American Psychological Foundation

A sobbing child can be instantly calmed by a soft, stuffed bear, just as an anxious executive can soothe his nerves by gripping a stress ball throughout a conference call. Could the same strategy work for a patient with schizophrenia on the verge of an aggressive outbreak?

New York University School of Medicine psychologist Daniel Antonius, PhD, thinks so. As this year’s APF Pearson Early Career Grant winner, Antonius is using the $12,000 grant to test a tool he’s developed to help people with serious mental illness defuse their aggression at two inpatient psychiatric units at Bellevue Hospital in New York City. Antonius’s Sensory Method Aimed at Reducing Tension, or SMART, is part stress ball, part carnival toy: a large, squishy football filled with tiny polyester beans.

“Patients can hold, shape, stretch and manipulate it with two hands, but it’s also soft enough that they won’t hurt other patients with it,” says Antonius.

Antonius hopes the balls not only reduce the use of restraint, seclusion and involuntary medication to calm agitated patients, but help protect staff as well. Studies show that between 36 percent to 54 percent of staff, mostly nurses and psychiatrists, are physically or verbally assaulted in psychiatric units. Health officials also say there’s a critical need to develop more humane alternatives to restraint, medication and seclusion. The Joint Commission on Accreditation of Healthcare Organizations stipulates in its 2009 Accreditation Process Guide for Hospitals that staff should consider those options a last resort for psychiatric patients.

In designing his stress ball, Antonius drew on the work of his mentors and collaborators, NYU olfactory experts Dolores Malaspina, MD, and Andreas Keller, PhD, to add an aromatherapy twist to SMART in the form of octyl acetate, an odor similar to oranges. Preliminary research by Keller finds that such smells may reduce people’s levels of salivary cortisol, a biomarker for stress and agitation, by 20 percent.

Antonius will examine how patients who hold the stress ball when they start to feel agitated compare with patients who don’t get that option. Specifically, he’ll ask patients and staff to rate the patients’ behavioral states and will measure their salivary cortisol before, during and after they use the ball. He’ll also test whether patients fare better with orange-scented stress balls than with unscented ones.

Antonius, who grew up in Norway and came to the United States for his education, worked at the Bellevue psychiatric unit for his internship in 2007 and still sees patients there pro bono. He says that if SMART makes a difference for psychiatric patients, it could be tailored for use with people with cancer or chronic pain, or in occupational therapy.

“It’s a very simple idea,” says Antonius. “We just need to bring the science to it.”

The potential to revolutionize patient care is what drew Pearson, the assessment company that funds the grant, to Antonius’s research, says Joe Grosdidier, a vice president at Pearson.

“Dr. Antonius is a shining example of why we established this grant,” he says.