Recently I met with one of the most experienced and skilled Mental Health Clinical Nurses in Queensland – Rachel Woolcock. Rachel has over 20 years experience with Mental Health including acute care and homeless health. Rachel has undertaken Sensory Modulation Brisbane training and applies Sensory Modulation strategies regularly when working with very distressed or agitated clients. Rachel identifies that one of the most beneficial techniques for this client group has been cooling down with the dive reflex response. In her experience, Rachel has found that it is important to acknowledge that the technique sounds 'unusual' or 'a bit funny' but continues to encourage people to try it, with positive outcomes!

Cooling down options include:

· Zip lock bags with cold water,

· Cold slushies

· Cold water in sinks,

· Cold stress balls

· Chill towels

· Cold face washer/face cloth/flannel

· Using ice sprays

· Disposable ice packs

· Cold Shower

· Jumping into a cold pool or ocean

· Cold drink

· Ice bucket challenge

Cold temperature can be useful for several reasons:

· It can cool the body when it is hot (eg when anger flushes the face and hands).

· As a calming strategy when anxious or panicking

· As a calming strategy when angry or feeling destructive or aggression.

· Cool water in conjunction with breath holding can invoke the mammalian dive reflex and reduce the heart rate. (this makes it unsuitable for people with heart conditons or anorexia nervosa without prior medical clearance. If you have a medical condion – ask your Doctor if this is ok for you)

· As an intense sensation, it can be an alternative to self harm.

· The sensory input can feel grounding and reduce dissociation.

· To cease hallucinations (we have had a couple of clients try this and found it is the most useful technique that they have found)

How to use cold water to chill:

· The cold items can be held in the hands, or applied to the face or the whole body. Each person can think about what will work for them and also how much cold that they are comfortable with using.

· Using the icy water on the face can be an intense sensation but can provide a very quick calm down strategy.

· Icy water can be either applied from a bowl or applied to the area under the eyes in a zip lock bag filled with water. The breath is then held. The combination of holding our breath and applying icy water activated the mammalian dive reflex. This reflex has the biological function of decreasing our heart rate to preserve the body and brain if a person falls into the icy water. By decreasing the heart rate and increasing carbon dioxide levels in the blood *by holding our breath) our feelings of calm and grounding increase. This technique is used within Sensory Modulation and also within Dialectical Behaviour Therapy as a distress tolerance skill (TIP skill) .

Further suggestions on Sensory Modulation items are in the Sensory Modulation Resource Manual or in the online course:

Using Sensory Modulation Course

Pre-recorded Videos, slides and downloadable infographics and handouts. IT is 5 hours CPD:

Sensory Modulation Resource Manual

DBT skill training handouts and worksheets Linehan (2014)

Intense Sensations Handout

Dive Reflex Blog

Image description: young woman with dark hair holding a purple gel mask over her face. She would be doing this to calm herself when distressed.