Transcript Effect on Tinnitus - Michigan Audiology Coalition

Tinnitus Activities Treatment
Shelley Witt, MA/CCC-A
The University of Iowa
Department of Otolaryngology – Head and
Neck Surgery
Tinnitus Patient #1
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Problems with concentration; struggles to read
Emotional disturbance;
Can no longer make decisions; forgetful; confused
Has a lot of fear-based thinking with regard to what she can physically
do because of her tinnitus;
Is depressed and battling anxiety;
Admits that her tinnitus is keeping her from doing things she has
always enjoyed; stays home; tries to complete daily chores but admits
that it is difficult; focused on pre-tinnitus life
Because of the tinnitus must keep a very strict routine or else her
sleeping pattern becomes disrupted and without sleep she cannot
function
Family very disappointed in her (changing roles)
Purpose of Today’s Talk
• Introduce you to a counseling approach that is currently
being used and has been found to be successful in some
patients
• No magic; all clinicians can do this; not all patients need to
fly to Iowa City
• Recognize that the Iowa Clinic is unique in that we do
specialize in Tinnitus and Hyperacousis
• The Iowa approach may need to be modified for your
clinic
• Get you excited about providing this type of treatment
Tinnitus
• A sound produced in your ear(s) or head
• Different sounds heard by different people (e.g. ringing,
buzzing, hissing, etc.)
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions 4
Tinnitus is Common
• 10 in 100 (10%) people have tinnitus
• 1 in 100 (1%) people are bothered by their tinnitus
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions 5
Who Will Come Into Your Office?
1.
Curious
- What is this sound?
2. Concerned but not bothered
- Can this sound hurt me?
- Could it get worse?
3. Distressed
- Can’t sleep
- Can’t concentrate
- Feel anxious
- Are depressed
- Contemplate suicide
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10 in 100 (10%) people have tinnitus
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1 in 100 (1%) people are bothered by their
tinnitus
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions 6
®
SoundCure
Quote
• “For the tinnitus patient, living with this
persistent condition requires changing the
way he or she thinks about health care
and daily life. Part of the audiologist’s role
is to help the patient regain a sense of
control and become an active participant in
treatment.”
Tinnitus Activities Treatment
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A counseling and sound therapy treatment
Picture-based
Focused on individual needs
Directed at primary areas affected by tinnitus
1) Thoughts and Emotions
2) Hearing and Communication
3) Sleep
4) Concentration
Tinnitus Activities Treatment
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Is provided for free on our website
http://www.medicine.uiowa.edu/oto/research/tinnitus/
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Activity Therapy Pictures
Below you will find different counseling presentations that relate to the thoughts and emotions,
hearing and communication, sleep, and concentration abilities for people experiencing tinnitus.
Within each presentation are activities to complete following the counseling. In addition, there is a
review for each counseling section that is typically completed at the beginning of the subsequent
follow-up appointment.
Introduction
Thoughts and Emotions
Review of Thoughts and Emotions
Hearing and Communication
Review of Hearing and Communication
Sleep
Review of Sleep
Concentration
Review of Concentration
Summary
Tinnitus Activities Treatment
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The series of pictures
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Provide orderly fashion
Not overlook important concepts
Easy format to understand concepts
Tinnitus Activities Treatment
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There is no right or wrong way to use the
pictures
There is no specific order
There are a few main topics but you can
pick and choose how you want to use
them and in which order you’d like
Tinnitus Activities Treatment
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Techniques in one are (sleep) can be used to
help in others (thoughts and emotions)
• The area addressing thoughts and emotions is
typically where you will spend the most time
– not easy concepts
– not easy for everyone to incorporate into their
daily life
– can be the most helpful
Tinnitus Activities Treatment
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Providing handouts after each session can be
helpful
Using the handout as a quick review prior to a
new session can also be helpful
A tinnitus diary is a great tool to help pts better
understand their own thoughts and emotions
Handouts will be provided
Tinnitus Activities Treatment
Introduction (Tinnitus History)
• Allows the pt to tell their story
• Answers to questions given during this
session can influence the direction of
counseling
• More listening than talking
• Pts first opportunity to tell the whole
story
Where do you want to start?
What do you think caused your
tinnitus?
Head Injury
Medications
Noise
Age
Unknown?
Disease
When your tinnitus began, what was
your life like (home, work, etc)?
How has tinnitus influenced your life?
How do you think we might be
able to help you?
• Use this slide to help set goals (short and long term)
• First opportunity to help pt start to make changes in their thinking (SoundCure Quote)
Clinician Responsibilities
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Listen
Be Patient
Be Sympathetic
Be Encouraging; but not a cheerleader
Be Able to Talk Candidly
Have Confidence in Your Ability to Help
Guide
Have the time
Understand Your Role
• Help your patient
– learn how to successfully live with tinnitus
– not eliminate the tinnitus, but rather to function
in spite of the tinnitus
– adopt a new identity as a person with tinnitus
– become their own coach
– figure out which techniques/tools work best for
them
Make the Experience Collaborative
and Verbalize This
• “I am here to help”
• “I am here to help you learn how to live with tinnitus”
• “I cannot take your tinnitus away, but I can show you some
tools and techniques that have been successful for other
people with tinnitus, which might work for you”
• “I need you to take an active role in this process and
together let’s see if we can make things better”
• “The process of counseling is for me to help you become
your own coach so when you are struggling with tinnitus in
your own environment you have some tools and techniques
that might help”
Tell Yourself That It’s Okay If You
Don’t Know all the Answers
• Be honest and supportive
– Pt: “Why does my tinnitus do this?”
– Clinician: “I don’t have an answer for that.”
“There is no predictable pattern for tinnitus.”
• Don’t put pressure on yourself to have all the
answers. Remind patients that tinnitus is different
for every individual and that there is much we are
still learning about tinnitus.
• Be an expert in helping, not in having all of the
answers.
Be willing to address additional
support
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Mental health counselor; psychologist
This process of tinnitus counseling can
uncover additional areas that might need
to be addressed
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Anxiety, Depression, Marital Problems, Loss
of Identity
Make referrals; work in conjunction with
other professionals
Identify the Psychology that was there prior to
the tinnitus
• Have a discussion about pre-vs-post tinnitus disposition
– What was your sleep like prior to tinnitus
– Did you ever have depression prior to tinnitus
– Prior to tinnitus have you ever had an episode of
anxiety
• In general whatever psychology was there prior to the
tinnitus can be magnified post-tinnitus
- If you have generalized anxiety disorder, depression
this path might be harder
- If your marriage was strong if might hit some
roadblocks; if your marriage was weak it might fall
apart
Your Outlook on Life
•Are you depressed?
•Yes
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•No
•Are you anxious?
•Yes
•No
© Copyright: R.S. Tyler 2006,
The University of Iowa
Intro 27
• How would you describe yourself?
– e.g. curious, concerned, distressed, sad…
• What are some things you are doing to help
with your tinnitus?
© Copyright: R.S. Tyler 2006,
The University of Iowa
Intro 28
Set Goals
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List goals for using sound therapy
– Hearing better
– Notice tinnitus less
• List goals for counseling
– Not hate my tinnitus
– Return to a more normal life
– Attend meetings
– Go to movies
Tinnitus Activities Treatment
Thoughts and Emotions (many parts)
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2.
3.
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5.
Hearing and hearing loss
Tinnitus
Attention, behavior, and emotions
Changing your reactions
Activities for home
Tinnitus Activities Treatment
Thoughts and Emotions
1) Information about Hearing, Hearing loss
and Tinnitus
• Provide knowledge to remove unknowns,
misconceptions, fears
• use patient’s own audiogram
• section that most audiologists feel
comfortable discussing
How We Hear
Hair Cells in Cochlea
Nerve activity carries information
to the brain
•To
Brain
•Inner
•Hair Cell
•Nerve
•Activity
•Nerve
•Fiber
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
34
Causes of Hearing Loss
•Head Injury
•Medications
•Noise
•Age
•Unknown?
•Disease
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
35
Hair Cells
Normal
Hearing Loss
Protecting Your Hearing
• Avoid exposure to very LOUD sounds
whenever possible
• If noise is unavoidable, wear ear protection
to prevent damage to your ears
• Exposure to everyday loud sounds is okay
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
37
Tinnitus
• Tinnitus results from damage to the hearing system
– May be associated with hearing loss
• Tinnitus will not damage your hearing
• Hearing may continue to decrease, but not because
of tinnitus
There are many different causes of
tinnitus
Head Injury
Medications
Noise
Age
Unknown?
Disease
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
39
Auditory System
Tinnitus, whatever the cause, must be represented in the
brain in the auditory area. It is represented there like any
other sound. It can be measured.
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
40
Tinnitus is likely the result of an increase in
spontaneous nerve activity
Normal
Hearing
Hear
Silence
Hear
Silence
Hearing Loss
(No Tinnitus)
Hear
Sound
Tinnitus
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
41
Robert Sweetow model
Carol Bauer animal research
What does your tinnitus sound like?
Whistle
Cricket
Your tinnitus?
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
43
• Currently no drug, surgery or other
treatments can reliably eliminate the source
of tinnitus
• However, you can change your reaction to
tinnitus and how it affects you
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
44
Basic treatment components
• Introduction Section (validation)
• Information about hearing, hearing loss and
tinnitus (understanding)
• 10 in 100 (10%) people have tinnitus
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Curious and Concerned Patients
• Individualized topics (hearing, sleep,
concentration, thoughts and emotions)
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1 in 100 (1%) people are bothered
by their tinnitus
Distressed Patients
Therapeutic Challenges
Areas that create roadblocks to living
successfully with tinnitus
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Not acknowledging grief regarding having
tinnitus
Giving up ways of controlling your tinnitus
Controlling your thoughts and emotions about
tinnitus
Acknowledge grief
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Ask the pt how they are feeling about having tinnitus
and its impact on their life
Create an atmosphere where it is okay for the pt to
grieve
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Grief over the loss of silence
Grief over changes in lifestyle (less spontaneous; letting go of
hobbies)
Verbalize that it is okay to be sad and to cry
Acknowledge their emotional upset; help them come to
terms with the fact that this has happened and is
disrupting their life
The introduction is a great time to address this
Acknowledge grief
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Grief may surface throughout many sessions
In later sessions start re-directing the grief towards a
change in thinking
Example: Let’s re-define silence for you; Silence is now
relaxing while listening to a sound that mixes well with
your tinnitus (sound searching)
Help them let go of hobbies that no longer work for them
and to discover new hobbies; get them excited about a
new chapter in their life
Warn them that there will be people who have tinnitus
who won’t understand their distress (refer back to
mechanisms and Hearing/Hearing Loss/Tinnitus
pictures); tell then not to feel bad about this
(mechanism); share Tyler Alumni response (“not
bothered, but if you have a cure I’ll fly there….”
Acknowledge grief
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Pts must move past the grieving stage and must start
taking control
If a pt is stuck here you can try an expressive writing
exercise (taken from Beverly Thorn; Cognitive Therapy for
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Chronic Pain)
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Take 10 min and write about your deepest thoughts and feelings
regarding your tinnitus
Write for yourself and not as if you are going to share (uncensored)
You might tie your thoughts and feelings regarding your tinnitus to
other aspects of your life
Write continuously; don’t worry about spelling, grammar or repeating
yourself
It’s natural to experience a wide range of emotions, including sadness
and anger and it’s okay to express them
Do this for 3 consecutive days; at the end of the assignment
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Keep the writings for future reference OR
Make a ceremony of burning the writings to let go of the emotions and to take with
them what they have learned
Acknowledge grief
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Review the assignment by asking the pt
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If they completed it
What they learned
Did they see any patterns (can help you find a focus for
counseling)
How they felt over the course of 3 days
What did you do in the end with your choice of either keeping
the writings for future reference OR to make a ceremony of
burning the writings to let go of the emotions and to take with
them what they have learned
(Discuss case example of pt who turned this into a daily
negative exercise; adjust to create a gratitude journal)
Let go! (physiology)
Stop trying to control the tinnitus
(it is what it is; tinnitus doesn’t have a heart, soul or mind )
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Some pts try to physically manipulate their
tinnitus to “calm it down”
Spend hours trying to make sense of what it is
doing
Get stuck trying to figure out the direct cause or
what they might have done wrong to “bring it
on”
Continue to search for the one successful
treatment to eliminate the tinnitus
Let go! (physiology)
Stop trying to control the tinnitus
(it is what it is; tinnitus doesn’t have a heart, soul or mind)
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Help them understand that tinnitus is the
result of an auditory insult (refer back to
hearing/hearing loss/tinnitus pictures); no
different than being diagnosed with a
disease (physiology versus perception)
Verbalize that by trying to control or
understand the tinnitus that the tinnitus is
really controlling them and they are giving
tinnitus importance
Let go! (physiology)
Stop trying to control the tinnitus
(it is what it is) – homework examples
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Stop internet searches (force them to keep an internet search diary)
Only try various interventions (acupuncture, hypnotherapy, herbalist) for
better health and well-being; not for the goal of getting rid of the tinnitus
Stop mentally taking an inventory of what your tinnitus is doing; what are
you learning that’s new about your tinnitus today that you didn’t know
yesterday; how does this information help us; write down all the things you
know about your tinnitus; read it and then burn it or throw it away (tinnitus
diary)
Send me an email at the end of each day listing 3 things you did that was
not tinnitus related (initiating of re-focus therapy)
Complete 1 enjoyable activity each day that has nothing to do with tinnitus
(initiating reduction of the impact of tinnitus on daily life/increasing
pleasant activities)
Create a mantra that will help you re-focus (mantra’s are very powerful!;
self-talk)
Thoughts and Emotions (Goals)
1. Change Interpretation of Importance
2. Change Emotional Reaction
3. Refocus on Other Activities
4. Reduce Contrast Between Background Sound and
Tinnitus
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
55
Tinnitus Activities Treatment
Thoughts and Emotions
2. Provide a clear explanation of the role of
our conscious versus subconscious with
regard to attention (interactive mini-lecture)
• Types of attention
• How things capture our attention
• How we can direct our attention
• Why some things cannot be ignored
Two Types of Attention
• Conscious— selectively attend to and think about
information.
• Subconscious—monitor background information.
However, a monitored item may grab your
attention at any time and move to conscious
attention.
We are not even aware that our subconscious
monitoring goes on all the time
•Blah, blah,
•blah, Fred,
Did I hear my
name?
•blah, blah
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions 58
Normally, we focus our attention on
one stimulus at a time
Conscious
Subconscious
Many stimuli compete for
our attention
Touch
Vision
Smell
Taste
Sound
Several things can influence our
attention
Emotional state
Important event
Unknown?
Novelty
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
61
We can direct our conscious attention to
different smells, sounds or things we feel
Conscious
Subconscious
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
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An important sound can ‘grab’
our attention
Conscious
Subconscious
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
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Some stimuli cannot be ignored
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
64
Things that capture our attention
Unusual
Important
Scary
Unexpected
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
65
Tinnitus Activities Treatment
Thoughts and Emotions
Purpose of this mini-lecture help pt understand
• We are meant to notice important stimuli
• We are meant to ignore unimportant stimuli
• Right now tinnitus is important and is very
noticeable
• You do have control over what you are attending
to
– practice adjusting attention
– help them find some control
Attention Control Exercises
• Learn to switch attention from one stimulus
(e.g. object, sensation, thought, activity) to
another at will
• Allows you to refocus your attention from
your tinnitus onto other stimuli, external or
internal
Tinnitus and Attention
If you determine tinnitus is not important,
the tinnitus will be easier to habituate to
If you determine tinnitus is important,
you will attend to it
Tinnitus Activities Treatment
Thoughts and Emotions
How do you change your reaction to tinnitus?
(Summary)
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Change Interpretation of Importance
– Understand Tinnitus
– Use self-talk to remind yourself that
1. Tinnitus is likely the result of increased spontaneous
nerve activity
2. Many people have tinnitus – you are not alone
3. Tinnitus is not threatening your health or hearing
4. Tinnitus and your reaction to tinnitus are two
different things (physiology vs perception)
Tinnitus Activities Treatment
Thoughts and Emotions
How do you change your reaction to tinnitus?
Change Emotional Reaction
Tinnitus Activities Treatment
Thoughts and Emotions
Understand the Connection between
our Thoughts and our Emotions
Our Thoughts and Emotions
Doorbell
Doorbell
Neutral
Fire
Injury
Anxiety
Angry neighbor
Flowers
Doorbell
Friend
Happiness
Prize
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
72
Tinnitus Activities Treatment
Thoughts and Emotions
Identify Unhealthy (negative) Thoughts
Change Negative Thoughts
• What kind of thoughts
have you had about
your tinnitus?
– Situations where
tinnitus is bothersome
– Thoughts and beliefs
about tinnitus
– Feelings about tinnitus
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
74
Tinnitus Activities Treatment
Thoughts and Emotions
How do you change your reaction to tinnitus?
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Have an open discussion with pt about their own
thoughts, beliefs, attitudes and perception about their
tinnitus (example = what was your first thought this morning)
Show them the link between thoughts and emotions
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I hate this noise elicits feelings of frustration, anger
This noise is okay is calming
When engaging in negative thoughts, challenge these
thoughts; neutralize them or turn them into a positive.
Engage in constructive thoughts
Cognitive Behavioral Approach (CBT)
Henry and Wilson (2002) A Self-Management Guide For The Ringing In Your Ears
McKenna, L., Baguley, D. & McFerran, D. (2010) Living with tinnitus and hyperacusis. London: Sheldon Press.
Cognitive Behavioral Approach (CBT)
Henry and Wilson (2002) A Self-Management Guide For The Ringing In Your Ears
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Need to have a discussion about automatic thoughts
– We all have negative, neutral and positive thoughts
– Give examples in your own life (having lunch); discuss thoughts in their own life
• Neutral = I’m going to have lunch
• Positive = I can’t wait for lunch today they are having my favorite
• Negative = Yuck I can’t stand what is being offered for lunch today
Need to have a discussion about the emotional consequences of our thoughts
• Neutral = I’m going to have lunch (no response)
• Positive = I can’t wait for lunch today they are having my favorite
(excitement)
• Negative = Yuck I can’t stand what is being offered for lunch today (discuss)
This is the basis of a CBT A-B-C model
– A) the situation/event
– B) thoughts/beliefs
– C) emotional consequence
(waiting for a friend)
Cognitive Behavioral Approach (CBT)
Henry and Wilson (2002) A Self-Management Guide For The Ringing In Your Ears
• ABC Model
– go back to pt’s own list and review
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“Why me?
“I’m suffering”
“I’m in agony”
“I can’t live with this sound”
• Re-discussion of the emotional consequences of our thoughts
• Vicious cycle
– negative thoughts – negative emotions – greater focus on the tinnitus/allowing the
tinnitus importance – further negative thoughts – continued negative emotions…….
• Go back to pt’s own ABC Model and physically write out the emotions
to understand their own vicious cycle
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“Why me? - helplessness
“I’m suffering” – despair/depression
“I’m in agony” – annoyance/frustration/tension
“I can’t live with this sound” – hopelessness/miserable
Connection Between Thoughts and
Emotions
Feedback Loop
Tinnitus
Problem
Annoyed
Event
Interpretation/ Belief
Consequence
Cognitive Behavioral Approach (CBT)
Henry and Wilson (2002) A Self-Management Guide For The Ringing In Your Ears
• Review = In order to change your reaction you must become aware of
your thoughts
• Homework
– 1 week of daily tallies monitoring the amount of negative thoughts
– Completing the ABC model daily (e.g. 3 times/day when doing your tally stop and
complete your ABC model)
– Set aside time at the end of the day and think back over your day and pick 3 events
and complete your ABC model
• This type of homework increases your awareness of your thoughts
• Provides some control because the pt has an activity to complete
• Sometime I see the number of tallies drop over 1 week simply by
doing the activity
Cognitive Behavioral Approach (CBT)
Henry and Wilson (2002) A Self-Management Guide For The Ringing In Your Ears
Might be helpful to review the 12 common styles of negative:
All or nothing thinking
Mind reading
Jumping to conclusions
Emotional reasoning
Overgeneralization
Blaming
Catastrophizing/Magnification
Minimization
Should statements
Filtering
Personalization
Labeling
Go over the definitions via the book; find and highlight the ones that match the pt’s style of thinking
(go over personal example)
Go over their own list of negative thoughts with regard to their tinnitus and label them
Cognitive Behavioral Approach (CBT)
Henry and Wilson (2002) A Self-Management Guide For The Ringing In Your Ears
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For some pts you need to quickly jump to the next discussion which is
changing the negative automatic thoughts
Pts need to learn to control the negative thinking (heart of CBT)
A-B-C-D-E model
– A) the situation/event
– B) thoughts/beliefs
– C) emotional consequence
– D) dispute or challenge your original thought THEN replace
– E) new emotional consequence
(personal example from last night)
D – What are the chances the sound was due to a person who wants to harm me
That wasn’t a person it was a small, soft, fuzzy animal
It was just a sound/houses make sounds at night
Cognitive Behavioral Approach (CBT)
Henry and Wilson (2002) A Self-Management Guide For The Ringing In Your Ears
• Go back to pt’s own ABC Model and physically write out and add the
D and E
A – situation/event) Having Tinnitus
B - thought) “Why me?
C - emotion) Helplessness
D - dispute/challenge/replace) I have tinnitus because there is
damage in my auditory system
E – new emotion) Understanding/Reassurance/Neutral
Cognitive Behavioral Approach (CBT)
Henry and Wilson (2002) A Self-Management Guide For The Ringing In Your Ears
• Go back to pt’s own ABC Model and physically write out and add the
D and E
A – situation/event) Having Tinnitus
B - thought) “I can’t live with this”
C - emotion) Helplessness/Hopelessness/Miserable
D - dispute/challenge/replace) My tinnitus is a bother, but I can live with
it; My tinnitus is only a part of me and I enjoy life; My noise is not
pleasant, but I can cope with it; this sound is okay
E – new emotion) Reassurance/Neutral/Acceptance/Positive
• Re-discussion of the vicious cycle after use of ABCDE model
– negative thoughts – negative emotions – greater focus on the
tinnitus/allowing the tinnitus importance – further negative
thoughts – continued negative emotions…….
Change Negative Thoughts
I hate this noise!
I can’t live the rest of my life
with this noise in my head!
I can’t concentrate with this
sound in my head!
I know this noise can’t harm me,
so I don’t need to be afraid of it;
I can learn to ignore it.
It’s OK if this noise doesn’t go away
because I can learn to put it in the
background.
Learning to Control Negative Thinking
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Takes a conscious effort!
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Visual cues (handouts that can be put in a visible place)
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Coping cards/Wild cards
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Thought-stopping Techniques
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Distraction Methods
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Increasing Positive Thoughts (case example of catatonic pt – M-Ms)
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Increasing Pleasant Events (Scheduling them into your routine/showers/drives in
the car/)
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Increasing Pleasant Sounds
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Use of mantras
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Allow the tinnitus to be present; it’s not good or bad, it’s just a sound
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Help pt feel a shift in the physical sense when going from negative to neutral
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Use neutral thoughts as much as possible when thinking or referring to your
tinnitus
“I can’t do this” – “This is okay, I can do this”
“I’m so tired of this sound” – “This sound is okay”
•
Letter to a Tinnitus Sufferer by Stephen M. Nagler, M.D., F.A.C.S.
(Nagler SM. Letter to a Tinnitus Sufferer. Tinnitus Talk (Australian Tinnitus Association, NSW). 2008 Jun.)
You can change your
emotional reactions
Tinnitus
Tinnitus
Tinnitus
Tinnitus
Negative
Thoughts
Negative Reaction
Constructive
thoughts
Anxiety, Irritation
Constructive
thoughts
Less Irritation
Tinnitus not
as prominent
No Reaction
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
87
Tinnitus Activities Treatment
Thoughts and Emotions
How do you change your reaction to tinnitus?
•
Change Emotional Reaction
–
–
–
–
Takes a conscious effort
When you can hear your tinnitus and not react with
annoyance, etc. brain will learn to ignore it
We all have negative, neutral and positive thoughts
Take all negative thoughts and try to neutralize them,
challenge them, replace them with something more
constructive
Stress – Appraisal Connection
(taken from Beverly Thorn; Cognitive Therapy for Chronic Pain)
•
•
•
•
•
Tinnitus is real
Tinnitus can trigger stress
Stress can make tinnitus worse
Managing stress can reduce tinnitus
Stress is a three-part reaction to something that people
think they cannot cope with:
– Biological – increased blood pressure, muscle tension,
etc
– Emotional – anxiety, sadness, anger, depression
– Cognitive – thoughts and images about the event and
the self
Stress – Appraisal Connection
(taken from Beverly Thorn; Cognitive Therapy for Chronic Pain)
• How we judge or appraise stress is important to
know
– Threat – the stress poses a danger that can
outweigh your ability to cope; leads to
avoidance or anxiety
– Harm/Loss – the stress has caused damage;
leads to helplessness or depression
– Challenge – the stress cannot outweigh your
ability to cope; leads to determination and
perseverance
Stress – Appraisal Connection
(taken from Beverly Thorn; Cognitive Therapy for Chronic Pain)
•
Patient #1:
Tinnitus Onset
Stress
Stress-Appraisal
Biological
1) Heart rate increased
2) Lack of energy
Deep breathing; Muscle relaxation;
physical exercise; increase pleasant
events
Emotional
feeling anxious (fear) and depressed (sad/loss)
Imagery Training (self-talk); Muscle
Relaxation; Deep Breathing; increase
pleasant events
Cognitive
I hate my tinnitus! I want my old life back
CBT (ABCDE Model); Mindfulness;
expressive writing
Tinnitus Activities Treatment
Thoughts and Emotions
How do you change your reaction to tinnitus?
•
Focus on other areas of your life
–
–
Help them let go of hobbies that no longer
work for them and to discover new hobbies;
get them excited about a new chapter in their
life
Focus on activities for the intrinsic value of
the activity and not as a method to reduce or
get rid of your tinnitus (massage,
acupuncture)
Activities in Your Life
• If you are doing less in
your life, does this help?
• If you keep so busy you
can’t sit still, does this
help?
• If you are doing this just
to escape tinnitus, it is
unlikely to help
– Activities need some
intrinsic value also
Tinnitus Activities Therapy
Thoughts and Emotions
How do you change your reaction to tinnitus?
•
Focus on other areas of your life
–
–
Stop comparing your “pre-tinnitus” lifestyle
to your current lifestyle living with tinnitus
Remind yourself that you have had an
auditory insult; this is now the new you; no
different than if you have been diagnosed
with a disease
Tinnitus Activities Treatment
Thoughts and Emotions
How do you change your reaction to tinnitus?
•
Reduce the Contrast Between Tinnitus and
Background Sounds
–
–
–
Talk about ways to introduce low level noise
or sounds into their environment
Non-wearable
Wearable options
Low level noise makes tinnitus more difficult to detect
•Tinnitus
•Low
Level
•Noise
•Tinnitus in
•Low Level
•Noise
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
96
Ways to Add Low Level
Background Sound
• Use sound in the environment
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
97
Do any sounds make your tinnitus
less noticeable?
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
98
Activities for Home
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
99
Activities
1. Identify activities you would enjoy
2. Try different low-level sounds in the
background
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
100
Activities
3. Complete the Tinnitus Diary
– Modify your lifestyle to engage in activities
where tinnitus is less noticeable/bothersome
– Use low-level background sound to make
tinnitus less prominent
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
101
Tinnitus Diary
•
Write down your thoughts and worries about tinnitus
1.____My tinnitus will ….________
2.____________________________
•
Check to see if these thoughts match what actually happens
1.____________________________
2.____________________________
•
List the alternative ways of thinking about tinnitus that you find
helpful
e.g. I have tinnitus, but it is really a small part of my life.
1.____________________________
2.____________________________
•
We will discuss your thoughts next visit.
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
102
Tinnitus Diary
•
List things that reduce
your tinnitus
1.________________
2.________________
3.________________
4.________________
5.________________
6.________________
7.________________
• List things that worsen
your tinnitus
1.________________
2.________________
3.________________
4.________________
5.________________
6.________________
7.________________
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
103
Tinnitus Diary
• List sounds you enjoy
1.________________
2.________________
3.________________
4.________________
5.________________
6.________________
7.________________
• List activities you enjoy
1.________________
2.________________
3.________________
4.________________
5.________________
6.________________
7.________________
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
104
Tinnitus Diary
• List alternative activities to engage
in when you find tinnitus bothersome
1.________________
2.________________
3.________________
4.________________
5.________________
6.________________
7.________________
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
105
Tinnitus Diary
• For a two week time period, keep a list of
new activities you engage in each day and
the effect your activities have on your
tinnitus.
• List any low level background sound you used
& its effect on your tinnitus
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
106
Tinnitus Diary
Week 1
Make changes in your daily life so you are doing more activities where
your tinnitus is better and fewer activities where your tinnitus is worse.
List the new activities and how your tinnitus was affected.
Activity:
• Day 1____________________
____________________________
• Day 2____________________
____________________________
• Day 3____________________
____________________________
• Day 4____________________
____________________________
• Day 5____________________
____________________________
• Day 6____________________
____________________________
• Day 7____________________
_____________________________
Effect on Tinnitus:
• Day 1____________________
____________________________
• Day 2____________________
____________________________
• Day 3____________________
____________________________
• Day 4____________________
____________________________
• Day 5____________________
____________________________
• Day 6____________________
____________________________
• Day 7____________________
_____________________________
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
107
Tinnitus Diary
Week 2
Activity:
Effect on Tinnitus:
• Day 1____________________
____________________________
• Day 2____________________
____________________________
• Day 3____________________
____________________________
• Day 4____________________
____________________________
• Day 5____________________
____________________________
• Day 6____________________
____________________________
• Day 7____________________
_____________________________
• Day 1____________________
____________________________
• Day 2____________________
____________________________
• Day 3____________________
____________________________
• Day 4____________________
____________________________
• Day 5____________________
____________________________
• Day 6____________________
____________________________
• Day 7____________________
_____________________________
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
108
Tinnitus Diary
• After two weeks, stop keeping this diary.
• The goal of this diary is to help you make changes
in your daily life so you are doing more activities
where your tinnitus is better and fewer activities
where your tinnitus is worse.
• The diary will also help you find alternative
activities you may engage in to take your mind off
your tinnitus.
© Copyright: R.S. Tyler 2006,
The University of Iowa
Thoughts & Emotions
109
Thoughts and Emotions
• Two main patterns for greatly bothered tinn pts
– Rumination is a way of responding to distress that
involves repetitively focusing on the symptoms of
distress, and on its possible causes and consequences
(focusing on the past)
– Worry is thoughts, images and emotions of a negative
nature in which mental attempts are made to avoid
anticipated potential threats (focusing on the future)
Thoughts and Emotions
• Both patterns (rumination and worry) can create
– Anxiety/Fear
– Depression/Grief/Sadness
– Perceived sense of helplessness
– Avoidance
• What sets these pts apart?
– They are bothered when they don’t hear their tinnitus
– (case example/fan)
– (case example/being in the shower)
– (case example/can’t describe the tinnitus because its not there)
Rumination/Worry
•
Learn techniques to stay in the moment
– Rumination keeps you thinking about the past
– Worry keeps you wondering about the future
•
Create a mantra (very powerful self-coaching tool)
– A word, sound or statement (“I statement”) that is
frequently repeated to aid in concentration
(case example of rumination)
- guilt regarding cause of tinn/stuck; took a long time to come up with an
appropriate mantra (“I am moving forward”)
(case example of worry)
- fear/stuck/what if the sound gets worse
- “It is what it is right now” (Lamaze technique)
- fear/stuck/wanting to travel
- “I will go on this vacation” “I will be fine if my sleep is disrupted”
Rumination/Worry
•
Pair the mantra with an object to remember to use it
(case example: rock/watch/small plastic piece of paper/sutinnit)
Mindfulness (Jennifer Gans)
Gans, O’Sullivan & Bircheff (2013)
• Mindfulness means paying attention in a
particular way: On purpose, in the present
moment, and nonjudgmentally (Kabat-Zinn,
1994)
Mindfulness
http://www.the-guided-meditation-site.com/mindfulness-activities.html
•
•
•
•
Most of the time we live our lives on "autopilot". Our minds seem to have a
will of their own. Thoughts come and go, and it seems as though we don’t
have much say in what thoughts turn up in our head.
When we are not mindful of our thoughts, they skip from one unfinished
idea to the next, constantly interrupting each other and overlapping in a
constant stream of pictures, ideas, memories and desires.
Children are free from much of this mental chatter and they are not burdened
by the responsibilities of adulthood that we all know so well. To a young child
the world is full of newness, fascination and wonderment. In some ways,
practicing mindfulness is like reclaiming the pure, simple awareness that you
had in your youth.
Mindfulness activities will help you to appreciate your life more completely.
They'll help you to free your mind and renew the way you experience your
life.
Mindfulness eating
http://www.the-guided-meditation-site.com/mindfulness-activities.html
•
•
•
•
•
This mindfulness activity is definitely the tastiest of them all! It involves nothing more
than eating a meal. HOWEVER, there are some do’s and don’ts that will turn this into a
technique for mindfulness and not just any old meal.
No gobbling! Eat slowly and deliberately. Mindful eating means paying full attention to
each piece of food you select to eat, how it looks, how it smells, how you cut the food,
the muscles you use to raise it to your mouth, the texture and taste of the food as you
chew it slowly. Be absorbed by the experience.
If possible, avoid engaging in any other activities. Put away the newspaper or book.
Turn off the TV or radio, and remain quiet whenever you enjoy your mindful meals!
You will be amazed at how much more enjoyable food can be when eaten in this way
and how much more fulfilling a meal can be. Eating this way also happens to be very
good for your digestion.
Remember, the purpose of mindfulness is to bring you into the present moment, and to
quiet your mind. The whole point of mindful eating is to dedicate your attention to the
experience of eating, leaving no room for mental chatter. This is a meditation on the
present moment and the present moment consists of you eating a meal...nothing more. If
your mind wanders off, then bring your attention back to the experience of eating. Be
with the moment throughout your mindful meal.
Mindfulness walking
http://www.the-guided-meditation-site.com/mindfulness-activities.html
• The same principles apply to mindful walking as they do to
mindful eating. In this mindful activity, you simply bring
your full attention to the simple act of walking.
• With this mindfulness technique, you become consciously
aware of and absorbed in the movement of your body as
you walk.
• Concentrate on the feel of the ground under your feet, or
your breathing as you travel. Just observe everything that
you physically experience, staying in the present moment
as you do so. If thoughts pop up, just let them go and
return your awareness to the walk.
Mindfulness listening
http://www.the-guided-meditation-site.com/mindfulness-activities.html
•
When was the last time you REALLY listened to the sounds that are taking place around you?
Most of the time you are surrounded by a whole range of environmental noises and most of them barely register in
your awareness.
Much like the noise inside your mind, external noises often go unnoticed. The noise in your mind and the noises in
the world around you both form an invisible backdrop to your entire life.
Stop and notice some of the sounds around you right now...the sound of the computer humming away under your
desk. The car that passes by in the distance. The sound of the television in the next room. The birds outside. All these
sounds present you with an excellent opportunity to experience the serenity that comes from mindful listening.
Stop whatever you are doing and just listen. Sounds simple doesn’t it? Well it is simple, but this mindfulness activity
does require some concentration or you’ll find your mind wandering off.
If you are new to this experience then you may find that it will be more effective if you begin by deciding how long
you will spend practicing mindful listening....
•
You might say to yourself, "For the next five minutes, I will practice mindful listening."
Now stick with it for that amount of time.
Let the sounds you hear be your anchor to the present moment. Don’t judge what you hear or analyse the sounds, just
listen, observe and experience them. If you become restless or impatient, notice these feelings and allow them, but do
not react to them.
Mindfulness breathing
http://www.the-guided-meditation-site.com/mindfulness-activities.html
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Breathing is absolutely crucial tool to learn to calm yourself down with. I recommend for everyone to do some in-depth research on proper breathing
techniques and how to breathe powerfully with your diaphragm. Breathe in strongly and slowly through your nose as you expand your diaphragm. Your
stomach should rise up and down, not your chest. Now, blow it out strongly and steadily through your mouth using your diaphragm. Repeat this several times.
Sitting comfortably or lying down with eyes closed, let's begin by becoming aware of the breath......
Feel the breath as it enters with a cool feeling and then warming as it gently travels down into the lungs.....
Fill the lungs with a deep inhale, bringing in energy and vitality.....
As you exhale, feel the body releasing toxins, stress and any negativity that has accumulated.....
Stay with this breath, focusing on the feeling of deep peace for ten deep inhalations and exhalations....
Feel the energy that is in the body....
Become aware of the warmth and tingling of every cell.....
Feel the energy that is in the extended environment, in every part of nature and in every living thing.....
Bring all those energies together and feel them as one.....
Visualize all of that energy shining brightly, as the sun.....
Bring the shining glow of bright energy over the crown of the head.....
Feel it starting to travel down into your body from the top of your head, slowly going down into your face and neck, traveling down into the shoulders, all the
way down into the arms, down to the fingers.....
Feel the healing energy and light going down into your chest, all the way down to your hips.....
Feel it continue traveling down your legs all the way down to your toes.....
Your whole body is now filled with divine healing light and energy.....
Allow that healing energy to completely fill any physical area that needs healing energy.....
Feel it warming, healing and expanding through the area......
Allow the healing light to bring peace and healing to any emotional issues or traumas.....
Bring your awareness to any intentions or desires that you may have.....
Hold the thoughts of those intentions or desires as you allow the healing energy to bring your deepest desires to life and your intentions into reality.....
Feel your connection to divine energy and light, and know that all is ONE.
Stay with this deep, relaxing, peaceful feeling of bliss.
“Pop Psychology”
Sixteen Strategies for Combating Rumination
How altering the inner dialogue enhances creativity and happiness
Published on July 14, 2012 by Carrie Barron, M.D. in The Creativity Cure
- for some pts this type of internet search is fun
- takes the focus away from the tinnitus
- can echo what you are saying during CBT
Basic Relaxation Tools
Tinnitus is more manageable when we are relaxed
•
•
•
•
•
Muscle Relaxation
Imagery Training
Deep Breathing
Mindfulness Training
Applied relaxation (Gerhard Andersson – Tinnitus
Treatment Clinical Protocols)
• Neurofeedback
• What can the pt do for better relaxation????
Depression and Tinnitus

Break your routine - Going through the same routine, day after day, can be monotonous and
depressing. It often leads to getting caught in a rut. To get out of it you need to temporarily change
your routine. Do something you don’t normally have time for or something you’ve never tried.
o
o
Spend some time in nature
List what you like about
yourself
o Read a good book
o Watch a funny movie or TV
show
o Take a long, hot bath







Take care of a few small tasks
Play with a pet
Write in your journal
Listen to music
Do something spontaneous
Exercise
Start a project. For many, this may seem like that last thing they want to do but an enjoyable project
can give you something to concentrate on that will bring your thoughts away from depression and
give you something to feel proud of when you’re done.
Tinnitus and the Spouse/Partner/Loved One
• I invite loved ones to sessions if the patient wants that
• I am not a marriage counselor OR a certified family counselor so I
make that clear and if problems arise I stop the drama and make
referrals
• I feel it is important for the pt’s support system to also understand the
basics of tinnitus and try to appreciate what the pt is going through
(especially in the beginning)
• HOWEVER, I feel it is important that the pt not use their support
system as a therapy system
• Advice from a fellow tinn suffer “Stop talking about your suffering
with your friends and family members. They love you and want to
help, but there is nothing they can do. Keep those discussions with
your tinnitus professional.”
Tinnitus and the Spouse/Partner/Loved One
• Marriage Help: Coping with a Spouse's Illness
http://www.articlesbase.com/marriage-articles/marriage-help-coping-with-a-spouses-illness-826450.html
–
–
–
–
–
Coping with a Sense of Loss
The Impact of Shifting Roles
Coping with Uncertainty
Letting Go of Guilt
Understanding the sick partner's emotional
reactions
• Tinnitus Spouse Survival by Terri E. Nagler, R.N.
Counseling Techniques
• Stuttering Foundation DVD featuring Dr. David Luterman
• David M. Luterman, Ed.D., CCC-SLP, joins Peter Reitzes and Eric
Jackson interview to discuss counseling people who stutter and their
families. We ask Dr. Luterman to discuss counseling from both speech
therapy and self-help perspectives.
• Dr. Luterman’s Stuttering Foundation DVD tiled Sharpening
Counseling Skills and his book Counseling Persons with
Communication Disorders and Their Families.
• No cheerleading
• Best compliment…….when a pt stops treatment and you never hear
from them again….you have clearly taught them tools.
• Tools for Success: A Cognitive Behavior Therapy Taster
Tinnitus Activities Treatment
Hearing and Communication Difficulties
Helps pt separate what is a hearing and
communication difficulty versus a tinnitus
issue
–
–
–
Factors that affect hearing and
communication
How tinnitus can affect hearing
How to improve your hearing
5. Strategies to Improve Hearing
and Communication
1.
2.
3.
4.
5.
Amplification
Reducing background noise
Watching faces
Using ‘repair’ strategies
Positively influencing the communication
situation
Communication Styles
• Assertive
– Interacts appropriately, guides communication partner
– Takes responsibility for communication difficulties
• Passive
– Withdraws from conversations/avoids social situations
– Bluffing/nodding/pretending to understand
• Aggressive
– Dominates conversation
– Bad attitude, hostile/belligerent, unwilling to take
responsibility for communication difficulties
© Copyright: R.S. Tyler 2006,
The University of Iowa
Hearing 129
Communication Repairs and Style
• What communication style do you believe
best describes you?
• What repair strategies would you be most
comfortable using?
© Copyright: R.S. Tyler 2006,
The University of Iowa
Hearing 130
Communication Style
• Take charge of hearing loss by using an
effective communication style
• Guide your communication partner
• Inform communication partners that you
have a hearing loss
© Copyright: R.S. Tyler 2006,
The University of Iowa
Hearing 131
Tinnitus Activities Treatment
Concentration
•
Another mini-lecture
Provides basic information
–
–
–
–
What is concentration
Why is it important
Things that affect concentration
How tinnitus affects concentration
Concentration is Important
• Necessary to complete many tasks
• Inability to concentrate results in frustration
and stress
• Good concentration will enable you to
remember more
1. Things That Affect Concentration
• The environment
–
–
–
–
Noise
Distractions
Lighting
Temperature
Tinnitus Activities Treatment
Concentration
•
•
•
Another mini-lecture
Provides an opportunity for pt to think about
specific problems they are having with
concentration
Provides information on how to improve
concentration
Allows pt to take a mental inventory of whether
they have tried to make a difference or not
3. Strategies to Improve
Concentration
A.
B.
C.
D.
E.
F.
Eliminate distractions
Adjust work habits
Stay focused
Consider task difficulty
Decrease prominence of tinnitus
Take control of your attention
Effects of Tinnitus on Concentration
• Observe the effects of tinnitus on your
concentration when you are doing simple or
complex tasks.
• Simple tasks (e.g. filing) may not be stimulating
enough – tinnitus fills in the gaps.
• Complex tasks (e.g. learning a new computer
program) are more demanding – tinnitus less
noticeable
• Effects can be different for each person
Tinnitus Activities Treatment
Concentration
Some tinnitus pt complain of poor memory and
inability to concentrate
–
–
–
In the field of cognitive psychology there is a divided
attention theory (Kahneman, 1973) that suggest that
we have a limited capacity for attention
Perhaps if someone is overfocused on tinnitus there is
less attention for other cognitive tasks
Concentration can become easier for some
individuals as they focus less and less on their
tinnitus
B. Adjust Work Habits
•
•
•
•
Work in shorter time spans
Set a realistic pace
Take breaks as needed
Reward yourself when task is complete
© Copyright: R.S. Tyler 2006,
The University of Iowa
Concentration 139
Tinnitus Activities Treatment
Sleep
Another mini-lecture
• Provide basic information
–
–
–
–
–
–
–
Normal sleep patterns
Things that affect sleep
Daytime activities to facilitate sleep
Evening activities to facilitate sleep
Preparing for sleep
Waking up at night
Waking up in the morning
1. Normal Sleep Patterns
• Normally, the amount of sleep required varies
greatly from one individual to another
– (6 ½ - 9 hours/ night)
• Normal sleep includes several periods of light
sweep or awakenings
– Older adults have more awakenings
• Tinnitus doesn’t usually wake people
– But when they wake normally and hear tinnitus,
it may create difficulties getting back to sleep
Sleep Cycles
0
Awake
REM
Sleep Stages
1
2
3
4
0
2
4
6
8
Hours of Sleep
Normal stages of sleep during one night. Sleep stages cycle from light
(stage 1) to deep (stage 4) and the cycle can repeat many times.
Tinnitus Activities Treatment
Sleep
•
•
•
•
Provides an opportunity for pt to think about
specific problems they are having with sleep
To think about their sleep hygiene
Introduces the concept of a worry diary
Gives you an opportunity to introduce
–
–
Progressive muscle relaxation
Imagery training
Progressive Muscle Relaxation
•
Two steps
1. Deliberately apply tension to certain muscle
groups
2. Stop the tension and focus on how the
muscles feel as they relax
Imagery Training
• Similar to daydreaming
• Attention is focused on some type of sensory
experience
– Creating novel mental images
– Recalling past places and events
• Warm and cozy
• The smell of roses
3. Daytime Activities to Facilitate
Sleep
• Avoid napping
– Don’t modify behavior after a poor night of
sleep
• Get regular exercise
– 3 to 4 hours prior to sleep
• Lead life as normally as possible,
even if tired
© Copyright: R.S. Tyler 2006,
The University of Iowa
Sleep 146
4. Evening Activities to Facilitate
Sleep
•
Create a curfew separating day and night
(at least 1½ hours before bedtime)
–
•
for example, 8:00 pm
After that time
–
Avoid stress, exercise, eating, alcohol,
caffeine
© Copyright: R.S. Tyler 2006,
The University of Iowa
Sleep 147
Evening Activities to Facilitate
Sleep
•
•
•
Exercise during the ‘day’ period
Go to bed only when tired enough to sleep
Sleep is best when you make the least
effort
© Copyright: R.S. Tyler 2006,
The University of Iowa
Sleep 148
Ways to Reduce Worrying at
Bedtime
1. Set aside time before curfew to write down
your worries—deal with them in the morning
2. If you think of additional concerns when in
bed, write them down and go back to sleep
3. Do this approximately 1 hour before
bedtime, so that the mind is not still buzzing
from this.
© Copyright: R.S. Tyler 2006,
The University of Iowa
Sleep 149
Sound and Your Spouse
• Play sound 24 hours/day that you both agree
is pleasant
• Use a pillow loudspeaker that only you will
hear
• You go to sleep first listening to sound that
turns off with a timer
© Copyright: R.S. Tyler 2006,
The University of Iowa
Sleep 150
Advice from a pt who had been in
counseling for 1 year (ruminator)
1. Work with a tinnitus professional because they understand
what is going on, but be open to working with other
professionals as well
2. Stop talking about your suffering with your friends and
family members. They love you and want to help, but
there is nothing they can do. Keep those discussions with
your tinnitus professional.
3. Have faith that things will get better.
4. No matter the characteristics of your tinnitus focus on
your thoughts and try to control them, not the tinnitus.