The Problem: Tinnitus or Reaction?

[UserID]

Elsewhere @R. David posted [in part]:

And i cannot stress this enough. My tinnitus was never the problem. My problem was my reaction to the tinnitus.

............

I happen to agree with R. David wholeheartedly, but the concept can be confusing to newbies (and to some not-so-newbies!) so I thought I'd take a few minutes to explore it.

Is the problem tinnitus, or is the problem the reaction?

In my opinion the difficulty lies not only in that there are good arguments on both sides of the coin, but also in the fact that both positions can actually be proven!

Those who feel that the problem is tinnitus have a very easy proof. They will say that without tinnitus there would be nothing to react to! And they'd be 100% correct. The real world challenge for those folks lies in finding a way to eliminate or at least mitigate their tinnitus. And that is a mighty challenge indeed. Others may have a different experience, but to the best of my knowledge, there has yet to be found a way to predictably lessen or eliminate tinnitus. I know I certainly can't do a thing about mine!

Those who feel that the problem is reaction also have an easy proof. They can point to the fact that the reason folks with tinnitus seek help is that their ears are ringing and in some way or another it makes them feel bad. "Feeling bad" can run the entire gamut - from being mildly curious and concerned about its significance to being totally incapacitated by it. Well, if people did not react to their tinnitus, they wouldn't feel bad. In fact they couldn't possibly feel bad – because feeling bad is a reaction! Indeed, I personally know of a number of folks with very soft tinnitus who can barely function (i.e., they have a huge problem) and a number of folks with very loud tinnitus who are not bothered by it in the least (i.e., they have no problem at all.) The challenge for those in the "reaction" camp lies in the fact that you cannot simply will yourself not to react to your tinnitus. It requires time, and it requires strategy.

So who's right – those who claim that the problem is tinnitus, or those who claim the problem is reaction? Since both positions can be proven, I do not see this as an issue of who is right and who is wrong. Rather, it is a question of what you believe and what you can do about it.

Here's to finding lasting meaningful relief - whatever path you take!

Dr. Stephen Nagler

Well put initial post, Dr. That is the gist of my supportive position to newbies. Like you say, it's not easy to get the point across, that the lack of reaction is key. Giving my own experience seems to help by putting a person in the thick of it who has been dealing with T since 1972. Through just about every form of therapy there is, I only came to a sense of progress when I chose to learn a relaxation technique which freed me from panic and allowed me once again to think positively, not fatally, not that T can cause eventual death, but it sure felt like it at times.
David

 

[russiancarl]

@Dr. Nagler I think you summed up my reaction to tinnitus pretty darn well and here I was thinking all along that I wasn't habituating right. It doesn't bug me much on most days now - habituation is still an ongoing process - but I don't think a moment has passed that I ever thought of accepting it. You're the first person I've heard say that they are two different concepts and I'm glad I'm not crazy!

On a completely unrelated note, I know in your opinion that there won't be a cure for tinnitus anytime soon if ever but have you been following the retigabine/potiga thread at all over in the treatments section? I personally am with you on your analysis - that tinnitus is not simply cured and if there will be a cure it won't be anytime soon. That said, there seem to be people responding very positively to using the epilepsy drug for off-label usage yet nobody with any medical expertise has chimed in on the possible promise or lack thereof. I'd be greatly interested in hearing your take on the whole situation.

Thanks again for coming back!

 

[Dr. Nagler]

On a completely unrelated note, I know in your opinion that there won't be a cure for tinnitus anytime soon if ever but have you been following the retigabine/potiga thread at all over in the treatments section?

No, I haven't been following any threads except a very few on the Support forum. Got a lot on my plate right now, and I do not have enough information to offer a responsible opinion on retigabine/potiga. Sorry.

Dr. Stephen Nagler

 

[Sjoerd]

agree with R. David wholeheartedly, but the concept can be confusing to newbies (and to some not-so-newbies!) so I thought I'd take a few minutes to explore it.

Elsewhere @R. David posted [in part]:

So who's right – those who claim that the problem is tinnitus, or those who claim the problem is reaction? Since both positions can be proven, I do not see this as an issue of who is right and who is wrong. Rather, it is a question of what you believe and what you can do about it.

Probably the people that truly habituate are the one's whom understand that it is the reaction that is the problem.

 

[gary]

I am finally understanding reaction. I had read a book by Dr. Wayne Dyer "Your Erroneous Zones" He pointed out reaction this way. You are mowing the lawn enjoying the sunshine, in the mean while your wife gets into a car accident and is badly injured, you are still mowing the lawn feeling great. Then when you get the phone call to come to the hospital that is when you react. Thus it is not a situation that caused your duress but your reaction to it, after you found out.

It may not make sense to some, but to me I see what Dr. Dyer is talking about. Not saying this is a good example for tinnitus, but for me, it gives me a better understanding of reaction.

 

[Dr. Nagler]

Usually at some point in a discussion about the role of reaction in tinnitus-related distress, somebody quite reasonably brings up a broken leg or the like. The idea is that a broken leg results excruciating pain. And there is simply no CBT, NTT, TAT, TRT, etc., etc. that is going to effectively address that sort of reaction. Case closed - it's not the reaction that's the problem; it's the tinnitus. Or so the argument goes. So I thought I'd bring it up first.

The counter requires a knowledge of neuroanatomy and neurophysiology. But boiled down to its essence, the neural pathways for pain and temperature are unique and totally distinct from the pathways for sound, taste, smell, touch, and vision. In other words, there's a reason we do not include pain and temperature among our five senses. Pain might occur as a result of a broken leg, but it is not a reaction to a broken leg.

Hope this clarifies more than confuses.

Dr. Stephen Nagler

 

[russiancarl]

@Dr. Nagler Thank you for your response. I can understand being too busy and not wanting to comment without thoroughly reviewing the information. As a doctor your word carries much more weight around here. Perhaps when you have an hour free you could peruse the thread. I'll link it here: https://www.tinnitustalk.com/threads/retigabine-trobalt-potiga.5074/ You might find it quite interesting as most of us have.

On a completely unrelated note, I have been making progress with the TRT regimen that I started last month but I am left with a few questions. Have you heard of using nature sounds instead of white noise for TRT? Instead of maskers my ENT suggested I play pleasing sounds at ear level 2-4 hours a day and she also said that it didn't have to be set near the volume of my tinnitus.

I haven't heard of this approach anywhere else and it seems to be a mix of Neuromonics and TRT. I do trust my doctor and it does seem to be working but I suppose I am still curious if this is an approach other TRT practitioners take.

Thank you again Dr. Nagler.

 

[Dr. Nagler]

@Dr. Nagler Thank you for your response. I can understand being too busy and not wanting to comment without thoroughly reviewing the information. As a doctor your word carries much more weight around here. Perhaps when you have an hour free you could peruse the thread. I'll link it here: https://www.tinnitustalk.com/threads/retigabine-trobalt-potiga.5074/ You might find it quite interesting as most of us have.

I am flattered that you would seek my input on this matter, but in all honesty whether or not I personally think the approach has validity is really irrelevant. My word might (or might not) carry weight around here, but either way it has absolutely no bearing on whether or not retigabine/potiga will ultimately be found to be efficacious.

On a completely unrelated note, I have been making progress with the TRT regimen that I started last month but I am left with a few questions. Have you heard of using nature sounds instead of white noise for TRT?

Yes. In TRT the use of nature sounds and the like is recommended for individuals who fall into Category 0.

Thank you again Dr. Nagler.

You are most welcome.

Dr. Stephen Nagler

 

[bwspot]

When I read this I start to realize the difference between the reaction and the tinnitus itself. I guess once I accept it and react to it positively I still can read and research while feeling great thx to the positive reaction.

 

[Rico Napoli]

@Dr Stephen Nagler Thanks for your insight and devotion on helping those in need. Three months in not sure what my game plan is but what is the time frame on average for one to habituate successfully ? Of course everyone is looking for a quick fix but realistically to being a client of yours and making the investment ? Please understand I am new and trying to understand all the treatments available

 

[Dr. Nagler]

Three months in not sure what my game plan is but what is the time frame on average for one to habituate successfully ?

Habituation is an ongoing process, not a state. At least that's how I have come to see it. So I don't think in terms of how long it might take.

Dr. Stephen Nagler