הפחתת מתח מבוססת מיינדפולנס
שָׂפָה:
הפחתת מתח מבוססת מיינדפולנס
Mindfulness and Tinnitus: Changing the Brain and Reducing Suffering
Introduction and Objectives
Hello, everyone, and thank you very much for joining us today. My name is Brooke Townsend, and I am the Content Development Audiologist at ReSound. I am very pleased to introduce our guest speaker for today, Dr. Jennifer Gans.
Dr. Gans is a clinical psychologist in San Francisco, and she specializes in the psychological impact of deafness and hearing on well-being. She is also the CEO and founder of MindfulTinnitusRelief.com, which is an eight-week, self-administered skill-building course, and it's to learn how to live comfortably with tinnitus.
Today, Dr. Gans will be providing us information regarding mindfulness and how it can be used to help our patients suffering from tinnitus.
I just need to go over the objectives for today, and then we'll let her get started.
So, after this course, you will be able to explain how to evaluate research to date on mindfulness as a management tool for tinnitus. You will also be able to describe Mindfulness-Based Tinnitus Stress Reduction and the components of the eight-week course and the online version, MindfulTinnitusRelief.com.
And you will be able to describe what is happening in the brain of a person experiencing bothersome tinnitus.
So, Dr. Gans, welcome.
Good morning to all of you people here on the West Coast. I'm calling in from San Francisco, and good afternoon to everybody on the East Coast and all of the times in between.
So, I'm really pleased to be here, and the topic that we're going to be talking about today is kind of new in the field—relatively new. It's Mindfulness-Based Tinnitus Stress Reduction, a program that I've designed, and I wanted to talk a little bit about kind of the backbone of the course, but from a tinnitus brain functioning and mindfulness perspective.
So, let us get started here. And Brooke, thank you so much for your introduction. I think that pretty much says it all.
Just a quick disclosure: I have no commercial or financial relationship with ReSound, but I kind of joined a partnership for this talk with ReSound just in good faith to expand everyone's knowledge about this topic. And I very much appreciate ReSound and our ability to develop such a good partnership.
The content of today's talk is really, though, property of mine.
So let's dig into the important stuff.
Goals for Today's Talk
Goals for today's talk, just to kind of frame where we're going to be heading.
I'm going to do a very, very brief tinnitus review. I don't have a great sense—there's quite a few people that have called in for this webinar—I don't have a great sense of where people's knowledge is about tinnitus, but I'm going to make some assumptions that if you're calling in about this, that you've kind of gotten your feet wet with tinnitus.
So I'm not going to spend too much time with the review of tinnitus.
But then we're going to talk about what is happening inside the tinnitus brain—or let me put it this way: what we think is happening inside the tinnitus brain.
Then I'm going to demystify meditation and mindfulness. I'm guessing again, it's hard because I don't see you all in person, and I can't ask for necessarily a raise of hands for who has had some experience with meditation and mindfulness.
But I want to really give us even some experiential education into what meditation even is. You know, it's a very—it's a sometimes misunderstood word. And so maybe through today's talk we'll be able to give you a good experience with what meditation really is.
So then we're going to talk about how meditation and mindfulness are tools to change the tinnitus brain, and MBTSR, which is the acronym for Mindfulness-Based Tinnitus Stress Reduction.
We're going to look at the research, and we're going to look at some of the findings. And then we're going to look at the next step in my career goals: the development of MindfulTinnitusRelief, which is basically the Mindfulness-Based Tinnitus Stress Reduction course flipped into an online version.
So then we're going to look a bit inside the course and, most importantly, how audiologists can lead and start to really branch out and be providing MBTSR courses and information in their own practices.
So let's really get started here.
Tinnitus Reviewed
Now, just again, I think we're—everybody knows somebody or is somebody with tinnitus. I mean, it's hard to avoid it. And certainly all of us in the hearing-related fields, you know, it can be a daily occurrence that we talk with people with tinnitus.
So the stats are that about 50 million Americans experience tinnitus. Now, that's quite a huge number, but let's make a real distinction here.
I really see tinnitus as really falling into one of two categories. There's the people who are bothered by tinnitus, but they're also the people that are not bothered by tinnitus.
And so today's—you know, the 50 million really encompasses all of those people. And what we're really concerned with, and the people that we see in our practices, are the ones that are bothered by tinnitus.
And so here we have this stat that 33 million are not bothered by their tinnitus.
Fifteen to sixteen million of the 50 million have a problem enough with their tinnitus that they actually will go to their doctor, will go to their audiologist, we go to some professional to say, "Hey, wait a minute. This tinnitus is bothering me. What's going on here?"
And then we have about two to three million Americans—just Americans—that are really debilitated by their tinnitus.
And those are people that are really needing some help. Oftentimes they've tried just about everything, and very little has given them relief.
And so let's—now, this slide I find really, really interesting.
Again, Brooke, thank you again for your introduction. I am a psychologist, and so many people are like, "Oh, wait a minute. Here we're talking about tinnitus. Why would a psychologist be interested in tinnitus?"
And I think this slide pretty much kind of sheds light on why I'd be interested in tinnitus.
So, over the years, you know, we've done some looking into the psychoacoustics—the psychoacoustic properties of tinnitus. And it's very interesting because we have these two groups, really: the people who are not bothered by their tinnitus and then the people who are bothered by their tinnitus, in the red and the greenish color here, the ones that are actually bothered by their tinnitus.
And it would stand to reason, you know, to most of us probably, that if you're not bothered by tinnitus, well, then your tinnitus must not be very loud, or be perceived as very loud.
And then if you are bothered by your tinnitus, well, gee, you know, the severity of your tinnitus probably is connected to the sound level of the tinnitus sensation.
Well, that's actually not the case.
You know what we're seeing here, if I can use a couple arrows, is that the people who are not bothered by tinnitus, you know, 2 to 20 dB is about where their tinnitus falls into.
Then we have the ones with the significant problem, the ones who are bothered enough to go to their doctor and say, "Hey, what's this?"
But again, we have 2 to 20 dB.
And then we have, in the third category, the ones who are severely bothered by their tinnitus. Lo and behold, their tinnitus is measured from 2 to 20 dB.
Now, what this tells me is that it's not about the damage or the problems that are going on with ear functioning that's really what determines the bother of tinnitus. And perhaps it's really not even about the ears, and it's more about what's between the ears.
Perhaps it's about what's happening in the brain.
And so again, you know, I'm kind of looking for the questions that are raised here. And the fact that, depending pretty much on average—again, on average—we're having similar decibel levels for the tinnitus really points to it's more about what's happening inside the brain.
And so that's really what I want to touch on a little bit today.
Facts About Tinnitus
All right, some facts about tinnitus, just to kind of wrap up our information on tinnitus being reviewed, and some things that will come into play throughout the rest of this talk.
Anybody that's worked with somebody with tinnitus is probably very much aware of this, but the top four complaints of tinnitus are depression, anxiety, sleep difficulty, and concentration problems.
So maybe it's not about so much the tinnitus sensation itself, but the depression, the anxiety, the sleep difficulty, and the concentration problems that kind of wrap tinnitus into a ball of frustration and discomfort and bother.
And then something else that I've certainly observed in my practice, and something you can certainly read about in the research, and again something I'm sure you've all had contact with, is that really, you know, we don't know everything about tinnitus, but we do know one thing:
Stress increases tinnitus bother. Relaxation decreases tinnitus bother.
So that's a pretty important fact that we'll be taking more into account as we go through this talk.
And so, for most tinnitus, unless there's an MRI that's taken place and there's an acoustic neuroma or a brain tumor on the acoustic nerve, for most tinnitus is really a benign, albeit very unpleasant, body sensation.
So let's move along here.
The Tinnitus Gordian Knot
So what I think is happening with tinnitus is that you have this benign, albeit very frustrating, body sensation.
But I wonder if it's really about the tinnitus and the body sensation of tinnitus, or the brain sensation of tinnitus, or is it about the emotions, the memories, the thoughts, the feelings, the beliefs, the perspectives—really the stories about the tinnitus—that are the true problem for people with tinnitus?
Okay, and I call this the Gordian knot, actually.
At the end, I believe there's a slide that points to an article that I've recently written for The Hearing Review that talks about this tinnitus Gordian knot.
You know, I see people coming into my practice just wrapped up. The tinnitus is definitely there, but what I'm seeing is their brain—they're lacking, or there's just a loss of integration. There's just so much weight put on the emotions, the stories that we create about the tinnitus, that are really wrapping people up into problems, which I think are perhaps the reason why depression, anxiety, sleep difficulty, and these concentration problems are really plaguing people with bothersome tinnitus.
And so, as a clinical psychologist, you know, I'm interested in—I think we all are—but helping our people with their quality of life.
As a general statement, we have these experiences that happen in life, and we react to them. We react in a very habitual way.
Like, for example, if you've experienced this with your clients, some of my clients, or pretty much most of my clients, will always check for their tinnitus in the morning.
You know, they'll wake up, they'll check to see if their tinnitus is there or not there.
So when you wake up, you check, and you see that your tinnitus is there, all of a sudden a cascade of stories:
"Oh God, I might as well not even get out of bed. This tinnitus is going to make it impossible for me to focus at work."
Or, "God, there's that tinnitus again. You know, this is all my fault. This is from all the years of loud music that I listened to."
Or, "What is this going to mean for my future? What is this going to mean when I'm older? Does this mean that I'm going to lose my hearing? Does this mean that my tinnitus is going to get worse?"
So a person can wake up in the morning, recognize their tinnitus, and all of a sudden their immediate body reaction is to kind of get into that Gordian knot, that ball of frustration.
And so I think that Viktor Frankl—he was actually a Holocaust survivor who then became a psychiatrist, who then wrote a very interesting book some of you might have read called Man's Search for Meaning—he was quoted as having said:
"Between every stimulus and response is a space, and within that space lies our freedom and our choice."
So let me say that again:
"Between every stimulus and response is a space, and within that space lies our freedom and our choice."
And people with bothersome tinnitus don't feel like they have freedom and choice. They are locked into this grip, this tight grip around their tinnitus, where life doesn't feel very open. Life doesn't feel like there's choice and freedom.
And so how do we take the stimulus—it may, you know, in this case it would be the tinnitus—and our reaction to the tinnitus, and create a little bit of space there so that we might be able to breathe a little easier and start to give ourselves some time even to choose a new way of relating to tinnitus?
And so, you know, this is really—this quote really does say it all for where I think that mindfulness is very, very helpful.
Demystifying Mindfulness and Meditation
So let's get into demystifying mindfulness and meditation.
Again, you know, for all I know, I can see the list of all of you out there. For all I know, you've all been meditating and had experience with mindfulness for the last, you know, 30 years, if you're lucky.
But for those who haven't, I want to take a few moments to demystify mindfulness and meditation.
And one thing that I want to say to start is that meditation—you know, the word meditation has been on the cover of Time magazine and everything, and it's really mindfulness. I hear it, you know, several times a day, especially living here in San Francisco, which feels like the mindfulness Mecca out here.
But still, these are pretty—you know, these are kind of new terms in our culture right now.
Meditation, to many, kind of throws us back to sitting in a cave and, you know, in a lotus posture and sitting and meditating all day.
But I really want to take the "meditation" out of meditation. I want to really break it down so that it can make sense to us.
Meditation and mindfulness is really about awareness building.
Because let me go back to this slide here, and that, you know, the question is: How do we create that space to give us that freedom and our choice between the stimulus and response?
And my experience and my belief is that awareness—when we become aware of something, we can then start to make some good choices for a healthy future.
So what I see meditation as is an awareness-building exercise.
I see some clients where I won't even use the word meditation. I might use the word "awareness building" instead.
You know, kind of in the same way that we go to the gym to build that bicep muscle. We'll lift up a barbell and we'll pump iron, so to speak, to build a muscle.
What we're doing with a meditation practice is we're really pumping up—and we're going to talk about which parts of the brain we're pumping up—but really strengthening our awareness, building our attention, where we place our purposeful attention.
And that's something that I think the person with tinnitus is really struggling with.
There's a lack of integration in their brain, where all of a sudden we have a million and one body sensations at any given moment, but for whatever reason the focus is on that tinnitus to the exclusion of all else that's happening.
So again, a meditation and mindfulness practice helps us to what's called meta-awareness—basically be able to step outside of ourselves and look in and start to say, "Wait a minute. Let me pause for a moment and start to maybe choose to put my attention where I want it to go."
The Definition of Mindfulness
Okay, so let's go to the definition of mindfulness.
It's tough—in a few written words or in a sentence or two, it's very hard to define mindfulness.
But I think that Jon Kabat-Zinn, who really was the founder of a Mindfulness-Based Stress Reduction program back in the '70s at UMass Medical Center in Boston, I think that he really has done a very, very good job of bringing this concept