Tinnitus Habituation And Exposure

In this talk I share how I have come to think about habituation, the process of the sound becoming something your mind no longer sees as a threat. Using an example of someone who became uncomfortable in crowds, I describe the idea of first learning to calm the body, then gradually meeting what feels threatening. Because tinnitus is always there, I suggest practicing first with smaller unpleasant things in life that cannot be avoided, such as traffic jams or a lost password, using meditation and breathing along the way. This content is educational and is not a substitute for one to one professional care.

Transcript

And so after a very long time of thinking about this, I've come to the conclusion that the best way to look at the path to habituation is through the lens of exposure therapy. Now, In classic exposure therapy, What's gone wrong is that an individual has come to view what should be a neutral stimulus as a threat. So I'll give an example of a case I was working on with someone who as a result of their isolation during COVID and after COVID, They kind of kept in a bubble. They really gotten uncomfortable, Almost a degree of unable to go into spaces with large crowds, Become an obstacle, To say the least, At their work. So what happened then is they've, Essentially their amygdala, The part of the brain that detects threat, The amygdala has come to view the presence of crowds in large spaces, Which most of us now see as neutral with COVID under wherever it is right now. See that as a threat. So what we have to do is change the perception, The amygdala's perception of that situation as threatening. And how we work with this is through exposing them to it. Now we don't just toss them right into a large audience and tell them get over it, Although there is some evidence that sort of approach works actually. But what we do as therapists is first to teach them breathing practices so they learn to be able to calm their body. Because we need the amygdala to see the body is going to get calm in this face, This situation it sees as threatening. So once we teach them some breathing practices, We then gradually expose them to the situation we want them to get used to. So we might do what's called imaginal work, That is have them contemplate in a private setting, In an office setting, What it's like and then we would have them go into gradually settings, Maybe smaller places, Smaller buildings with one or two people, Maybe small offices and then larger offices and larger offices too until they finally get acclimatized, Get used to being in this large situation. So that's how exposure therapy works. Over time the body will learn to calm down in the face of what it perceives as threatening. And in fact this does explain why most people who have tinnitus do in fact habituate. They're around the sound all the time and the body naturally habituates to things it finds frightening if it's around it enough. Usually. However, In the case of those with tinnitus distressed, They have not reached that stage. And there's a percentage of the people who are distressed by tinnitus who still view the stimulus of the noise as a threatening thing. We need to get them to see it as a neutral thing. That's the task. And this is just what exposure therapy does. Now, There is a problem in this analogy. Well, Why aren't they used to it? By now they're almost around it. How are we going to get them to gradually expose to a sound that they're always around. And the trick here, The key here, I've come to see, Is that tinnitus is not a unique phenomenon in our lives. Tinnitus is an example of an actually relatively common phenomenon of life, And that is events that are unpleasant to painful that we can't avoid. And this is everything from forgetting my password, So I have to go through a song and dance to getting stuck in traffic, To having a roof leak or appliance breakdown or a car breakdown, To getting sick. To getting old, As the Buddha said, And ultimately to dying. So there's a lot of stuff in life, Unpleasant things that we can't avoid. And we react to them usually in the way that the person with tinnitus distress reacts to their tinnitus. We don't want the unpleasant thing to be there. We want to push it away and we get all stressed about it. And that's actually the worst thing we can do. What we need to do, Of course, Is learn to open up to it and accept it as inevitable. There's all the difference in the world between being stuck in a traffic jam and fuming and fretting about it, Cursing the city and other drivers and your own stupidity for not checking your GPS, Between doing that versus being in the traffic jam and just letting it happen. This is what happens in life. We have traffic jams. Training on some music, Maybe planning your next vacation, Right? The same event, One person sees it as threatening and is stressed. Another sees it as one of the things that happens in life and just let it wash over them, Right? So what we need to do in training ourselves not to see tinnitus as a threat, We don't, Just like an exposure term, We don't start with throwing a person into a large crowd who is afraid of crowds. We don't start by telling ourselves tinnitus isn't a threat. We start with smaller, Threatening, Unpleasant, Unavoidable situations and train ourselves to accept those. So it's the same process. We first want to develop a meditation practice and a breathing practice so we have some control over our body so we can calm it down, Take some deep breaths. Basic calming breathing practice. And then we gradually learn to work with smaller unpleasant, Unavoidable things in life. The traffic jam, The lost password, The car breakdown, The inevitable unpleasant things that we don't want to happen that happen in life. And practice opening up to those. Calming the body, Taking some breaths, And also telling ourselves, This is one of the things that happen in life. And as we work over time with developing a tolerance of and an ability to see these previously threatening events as simply part of life, We can gradually move to working with tinnitus in this way. Learning to calm the body in the face of it, That's what our meditation practice does, And slowly training ourselves to recognize this is one of the things that happens in life. Recognizing that this is the path we're working toward is losing the having the amygdala the threat center of our body Lose its sense of tinnitus as a threat and see it as something non-threatening that we don't just jump to that from 0 to 100 Instead we gradually work our path our way towards that goal It's going to take time but I do believe that is the process by which those who are distressed by tinnitus can gain the capacity to no longer see an event as the tinnitus as threatening. And the benefit of that is along the way you develop a very different attitude, A much healthier attitude toward all the unpleasant things in our lives that are going to happen. And this has been shown to be beneficial, For example, With aging. We know that folks who see aging in a positive sense have much better health and mental health outcomes than those who are resentful, Looking backwards, Just hate being older. You can have that attitude and you suffer, Or you can embrace it as one of the things, As part of life, And go with the flow. And that's the attitude that we instill through mindfulness practice and through the trainings. So hopefully that will give you some ideas that might be useful to you. As you work your path toward habituation.