Where is TINNITUS in my BRAIN? Dr. Jennifer Gans explains what is happening with tinnitus.

Using the Brain to Change the Brain
Now, if we have a moment, I can talk about where this is happening in the brain.

Again, the educational piece is pretty important because the biggest help with tinnitus is using our brain to change our brain.

So, today I'm talking to our prefrontal cortex. I'm talking to people's ability to use logic.

Okay? You know, yes, I am a psychologist, and people are like, “Oh, you're going to be doing therapy, and, you know, oh, you'll be using cognitive behavioral therapy, you'll be using mindfulness, what have you.”

And I say, “Well, usually on the first session, we're using logic.”

If I say something that doesn't feel logical about your understanding of the human body, I say, “Please stop me, and then we'll go back and we'll make everything make sense.”

So, logic about tinnitus is the number one. Again, that's the educational piece. Let's be logical here.

The Three Parts of the Brain
So, if I break again the brain into three parts—there goes that number three—we have the brain stem, which is subconscious.

Okay? The brain stem takes care of our heartbeat, respiration, sleep-wake cycles, hunger—all the things that we don't have to be thinking about necessarily.

The brain just kind of, you know, does us a favor and takes care of it for us without our conscious awareness because, boy, we've got other important things going on.

So, there's our—the base, the base of the brain, which is pretty reptilian, takes care of all that.

Now, the second part of the brain to develop is the limbic system. It's midbrain, and the limbic system—we associate it with our emotional centers.

And there's this almond-shaped area called the amygdala that's inside the limbic system, and it's a small little area that has a mighty job.

Okay? So, the amygdala's job is to take in information from the external world and take in information from the internal world and make a decision.

So, the decision the amygdala makes is: Is this sensation I'm experiencing in this moment a danger, and I better put it into the danger category and keep my lens locked and loaded on it? Or is this boring, benign, uninteresting, and I can safely push it into the background and focus on whatever I want to focus on?

When the Amygdala Gets It Wrong
So, on day one of tinnitus, the problem is the amygdala made an error.

It picked up on the sensation of tinnitus—and this is still the subconscious part of the brain—it picked up on tinnitus and it put it into the wrong category.

Now, what happens when something goes into the fear category is it trips our autonomic nervous system. It hits our fight-or-flight response.

And again, what happens there is the thalamus is the gateway between our subconscious emotional centers and our conscious—the third part of the brain to develop—our prefrontal cortex, the cortex, or outer bark, of the brain.

And so, the thalamus, when the amygdala starts rearing its head and it's saying, “Alert, alert, alert! There's a probable danger here,” the thalamus says, “Well, okay.” Opens the gate, and whatever was subconscious now goes into consciousness.

So now people with tinnitus have tinnitus now in their conscious mind, whereas probably all of us have tinnitus, but it's staying below the hood.

Reappraising Tinnitus
So, our work together is to educate so that the prefrontal cortex, which actually does communicate with the amygdala with these downregulating neuropeptides to calm things down, is able to use reasoning.

And this is where the response to tinnitus comes in once you're educated as to what it is.

If the amygdala—and it's nobody's fault; the amygdala is subconscious. It's going to do what it does.

So, when it starts to rear its anxiety head, we can use our prefrontal cortex to say, “Oh, wait a minute. Wait a minute. I heard that lecture with Sher and Jennifer, and I know that tinnitus is a benign body sensation, and that it is a paper tiger, and that I'm actually safe, and that my brain has misunderstood it as important to pay attention to when, in fact, it isn't.

“And so, I can take a deep breath. Nothing, you know, nothing's broken here. And I can ask myself, in this moment, how can I help myself in light of the fact that tinnitus is here?”

And it's—nobody likes tinnitus.

So, it changes the mood around tinnitus so that the prefrontal cortex—we can use our brain to calm the centers of the brain that have misunderstood it.

So, that is the framework of what we're working with: helping the brain to reappraise tinnitus for what it actually is—a benign body sensation.

The thalamus closes, and tinnitus stays under the hood.