Mindfulness for tinnitus
Last updated on 04 November 2013
Claire Bartlett, Jenna Love and Laurence McKenna discuss a new approach to coping with tinnitus
There are a number of startling things to know about tinnitus:
- it is one of the most common symptoms to affect humanity
- not every one who has tinnitus suffers
- the science tells us that those who suffer do not have different tinnitus from those who do not.
The psychology of tinnitus
At first sight, there would seem to be a real challenge in reconciling these facts. They can be explained however when we understand that most people who have tinnitus habituate to it. This simply means that with time the brain adjusts to the presence of tinnitus and does not respond so strongly and the result is less awareness of the noises. Some things, however, can get in the way of habituation. From a clinical point of view, worrying about tinnitus is one of the most important obstacles to habituation. When a patient reports that tinnitus is the thing that is stopping them leading a normal life, or is preventing them from enjoying things then habituation is slowed. When people find themselves in this position they tend to take steps to try to keep tinnitus at ‘arm’s length’. They may try to cover the tinnitus with background noise or maskers. They may avoid situations which they think will make it worse or harder to deal with, such as very quiet or noisy situations. Avoidance can often be quite subtle; for example, trying not to listen to or think about tinnitus. While this approach is certainly common and may be helpful for some, people tell us that this battle to avoid tinnitus can become a problem in its own right. It can actually keep the attention focused on tinnitus and so help to strengthen any anxieties. For example, we know that trying not to think about something is often ineffective and can be very mentally demanding. In this way, being ‘on the run’ from tinnitus can become frustrating and exhausting. There may, however, be value in another way of responding to tinnitus, based on mindfulness meditation, which involves turning towards tinnitus rather than away from it. Before we consider how this might apply to tinnitus, let us first look at mindfulness more generally.
Mindfulness meditation is a particular way of paying attention to the present moment – intentionally and without judgement. This is practiced in specific meditations when we bring this quality of awareness to focus on something specific, such as our breath. It is an approach which has its roots in Eastern Buddhism and has now been brought into western, non-religious settings, initially by a microbiologist called Jon Kabat-Zinn at the University of Massachusetts Medical Centre. He, and many others since, has shown that mindfulness meditation can have a range of positive effects. For example, meditation has been found to reduce blood pressure and help individuals cope with the distress of debilitating illnesses and chronic pain. Research has also suggested that when integrated with western psychology techniques, mindfulness can be beneficial in treating emotional disorders such as depression. It also can improve well-being for those without specific psychological difficulties.
We can learn to practice mindfulness in many aspects of our daily life, such as when we brush our teeth, eat a meal, or wash the dishes. Activities can become so automatic that our minds wander to faraway places. We spend so much time replaying past events in our minds, planning tonight’s dinner or worrying about the future that we forget to experience the now. Mindfulness involves paying close attention to the experiences of the moment; the smells, tastes, bodily sensations, visual images and sounds. Being mindful brings us back to the present moment which can have huge advantages when it comes to responding to negative thoughts, worries or unpleasant emotions.
Mindfulness and tinnitus
Therapy approaches involving mindfulness suggest a way of being with difficult sensations without needing to change them. This led us to consider whether it might be helpful for those distressed by tinnitus. The attitudes of mindfulness meditation encourage interest, curiosity, non-judgement and acceptance and we encourage individuals to see if they can experiment with bringing some of these attitudes towards their tinnitus, rather than ‘pushing it away’. We do not expect mindfulness to necessarily change the nature of the tinnitus, but it may help to change the relationship we have with it.
Exploring tinnitus can be difficult, and so we begin by bringing this interested awareness to other aspects of our everyday life, such as eating, sensations in our body and the sensation of our breath. Participants in our groups are introduced to simple meditations, which we practice together and they also practice at home. This home practice seems to be a very important part of the experience and provides opportunity to become more familiar with the natural tendencies of the mind: noticing when our mind has wandered and returning it to the focus. In some meditations we ask people to spend brief amounts of time deliberately paying attention to their tinnitus. This request can understandably cause people to feel anxious, however the group is a gentle way to test out some of these fears. By turning towards the sounds, with an attitude of acceptance, friendliness and calmness, people may find that the sounds do not appear as threatening as expected.
Mindfulness can also help us to become more aware of our habitual responses to difficulties such as tinnitus. Negative thoughts for many people can maintain the focus on tinnitus, and lead to strong emotions such as anxiety, anger or depression. We may not be able to change the external events around us, but we can change how we respond to them. Mindfulness therefore can allow us to ‘catch’ thoughts before they spiral out of control and so can provide us with a greater sense of control over our experiences.
Our experiences with mindfulness and tinnitus
We have run five groups at the Royal National Throat Nose and Ear Hospital for people distressed by tinnitus. We teach the Mindfulness Based Cognitive Therapy (MBCT) 8 week course, adapted specifically for tinnitus but remaining close to how this approach is taught in many other settings. Learning to meditate and be mindful involves practice and commitment. Results are not instantaneous and so we ask participants not to evaluate whether the approach is helpful until the end of the course. Outcomes to date suggest that most participants show a clinically significant improvement in measures of tinnitus distress and emotional well-being. Their comments also suggest a positive experience:
“The mindfulness course I attended for tinnitus gave me many practical and effective ways of alleviating my distress. It has improved my well-being and my everyday life. It has proved to be a positive and lasting gift - and I know many of the people on the course feel the same.”
“Completing the mindfulness course gave me a tool with which to finally try to cope with tinnitus and the resultant stress. It was not a cure and was never sold as such but it offered a way of approaching life, not just tinnitus, which showed that there were ways of trying to alleviate the significant distress caused by this chronic condition.”
“Mindful meditation helped me to think (and not think) about tinnitus in ways that had not occurred before, and in doing so made tinnitus much less of a burden to carry. It did not fix my tinnitus but it fixed me in a way that made tinnitus easier to bear. I now feel as if I live in the same universe as everybody else. I wouldn’t be anywhere else.”
We acknowledge that this approach is radically different from what most tinnitus sufferers have tried before and may not be appropriate for everyone. Our work on mindfulness and tinnitus is in its early days, however these preliminary results are promising. We are keen to explore this interesting approach further.
Mindful meditation courses are taught across the country, although their availability on the NHS is limited. We are not aware of other courses specifically focused on tinnitus. You can explore the ideas in the article further with the following websites and books:
The Mindful Way through Depression by Mark Williams, John Teasdale, Zindel Segal & Jon Kabat-Zinn.
The Mindful Manifesto by Dr Jonty Heaversedge & Ed Halliwell
Centre for Mindfulness Research and Practice, Bangor University. www.bangor.ac.uk/mindfulness/
Claire Bartlett, Jenna Love and Laurence McKenna are Clinical Psychologists at the Royal National Throat Nose & Ear Hospital, London. Laurence is a member of the BTA’s Professional Advisers’ Committee and has co-authored the BTA’s Good Night Sleep Tight, Taming Tinnitus and (with Jenna) Tinnitus and Stress leaflets.
This article originally appeared in the Spring 2011 issue of Quiet.
For further information about the planned research in this area, follow this link.
a range of positive effects