my opinion. They had the participants utilize the papoose board for three out of the four stages, including the duration of the dental procedure. Though they noted shifts, these data cannot give us insight on differences had the participants not had a papoose board during the procedure.
The final study dissected (wisdom teeth extraction in a general population sample size) only included qualitative data, if included, is something that would undoubtedly strengthen the methodology. Although I understand the potential reasoning for the omission of these data, the inclusion would offer us better insight on the perceived anxiety levels of those who participated, as perception may be different than physiological which we discovered in the research studying those who had special needs. If you recall, the caregivers’ perceptions of their patient’s anxiety levels did not match the physiological data, as they believed their patient was anxious throughout despite the physiological evidence showing otherwise.
Overall the researchers appear credible, they performed their research within a University, and it was funded by a general grant that was not aimed towards advertising weighted blankets.
Personally, I would have liked to see some qualitative data for the weighted blankets, asking the participants about their general dentist anxiety; maybe asking a question as to why they fear the dentist. There wasn’t anything mentioned if the participants had dental anxiety or just signed up willy-nilly. This could offer more evidence and generalizability if this were to be included in the study’s protocol.
I would have also liked for the authors to include the measurement of time in the study so that we could know how quickly the blanket started working, but hey that’s why research is an ongoing process and continues to evolve.
Robert’s notes (only accounts the first study discussed in this article):
First, results from the self-report scales are reassuring on one point: before getting their teeth worked on, people are anxious! This indicates that the researchers were clever to use dental treatment as a setting for this work. It does seem to be a context in which people by and large experience anxiety.
Second, let’s return to the point above about the order that patients had the blanket on versus off, recall that the researchers eliminated the possibility that it was due to the simple passage of time. Therefore, because this is an experimental study, with random assignment, the results of this study support the view that the weighted blanket causes a reduction in these measures of anxiety. That’s an important point. Most people know that simply finding a correlation doesn’t let you conclude that one thing caused another. Here, because it was an experiment, we’re entitled to start talking about causality.
Of course, as with all good research, these findings raise as many questions as they answer. For example, prior research has shown that weighted blankets are effective for people with certain kinds of disorders (Mullen et al., 2008). This study was conducted on people with no such disorders. That implies that weighted blankets might have similar effects on both those with and without psychological disorders. Additional research will be needed to address this question. Similarly, recall that there were a number of criteria that had to be met for participation. Would the same results have been obtained if the patients did not meet those criteria? From this study alone, we don’t know.
As you can tell, there is a great deal more work to be done!
Ryan’s Notes:
Interestingly, in the 2016 study, the authors did not report using unweighted blanket controls. In this way, their control groups did not receive any sort of blanket. Previous studies of ADHD using weighted vests, used the appropriate unweighted vest controls. Alternatively, the authors attempted to normalize for this by having two treatment phases. This design produced some interesting data that suggests that weighted blankets may enhance parasympathetic activity.
Nevertheless, the greatest limitation to the 2013 and 2016 studies is the absence of a non-weighted blanket control. In the 2016 study, this ideally would have been applied to the control group during Tx2. Without this control, one can speculate that the observed change in HF-HRV was simply due to the notion that someone was caring for the patient by applying a blanket. Alternatively, while the temperature in the room was controlled for, perhaps the weighted blanket increased the patient’s skin temperature and that caused the observed change in HF-HRV.
Overall, this is very interesting and encouraging research that suggests weighted blankets may modify autonomic nervous system activity.
References
Chen, H. Y., Yang, H., Chi, H. J., & Chen, H. M. (2013). Physiological effects of deep touch pressure on anxiety alleviation: The weighted blanket approach. Journal of Medical and Biological Engineering, 33(5), 463-470.
Chen, H., Yang., Chi H., & Chen, H. (2014). Physiologic and behavioral effects of papoose board on anxiety in dental patients with special needs. Journal of the Formosan Medical Association, 113, 94-101.
Chen, H., Yang, H., Meng, F., Chan, P., Yang, C., & Chen, H. (2016). Effects of deep pressure input on parasympathetic system in patients with wisdom tooth surgery. Journal of the Formosan Medical Association, 115, 853-859.
Mullen, B., Champagne, T., Krishnamurty, S., Dickson, D., & Gao, R. X. (2008). Exploring the safety and therapeutic effects of deep pressure stimulation using a weighted blanket. Occupational Therapy in Mental Health, 24(1), 65-89.
Meet Our Contributing Authors
Robert Ph.D: Robert holds a Ph.D in psychology as well as a Masters of Public Administration. His research focuses on human social behavior, especially cooperation, moral judgment, and political attitudes. During his career as a social scientist, he obtained the rank of full professor, writing over 100 peer-reviewed articles and book chapters. Google scholar shows that his work has been cited more than 10,000 times. He currently works as a freelance writer and consultant.
Ryan M.D-Ph.D: Pending Biography
