Does TRT Work?

[tinnitussufferer]

There is no substitute for peace and quiet and silence. Think of what a piece of music would be without those silent pauses. Without silence your mind and brain is constantly being kept alert. The brain can never relax so you feel tired and agitated.

TRT doesnt change your tinnitus it just forces you to accept that nothing can be done and to live with it. The treatment is a success once you reach that stage.

You still hear the relentless ringing noise at night and throughout the day. You still cant escape it. TRT just trains you to deny that you are suffering even though you are.

 

[MattK]

TRT just trains you to deny that you are suffering even though you are.

This last line of yours says it all. You've already determined that it does not work and nothing apart from an actual cure will be considered a "success" to you. So, for your sake I hope that cure comes sooner than later. Until then, sorry that you'll be suffering.

 

[Telis]

I think this might have been discussed in another thread.

 

[linearb]

There is no substitute for peace and quiet and silence. Think of what a piece of music would be without those silent pauses. Without silence your mind and brain is constantly being kept alert. The brain can never relax so you feel tired and agitated.

I don't think this is true at all. Your brain receives constant auditory stimulation 24/7 whether tinnitus is a part of it, or not. Additionally, many people feel at peace in extremely noisy urban environments which have constant input at a fairly loud level.

TRT doesnt change your tinnitus it just forces you to accept that nothing can be done and to live with it. The treatment is a success once you reach that stage.

I haven't personally done TRT, but from what I've read this is a significant mischaracterization. The treatment is considered a success when the person reaches a point where they are no longer distressed by their tinnitus. On the face of it that doesn't seem to have much in common with someone who simply loses hope.

You still hear the relentless ringing noise at night and throughout the day. You still cant escape it. TRT just trains you to deny that you are suffering even though you are.

Again, I don't think this is an accurate characterization. You seem to be assuming that someone who suffers terribly with tinnitus, will continue to suffer terribly as long as they have it. Whether or not this may be true for some people, I have no idea, but it seems very unlikely to be true for everyone or even most people given the wide number of contrary anecdotes.

I am slightly sorry to be quoting a religious idea here because it's usually not popular to do so, but I believe that the Zen understanding of suffering is extremely relevant:

Suffering takes many forms. People must have observed at one time or another, how their aged relatives suffer. Most of them suffer aches and pains in their joints and many find it hard to move about. With advancing age, the elderly find life difficult because they cannot see, hear or eat properly. The pain of disease, which strikes young and old alike, is unbearable, and the pain of death brings much grief and suffering. Even the moment of birth gives pain both to the mother and the child that is born.

The truth is that suffering of birth, old age, sickness and death are unavoidable. Some fortunate people may now be enjoying relatively happy and carefree lives, but it is only a matter of time before they, too, will experience suffering. What is worse, this suffering must be borne alone.

I sometimes wish I still physically felt like I did when I was 18 (and had no tinnitus, among other problems). Thinking like that creates a mental divide between our current experience and our wishes for ourselves. The Zen take is that it is this mental act of striving which creates what we experience as suffering, and not the physical realities which create the striving.

Being a little woo-woo here isn't totally off base, either, because CBT is an essential ingredient to TRT, and CBT is basically Zen stripped of its religious implications and adapted for a Western audience.

 

[FlyFish]

Where does one go to get TRT?

 

[Street Spirit]

Maybe folks who have completed TRT will report back....

 

[Street Spirit]

Where does one go to get TRT?

that depends. .are you looking for trt, or TRT?

 

[Leah]

How does TRT work? Do all use sound and maskers? I have a friend who said that she did not use sound as part of her treatment.

How is the counseling done?
What does a TRT appointment/session consist of? How does TRT make you not care about hearing the sound?
Thanks

 

[Gr8fulDude]

Read Dr. Nagler's posts on TRT.

 

[Leah]

Yep, should have done that first

 

[Dr. Nagler]

Yep, should have done that first [read my posts on TRT]

I'd like to think so, Leah, which is why I spent so much time writing them. This one, for instance:

https://www.tinnitustalk.com/threads/thoughts-on-trt.7863/#post-90756

But if after reading it, you still have questions, then I will do my very best to respond. Just please be sure to tag me, so I do not miss your inquiry.

Here's to quieter days ahead for all -

stephen nagler

 

[Leah]

My appt in Pa is May 31st, doc opened up some Saturday appts.
Excited

 

[Dr. Nagler]

My appt in Pa is May 31st, doc opened up some Saturday appts.
Excited

How wonderful. I am excited for you.

I must tell you that I have known Gail Brenner for longer than either of us would ever admit to. We have become close personal friends over time, and as you already know I recommend her unconditionally. Indeed in all the years I have known her, I can recall only one instance when I ever questioned a decision she made. It was back in 1997. That's when I tried to get her to move from Philadelphia to Atlanta to work with me treating tinnitus patients. She ultimately decided to stay in Philly, where she had already established strong roots. Turned out to be a wise decision for her - but it really disappointed me at the time.

Please be sure to give Dr. Brenner my very best personal regards when you see her. I'm not exactly sure, but she may just qualify as a finalist for the World's Nicest Person Award.

 

[NiNyu]

Until then, sorry that you'll be suffering.

We all do suffer. Well those with extreme T +H do. There is no choice. Nothing psychology could do about.

I don't think this is true at all. Your brain receives constant auditory stimulation 24/7 whether tinnitus is a part of it, or not.

And silence is part of it as well. Yes, silence is an auditory stimuli. Breaks are part of it. Nobody in the world but T patients hear annoying, torturing, painful monotonous noises 24/7! Comparing this with noisy urban environments is tantamount to being blind and driving a car on the interstate 'cause accidents just happen. Just because you are blind, doesn't mean you can't drive on the interstate.

The treatment is considered a success when the person reaches a point where they are no longer distressed by their tinnitus.

So like having pain and pretending the pain isn't painful anymore? Maybe it depends on how bad the pain actually is?

You seem to be assuming that someone who suffers terribly with tinnitus, will continue to suffer terribly as long as they have it.

And yet, people do off themselves for a reason. Probably other issues..

 

[Beth]

I agree with linearb and I'm often a little woo- woo myself but I agree with what he says about suffering. Suffering is never caused by what is happening to us but by the size of the gap between what is happening to us and what we would like to be happening to us. I guess that's why acceptance of our fate, whatever it is, works, because the gap is closed. After that serious profound quote, I will now go and do a pile of ironing in a mindful way!!

 

[tinnitussufferer]

if TRT is so successful why do we need a cure?

 

[linearb]

And silence is part of it as well. Yes, silence is an auditory stimuli. Breaks are part of it.

Er, no they aren't? There's no such thing as silence. Find someone who has no tinnitus, put them in a sensory deprivation tank, and ask them what it sounds like in there... the human body gets really loud when external stimuli are removed.

Nobody in the world but T patients hear annoying, torturing, painful monotonous noises 24/7!

I don't think this is true either. I hear low frequency noise 24/7 with frequent booms and bursts of high-frequency noise as a result of living in a city by an airport. People who live in industrial zones in countries without OSHA and the like, have it much much worse than I do in this regard.

Comparing this with noisy urban environments is tantamount to being blind and driving a car on the interstate 'cause accidents just happen. Just because you are blind, doesn't mean you can't drive on the interstate.

I do not understand the analogy at all, but I'll just say that for me, my annoyance with excessive sound input definitely doesn't end at my skull, and this is why I'm in the process of setting my life up so that I can move from said urban environment out into the woods.

So like having pain and pretending the pain isn't painful anymore? Maybe it depends on how bad the pain actually is?

I have a different view on this than @Dr. Nagler because I think that tinnitus signal and pain signaling in chronic pain patients do have an awful lot in common... but I am not distressed by that because of the large and growing body of evidence that the objective intensity of pain signaling, is deeply entwined with conscious thinking and psychological machinery.

But, if you're stuck on this "pretending pain isn't painful" and "self-deception" angle, then you're really not getting what I am saying. For me, the meditation practices I do to help get a grip on my ringing, have nothing at all to do with self-deception or trying to be less aware of the ringing, quite the contrary. To be clear, it's taken me a long time and a lot of effort to make progress on that front and start to see how my tinnitus and my toxic thinking are twisted together. It has not been fun. I wish I hadn't had to do that, but, it is what it is.

As far as citations for "pain responds to the way you think",
http://ptjournal.apta.org/content/91/5/700.full
http://www.sciencemag.org/content/288/5472/1769.short
http://www.sciencedirect.com/science/article/pii/S0959438802003136
http://news.todayinpt.com/article/20100607/TODAYINPT0104/100623003

The last one contains this nugget which I think has very specific connections to the ways that people's tinnitus reactions are caught up in their emotional state:

Some psychological issues that can worsen pain follow:
• Fear of pain, which can lead to a patient not moving, especially when a certain movement caused pain in the past
• Pain "catastrophizing" — an inability to stop thinking about one's pain and to characterize pain as unbearable, which increases activity in areas of the brain related to anticipation of pain, according to several studies

Catastrophic thinking keeps the limbic system in a state of hyper-arousal. This has negative implications for pain intensity, tinnitus intensity, and any number of other negative things.

And yet, people do off themselves for a reason. Probably other issues..

Unless you can show me a large body of work that contradicts the existing large body of work which has concluded "people with tinnitus do not commit suicide more often than people without tinnitus", then, yes, I attribute such unfortunate cases to factors beyond tinnitus itself.

 

[tinnitussufferer]

yes there is such thing as silence. Its what we all had before we got tinntus. Thats the definition of it. its what we will all probably never hear again.

You cant compare tinnitus to living in a noisy city. You can always wear earplugs for that or move location. There is always the chance of hearing silence if you really need it. With tinnitus there is no break, it just never stops.

pain signalling is not entrenched in psychology. Can anybody really learn to tolerate pain through psychological therapy?

There isnt enough research on how we perceive pain and suffering and what can affect it because the brain is probably the least understood part of our bodies.

if all pain and suffering comes down to how we think rather than what is actually happening to us, then whats the point in finding cures to cancer, tinnitus, bowel diseases or any other horrible illness? Why should we find a cure to cancer? is it not to stop human suffering?

 

[linearb]

I didn't say that pain was psychogenic, I said that psychological reactions to pain can impact how severe it is, and then provided a bunch of peer reviewed research to support that claim. If you don't find that convincing, that's certainly your right, but I try to live in a rational and evidence based mind state, so I don't know what else to do except explain my own experience and provide whatever objective citations I can.

Tinnitus sucks. Chronic conditions suck. If you're stuck with a chronic condition, I really think you only have a couple options: hold on tightly to your preconceived notions of yourself, and suffer terribly every step of the way, or try to find a way to change and adapt to the circumstances of your life.

I'm sure TRT does not work for everyone. I'm sure that even when it does, it can be a very slow and painful process. Letting go of my own preconceived notions of myself to any useful degree, has been incredibly painful, and occurred on a glacial time scale. But, for me, that change has been less shitty and less hard than trying to hold on to ideas about life and self which no longer map out to the real world.

What do you want? Do you want to change? Can you embrace your pain, fear and yes your tinnitus, as a part of yourself? If you are unable or unwilling to do those things, then I expect that you have few options besides continuing to suffer.

Ontology is not rigid. It is plastic.

 

[linearb]

And for what it's worth, I really have no idea what you need to do, to deal with your tinnitus. I tend to basically trust what Dr. Nagler has to say on the subject because he's worked with a lot of people over a long time frame. I have only my own experience as a guide. It has worked for me, but I am not you, and the things that have comforted me and eased my suffering, might not help you. But, I know that I have suffered terribly with this condition, and suffer a lot less now than I did a couple years ago. Trying to share that, is my only reason for posting here.

 

[tinnitussufferer]

And for what it's worth, I really have no idea what you need to do, to deal with your tinnitus. I tend to basically trust what Dr. Nagler has to say on the subject because he's worked with a lot of people over a long time frame. I have only my own experience as a guide. It has worked for me, but I am not you, and the things that have comforted me and eased my suffering, might not help you. But, I know that I have suffered terribly with this condition, and suffer a lot less now than I did a couple years ago. Trying to share that, is my only reason for posting here.

its possible that you were not actually suffering at all. You only thought you were. That could explain why you no longer suffer. It could explain why others cannot find relief.

 

[linearb]

its possible that you were not actually suffering at all. You only thought you were. That could explain why you no longer suffer. It could explain why others cannot find relief.

Yes, I'm sure I did not suffer through all those sleepless nights where I screamed through tears at my wife to please let me commit suicide because of the noise in my head.

You are making the "no true Scotsman" fallacy here.

I should not need to point this out, but it's incredibly conceited and insulting to tell me, or any one else, that they have not gone through extreme pain and trauma as a result of this condition. It fucked my life up. It's taken me years to get to a point where I feel genuinely happy a lot of the time. I'm sorry if you don't believe me, but you should keep that to yourself unless you're just trying to provoke me to the point of saying fuck it and putting you on ignore.

 

[tinnitussufferer]

Yes, I'm sure I did not suffer through all those sleepless nights where I screamed through tears at my wife to please let me commit suicide because of the noise in my head.

You are making the "no true Scotsman" fallacy here.

I dont deny that you screamed, had sleepless nights and wanted to commit suicide. But that still doesnt mean you were suffering.

The problem is, there is no way to measure suffering. So there is no way to know if somebody is really suffering or not and to what extent.

 

[tinnitussufferer]

The proponents of TRT are the ones who commit the same fallacy. They are the ones who will say to those for which TRT failed, ''you didnt try hard enough. You didnt apply it properly. It takes determination. etc''

 

[linearb]

I dont deny that you screamed, had sleepless nights and wanted to commit suicide. But that still doesnt mean you were suffering.

The problem is, there is no way to measure suffering. So there is no way to know if somebody is really suffering or not and to what extent.

Lol. Sure dude. Tell yourself whatever you need to, to get through the day.

 

[NiNyu]

There's no such thing as silence. Find someone who has no tinnitus, put them in a sensory deprivation tank, and ask them what it sounds like in there... the human body gets really loud when external stimuli are removed.

Yes, there is. But silence doesn't mean literally no sounds at all -- a total void of acoustic is sheer impossible -- but silence, the moment when there's little next to no loud ambient sounds does exist. Putting somone in a tank so that they can hear their own body more clearly has little to do with the removal of external stimuli. Your body makes up for it.

People who live in industrial zones in countries without OSHA and the like, have it much much worse than I do in this regard.

Yeah, they couldn't relocate and enjoy silence.. like you could do, right?

I think that tinnitus signal and pain signaling in chronic pain patients do have an awful lot in common...

I totally agree with that. But I doubt that pain signaling is deeply entwined with conscious thinking unless you refer of being conscious vs unconscious. Then yes, being unconscious is definitely a pain reliever in some way.
I really do not need to think about my T and characterize it as unbearable 'cause it DOES SCREAM on full blast 24/7 and is completely unbearable. Suicidally unbearable!

Tell yourself whatever you need to, to get through the day.

But isn't that exactly what you are doing? Telling yourself that embracing your pain, T is an end to suffer.
Is it really?

 

[linearb]

If you don't think that conscious reaction to pain affects the pain itself, and aren't willing to read or attempt to rebut the numerous and varied studies I've already posted to that effect, I don't have the patience to discuss this further because it is like talking to a wall.

Yeah, they couldn't relocate and enjoy silence.. like you could do, right?

You're right, many people lack the means to relocate away from loud places. I am very lucky in that regard.
[/QUOTE]

But isn't that exactly what you are doing? Telling yourself that embracing your pain, T is an end to suffer.
Is it really?

For me? It's good enough, I enjoy what I'm doing most of the time. For you? I have no idea, but I wish you good luck.