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The first PhD thesis in Cognitive Psychology about Snoezelen with old people

The first PhD thesis in Cognitive Psychology about Snoezelen with old people, was presented at the University of Coimbra (Portugal) on 26 February. In the presence of an international jury (with Maria Jose Cid), Amelia Martins, defended the thesis where he obtained the highest rating: distinction with honors unanimously. The title of the thesis was: "instant utility and recalled the snoezelen approach in institutionalized elderly and cognitive models of efficacy in caregivers". The snoezelen as multisensory stimulation, has been the subject of increasing interest and has significantly increased its scope of application. Nevertheless, some doubts about the effects lasting beyond the sessions. This situation also indicated a gap between the widespread recognition it enjoys and its empirical evaluation. This research aimed to help reduce this gap through two empirical studies.

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The Snoezelen method of multisensory stimulation has been the subject of increased interest and significantly enlarged its realm of applications in recent years. Despite this growing popularity, questions remain over its ability to produce beneficial effects outside the sessions’ timeframe, the sort and extent of those effects, or the legitimacy of imputing them to the method rather than to unspecific reactivity. This situation signals a gap between the widespread recognition enjoyed by the technique and its empirical evaluation, which seems to lag behind.

This work is aimed at contributing to reduce this gap by means of two empirical studies. Study 1 attempted to assess the effect of snoezelen interventions on the daily well-being of two groups of institutionalized elderly (n = 10 in each group). It rested on a reversal design alternating between weeks without (baseline: A) and weeks including snoezelen interventions (B).The design was of the A-B-A-B-A-B type in one group, and of the A-A-B-A-B-A type in the other group, providing distinct baselines across-groups. The core dependent variable was hedonic well-being obtained from ratings given by participants (how well they felt) on a VAS scale. An Experiential Sampling Method (ESM) was used to randomly collect ratings at multiple times each day (instantaneous utilities), in addition to weekly ratings concerning overall satisfaction during the week (remembered utilities).

Study 2 sought to compare the functional representations of snoezelen effects between a sample of institutionalized elders (n = 29) familiar with sonezelen programs and a sample of caregivers with (n = 15) and without (n = 17) experience of snoezelen interventions. Information Integration Theory was the methodological framework. Participants were presented with vignettes depicting a fictitious elder attending a snoezelen program, and rated the effects of the program on the daily well-being of the character. The vignettes specified the age (below/above 80) and functional autonomy (none, moderate, high) of the elder, whether he/she partook in other activities, and the number of weekly sessions (1 to 3). Taken together, they implemented a repeated measures factorial design with 36 conditions.

Data of Study 1 disclosed an increasing trend of instant hedonic well-being all along the six weeks. No effects of reversals between baseline and intervention were found. This was true also for a number of supplementary behavioral and physiological measures taken at the same occasions. A significant reduction in the ratings variance was found in type-B weeks, suggesting a more stable hedonic tone. Except for this, evidence appeared overall more favorable to participants’ reactivity to the study than to a specific effect of interventions. These outcomes remain nevertheless inconclusive, being conditional to the acceptation that a one-week alternation period is adequate and that snoezelen effects are subject to reversals, which needs checking in further studies.

Remembered utilities also showed no reversals and were systematically higher than instantaneous evaluations. This indicates that weekly ratings of well-being overestimate experienced utilities. Differently from what the peak-end model of aggregation of instant utilities would lead to predict, a peak model was more in line with the results, revealing duration neglect except for the moment of the highest (peak) experienced utility.

Data analysis in Study 2 rested on the inspection of factorial patterns and on repeated measures ANOVAS. Comparisons concerned (1) the general attitude towards the snoezelen (i.e., the mean estimated benefit), (2) the representation of how the several factors in the vignettes jointly determine the estimated benefit (functional representation), and (3) the ordering of importance of these factors. The general attitude was favorable in all groups, but more so among the elders and, within them, among those with a lower record of monthly visits. The functional representation was mainly stable across groups, yet more similar between the elderly and the caregivers with direct experience of interventions. Disagreements concerned mainly the effects of age and other activities. To the elderly, having more age and not partaking in other activities significantly lessened the rated benefits; to the caregivers, these factors had no effect, while displaying an opposite trend. In all groups, functional autonomy was the most important factor and age of very little importance. Frequency of the sessions was the next most import factor for caregivers, but of little concern to the elderly, which valued above it partaking in other activities. A suggested synopsis of the findings is that the representation of snoezelen efficacy in the elders is closer to a psychosocial model of care (in which the snoezelen potentiates/is potentiated by surrounding factors) than to a medical model focused on impairment and dosage/frequency issues.

 

Available for download after March 18th