Habituation and how the brain ties fear to Tinnitus. Dr. Jennifer Gans

Experiencing Habituation
So, I want—I'm assuming everybody's either sitting in a chair or has somehow has their feet on the floor right now.

So, let's take our zoom lens, our mind's eye, and let's zoom it in on the bottom of our foot.

Imagine the bottom of your foot on the floor.

I'll speak for myself. I—I feel—I feel tingling. I feel kind of a warmth, kind of a little bit of a pressure.

Now, let's get back into our conversation.

And I would venture to say that after our talk is over, if we hadn't brought our direct attention to the bottom of our foot, nobody's thinking about the bottom of their foot.

The Brain's Triage System
Right now, the brain has this triage system where—you know, it's—we're—well, let me go back to the foot.

The bottom of your foot, the brain can predict that. You know, our foot has been on the floor multiple times, and the brain has this wonderful way of kind of shifting, or taking out, what's not important and zooming in on what's important.

And hopefully, the people watching today think that what we're talking about today is more important than the bottom of their foot.

And so the brain does us a favor. The brain says, "You know what? Bottom of my foot, not so interesting right now. So, I'm going to let it go into the recesses of my mind."

That's habituation.

The Brain as a Prediction Machine
Well, the brain is a prediction machine. You know, it's—the brain is constantly downloading data. It's a data-downloading machine.

But then, once the data is downloaded in any given moment, we have to have a way of organizing it.

And so the brain has to—almost like a triage system in an emergency room—it puts them, you know, usually the things we fear go into the number-one slot, and everything else takes second fiddle.

It's second fiddle because that, you know, what is feared has to be paid attention to, and the zoom lens goes right onto that number-one slot.

And so, the habituation process is happening to all of us right now.

Going back to your question, habituation is something the brain does for us. Nobody has to learn how to do habituation.

Nobody's habituation process is broken because, again, we're doing it right now.

Nobody, hopefully, is paying attention to the bottom of their foot.

Now, if I, God forbid, had cancer at the bottom of my foot, I guarantee that's the only thing I'd be able to focus on.

But again, my brain does me a favor and says, "Ah, that pressure you feel at the bottom of your foot, I've felt it all my life. I would expect to feel it because my foot's on the ground. So, I'm going to push that off to the side, and I'm going to stay focused on, you know, our conversation right now."

So, that's my long-winded way of saying that habituation is a subconscious, natural process. Nobody's habituation machine—or is—broken.

Taking Tinnitus Out of the Number-One Slot
So, we just have to set the scene for habituation.

And like I said before, we have to take tinnitus out of the number-one slot.

People fear tinnitus. They're frustrated by tinnitus. Nobody's usually fascinated by it.

But remember those four Fs.

And so, people with bothersome tinnitus, there's usually—they connect tinnitus, at least initially—they'll connect tinnitus to fear.

And once that connection happens, whatever the mind fears goes into the number-one slot, and the lens gets locked and loaded.

So, our job as clinicians is to—and every individual's job is to—disengage tinnitus from fear.

That is number one, because the brain can now, you know, take it out of the number-one slot and reappraise, "Well, what is most important in this moment?"

So, it's, um, you know, people think that that—that habituation process, the—h—the habituation process is an active process.

It's actually a passive process.