The Psychology Behind Habituation

I find the psychology behind tinnitus acceptance (and habituation) fascinating.

Apparently tinnitus affects about 20% of the general population. Only a fraction of that percentage find it totally debilitating. I imagine that many of us on this forum must fall into the latter category. But I’m sure you all have encountered as many people as I have in the former category who have tinnitus but, “don’t listen to it.” “How do they do it,” we all wonder. Well, the great irony of tinnitus seems to be that in order to “not hear it,” and therefore not be bothered by it, you must learn to not let it bother you. WTF... this is something I would expect in the Twilight Zone, but not real life! For many of us it feels like the worst thing that ever (and could ever for that matter) happen to us. So in order for us to get to the place where most people living with but not debilitated by tinnitus are, we need turn something utterly devastating and catastrophic into something that is as neutral as the feeling of the clothes against our skin. That is a tall order to say the least... and at first it seems impossible but let’s look at our weapons in this war:

1) Time: is both friend and foe. The more time we put between us and ground zero, the better BUT, every second of dealing with high level intrusive tinnitus is like being stuck in Guantanamo... unimaginable torture. So step one needs to be a survival strategy that helps us survive the first 6 months of this hell on earth. I will admit that I have nothing to help me through this stage other than pure stubbornness and good family support... oh and copious amounts of alcohol (and coffee in the morning). I suppose my strategy could be summarized as, “drink through it!” I would love to hear techniques that you all find helpful in surviving this stage though as mine is not something I can keep falling back on indefinitely.

2) Perspective: ultimately with time comes a change in attitude that I think has as much to do with our ability to forget what it was like to not have tinnitus as it is to make peace with this new reality. Note that, heavy drinking and associated memory may shorten this process (just kidding of course).

Please feel free to add your own thoughts as to obstacles to habituation and techniques or concepts that you turn to when you are struggling with tinnitus, especially in the early stages.

 

There are a number of techniques that help you change your emotions towards tinnitus and hence how it affects you. They are very similar to the approach in some chronic pain treatments. There appears to be a few different approaches:

Change from a fear based response and hyper focus to acceptance and the understanding that tinnitus is a made up phenomenon by your brain and cannot physically hurt you. You stop the hyper focus, detailed monitoring and measurement and explore your emotions about it and let it go. You stop the catastrophic thinking and constant worse case “what if’s”.

Another approach is based on the idea that buried sub conscience anger or rage has created the tinnitus or has latched on to it and started this cycle that keeps us from getting better as a distraction from deeper issues

There are some very specific treatments with physical procedures like eye movements and thoughts to perform retraining of your brain.

Examples are Somatic Tracking, Mindfulness, CBT, Back to Silence, TMS Healing, and EMDR. There are many interesting and helpful books and videos, I found many of them here on this site.

I read so many stories here about people who have this intense hyperfocus and fear loop in progress with constant projecting of worst case outcomes. Some have a laser focus on drugs like steroids when there is no confirmed and uniform success with these drugs except in very specific circumstances. This is probably from the symptom/test/drug model that is so common. While this model successfully treats many conditions it’s not very effective for many chronic conditions or those with an emotional component. So many are told to go home and live with it by medical professionals and that can amplify all of this and make it worse. The suffering is real and the sounds are being perceived as real but if that cycle can be broken, there can be relief for so many people. How much relief, how permanent? I don’t know but I believe that everyone can get relief, in some cases, dramatic relief.

George

 

Excellent post. Also saying CBT and mindfulness is crap will get you nowhere because THERE ARE NO OTHER TREATMENTS. I rather have a cure but unfortunately we got poop.

 

I would like to add that I believe that for some here, they need tinnitus, it defines them. As tortuous as it is, they don't feel that they can let it go. This relates to the mechanisms I summarized in my previous post, especially repressed emotions. The hurt inner child now has a badge to display highlighting the pain of unpleasant childhood trauma, that sort of thing. Of course this is not what is happening with everyone but its one of the mechanisms that can be explored and resolved.

I experienced this in the 80's with a hypoglycemic diagnosis during a break up, massive job stress, tons of bad lifestyle choices, ... It started with some wicked panic attacks that scared the shit out of me followed by a diagnosis, countless doctors, tests and drugs. Then Benzo dependency and a wicked withdrawal process (way worse than my biggest tinnitus spike). Turned out I held the key to resolving the whole thing. Lifestyle changes, diet and supplement changes, quieting my mind, removing anything toxic in my life, reflexology (this was a big one). It took me a few years to figure this out but this completely went away with my own actions soon after I really started the work and has been gone for 40 years. BTW, I didn't even have hypoglycemia, it was stress related disruption to my adrenal system with the attendant nutrient deficiencies as the root cause, but I got stuck on the diagnosis and owned the shit out of it. Sure if I really push the limits on a bunch of bad choices I get a little shaky and cranky but then I just say nothing to see here, go eat a banana and Magnesium and get back to work. Easy peasey. No fear cycle to push it into overdrive.

The brain controls everything and your emotions and memories sit in the same noggin with all the nerve conduction, sensations and control both sympathetic and parasympathetic.

All the best,
George

 

I see a lot of that here. People getting pissed off at success stories, saying that a psychosomatic illness process is crap, saying harmful and terrible things to people that post asking for help when they are emotional and their mind is running away with the problem. It's a shame but somewhat predictable. The stigma of any emotional component to illness, seeing it as hypochondria and hence mental illness, perceiving talking about emotions as weakness, staying stuck on the symptom/test/drug model, where's my pill? Then there is hanging on to the cycle for dear life because its a distraction to scary inner memories and emotions and merely suggesting that link brings out anger and rejection.

It's funny, we have no problem accepting this feedback cycle in a physical model. Sprained ankle, keep pushing it, more pain and swelling, longer duration of sprained ankle. Chronic pain doctors and people here talking about their resolved tinnitus talk about breaking that cycle and walla, no more suffering. For some merely explaining the mechanism solves the problem. For others it requires more work.

I believe that there is always at least some relief for everyone, but just staying stuck and waiting for the cure is just wasting your good days. I have stage 4 cancer and I work every day to not waste any of my remaining good days. Every day.

George

 

To Barry098:

Are you seriously reporting that your daily response to this involves "copious amounts of alcohol"?

I knew very well two people who died of alcoholism.

With all due respect, this is tantamount to committing suicide on the installment plan.

I am absolutely not judging you; I have not had a drop of alcohol since 1981, but given the severity of this condition, if I were a drinker I would have used alcohol to anesthetize myself to the point where I would most assuredly be dead.

I was told by a Veteran who is active in Veteran's affairs that social researchers sought out a homeless Veteran on the streets of San Francisco, and he said that heroin was the only antidote that enabled him to coexist with tinnitus.

This Veteran who reported this also has tinnitus, and he mentioned that his ENT Doctor said how heartbreaking it was to receive patients still in their 20's who were recently discharged from the Military; so much of their hearing had been lost that the tinnitus blocked their capacity to hear most external sounds.

To Wrfortiscue:

The fact that there are no other treatments does not in the slightest improve the unsatisfactory, disappointing character of CBT and Mindfullness.

However, your point is insightful and very well taken in that we have no recourse but to make the best of that which is available (no matter how untrustworthy and only partially serviceable such methods may be).

Yesterday we went on the Nature Trail in the Indiana Dunes National Park, and sat for awhile on a bench in the Wetland Zone. The Fall Colors were magnificent in the full Sun, but the surrounding silence only cruelly magnified that high-pitched, beady hissing I have. I kept nodding enthusiastically to my wife, but to myself I said, "Tinnitus will always ruin everything that I previously so enjoyed; just get me the f**k out of here."

No one has the right to judge anyone regarding whatever course of action (however destructive) he or she decides to take because of this.

 

Alcoholism has about a 15% rate in the US, similar to the 20% rate of tinnitus. Self medication is a common coping strategy as you highlighted in your post. It's an extension of so many chronic illnesses both physical and mental. I got off that train in 1998 but I recently lost a friend to it, its a devastating disease which I have watched throughout my family for over 60 years. The single largest thread on this forum is titled "Suicidal", there is a lot of suffering and coping to go around. The plight of war veterans is heart breaking but I often think of the legions of healthy teenagers blasting earbuds, car stereos, concerts, etc. and damaging their hearing. Like most of us I was told that you will go deaf. Nobody ever told me that I risk spending the rest of my life with this involuntary screeching in my head. We are a curious lot that's for sure but I must say that I did enjoy the perks of being young, dumb, tough and invincible. Youth is wasted on the young.

DavefromChicago: I don't agree with some of the buildup but strongly agree with your close:

"No one has the right to judge anyone regarding whatever course of action (however destructive) he or she decides to take because of this."

I am Georgefrom Chicago BTW. All the best brother.

George

 

Couldn't agree more George. Well put.

I applaud you for having such a mindset to carry on, given all the struggles you go through with the cancer and all.

“Courage doesn’t always roar. Sometimes courage is the little voice at the end of the day that says I’ll try again tomorrow.”
― Mary Anne Radmacher

 

I'm now a few days past my first anniversary date of onset of reactive tinnitus & hyperacusis. I have not habituated to it. I have been suicidal since the day it occurred; visited emergency room three times - the first time was worth it since I received Xanax & ear drops but the second & third time was huge waste of time within first month of this horror. They wanted to take me off Xanax & my General physician who read all the hospital reports was agreeing with them because they to him are 'experts' because they were specialists, but in psychiatry NOT tinnitus!!!

They knew nothing about severe tinnitus or even heard about hyperacusis! Totally clueless. They also were all against anyone being on Benzos because shortly before my incident the College of Physicians & Surgeons sent out a warning memo to all physicians about the huge number of people taking Benzos for unlimited number of years & therefore concluded it was too addictive to prescribe. I had decided that if that were to happen I would have no choice but to take my own life soon after since Xanax was helping lower the extreme loudness of the perceived tinnitus in both ears. Thankfully I finally was able to see an ENT shortly after & she saved my life by letting my G.P. know that she thought it was fine for me to continue being on Xanax considering the mental state I was in.

Because everything was being shut down in my city at the time of my incident due to COVID-19, I had to depend on communicating with experts online & speaking to people at ATA which was helpful. I had to wait two months until I could see an Audiologist in person who gave me a set of sound generators with pink noise to try out for a month. The sound generators helped take my mind off the terrible disturbing tinnitus in both ears but of course did not help with hyperacusis too much. I had done ton's of reading about tinnitus & how emotions play into it. The first 6 months are worst because you end up being consumed by tinnitus trying to figure out what's happening with your ears/brain & experimenting with what works to help if anything.

I've suffered with chronic pain all my adult life & nothing, and I mean nothing comes close to the distress & intrusiveness of the tinnitus/hyperacusis I have. You feel helpless & like the world has control of your condition holding the lever or tuning dial since it's affected by practically everything related to sound. I did everything I could to deal with all my anger, frustration, past misgivings, blame including self blame, etc... it helped to some degree but everyday for me is still a huge struggle & challenge.

 

People like you, who still carry on in the face of the insane adversary that is tinnitus and hyperacusis, are one of the most resilient people I know.

 

Thanks Stacken77. I understand your condition is similar so ditto goes for you.

 

You’re an inspiration to me too Stacken, same with @Exit, @aura, @Damocles and @Steph1710.

 

To be honest, I’m not quite sure what your analogy to the physical model has to do with breaking the tinnitus cycle. In the case of the inflammation of the ankle the condition improves through, as you say, not exposing it to more harm.

Clinicians, from what you’re saying, don’t seem to understand the model you cite above, even in the physical model. In many cases they give those with tinnitus and hyperacusis/noxacusis the opposite advice.

These are actually a physical model also. Your ear has been injured. There is often inflammation involved. If an ankle doesn’t work the same when inflamed, why would the ears? Still yet a clinician will tell you that protecting your ears is the wrong approach and believe it is all psychological. My ENT surgeon told me protecting was worsening my condition.

I never a single day have protected 24/7. I only protected in public the majority of the time when around traffic, loud playgrounds etc. so I’m far from obsessive about protection. I only protect at home when my kids are screaming playing or doing loud chores like vacuuming. Yet I was told that’s making things worse lol.

This misinformation from clinicians has led to endless people here experiencing no improvement, or worse their condition deteriorates.
Certainly, these clinicians have had this model explained to them and beyond that they’ve had extensive training on it, so why do they not get it?

I understand this is a bit of a tangent, but it just seems the physical model isn’t as easily grasped as you imply, so perhaps the psychological model isn’t either. Especially since they are directly linked in this case. You physically don’t take precautions, which continues the cycle of suffering or worsens it while you are trying to implement the psychological cycle. Thus preventing the likelihood of the relief occurring, all at the hands of misinformed clinicians on both they medical and psychology related sides.

 

I should probably re-word that as I too know some serious drinkers who died young due to the bottle and I didn’t mean to imply that I was trying to drink myself to death. I do find that alcohol helps me to cope but in all actuality I seldom drink more than 3 drinks/day because more than that really messes up my sleep cycle and leaves me totally nonfunctional the next day. I think this is considered somewhere just beyond moderate level drinking (although, I have family members who consider it to be excessive).

 

I see that I did not make my point clearly. The analogy that I was trying to make is that we easily accept the physical injury model. You sprain your ankle and if you continue to apply physical injury it gets worse in a positive feedback loop. The cycle must be broken to heal. The doctor prescribes 6 weeks of rest in a soft cast and most of us follow orders. Back to football in no time.

I was trying to draw the parallel to the destructive positive feedback loop of tinnitus-hyperfocus-fear-worsening symptoms-more fear, IOW in the emotional sphere. If you try to describe that process to people and suggest that this destructive emotional loop needs to be broken for healing this idea is not as readily accepted. People still want a physical explanation and a cure through standard exams, tests and drugs. In some cases this will help and there may be more help in the future but today this is rarely a solution.

Regarding how to physically handle tinnitus: silence, protecting, masking, sound exposure therapy - that's an entirely different subject with volumes written here and elsewhere.

All the best,
George

 

No judgement brother, I needed to quit drinking in 1998 so I have traveled this road. When does one have a drinking problem? Work, health, family, friends, finances, the welfare of others. If drinking damages any of those things then it's a problem. The volume and frequency is unique for every person. For some it's a bottle a day and for others it's winding up in jail every Saturday night. That's for you decide, but you are parsing your words so you have put some thought into it, which is good. We always know the answer to this question somewhere inside. If it's not a problem for you then carry on soldier, I hope you find some healing.

George

 

I understood what you were getting at. What I was getting at is if the general physical model for tinnitus is off, then perhaps the general psychological model is also. I see a lot of people lately on here talking about “oh sufferers are neurotic this and that” or as you said they have this attachment to their tinnitus. I think for a support forum it’s just as negative as those who you mentioned lash out at others. Kind of comes off as a form of victim blaming.

The analogy to a swollen ankle is a poor one. Most people seeking help on this forum aren’t people with a level of tinnitus comparable to a swollen ankle. I certainly wouldn’t compare severe tinnitus to a swollen ankle.

I’ve taken an extended break from the site and recently came back due to a setback. Reading posts like several you’ve made in this thread and as I said some others I’ve seen people make recently gives me the feeling I need to take another break till this wave passes. When I first started posting here these certainly weren’t the sentiments I saw regularly.

 

Point taken that you don't find my analogy appropriate. What other perspectives from me or others are, from your viewpoint not helpful and cause you to want to leave the site? You see my perspectives on the emotional part of the process as victim blaming? I want to know if the things that I post are hurting and not helping people.

I suffered because of the very process of having an attachment to an (real) illness in the 80's and it hampered my improvement for a decade, and I got addicted to Benzos in the process. The whole thing was horrible. Part of it was me and my emotions making real physical suffering worse and limiting recovery. Once I understood what was happening I got better. I am trying to highlight one part of this puzzle for some people to help them, based on my own experience. Every one of the things I reference I have experienced. Again, I am sorry that I did not communicate effectively and have not been helpful. Is it victim blaming? I don't feel that I am blaming myself for having suffered from this process. In addition to the condition, my brain and thinking were part of the problem but it wasn't my fault as it is not for any one else here. We are a mind body system and for some chronic conditions, we need to address the entire system, me included.

All the best, I hope you find relief.

EDIT:

It's a touchy subject. If I tell you that you may be Magnesium deficient and suggest the glycinate chelated form. You might ask for an Amazon link. If i suggest an emotional component to your suffering you might get defensive. We stigmatize our brains effect on our illnesses which is a real shame. In the current book I am reading on the subject, the author recounts how he threw the first book on the subject across the room calling the idea crap and then suffered for 5 more years. When all the physical based work failed he came back to this concept, got better and made this his life's work. The first time a doctor told me that maybe I needed to be sick, I got pissed off. Then I understood what he was saying, pursued that view and got better, with more than one condition.

George

 

Or as @DaveFromChicago called it elsewhere, Junk Placebo... I call it Snake Oilery...

My favorite BS is from another support group where the moderators state that your brain will habituate no matter what, and to keep living as if you didn't have tinnitus. Play your musical instruments, go to concerts, night clubs etc. You will get better they promise.

Like they have any accountability if their "advice" drives one to disability...