Associative Awareness Technique (AAT) is a somatic intervention developed by two physical therapists (Scott Musgrave and Ernie Quinslick) in collaboration with mental health professionals with the goal of interrupting cycles of chronic pain. Through a technique called Sensory Flow, physical therapists provide the client’s body with safe sensory stimulation (including light touch, tapping, scratching, vibration, and deep pressure) to bring the client’s central nervous system out of the sympathetic response and into a homeostatic or parasympathetic state. Through the AAT process, clients learn techniques to provide themselves with safe sensory input, as well as engage emotional and cognitive processing with this safe input to help decrease the frequency and intensity of entering a sympathetic state.

AAT is a 7-step process, though not every step is needed or helpful for every client, and often clients will need more than 1 session to move through a particular step or two. When starting AAT, you should plan for a weekly session for at least 8 weeks. Your AAT-trained clinician will guide you through the process and help you discern how many sessions you will benefit from along the way.

The central nervous system is always in one of three states: Sympathetic, Parasympathetic, or Homeostasis. Here’s a little more about what each state does to the body:

Sympathetic (Fight/Flight/Freeze) - increases heart and respiratory rate and elevates blood pressure; moves blood to the extremities to feed and tense muscle; releases cortisol and adrenaline to prepare the body to act

Increased time spent in the Sympathetic state results in GI distress, increased pain from muscle tension, and difficulty sleeping.

Parasympathetic (Rest and Digest) - slows heart and respiratory rates and reduces blood pressure; moves blood to the internal organs, promoting digestive processing; relaxes muscles; releases melatonin to prepare the body to rest

Homeostasis - heart and respiratory rate are even and stable, and blood pressure is normal; the blood supply is evenly shared between the GI and muscular systems; serotonin is released creating a balance between the sympathetic and parasympathetic where the needs of the full body are met in harmony

The amygdala, found in the brainstem, houses the switch that determines the state of our central nervous system - if we are in a sympathetic, homeostasis, or parasympathetic state. The amygdala receives input from our cortex (thoughts and beliefs), our limbic system (emotions), and our body (physical sensations) in order to determine its state and need to be ready to react or ability to rest. AAT helps you gain control over the switch, providing sensory input and tools that move the body away from its sympathetic response and toward the parasympathetic response in order to decrease the demand on the cardiovascular and respiratory systems, promote digestion, release muscular tension, and reduce pain.

A short answer: YES.

Some clients come just for AAT. Others will come for a combination of traditional physical therapy care or vestibular rehabilitation and AAT. Truly, it depends on the client’s experience, presentation, and needs.

In the assessment, your clinician will evaluate you for and recommend all applicable interventions JH provides, and help you assemble the pieces of your therapeutic plan accordingly.