The Nature of Habituation

[Boxdra]

Just some ideas and questions I had.

When I read here on TT (and yes, i'm pretty new) I read a lot about habituation. It looks like there are a lot of opinions about it, but we all someone say the same.

Now, before I went here I never heard about this word in relation to an illness or disorder. Somehow, habituation is used as a 'treatment' wich will in the end up saving you (some say you won't hear it, others say you don't care) from tinnitus.

When I was thinking about this, I thought: why are we using this only in relation to tinnitus? Isnt this something that happens with every incurable disease or disorder? In fact, Isnt this a crucial part of life?

It comes down to the definition of the word. Is the habituation succesfull when you still hear the T? Yes. So in the end, you just learn to live with it in such a way that you are still content. Some say that the habituation is only complete when it doest interruptie your life. But this is not true. Because when you use earplugs, it actively stops you. Some things are even made impossible for some (concentration, etc)

In the end, Isnt is just about being content with the situation and having a neutral feeling to the sound? So for example someone who has no arms goes trough the same proces. Will he ever be able to play the drum? Probably not. Will you ever be able to concentratie as good as you once could? Probably not. But this is not important.

What's important is that you learn to accept the situation and still be content with life and the sound. This is actually a life lessen we as human breings all have to learn. We cant control everything! Happyness is not there all of a sudden when your hearing is perfect. Of course it can help, but in the end accepting the situation and still being able to enjoy life is what's important.

And when you are able to do this, then life gets good again.

 

[Markku]

Dr Stephen Nagler explains it like this:

TRT is not a cure for tinnitus. It is a treatment approach designed with the goal of tinnitus ceasing to be an issue in the patient's life. It is designed with the goal of making tinnitus into a pair of pants. Ninety percent of the time, people are unaware of their pants. The 10% of the time they are aware, they do not "cope" with their pants, they do not "deal" with their pants, they do not "learn to live" with their pants, and they most certainly do not spend any time worrying whether the following day will be a "good pants day" or a "bad pants day." They simply wear their pants; and when the goal of TRT has been met, tinnitus should be just like that!

 

[billie48]

What Dr. Nagler's message is basically saying accepting tinnitus as part of one's being, so much so that the brain will stop treating tinnitus as an alien piece or a threat to one's existence. I often call this peaceful co-existence with tinnitus without the need for negative reaction. There is no need to resist it (which is futile usually anyway), let me it, and let your life be. It is attainable but you need to give the body time to get to such state without all the negative reactions.

 

[Magpie]

I must admit I never liked the "pair of pants" analogy and never compared it to tinnitus. I get the gist but it is a bit hard to put pants and tinnitus into the same basket. Similarly comparing tinnitus to living near a train line and some of the other analogies. Habituation for me is losing all those negative feelings.....fear, anxiety, worry etc... and not allowing tinnitus to be something that impacts on your life. When you reach that point tinnitus becomes a non issue even though you might still hear it as much as you did in the beginning. Habituation might be a continual work in progress as it is in my case but I no longer fear it or focus on it.

 

[Boxdra]

The pants analogy is not really accurate. You can strive for it to be like a pants, but it can never be one because a pants doesnt actively annoy you. So you will always fail in that matter, and no one will be truly habituated. I agree with magpie.

 

[Dr. Nagler]

The pants analogy is not really accurate. You can strive for it to be like a pants, but it can never be one because a pants doesnt actively annoy you. So you will always fail in that matter, and no one will be truly habituated. I agree with magpie.

Well, let's look at the pants analogy for a moment. The reason you are unaware of your pants most of the time is that you do not react to your pants. And the reason you do not react to your pants is that your brain classifies the pressure your pants exert on your legs as a neutral stimulus. That's a really important concept, in my opinion, because the brain prioritizes. It is so busy doing things that are vital to your existence that even in the resting state it simply cannnot attend to neutral stimuli. Your tinnitus? Well the reason it annoys you is that it is not a neutral stimulus - in most cases for the folks on this board not by a long shot! But if your brain can be retrained to categorize your tinnitus as a neutral stimulus, then regardless of how loud or pitchy your tinnitus might be, you will become largely unaware of it. And that is the essence of TRT, which is why I happen to like the pants analogy.

sp

 

[alibee]

I think the nose analogy (as in, you always see it but seeing it rarely bothers you) is better than pants. After all, if our pants are really bothering us, we can take them off.

 

[Dr. Nagler]

I think the nose analogy (as in, you always see it but seeing it rarely bothers you) is better than pants. After all, if our pants are really bothering us, we can take them off.

There are many possible analogies - just as long as the message comes across:

Habituation is the natural attenuation of a non-reinforced response to a repeated stimulus over time.

The reason people can live in a house with a cuckoo clock or a grandfather clock yet be pretty much unaware of the sound they is that their brain categorizes that sound as a neutral stimulus. Same for folks living near railroad tracks or airport runways. Sure, they'd prefer to live elsewhere - but that said, most of the time they are unaware of the racket. Now clearly tinnitus is an internal sound rather than an external one. You can't exactly walk away from your tinnitus. But the neural pathways for sound are the same regardless of origin. If your brain classifies the sound - external or internal - as a neutral stimulus, you cannot help but become largely unaware of it over time. The solution, then, as I see it, is to find a strategy that will induce your brain to reclassify your tinnitus.

Back to your nose, for a moment. With pants the neutral stimulus is the tactile sensation applied to your legs. What do you consider to be the neutral stimulus in your nose analogy?

sp

 

[NeoM]

@Dr. Nagler how long does it take someone to naturally habituate to tinnitus without doing Tinnitus Retraining Therapy or something like neuromonics?

 

[alibee]

Back to your nose, for a moment. With pants the neutral stimulus is the tactile sensation applied to your legs. What do you consider to be the neutral stimulus in your nose analogy?

Stephen Nagler

The fact that it's constantly in my vision and yet I don't actively notice it.

 

[Dr. Nagler]

The fact that it's constantly in my vision and yet I don't actively notice it.

Hmmm. Maybe it's a question of facial contour. My nose is never in my field of vision unless I purposely look down and turn my eyes inward. With my eyes in a neutral position, try as I might I cannot see my nose. If I could, that would be another story. But since I can't, your analogy does not work for me. It might work for Pinocchio or Cyrano de Bergerac, but it doesn't work for me.

Stephen Nagler

 

[Dr. Nagler]

@Dr. Nagler how long does it take someone to naturally habituate to tinnitus without doing Tinnitus Retraining Therapy or something like neuromonics?

I am tempted to say, "Too long," but I suspect that answer would be seen as flippant.

And I am tempted to say, "It varies," but that's not a very satisfying response either.

So here's the deal, as I see it. Above I defined habituation at the natural attenuation of a non-reinforced response to a repeated stimulus over time. In the case of intrusive tinnitus, the stimulus is the tinnitus, and the response is tinnitus-related distress. The response should resolve in it's own (natural attenuation) provided it is not reinforced. There are external factors and internal factors that reinforce the response. We control the external factors, but we have precious little control over the internal factors. (That's where TRT, Neuromonics, etc. come in.)

Here are a couple of examples of things we can control. (1) We can stop keeping tinnitus diaries. (2) We can cut down on the time we spend unnecessarily thinking about tinnitus as in wondering about cures, etc. Believe me, if somebody comes up with a true cure, you'll know about it soon enough!

What we cannot directly control are the emotional and autonomic factors.

So to get back to your question. I would say that you do the best you can to eliminate the external factors you can control, and then if things are not moving quickly enough for you, that's when you begin to consider TRT, etc.

For me personally, I would not suffer one day longer than I absolutely had to. But that's just me.

Stephen Nagler

 

[alibee]

Hmmm. Maybe it's a question of facial contour. My nose is never in my field of vision unless I purposely look down and turn my eyes inward. With my eyes in a neutral position, try as I might I cannot see my nose. If I could, that would be another story. But since I can't, your analogy does not work for me. It might work for Pinocchio or Cyrano de Bergerac, but it doesn't work for me.

Stephen Nagler

I think it's fairly insulting to equate people who can see their noses with Pinocchio and de Bererac.

 

[epin3m]

I think it's fairly insulting to equate people who can see their noses with Pinocchio and de Bererac.

I think he did not insult anyone alibee. I think he just has put an extreme example. In my case I have a big nose as you can see in the picture and I can barely see it without the need to turn my eyes but I can see it. Sp cannot and others might not. Nevertheless that is not important. What it is important is the idea of habitutation to a neutral stimuli and if the nose analogy works better for you than the pants analogy go for it! That it is what it´s important

 

[Dr. Nagler]

I think it's fairly insulting to equate people who can see their noses with Pinocchio and de Bererac.

Alibee, it never dawned on me that some folks can see their noses without looking down and turning their eyes inward. My bad. My ignorance. And I apologize if you or anybody else was insulted. For you the nose analogy makes perfect sense. By the way, if your avitar is a photo of you, you are a beautiful woman with a beautiful nose. How fortunate for you that you can see it any time you choose to!

Stephen Nagler

 

[Magpie]

alibee wrote:
The fact that it's constantly in my vision and yet I don't actively notice it.

It's always been part of who we are. Unlike our noses, ears, feet or any other part of our body tinnitus is a new experience and a distressful one at that because our peace/serenity or whatever we like to call it has suddenly been shattered. If a dog barked outside our bedroom window 24/7 or a smoke alarm went off 24/7 it would drive us nuts. Similarly we have no escape from tinnitus. It is only after a period of time and acceptance, educating ourselves or successful treatment that we start to recover. One day hopefully we realize that the answer is in the way we react to tinnitus. No Reaction = No Distress. The tricky part is how we get there because tinnitus is often accompanied by anxiety, fear, depression etc.... so these feelings also need to be overcome in order to facilitate habituation.

 

[Sen]

the reason you do not react to your pants is that your brain classifies the pressure your pants exert on your legs as a neutral stimulus.

unless your pants are particularly tight, or itchy, or smell bad. then you're probably reacting to your pants more than you'd like to.

habituating to tinnitus is more like habituating to a permanently smelly poop stain in your pants than it is habituating to normal pants.

 

[Dr. Nagler]

Habituating to your tinnitus is not like habituating to your pants. I never said it was.

What I said was that after you have habituated to your tinnitus, then it's like your pants.

Stephen Nagler

 

[Neenie]

Everything annoys me though. My pants, my bra, my hair on my face, my oily face, my shoes, sitting upright all day, feeling bloated after eating, feeling tired.......but the thing is when I get home, that all changes, I can lie down, i wash my face, i get my hair out of my face, my pants come off, my bra comes off, and only then am I a little more comfortable. So for my, the pants analogy doesn't work because I actively notice my pants all day and cant wait for the moment that I can finally take them off. I've been thinking this for a while and I'm wondering if this means that I will be less likely to habituate to tinnitus if I cant even habituate to totally neutral stimuli

 

[DebInAustralia]

Well, let's look at the pants analogy for a moment. The reason you are unaware of your pants most of the time is that you do not react to your pants. And the reason you do not react to your pants is that your brain classifies the pressure your pants exert on your legs as a neutral stimulus. That's a really important concept, in my opinion, because the brain prioritizes. It is so busy doing things that are vital to your existence that even in the resting state it simply cannnot attend to neutral stimuli. Your tinnitus? Well the reason it annoys you is that it is not a neutral stimulus - in most cases for the folks on this board not by a long shot! But if your brain can be retrained to categorize your tinnitus as a neutral stimulus, then regardless of how loud or pitchy your tinnitus might be, you will become largely unaware of it. And that is the essence of TRT, which is why I happen to like the pants analogy.

Stephen Nagler

thank you Stephen,

Does everyone habituate? I am fearful that it wont happen for me?
Is it necessary to use maskers with trt?

 

[Stina]

I think that according to statistics around 7o-80% habituate naturally, so I suppose for most people TRT happens naturally. Of course that probably depends on how intrusive the ringing is.

 

[Tenna]

@Neenie I don't think the analogy is to be applied to female clothing lol. Anyhow that's quite a bunch of things Neenie :O

I actively notice my pants all day and cant wait for the moment that I can finally take them off.

Tinnitus could be considered of the same annoyance as the other things you mention, if that quote should be interpreted in some movie (where one must always overanalyze ofc!).. I don't know, I kinda think of when American Psycho takes off his mask in the start of the movie, just on a much lighter scale ofc
Either all kind of normal things you're annoyed about are actual problems; you might be bloated lol, or there's something about your hair etc you don't like, or you respond way too much to things that shouldnt really matter?:O Same response would apply itself to tinnitus perhaps?
Might be overanalyzing, but such quote could make an entire script

 

[Dr. Nagler]

Does everyone habituate? I am fearful that it wont happen for me?
Is it necessary to use maskers with trt?

Deb, strictly speaking habituation is a process rather than a state. So the answer to your first question is that over time most everybody habituates his or her tinnitus. The real issue is the degree to which that process occurs and the length of time it takes. Treatment protocols such as CBT, MBCT, TRT, TAT, PTM, and NTT may be viewed as vehicles for facilitating the process - so that it happens faster and to a greater degree.

Regarding your TRT question, TRT never involves masking. It does, however, involve sound therapy, and in three of the five TRT categories that sound therapy is delivered via the temporary use of small wearable broadband sound generators. So one essential component in TRT is sound applied in accordance with TRT category, and the other component is counseling applied in accordance with TRT category.

Hope this helps more than confuses.

Stephen Nagler

 

[DebInAustralia]

Deb, strictly speaking habituation is a process rather than a state. So the answer to your first question is that over time most everybody habituates his or her tinnitus. The real issue is the degree to which that process occurs and the length of time it takes. Treatment protocols such as CBT, MBCT, TRT, TAT, PTM, and NTT may be viewed as vehicles for facilitating the process - so that it happens faster and to a greater degree.

Regarding your TRT question, TRT never involves masking. It does, however, involve sound therapy, and in three of the five TRT categories that sound therapy is delivered via the temporary use of small wearable broadband sound generators. So one essential component in TRT is sound applied in accordance with TRT category, and the other component is counseling applied in accordance with TRT category.

Hope this helps more than confuses.

Stephen Nagler

yes you are making perfect sense.

i am seeing an audiologist in a few days, and want to ask about trt.
i was concerned about masking, since i question how my brain is going to adapt if i continually mask t
the small wearable broadband sound generators aren't neuromonics/related products are they? sorry for being daft!

 

[DebInAustralia]

whats everyone's feeling about other sound therapies ie neuromonics, mute button etc?

 

[Dr. Nagler]

i was concerned about masking, since i question how my brain is going to adapt if i continually mask t
the small wearable broadband sound generators aren't neuromonics/related products are they?

Deb, your concern about masking goes to the core of why you do not want to mask in TRT. Excellent observation.

Neuromonics is a totally different treatment from TRT.

sp

​

 

[DebInAustralia]

but....aren't they bb sound generators doing just that?

 

[Dr. Nagler]

but....aren't they bb sound generators doing just that?

No. The volume of the broadband sound generators used in TRT is never set high enough to mask your tinnitus. The principles involved in setting the devices used in TRT are contrast and associative conditioning, not masking.

sp

 

[DebInAustralia]

ah... I get it...

can the bb sg make t worse?

thanks a lot!

 

[Dr. Nagler]

can the bb sg make t worse?

No, not if they are set properly in accordance with your TRT category.

sp