Strategy to Habituation

Dear Dr. Nagler,

You mention the following to be essential to free yourself from T suffering.

Strategy
Determination
Flexibility
Insight

Would you mind just shortly to express your meaning of each of them?

 

@David S wrote:

Dear Dr. Nagler,

You mention the following to be essential to free yourself from T suffering.

Strategy
Determination
Flexibility
Insight

Would you mind just shortly to express your meaning of each of them?

...........

Glad to. But please understand that this approach is based not on science, but rather solely on what makes sense to me. Moreover, four steps are not "essential" (to use your word); they are just the way I have come to look at things. And for that matter, they are not necessarily steps to habituation, as suggested in your subject line. I see them more generally as steps to overcoming one's tinnitus.

So, with that in mind ...

Strategy is the overall approach: CBT, TRT, NTT, PTM, masking, MBTSR, whatever. The list goes on. We can even include the "alternative therapies" that, I suppose as a result desperation, seem to appeal to some. And let's add in TOT (Tincture of Time). So you start by researching the problem and choosing a Strategy that seems best to suit your philosophy and situation.

Now with any of these approaches there will inevitably be bumps along the road. Improvement is never a straight line type of thing. So it takes some degree of persistence and Determination to appreciably free yourself from suffering. (Although to be frank with you, if you are going the alternative route, I really wouldn't push the Determination piece. There's a reason it's called "alternative.")

Just as important as is the role of Determination, is the role of Flexibility. At some point you must be prepared to acknowledge that in spite of your being determined, your Strategy is not getting you where you want to go. It is often very hard to recognize that point. It is even harder to acknowledge it. And it is harder still to be flexible enough to back off an initiate another Strategy consistent with your philosophy. But sometimes that is exactly what is called for.

Above I wrote that you select a Strategy consistent with your philosophy; to me that step is very important. It can take considerable Insight, however, to come to the realization that the barrier may lie in your philosophy itself. And it can take a good deal of courage to go back to square one and do a total reboot based on that realization, so much so that in some cases (I personally know of several) folks wind up truly suffering needlessly for years and years. The most common example of what I am talking about is the (quite understandable) insistence of many on focusing their efforts towards finding a way to effectively address their tinnitus. The logic here is: "If I didn't have tinnitus, then I wouldn't have a problem. And if I had less tinnitus, then I'd have less of a problem." And who can argue with that logic? I sure can't. The difficulty lies not in the logic, but in its practical application. In the year 2014 we simply do not have a predictably effective surgical, pharmacological, psychological, neurological, or audiological method of lastingly ablating or even lastingly mitigating ones tinnitus. The best we have been able to come up with so far are: the suppression of tinnitus through masking, the temporary suppression of tinnitus through residual inhibition, the possible partial suppression of tinnitus through various poorly understood and poorly documented pharmacological effects, and, of course, the seemingly endless anecdotal reports of various shapes and sizes. For argument's sake, let's also include all the investigational treatments that typically generate so much excitement on boards such as this but have yet to be demonstrated to be effective - or they would no longer be "investigational." So if your focus is on your tinnitus, and it is getting you where you want to go (for instance, if you are happy and content with what masking can do for you), then all the more power to you. But if focusing on your tinnitus is not getting you where you want to go, then in order to succeed you may need to adopt a totally different philosophy and consider addressing your reaction to your tinnitus rather than your tinnitus itself by adopting a habituation-based strategy consistent with this second philosophy. And if you have invested a lot of yourself in one philosophy, totally switching gears and adopting another philosophy can be a very daunting task indeed.

So, @David S, great question. I hope I have justified it with an equally great answer!

Dr. Stephen Nagler