A Brain-Based Approach to Understanding and Managing Tinnitus

Speaker 1: Welcome to This Week in Hearing. I am Shari Eberts. Do you have tinnitus or know somebody who does? I’ve had tinnitus for many years, and mine’s usually a faint hum. It kind of sounds like a fluorescent light bulb. But other times, it can be more forceful and blaring, and I’m pretty lucky to have it under control most of the time. But many other people with tinnitus are not as lucky. And today’s guest is Dr. Jennifer Gans. She’s a clinical psychologist, a tinnitus researcher and educator, focusing on the neuroscience of tinnitus distress. And she believes that it’s how the brain interprets the tinnitus rather than the sound itself that shapes whether it becomes bothersome or not. And she recently launched a new weekly column at Hearing Health Technology Matters that’s called ‘Tinnitus Education Corner’. So, thank you, Jennifer, for being here today to help us get a better understanding of tinnitus and how we can reduce its impact on our daily lives.

Speaker 2: Oh, good morning, and thank you, Shari. I appreciate the opportunity, as education is the pinnacle of good tinnitus care. So, let’s dive in and, you

Speaker 1: Absolutely, absolutely.

Speaker 2: … and understand all things tinnitus.

Speaker 1: Excellent. So before we get into the details, I just have to ask the proper way to pronounce it. Is it tinnitus? Is it tinnitus? This is always one of the first questions I get.

Speaker 2: Well, actually, it’s kind of a tomato – tomahto situation,

Speaker 1: Okay.

Speaker 2: you know, don’t feel bad if you’ve been calling it tinnitus. Don’t feel bad if you’ve been calling it tinnitus. It’s all tomato/tomahto. However, there’s a reason why I call it tinnitus. And so, if you look at the at the word tinnitus or tinnitus, tin means ring. That’s the, I guess, the Latin derivation, and then itis. So for those out there that call it tinnitus, think about tin is the ringing part. Itis is a word or is a it means inflammation. And the problem I have with calling it tinnitus is it actually has nothing to do with inflammation. So, I guess, you know, I’m a stickler for accuracy. I’m a stickler for, you know, the importance of the word. And so, I always call it tinnitus because it seems more accurate to me.

Speaker 1: Okay, good to know. And I guess I did it that way in the introduction, so phew. That was good news for me, right? so, let’s talk a little bit about how you became interested in studying tinnitus and how your career path has sort of led you to this current education work that you’re doing.

Speaker 2: Okay, yes. Well, I’m a clinical psychologist by training, but I have always woven in deafness into my work through the years. And I was working at the UCSF Cochlear Implant Center, and my job was to basically evaluate everybody who was a potential candidate for a cochlear implant to make sure that they were emotionally ready, that they were psychologically supported so that they would be a better cochlear implant user. So, that was the goal, is to obviously have some good cochlear implant users. And so while I was there, I’m going through patient after patient after patient, and I’m hearing a lot of people saying, “You know, my tinnitus is really bothering me.” And, you know, none of the doctors wanted to touch it. You know, they would say, “Oh, well, let’s just focus on the hearing loss.” Let’s, you It was almost as if tinnitus was the stepchild of these patients coming in here, and just being the person that I am, it actually made me more curious. So, I started going down the tinnitus rabbit hole, and at the same time, I was also becoming fascinated and studying Jon Kabat-Zinn and his work with mindfulness-based stress reduction. And there was some wonderful research that he was producing, I think that, well, some great research that was coming out with mindfulness-based approaches or his approach with chronic pain. And anytime there’s a treatment for chronic pain, it makes me wonder, “I wonder if it will help somebody with tinnitus.” And so that began my my research study that looked at mindfulness-based tinnitus stress reduction, an eight-week program that I created at UCSF. So I guess that pretty much summarizes it. It just came from where no other doctors wanted to touch it, if, you know, me being who I am, I got really curious about that and finding that that tinnitus is not this this this un-understandable body sensation. So that brought me down this road.

Speaker 1: Well, that’s wonderful because I know for me and for a lot of people who have tinnitus, when we ask our doctors or professionals about it, sometimes we just get this kind of shrug of the shoulders or, “There’s really nothing you can do.” And that’s absolutely untrue. So I’m glad that you’re out here sort of spreading that message for people because it’s really an important one.

Speaker 2: Right, and I, you know, we could get into reasons why that might have developed over time. There’s,

Speaker 1: Mm-hmm.

Speaker 2: I think it’s also important to understand that. But I have found through thousands of hours of sitting with people with bothersome tinnitus, and we can distinguish between bothersome and non-bothersome tinnitus or no tinnitus at all, but for the people that have bothersome tinnitus education is critical and for anybody that has tinnitus, the first thing they do is they go to the internet, and all it takes is one bad piece of information to get their mind locked and loaded on it and the stories to start swirling around it, and that is the downfall of anybody with tinnitus. And so, my what I have found to be the most rewarding part of my work is making sure that everybody has the fundamental or the primary part of tinnitus care, which is accurate education.

Speaker 1: Right. So let’s dive into that though, because I think a lot of listeners might think of tinnitus as sort of an unwanted ringing or buzzing or sound. But if I understood your research properly, it explains it a different way, right, as a failure of our brain to disregard these signals rather than the creation of these signals. So, did I get that right? And can you talk a little bit more about that concept?

Speaker 2: Yes. And the only word that I would change in that description is unwanted. I would change that for a mistake. The brain, under times of stress, is just more prone to making errors. And so, eh, the reason why tinnitus has come into a person’s consciousness is really based on a brain mistake or a brain error rather than something broken.

Speaker 1: Okay.

Speaker 2: And so it kind of softens it a little bit. But let me preface it preface the rest of our talk today by saying that again, I’ve sat for thousands of hours with people with bothersome tinnitus, and I can sound very easy-breezy about it. “Oh, it’s just a mistake of the brain. It’s a benign body sensation. Oh, it’s a paper tiger.” But I want listeners to understand that it is definitely, definitely not lost on me on how devastating tinnitus can be. but at the same time, as a clinician, it’s very hard for me to get excited about a benign body sensation. And so that kind of starts us off on how do we really want to define tinnitus? And so, tinnitus is a benign body sensation that the brain thinks is important to pay attention to, when in fact, it can allow it to go comfortably into the background. So I’ll say that probably 15 times today, but tinnitus is a benign body sensation that the brain thinks is important to pay attention to, when in fact it isn’t.

Speaker 1: Okay.

Speaker 2: So you know, if I could get into the numbers, we have 50 million Americans. That’s a huge number. 50 million Americans experience tinnitus. But that huge number doesn’t give us really the information we need. So of that 50 million, if we break it into parts, of that 50 million, 20 million are bothered enough by their tinnitus to go to their doctor and say, “Oh God, this is not okay. Something is really wrong.” Okay? So I call that, the 20 million, I call that the bothersome group, and I keep things very simple. So if we all do the math together, that leaves 30 million Americans that are walking the streets of our country with tinnitus and they don’t care.

Speaker 1: Mm-hmm.

Speaker 2: my work is not to get rid of tinnitus, because first of all, I don’t know that I have, well, I definitely don’t think I have control of that, and if, you know, I don’t think people with bothersome tinnitus necessarily have control of that or they wouldn’t come see me, right? Or they wouldn’t be pursuing help. So I’m gonna leave that to the powers that be. It’s not to say that tinnitus won’t go away, but it’s just my way of saying I don’t necessarily have control of that. But what I 100% know to be a fact is that you can shift tinnitus from the 20 million bothersome group into the 30 million non-bothersome group. And then I ask my patients, “If you have a benign body sensation for the rest of your life and it doesn’t bother you, can you be okay with that?” And invariably, they say, “Of course.” I mean, we’ve got a lot of benign body sensations going on in our body that, you know, we might notice one day and then we’re, you know, it’s the furthest thing from our mind. And so that, I like to pursue the 100%. I find that my job is so much more rewarding and people get very, very definite relief if we focus on the goal of shifting tinnitus from the bothersome group into the non-bothersome group.

Speaker 1: Mm-hmm.

Speaker 2: And so that is really, I think, what everybody’s anybody that’s bothered by tinnitus should be aspiring to, is, I call that the effective cure. You know, people get all up in arms. “Where’s the cure? What’s wrong with these researchers? What’s happening with these doctors? Where’s the pill? Where’s the procedure?” Well, you know, you can’t fix something that’s not broken, first of all. Okay? And so, but what we do have is the ‘effective cure’. If tinnitus doesn’t bother you, then so what? A benign body sensation that doesn’t bother you is, you know, just another sensation.

Speaker 1: So that’s the million dollar question though, I guess, right? So how do you become a person where this tinnitus, this sound that’s bothering you becomes less of a bother? So how do we start that process?

Speaker 2: Yeah. Okay. So it’s you know, I keep saying simple but it isn’t. It’s simple, but not easy. Okay? So I’m gonna break it into threes. For some reason, threes come up with tinnitus. So the number one thing this I call the tinnitus trifecta. If you have one, two, and three, you will allow the brain to do what the brain knows how to do, which is to habituate. Your brain already knows how to do that. Nobody has to teach the brain how to habituate. It’s something that we’re all doing right now. So so one, two, and three. Number one is to reduce anxiety around tinnitus. Okay? And we can go back to anxiety, because that is the fire that is below this benign body sensation. So reducing anxiety around tinnitus. Number two, making sure you’re an expert in what it is, because what we’re gonna talk about is using the brain to correct the part of the brain that has misunderstood tinnitus. So we do that through accurate education. Okay? And I have to emphasize accurate, because education is not always accurate. Number three is finding a way to reduce stress consistently so that we create some space and freedom in our brain to, instead of react to it, respond to it. So that’s a subtle difference, but it makes all the difference, is this idea of instead of old reactions that have brought you to this place, replacing them with responses to tinnitus that can then open the door to habituation.

Speaker 1: Right. That makes a lot of sense. and I use a lot of meditation actually to help me cope … with my tinnitus, and I feel like that’s a major focus of meditation in general, or mindfulness in general, is sort of shifting from that reaction to taking the time to respond thoughtfully.

Speaker 2: Mm-hmm.

Speaker 1: so, this seems like it’s really built on a lot of those tenets that have been tested across many, many different areas.

Speaker 2: Yes. And I’m very research-focused. You know, while you know, I want to do what works, and so And do what works consistently. We need some reliability and validity here. So, you know, again, these three things, if you have two of these three things, eh, you might have good days, you might have bad days. If you have one of these things, you know, good luck. But if you put these three things together, anybody, 100% of the time has the effective cure for tinnitus. The brain will shift it from bothersome to non-bothersome. When we can get into what’s actually happening in the brain, like where the actual mistake so that we can reverse engineer that error and start responding to tinnitus in a way that helps the brain put it where it belongs. And so, you know, it’s interesting because I use my hands a lot, that’s, I guess part of my work in deafness. I’m also, I also sign and, and such, so forgive my hand motions.

Speaker 1: Oh, no worries.

Speaker 2: But inside of our brain, we have a camera lens. And so when something is either fearful, fascinating, or frustrating at the three Fs the lens of the mind zooms in, and boy, can it, can it see what it’s looking at with amazing clarity. Now, it can’t see anything else, but it sure can see what it’s looking at. Now, if you open up the aperture of the mind, which the mind can certainly do is kind of broaden or open, obviously what we’re looking at is still in the picture, but it’s within the context of everything else around it. And so the error that’s made on the first day or the moment that the person is first aware of tinnitus is the brain zooms in on it and says, “Oh my God, what is that?” And then all of a sudden, the story gets wrapped around the lens, “Oh my God, maybe I have a brain tumor. Oh my God-” does this mean I’m going to lose my hearing? Oh, no, how am I going to concentrate at work? This is all my fault for all the music I listened to when I was a kid.” And so what ends up happening is we have this lens that has a story and a riddle, basically a Gordian Knot of, of mistruth around it, and all of a sudden, the lens gets stuck. And the person now is sentencing themselves to a life of walking around with tinnitus being in their zoom lens. Now, what happens when you unravel those stories, because, you know, it’s not a brain tumor, it’s I know there are acoustic neuromas, they’re very rare, and those are also benign. But, you know, that’s, that’s sort of a different topic. But everybody goes for an MRI, and an MRI for somebody with bothersome tinnitus is, just atrocious. It’s very, you know, being in that closed space and they’re loud and whatnot. But anyway, so this story of it’s all your fault for all the music you listen to, or I’m going to lose my hearing because of it, or this is going to get worse, all of those false stories are keeping the lens stuck. So if we can unravel those stories with accurate education, the brain can naturally open up and sure, tinnitus might be there, but it’s within the context of everything else around it, and it’s no longer a focal of… a focus. So this is an important thing for people to understand about tinnitus, is that by unraveling those stories, and that is usually done with accurate education, they can take a deep breath and start responding to tinnitus in a new way.

Speaker 1: So, is there a habituation process that we need to do, or the brain is going to do that automatically? And how do we stimulate… Or is there a way to sort of help the brain along in that process?

Speaker 2: Oh, that’s a great question. And in fact, I’ll, I’ll do a little experiment with with everybody that’s watching right now. So I want I’m assuming everybody’s either sitting in a chair or somehow has their feet on the floor right now. So let’s take our zoom lens, our mind’s eye, and let’s zoom it in on the bottom of our foot. Imagine the bottom of your foot on the floor. I’ll speak for myself. I feel, I feel tingling. I feel kind of a warmth, kind of a little bit of a pressure. Now, let’s get back into our conversation, and I would venture to say that after our talk is over, if we hadn’t brought our direct attention to the bottom of our foot, nobody’s thinking about the bottom of their foot, right? Now, the brain has this triage system where, you know, we’re… Well, let me go back to the foot, is that the bottom of your foot, the brain can predict that. You know, our foot has been on the floor multiple times, and the brain has this wonderful way of kind of shifting or taking out what’s not important and zooming in on what’s important, and hopefully the people watching today think that what we’re talking about today is more important than the bottom of their foot. And so the brain does us a favor. The brain says, “You know what? Bottom of my foot, not so interesting right now, so I’m going to let it go into the recesses of my mind.” That’s habituation. Well, the brain is a prediction machine, you know, it’s… The, the brain is constantly downloading data. It’s a data-downloading machine, but then once the data is downloaded in any given moment, we have to have a way of organizing it. And so the brain has to, almost like a triage system in an emergency room, it puts the it, you know… Usually, the things we fear go into the number one slot and everything else takes second fiddle, is second fiddle because that, you know, what is feared has to be paid attention to, and the zoom lens goes right onto that number one slot. And so the habituation process is happening to all of us right now. Going back to your question-It, habituation is, is something the brain does for us. Nobody has to learn how to do habituation. Nobody’s habituation process is broken, because again, we’re doing it right now. Nobody, hopefully, is paying attention to their bottom of their foot. Now, if I, God forbid, had cancer at the bottom of my foot, I guarantee that’s the only thing I’d be able to focus on. But again, my brain does me a favor and says That pressure you feel at the bottom of your foot, I’ve felt it all my life, I would expect to feel it because my foot’s on the ground. So I’m going to push that off to the side and I’m going to stay focused on, you know, our conversation right now.” So, that’s my long-winded way of saying that habituation is, it’s a, it’s a subconscious, natural process. Nobody’s habituation machine or, or, or is broken. So we just have to set the scene for habituation, and like I said before is we have to take tinnitus out of the number one slot. People fear tinnitus. They’re frustrated by tinnitus. Nobody’s usually fascinated by it, but remember those four Fs. And so, people with bothersome tinnitus, there’s usually, they, connect at least initially they’ll connect tinnitus to fear, and once that connection happens, whatever the mind fears goes into the number one slot, and the lens gets locked and loaded. So, our job as a as clinicians is to, and every individual’s job, is to disengage tinnitus from fear. That is number one. Because the brain can now, you know, take it out of the number one slot and reappraise, “Well, what is most important in this moment?”

Speaker 1: Mm-hmm.

Speaker 2: So it’s you know, it’s … People think that, that, that habituation that that habituation process is an active process. It’s actually a passive process. And again, it’s a gift that our brain does for us without us having to think about it.

Speaker 1: It sounds a lot to me like when you, you know, you go nose-blind to something, if that’s the right term. You know, you walk into space and there might be a strong odor or something that you notice, and then, you know, five minutes later, or three minutes later, you don’t smell it anymore.

Speaker 2: Right.

Speaker 1: Because maybe you determined, “Well, it’s not a gas leak. Okay, so I don’t know what it is, but I don’t-“

Speaker 2: But if you, but if you thought it was a gas leak, I guarantee that smell would not leave your mind. And you know, I … Shari, if you give me a moment, I’d love to share something with you that not many people know. Okay, so the brain again, we’re The brain can make errors under times of stress. And so, let’s, let’s talk about our five senses, and there’s more than five senses but let’s just talk about the main five. We have touch, taste, smell, vision, and hearing. Okay? So for those out there who’ve heard of phantom limb sensation, okay? God forbid I cut my hand off. Let’s say my hand is gone but my hand, my hand while it’s literally here, is actually right here because this is where all the sensations come to. This is where all the commands come from, and this is where all the memories of my hand are, are right in my brain. So, God forbid I cut my hand off and this is my ability to touch and, and feel, the sense of touch. And so what happens? The brain doesn’t like to lose. The brain loves to fill things in. And so when it senses that it’s not perceiving the sensation of touch, the brain says, “Wait a minute, it has to be here. It’s always been here. I better search for it.” So the brain searches and searches and searches, and the brain gets really frustrated when it can’t find what it’s looking for, so it searches harder. And in that hard search, boom, it creates a sensation as if the hand were still there. So that’s phantom limb sensation. Now let’s go through the other four senses.

Speaker 1: Okay.

Speaker 2: sense of smell. There are reports that when somebody loses their, a sense of smell, they many doctors’ offices are filled with people that come in and say, “You know, I have no sense of smell but I’m getting these phantom smells.” You know, oftentimes they, they are unwanted smells. But what ends up happening is in the absence of that particular sense of smell, the brain says, “But I’ve always been able to smell.” And so it starts to over-fire in that search for smell and it ends up creating a smell. Now let’s move on to taste. So our sense of taste, same as sense of smell in that when we lose our ability to taste, the brain will create phantom tastes. And let’s move on to vision. In, when, when somebody loses vision it’s actually called Charles Bonnet syndrome, for anybody that wants to go look that up. When somebody loses vision, the brain freaks out and, you know, starts looking for the vision that it’s not able to see and creates phantom visions. So this is Charles Bonnet syndrome.

Speaker 1: Okay.

Speaker 2: You know, visual snow has, has some similarities but Charles Bonnet syndrome is more a direct it seems, you know, is, is a more direct occurrence that happens when the, the brain is not able to t see in a way it used to. Well, let’s get to number five, hearing. Now, inside our inner ear, inside the cochlea which is shaped like a little snail shell, there are these tiny little hair cells that line the inner lining of this snail shell. So imagine a tiny snail shell that’s turning in on itself. Now if you take that snail shell and unravel it so that it’s in front of you right here, just a, like a line, the hair cells will be sticking up. You have the high frequency hair cells here, the low frequency hair cells down here, and just like a piano, you have every tone in between. So if we roll that back up, so let’s roll it back up into the snail shell. The mouth of the cochlea corresponds to the high frequency hair cells. The low frequency hair cells are deep, deep, deep inside, very well-protected. Now, over our lifetime, air comes through the ear and it’s just a physiology thing, the highest frequency hair cells chafe off first. And so you could honestly say that everybody after a certain age, probably somewhere in your 20s or so, has hearing loss because it’s just the nature of time. So waves of air come in and start to chafe off the highest frequency hair cells first. Now, the brain says, “Wait a minute. I used to be able to hear that frequency. Where is it? It has to be here.” So what does the brain do? It searches and searches and searches and it gets really frustrated ’cause it can’t find it, and in that search, the excitation of that search creates what we call tinnitus. Now whether or not you’re bothered by it, or not bothered by it, has everything to do with three more things.

Speaker 1: Mm-hmm.

Speaker 2: Okay? So let me share you, share with you. Again, three is just the magic number when it comes to tinnitus. So there are three things that every single person with bothersome tinnitus has in common. Now let me remind you, I’ve sat for thousands of hours with people with bothersome tinnitus, so I’m gonna say that I don’t know a single thing about the people … non-bothersome tinnitus. Why? ‘Cause they don’t come to see me. But I know an awful lot about the people with bothersome tinnitus, and I feel that it’s my occupational responsibility to share with you what I’ve, what I’ve learned. So, what I have found is that every single person, not 83%, not 93%, not 99.999%, but 100% of people with bothersome tinnitus have one, two, and three in common. Okay. I’m going to share with you what those three are. Number one, hearing loss. Everybody with tinnitus, it’s, it’s the flint that starts the fire of tinnitus. You have to lose something in order to search for it, right? So, everybody with tinnitus, bothersome tinnitus, or you could say anybody with tinnitus, has some form of hearing loss. Now, many people will come and say, “Oh, no, you don’t know what you’re talking about. I went to my doctor. They said I have perfect hearing.” Well, they, they measure you on an audiogram between 250Hz to 8 kHz. But humans hear out to 20,000Hz So I always say, you know, “Congratulations, you have awesome hearing,” and that’s something to go home and celebrate, but I’m afraid that in the highest of all high frequencies, everybody has hearing loss after a certain age. So, anyway, so the, the, you have to lose something in order to search for it. Therefore, that is the, that is the necess-, one of the, one of the necessary three parts of a person with bothersome tinnitus. Number two, stress. Everybody with bothersome tinnitus is experiencing some form of stress, and this is where the mindfulness meditation can be so helpful. And then number three, every single person with bothersome tinnitus has an amazing personality. Okay. And that’s usually what happens when I when I mention number three, people start to laugh and, but I, I’m actually very I’m very, I’m very serious about that, in that the, the personality that I’ll describe to you in a moment is something that people love about themselves. It’s what their employers certainly love about them. It’s what has made them successful in their lives. It’s what people care, you know, people love about them. So, we are actually talking about an amazing personality, but that amazing personality has an underbelly that’s pulling them down. And so my job is to help people recognize, because we’re often unaware, but to recognize the underbelly that’s pulling them down, remove it so that they can go off with their amazing personality and keep, you know, keep making this world go round. So, let me explain to you this amazing personality. 100% of the people with bothersome tinnitus are the kind of people who are very alert, aware, alive, and they are vigilant. And for example, they might walk into a room and they scan the room, and if they spot a problem, they latch on and have trouble letting it go until they figure it out. Okay? So this is not 93% of the time. It’s 100% of the time, people with bothersome tinnitus have this vigilance. And why? Because they’re noticing something, they’re noticing what probably should have gone unnoticed, to be honest, and they are placing it into the number one slot of the mind’s triage system. Now if we have a moment, I can talk about where this is happening in the brain. That I, I mean, again, there’s this educational piece is, is pretty important because the biggest help with tinnitus is using our brain to change our brain. So if, so Yeah. I’m talking to our prefrontal cortex. I’m talking to people’s ability to use logic, okay? You know, yes, I am a psychologist and people are like, “Oh, you’re going to be doing therapy and da, da. You know, oh, you, you’ll be using cognitive behavioral therapy, you’ll be using mindfulness,” what have you, and I say, “Well, usually on the first session, we’re using logic.” If I say something that doesn’t feel logical about your understanding of the human body, I say, “Please stop me, and then we’ll go back and we’ll make everything make sense.” So logic about tinnitus is the number one again, that’s the educational piece. Let’s be logical here. So if, if I break, again, the brain into three parts, there goes that number three. We have the brain stem, which is subconscious, okay? The brainstem takes care of our heartbeat, respiration, sleep/wake cycles, hunger, all the things that we don’t have to be thinking about necessarily. The brain just kind of, you know, does us a favor and takes care of it for us without our conscious awareness, ’cause boy, we’ve got other, other important things going on. So there’s our, the base the base of the brain, which is pretty reptilian, takes care of all that. Now, the second part of the brain to develop is the limbic system, the, it’s midbrain. And the limbic system, we associate it with our emotional centers, and there’s this almond-shaped area called the amygdala that’s inside the limbic system, and it’s a small little area that has a mighty job. Mm-hmm. Okay? So the amygdala’s job is to take in information from the external world and take in information from the internal world and make a decision. So the decision the amygdala makes is, “Is this sensation I’m experiencing in this moment a danger and I better put it into the danger category and keep my lens locked and loaded on it? Or is this boring, benign, uninteresting and I can safely push it into the background and focus on whatever I want to focus on?” So, on day one of tinnitus, the problem is, is the amygdala made an error. It picked up on the sensation of tinnitus and, and this is still subconscious part of the brain, it picked up on this tinnitus and it put it into the wrong category. Now, what happens when something goes into the fear category is it trips our autonomic nervous system. It, it hits our fight or flight response. And again, what happens there is the thalamus is the gateway between our subconscious emotional centers and our conscious, the third part of the brain to develop, our prefrontal cortex, the cortex or outer bark of the brain. And so the thalamus, when the amygdala starts rearing its head and it’s saying, “Alert, alert, alert, there’s a, there’s a-“… probable danger here. The thalamus says, “Well, okay,” opens the gate, and whatever was subconscious now goes into consciousness.

Speaker 1: Mm-hmm.

Speaker 2: So now, people with tinnitus have tinnitus now in their conscious mind. Whereas, probably all of us have tinnitus, but it’s staying below the hood. So our work together is to educate so that the, the prefrontal cortex, which actually does communicate with the amygdala, with these down-regulating neuropeptides to calm things down, is able to use reasoning. And this is where the response to tinnitus comes in. Once you’re educated as to what it is, if the amygdala and it’s nobody’s fault, the amygdala is subconscious, it’s gonna do what it does. So so when it starts to rear its, its anxiety head, we can use our prefrontal cortex to say, “Oh, wait a minute, wait a minute. I heard that lecture with Shari and Jennifer-” and I know that tinnitus is a benign body sensation and that it is a paper tiger and that I’m actually safe, and that my brain has misunderstood it as important to pay attention to, when in fact it isn’t. And so I can take a deep breath, nothing, you know, nothing’s broken here, and I can ask myself in this moment, ‘How can I help myself?'” In light of the fact that tinnitus is here, and it’s, nobody likes tinnitus.

Speaker 1: Right.

Speaker 2: So, it, it changes the the, the mood around tinnitus so that the prefrontal cortex, we can use our brain to, to calm the centers of the brain that have misunderstood it. So that is the, that is the framework of what we’re working with, is, is helping the brain to reappraise tinnitus for what it actually is, a benign body sensation, the thalamus closes, and tinnitus stays under the hood. And that’s the shift.

Speaker 1: Okay.

Speaker 2: That’s the shift from bothersome to non-bothersome.

Speaker 1: Right. Well, that’s a very detailed explanation. I appreciate that. And I, I think it, it does definitely take some some education. And so hopefully this is a first step for people on their journey to learn more about it. And I know that you’ve just started a new weekly column at Hearing Health & Technology Matters, and I, I’m imagining this column is sort of part of that education process. So can you talk a little bit about what you plan to do with the column and, and what types of information people will be able to find there?

Speaker 2: Yes. Well, you can see my passion about this.

Speaker 1: It’s wonderful.

Speaker 2: you know, yeah. And, and, you know, if, if I can write about it, if I can stand on a mountain and scream about it, I’ll do it. And so I wanna, you know, thank Hearing Health Matters for giving me this platform. And so what I have created with the help of Hearing Health is a, a weekly column that, it, it just takes little bites of education on different topics. If a if one of my if one of my clients comes in with a question that needs answering, I might write an article about that question and answer it. And so you know, that is certainly know, why that has come up. And also yes. So, that, that was really the birth of this idea, was to get this education out there, and for people to start using their own resources for changing themselves so that we don’t get into that, that mix of spending money on tinnitus, which I think nobody should be spending money on, and all these devices and, and, and pills that people take, and all the junk that you hear, we need to quiet that and start realizing that we can use our brain to change our own brain. And yeah. And you know, there’s, there’s also other resources I’ve created. I mentioned at the beginning of our talk today a mindfulness-based tinnitus stress reduction is, you know, a tried and true, it’s been around for 10 15 years or so now. I’ve flipped that eight-week course into an online course found at mindfultinnitusrelief.com and this course does those three things that we talked about. It helps people to reduce anxiety around tinnitus, it makes sure that people are, are experts in what tinnitus is. Every lesson every week has, you know, similar to the articles, it has educational pieces that, that are there to take care of the number two part. And then number three, it starts people off on an eight-week mindfulness meditation practice that, again, is a wonderful way to start to help the brain to tune itself. I think of meditation as… I, I don’t know if anybody can see up here, but I have a violin here in the back. And so it’s interesting because I think of my patients as, as beautiful violins, but if you take a Stradivarius per se, and you take the pegs, there’s four, four, four pegs on a, on a violin or and if, and you take those pegs and you crank ’em really, really tight, you pick up that violin and it just, you’re playing sharp, it doesn’t sound very good. Now, you don’t throw out the violin. What do you do? You just, you tune the violin. You loosen the strings a little bit so that everybody can play in concert. And so this course and mindfulness as a practice is, it doesn’t fix anything, but it simply helps us to bring awareness to areas in which we might be sharp so that we can do the hard work, but the worthwhile work of loosening our strings a little so that we start to see the world in a more balanced way. So, these are, again, you know, touching on these three things. And so I think the the articles that I’m writing really focuses very much on the educational piece. The anxiety piece is very, very important, and also the stress reduction and the tuning of the mind’s orchestra is very important. But at least we’re taking care of number two

Speaker 1: Well, it’s a good start at, at a minimum, right? Because we do need to, as you’ve mentioned, focus on all three of those aspects.

Speaker 2: Mm-hmm.

Speaker 1: And so this is a great resource for anyone who has this bothersome tinnitus that you’ve been talking about. So thank you so much for being here and sharing all this information. We might have to do a part two. There’s just so much to cover on this important topic. Yeah, thank you

Speaker 2: you can see, you can see this is my passion. We can do 10, you 10, 10 recordings and we probably could do 10, 10 after that. So you know, thank you again for having me and let’s all shift tinnitus from bothersome to non-bothersome so that we can get on with the important thing of life, which is living with less suffering.

Speaker 1: I love that. Thanks so much.

Speaker 2: All right. Take care.