Working With Tinnitus Anxiety

14:19

Working With Tinnitus Anxiety

by Peter Vernezze

Type

talks

Activity

Meditation

Suitable for

Everyone

Plays

1

In this talk, I describe a way of looking at anxiety as a habit made of a trigger, a response, and a reward, and how I think this applies to tinnitus. The sound can set off the body's fight-or-flight response, and worry and rumination can keep the loop going. I suggest turning toward what you feel in your body with curiosity instead of worry, then adding kindness toward yourself in three steps: noticing that this is hard, remembering that many other people feel the same, and asking what you can do to suffer less. I also mention that breathing practices and working with distressing thoughts can fit in here. This content is educational and is not a substitute for one-to-one professional care.

Sensation Investigation Polyvagal Informed Self Regulation Practice Mindful Awareness Anxiety Tinnitus Habit Curiosity Emotional Regulation Fight Or Flight Mindfulness

Meet your Teacher

Tucson, AZ, USA

Meet your Teacher

Tucson, AZ, USA

Transcript

So it will come to no surprise to anybody watching this. That anxiety is a problem for tinnitus. I mean, Anxiety is a problem for everybody these days, But in fact. . . Those of us with tinnitus have. Clinical anxiety, Or what's known as generalized anxiety disorder. At two to three times the rate of the general population. That's pretty high. So, What I want to talk about today is a novel way of treating anxiety. That comes from some work from Dr. Judson Brewer, Who is a fascinating neuroscientists, Psychiatrists, And Mindfulness. Trainer of sorts. And what he does is bring mindfulness and to a number of problems that are a source of human suffering. Specifically, He's worked with smoking and overeating. And most recently, Anxiety. And interestingly, He uses the same model in all of these issues. That is, He sees them all as habits. Now, That's relatively easy to account for when you're talking about overeating and smoking, But we generally don't see anxiety as a habit. And yet, Dr. Brewer makes a pretty good case that it is a habit and that working with it as a habit can offer an alternative to the traditional way of working with it. But first, Let's talk about what a habit is and how it works. So, According to Dr. Brewer, There are three parts to a habit. There is a trigger. There is the behavior and there is the reward or the response. So let's look at. . . Pretty basic example to understand how this works. Let's look at that wonderful habit of checking our cell phones that we can all relate to. So, I'm feeling a little bored maybe and I pull out the phone and I look at maybe a Facebook post. And this is a habit a lot of us have, Excessively so. How is this a habit? Well, The boredom is the trigger. The pulling out the Facebook. . . Pulling out the phone and looking at Facebook is the behavior. And then we get a little extra shot of dopamine as a reward. That's what keeps the habit going. Why I keep going back to it is to get this little shot of dopamine to help work with this boredom. So, If we want to break a habit, According to Dr. Brewer, What we need to do is bring something else to the table that can be a substitute for the behavior we're trying to break. So let me explain with the example he uses, His work on smoking, Which has been pretty groundbreaking and very successful. So, What do we do? Well, Again, We have the trigger whatever it is that triggers you to pull out the cigarette and smoke. And you get some hit of various neurochemicals that give you some reward to keep the habit in place. So now if we want to break the habit. Essentially, What he says is we have to give the brain what he calls a bigger and better offer. Something bigger than the the reward of the cigarette. And what he uses is mindfulness, Essentially. How does he use mindfulness to do? Well, He brings mindfulness in at two ends of this activity spectrum, Behavior, Trigger, Behavior, Reward. First, He says, Really, He has us bring mindfulness to the smoker. Really be aware of what's going on when you smoke. Notice the taste in your mouth. Smell the smoke. Think about what this is doing to you. That's one way to bring mindfulness. So you become aware of what the result is. It's not a very pretty picture. So what you need to do then is offer the brain a bigger and better offer. A BBO as he calls it. And this is also mindfulness. And specifically he has us say bring curiosity first to the event, What's going on. So if you are feeling a little nervous, And a cigarette is your default mode to address that. Stop and just bring some curiosity to what you're feeling exactly. What is going on? Is my stomach a little nervous? As my palms are a little sweaty, My back is a little sweaty. Pulse a little, Upregulate it, Just observe what's going on with the event and bring awareness and curiosity. It's an open awareness. Just be, Hmm, That's interesting, As he puts it. Just open up to the event with a level of curiosity as well as a dollop of compassion. This is really difficult to be going through. This is hard. And what's that feel like? And his contention is that bringing curiosity and compassion to a situation like smoking, Like overeating, Is a bigger and better reward than the actual activity when you realize what is going on with the activity. When you see the activity for what it really is, As overeating or smoking, And what it's doing, And have this alternate route of curiosity and compassion, The brain will take the bigger and better offer every time. Well, Not every time, But often enough that he's gotten some pretty astounding results in working with both smoking and overeating. So, Let's turn to anxiety in general, And then tinnitus anxiety in particular. Doesn't seem off the top of your head to work like a habit, But in fact he claims it is. How so? Well, Let's say I'm taking a test for I don't know, License or something, A licensure, Professional licensure, Whatever, And I'm a little anxious. I've taken the test and I'm waiting to hear the results. And this anxiety, Which is a nervousness that's physiologically measurable in the body, Is the behavior in response to the trigger. And the result then is I end up ruminating and worrying. And that actually is a sort of a reward because I at least feel it's at least positive in that it gives me the illusion that I'm doing something. I'm applying my brain to this process. So my brain figures things out. So maybe I'll figure this thing out. Keeps going because it thinks it's doing something. So, In order to break this habit loop, As he calls it, Again, We bring awareness, Mindfulness, To what's actually going on. So, Feel that anxiety. Be aware of what's going on in the body. Feel whatever you're feeling in the body, The pulsing, The shaking. Listening to your thoughts. Notice what you're telling yourself. Just be curious about it. Which is a very different state than walking into rumination. Be curious. Oh, This is what's going on. My stomach's a little upset. I'm breathing a little fast. I can feel my pulse. Thinking these catastrophic thoughts. This is what it is. This is what anxiety is. It's an alternative route to the rumination worry. And then bring compassion. This is a real difficult time. What can I do at this point to maybe deal in a little more skillful way with these physiological feelings than jumping into rumination? And see what you can come up with. Maybe it's just a breathing technique, Maybe it's a distraction. But in either case, Curiosity and compassion can result in a bigger and better offer that allows the brain to have an alternative route to go, Rather than to the worry and rumination. And insofar as anxiety goes, Again, His lab has gotten pretty good results and his book was a really best seller. So, Finally, Tinnitus. It works just like regular anxiety, Right? So the tinnitus is the obvious trigger, The sound of tinnitus. And that sets the body. Into essentially fight or flight. What happens is the body perceives the sound as a threat. The heart rate increases. Your breathing rate increases. Your body begins to draw on resources to get it ready to engage in battle with the threat or to run away. The classic fight or flight response. So, That's the situation that we find ourselves in. And then we start worrying and ruminating about the whole thing and it just keeps the loop going because the worry and rumination increases the sense of threat, Yada, Yada, Yada. All right. How does mindfulness come in here? First, Let's turn to what's going on. Just be aware. Instead of jumping into the rumination. Turn to the symptoms. Open up. What's going on? Well, My heart is racing. My chest is a little pounding and my stomach is a little weak. Maybe, Again, I'm breathing fast. Just bring awareness. Hmm, Curiosity, What's going on at this moment? And curiosity is a very different flavor than worry and rumination. Worry and rumination has what he calls this closed, Tight attitude that shuts us off. Curiosity is open and inherently inviting and relaxing. Once I get to this curious state, Then I can bring compassion. To the situation, And here specifically I think of the work of Kristen Neff and her self-compassion or mindful self-compassion work over many books. And she has something called a self-compassion break, Which seems just the perfect thing to bring in at this moment as in a response to the anxiety. Rather than going down the worry-rumination loop, Her self-compassion break has three components. First is mindfulness. Be aware. As we just talked about, What we just kind of went over is the awareness. Oh, This is what's going on with my body. And then, After the notion of a mindful awareness, Bring some of what she calls common humanity. Recognize it's not just me suffering. Millions of people with tinnitus are suffering in the same way. To tell yourself, You know, This is. . . First, This is hard. That's the first stage of the awareness. And then second, Others, Many others are suffering like me. Share the burden. Spread it out. Recognize you're not this isolated individual. And finally, As she says, Bring the compassion component to it. What can I do to nurture myself in this moment? What can I do to suffer less? And we can turn to the elements of tinnitus distress, Which are, As we talked about, Either the physiological reaction of the body, The thoughts that I'm having, Or some emotional dysregulation. And I can look and say, How can I suffer less with all these? Can I turn down the temperature on my body, Metaphorically speaking? Can I regulate it by some breath practices to bring my body down sympathetically upregulated state. Am I having distressing thoughts? Can I look at those and recognize they are? Irrational, Catastrophic nature. And finally, With distressing emotions, Sometimes what we need to do is sit with these and recognize we can tolerate distressing emotions using emotional regulation strategies, Which should be part of all of our makeup, Our general psychological makeup. So bringing curiosity and compassion to this situation can begin to deal with the actual elements of what's going on with my tinnitus and reduce my suffering rather than exacerbate it by imagining it going into the future and having these horrible distressing thoughts. So, That's a strategy I urge you to try out. Take a look at the work of Dr. Brewer.