MBTSR: The Variety of Experience

We provide a variety of mindfulness exercises throughout the eight-week MBTSR course, largely because different people seem to have an attraction to certain practices more than others.

11Some have an affinity for connecting with their bodies through the “body scan” exercise. Others gravitate to the “sitting meditation,” and still others seem to prefer the “moving meditations” like the Walking Meditation or Gentle Yoga Stretches.

Although it is quite natural for the mind to place judgements and compare one more favorably than another, we want participants to “catch” their minds having these thoughts. We encourage people to try all of the different practices as they appear in the Weekly Classes.

The approach:

See if you can just notice the mind’s tendency to compare and show preference. And then approach these as just passing thoughts and preferences and continue to practice all of the different exercises with a stance of curiosity, openness, acceptance, and radical caring for your self. 

Tinnitus: Changing Perception

Mindfulness is a way of approaching each moment by focusing one’s attention and purposefully living in the moment as a way of relieving physical and emotional pain. This is not a new idea. Rather, mindfulness is a 2,500 year-old practice that is experiencing a resurgence, in part because of recent scientific findings that substantiate its myriad healing benefits.

EarPuzzleA growing body of research has shown the efficacy of mindfulness-based approaches in managing chronic pain, sleep disturbances, depression, anxiety, multiple sclerosis, cancer, and long list of other health maladies. My own research suggests that mindfulness can also be particularly useful in managing tinnitus.

I first learned about mindfulness as a pain management tool when I was a clinical psychologist and researcher at the University of California, San Francisco. After seeing the positive impact it had with other conditions, I wanted to study the impact of mindfulness therapy in changing a person’s relationship with bothersome tinnitus. With several colleagues, I organized a pilot study in which eight tinnitus patients received eight weeks of Mindfulness Based Tinnitus Street Reduction (MBTSR).

The results of this study were stunning. We found that mindfulness therapy greatly reduces the perceived burden and handicap of tinnitus. What’s more, the benefits were enduring, with improvement lasting through the end of the 12-month study window. In addition to a decrease in tinnitus burden, depression and anxiety scores went down and quality of life scores went up after program completion.

images-3So what is mindfulness and how does it improve a person’s perception of tinnitus? Mindfulness is a way of approaching each and every moment that arises with a “special” kind of awareness. By “special” I mean not just an ordinary awareness but rather full consciousness of immediate experience, approached with curiosity, acceptance, openness to whatever arises, and a gentle self-compassion toward one’s self.

Tinnitus patients often try to avoid awareness as a way to ignore the ringing in their ears. This works for some, but it also closes people off from living a full, unencumbered life. Mindfulness teaches that we can benefit by fully embracing our experience with tinnitus. By leaning into our tinnitus, we can break through to a better, fuller experience. Mindfulness also helps relieve the anger and apathy that so many tinnitus patients experience.

MBTSR: The Online Decision

How a tinnitus online course reaches those who might not benefit from in-person tinnitus group care.

EarPuzzleCreated in 2009, the MBTSR curriculum was initially designed as a group, in-person skill building course. Each class brought people with tinnitus in the Bay Area community together for 2 hours per week over an 8-week period to practice the skills needed to support change in a person’s relationship to living with tinnitus. The research results were astounding, as I literally watched the healing transformation in participants each week.

So when I began designing the MBTSR online course, I was worried that an online course—where the weekly MBTSR classes were practiced separately, in the privacy of each person’s home — would not be attractive to people. But as the weeks passed by and people with tinnitus began taking the class, I began hearing encouraging statements from participants. For example:

“The MindfulTinnitusRelief.com course is warm and inviting and gives the tinnitus patient an honest opportunity, without false hope, to feel better. I also like the way the modality appears to encompass CBT and Buddhism with its mindfulness main principles.”

That’s when I began to realize that there are many people who — due to geographical distance, demanding work schedules, health issues, and discomfort participating in a live group setting — would now have easy and comfortable access to a novel new treatment for tinnitus.

Why Go Online: Pragmatic Benefits

•  Less expensive per participant
•  Reusable components
•  Easier recruitment
•  Available to more people with less burden
•  Serious dissemination

Why Go Online: Effectiveness

•  Facilitates daily learning and practice
•  More effective monitoring
•  Easier faster participant contact
•  Simplified record keeping
•  Reach a different audience

Why Go Online: Challenges

•  Less personalization
•  Less personal contact / sense of commitment
•  Only works for skills interventions
•  Not, e.g., acupuncture

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.