Information What can I do about it? Mindfulness Mindfulness for tinnitus You can try mindfulness for yourself at the forthcoming Talking Tinnitus Expo Dr Liz Marks and Dr Laurence McKenna, Clinical Psychologists, discuss what Mindfulness is and how it can help with tinnitus. Introduction To understand how mindfulness can help, it is important to understand a few things that research has shown us about tinnitus: It is one of the most common symptoms to affect humanity Many people who have tinnitus are able to live with it without suffering. The difference between people who have tinnitus and suffer with it and people who do not suffer is not related to the type of tinnitus they have. It is possible to learn to live with tinnitus without being distressed by it. The psychology of tinnitus Over time, most people with tinnitus habituate to it. This is a natural process where the brain adjusts to the presence of tinnitus and stops responding to it. As a result, the individual becomes less aware of the noise. Different things can get in the way of habituation, which may explain why some people remain aware and distressed by tinnitus for longer, whilst other people do not. Two of the biggest obstacles to habituation are worry and attentional focus. Sometimes tinnitus can be experienced as so intrusive that people find they cannot live their life as they wish, and they no longer enjoy things as they used to. Such changes can make tinnitus seem like an increasing threat and people become more and more focused on the noises. This narrows the focus of attention to be more upon tinnitus, and this slows down the natural process of habituation. This worry and attentional focus leads people to change their behaviour in other ways, in particular, they understandably try do anything and everything they can to push tinnitus away. This might include using noise or sound generators to mask tinnitus, and avoiding quiet places where tinnitus may become more obvious. They may try to avoid noisy environments, which they fear will make tinnitus worse. Sometimes people may try to keep physically or mentally busy all of the time so they can ignore or distract away from tinnitus. This ‘fight’ with tinnitus may seem like the only option but it often makes tinnitus worse. Efforts to push tinnitus away paradoxically keeps tinnitus in the centre of attention. Such demanding mental effort can lead to exhaustion. And as tinnitus persists, the individual feels as if it is increasingly uncontrollable, as their usual ways of fixing a problem are not working. This can lead to anxiety and low mood, and habituation is also less likely to happen. If fighting against tinnitus is preventing habituation and making things worse, then what might happen if we did the opposite and stopped fighting it? Mindfulness-Based therapies suggest just that. Rather than expending energy on trying to get rid of tinnitus, we can learn to allow it to be present, and this can lead to a new and less negative relationship to the noises. What is Mindfulness? Mindfulness is a form of meditation that is all about learning to pay attention to our experience in a specific way: “Paying attention… in the present moment, on purpose and non-judgementally” (Jon Kabat-Zinn) Mindfulness originates from Buddhist meditation practice, but over the past few decades it has been taken up by Western medicine and developed into a non-religious, therapeutic approach to managing difficult health problems. The founder of this approach, Jon Kabat-Zinn at the University Of Massachusetts Medical School, found that it was extremely helpful for patients with chronic stress and illness, for whom standard medical approaches offered little benefit. Since the 1980’s, hundreds of research articles have been published demonstrating the wide range of positive effects that mindfulness meditation can have across health conditions. For example, learning mindfulness meditation has been found to lead to significant benefits for people with high blood pressure, chronic pain, cancer and fatigue. More recently, mindfulness has been integrated with modern psychological techniques and is a proven effective treatment for emotional disorders, particularly depression. Mindfulness also benefits general well-being for people without any particular physical or mental health difficulties. We also have growing evidence that mindfulness can lead to improvements in tinnitus, which we discuss more below. How do I learn Mindfulness? Mindfulness is taught by learning formal meditation practices, where one is invited to pay purposeful, present moment-attention to experiences in the moment. Meditations often ask you to focus in this way on things such as the breath, body sensations, visual images or sounds. This quality of mindful awareness can be brought to daily life, for example, when brushing our teeth, eating a meal or washing the dishes. For most of us, these activities have become so automatic we conduct them on ‘autopilot’. Rather than focusing on what is happening in the present moment, our mind wanders far away – replaying past events, worrying about the future, or simply planning what is for dinner. Mindfulness brings us back to the present moment, which has many advantages. It can enrich our present experience as we become more aware of all of our senses. It can also help us to get less caught up in negative thoughts, feelings and behaviours that can drive emotional distress, and our experience of tinnitus. How can Mindfulness help tinnitus? “I find I am more accepting of my tinnitus and so it is less intrusive. I can live with it more easily” Mindfulness does not aim to ‘fix’ tinnitus or make it go away, but rather make it less intrusive, to a point where it is no longer a problem for people. It teaches one how to live alongside difficulties such as tinnitus, without having to fight or change it. Practising mindfulness meditation can cultivate a more helpful way of responding to tinnitus, by encouraging gentle interest, curiosity, non-judgement and even acceptance, rather than ‘fighting it’ or ‘pushing it away’. Mindfulness does not aim to change the nature or sound of the tinnitus, instead, it can help us come to a better relationship with it, and this can aid habituation. It can be difficult to change how we react to something like tinnitus, so mindfulness therapy for tinnitus begins slowly. In treatment, we begin by learning how to pay mindful attention to other aspects of our daily life, such as eating, the sensations in parts of the body or feeling the physical sensations of the breath. This is done in a group, alongside other people who also struggle with tinnitus, and who are probably new to mindfulness. We go through simple meditations together and you also practice these at home. Regular home practice is important as it helps you to become more familiar with the technique and discover what mindfulness is really about. Later on in the group, it is possible to begin to spend brief moments deliberately paying mindful attention to sound and tinnitus. Understandably, this can lead to some anxiety, and the group offers a way to test out these fears, and in a way that allows you to feel safe. By ‘turning towards’ the sounds, with an attitude of calmly and gently allowing people may find that the sounds do not appear as threatening as expected. Research also shows that people who learn to become more able to ‘allow’ tinnitus will find it less distressing over time. This practice also reveals our habitual responses to difficult experiences generally, including tinnitus. Many people describe negative thoughts about tinnitus (the losses it has led to, and the fears of what will happen in the future). These negative thoughts can cause powerful emotional responses such as anxiety, anger or sadness, and keep the mind fixated on the tinnitus, preventing habituation. By becoming more aware through mindfulness practice, we learn to ‘recognise’ these thoughts. We can also recognise how they can spiral into familiar patterns of emotions and behaviours. The insight gained through meditation can allow us to choose how to respond to these negative thoughts so that they are less likely to lead automatically to painful emotions and unhelpful behaviour. Our experiences with mindfulness and tinnitus Since 2010, we have been offering Mindfulness Based Cognitive Therapy (MBCT) to patients with chronic tinnitus attending the Royal National Throat Nose and Ear Hospital. Our treatment is based on the standard 8-week MBCT course that is offered in other settings, however, we have adapted it for people with troubling tinnitus, and it is taught by clinical psychologists with expertise in working with tinnitus and other audiological conditions. Since this time, hundreds of patients have attended our groups and we have gathered strong evidence that this approach is of great benefit to them. In 2017 we published two papers that demonstrate that MBCT is an effective treatment for people with distressing tinnitus: A randomized controlled trial, funded by the British Tinnitus Association, compared MBCT for tinnitus to Relaxation Training. This study clearly showed that MBCT led to significant reductions in the distress caused by tinnitus than Relaxation. These improvements lasted for longer and got even better in the six months following treatment. It also led to reduced levels of emotional distress and disability. We looked at how patients were before and after attending MBCT routinely in our clinic. We followed 188 patients from the beginning to the end of the course of meditation and found that the treatment was associated with significant and reliable improvements in tinnitus-related and emotional distress. We also asked patients to give us feedback on their experiences of Mindfulness. Most of the feedback was extremely positive, and showed how treatment helped people not only to habituate to tinnitus but also to cope with other difficulties that life throws at us: “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.” “I am more able to observe myself having worries or fear and to pull back rather than getting overwhelmed. I am seeing more clearly that I don’t have to continue negative thought sequences” “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.” The mindfulness approach is radically different from what most tinnitus sufferers have tried before, and it may not be right for everyone. We are confident, however, that the growing research base has demonstrated how it can offer an exciting new approach to people who may have found that traditional treatment has not been able to help them. Further reading/resources Mindful meditation courses are taught across the country, although at this time, few have been adapted to be tinnitus-specific, something that may change in the future. It is also possible to learn a lot about mindfulness from the many books and websites that are available on the topic. We would recommend the following as a place to start: Mindfulness: Finding Peace in a Frantic World by Mark Williams and Danny Penman. The Mindful Way through Depression by Mark Williams, John Teasdale, Zindel Segal & Jon Kabat-Zinn. Centre for Mindfulness Research and Practice, Bangor University. www.bangor.ac.uk/mindfulness/ www.bemindful.co.uk New research Dr McKenna and Dr Marks are now running a new research project, where they are looking at the best ways of helping people who have sleeping problems (insomnia) related to their tinnitus. This research project is still open to new participants. You can find out more here: https://www.tinnitus.org.uk/Blogs/news/tinnitus-and-insomnia-study For further information Our helpline staff can answer your questions on any tinnitus related topics on 0800 018 0527. You may also find our website takeontinnitus.co.uk helpful.