Habituation Isn't a Myth, It Is an Impossibility

Among my many scholarly articles I have surveyed in keeping up to date with tinnitus research, I have come to find a few things in landmark studies that seem to greatly undermine the idea purported by both healthcare professionals and users of this site alike. Many of these people claim that habituation, the sensation whereby a tinnitus suffered becomes desensitized to the ringing and largely ignores or eliminated it from consciousness, as the best "cure" or hope we have in this life. While I agree that there is currently no big hope in regards to getting rid of this curse, I want to dispel the myth of habituation once and for all. I will admit my bias in this argument: I have never stood for CBT, TRT, or any other anxiety/depression (not tinnitus) therapy whose end goal is the supposed "habituation".

As the study the link provided below highlight, those with chronic tinnitus have dysfunctions in various neural networks. In this case, those networks are the dorsal attention network (DAN) and default mode network (DMN). The DAN is activated and used when we are required to pay attention to something, when the brain is most active in trying to capture and encode sensory information. When we aren't paying attention to anything, or at rest, we use the DMN, meaning we aren't paying attention to anything and are at rest.

The neuroimaging study found that those with chronic tinnitus seem to constantly use the DAN, meaning our brain is always paying attention to something (likely the noise) and could explain why many suffers constantly feel tired. If this is the case, then the brain constantly using the DAN would mean we never truly habituate and that eliminating it from our mind is impossible. Another study by Josef Rouschecker (I'm not providing a link but he did a TED Talk on tinnitus) suggested a possible gate keeping mechanism of the Thalamic Recticular Nucleus in the limbic system, which in a healthy person suppresses an unwanted sound. When the limbic regulation fails, so too does the TRN, allowing the tinnitus signal to reach levels of consciousness.

Tinnitus happen for many complex changes in the brain, but it seems increasingly obvious that the brain dedicates much of its resources to maintaining attention to it. A meta-analysis paper suggested that tinnitus is the brain's way of trying to prevent apoptosis (neuron death) in the auditory cortex by producing artificial sound so the neurons stay stimulated, rather than letting them die off as they are useless without their accompanies hair cells in the cochlea to give them information.

With this, I conclude that habituation is not what many professionals or users on this site claim it is. I'm sure some of you might respond with "Well I only hear mine when I think about it or its really quiet". It does not disprove my point because it is constantly acting at the level of conscious attention, and your brain makes it very difficult to ignore. There might also be variances in your specific brain, such as a TRN that still partially works, and if you have a positive affect, may allow it to be occasionally suppressed.

But this post is to address those with true, chronic tinnitus that ruins their lives, even on a good day.

The link describing the study from the school that published its is below:

http://illinois.edu/emailer/newsletter/137502.html

 

Thank you.

 

I agree, as I posted the same link a few days ago. But where's the cut off point for chronic tinnitus! Some say at 7/10 or 8/10, some say higher. I think that 7/10 or 8/10 is unsetting. Then what percentage overall has chronic tinnitus like us who posted so far! Somatic tinnitus does have a 10x coping factor and that must be considered. I do believe that if you don't have somatic physical tinnitus then one can't speak for those who do.

 

Yes but people can stay locked into ‘chronic’ tinnitus if they are stuck in fight or flight mode.

I remember when I first got my very loud screech 6 years ago, I was also very worn out because for some strange reason I felt I HAD to give it attention.

Later I discovered that when I didn’t give it attention (not easy I know), my anxiety levels dropped (causing the T to be quieter when I did notice it). Eventually I realised my brain really was adapting so that eventually I really did not hear it unless I choose to.

Maybe we should separate the forum into two parts. Those who seem to have been stuck with T for a very long period and those who are new to it. I’m seeing a lot of posts popping up on here which will dishearten newbies and take away any hope. Some are frankly irresponsible.

The fact is that despite any academic input, most people do eventually move on. even those who come on this forum!

 

Chronic tinnitus has nothing to do with intensity. Tinnitus is considered chronic if it persists for 6 months or more.

 

Can you elaborate the rationale behind that statement?

 

There's a link to the full article at the bottom of the page, in the editors note.

 

A lot of the time CBT is to deal with tinnitus distress., or other aspects such as tinnitus related insomnia. You can argue that if you deal with the distress that means you have habituated.

I consider myself to be in a state of habituation. I can tell you that mine is not ignored, it is loud and reactive. It is not eliminated from consciousness, sometimes it is but not too often. What I do not do is react stressfully or excessively in a negative way. It is still a pain in the arse but it does not rule me. No CBT was used to get me here, it was a natural process.

I've just returned from the TRI conference. There were a lot of ideas and a lot of models, they were not all in agreement. One presentation highlighted how a lot of very well run studies came up with polar opposite findings. You think you have tinnitus nailed and it manifests in different ways. More work on the theory in the article needs to be conducted, once that is completed we will have corroboration.

Even then I don't see how the article proves that habituation is a myth? If you have the sound but are not attending consciously and giving energy to it, despite it being still there, is that not habituation?

The brain is always attending to tinnitus without us wanting it to. If it were not, then the tinnitus noise would disappear. That's the holy grail, teaching the brain not to attend, teaching it that silence is the absence of noise, not the tinnitus signal.

 

Ok great. You've scowered through the internet and found something that can confirm you will never habituate. Hopefully you are satisfied. I can find a thousand articles that will say the contrary. But you've made your mind up. You can't habituate.

I have extremely loud constant high pitch tinnitus. To which I spend 95ish percent of the day not thinking about. That's the only study I'm paying attention too. Fuck DMN, DAN OR DIN. The truth is habituation is possible.

 

The article I cite demonstrates that habituation is a myth because in those with chronic tinnitus (6 months or longer for those unfamiliar with the operational definition) because the brain region which connects between those two networks, the dorsal attention network and default mode network, differ in those with chronic tinnitus. For us, it is more tethered to the dorsal attention network rather than the default mode network. As a result, the brain is trying to drive attention to the tinnitus. I have had very brief moments where it disappears, but share in your experience. Decreasing reactivity and thus anxiety/depression can be effective. My dopamine agonist Adderall helps me not care so much about it despite hearing it a lot. That being said, it does explain why it was easier to ignore during the initial onset a year ago compared to now, where it is very hard to mask or ignore.

I suppose I got a bit aggressive at someone suggesting I was sending people over the edge. This is not my goal. I am pretty negative for a guy holding such an adorable animal in his profile picture, but I want people to be informed. Yes, most tinnitus research is depressing to read but it can help us understand why things are they way they are. The studies I describe help give answers to why people with tinnitus get more depressed or anxious so easily. In the case of this study, they explain why the ringing is so pervasive. There is a method to my madness and it is about informing other people of the research that is being done. As depressing as it is, that research is what will eventually get us a cure. Common findings like a smaller left hippocampus are huge because those findings are also seen in those with depression and anxiety disorders, as well as disorders like PTSD.

Most tinnitus, from what I've read, appears to originate in the left ear, as it did for me. Why might this be? It could lead to some interesting findings. Research regarding the role of the limbic system, while misguided in my opinion, could explain why some people with hearing loss develop tinnitus and others don't. I have a very poor way of expressing it, but as depressing as reading about grey matter loss may be, it should excite people that we are discovering trends that may one day lead to a new treatment to help mediate the damage and eliminate or greatly reduce the noise. I am skeptical over whether such breakthroughs are possible or realistic, but people should at least know what is happening. Should an oncologist not tell their patient the ramifications of the cancer they have? The patient should be informed. ENTs and audiologists aren't doing that for us, so we must find the information for ourselves.

 

Yeah, screw well constructed scientific studies that conflict with your point of view am I right? Sounds like that type of argument I'd hear from an evolution denier.

 

Does it matter as most people eventually move on happily with their lives without any scientific input?

The trouble is that science (and the medical profession) usually only get involved when the T becomes a big problem for someone psychologically. Most people who experience T deal with it with no intervention from professionals or gaining advice from browsing internet forums.

For those who do continue to struggle with the psychological element there is plenty of help out there and good advice. The problem is that if someone convinces themselves they can’t move on without a ‘magic pill’ they won’t move on until one is found.

 

There is no magic pill. I have not accepted my tinnitus as part of me, nor surrendered to it. I continue to resist it mentally and see it as a threat to my survival, but lack the energy to constantly do so. Thus I have become numb instead. I take anti-anxiety medications to suppress cortisol activity so the body's "fight or flight" response is denied and I do not suffer the health consequences. I could accept and say "I'll do everything in power to live a good, productive life and allow this to ring as loud as possible". I could become healthy, active, and even help others who are struggling. No chronic inflammation, no heart disease, no antidepressants, and no premature death at age 40. Rather, I will continue to fight the brain, show its "survival" mechanism as a threat and do anything and everything to get in its way and block its ability to keep balance. I want to throw the balance off, allow the brain to freak and and short circuit more neurons as it fails to heal itself. I want to the brain to suffer in a hopeless pit of despair that this goddamn condition has left me in.

 

It depends on how you are defining habituation. 16 years in my tinnitus is not any quieter than it was due to the above mentioned mechanisms. My brain has not learned to "ignore it" in such a way that I can no longer consciously perceive it and that article you posted details the reasons why that is so. In fact any time I actually focus my consciousness to it I can indeed hear it and it is just as loud as it was back then 16 years ago (as far as I can tell). However it doesn't bother me one IOTA. It's a passing thought and in fact it bothers me so little I've said it before that even if there was a miracle cure I wouldn't bother with it unless it was close to 100% risk/side effect free because I've trained myself to put the subjective tinnitus at the back of my thoughts and not give it any of the attention that it actively seeks.

IMHO habituation is not about habituating the sound away, it's about changing the way you spend your time thinking about it. Sure sometimes I'm laying in bed and i'm like "there's that annoying T again" but it's more of a passing/fleeting thought and not one I ruminate about.

Now I'm unfortunately dealing with extremely rare form of objective physical tinnitus (that I can record on my cell phone) due to middle ear myoclonus and palatal myoclonus which is like having constant hiccups in your throat and ears that you both feel and hear. Yet still I am working on training my brain to ignore it (not that I can actually make it go away due to its physical nature.)

A better way to summarize the article above is "You probably won't ever reduce the actual perceived sound level of your tinnitus when you consciously focus on it" however some of us veterans will tell you "that doesn't mean you won't learn to tune it out and move on with your life instead of endlessly sitting there and ruminating about it."

It's an important distinction. It's also the reason why I tell new T sufferers to stop obsessing about some miracle silver bullet that will stop your T. Based on current medical technology we have no such T silver bullet for most forms of subjective T. Your well being and "habituation" will progress much quicker once you accept your condition and break your mind out of that loop where you ruminate about it every waking moment (been there done that). If anyone wants to read my intro post here it is:

https://www.tinnitustalk.com/thread...-myoclonus-—-also-some-words-of-advice.25540/

Feel free to PM me if you have any questions and/or looking for some insight/support.

 

Your way of thinking is so so limited. Let's do this, you stay the way you are and let's not try to feed innocent people that need help, the poison that manifests in your head. It's sickening to read so much negativity. If you want to live in gloom and doom, there is no need to carry innocent people down with it. Just because you have given up, doesn't mean that people have given up.

Keep your ugly bias to yourself and maybe try to contribute to this forum.... instead of just lashing out, every second you can...

This forum is suppose to be here to help people. Your points of view, are basically that YOUR points of views that majority don't share. You keep posting negative garbage and i'll come here and sprinkle positivity....

You are not the only one that suffers on this board, but you are the one that constantly complains the most....

 

I'm glad the useless troll found my post funny

 

I understand, I was very angry when I wrote the post you quoted. With all due respect, your way of thinking isn't the only way. As negative as I may be, I provide information to people they otherwise wouldn't know. Is it depressing? Yes it is, but a cancer patient cannot endure treatment or the misery of their condition without knowing how bad something is. Its the same principal, until people know what exactly tinnitus is, how it manifests, and affects their behavior, they cannot truly appreciate this condition, as awful as it is. As I have already stated, the dysfunctions in the limbic system can help sufferers understand why they are more prone to anxiety and depression.

However, I will note not everyone has a basic understanding of neuroscience, so they cannot contemplate the brain regions, reduction in grey matter, etc. that I describe. Still, I simply want other people to be educated on the matter, though I will admit, I do partially make my posts more negative to spread my misery about. Not intending to bring others down, but rather to show how miserable I am, since I don't show that to other people most of the time.

 

Therein lies a problem. Mind-body duality.

Fighting yourself is futile. You need to understand the brain and work with the mechanisms that make sense to you. In your dialogue you are fighting yourself, that's never going to be a good way to act.

 

Strange, I'm the one posting articles about brain changes and brain regions so I think I have that down.

I am not going to accept this condition. I don't care as much about because I am numb to it, not because I accepted it. The brain makes this noise because it is basically broken and dysfunctional. I'm not sure what exactly I "work with", as you suggest.

 

Huh. Wonder if I should show this article to the people I know with chronic tinnitus who are not bothered by it. They hear it, they just don’t pay any attention to it. Maybe I should tell them they’re not habituated based on a study.

Actually, the study conclusion references the resting state function not changing for those who habituate or have mild tinnitus. Which leads me to wonder if the results they found are caused by tinnitus or caused by the anxiety and depression that can go along with tinnitus.

 

The problem seems to be that you are fighting with yourself. It's like having a bad stomach that you keep punching as punishment. Catastrophising tinnitus is damaging to you and damaging to others reading your posts.

You do not need to accept tinnitus, you just need to accept that you are a person with tinnitus. That doesn't mean that you stop searching for a cure or understanding more about it or try to beat it.

What are you currently doing to treat your tinnitus?

 

Affect is different from attention. I may not be bothered some of the time but I am not habituated just because I'm less reactive.

 

That's exactly the sentence I wanted to write.
A first step in the habituation is in my opinion not to feel the tinnitus threatening any more. Another, not to be annoyed by him anymore. A third step to continue life normally with "eeeeeee" or "szszszsz" in the ear.
Maybe I am wrong....

 

That depends on the definition of habituation.

For many people, not paying attention to their tinnitus means it does not affect their mental well being.

Or are you suggesting that even when we do not pay attention, it is affecting our brain? The study indicated that is not always the case.

 

Gl0wout again you are changing what we mean by "habituation." Words lose their value and meaning when you apply some completely proprietary meaning to them. When we talk about habituation in the context of tinnitus we are talking exactly about becoming less reactive to and learning to ignore the sound for which you have no control over. All your study proves is that we can't teach our brains to no longer perceive the sound, it doesn't mean you can't teach your brain to put it in the background and ignore it when it comes to the daily grind.

There have been so many times I've heard someone's smoke alarm beeping every 30 seconds in my headset because they have a smoke alarm somewhere in their house that has low batteries. I'm usually like "you hear that beeping going on how can you deal with that going on in your house all day?" keep in mind those things beep at like 115+db absolutely ear piercing up close. Usually the answer is like "oh I'm so used to it I don't even notice it anymore." Does this mean they are no longer able to hear smoke detectors? Nope they hear it just as loud as you or me but they have HABITUATED into tuning it out and it no longer has the ability to draw their attention away. This is exactly what happens with Tinnitus habituation. It's not that your brain isn't still producing the signal it's that your conscious mind has learned to ignore it most of the time unless you actively draw your attention to it. Sure they hear it when I bring it up but they don't hear as they go through their day. They even sleep with the darn thing going off every 30 seconds. We are ROBUST creatures when it comes to lots of stuff like this and all you T sufferers need to keep that in mind.

"I am not going to accept this condition."

That is quite a silly way to think about very real things that are beyond your control as you go through life. Does an amputee have any choice in accepting their condition? Sure they can be delusional and pretend they still have all their limbs but that doesn't change the reality of their situation which is that they are missing a limb and will need to make adjustments in their life because of that. The amputee example is extremely relevant here because our current state of medical science is as capable at regrowing that person's limb as it as at eliminating most forms of tinnitus (in that it absolutely can't).

Should that amputee spend the rest of their days ruminating about how unfair life is and spend their days looking for some miraculous way to regrow their limbs? Or would they be better off making the necessary adjustments in thir life, accepting the reality of their situation, and moving on with their lives best they can? Sometimes in life you just have to row with the punches and there isn't a solution to every single problem. Go watch Forrest Gump again and study the progression of the character "Lt. Dan." He finally found peace and joy once agan in his life when he accepted his situation.

 

My definition of habituation, albeit imperfect, regards the idea that tinnitus can mostly be ignored or not heard consciously, a notion that conflicts with what the study finds. I myself might have habituated under your definition, but if the brain rewires itself to use its attention network more than the default mode network, thereby interfering with rest, then that says to me a person cannot truly habituate if they cannot access the default mode network and thus truly be at rest without the tinnitus' disruption. I have to take medication to sleep, so that by itself is a testament to how I haven't really habituated.

 

Let me clarify, I accept I have the condition, but I refuse to accept that this is how my life will stay until I die. I will always search for something, anything that could lessen or even eliminate this awful affliction. As far as attention goes, the study validates my experience. Those with acute tinnitus did not have the changes in attention networks as those with the chronic condition do. During my first known months of onset, it was a lot easier for me to ignore and not be bothered by the tinnitus. Then in June of last year, I contracted sinusitis that went untreated for 2-3 weeks and it became a lot worse after that. In July it became bilateral and not just unilateral, and in August I became suicidally depressed over the condition. During which time I got basically no help from so called "experts", ENTs, audiologists, psychiatrists, etc. I'm not pessimistic for the sake of it, I am pessimistic for a very good set of reasons based on poor life experiences.

 

This might be the start for you moving forward in coming to terms with your tinnitus but does not mean you can not hear it so hope this little light might be the start of a better future for you and get your smile and laughter back too,
We live in hope Your a nice guy whom just needs some directionlove glynis