Listening To Your Tinnitus

16:03

Listening To Your Tinnitus

by Peter Vernezze

Type

talks

Activity

Meditation

Suitable for

Everyone

Plays

3

In this talk I answer a question from a former student about practicing listening to your tinnitus on purpose, starting with one minute and building up. I go through the steps suggested: beginning in a calm place, asking yourself questions about the sound, noticing thoughts without following them, and finishing with a relaxation and a small reward. Then I share my own adjustments, such as starting with a background sound and moving gently back and forth between the tinnitus and a calming sound or image, always staying within what you can comfortably tolerate. I close with a second, very different practice of choosing where to place your attention. This content is educational and is not a substitute for one to one professional care.

Sound Focus Attention Training Technique Detached Mindfulness Tinnitus Exposure Therapy Stress Reduction Mindfulness Window Of Tolerance Acceptance And Commitment Therapy Attention

Meet your Teacher

Tucson, AZ, USA

Meet your Teacher

Tucson, AZ, USA

Transcript

Well, I'm back. I got busy and then I got sick and now I'm better. So we'll hopefully get these videos out a little more frequently in the future. But I wanted to do today's video on a question I just received a few days ago from an old student. It's right on topic and I think it's worth spending. A session on here. So he writes. I wanted your opinion about a chapter I read last night in Cognitive Behavior Therapy for Tinnitus. A very good book, I will say a little more about. Of which I included a PDF. Four pages all have the book. If you have time to read it, If not, It essentially says to practice listening to your tinnitus as an approach to aid in habituation. It's called in CBT exposure technique and claims this technique has been shown to change the way your brain responds to tinnitus. And although things like keeping busy and playing other sounds to distract us from tinnitus work, They do not help us manage tinnitus. Basically, To implement this technique, The book says to start out with a minute and work your way up to longer attention periods to the tinnitus sound. I know we've said, This is from the class, What you resist persists. However, I have not heard anyone talk about practicing listening to tinnitus to aid in habituation. I know we are all different and what works for one may not work for another, But just wanted your thoughts on this method for the general population of tinnitus sufferers. It's a pretty simple thing to try, But I have my reservations. I appreciate your experience and trust your views. So as I said, It's from this book, Cognitive Behavior Therapy for Tinnitus, Which is. . . I have a couple of reservations I'll talk about now, But outside of that it's an excellent book. Combination of therapists and audiologists put together. It's published out of Europe. It's an expensive book, Roughly $100, But I would argue it is worth it, That there is really nothing. In his class. My reservations have to do with the fact that it does use what's referred to as second. Waved cognitive therapy as opposed to third wave, And the mindfulness chapter is really lame. But those two things aside. It's the best book in its class in terms of second wave CBT. So I'm going to go over the chapter. And talk a little bit about the technique and what I think about it. Kind of spoiler alert, Basically it's a sound technique. So, Let's see, One of your goals should be to get used to the sound of tinnitus. If you grasp that tinnitus is a sound with no meaning, You can learn to tune it out. The goal is for you to respond in a neutral manner when you do hear tinnitus. The aim of this exercise is to help you process and think about tinnitus as you think about neutral sounds. So it's the purpose of actively listening to tinnitus. Is to stop trying to avoid it. Because doing so may lower your quality of life. Knowing that you can listen to your tinnitus for periods of time can also increase your sense of control and tolerance for tinnitus. And control is really big here, I should say. I've been listening to some lectures on Robert Sapolsky, Who is sort of kind of the stress expert. And he mentions control as one of the factors that has been shown to achieve stress reduction. So to the degree that we can feel we have some control of our tinnitus, That will reduce the stress. To the degree that we reduce the stress, Our tinnitus reaction will probably go down. It also, Listening to your tinnitus, Helps you to realize you don't need to avoid tinnitus all the time by distracting yourself. And you will learn that distress, And this will lessen the distress linked to hearing tinnitus. It goes on, I'll read a little more before we start into this. Do you perhaps keep busy? Think about how you tend to manage your tinnitus. Do you perhaps keep busy or play other sounds to distract you from tinnitus? Although this does work, It will not help you manage your tinnitus. Um. . . For example, You'll find it difficult to manage your tinnitus in a quiet place. Almost avoiding tinnitus is not a good plan because there may be times when you can't avoid it. When you listen only to your tinnitus, You can get used to it. Being able to listen to your attendance will help you view it as a neutral sound that is unimportant. So, I agree with the goal. And we want to get there. To the place where the tinnitus is unimportant. And what they're suggesting, As my student said, Is essentially exposure therapy. Exposure therapy can actually take two forms. One is throw you into the deep end of the pool or the pit of snakes. And see how that works. And there is some evidence that that is successful. They recommend a milder form, A more gradual form of exposure therapy, Which I would recommend as well. The example they give is, Imagine someone being scared of the dark. To overcome a fear, The person has to accept the dark, But this might start by being in a room with a lamp. On the brightest settings. Then, The next day, You dim it for a slightly longer time. You can dim the light and increase the time in the dark. By dimming the light slowly, The fear of the darkness will become less. So, It's just a gradual getting used to the darkness and that's what they want to do with respect to the tinnitus. So. The purpose is not to focus on your tinnitus all the time with this practice, Only for certain periods of time that you choose. And as the student said, Their recommendations start with a minute and build up to 10. Listening to your tinnitus on purpose may not be pleasant, But remember that your tinnitus is harmless. Um. . . So. The exposure therapy piece of this is solid. Psychological research, Yet exposure therapy does work for a whole range of events. Whether it's the best thing for tinnitus. I certainly don't think there's any harm in working with exposure therapy. I'm going to have a couple of caveats on how I would suggest pulling this off. And some other suggestions. But let me actually go over what they recommend and then throw some stuff out. To add to it. So how to actively listen to your tinnitus, When and where to practice. Begin in a place where you feel relaxed. Select somewhere that allows you to focus on your tinnitus. As you progress, You can try other places such as a different quiet room. Select somewhere you feel peaceful. Select the time when you feel relaxed and calm and nothing is rushing you. So it's pretty clear here that they intend it you to have no sound. Whatsoever with the tinnitus. And I guess the first change I would make is To start out for the first time, It wouldn't hurt to have a sound as a buffer in which you could play your attention. Phase of exposure therapy so that you have a chance to have another sound and you can switch between your sound and the tinnitus to include that as part of the process. How to actively listen to your tinnitus. Try to ask yourself questions. What does it sound like? How loud is it? What is the pitch? Does it remind you of anything? Where do you hear the sound coming from? Does it move around? Is it one sound or many? Does it change somehow when you listen to it? Managing your thoughts. When focusing on your tinnitus, Negative thoughts may arise. Remember not to focus on these, But instead listen to your tinnitus. It's a very mindfulness-based technique, So mindfulness will be helpful here. A thought arises, We need to let it go. We need to bring mindfulness to this technique. Write down any negative thoughts or emotions that occur. Steps to take. So it's a five-step process. They have you start by first doing some positive mental imagery. Positive mental imagery is a good idea in general. I'm not going to go into it here. It's a way to calm the nervous system down. So much of working with tinnitus is finding ways to calm the nervous system. So you could find, If you want to look up, Safe place visualization. On an app like Insight Timer. You could find literally hundreds of safe place visualizations. That can be very useful in calming a nervous system. So the goal is to start with a calm nervous system. To explore your tinnitus, Think about what it sounds like for the period of time set aside. Is it normal? For tinnitus to seem louder when you focus on it. The effect of focusing on it may make your tinnitus louder. This is not uncommon. Remember to try to keep listening until the distress lessens before stopping. So, I mean, This is important. In the therapy biz, We talk about the window of tolerance here. And so you always want to work with exposure therapy within a window of tolerance. A window of tolerance is what you can stand before you go into either hyperarousal, Just really bad sympathetic activation. Or hypoarousal and dissociating. It's the latter that's probably going to be the case when it comes to this exercise. So, You know. Be very wary if you start. Going out of, If you don't feel any window of tolerance, It's time to stop. Write down any negative thoughts. And that's step two. Step three. Okay, And then start by listing your tendencies for one minute, Gradually increasing the time. And again, I would say, Always staying within your window of tolerance. Three, End again by relaxing and viewing your positive mental image. Good thing to do, Have a relaxation technique, A breathing exercise. When you are finished, Reward yourself. Select something that will take your mind off of tinnitus, Maybe listening to music. Having something to eat, Do this exercise at least once a day initially. Uh. . . Start with one minute build up to ten So. Try it out. Again, I'm going to give a couple of caveats. As I've said, I would start with the sound in the room and take that away gradually over time as you work with the tinnitus. Um. . . I do have some. . . Issues with this that, You know, I don't think it can hurt, But if you think about how you get used to a sound like your refrigerator. I mean, I pretty much, Maybe you can hear it, I pretty much acclimatized or habituated to my refrigerator. I didn't spend any time sitting and listening actively to my refrigerator. Now maybe it would have lessened the actual time. There are meditations that I do that are in the tradition of working with unpleasantness, Psychological and physical. Of turning towards the unpleasantness and learning to sit with it for a while. So to do that within the context of a meditative process, It's kind of The same thing here, Because in the meditative process you're calming yourself down, Which is what they do with their visualization, And then you mentally turn towards the tinnitus. For various periods of time and what you do is, And I think it can be a little more useful is you can go back and forth between whatever sounds you're working with in your meditation and the tinnitus again, So you do what's called titration. Pendulation going back and forth and pendulation can be a little more effective I think you can do it you can you can you can work a little more gradually you know okay 30 seconds 10 seconds back to the safe place so a practice of pendulation and I also wanted to close with another exercise that's interesting to compare it to the Listening to Tinnitus exercise. This is from the last issue, Not the just last issue, But two issues ago, Of Tinnitus Today, And it's from of Stephen Hayes. Who is the founder of something called Acceptance and Commitment Therapy, Who himself developed tinnitus and used his therapeutic techniques, Which has a lot of mindfulness in it, In order to work with his tinnitus. And he has an exercise that is very different in nature than the listening to tinnitus practice. In fact, What you're doing is trying to work your concentration on focusing on something else. In particular. And so you can focus on what you want with the tinnitus in the background. So it's kind of like the opposite. He says you're working with something called flexible attention so you can place your attention where you want it. You can practice by, For example, Listening only to the brass instruments in orchestral music, And then listening only to the strings, And then only to the wind instruments, And so on. If, While listening only to the brass, You try not to listen to the strings, The strings will be heard. Never become interested in subtracting interest That is just another very sticky form of interest. Instead, Simply abandon any interest in the strings dispassionately. You hear them, If you don't, You don't. And let them be equal either way and then listening to. And then listen to the brass. So it tries to get to the same and that is having this. Tinnitus sound just become uninteresting and you do so by focusing your attention on one thing and ignoring everything else in the background. Not ignoring it, But just focusing on that one thing and letting the other stuff drop into the background. And that way the tinnitus in this analogy is going to just be there and you're not going to pay any attention to it. Again, Seeing all this is a very different practice than having the tinnitus lose its impact by paying attention to it. And I mean, I guess there's nothing wrong with trying them both out. I don't see that that would be problematic and they might even reinforce each other. So it's a couple of practices to think about.