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Tinnitus Activities Treatment Thoughts and Emotions Session...• A sound in ear(s) or head •...
Transcript of Tinnitus Activities Treatment Thoughts and Emotions Session...• A sound in ear(s) or head •...
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Tinnitus Activities Treatment
Thoughts and Emotions 1
Thoughts and Emotions Session
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Overall Plan
1. Hearing and hearing loss
2. Tinnitus 3. Attention, behavior,
and emotions 4. Changing your
reactions 5. Activities for home
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PART 1: HEARING &
HEARING LOSS
1. How we hear, and what is hearing loss 2. Causes of hearing
loss Thoughts and Emotions 3
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How We Hear
Thoughts and Emotions 4
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Cochlea like piano
Low Pitches
High Pitches
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Hair Cells in Cochlea
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Nerve Activity Carries Information to the Brain
Hair Cell
Nerve Activity
Nerve Fiber
To Brain
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Spontaneous Activity on Hearing Nerves
No Sound (Quiet)
Hear Silence
Thoughts and Emotions 8
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Different Nerve Responses Result in the Perception of Different Sounds
“Table”
No Sound (Quiet)
Word “Table”
Sound of a Cricket
Hear Silence
Hear “Table”
Hear a Cricket
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Causes of hearing loss
Causes
Head Injury
Medications
Age
Disease
Noise
Unknown
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Normal Cochlea Cochlea with hearing loss and missing hair cells
Hearing Loss Similar to Missing Piano Keys
Thoughts and Emotions 11
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Normal Hair cells
Abnormal Hair cells, Hearing Loss
Hearing Loss and Missing Hair Cells
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Normal Hearing
Lots of information sent to the brain
Hearing Loss
Limited information sent to the brain
Nerve Activity
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Solutions for Hearing Loss
Cannot Replace Hair Cells
Hearing aids can help make sounds: • Louder • Easier to understand
• Do not restore normal hearing
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Protecting Your Hearing • Avoid exposure to loud sounds
whenever possible • If noise is unavoidable, wear ear
protection to prevent damage to your ears
Thoughts and Emotions 15
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Your Audiogram
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O O O O O
X X X X
X X O
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Your Hearing?
• Do you have a significant hearing loss? • What difficulties does your hearing
loss create? • What steps have you taken to improve
your hearing?
Thoughts and Emotions 17
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Pitch and Loudness
Pitch (frequency) • High pitch vs. low pitch
Loudness (intensity) • Soft vs. loud
Thoughts and Emotions 18
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PART 2: TINNITUS • A sound in ear(s) or head
• Heard differently by different people
(e.g. ringing, buzzing, hissing, etc.)
Thoughts and Emotions 19
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Tinnitus and Hearing • Tinnitus results from damage to the
hearing system
– May be associated with hearing loss
• Tinnitus will not damage your hearing
• Hearing may continue to decrease, but not because of tinnitus
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There Are Many Different Causes of Tinnitus
Causes
Head Injury Medications
Age
Disease Your
Cause?
Noise
Unknown
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Tinnitus is Common • 15 in 100 (15%) people have tinnitus • 1 in 100 (1%) people have troublesome
tinnitus • 30 in 100 (30%) people over 60 years old
have tinnitus
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Expectations for Relief
• Currently no drug or surgery can reliably eliminate the source of tinnitus
• However, YOU can change your reaction to tinnitus and how it affects you
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Auditory System • Tinnitus, whatever the cause, must be
represented in the brain in the auditory area. It is represented there like any other sound. It can be measured.
Thoughts and Emotions 24
Auditory cortex
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Tinnitus is an Increase in Spontaneous Nerve Activity
Hearing Loss (No Tinnitus)
Normal Hearing
Tinnitus
Hear Silence
Hear Silence
Hear Sound
Thoughts and Emotions 25
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What does your tinnitus sound like?
Whistle
Cricket
Another sound ?
Thoughts and Emotions 26
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PART 3: ATTENTION
1. Types of attention 2. How things capture our attention 3. Emotional state has an effect on
attention
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Two Types of Attention
• Conscious—Selectively attend to and think about information
• Subconscious—Monitor background information. Stimuli that are monitored may grab attention and move to conscious attention
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Many Stimuli Compete for Our Attention
Touch
Smell Vision
Sound
Taste
Thoughts and Emotions 29
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We can only consciously attend to one thing
Subconscious
Conscious
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We can typically direct our conscious attention to another stimulus
Thoughts and Emotions 31
Subconscious
Conscious
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We can direct our conscious attention to different smells, sounds,
or things we feel
Thoughts and Emotions 32
Subconscious
Conscious
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We are not even aware that our subconscious monitoring goes on
all the time Blah, blah, blah, Fred, blah…
Did I hear my name?
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Several things can influence our attention
Important Event
Novelty Unknown?
Emotional state
Thoughts and Emotions 34
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How do we respond to important stimuli?
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Subconscious
Conscious
?
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An important sound can grab our attention
Thoughts and Emotions 36
Subconscious
Conscious
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Things That Capture Our Conscious Attention
Unusual
Scary
Unexpected
Important
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Deciding to Pay Attention Everything is OK (no longer attend)
Do something, then will be OK (and will no longer attend)
Uncertain, may be important? (continue to attend)
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Some Stimuli Cannot Be Ignored
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Background Sounds Monitored
New Refrigerator is loud at first Soft
Not even aware it is present
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We Notice Important Things And Ignore Unimportant Stimuli
Refrigerator: Ignore
Lion: Cannot ignore
Crowd: Monitor information automatically
Thoughts and Emotions 41
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Tinnitus and Attention
If brain determines tinnitus is not important, the tinnitus can be ignored
If brain determines tinnitus is important, we will pay attention to it
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Cochlea
Brainstem Subconscious
Monitoring
Brain Conscious
“Hears” “Interprets”
Attention Emotions
How We Attend
Thoughts and Emotions 43
Memory
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Tinnitus does not…
• Make you deaf • Lead to senility • Imply a sign of mental illness
• When you worry about such things, you
can become preoccupied with tinnitus
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If the brain decides tinnitus is not important
• Not attend to it • Becomes less noticeable/bothersome • Can take some time (several months) • For some people it may occur quickly • For other people it will take longer
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Activities
• Describe an image you like (e.g. a new car) and one you don’t like (e.g. a snake)
• Describe a sound you like (e.g. music) and one you don’t like (e.g. a siren)
• Describe your tinnitus
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PART 4: CHANGE THE EMOTIONAL REACTION TO
TINNITUS
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Understand the Connection Between our
Thoughts and Emotions
Thoughts
1. Neutral
2. Negative
3. Positive Thoughts and Emotions 48
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Our Thoughts and Emotions
Doorbell
Doorbell
Doorbell
Neutral
Anxiety
Happiness
Fire
Injury
Angry neighbor
Flowers
Friend
Delivery
Thoughts and Emotions 49
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Identify Unhealthy (negative) Thoughts
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Change Negative Thoughts
• What kind of thoughts have you had about your tinnitus? – Situations where tinnitus is bothersome – Thoughts and beliefs about tinnitus – Feelings about tinnitus
Thoughts and Emotions 51
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Restructure Unhealthy (negative) Thoughts
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Change Negative Thoughts
I hate this noise!
I can’t live the rest of my life with this noise in my head!
I can’t concentrate with this sound in my head!
This noise isn’t pleasant, but I can learn to ignore it. It’s OK if this noise doesn’t go away because I can teach my brain to ignore it.
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How to Change Our Reaction to Tinnitus
1. Change Interpretation of Importance
2. Change Emotional Reaction
3. Refocus on Other Activities
4. Reduce Contrast Between Background Sound and Tinnitus
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1. Change Interpretation of Importance
• Tinnitus is likely the result of increased spontaneous nerve activity
• Many people have tinnitus – you are not alone
• Tinnitus is not threatening your health or hearing
• Tinnitus and YOUR REACTION to tinnitus are two different things
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Decreasing attention to tinnitus
• Our goal is to help you move from the group of people who are bothered by their tinnitus to the group of people who are not bothered by it.
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Decreasing Attention
• Consider subconscious and conscious attention
• Brain monitors background sounds all the time
• We pay attention to important, strange, fearful sounds
• If tinnitus is not important, it is less likely you will pay attention to it
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2. You Can Unlearn/Change Your Emotional Reactions
Tinnitus Tinnitus Tinnitus Tinnitus
Negative Reaction Anxiety, Irritation Less Irritation No Reaction
Negative thoughts
Negative thoughts Constructive thoughts
Tinnitus not as prominent
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3. Refocus on Other Activities • What hobbies do you have?
• What activities help you ignore your tinnitus?
• What new activities could you become involved in?
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• Involving yourself in activities that you enjoy—that bring intrinsic value—will also be helpful to focus away from tinnitus
Activities in Your Life
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4. Reduce the Contrast Between Tinnitus and Background Sounds
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Low level noise makes tinnitus more difficult to detect
Tinnitus
Low Level Noise
Tinnitus in Low Level
Noise
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Tinnitus Level
Level Tinnitus
Decrease Prominence of Tinnitus
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Background sound masks unwanted sounds
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Ways to Add Low Level Background Sound
• Use sound in the environment
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Ways to Add Low Level Background Sound
• Listen to recorded material: – Relaxation CDs – Smartphone apps – Nature sounds – Music
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Ways to Add Low Level Background Sound
• Use a sound playing device
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Do Any Sounds Make Your Tinnitus Less Noticeable?
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Rain Music
Waterfall Static
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PART 5: ACTION PLAN
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Activities 1. Practice focusing your attention on your
tinnitus, and then on something else 2. Identify alternative activities you enjoy 3. Try different low-level background sounds
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Task: Complete a Tinnitus Diary
• Neutralize negative thoughts about tinnitus
• Modify your lifestyle to engage in enjoyable activities
• Use low-level background sound to make tinnitus less prominent
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Example Tinnitus Diary 1. Write down your thoughts and worries about
tinnitus – My tinnitus will get worse over time.
2. Check to see if these thoughts match what actually happens
– Though some days can be worse, my tinnitus is about the same.
3. List the alternative ways of thinking about tinnitus that you find helpful
– I have tinnitus, but it is really a small part of my life.
4. We will discuss your thoughts at your next visit. Thoughts and Emotions 72
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Tinnitus Diary, cont’d
1. List the things that reduce your tinnitus 2. List the things that worsen your tinnitus 3. List activities you enjoy 4. List sounds you enjoy 5. List alternative activities to engage in
when you find tinnitus bothersome 6. List any low level sounds you used, and
their effect on your tinnitus Thoughts and Emotions 73
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Tinnitus Diary, cont’d
• For two weeks, keep a list of new activities you engage in each day, and the effect your activities have on your tinnitus.
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Example Tinnitus Diary – Week 1
Activity • Day 1: Walking
• Day 2: • Day 3: • Day 4: • Day 5: • Day 6: • Day 7:
Effect on Tinnitus • Day 1: Heard birds chirping,
did not notice tinnitus • Day 2: • Day 3: • Day 4: • Day 5: • Day 6: • Day 7:
• Make changes in your daily life so you are doing more activities where your tinnitus is better and fewer activities where your tinnitus is worse. List the new activities and how your tinnitus was affected.
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Example Tinnitus Diary – Week 2 Activity • Day 1: Gardening • Day 2: • Day 3: • Day 4: • Day 5: • Day 6: • Day 7:
Effect on Tinnitus • Day 1: Focused on yard
work, tinnitus less noticeable
• Day 2: • Day 3: • Day 4: • Day 5: • Day 6: • Day 7:
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Tinnitus Diary Review
• After two weeks, you may stop journaling • The intent is NOT to think of your tinnitus,
but to find other activities you can engage in that take your mind off tinnitus.
• YOU can then make changes in your daily life so you are doing more activities where tinnitus is better and fewer activities where tinnitus is worse.
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