Back to Silence

You're welcome. I did not find your post too negative or combative. So I am good on my end. I am reminded of the Buddhist quote "Pain is inevitable, but suffering is optional." If you can accept pain for what it is, an inevitable part of life, and practice this acceptance in the place of resistance then your suffering could lessen.

 

Some friend for sure.

He has tinnitus too. The protocol is called "Tinnitus Habituation Protocol by Ed Leme." It's silly, I know, but I understand the reason behind why we would want to look at our tinnitus as a friend instead of something horribly negative (an enemy). It's supposed to help with habituation.

When it comes to tinnitus, at least in the first months, I was open to trying anything to get me out of the suicidal thoughts and manic I was having. I think it did help somewhat, after all is said and done.

I want a cure just as much as the next person. Here I am icing my ear at 9 in the morning because my "friend Tom" loves to sing to me all day and all night because he just loves me so much.

 

That's where I'm at today. I cry a lot, then pull myself together and do the next thing, then cry again. At least I know I'm not alone if you and others are doing the same.

I actually had a dream where my husband, my cat, and I were being stalked by a stranger. She seemed harmless, but it was creepy because she kept following us at a short distance. She claimed to be keeping an eye on us in a friendly sort of way, like a bodyguard or guardian angel.

I asked her, "What is your name?", and she mumbled something that sounded like Kim.

"Did you say Kim?" I said.

"No, I said Tin."

I thought Tin was a strange name for her, considering she looked Caucasian (whereas there are Asian Americans who have names like Lien or Tien).

When I woke up from the dream, I knew immediately that Tin was short for tinnitus. Since then, I've been trying to find a positive spin to the dream like your psychiatrist suggested, but it's not that easy. It could take a long time for me to have a neutral feeling about tinnitus & hyperacusis, let alone a positive feeling about it.

 

I understand that. Hang in there. I know it's tough. I'm only 7 months in and it's still hard, but way easier than the first 3 months.

 

Remove my reactive/sound sensitive debilitating aspect to my tinnitus, and I could master "Back to Silence" with all my tinnitus sounds in about 2 weeks. Reactivity is such a variable beast, especially at 13-14 kHz!

 

No one can claim to cure or reduce tinnitus or hyperacusis nowadays and be taken seriously. Sounds just like another scam.

 

Just to be clear, Dr. Hubbard does not claim to cure anyone from tinnitus or hyperacusis. He only works with people to help them habituate. See here on how habituation is described:

 

Thanks for mentioning Dr. Leme's protocol. I read the protocol and indeed it looks very good to me (I am a retired psychotherapist). He also has a book on it here. His program is very well documented and he supports people along the way. All at no cost. Certainly something to check out at the least I would say.

 

According to that diagaram, I'm still at phase 1 and it's been 5 years for me. I truly am fucked. Or maybe, just possible... habituation isn't a real thing. Which I think is way more likely.

 

You may be right asserting that habituation isn't a real thing. There is no scientifically sourced proof for the generally believed to be true assertion that most people by far can and do habituate, with or without help, in time. It is definitely true that some people are unable or can't habituate since most professionals assert that is the case and clearly there are people who assert that is the case for them. We don't know exactly why it is the case some can't habituate and there are people working on trying to figure that one out. I am sorry if you are among those unfortunates. This conversation reminds me of this quote:

“Pain is inevitable. Suffering is optional.”

If you can accept pain for what it is, an inevitable part of life, and practice this acceptance in the place of resistance, then your suffering could lessen. One can stop directing all of their energy towards trying to change the unchangeable or lament the unfairness of a situation that has happened. See here for more on that element:

MindOwl: Pain Is Inevitable, Suffering Is Optional

I do wish you well.

 

That's fine - I understand the reasoning.

I regard mine a friend who is one big bore - and consequently gets ignored.

 

I think it's real... for mild tinnitus. I had tinnitus for many years and was habituated before I even heard (or read) anyone talk about it. I didn't think about it much except in a very quiet room like in bed at night or waking up. But when tinnitus gets a lot more intense and variable, cycling between different sounds every couple days, and continues to get worse as months pass by, habituation is no longer realistic.

 

I guess that's what I've been trying to do recently; just shrug at it.

But today, I was overwhelmed with it. The tears welled up, but didn't fall.

 

I have read this type of assertion many times. It may be 100% correct for many with severe tinnitus or even most.

My personal experience is it is not 100% correct for all. Why? I have at least moderate tinnitus sounds and I have habituated and I am not remarkable. People with really severe tinnitus report they have habituated like @I who love music who started this Back to Silence thread years ago. Like Glenn Schweitzer who wrote: “Rewiring Tinnitus: How I Finally Found Relief from the Ringing In My Ears”. Also psychologist Dr. Bruce Hubbard other professionals who have tinnitus and/or work with people to help them habituate report success even with those with severe tinnitus. Then, I am sure they also have their treatment failures as well. I can’t help but wonder if some of those who believe they have too severe a case of tinnitus are stuck in the Henry Ford area of “Whether you think you can or you think you can’t, your right” spot. Or maybe they are “arguing for your limitations” which is the tendency of individuals to provide reasons, justifications, or excuses for why they cannot achieve habituation that keeps the “I can’t” dynamic solidly in place. When I read these type of posts I wonder if they have really challenged their limitations. Have they worked every angle and sought out treatment providers? Then, I know at the same time that indeed there are people who can’t habituate.

Hopefully at some point nobody will be writing they can’t habituate any longer. It is truly a tough spot to be in with severe or catastrophic tinnitus. I wish I could figure out the solution for all of course but indeed that is not gonna happen since plenty of people way beyond my skill set still have not figured it out.

You may be 100% correct about your situation. I sure don't know.

 

Habituation normally happens over time. One just needs to use common sense: avoid excessive noise, eat well, exercise, try to be relaxed even if unexpected noise happens etc.

There's nothing "medical" or scientific about it...

 

Yes, for most people habituation happens normally over time especially for those with mild tinnitus. For most people, usually the beginning of tinnitus, in the first few weeks the distress level is very high or even extremely high. Then over months it tends to decrease. If there are systems in place to educate the "newbie" their suffering will be reduced and habituation can happen faster. This type of person would not require a physician, licensed mental health professional or audiologist of course to give that education.

Then there is a substantial minority of people who do not naturally habituate and/or have what could be called complex tinnitus adjustment and/or have personality or mental health issues develop (anxiety disorders, depressive disorders, suicidal ideation, etc.) as a reaction to the tinnitus. These type of people can benefit from medications, counseling, sound sound therapy, etc. This type of care does require doctors, mental health practitioners, and audiologists in those types of cases. Additionally, the treatment approaches used by these professionals would ideally be based on evidence developed via the scientific method.

Now, let's also not forget that one of the types of tinnitus is somatic tinnitus that has causes (issues with the inner ear, TMJ for example) that can respond to interventions by doctors, physical therapists, dentists, massage therapists, etc.

Lastly, when it comes to mitigating the damage from loud sound events, ENT doctors (otolaryngologists) may employ certain interventions, including the use of drugs, if treated promptly.

Thus, I would say the preponderance of the evidence is there is a lot of need for medical, psychological and scientific efforts to support people in habituation and some very lucky folks, maybe a cure happens for them.

 

I don't think doctors are addressing the tinnitus in those cases, but the mental health consequences or the distress caused by tinnitus, which is a very different thing.

 

I am not clear on what you are asserting with "those cases" and with "...which is a very different thing." All I can say is there is at least a preponderance of the evidence that there is value for most people by far in learning how to habituate over "letting it happen naturally" and value for some in what doctors can provide for those with tinnitus who are having what I will call complex tinnitus adjustment for lack of a better term. You may think otherwise and that is OK with me.

 

Hi Juan,

Perhaps it is common sense for you, but it isn't for most people. It can be very distressing in the initial few months and it helps a lot when someone lays down the process of habituation. It often helps you get there faster than you 'naturally' would.

More importantly, it gives people hope. Admittedly, hope was my biggest struggle initially and I had never imagined I'd get habituated until someone told me about it.

I guess we are all different. You might just naturally have a strong mind. Good for you.

G'day.

 

I think most people would break if they had severe hyperacusis. That said, there's always a low where things usually start getting better.

As a long time hyperacusis sufferer of a case of very rare, very severe hyperacusis, I can assure you that advice on this condition can be done in just one session, and if "therapists" do not do this, it is because (i) they do not truly know how hyperacusis works; (ii) they are only after the money, so patients will leave the clinic with the same problem... and empty pockets.

Most "therapists" are just charlatans that are after your money. They do not have a clue about hyperacusis or tinitus, let alone how to fix it... nowadays no one can fix it.

One thing is the hyperacusis and / or the tinnitus, and another the distress or the mental health issues as a consequence of hyperacusis and / or tinnitus.

There's also people who previously had mental health issues, anxiety etc and then hyperacusis and tinnitus happened on top of that. But, again, those are other pathologies.

So people who have anxiety or mental health issues should go to a psychiatrist, which is the doctor specialised to treat those. And people who have hyperacusis and tinnitus could go to an ENT or maybe a neurologist (or neuro-otologist) but they will find no treatment... so they may as well go on with their lives without visiting any doctor, and trying to live the best they can. That's the pure reality about hyperacusis and tinnitus.

 

I know what you mean.

There are far too many people out there who will use your misery to make a quick buck.

Kills your faith in the system.

You've got it rough, but you've still managed. More power to you!

 

When my hyperacusis started, I still had a bit of faith in the medical profession, basically due to lack of knowledge. I did not have any health problems before that, so I was actually ignorant about how the "medical ecosystem" works. Over the years, I have realised most doctors are just after the money, and not only regarding hyperacusis and tinnitus... it is something one could say about the medical profession in general.

In Spain, where I live, there are more and more private clinics (even though everyone has free public healthcare), and those clinics just want patients to swipe the insurance card as often as possible. This means that in many clinics a patient has to go 3 times just to get basic audiometric testing.

Patients have reacted, stopped going to those clinics and they have ended up going to shops that sell hearing aids, where they can get an audiometric test for free, without queues, without having to go 3 times to a place... there's a selling component in those shops obviously, but at least they are upfront about it.

Some doctors in Spain are also promoting themselves actively in social networks, internet etc... this is relatively recent here and most doctors who do that are the worst kind, bad, unskilled professionals that are only after your money.

I remember one clinic that mixed healthcare with religion. It is a religious clinic and they charge crazy amounts for anything. It is normal to go for a visit and walk out with €1,000 EUR less, which is a lot for Spain (but my private insurance covered all of it). These people are not only incompetent, but when patients challenge their useless "advice," they threaten patients about disclosing personal and medical data etc etc which is plain illegal.... Just imagine being blackmailed like that when being at a really low moment in life.

I have also gone to clinics where any doctor can access your medical data. Let's imagine you go to the eye doctor, you may go to let's say the rheumatologist another day and she can access without your knowing or your consent the data the eye doctor stored.

So I do not have any sympathy for these kind of scammers, no matter how they try to disguise, or under which cover they present themselves (it's common too for clinics with good reputation to have some scammers among their "doctors").

Well, I told the truth in those paragraphs. Watch out for your wallet!

 

Can you provide some pointers to that evidence?

I'm curious to see how they define "habituation" in those studies, given how hard we struggle to define it ourselves in this very forum.

 

Would love to hear this is working for someone who can hear their tinnitus pretty much everywhere. Maybe there is someone somewhere in the 20 pages of this thread.

 

I would say the following to your questions:

1. In terms of scientific research on tinnitus, there is insufficient science to definitively say about treatments or education about how to habituate although some treatments to facilitate habituation have more research on them than others. There certainly is not "settled science" as the term is used by some (given science is never really "settled" since the method often overturns what was once settled science at times as it should if science is done well).

2. When I wrote "preponderance of the evidence" I was making an analogy to the USA civil justice court system where the standard of evidence for the plaintiff to win is they must show a “preponderance of the evidence" if you will. It is not the higher standard of USA criminal courts of "beyond a reasonable doubt". One can certainly doubt my assertion although I would ask the same question of someone who doubts my assertion. What evidence do you have to discount my assertion? After all I could be totally wrong and it would be good for me to find out that was indeed the case. If nothing else, knowing the other side of the argument is good to fully understand any issue.

3. My “evidence” would be the following which certainly is not a scientific assertion of proof positive when I posted earlier:

“All I can say is there is at least a preponderance of the evidence that there is value for most people by far in learning how to habituate over "letting it happen naturally" and value for some in what doctors can provide for those with tinnitus who are having what I will call complex tinnitus adjustment for lack of a better term. You may think otherwise and that is OK with me.”

My opinion is based on my readings in the tinnitus literature over 12 years making a similar assertion; my professional experience as an addictions counselor who used CBT for 40 years; and my personal experience mapped on to others’ situations.

That said, I don’t discount that the ability to habituate is strongly influenced by how intense one’s tinnitus might be. Almost certainly those with mild tinnitus would likely have a much easier (been there and done that once myself) time reaching habituation on average than those with moderate tinnitus (been there and done that) or those with severe or catastrophic tinnitus (don’t think I have been there but I am not dead yet).

4. On how to define habituation, I would agree there are differing definitions. I like this approach proposed by British psychologist Richard Hallan:



I trust this addresses your question well enough.

 

I can not see Back to Silence working for someone that can hear their tinnitus pretty much everywhere. That sounds like me, and it's an intense very piercing high pitch sound on many days, and that direct link activates the sympathetic nervous system and the fight or flight response which causes anxiety and depression, regardless of what I consciously "choose" to think about it or try to "ignore" it.

For more mild tinnitus, I can see being able to habituate over time. I had that for 20 years when my tinnitus was much more mild, and I just adjusted automatically and lived my life without really thinking much about the tinnitus.

But when tinnitus gets a lot worse, it becomes a different matter, as I mentioned earlier. A colorful chart with words posted repeatedly doesn't change that. We need real treatments that reduce tinnitus, not gaslighting that we can just ignore it.

 

I hope when you read my colorful chart you are not thinking I think you can just ignore tinnitus. I personally don't recommend anyone just ignore it nor does the Back to Silence method recommend that nor any other approach I can think of. I also agree with you that new treatments need to be developed that will reduce tinnitus. Just for the record, I don't think someone with severe or catastrophic tinnitus would have as easy a time getting to Stage 4 of habituation if at all. To say it is not possible is not accurate in my reading either. @I who love music that established this thread may be one with severe tinnitus and I have read of others. They may be the exceptions that prove the rule. I must admit that people with severe or catastrophic tinnitus can't habituate. I would like to think everyone can at least reduce their suffering that has tinnitus. That said, even if someone afflicted at that level can just get to Stage 2 that would be a reduction of pain and suffering and worth working toward I figure.

I wish you well.

 

I said ignore because of the wording for Stage 4 says "attention rarely given to the tinnitus". The tinnitus is still there, though. After 17 months since a sudden worsening and some additional worsening this year, I would say I'm a Stage 2 on my more mild "hissy" days, except continued poor sleep and still needing sleep meds. But my worst "piercing squealing" days are closer to Stage 1 - high anxiety, depression. I cycle between these different sounds every 2 or 3 days with no apparent triggers, so it's like getting hit with new tinnitus every 2 or 3 days.

 

I have a similar experience. My cycle these days is about 4 days long, different sound experiences on different days, making it pretty challenging to habituate. I have tried the Back to Silence method. Although I didn't achieve full habituation, it greatly helped reduce my anxiety response. In fact, I credit it for the lead reason for reducing my anxiety. Practicing the method, for me, was a form of acceptance. My anxiety dropped rather dramatically in the few weeks I was practicing it. And after about a few months of practicing acceptance directly, I was able to peel off antidepressants and sleep aids.

 

I have a theory about how this works. I think it's how the communication between the conscious and subconscious work.

The communication works by acting (behaving) in the right way (for example, tinnitus is not dangerous).

This shows the subconscious (over time) that it's ok to not keep tinnitus at the front of our mind anymore.

We are ok with the sound, it's just meaningless information. Like any other sound. Nothing more, nothing less.

After a while, the brain can reclassify the sensation. This can work with for example dizziness as well.