More Wiring More Firing: Conditioning the Brain to Better Handle Stimulus-Response

[Dr. Gans]

I have attached an article I wrote on what appears to be happening in the brain of the person with tinnitus. Take a look and let me know your thoughts.

 

[mmacabre]

What if the sheer intensity of a stimulus, in terms of magnitude, is enough to cause the amygdala to perceive distress, rather than the idea that that stimulus necessarily poses any (future) danger? I would think the reason tinnitus is classified as being "dangerous" is not because it heralds some sort of threat to health or safety in the future but because it is intensely distressing in the present. That is to say that it can be fully understood that tinnitus is not dangerous in and of itself, and for it to cause significant distress because of the sheer intensity of the stimulus. Throughout the day, for example, I will routinely become itchy at several parts of my body, but never intensely, overwhelmingly itchy and never more for a few seconds. I can't think of any other natural body stimulus that could even compare in terms of intensity to severe, intrusive tinnitus unless it is severe pain. How can a stimulus not be seen as intrusive if it is so intense that it affects my ability to taste, smell, see, listen, feel, hear, and think, just by merit of it being more intense than any taste, feeling, sight, sound, etc.? Maybe I'll get distracted for a few seconds by one of these things, but never more than that; I would have to be constantly bombarded by novel sensations in order to have the tinnitus recede into the background. I'm just confused and it seems like the mindfulness approach only makes sense if the tinnitus is mild and comparable to other body sensations.

 

[dan]

What if the sheer intensity of a stimulus, in terms of magnitude, is enough to cause the amygdala to perceive distress, rather than the idea that that stimulus necessarily poses any (future) danger? I would think the reason tinnitus is classified as being "dangerous" is not because it heralds some sort of threat to health or safety in the future but because it is intensely distressing in the present. That is to say that it can be fully understood that tinnitus is not dangerous in and of itself, and for it to cause significant distress because of the sheer intensity of the stimulus. Throughout the day, for example, I will routinely become itchy at several parts of my body, but never intensely, overwhelmingly itchy and never more for a few seconds. I can't think of any other natural body stimulus that could even compare in terms of intensity to severe, intrusive tinnitus unless it is severe pain. How can a stimulus not be seen as intrusive if it is so intense that it affects my ability to taste, smell, see, listen, feel, hear, and think, just by merit of it being more intense than any taste, feeling, sight, sound, etc.? Maybe I'll get distracted for a few seconds by one of these things, but never more than that; I would have to be constantly bombarded by novel sensations in order to have the tinnitus recede into the background. I'm just confused and it seems like the mindfulness approach only makes sense if the tinnitus is mild and comparable to other body sensations.

What you say is very true.
That stuff is geared for people with mild to moderate tinnitus intensities.
I'm sure Dr.Gans will concede to that.
The thing Mech, most people will react to a soft tinnitus just as badly as say you and i react to our intense tinnitus - but they can train their brains to ignore it.

 

[Dr. Gans]

Great comments. The magnitude of tinnitus is about the perception of the tinnitus signal rather than the measurable magnitude of the tinnitus. I believe it was Jasterboff years ago who wanted to know the decibel level of the tinnitus sensation for a person who was mildly bothered by tinnitus, moderately, and severely bothered. The results were surprising. The decibel level for all three groups was from 0 to 20 decibels regardless of how bothered they were by the tinnitus.

What I mean to say (and I thank you for bringing this to my attention) is that the amygdala really places all sensory information into three categories: threatening, non-threatening, and the "not sure if threatening or non-threatening". If judged to be threatening, the amygdala warns us to keep a close watch. If judged to be non-threatening, the amygdala allows the sensation to recede into the recesses of our minds. If the amygdala can't make heads or tails of the sensation (which happens in the case of tinnitus) alertness is maintained on the signal until it can make sense of the sound. The brain mis-perceives or can't make heads or tails of the tinnitus sensation and therefore, places it 'front and center' maintaining sharp attention.

One of the many benefits of mindfulness is that it helps to stabilize the mind. The Pre-Frontal Cortex, with its executive function of "response flexibility" can be accessed. This is the function that helps us to stop…and think…before acting. So we learn the skill (and practice the skill) of pausing between the tinnitus sensation and our reaction to it. With practice, we are able to take a step back and use our reasoning to calm down the amygdala's quick but inaccurate appraisal of tinnitus and we can relax our vigilance around the sensation and notice a more broad array of what we can actually experience in any given moment.

Therefore, a mindfulness practice is really helpful for all people (bothered, moderately bothered, mildly bothered, or not bothered at all by tinnitus).

 

[mmacabre]

So even some of us whose tinnitus measures in excess of 20 dbSL (mine was 23 when it was about half as severe as it is now), you believe that mindfulness can still help mitigate reaction even to tinnitus that might be of a very high magnitude? (I decided to alliterate with M's haha)

 

[dan]

So even some of us whose tinnitus measures in excess of 20 dbSL (mine was 23 when it was about half as severe as it is now), you believe that mindfulness can still help mitigate reaction even to tinnitus that might be of a very high magnitude? (I decided to alliterate with M's haha)

0-20 Mech

 

[Rhea]

I'm just going to take my amygdala quietly to one side and say CHILL THE F*CK OUT ......

.....brb

 

[Rhea]

Yeah it wouldn't listen :|.....back to the drawing board pff

 

[Mpt]

Great comments. The magnitude of tinnitus is about the perception of the tinnitus signal rather than the measurable magnitude of the tinnitus. I believe it was Jasterboff years ago who wanted to know the decibel level of the tinnitus sensation for a person who was mildly bothered by tinnitus, moderately, and severely bothered. The results were surprising. The decibel level for all three groups was from 0 to 20 decibels regardless of how bothered they were by the tinnitus.

What I mean to say (and I thank you for bringing this to my attention) is that the amygdala really places all sensory information into three categories: threatening, non-threatening, and the "not sure if threatening or non-threatening". If judged to be threatening, the amygdala warns us to keep a close watch. If judged to be non-threatening, the amygdala allows the sensation to recede into the recesses of our minds. If the amygdala can't make heads or tails of the sensation (which happens in the case of tinnitus) alertness is maintained on the signal until it can make sense of the sound. The brain mis-perceives or can't make heads or tails of the tinnitus sensation and therefore, places it 'front and center' maintaining sharp attention.

One of the many benefits of mindfulness is that it helps to stabilize the mind. The Pre-Frontal Cortex, with its executive function of "response flexibility" can be accessed. This is the function that helps us to stop…and think…before acting. So we learn the skill (and practice the skill) of pausing between the tinnitus sensation and our reaction to it. With practice, we are able to take a step back and use our reasoning to calm down the amygdala's quick but inaccurate appraisal of tinnitus and we can relax our vigilance around the sensation and notice a more broad array of what we can actually experience in any given moment.

Therefore, a mindfulness practice is really helpful for all people (bothered, moderately bothered, mildly bothered, or not bothered at all by tinnitus).

decibel levels aren't arithmetic, 20db is approximately 10x as loud as 10 db( not twice as loud)- so the good professor Jastebroff's argument there doesn't hold water, but I digress, Dr. Gans I would like any thoughts about the following link and this person's experience meditating after having overcome tinnitus once...

http://www.headspace.com/forum/viewtopic.php?f=8&t=465

I'm not trying to be inflamatory moderators, its a legitimate question...

 

[Zimichael]

Dr Gans...
I agree with comments above, that with fairly mild an what I will call "normal T" (which is a huge generalization I know), then Mindfulness, Vipassana, etc. is surely likely to be helpful "just because". It's good for a lot of things!

However I have to rather clearly disagree with statements like this:
We know through science and experience that tinnitus—in and of itself—is not a cause for alarm and can safely be sent to the recesses. How, then, might we reassure ourselves of this and assist the amygdala in choosing the more benign response?
What I would call "sound reactive tinnitus/hyperacusis" is a whole different ball-game. It is cause for alarm! For good reason. I have had three objective levels of increase in T volume (as in I can clearly remember where each level was masked by common sounds/levels) since the original level, and increases each time in the reactivity/H component.

I can assure you that after habituating completely to levels 1, 2 and almost 3 (got zapped again as was really close), that after successive permanent damage and the typical "Oh no!!!!!!!!!" trauma that follows, it - Tinnitus as I have it anyhow, is very definitely 'cause for alarm'. The worse it gets the more it has robbed my life. Very literally.
No matter what anyone says, I think louder T volumes and especially "sound reactivity", are much, much harder to adapt to and 'send to the recesses'. It's a "body" thing, not a "mind" thing...like a hammer reflex on the knee and the leg kicks. Try "imagining it" not to. (may be a bad example as I figure it may be possible to clench your leg enough to stop it - have not tried , but you get the idea perhaps).
Thus activating prevention to further damage and allowing time to slowly cool down the H, or reactivity in particular is 'cause for alarm' to make sure another increase does not happen! I can do without "stage 5"!
By the way, this "alarm" is non-existent when I am alone, at home, or in the high Sierra's etc. I'm "habituated" and don't really bother too much about my very loud T...as in these situations the "alarm" part is irrelevant. No noisy humans around so the "watch out" component is 100% off duty. Trouble is, I have to live in the world, and it ain't much of a life compared to what it was.

However, I would agree that reduced tension, reduced stress, calmness, etc. - that are all encouraged through Mindfulness are of course helpful...in general.

Best, Zimichael

 

[Mpt]

I have attached an article I wrote on what appears to be happening in the brain of the person with tinnitus. Take a look and let me know your thoughts.

http://www.headspace.com/forum/viewtopic.php?f=8&t=465

http://www.headspace.com/forum/viewtopic.php?f=8&t=465

Dr. Gans,

I started back on a meditation practice around the first of this year, a few weeks I asked you about this phenomenon the first time. My own experience mirrors the guy who posted the question above on headspace: my tinnitus didn't relapse exactly but I became aware of a humming feeling/noise after falling into a deeply centered, meditative state. The guy asking the question in the link actually relapsed with his ringing sound.

It makes intuitive sense to me that such a state actually brings any headnoise to the forefront of the mind and thus might be counterproductive for individuals who have either habituated or alltogether lost their tinnitus. I'm not religous, i'm not even spiritual-- so meditation was never some mystical practice for me- it was more utilitarian- like taking a shower for my mind. Before my onset of tinnitus I meditated for 20-30 mins everyday and was actually quite good at it: I could enter a deep trance/centered state and literally have no thoughts of anything for the entire time.

Obviously the benefits I derived my meditation practice are outweighed by the catastrophic consequences of potentially relapsing tinnitus. I had two questions: do you have any advice for me regarding my practice (I've tried doing it with music in the background but the practice is not even close to the same) and 2. do you think that meditation might actually be harmful for tinnitus sufferers when it comes to habituation of perception. Your study indicates that it might be helpful when it comes to habituation of reaction, reducing distress, etc. But as many sufferers are aiming for the "holy grail" of habituation of perception I was wondering if you have any oppinion whether or not it could actually be harmful in that regard.

 

[linearb]

Anything that can possibly have any beneficial effect, carries some risk with it, inherently, by virtue of "doing something".

It is not unheard of for people to develop tinnitus as a result of extremely intense meditative arts like kundalini.

How do you want to live? Do you want to just skim along the surface of life, mindlessly chasing one pleasure or another? Or do you want to wake up?

If you want to remain unaware, mediation is probably a bad idea.

 

[linearb]

Note that I'm biased by my own experience, because tinnitus drives me right up the fucking wall, but breath meditation, even in silence, calms me down. I'm convinced it's a chemical thing, my pupils dilate like clockwork after five minutes. Brain scans of meditators show increased GABA mediated inhibition. I just wrote a long thread about this on reddit:http://www.reddit.com/r/tinnitus/comments/35v4om/tinnitus_gaba_neurology_and_meditation/

 

[linearb]

@Dr. Gans , I like your article and it makes sense to me. Unfortunately for me, I have a nearly twenty year history of badly managed anxiety and benzo/AD/drug use prior to my T. So, I don't have much hope that getting myself out of this mess is going to be a quick or easy process.

Could you look at the reddit post I linked above, which I wrote, and let me know what you think? I had come to similar conclusions just from reading white papers and stuff, but I'm hardly a scientist

 

[Dr. Gans]

I have not been a diligent writer, and I apologize for that. I appreciate all of your comments and questions. In brief, I am a big fan of anything that works to bring tinnitus relief. If you find that a meditation practice gets in the way of your mind's ability to habituate, then it is time to take a break (to be returned to at a later time, if it feels comfortable). I would never recommend meditation/mindfulness to someone who felt that the brain training/practice of meditation brought more bother than relief. BUT, there are many that really do feel that a mindfulness practice is helpful to them and their life as a whole. Two things we know for sure about tinnitus is 1) Stress increases tinnitus bother, 2) Relaxation decreases tinnitus bother. Do what relaxes you-- If a mindfulness practice does not feel good to you at this time, take a break and maybe come back to it at a later time.

 

[Danny Boy]

I have not been a diligent writer, and I apologize for that. I appreciate all of your comments and questions. In brief, I am a big fan of anything that works to bring tinnitus relief. If you find that a meditation practice gets in the way of your mind's ability to habituate, then it is time to take a break (to be returned to at a later time, if it feels comfortable). I would never recommend meditation/mindfulness to someone who felt that the brain training/practice of meditation brought more bother than relief. BUT, there are many that really do feel that a mindfulness practice is helpful to them and their life as a whole. Two things we know for sure about tinnitus is 1) Stress increases tinnitus bother, 2) Relaxation decreases tinnitus bother. Do what relaxes you-- If a mindfulness practice does not feel good to you at this time, take a break and maybe come back to it at a later time.

Well, we're all relying on the future treatments of potassium channel modulators now. Mindfulness does sound interesting though.

 

[Halsy]

I'm late to the party but I just found this thread. I can chime in here via my own personal experiences which, I believe, validate this hypothesis somewhat. Once in my early 20s I was at a party and spiked with a large dose of X. I had a really rough time coming down off it and went to Emerg where they referred me to a neurologist who gave me a 2 week course of ADs - can't recall which specifically. And it helped. However, what he told me at the time always stuck with me. He said that the brain, during crises or important events, is ordered by the subconscious to "lay down a path for recall" of said event - as memory is what allows us to make use of our intelligence and that's a necessary evolutionary trait. It's not a lot of good to learn something important and forget it.

Anyway, move ahead 2 decades. Seven years ago I went through a period of extreme duress. Suffice it to say it was one of the worse periods of my life for myriad reasons. Stress went through the roof during this period and I ended up with something called "hyperventilation syndrome". It's the feeling that you can't catch a sufficient breath - you think T is annoying and scary? Try not being able to breathe properly. So, go see my doc, he puts me on Valium tells me to work on stress management, diet and exercise. So in my research of this condition it comes back to the same thing about the brain needing to be reset. Thankfully this only lasted about 2 weeks, but it really reinforced for me how the brain can get locked into a downward spiral. Most of the medical papers I've read on T often cover this as well, that people who tend to obsess (OCD types) more or just don't handle stress well react much more negatively to T. And now with this latest research from Dr. Shore which shows that interrupting the DCN for even as little as 5 milliseconds can reset the brain shutting down T entirely.

And I also came across a really interesting bit of research from 2015....

Breakthrough in tinnitus research could lead to testable model
https://www.sciencedaily.com/releases/2015/05/150512152646.htm

"Tracing the network's course, the investigators identified a major hub within the central auditory pathway, the sound processing center of the brain.

"Other research has shown this activity, but what is novel about the current study is the amygdala pops up. This is the part of the brain that assigns emotion to our perceptions," says Salvi. "Many patients report the onset of tinnitus after experiencing significant stress or anxiety. We think it's not just the hearing loss that's essential. There are other emotional factors working together with the auditory factors."

The reticular formation, an arousal center involved in the "fight or flight" response is active too, plus the hippocampus, the memory region of the brain that helps identify where things are located, such as the location of the phantom sound. So the auditory system is connecting sound to a location, the ear in this case. There is emotion and arousal, but the final puzzling piece to the network is activity in the cerebellum, normally activated during motor planning events like reaching for a cup or catching a ball.

"We were shocked when this part of the brain popped up," says Salvi. "Almost all parts of the network can be explained: location of sound; the emotional attachment; why people get aroused when they have tinnitus; we're puzzled by the cerebellum involvement, but it might act like some kind of "gate" that's allowing the phantom sound to enter the consciousness," says Salvi."