Exploring the relationship between affect and sensory processing patterns in adults.
Abstract: Purpose: Growing evidence exists regarding the relationship between sensory processing and affective disorders. However, most of this evidence relates to children. This study aimed to explore the relationship between positive/negative affect and sensory processing patterns as expressed in daily situations among healthy adults.

Procedure: Two hundred and thirteen healthy individuals aged 18-50 years completed the Adolescent/Adult Sensory Profile (AASP) and the Positive and Negative Affect Schedule (PANAS).

Results: Negative affect correlated positively with Sensory Sensitivity, Sensation Avoiding and Low Registration. Positive affect correlated with Sensation Seeking.

Conclusion: Sensory processing patterns might be related to the person's affect. In practical terms, this relationship among typical individuals suggests that people could benefit from knowledge about the impact of their sensory processing patterns on everyday life or, in some cases, from occupational therapy intervention. Nevertheless, further studies are needed to elucidate this relationship and its impacts on participation, quality of life and wellbeing.

Key words:

Sensory, psychological, human information processing.
Article Type: Report
Subject: Adults (Health aspects)
Affective disorders (Care and treatment)
Affective disorders (Research)
Quality of life (Research)
Authors: Engel-Yeger, Batya
Dunn, Winnie
Pub Date: 10/01/2011
Publication: Name: British Journal of Occupational Therapy Publisher: College of Occupational Therapists Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 College of Occupational Therapists Ltd. ISSN: 0308-0226
Issue: Date: Oct, 2011 Source Volume: 74 Source Issue: 10
Topic: Event Code: 310 Science & research
Product: Product Code: E121940 Adults
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 271053260
Full Text: Introduction

Affect is known to be closely related to the individual's quality of life, health status and wellbeing (Abbey and Andrews 1985, Denollet and De Vries 2006). For this reason, affect has received growing attention in wellbeing therapy (Belaise et al 2005) and research. Most studies about affect have focused on its relation to personality traits, emotional disturbances, including depression and anxiety, or various health conditions, such as chronic illness, infections and persistent fatigue (Denollet and De Vries 2006). The present study suggests a new perspective, which discusses positive/negative affect and the way in which individuals experience and perceive the world through their senses, that is, their sensory processing patterns.

Literature review

Review of affect

Affect refers to subjective moods and feelings rather than thoughts about specific events (Russell and Carroll 1999). Watson and Tellegen (1985) presented a basic consensual model consisting of two factors, positive affect and negative affect, which have been used extensively in the self-report mood literature (Diener et al 1985, Watson et al 1988). Positive affect reflects the extent to which a person feels enthusiastic, active and alert. High positive affect is a state of high energy, full concentration and pleasurable engagement, whereas low positive affect is characterised by sadness and lethargy. In contrast, negative affect is a general dimension of subjective distress and unpleasurable engagement that subsumes a variety of aversive mood states, including anger, contempt, disgust, guilt, fear and nervousness, with low negative affect being a state of calm and serenity. The terms positive affect and negative affect might suggest that these two mood factors are opposites (that is, strongly negatively correlated) (Crawford and Henry 2004).

Positive and negative affect are being increasingly identified as distinctly different features of emotional experience in relation to a wide variety of health-related outcome measures (for example, Von Kanel et al 2005). The broaden-and-build theory described by Fredrickson (2001) emphasises that positive emotions broaden people's thought-action repertoires, encourage them to discover novel lines of thought or action, and broaden attention and cognition, whereas negative emotions narrow people's thought-action repertoires, leading them to fight or flight reactions (Fredrickson and Joiner 2002).

Studies indicate that positive and negative affect operate through different mechanisms to influence health. People with high positive affect are more likely to participate in social activities (Ryff and Singer 1998), report higher life satisfaction and cope successfully with stressful situations (Folkman 1997), whereas people with high negative affect are more likely to be depressed or anxious, or report additional health complaints (Watson et al 1988, Denollet and De Vries 2006). These characteristics are also prevalent among individuals with sensory processing difficulties (Pfeiffer et al 2005, Engel-Yeger and Dunn 2011).

Review of sensory processing

People experience and respond to sensory stimuli every minute of the day. Research has shown that each person processes sensory information in different ways and has individual sensory preferences (Brown 2002). Sensory processing refers to the ability of the nervous system to manage incoming sensory information, including the reception, modulation, integration and organisation of sensory stimuli (Dunn 1997, Miller and Lane 2000).

Dunn (1997) developed a model about the relationship between a person's neurological threshold and the behavioural responses derived from self-regulation strategies (Dunn 1997, Brown et al 2001). Neurological thresholds exist on a continuum from low to high; a low threshold indicates that it takes very little stimulation to activate, whereas a high threshold requires a lot of stimulation for activation. According to this model, individuals use different strategies to deal with their reactivity level to sensory input. Those who use passive self-regulation strategies allow stimuli to occur and then respond to them, whereas those individuals who use active self-regulation strategies act to control the amount and type of sensory input they receive (Dunn 2007).

Dunn's (1997) model suggests the existence of four sensory processing patterns. Each of these patterns describes the interaction between the individual's neurological threshold and behavioural responses.

1. Low Registration represents individuals with a high neurological threshold (requiring high intensity stimuli to notice sensory input) and a passive self-regulation strategy (failing to detect stimuli that others notice). They might be perceived as indifferent, as having a lack of motivation or interest in the world, and might not initiate relationships. They might show an inability to recognise emotions, to express emotions or to infer others' emotions from body language or facial expressions, and might lack a sense of humour (Dunn 1997).

2. Sensation Seeking represents individuals with a high neurological threshold and an active self-regulation strategy. They experience pleasure from rich sensory environments and behaviours that create sensation. They often show risk taking, might seem overly affectionate or lack physical boundaries with other people. They might be considered by others as irresponsible, impatient and lacking respect (Zuckerman 1994, Brown et al 2001, Dunn 2001).

3. Sensation Avoiding represents individuals with a low neurological threshold (requiring low intensity stimuli to react) and an active self-regulation strategy. They are usually engaged in behaviours that limit exposure to stimuli, and show seclusion and social withdrawal (Miller et al 2007).

4. Sensory Sensitivity represents individuals with a low neurological threshold and a passive self-regulation strategy, who often experience distractibility and discomfort with sensation. Yet, they let things happen and do not actively avoid them (Dunn 1997, 2001). These individuals can have aggressive and negative reactions to sensory stimuli that they experience as intense, overwhelming and invasive (Miller et al 2007), even when others perceive the sensory experience to be mild or moderate in intensity. Their intense reactivity to sensations might explain why they feel tension, anxiety and nervousness, have an inability to be comforted and to relax, and might experience problems in initiating relationships.

Whereas most people have typical sensory processing patterns that support their performance and participation, some people exhibit extreme sensory processing patterns (Wilbarger and Wilbarger 1991, Simeonsson et al 2003). As described above, these extreme patterns might negatively impact the person's physical and mental status, reduce adaptive behaviour, disrupt friendships and relationships, and affect daily routines and participation in daily living (Brown et al 1994, Ahn et al 2004, Pfeiffer et al 2005, King et al 2006). Extreme sensory processing patterns might also be related to the person's affective status, because of the emotional burden that accompanies the intensity of sensory processing.

Affect and sensory processing patterns

Growing practical and empirical evidence exists regarding the relationship between atypical sensory processing patterns and affective disorders (Kinnealey and Fuiek 1999, Neal et al 2002, Pfeiffer et al 2005). Wilbarger and Wilbarger (1991) even used the term 'sensory affective disorder'. Affective disorders, such as depression and anxiety, were related to sensory processing patterns: sensory hyposensitivity, that is, high neurological threshold, was associated with depression and with characteristics such as low levels of arousal, whereas sensory hypersensitivity was associated with anxiety and high levels of attention and arousal, and high levels of stress (Last and Hersen 1988, Kinnealey and Fuiek 1999, Lane 2002, Neal et al 2002, Pfeiffer et al 2005).

Previous studies suggested that a neurological mechanism was the basis of this association. For example, enhanced activity of the limbic structures and components of the reticular system, hypothalamus and cortex was associated with exaggerated defence mechanisms that characterised individuals with sensory hypersensitivity, expressed in hyperemotionality, difficult temperament, negative affect and poor self-regulation (Zero to Three/National Center for Clinical Infant Programs 1994, Naatanen and Alho 1995, Case-Smith et al 1998, Morgan and Grillon 1999). Most of these studies referred to specific sensory modalities, mainly auditory and visual (Naatanen and Alho 1995, Bleich et al 1996, Morgan and Grillon 1999).

The neurological mechanism and self-regulation processes that characterise individuals with extreme sensory processing patterns might explain their affective responses. However, previous studies partly referred to this issue and described it mainly in relation to children. Some of these studies referred to the child's temperament ('the way in which an individual behaves ... [and that it] can be equated to the term behavioural style' [Thomas and Chess 1977]). Goldsmith and Rothbart (1991) described temperament dimensions, such as activity level, anger/frustration, approach and withdrawal, attentional focusing, shifting, discomfort, reactivity, fear, intensity pleasure, impulsivity, inhibitory control and perceptual sensitivity. This led Rothbart et al (2001) to conclude that positive and negative affectivity are overarching factors, which subsume the temperament dimensions. According to Rothbart and colleagues, negative affect might be expressed by fear, irritability/anger and persistence (Rothbart et al 2000a, 2000b). Similar constructs were also reported among adults (Costa and McCrea 1987, Caspi 2000, Rothbart et al 2000a).

Rothbart et al (2000a) described a four-factor temperament structure. Interestingly, an overlap might exist between this structural model and Dunn's (2001) model. Low Registration might be related to persistence and effortful attention. Sensation Seeking might be related to agreeableness and extraversion. Characteristics of negative affectivity are described regarding sensory processing patterns related to a low neurological threshold: Sensation Avoiding is related to fear, negative affect and neuroticism, and Sensory Sensitivity is related to irritability and anger (Dunn 2001). Daniels (2003) reported moderate correlations among Rothbart's and Dunn's model components in typical preschoolers. Others reported these relationships in children with autism (Koenig 2003).

The relationship between sensory processing patterns and affect was also found in children and adolescents with Asperger's disorder. Pfeiffer et al (2005) found that in these individuals sensory sensitivity was related to negative affect characteristics, such as anxiety and depression, which also interfered with the child's academic performance, leisure participation, community use and social skills.

Nevertheless, most evidence relates to infants and children (Case-Smith et al 1998, Rothbart et al 2000a, Pfeiffer et al 2005) and only few studies discussed this association in adults (Kinnealey et al 1995, Kinnealey and Fuiek 1999, Jerome and Liss 2005). Moreover, the existing information refers mostly to the association between extreme sensory processing patterns and negative affect only, and is focused on specific modalities (that is, auditory or visual).

Aims of the study

The aim of the study was to elaborate the knowledge about the relationship between sensory processing patterns and positive/negative affect in typical adults. This elaboration might have theoretical and practical implications for occupational therapists. From the theoretical aspect, the results of this study might strengthen previous reports, focus their implications about affect and be used as a platform for further studies that will examine the relationship between sensory processing patterns and personality traits. If relationships that have been reported with children occur also with adults, this will lead to the creation of theoretical models that will explain the impact of both sensory processing patterns and affect on the person's performance, participation and wellbeing. From the practical aspect, understanding a possible relationship between sensory processing and affect might be useful in the evaluation of, and intervention for, individuals with affective disorders.

Based on the literature review, it was hypothesised that:

1. Negative affect will be positively correlated with sensory processing patterns associated with a low neurological threshold (that is, Sensation Avoiding and Sensory Sensitivity) and with the Low Registration pattern.

2. Positive affect will be positively correlated with the Sensation Seeking pattern.

3. Significant differences in positive/negative affect will exist between the four sensory processing patterns.

Method

Participants

At power = 0.80, for two-side alpha = 0.05, and effect size of 0.25, the sample size should consist of 111 participants.

Two hundred and thirteen healthy individuals, aged 18 -50 years, who met the inclusion criteria, participated in this study. Participants were residents of the north of Israel. Exclusion criteria included the presence of systemic severe chronic diseases (such as diabetes and arthritis), including severe impairments in the nervous system (such as stroke, Parkinson's disease and traumatic brain injuries), or the need to use medication on a daily basis (such as methylphenidate and insulin). Table 1 summarises the participants' sociodemographic information.

Instruments

Demographic questionnaire: This requested data on the person's health status, sociodemographic status, medications and treatments.

The Adolescent/Adult Sensory Profile (AASP) (Brown and Dunn 2002) is based on Dunn's model of sensory processing (Dunn 1997). In this self-reporting tool, participants answer questions about their responses to sensory experiences. There are 60 items, including questions pertaining to each of the sensory systems. For scoring, the 60 items are sorted equally into four quadrants--Low Registration, Sensation Seeking, Sensory Sensitivity and Sensation Avoiding (based on factor analysis)--reflecting different sensory processing patterns. Participants indicate how often they respond to the sensory event in the manner described in the items, using a 5-point Likert scale (from 1 corresponding to 'almost never' to 5 corresponding to 'almost always'). Four scores are obtained for each person (that is, Seeking, Avoiding, Registration, Sensitivity). The resultant score for each quadrant ranges from 5 to 75. Based on United States national samples of 950 adolescents and adults (aged 11-90 years), norms were defined for each age group (11-17; 18 -64; and 65 and older). The English version of this questionnaire has good internal consistency, with coefficient alpha values of 0.692 for Low Registration, 0.639 for Sensation Seeking, 0.657 for Sensory Sensitivity and 0.699 for Sensation Avoiding (Pohl et al 2003). This questionnaire was translated into Hebrew and back-translated into English by bilingual occupational therapists, in order to examine the validity of the translated version for this study.

The Positive and Negative Affect Schedule (PANAS) (Watson et al 1988) is a 20-item scale, with 10 positive and 10 negative affective descriptors. Participants are asked to rate their feelings concerning the affective descriptors in general. Responses are scored on a 5-point scale (1-5), ranging from 'very slightly or not at all' to 'very much or extremely'. The positive and negative affect scales each have a potential range of 10-50, where higher scores indicate higher affect. According to the study by Crawford and Henry (2004), performed on a non-clinical sample, Cronbach's alpha was 0.89 (95% CI = 0.88-0.90) for the positive affect scale, and 0.85 (95% CI = 0.84-0.87) for the negative affect scale. Ostir et al (2005) indicated that the PANAS can provide reliable and consistent information for patients who received inpatient medical rehabilitation. The PANAS was translated into Hebrew. The 20-item Hebrew version was first tested on 74 students, with an internal reliability of 0.82 and a correlation of 0.34 (p<0.01) with social desirability (Ben-Zur 2002).

Procedure

After receiving ethical approval from the institutional review board, advertisements for participation in a study about sensation and personal characteristics were published in several neighbourhoods in the north of Israel. People who wished to take part in this study telephoned the research coordinator and completed a demographic questionnaire, which requested sociodemographic data and information about health status. This questionnaire was used to determine participant eligibility. The data collector arranged a meeting with those who met the inclusion criteria in their homes, where they were asked to fill in the questionnaires in the presence of the data collector. After signing the consent form, participants completed the AASP and the PANAS.

Data analysis

The AASP manual defines five categories for the sensory processing patterns ('Much less than most people'; 'Less than most people'; 'Similar to most people'; 'More than most people' and 'Much more than most people'). For the purposes of this analysis, these were collapsed into three categories: (1) 'Much less than most people' and 'Less than most people' were merged and defined as 'Less than most people'; (2) 'Similar to most people' was not changed; (3) 'More than most people' and 'Much more than most people' were merged and defined as 'More than most people'. This strategy yielded a higher number of participants in each of the three categories, while maintaining the directionality of participant scores.

The Pearson correlation test was employed to examine the relationship between the AASP and PANAS scores. Although the original scores of the AASP and PANAS questionnaires are ordinal, they were referred to as scaled variables in order to characterise the whole group, and parametric statistics were used. The Analysis of Variance (ANOVA) was also computed, with the Scheffe Post Hoc test to control for the number of comparisons, in order to examine whether significant differences in PANAS scores exist between the different categories of each sensory processing pattern (that is, the three collapsed categories). Here, the PANAS scores were also referred to as scaled variables.

Probabilities at or below 0.05 were considered significant.

Results

Hypothesis 1

Hypothesis 1: There will be a relationship between low neurological threshold sensory processing patterns (Avoiding and Sensitivity), Low Registration and PANAS scores.

When referring to sensory processing patterns related to a low neurological threshold, the Sensory Sensitivity score was positively correlated with higher negative affect (r = 0.41, p [less than or equal to] 0.0001). Similarly, the Sensation Avoiding pattern score was positively correlated with higher negative affect (r = 0.39, p [less than or equal to] 0.0001).

The Low Registration pattern, which is associated with a high neurological threshold, was also positively correlated with higher negative affect

(r = 0.24, p [less than or equal to] 0.0001).

As presented in Table 2, most items of the PANAS negative affect scale were positively correlated with Low Registration as well as with Sensory Sensitivity and Sensation Avoiding. There were stronger positive correlations for the items 'upset' and 'jitteriness' with Sensitivity and Avoiding, the low threshold sensory processing patterns.

Hypothesis 2

Hypothesis 2: There will be a relationship between positive affect and Sensation Seeking pattern.

Sensation Seeking pattern score was positively correlated with higher positive affect (r = 0.14, p = 0.042).

Hypothesis 3

Hypothesis 3: There will be differences in positive/negative affect when compared with the different categories of the four sensory processing patterns.

Low neurological threshold

First, the low neurological threshold scores on the AASP (Avoiding and Sensitivity) were examined in relation to the PANAS scores. A significant difference was found between the Sensory Sensitivity pattern and positive affect ([F.sub.2,212] = 4.34, p = 0.014). Individuals whose Sensitivity score was in the 'Less than most people' category had significantly higher positive affect than those found in the 'Similar to most people' category (mean difference = 0.36; p = 0.046) and in the 'More than most people' category (mean difference = 0.44; p = 0.014).

Significant differences were also found between the Sensory Sensitivity pattern and negative affect on the PANAS ([F.sub.2,212] = 14.51, p [less than or equal to] 0.0001). Individuals who were more Sensitive (scored in the 'More than most people' category) had significantly higher negative affect than those found in the 'Less than most people' category (mean difference = 0.69; p = 0.005) and those found in the 'Similar to most people' category (mean difference = 0.57; p [less than or equal to] 0.0001).

The other low threshold pattern is Sensation Avoiding. Significant differences were found between the Sensation Avoiding pattern and positive affect on the PANAS ([F.sub.2,212] = 4.23, p = 0.016). Follow-up testing with the Scheffe test indicated that individuals found in the 'Less than most people' category for Avoiding had significantly higher positive affect than those found in the 'More than most people' category (mean difference = 0.43; p = 0.016).

Significant differences were also found between the Sensation Avoiding pattern and negative affect on the PANAS ([F.sub.2,212] = 10.69, p [less than or equal to] 0.0001). Individuals found in the 'Similar to most people' category for Avoiding had significantly higher negative affect than those found in the 'Less than most people' category (mean difference = 0.46; p = 0.005) and significantly lower negative affect than those found in the 'More than most people' category (mean difference = 0.48; p = 0.024). Individuals found in the 'Less than most people' category had significantly lower negative affect than those found in the 'More than most people' category (mean difference = 0.94; p [less than or equal to] 0.0001).

Table 3 summarises the mean and standard deviations of the PANAS scores of the participants found in each performance range in each sensory processing pattern.

High neurological threshold

The scores in the high neurological threshold patterns from the AASP, which include Sensation Seeking and Low Registration, were also examined in relation to the PANAS scores. A significant difference was found between the Low Registration pattern and positive affect ([F.sub.2,212] = 4.07, p = 0.018). Follow-up testing revealed that individuals found in the 'Less than most people' category had significantly higher positive affect than those found in the 'More than most people' category (mean difference = 0.39; p = 0.02). Significant differences were also found between the Low Registration pattern in negative affect ([F.sub.2,212] = 11.95, p [less than or equal to] 0.0001). Individuals found in the 'Similar to most people' category had significantly lower negative affect than those found in the 'More than most people' category (mean difference = 0.52; p [less than or equal to] 0.0001).

No significant differences in positive/negative affect were found between the different categories of the Sensation Seeking pattern.

Discussion

The present study examined the relationship between patterns of sensory processing and personality traits of positive/negative affect. As mentioned above, the neurophysiological-behavioural personality interaction has already been examined in neurophysiological studies (Bleich et al 1996). However, these studies referred to specific sensory modalities (such as auditory or visual), whereas the AASP used in the present study referred to the sensory processing of all sensory modalities as experienced in daily living situations. This study makes a unique contribution to the existing literature because:

(a) Sensory processing patterns are demonstrated in various sensory modalities

(b) Sensory processing patterns are examined as they are manifested in daily living scenarios

(c) The study examines affect and sensory processing patterns in adults.

The relationship between negative affect, Sensation Avoiding, Sensory Sensitivity and Low Registration

Most of the neurophysiological studies and other studies regarding sensory processing patterns and affect examined mainly individuals with sensory hypersensitivity. It may be that these individuals, who need to cope with the unpleasantness of sensations, are more noticeable in research and are referred more frequently to therapy, because of their hypervigilance, aggression, need to control or avoid situations and the emotional burden and distress that they experience (Kinnealey and Fuiek 1999, Jerome and Liss 2005, Miller et al 2007). Indeed, these characteristics might be associated with negative affect. The present study supports these reports by showing how negative affect is related to the patterns of Sensory Sensitivity and Sensation Avoiding. Moreover, in the present study, stronger negative affect of participants was positively related to hypersensitivity (that is, those found in the 'More than most people' category on the AASP compared with those who were found to be in the 'Less than most people' category).

In addition to parallel characteristics between sensory processing patterns of a low neurological threshold, as presented in Dunn's (1997) model, and negative affect presented in Rothbart et al (2000a) (such as fear, irritability and anger), the present study showed that individuals with either Sensitivity or Avoiding also display additional negative affect characteristics, such as distress, upset, guilt, shame, fear, jitteriness, hostility, irritability and nervousness. The strongest correlations were found between the Sensitivity and Avoiding sensory processing patterns and the 'upset' and 'jitteriness' items of the PANAS, emphasising the negative impact of the annoying sensations, the inability to stay calm, the enjoyment of experiences and optimal engagement in different situations. These characteristics might result from the coping mechanisms that these individuals use, including mental preparation (such as anticipation or confrontations) and cognitive strategies (such as avoidance, choice of activity or organisation of the environment), which emphasise the cognitive and emotional burden that they experience when dealing with the unpleasantness of sensations in their environment (Kinnealey et al 1995). Perhaps their low sensory threshold for detecting sensory events when compared with others cause them to detect and respond to more stimuli than most people, increasing the effort of participation in particular situations. The need for order and routine has been associated with people who have Avoiding and Sensitivity patterns (Reich and Williams 2003). It is possible that setting routines in place is a strategy for managing unpredictable sensory input; set patterns of activity might serve to provide familiar and predictable sensory experiences, thus reducing the cognitive and emotional load and minimising behaviours related to negative affect.

When referring to sensory processing patterns with a high neurological threshold, an interesting relationship was found between Low Registration and negative affect: individuals with sensory processing patterns of Low Registration showed the same negative affect characteristics as those individuals with sensory hypersensitivity (Sensitivity and Avoiding). Dunn (2001) reported that there might be a relationship between Low Registration and persistence and effortful attention (similar to coping mechanisms related to sensory hypersensitivity). Nonetheless, when examining the correlations in Table 2, the overall correlations with Low Registration are weaker than with Sensitivity and Avoiding. Different characteristics were most strongly correlated with the low threshold patterns (upset and jitteriness were strongest in both Sensitivity and Avoiding) when compared with Low Registration (fear, guilt). This might suggest that some additional differences regarding Low Registration require further study. It is possible that some of the items on the PANAS reveal behaviours associated with less responsiveness. Among individuals with Low Registration, the failure to detect incoming sensory information accurately (Miller et al 2007), and the feedback they perceive from society that characterises them as lazy, withdrawn, inattentive, unmotivated or self-absorbed (Miller et al 2007), might contribute to their negative affect expressed through fear and guilt. Thus, the relationship between Low Registration and negative affect should be further studied, because of possible impact on performance in daily living.

The relationship between positive affect and Sensation Seeking

In contrast to Low Registration, Sensation Seeking, which is also a pattern with a high neurological threshold, was positively correlated with positive affect. The active self-regulation strategy used by Seekers, as compared to the passive strategy used by individuals with Low Registration, might be the answer to this result. By being active, Seekers exert control over their circumstances regarding sensory stimulation (Jerome and Liss 2005). They show higher self-efficacy and self-confidence, which is expressed also in their choice of activity (Slanger and Rudestam 1997). In line with Dunn's model for sensory processing (1997, 2001), sensory seekers behave to meet their high sensory threshold and enjoy the results that suit their sensory needs, which in turn contributes to their positive affect. The role of self-regulation strategy should receive attention in future research and practice.

Overall, although these correlations should be interpreted with caution (some of them were relatively weak and, in addition, parametric statistics were used), the present study suggests that when individuals' sensory experiences exceed or fail to meet their neurological threshold, increased burden can be created, which can contribute to negative affect.

As affect is closely related to quality of life and wellbeing (Abbey and Andrews 1985, Belaise et al 2005), there is a need to consider the capacity to experience positive emotions as a fundamental human strength that enhances people's physical and psychological resources in intervention programmes (Fredrickson 2001, Fredrickson et al 2003).

Rothbart and Jones (1999) stated that positive affect and negative affect are not anchor points on the same scale. Based on this, Dunn (2001) suggested relevant implications for intervention programmes and argued that in intervention programmes, 'individuals should not be perceived as "doomed" to experiencing distress and fear if they have a high degree of negative affect' (p615). Although they can be prone to distress or fear, which are related to negative affect, they might still experience a positive affect. Dunn (2001) based these implications on data gathered about children, but the results of the present study suggest that these implications might be relevant also for adults.

The present study also expanded on previous work by including all sensory modalities in the testing (using the AASP); earlier studies related mainly to specific sensory modalities (such as auditory or visual). Thus, by using the AASP, more relevant information about overall sensory experiences could be included.

Limitations of the study

Although the AASP has performance ranges, its Hebrew translation was used and, therefore, data about the validity of the AASP in Israel need to be examined. The AASP categories were collapsed. In addition, parametric statistical tests (ANOVA) were used, although the scales of both the AASP and the PANAS are ordinal. Due to these strategies, the authors might have missed some important information about the relationships or about generalisability of the findings.

This study was based on a convenience sample that included healthy individuals. Hence, the fact that these patterns were identified is notable, and suggests that future studies need to examine clinical populations, such as people with psychological, emotional or behavioural difficulties (for example, different kinds of phobias, post-traumatic stress disorder and autism).

Conclusion

Sensory processing patterns might be significantly related to the person's affect. Whereas most previous studies examined the relationship between low threshold sensory processing patterns (Avoiding and Sensitivity) and affect, this study also depicted the relationship between high threshold sensory processing patterns (Seeking and Registration) and affect. Additional studies should illuminate the relationship between affect and sensory processing and examine how it influences individuals' participation, quality of life and wellbeing. This might contribute to the understanding of how to incorporate sensory processing strategies in intervention programmes. Specifically, it might assist therapists by providing specific information about the relationship between the individual's affect and sensory processing patterns, which can inform the evaluation and intervention processes.

Information such as that which is reported in this study can provide a broader basis for building effective interventions that identify the optimal conditions for enhancing the individual's adaptive behaviour. For example, a therapist could suggest arranging the environment at home or at work in a way that modulates extreme sensations (for example, decreasing the level of lighting, avoiding bright colours and loud noises), or could outline cognitive strategies to deal with sensory stimuli that might trigger irritability, anxiety and other characteristics of negative affect. By using sensory-based strategies as part of management and coping, professionals can enhance the client's positive experiences and positive affective reactions, leading to better participation in life experiences, elevated health status and wellbeing.

Conflict of interest: None declared.

Key findings

* Sensory processing patterns might be related to the person's positive/negative affect.

* This relationship also exists among healthy adults and has an impact on their adaptive behaviour.

What the study has added

Affect is related not only to hypersensitivity but also to patterns representing a high neurological threshold (that is, hyposensitivity). Intervention options for affective disorders might be expanded to address associated sensory processing difficulties.

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Batya Engel-Yeger (1) and Winnie Dunn (2)

(1) Senior Lecturer and Head, Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel.

(2) Professor, Department of Occupational Therapy Education, University of Kansas Medical Centre, Kansas City, Kansas, USA.

Corresponding author:

Dr Batya Engel-Yeger, Senior Lecturer and Head, Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel. Email: batya@research.haifa.ac.il

Reference: Engel-Yeger B, Dunn W (2011) Exploring the relationship between affect and sensory processing patterns in adults. British Journal of Occupational Therapy, 74(10), 456-464.

DOI: 10.4276/030802211X13182481841868

Submitted: 31 January 2011.

Accepted: 21 June 2011.
Table 1 Participants' sociodemographic information
General sample

Age range (years)              18-50
Mean age [+ or -] SD (years)   29.95 [+ or -] 6.68
Years of education-range       23-Oct
Mean years of education        14.63 [+ or -] 2.19
  [+ or -] SD
Socioeconomic level            Low                   41.5%
                               Average               22.4%
                               High                  24.5%
                               Missing cases         11.6%

                               Men                   Women

Number                         88                    125
Age range (years)              18-50                 20-50
Mean age [+ or -] SD (years)   30.54 [+ or -] 6.23   29.53 [+ or -]
                                                       6.97
Years of education-range       10-22                 10-23
Mean years of education        14.63 [+ or -] 219    14.88 [+ or -]
  [+ or -] SD                                          1.89

Table 2. The significant correlations between items
included in the PANAS negative affect scale and the
sensory processing patterns

Negative           Low          Sensory     Sensation
affect items   Registration   Sensitivity    Avoiding

In distress      0.212 **      0.301 **     0.295 **
Upset            0.199 **      0.423# **    0.396# **
Guilty#          0.228 **      0.324 **     0.312 **
Scared           0.199 **      0.269 **     0.284 **
Hostile            NS          0.162 *      0.143 *
Irritable          NS          0.262 **     0.264 **
Ashamed          0.175 *       0.220 **     0.263 **
Nervous            NS          0.245 **     0.220 **
Jittery#         0.167 *       0.342# **    0.336# **
Afraid           0.257 **      0.309 **     0.291 **

Note: PANAS items related to negative affect that
showed the strongest correlations with the sensory
processing patterns are marked in bold. NS = not
significant; * p [less than or equal to] 0.05; ** p
[less than or equal to] 0.01.

PANAS items related to negative affect that
showed the strongest correlations with the sensory
processing patterns are marked are indicated with #.

Table 3 Mean and standard deviations of PANAS
scores in regard to each of the sensory processing
patterns

High neurological   Low            Less than most people (n = 16)
threshold           Registration   Similar to most people (n = 122)
                                   More than most people (n = 75)

                    Sensation      Less than most people (n = 46)
                    Seeking        Similar to most people (n = 147)
                                   More than most people (n = 20)

Low neurological    Sensory        Less than most people (n = 14)
threshold           Sensitivity    Similar to most people (n = 136)
                                   More than most people (n = 63)

                    Sensation      Less than most people (n = 32)
                    Avoiding       Similar to most people (n = 161)
                                   More than most people (n = 20)

                      Positive      Negative
                       affect        affect

                    Mean    SD    Mean    SD

High neurological   3.88   0.48   2.15   1.01
threshold           3.61   0.51   2.08   0.67
                    3.49   0.52   2.61   0.75

                    3.51   0.53   2.22   0.65
                    3.59   0.51   2.28   0.82
                    3.74   0.51   2.29   0.61

Low neurological    3.95   0.54   1.98   0.98
threshold           3.59   0.48   2.11   0.71
                    3.51   0.56   2.68   0.68
                    3.75   0.48   1.83   0.59
                    3.59   0.49   2.31   0.75
                    3.33   0.65   2.78   0.81
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