About Yoga & Its Role in a Mindfulness Practice

Meditation.jpgA practice of yoga is an important part of any mindfulness practice. Yoga is a Sanskrit word that means “to yoke” and can be viewed as a moving meditation linking or yoking our awareness of the body’s movements and sensations with the mind. So we practice gentle yoga postures, linking the breath with each movement. Breathing in deeply with each posture, we notice the world of sensations felt in our bodies. This often is an opportunity to notice the mind’s habitual reactions to the pleasant, unpleasant, and/or neutral sensations we feel in any given moment. The tendency to want certain postures to end, the judging of one’s performance, the comparisons to others or to yourself at a different moment in time are noticed and observed as just activities of the mind. We bring awareness to the habitual clinging to these thoughts and automatic reactions as we gently and lovingly return our attention to the breath, to the body’s posture in the present moment. We observe whatever is there to be felt.

There are many different kinds of yoga, from Bikram Yoga to Ashtanga to Flow and Restorative Yoga. People often come to a specific type to address chronic pain, for relaxation, or to cope with stress. What these practices all have in common though is the coming together of the mind, the breath, and the body in a practice of bringing awareness to the present moment.

About the Ears

anatomyThe ear can be divided into three sections, the outer ear, the middle ear, and the inner ear. Hearing loss or pain in the outer or middle ear is often easy to treat. However, when our hearing sensory organ—the cochlea—in the inner ear is damaged, permanent hearing loss is the result. This is also known as sensori-neural hearing loss. Inside the cochlea we have these fragile hair cells, or cilia, that take an electrical signal and convert this to a chemical signal. This chemical signal is then transmitted to the auditory nerve and sound processing centers in the brain. The hair cells are laid out from low to high frequencies, much like the keys of a piano go from low to high notes. When this strip of hair cells is rolled into the cochlea, high frequency hair cells, the ones closest to the  the cochlea’s opening, are the ones most exposed to potential injury. This is why we usually lose our hearing up in the higher frequencies as we age. Once these tiny hair cells are damaged, hearing loss is the inevitable result.

Can Hearing Aids Help?

Hearing aids are helpful for some people suffering with tinnitus. Theories describing the onset of tinnitus explain how the tinnitus sound occurs in the frequencies that are lost. Therefore, a hearing aid may help: 1) it gives us more sound stimulation, and 2) it allows more sound to enter the ear, providing the ear and brain with enough stimulation so that tinnitus is not triggered. Your audiologist can fit you with hearing aids to see if using them could be helpful.

Tinnitus and Treatment

The following blog is a letter written by me in response to a physician’s questions regarding a woman he is treating with tinnitus:

March 19, 2014

Dear Dr. M.C.,

I’m glad you contacted me about your patient who has been struggling with severe tinnitus for several years. You mentioned that she has been to many specialists and has found little relief from treatments she has tried. Right now, I am flying back from New Zealand after speaking at the 8th International Tinnitus Research Initiative (TRI) Conference, so I had an opportunity to learn up-to-date information on tinnitus from top researchers and clinicians from around the world.

Because of the heterogeneity of tinnitus causes and severity, there is really no silver bullet that can be relied on to bring relief to all people with bothersome tinnitus at this time. Furthermore, there are no FDA approved drugs for treating tinnitus. Nevertheless, drugs to help with frequently accompanying symptoms such as depression, anxiety, and sleep difficulty can be a help as well as anything that aids her in relaxation (stress is a big trigger for bothersome tinnitus).

Because there is no “cure” for tinnitus for all people and the effectiveness of many treatments has not been proven sufficiently in the research, I have decided to go a different route with my work. I’ve turned my focus away from conventional treatments to instead explore what a person with tinnitus can do to use their own internal resources for “healing”–putting the responsibility for wellness into the hands of the patient. 

MindfulTinnitusRelief.com is the online version of the 8-week Mindfulness Based Tinnitus Stress Reduction (MBTSR) course that I developed at the University of California, San Francisco (UCSF) Audiology Clinic. The pilot study indicated large effect sizes with a 12-month follow-up study showing an enduring and continued drop in tinnitus handicap. So the benefits appear to last. The MBTSR skills are taught through mindfulness meditation, breathing exercises, Discussion Forums, gentle yoga stretches, readings, home practice assignments, and various activities.

anatomyWhat makes MBTSR special is how it encourages her to continue other approaches to tinnitus management she is currently trying in conjunction with the Mindful Tinnitus Relief 8-week course. For example, if she uses hearing aids, sound therapy, TRT, CBT, talk therapy or any other management tools that she finds helpful, the MBTSR program encourages her to continue their use while participating in the MindfulTinnitusRelief.com program. MBTSR nicely supports the effectiveness of other devices and tools that she might already be trying. It is worth noting that although efficacy is not consistent in the research, there are some accounts of people finding at least partial relief (effectiveness) with a hearing aid and various sound therapies (I’m guessing she has tried these).

I would recommend highly for her to take the online course MindfulTinnitusRelief.com in conjunction with other treatments she is trying. (Though I recommend a conservative approach to any drugs she is prescribed). Brain imaging studies looking at Mindfulness have found cortical growth in areas like the pre-frontal cortex and right insula in advanced meditators. This suggests that with a mindfulness practice, she can “strengthen” the parts of the brain that down regulate limbic system firing, leading her to experience the tinnitus signal as a meaningless body sensation not requiring her attention.

I certainly recommend contacting Dr. S.C. He has a different perspective but I believe our approaches are complimentary. With tinnitus it seems best to ‘throw in the kitchen sink’ in hopes one or several concurrent treatments can be of some relief.

I’d be happy to discuss this further if you have any questions. The MBTSR course is not available in Chicago which is why I have developed MindfulTinnitusRelief.com, the online version, so people from around the world can take the course anywhere at any time from the privacy of their own home.

Warm regards,



A Recap of the 8th International Tinnitus Research Initiative Conference (TRI)

I recently attended the 8th International Tinnitus Research Initiative (TRI) Conference, March 10th through the 13th in Auckland, New Zealand. Every year the Conference brings together researchers, otologists, neurologists, audiologists, psychologists, and an array of hearing health professionals to report on their findings in the field of tinnitus.

jennzIt was amazing to have various disciplines from around the world coming together to share their work. Tinnitus research is being done all over the world, and the sharing of ideas is crucial to steady growth. I gave a workshop on the first day on my findings and experience creating Mindfulness Based Tinnitus Stress Reduction (MBTSR) and our online course, MindfulTinnitusRelief.com. There was great interest at the meeting in mindfulness as a management tool for tinnitus—and interest in the online version of the 8-week course, making mindfulness training easily available to people all over the world. 

The first day of the Conference consisted of workshops by leaders in the field, including: Dr. Grant Searchfield of New Zealand, presenting on sound therapies; Dr. Natan Bauman of the United States, presenting on Cognitive Habituation Tinnitus Therapy (CHaTT); and Professor Billy Martin from Singapore, presenting on building a tinnitus practice from the ground up, describing his experience setting up a new tinnitus clinic in Singapore.

The days following were filled with presentations covering a broad range of topics from transcranial stimulation, evidenced based treatments, sound therapy, brain imaging research, hyperacusis, and multi-sensory contributions to tinnitus and others. 

jennz2It is encouraging to see how different disciplines are coming to similar conclusions in their results. Josef Rauschecker, PhD from Georgetown University shared his findings implicating a decrease in cortical brain mass in people with tinnitus in the very same areas that mindfulness brain-imaging research is finding increased growth (specifically: Medial PreFrontal Cortex and right insula). This is very exciting to see, and a study combining neuro-imaging with the 8-week MBTSR program is a research direction to be explored. 

I left the TRI Conference very excited and inspired to share MBTSR with people around the world. This year I will be collecting data to present at next year’s Conference on findings of the efficacy of the MindfulTinnitusRelief.com online course for tinnitus relief.

Yoga & Tinnitus


The word yoga is a Sanskrit word meaning “yoke,” as in linking two things together. In the case of yoga, it is the yoking of the mind and the body. With each yoga pose, we bring awareness to immediate body sensations, using the breath as a guide, while keeping the mind calm, focused, and stable.

The unpleasant nature of the tinnitus sensation—and the seeming lack of control a person has over it—can foster a dislike and distrust of one’s own body. Feelings of anger, guilt, fear, and blame may arise with this feeling of lack of control. After a while, it is not uncommon for person to feel helpless, disconnected, and just “cut off” from their own bodies.

MeditationYoga is an important teaching tool in any mindfulness practice, especially for those feeling cut off. With each movement of the body and with every pose, using the breath to ground us in moment-to-moment sensations, yoga is the practice of building awareness and acceptance of the present moment, whether a body sensation is sensed as pleasant, unpleasant, or neutral. We observe and explore how all body sensations change. For the person with tinnitus, practice with tuning into the sensations of the body lays the groundwork for the person to re-connect with what has been a dis-connection. When the re-connection is re-established, the person with tinnitus can then choose a wise response to explore the tinnitus sensation without the fear, dis-trust, and dis-like that may have been preventing the linking of mind and body.

Yoga is a practice of coming back: reconnecting, befriending, and “yoking” the mind with one’s own body.