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Healthcare Practioner 
QUICK REFERENCE GUIDE

Evidence-Based Resource for Clinical Decision-Making

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WHAT IS FLOTATION-REST?

Flotation-REST is a non-pharmacological intervention involving sensory reduction in a specialized tank containing skin-temperature (35°C) water saturated with magnesium sulfate (Epsom salt). High buoyancy allows effortless floating, while reduced sensory input (darkness, sound attenuation) facilitates deep relaxation and parasympathetic nervous system activation.

 

Mechanism of Action:

  • Parasympathetic nervous system activation

  • Reduced sensory input allowing nervous system reset

  • Decreased functional connectivity between pain and emotional processing networks

  • Possible transdermal magnesium absorption

  • Enhanced interoceptive awareness

EVIDENCE-BASED CLINICAL APPLICATIONS

Primary Indications Supported by RCT Evidence

1. GENERALIZED ANXIETY DISORDER (GAD)

Evidence Level: RCT with waitlist control

Key Study: Jonsson & Kjellgren (2016) - BMC Complementary and Alternative Medicine

  • Design: RCT (n=50), 12 sessions over 7 weeks

  • Primary Outcome: GAD-symptomatology significantly reduced in treatment group (p<.001) vs. waitlist control (p>.05)

  • Remission Rate: 37% achieved full remission in treatment group vs. 14% in control

  • Effect Size: ηp² = .062 for GAD symptoms

  • Secondary Benefits:

    • Sleep quality: 43% achieved "good sleeper" status (ηp² = .16)

    • Depression: 42% full remission (ηp² = .34)

    • Emotion regulation difficulties: Significant improvement (ηp² = .16)

  • Durability: Effects maintained at 6-month follow-up (except depression)

  • Safety: No adverse events reported

Clinical Note: While GAD core symptom (pathological worry) showed limited response, physiological manifestations (restlessness, muscle tension, fatigue) demonstrated robust improvement.

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2. ANXIETY SENSITIVITY & ACUTE ANXIETY

Evidence Level: Multiple RCTs

Key Study: Feinstein et al. (2018) - Biological Psychiatry: Cognitive Neuroscience and Neuroimaging

  • Design: RCT comparing 90-minute float vs. relaxing film condition

  • Results: Float condition produced significantly greater reductions in:

    • State anxiety (STAI): Large effect size

    • Muscle tension: Significant reduction

    • Blood pressure: Both SBP and DBP decreased

    • Enhanced cardiorespiratory interoceptive awareness

  • Safety: No serious adverse events across 50 participants

  • Clinical Significance: More severe baseline anxiety associated with greater benefit

Additional Evidence:

  • Garland et al. (2024): 6-session protocol showed 85-89% adherence, no serious adverse events

  • Positive experiences endorsed more commonly than negative, with higher intensity ratings

 

3. CHRONIC PAIN

Evidence Level: Mixed findings from RCTs

Key Study: Loose et al. (2021) - JAMA Network Open

  • Design: RCT (n=99) with placebo and waitlist controls, 5 sessions

  • Long-term Results: No significant between-group differences at 1, 12, or 24 weeks

  • Short-term Results: Significant within-group improvements immediately post-session:

    • Pain intensity: -17.0 points (p<.001)

    • Anxiety: -10.1 points (p<.001)

    • Relaxation: +23.9 points (p<.001)

    • Pain area: -3.6% (p<.001)

Earlier Studies (Pre-2021):

  • Kjellgren et al. (2001, 2009): Multiple studies showing benefits for stress-related muscle pain

  • Bood et al. (2005-2007): 12-33 sessions demonstrated sustained improvements in pain, anxiety, depression, sleep quality

Clinical Interpretation: Evidence suggests:

  • Acute session benefits are robust

  • Long-term benefits may require >5 sessions (earlier studies used 12-33 sessions)

  • Best suited for stress-related and musculoskeletal pain conditions

Float PROTOCOLS

CHRONIC PAIN

Intensive Phase:

  • Frequency: 2-4 sessions per week

  • Duration: 90-minute sessions recommended

  • Course Length: Up to 1 month (8-16 sessions)

 

Maintenance Phase:

  • Frequency: 1-2 sessions per month

  • Duration: 90 minutes

  • Indication: Continue as long as therapeutic benefit maintained

 

ANXIETY DISORDERS

Initial Phase:

  • Session 1: 60 minutes (assess tolerance)

  • Subsequent Sessions: 60-90 minutes based on patient preference

  • Frequency: 1-2 sessions per week

  • Course Length: Until noticeable anxiety reduction (typically 6-12 sessions)

 

Maintenance Phase:

  • Frequency: 1-2 sessions per month

  • Adjustment: Add extra sessions during high-stress periods

  • Duration: 60-90 minutes

SAFETY PROFILE

Systematic Review Evidence

Multiple RCTs report no serious adverse events associated with flotation-REST.

Common Minor Side Effects (typically mild):

  • Transient skin itchiness

  • Dry mouth

  • Saltwater contact with eyes (preventable with proper instruction)

  • Discomfort if saltwater contacts open wounds or cuts

Positive Effects (More Common Than Negative): Studies consistently show positive experiences endorsed more frequently and at higher intensity than negative experiences. Most participants (>95%) express desire to repeat treatment.

 

CONTRAINDICATIONS

Absolute Contraindications

  • Active psychosis or history of severe psychotic episodes

  • Uncontrolled epilepsy

  • Open wounds or active skin infections

  • Severe claustrophobia (unless modified protocol with open tank/light options)

  • Acute intoxication (alcohol or substances)

 

Relative Contraindications (Requires Physician Evaluation)

  • Recent surgery (within 2-4 weeks, depending on site)

  • Severe uncontrolled cardiovascular disease

  • Pregnancy (particularly first trimester - consult OB/GYN)

  • Pacemaker or implanted cardiac device (evaluate case-by-case)

  • History of dissociative disorders (requires close monitoring)

  • Recent significant trauma or PTSD (may require modified introduction)

  • Active suicidal ideation (requires stabilization first)

 

Special Populations

Pregnancy: Limited evidence; consult obstetrics. Theoretical benefits for stress/pain management but requires individualized risk assessment.

Elderly: Generally safe; consider assistance entering/exiting tank and cardiovascular clearance.

Pediatric: Minimal evidence; not routinely recommended for patients <18 years.

CLINICAL DECISION ALGORITHM

Step 1: Screen for Indications

Consider Float Therapy for:

  • GAD with prominent somatic symptoms

  • Chronic stress-related muscle pain

  • High anxiety sensitivity

  • Patients seeking non-pharmacological options

  • Adjunct to CBT or other psychotherapy

 

Step 2: Assess Safety

Review contraindications (see above)

  • Absolute contraindications → Do not refer

  • Relative contraindications → Evaluate risk/benefit, consider consultation

 

Step 3: Set Expectations

Educate patient on:

  • Treatment involves floating in sensory-reduced environment

  • Typical session: 60-90 minutes

  • Course of treatment: 6-12 sessions for anxiety, 8-16 for pain

  • Evidence shows short-term benefits; long-term effects require maintenance

  • Not a substitute for evidence-based first-line treatments

 

Step 4: Provide Referral

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  1. Direct Referral to Kairos Float & Wellness Studio

    • Greenville, NC 27858

    • Contact: Rebecca.Harris@kairosfloats.com

    • Evidence-based protocols

    • Clinical-grade sanitation (AOP system, FDA Class 1 drinking water standards)

    • Two Deluxe Float Suites (6.5' wide, 8' long, 7.5' ceilings)

  2. General Float Center Guidance

    • Verify sanitation standards (UV, ozone, filtration systems)

    • Confirm staff training in clinical applications

    • Ensure accessibility features (intercom, lighting control, emergency protocols)

    • Ask about protocols for anxious/clinical populations

BILLING & INSURANCE CONSIDERATIONS

Current Status (2024-2025):

  • Float therapy is not currently covered by most insurance plans

  • No established CPT codes for flotation-REST

  • Patients pay out-of-pocket (typically $50-100 per session)

  • Some HSA/FSA accounts may reimburse with physician letter of medical necessity

 

Documentation for Medical Necessity, Include in referral:

  • Primary diagnosis (ICD-10 code)

  • Failed or suboptimal response to conventional treatments

  • Contraindications to pharmacological options (if applicable)

  • Clinical rationale for non-pharmacological intervention

WHEN TO CONSIDER FLOAT THERAPY

Strong Consideration

  • GAD with inadequate response to first-line CBT

  • Patient preference for non-pharmacological intervention

  • Chronic pain with prominent anxiety/stress component

  • Multiple failed medication trials

  • Contraindications to standard treatments

 

Adjunctive Consideration

  • Alongside CBT for anxiety disorders

  • Stress management for chronic medical conditions

  • Athletic recovery and performance enhancement

  • Burnout prevention in high-stress occupations

  • Sleep disturbance secondary to anxiety

 

Low Priority

  • Acute psychiatric crisis (stabilize first)

  • When evidence-based first-line treatments haven't been tried

  • Severe depression without anxiety component

  • Primary pathological worry without somatic symptoms

MONITORING & FOLLOW-UP

Recommended Assessment Schedule

 

Baseline:

  • GAD-7 (anxiety) or VAS (pain)

  • Document current medications

  • Establish treatment goals

 

Week 4 (Mid-treatment):

  • Brief symptom check

  • Assess tolerance and adherence

  • Address any concerns

 

Week 8-10 (Post-treatment):

  • Repeat baseline measures

  • Assess clinical significance of change

  • Determine need for maintenance protocol

 

3-6 Months:

  • Long-term follow-up

  • Reassess need for additional sessions

KEY TAKEAWAYS

  • Flotation-REST has Level 1 evidence (RCT) for anxiety reduction, particularly GAD with somatic symptoms

  • Safety profile is excellent - no serious adverse events reported across multiple RCTs

  • Typical protocol: 6-12 sessions (60-90 min), 1-2x/week, then maintenance

  • Best candidates: GAD, high anxiety sensitivity, stress-related pain, patients seeking non-drug options

  • Absolute contraindications: Active psychosis, uncontrolled epilepsy, open wounds, severe claustrophobia

  • Not covered by insurance - patient pays out-of-pocket ($50-100/session), some float centers accept HSA/FSA (Kairos is HSA/FSA Eligible)

  • Evidence strongest for short-term benefits - long-term effects require maintenance sessions

Bridging the gap between research evidence and clinical practice

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For physician consultations, research collaborations, or CME information:
Dr. Rebecca Nolan Harris, PhD (Physiology)
Founder, Float Therapy Medical Education Initiative
Greenville, NC

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This guide is intended for educational purposes and to facilitate informed clinical decision-making. Individual patient care decisions should be based on comprehensive clinical assessment and shared decision-making with patients.

Connect with Us

Email: info@floatmedicineinstitute.org

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Copyright Notice: © 2025 Kairos Float & Wellness Studio / The Float Therapy Medicine Institute. All rights reserved.

 

Medical Disclaimer: This website provides educational information for healthcare professionals. It is not intended to provide medical advice or replace clinical judgment. Healthcare providers should use their professional discretion when considering treatment recommendations for individual patients.

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