Contents of Part 2

(Part 1: Click here to go to Part 1) • How do rest and sleep affect the memory of HSP? • What factors help highly sensitive people create a better life? An assessment for increased well-being • The influence of loneliness on the relationship between environmental sensitivity and health • Pain and quality of life: high sensitivity and central sensitisation (HACS) in chronic pain patients • The role of environmental sensitivity in post- traumatic growth and coping with stress • Roundtable discussion on high sensitivity and mental health: Q&A on positive and negative factors influencing mental health, preventive measures for HSP, special features of psychotherapy with HSP, links to other forms of neurodiversity, cultural acceptance, differences between countries, etc.

How do rest and sleep affect

the memory of HSP?

Dr Robert Marhenke from the University of Innsbruck (Austria) is investigating the influence of waking rest and sleep on memory. In the experiment, participants were divided into two groups. Both groups were first asked to memorise two lists of words. • One group was then allowed to rest with their eyes closed for 8 minutes. • The other group was asked to complete tasks that required visual attention during the same time. A week later, they were asked which words they could remember. • Among Non-HSP, there were no differences between the two groups. • Among the highly sensitive people, the group that had rested their eyes for 8 minutes could remember significantly more words than the average, while the other group could remember significantly fewer than the average. • However, this difference among the highly sensitive individuals did not appear immediately after the experiment, but only when they were questioned several days later! Interestingly, during the rest period, the highly sensitive individuals showed more intense brain activity connections within the default mode network between the hippocampus and the precuneus. This could indicate a mechanism of ‘system consolidation,’ in which memories that are initially typically stored in the hippocampus are transferred to the neocortex for long-term storage. Such mechanisms can occur in a calm, awake state, but are typical of the REM sleep phase. They may either indicate enhanced long-term memory, or deeper processing of experiences. Another experiment compared the effect on memory of an 8-minute break with eyes shut to 8 minutes of Instagram browsing. Here, the highly sensitive Instagram users showed the poorest memory performance of all when asked about the words 16 and 35 minutes after the test. Further studies seem to show that this higher memory capacity in highly sensitive people only works if the rest period follows immediately after learning. No differences were found when breaks were taken later in the day or from regular night sleep. The results show that highly sensitive people have a better memory if they take a break to process new experiences immediately after they occur. If they wait, this advantage is lost.

What factors help highly

sensitive people create a better

life for themselves? An

inventory for greater well-being

Dr Becky Black from the University of Melbourne and Dr Rohan Borschmann from the University of Oxford are conducting an ongoing review of the specialist literature on sensitivity from 1990 to the present day. They are looking for all possible factors that improve the well-being of people with HSP. These factors and strategies are likely to have a positive effect on everyone. However, this effect appears to be above average for highly sensitive people. • Environmental factors: Attentive and supportive parents, positive transitions in school, a supportive work environment. • Connection to nature: Immersion in nature reduces rumination and improves mood. Even short stays in nature have a positive effect. Forests have a more positive effect than fields. • Psychological strategies: Mindfulness, meditation, self-acceptance, positive thinking, emotional self-regulation – in particular, consciously discussing situations with oneself in order to see them from a different perspective and evaluate and relativise them more rationally (‘cognitive reappraisal’). • Social support and relationships: Sharing experiences with other HSP provides validation; developing interpersonal skills is particularly important for preventing depression in young people; a good balance between socialising and spending time alone; perceived support from your environment and family. • Physical activities: Yoga and meditation, regular exercise and sport, healthy eating, routines and structures. • Coping strategies: quiet environment, noise-cancelling devices, expressing emotions, seeking support and help, problem solving and planning, avoiding overstimulation. • Personal development: self-awareness, especially knowledge about high sensitivity, developing emotional intelligence, finding meaning and purpose in life. • Professional help: high-quality psychotherapy with therapists who are familiar with the trait of high sensitivity, appropriate interventions (e.g. highly sensitive children respond better to individual therapy than group therapy), programmes to promote resilience. • Work and career: finding a career that suits high sensitivity, in an environment that allows autonomy and practises supportive leadership styles. The results show how important both the environment and personal strategies are. Future research could investigate the effect of individual psychological or therapeutic interventions.

The influence of loneliness on

the link between high

sensitivity and health

Dr Grant Benham from the University of Texas in the Rio Grande Valley is investigating how challenges in interpersonal and social areas affect the health of highly sensitive people. Examples of such challenges include: • Deficits in interpersonal and communication skills, • Social phobia, • Superficial relationships, • Absence of positive relationships. This does not refer to introversion or shyness. It is important to remember that low sociability can also be a chosen coping strategy against overstimulation. Dr. Benham published his first study on the link between sensory processing sensivtivity and health back in 2006, then focused on physical symptoms. Since then, there have been various studies on the connection between high sensitivity and both physical and mental health issues. Highly sensitive people are known to have more voluntary alone-time. Being alone (‘solitude’) should be distinguished from loneliness, which is involuntary and perceived as a stress. One of the questions Dr Benham investigated was: Do highly sensitive people also feel lonely more often? Or does more chosen alone-time actually reduce feelings of loneliness? The results showed that HSP do indeed experience feelings of loneliness more often than people with normal sensitivity, and that this is not positively influenced by more voluntary alone-time. However, the study mainly surveyed young adults with a Latin American background in southern Texas, was based on self-reporting and did not ask about childhood quality. Further research findings reveal a paradox of being alone: the tendency to be alone does not improve well-being if people are not mentally healthy. In other words: if anything, only healthy HSP will experience being alone as a relief.

Pain and quality of life: high

sensitivity and central

sensitisation in chronic pain

patients

Dr Veronique de Gucht from the University of Leiden (Netherlands) is currently studying the links between central sensitisation (HACS – Human Assumed Central Sensitisation) and quality of life in highly sensitive people. What is central sensitisation, also known as neuroplastic pain? Some chronic pain patients develop over time a pain system so sensitivite that even normally non-painful stimuli lead to excessive pain. It can also happen that the mere possibility of future pain leads to excessive pain expectations (‘pain catastrophising’), rumination and feelings of helplessness. The difficulty in research is that pain perception is subjective and cannot be measured objectively. Various specialised questionnaires have been developed for the various measurements: • Central Sensitisation Inventory (CSI), • Brief Pain Inventory-Short Form (BPI-SF), • for quality of life: the Short Form Health Survey-12 (SF-12v2), • and for high sensitivity, Dr. de Gucht himself has developed a questionnaire, the Sensory Processing Sensitivity Questionnaire (SPSQ – www.sps-q.com). Objective pain measurements remain difficult. However, attempts are being made to introduce some objectivity, e.g. with the cold water test. (This involves immersing limbs in cold water and measuring the physiological effects on the heart and circulation.) One question that seems to play a key part in the outcome is: How do people fundamentally experience and evaluate their high sensitivity – as positive or negative? • For HSP who experience their high sensitivity as rather negative, central sensitisation and, in particular, pain catastrophising are more pronounced than in people with normal sensitivity. • Conversely, a positive view on one‘s own high sensitivity actually reduces pain catastrophising compared to people with normal sensitivity! This leads to lower central sensitisation. The study revealed what seems to be a chain of effects leading from pain anticipation to quality of life and playing a central role here: 1. A positively experienced and accepted high sensitivity leads to lower pain catastrophising. 2. Lower pain catastrophising in turn reduces central sensitisation. 3. This lower sensitisation leads to a better quality of life. This opens doors to approaches for intervention. In particular, therapies should address both areas in combination: • the cognitive area (pain catastrophising) • and the physiological area (sensitisation). It is still difficult to give general recommendations for pain patients to reduce their anticipation of pain and thus influence their quality of life. However, mindfulness techniques are increasingly being used in pain clinics. Future research may examine other factors such as the type and duration of pain, and various forms of treatment.

The role of environmental

sensitivity in post-traumatic

growth and coping with stress

Maria Jernslett is a doctoral candidate at the University of Edinburgh. Her works try to answer the following questions: How can trauma be used for personal growth? And what role does high sensitivity play in this? Post-traumatic growth means processing and integrating trauma and thereby growing from it. Post-traumatic stress disorder and post- traumatic growth are by no means mutually exclusive. A meta-analysis showed that both can occur in parallel! The two most commonly occur in combination when the trauma is moderate. Factors that promote growth from trauma include, in particular: • interpersonal intimacy and connection, • spiritual growth, • and a sense of one's own strengths – which should be developed in case of a lack thereof. Ms Jernslett's study surveyed 302 adults, most of whom reported above-average trauma. There are some limitations to the validity of the study: for one, most participants were well-educated women. Then there is the cognitive distortions that arise when one evaluates a situation in retrospect and has already wrapped it into a a personal narrative. The results: • Post-traumatic growth appears most pronounced in people with medium sensitivity. • People with low sensitivity appear to lack emotional coping mechanisms. • Highly sensitive people tend to be emotionally overwhelmed, which can inhibit post-traumatic growth, especially in cases of severe trauma. • One aspect stood out: aesthetic sensitivity seems to be associated with higher post- traumatic growth. However, this connection only works if the environment is supportive or if therapy is sought. The environment therefore proves to be a key factor, as it can have a positive or negative effect – and usually has both. Can we conclude that HSP are more resilient? The concept of resilience is too complex and general for that. However, if we limit our view to personal growth, it becomes clear that HSP can achieve this above average – but only if the environment is supportive.

Panel discussion: High

sensitivity and mental health

The event ended with a panel discussion moderated by Michael Pluess, with Francesca Lionetti, Corina Greven, Tom Falkenstein, Elizabeth Roxburgh and Elena Lupo. Do highly sensitive people have more mental health issues than others? The studies suggest a moderate correlation between sensory processing sensitivity and mental health issues. However, according to Prof. Greven, studies too rarely isolate environmental sensitivity from so-called neuroticism (a tendency towards negative emotions and feelings), one of the five components of the ‘Big Five’ or ‘O.C.E.A.N.‘ personality model. And the vast majority of studies are based on self-reported data from the participants. Objective measurements are still difficult in this area. The number of participants also often remains small. However, in the case of burnout and depression, there appears to be a confirmed moderate link with high sensitivity. What biological, neurological and medical factors could play a role in the link between high sensitivity and increased mental health problems? According to Dr Elizabeth Roxburgh from the University of Canterbury, there is no useful explanatory model for this yet. One factor may be that many HSP do not feel accepted in their childhood and adolescence, which increases their mental vulnerability either at that time or later in life. Social expectations and norms, as well as various forms of discrimination, also play a role. Burnout can come from a heavy workload, but there is also exhaustion from being overwhelmed by compassion and empathy! People have not protected themselves sufficiently and end up suffering from empathy burnout. Should psychotherapeutic treatments be specifically tailored to HSP? Tom Falkenstein is a psychotherapist from Germany with a practice in England. He believes that interventions tailored to a specific condition can be applied to everyone and do not need to be specifically adapted to HSP. However, he repeatedly receives requests from HSP who have tried various therapies, were unhappy with them and are now looking for someone who is familiar with the trait of high sensitivity. Perhaps the most important key factor is always the therapeutic relationship. A good understanding of high sensitivity is certainly supportive to this quality of relationship. So you could say that therapists should always keep their patients' high sensitivity in mind. But beyond that, they can use the same interventions as with other patients. Are highly sensitive people easier to treat with psychotherapy? In Mr Falkenstein's experience, the therapeutic relationship with HSP is often more profound. This may well favour the therapeutic success. Acceptance of high sensitivity: what are the differences between countries? Dr Elizabeth Roxburgh knows from surveys of students in different countries that highly sensitive people in China feel above average in terms of well-being, but that, in the United Kingdom, their well-being is below average. Elena Lupo gave up her registered psychotherapist‘s office in Italy and became a coach and consultant to escape institutional restrictions on therapy choices. She founded her own association and now trains therapists. She notes how many people still classify high sensitivity as a New Age fad, or as coquetry, or as an excuse for teenage suicide, or even as another name for mild autism. Tom Falkenstein sees a change in Germany over the last 10 years. There is more acceptance of the topic of high sensitivity. However, research funding remains low. Elizabeth Roxburgh notes that there are currently no training programmes on environmental sensitivity in the United Kingdom, albeit helpful they would prove. Is high sensitivity linked to ADHD or autism? This question comes up very often. Prof. Corina Greven originally comes from ADHD research and also has close links to autism research. The studies currently available do not confirm any link. Some studies show a slight correlation but are mostly of insufficient quality: small numbers of people are surveyed, and instead of clinically established diagnoses, the studies are usually based on self-reporting. Furthermore, even if there were a statistical correlation, it would not mean much, especially in terms of underlying causes. What role does prevention play in the well-being of highly sensitive people? Many points have already been raised above, particularly by Dr Black. Dr Roxburgh identifies factors such as a connection to nature, a good balance between periods of sociability and periods of solitude, and personal development (such as keeping a gratitude journal, which seems to be effective). Genuine close relationships are also important. Highly sensitive people tend to experience emotional loneliness rather than social loneliness. If relationships are too superficial, HSP may feel lonelier with people than without them. Breathing techniques, creative tasks and self- acceptance also help. In addition, everyone can work to raise social awareness of high sensitivity and try to connect with other HSP in their area. Can high sensitivity also have a positive effect on mental health? Tom Falkenstein always helps his highly sensitive patients to reframe situations from a different perspective and uses psychoeducation to help them understand themselves better and become aware of the resources their high sensitivity makes available to them. Elena Lupo sees a huge difference in mental health between highly sensitive people who seek help and those who do not. Support and guidance in dealing with high sensitivity and increasing agency are very helpful. It is also important for HSP to connect with higher tasks or goals – with a greater good, possibly on a spiritual level. And highly sensitive people need to get out of their heads. They tend to think too much. Thinking and feeling need to be better integrated. Interventions including the body are helpful here. Somatic Experiencing is one example. Is there a connection between high sensitivity and introversion/extraversion? Introversion and extraversion do not seem to be distributed differently among HSP than in the general population. Looking at the ‘Big Five’ or ‘O.C.E.A.N.‘ personality model (which also includes extraversion/introversion), high sensitivity correlates more with neuroticism (N) and openness to new experiences (O). Information on new scientific studies and upcoming research events can be found on the Sensitivity Research Network. Read also: • Summit meeting on high sensitivity research 2024: a report (German only) • Coaching for highly sensitive people • High sensitivity in the workplace, in management and leadership • The dark side of high sensitivity • Further articles and blogs • How does a coaching session look like? • Contact and appointment for a coaching session in English, German or French