Tinnitus is a debilitating condition for many adults… What is happening inside the brain of someone suffering from tinnitus and how does a mindfulness-based approach address the problem different than, say, conventional tinnitus maskers that some audiologists prescribe?

First let me emphasize, that the best tinnitus management approach is a broad tinnitus management approach. As a psychologist and specialist with sound sensitivity disorders a major focus of my work is on the psychological underpinnings of such disorders such as the depression, anxiety, sleep difficulty, and concentration problems blocking well-being. That said, I fully see the necessity for good audiological care as an important part of the management picture. Mindfulness-based approaches address the problem of tinnitus with (rather than as a replacement for) conventional tinnitus sound generators and there are many other tools that can be used in concert to reduce stress and promote healing. For example, while practicing any mindfulness or meditation approach I always encourage patients to use sound therapy if that helps them to relax, ease tension and discomfort.
To the question of what is happening inside the tinnitus brain, I think that Josef Rachecker, PhD of Georgetown University said it best in a recent article when he describes the generation of tinnitus as a “dysfunctional valuation process and abnormal assignment of negative meaning to a neutral stimulus” (Rachecker et al 2015). What is meant here is that the brain’s misappraisal of the tinnitus (and hyperacusis) sensation as a threat rather than as a benign body sensation is linked to imbalances in the brain’s threat appraisal system. We know through science and experience that tinnitus—in and of itself—is not a cause for alarm and can safely be habituated. The question then is, how might we reassure ourselves of this, and assist the brain in choosing the more accurate and adaptive response?
The 8-week Mindfulness Based Tinnitus Stress Reduction (MBTSR) skill-building program developed and researched with my colleagues at UCSF, teaches a meditation practice as a mental calisthenics of sorts. The awareness building practice of meditation is a way of exercising and re-wiring the brain’s learned yet unhelpful tinnitus reaction in exchange for more emotional balance and an adaptive response as to how we choose to relate to the sensation. This very process helps to clear the way for the brain to do what it likes to do naturally, habituate to the bothersome sound.
MBTSR and brain training.
A central goal of the 8-week MBTSR program is to help participants train the brain to convince the fast-acting and mis-appraising amygdala (a structure within the Limbic System of the midbrain that is associated with the fear response) that keeping tinnitus in our awareness is a waste of our energy and resources. Like the sound of a white noise machine or fan, tinnitus also can safely recede into the recesses of our mind.
Convincing the amygdala of this fact is the job of the higher developed areas of the brain. The pre-frontal cortex conducts our executive functioning tasks, including judgment, reasoning, emotional regulation, bringing awareness to certain things, and fear modulation, to name a few. This conscious part of the brain can be enlisted to exert more control. With awareness there is a slowing down of the habitual knee-jerk reaction, bringing awareness to certain processes such as an overactive fear reaction “chilling out” the over-firing amygdala.
The pre-frontal cortex is slightly slower in processing than the amygdala. This partly explains why our brains tend to place sounds in the “better-safe-than-sorry” danger category. Research in brain anatomy and physiology shows that, when directed, the pre-frontal cortex sends fibers to the overactive amygdala. These fibers are the down-regulating neuropeptides, such as GABA, that serve to “calm down” this area so that we can use reasoning to put tinnitus in the benign category, where it belongs.
Mindfulness: The Personal Trainer of the Pre-Frontal Cortex
A mindfulness-based approach, and the 8-week MBTSR course specifically, builds these new neural networks or “mental muscles”. Because many people have lived with bothersome tinnitus for years or decades, there are a lot of familiar patterns that they feel are impossible to overcome. However, with diligent practice, MBTSR teaches step-by-step skills needed to help the thinking brain more accurately determine real threats, and to calm “knee-jerk” reactions to bothersome tinnitus/hyperacusis.
A mindfulness approach to tinnitus helps extinguish the automatic fear reaction and replaces it with a letting go of attention and perception of tinnitus. The MBTSR program focuses on helping people uncover their own internal resources toward a reinterpretation of tinnitus. With practice, people with tinnitus are capable of “More Firing, More Wiring”: strengthening connections in the pre-frontal cortex for a greater, more measured, balance in daily life. This is an important step towards unraveling the Gordian Knot of tinnitus. For a more in depth description of what is happening inside the tinnitus brain and how a mindfulness practice can help transform “bothersome” tinnitus into “non-bothersome” tinnitus, visit the link: Mindfulness & The Tinnitus Gordian Knot.

Bookmark the permalink.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>