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The relationship between sensory processing sensitivity and psychological distress: A model of underpinning mechanisms and an analysis of therapeutic possibilities

The relationship between sensory processing sensitivity and psychological distress: A model of underpinning mechanisms and an analysis of therapeutic possibilities
In the highly sensitive person, cognitive reactivity might be a driving mechanism in the relationship between sensory processing and psychological distress, write Hedda Bratholm Wyller and colleagues.
COGNITIVE REACTIVITY: The concept of cognitive reactivity refers to both dysfunctional thought content and maladaptive thought processes, write Hedda Bratholm Wyller and colleagues. Illustration: Aurora Nordnes. The relationship between sensory processing sensitivity and psychological distress: A model of underpinning mechanisms and an analysis of therapeutic possibilities

The concepts of sensory processing sensitivity (SPS) and the highly sensitive person (HSP) were introduced to the public and academic circles about two decades ago SPS is described as a genetically-based personality trait involving hypervigilance to subtle changes in sensory signals and a tendency to be more easily overwhelmed when in a highly stimulating environment (). SPS is characterised by increased emotional reactivity, leading to attenuated cognitive functioning and problems in effectively selecting and deselecting stimuli. Initially, the trait was presented as dichotomous (either present or absent) and proposed to be present in about 15-20% of the population. This percentage - the HSPs are said to be more easily affected than non-HSPs by a wide range of different sensory stimuli (e.g. loud noise, changes in temperature) and to suffer from impoverished top-down processing ().

The validity of the SPS construct has been questioned. While some claim that SPS captures individual differences not satisfactorily described by existing personality constructs (), others might argue that the conceptual framework draws on a comprehensive lineage of concepts depicting individual differences in sensitivity, such as introversion (); brain stem arousal (); low sensory threshold and social withdrawal (); and introversion, neuroticism, and openness (). Furthermore, questionnaire studies attempting to operationalise the SPS construct have yielded different dimensionalities. Nevertheless, studies suggest that SPS relates to aspects of biological functioning. There has been reported an association between SPS and genetic markers (the serotonin transporter gene 5-HTTLPR as well as between SPS and brain sensory processing assessed by imaging techniques Also, several studies have indicated associations between SPS and psychological distress

One striking point in the SPS literature is that neither heterogeneity within the HSP category nor variation in individual sensitivity over time is considered. While the cut-off in the distribution () gives empirical evidence for a pragmatic distinction between HSPs and non-HSPs, this observation should be distinguished from the assumption that SPS is fundamentally dichotomous. Rather, the trait might be more in line with continuum models in personality trait research (). Furthermore, sensitivity might not be regarded as a static concept, but rather as a dynamic one which varies depending on a range of different factors within the individual (e.g. social context, sensory stimuli, circadian rhythms). Finally, for therapeutic interventions to have impact, parts of the SPS concept must be malleable. Developing a treatment for psychological problems associated with SPS would make little sense if the problems did not have plastic features.

Although several studies have confirmed an association between SPS and psychological distress, theoretical models attempting to explain this association are lacking. Such models are prerequisites, however, for developing methods to alleviate SPS-related psychological distress (). Identifying key mechanisms which drive problem maintenance and developing clinical interventions which are logically derived from such risk mechanisms has, therefore, clinical as well as theoretical interest.

The aim of this paper is twofold. Firstly, we present and discuss a model in which a cognitive science account of recurrent depression - the Differential Activation framework is applied on the relationship between SPS and psychological distress. Secondly, we discuss the clinical implications of this model. Drawing from advances in depression research (;, we start out by suggesting that it is the tendency to react to psychological problems, typically trying to change or get rid of them, which serves to maintain and exacerbate psychological distress in SPS. Thus, we argue that it is not SPS per se that should be regarded as psychologically inexpedient but rather the subsequent cognitive processes associated with the experiences conferred by the (assumed) trait. Irrespective of the extent to which SPS itself may be malleable, the hypothesised cognitive reactivity to sensory and emotional experience in those with SPS might represent a possible clinical target. A therapeutic intervention that specifically addresses cognitive reactivity is Mindfulness-Based Cognitive Therapy (MBCT;). MBCT aims to alter negative thought processing through non-judgmental awareness and acceptance, thereby changing the relationship to the experience. Whilst MBCT was originally developed to target cognitive reactivity in depressed patients, we here discuss the possible therapeutic effects of it on SPS-related psychological distress.

Sensory processing sensitivity and psychological distress: A proposed model

Associations between sensory processing sensitivity and psychological distress

SPS has been found to correlate with a wide range of psychological problems, such as general anxiety/panic, tension and worry about everyday events, and social phobia (N); harm avoidance and agoraphobic avoidance (); and depression (). Corroborating these results, Benham () found that SPS correlated with a wide range of physical health problems (). This study is interesting as it suggests a possible link between SPS and conditions that are often understood as "functional" or "psychosomatic" in the medical literature. A possible explanation for the positive relationship between SPS and physical complaints is that HSPs are more sensitive to and aware of somatic sensations, paying attention to minor physiological sensations which others may not notice. This interpretation is in line with the hypervigilance model of pain perception () which suggests that chronic pain patients have a heightened sensitivity to pain (e.g. low threshold and tolerance). Such sensitivity, the model proposes, stems from increased attention to external stimulation

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