cognitive therapy
GKeller245
hi. My name is Irene and I'm new to T and the net. Thanks to those of
you who have responded to me. It helps to know that I'm not alone. I
have a friend with T and hearing loss who is undergoing treatment in
England with a Dr. Hazel. It's a combination of cognitive restructuring
to change the way he thinks about the T and also acoustic habituation.
Has anyone tried this treatment? I'm also wondering if it exists in L.A.
His treatment will take at least six months and he's just starting so he
can't tell yet if it will work for him. It would be nice to have silence
back. Thanks.
Carol Morgan
It doesn't sound like the goal of the treatment is silence. It sounds
like the goal of the treatment is to reframe his auditory perception so
that he is less bothered by the T.
Carol Morgan
Sign...@ix.netcom.com
In <4p7ci7$7...@newsbf02.news.aol.com> gkell...@aol.com (GKeller245)
writes:
Stephen M. Nagler
sign...@ix.netcom.com(Carol Morgan ) wrote:
Wrong Carol (with respect) -
The goal IS silence. Silence is a function of two variables: 1) the
intensity of sound (loudness and pitch), and 2) whether or not that
intensity is noticed. If a person does not notice the sound, then
there is no tinnitus. If there is no tinnitus, then there is silence.
That is the goal of Dr. Hazel's and Dr. Jastreboff's protocols. This
goal is accomplished in stages - like most goals. First, the patient
habituates to the response to tinnitus - that is, the patient learns
to understand tinnitus and not have such a visceral/emotional response
to it. Next, the patient ceases to be constantly aware of it. Next,
the patient is aware only "upon hard listening." Finally, even when
the patient tries, he/she cannot discern the tinnitus. The goal of
auditory habituation is the point at which tinnitus cannot be
discerned. The latest data from U. of Md. indicates that substantial
improvement can be accomplished in 84% of cases. The percentage of
patients achieving the ultimate goal is, of course, lower. But, most
tinnitus sufferers would gladly settle for being aware only "upon hard
listening." I would. Wouldn't you?
SMN
Stephen M.Nagler, M.D.
nag...@atl.mindspring.com (E-Mail)
(770) 396-7829 (Fax)
Jim Chinnis
nag...@atl.mindspring.com (Stephen M. Nagler) wrote:
>sign...@ix.netcom.com(Carol Morgan ) wrote:
>>It doesn't sound like the goal of the treatment is silence. It sounds
>>like the goal of the treatment is to reframe his auditory perception so
>>that he is less bothered by the T.
>
>Wrong Carol (with respect) -
>
>The goal IS silence. Silence is a function of two variables: 1) the
>intensity of sound (loudness and pitch), and 2) whether or not that
>intensity is noticed.
Wrong, Stephen. :) Perceived silence means not noticing sound. One
cannot have intense tinnitus (sound) and not notice it, because it is
only by noticing it that it can be measured and found to be intense...
Loudness of sound of any kind is a property of the perceiver and
nothing else. Trying to distinguish between not having the tinnitus
and not noticing it is a hopeless affair.
> If a person does not notice the sound, then
>there is no tinnitus. If there is no tinnitus, then there is silence.
>That is the goal of Dr. Hazel's and Dr. Jastreboff's protocols. This
>goal is accomplished in stages - like most goals. First, the patient
>habituates to the response to tinnitus - that is, the patient learns
>to understand tinnitus and not have such a visceral/emotional response
>to it. Next, the patient ceases to be constantly aware of it. Next,
>the patient is aware only "upon hard listening." Finally, even when
>the patient tries, he/she cannot discern the tinnitus. The goal of
>auditory habituation is the point at which tinnitus cannot be
>discerned. The latest data from U. of Md. indicates that substantial
>improvement can be accomplished in 84% of cases. The percentage of
>patients achieving the ultimate goal is, of course, lower. But, most
>tinnitus sufferers would gladly settle for being aware only "upon hard
>listening." I would. Wouldn't you?
A great description! I, too, tend to think of this treatment as
producing a fundamental change in the perceptual system.
Jim Chinnis
Manassas, VA USA
--
Jim Chinnis jchi...@interramp.com Manassas, VA USA
Stephen M. Nagler
jchi...@interramp.com (Jim Chinnis) wrote:
(snip)
>Wrong, Stephen. :) Perceived silence means not noticing sound. One
>cannot have intense tinnitus (sound) and not notice it, because it is
>only by noticing it that it can be measured and found to be intense...
>Loudness of sound of any kind is a property of the perceiver and
>nothing else. Trying to distinguish between not having the tinnitus
>and not noticing it is a hopeless affair.
(snip)
.........................................................................................................................................................
I think that Jim and I may actually be saying the same thing. This
concept may be analogous to the classic puzzle: If a tree falls in
the forest and nobody is around for ten miles, is there sound? The
physicist says that there is sound, which by his/her definition is a
phenomenon created when a vibrating object (the tree) causes the
surrounding medium (the air) to vibrate. The philosopher says that if
one does not hear it, there is no sound. We tinnitus sufferers need
to be philosophers, not physicists.
Jim adds (importantly) regarding tinnitus, "Trying to distinguish
between not having the tinnitus and not noticing it is a hopeless
affair." It is my very strong feeling that too many tinnitus
sufferers focus on this very issue, thereby delaying their becoming
"whole" again. It simply does not matter whether or not the cause of
the tinnitus is fixed (once underlying medical conditions and
ototoxicities have been addressed); all that matters is whether or not
the individual is aware of the sound - or to what degree the
individual is aware of the sound.
Of the many available valid treatments out there, it is my hope that
each of us can find the one most suited to his/her particular needs to
minimize our awareness of the sound, if not erase it completely.
Thanks, Jim, for helping me clarify this point.
Stephen Nagler
DEAKCPA
The ATA (for $50) has a workbook (workshop manual) on Cognitive Therapy
and Tinnitus.
The manual was written by Donna Wayner, PH.D in 1991.
Her description of the Cognitive approach is that "it attempts to modify
an individual's attitude about Tinnitus by assisting them to adjust their
reaction to the Tinnitus. It cannot and does not alleviate the experience
of Tinnitus but has been useful in improving how the person perceives the
Tinnitus and doing this, provides relief.
Mike Deakin
Buffalo, NY
Mike Deakin
DEA...@aol.com
Jim Chinnis
dea...@aol.com (DEAKCPA) wrote:
<snip>
>Her description of the Cognitive approach is that "it attempts to modify
>an individual's attitude about Tinnitus by assisting them to adjust their
>reaction to the Tinnitus. It cannot and does not alleviate the experience
>of Tinnitus but has been useful in improving how the person perceives the
>Tinnitus and doing this, provides relief.
>
>Mike Deakin
>Buffalo, NY
Mike, this thread is mixing two distinct, but sometimes combined,
approaches, cognitive therapy and auditory habituation. Your post is
perfectly correct. But my knowledge is greater concerning auditory
habituation, which does alleviate "the experience of tinnitus."
Mr Laurie Prior
This is an interesting exchange of perceptions.
I have booked to go for consultation with Dr Hazell in London in October.
It is particularly interesting as a potential treatment to me because I believe
we T sufferers are the worlds, "hear a pin drop" brigade, in other words we
have or had over-acute hearing. If ordinary people had our level of T they
probably wouldn't notice it from the background noise in their heads.
But if you are a deep listener who is like the vocal impressionist and can
analyse the pitch and structure of sounds quite easily, then you too will be an
over-listener or over-hearer, and hence a sensitive hearing person. BUT
if you end up with deafness, then it's interesting to learn as I did that the
cognitive therapy of this technique does stress that hearing defects should be
corrected first. I have several hearing losses at frequencies that make
sibilants and consonants in peoples' speech hard to hear. Yet less than four
years ago my hearing was better than average for someone ten years younger than
I then was, (45)
Having to tune pianos for a living doesn't help as I find I am trained
to over-listen to quiet harmonics and decaying sounds. But quite why the
sudden deafness and onset of T should occur in 1992 I can't say. I am
interested to try Dr Hazells consultation as deafness does make T worse,
a.because of the hair cells ghosting sounds from the damaged areas and b.
because your hearing losses being interrupted and swamped by the T are a
viscious circle rendering you hearing more T than you otherwise would, as you
strain to hear. I just hope that tuning pianos has not actually been a way of
Disintegrating Auditory function so that the treatment won't work unless I stop
earning a living. But I will stop if that is what I have to do to stop noticing
T.
Sorry to go on so!
Mr Laurie Prior
Lau...@pamprior.demon.co.uk
Carol Morgan
VERY, VVEEEEERRRRYYYYY interesting. Thanks for your considered and
clear response. I'm impressed with the fact that you get ANYONE to the
point where their T is not discernable upon hard listening. Very
impressed. In fact, I'm incredulous and reminded of the Zen koan -
about the tree falling in the forest. If there is T, but the person
doesn't hear it, is it there? If the nerves are firing, and the brain
is preventing awareness of this - is it T? But perhaps I am facetious
here. I am terribly irreverent. Pardon me. (smile)
From time to time here, someone reminds us that their T is only
noticible in this way. For myself - my T was really no problem, and
only noticible if I paid attention and listened for it ( I guess this
is "hard listening" - right?), for many years. In fact, we can't really
figure out when it started because of this. However recently, it has
become much worse. Still, though, my earlier habituation to it has been
very helpful - I am only occasionally troubled by it, and am noticing
that, for example, at night, I have learned several strategies for
going to sleep - even when it's very bad- that I adopt automatically.
In fact, I use aspirin to relieve the sense of fullness from my
Meniere's despite the marked increase in T it brings, because I can
easily deal with the T and I prefer T to earache.
My answer to your question, of course, is "Absolutely."
I do notice now, since I have hearing loss and my auditory
discrimination is rapidly progressing into the terrible range, that my
habituation to my T is so automatic that it is at times causing me to
miss opportunities to improve my hearing. In a rather amusing example,
I needed and ordered new earmolds for my hearing aids. While I was
waiting for them, I noticed I had this particularly annoying and
intermittent T. Whispery and high-pitched kind of a sound. I dismissed
it for three days, before realizing it was my ear molds!! I could have
been reaching up and pressing them more firmly into my ear and ended
each occurance immediately! Haha Other examples occur more often as I
have greater problems making sense of the sounds in my environment. I
always figure everything's environmental, when sometimes it's my ears!
I'm very interested in the component of your treatment that reduces the
"Visceral and emotional response" to the T. T seems to precipitate a
strong emotional reaction in many people, and reducing that would
certainly be beneficial. Does that alone lead to an increase in
"silence" by virtue of the person's not noticing the T?
Carol Morgan
Sign...@ix.netcom.com
In <4p9ij3$1m...@mule2.mindspring.com> nag...@atl.mindspring.com
(Stephen M. Nagler) writes:
>
>sign...@ix.netcom.com(Carol Morgan ) wrote:
>
>>It doesn't sound like the goal of the treatment is silence. It sounds
>>like the goal of the treatment is to reframe his auditory perception
so
>>that he is less bothered by the T.
>>Carol Morgan
>>Sign...@ix.netcom.com
>
>
>Wrong Carol (with respect) -
>
>The goal IS silence. Silence is a function of two variables: 1) the
>intensity of sound (loudness and pitch), and 2) whether or not that
>intensity is noticed. If a person does not notice the sound, then
>there is no tinnitus. If there is no tinnitus, then there is silence.
>That is the goal of Dr. Hazel's and Dr. Jastreboff's protocols. This
>goal is accomplished in stages - like most goals. First, the patient
>habituates to the response to tinnitus - that is, the patient learns
>to understand tinnitus and not have such a visceral/emotional response
>to it. Next, the patient ceases to be constantly aware of it. Next,
>the patient is aware only "upon hard listening." Finally, even when
>the patient tries, he/she cannot discern the tinnitus. The goal of
>auditory habituation is the point at which tinnitus cannot be
>discerned. The latest data from U. of Md. indicates that substantial
>improvement can be accomplished in 84% of cases. The percentage of
>patients achieving the ultimate goal is, of course, lower. But, most
>tinnitus sufferers would gladly settle for being aware only "upon hard
>listening." I would. Wouldn't you?
>
>SMN
Carol Morgan
(LAUGHING WITH DELIGHT - having just written my response). Uhhh forgive
me for not reading a.s.t. and responding more promptly. I read
Stephen's response to my post...."Wrong, Carol - respectfully" and
Jim's response "Wrong, Stephen". and now am delighted to read yours,
Stephen
Haha. I am often interested, sometimes bored, sometimes furious at what
I read here. Rarely have I been so amused and delighted......Thanks
guys.
Stephen, I agree totally with your last paragraph. And yes, by all
means the distinction is between the philosopher and the physicist.
This is often a choice offered to each of us - to respond on our
perception, and possible illusion, or to a certain reality. I think it
is one of life's most entertaining, and certainly most powerful,
features. It is well to use it to our advantage. It appears this is the
essence of this treatment.
Carol Morgan
Sign...@ix.netcom.com
In <4pbd24$1f...@mule2.mindspring.com> nag...@atl.mindspring.com
(Stephen M. Nagler) writes:
>
>jchi...@interramp.com (Jim Chinnis) wrote:
>
>(snip)
>
>>Wrong, Stephen. :) Perceived silence means not noticing sound. One
>>cannot have intense tinnitus (sound) and not notice it, because it is
>>only by noticing it that it can be measured and found to be
intense...
>>Loudness of sound of any kind is a property of the perceiver and
>>nothing else. Trying to distinguish between not having the tinnitus
>>and not noticing it is a hopeless affair.
>
>(snip)
>
>......................................................................
.......................................................................
..........
>
>I think that Jim and I may actually be saying the same thing. This
>concept may be analogous to the classic puzzle: If a tree falls in
>the forest and nobody is around for ten miles, is there sound? The
>physicist says that there is sound, which by his/her definition is a
>phenomenon created when a vibrating object (the tree) causes the
>surrounding medium (the air) to vibrate. The philosopher says that if
>one does not hear it, there is no sound. We tinnitus sufferers need
>to be philosophers, not physicists.
>
>Jim adds (importantly) regarding tinnitus, "Trying to distinguish
>between not having the tinnitus and not noticing it is a hopeless
>affair." It is my very strong feeling that too many tinnitus
>sufferers focus on this very issue, thereby delaying their becoming
>"whole" again. It simply does not matter whether or not the cause of
>the tinnitus is fixed (once underlying medical conditions and
>ototoxicities have been addressed); all that matters is whether or not
>the individual is aware of the sound - or to what degree the
>individual is aware of the sound.
>
>Of the many available valid treatments out there, it is my hope that
>each of us can find the one most suited to his/her particular needs to
>minimize our awareness of the sound, if not erase it completely.
>
>Thanks, Jim, for helping me clarify this point.
>
>Stephen Nagler
>
>
>
>
Stephen M. Nagler
sign...@ix.netcom.com(Carol Morgan ) wrote:
(snip)
>I'm very interested in the component of your treatment that reduces the
>"Visceral and emotional response" to the T. T seems to precipitate a
>strong emotional reaction in many people, and reducing that would
>certainly be beneficial. Does that alone lead to an increase in
>"silence" by virtue of the person's not noticing the T?
>Carol Morgan
>Sign...@ix.netcom.com
...........................................................................................................................................................
Some thread, huh?
I'd like to take credit for research in retraining and auditory
habituation ("your treatment"), but I can't. I'm a surgeon, not an
ENT, Otologist, or researcher. My understanding (or lack thereof) of
tinnitus and its treatment comes only from being a tinnitus sufferer
(such as yourself), from seeing numerous doctors in search of relief,
and from reading extensively. I'd like to think that my medical
background gives me a bit of an edge in evaluating various treatment
protocols, but sometimes it can be a hinderance, too.....kinda like
not seeing the forest for the trees.
Regarding reduction of the visceral and emotional response, the folks
who push retraining and auditory habituation (notably Jonathan Hazell
in London and Pawel Jastreboff in Baltimore) believe that education
and counseling are essential in this aspect of the therapy. They feel
that the results of retraining/habituation in the absence of education
and counseling are clearly suboptimal. Additionally, they have had
some success in treating tinnitus using only education/counseling to
reduce the response to tinnitus, but their best results combine the
treatments: specifically education/counseling to reduce the emotional
response and the use of low level white noise generators to aid in
habituation. It is crucial to this aspect of treatment that the white
noise generators do not mask the tinnitus, but rather provide a
backgound over which the tinnitus is still heard. Their feeling is
that if the tinnitus is completely masked, habituation cannot occur.
For a more complete, accurate, and erudite explanation, you may wish
to visit Dr. Hazell's web page:
http://www.ucl.ac.uk/~rmjg101/tinnitus1.html
Stephen Nagler
Stephen M. Nagler, M.D.
Jon Wallis
In article <4p82rv$p...@dfw-ixnews8.ix.netcom.com>, sign...@ix.netcom.co says...
>
>It doesn't sound like the goal of the treatment is silence. It sounds
>like the goal of the treatment is to reframe his auditory perception so
>that he is less bothered by the T.
There's a lot of information about Jonathan Hazell's
"habituation and retraining" approach to Tinnitus therapy at:
http://www.ucl.ac.uk/~rmjg101/tinnitus1.html
Regards
Jon Wallis
University of Wolverhampton, UK
(My opinions are my own)
Philipp von Wallenberg
In article <4p7ci7$7...@newsbf02.news.aol.com>, gkell...@aol.com (GKeller245) writes:
>hi. My name is Irene and I'm new to T and the net. Thanks to those of
>you who have responded to me. It helps to know that I'm not alone. I
>have a friend with T and hearing loss who is undergoing treatment in
>England with a Dr. Hazel. It's a combination of cognitive restructuring
>to change the way he thinks about the T and also acoustic habituation.
>Has anyone tried this treatment? I'm also wondering if it exists in L.A.
>His treatment will take at least six months and he's just starting so he
>can't tell yet if it will work for him. It would be nice to have silence
>back. Thanks.
Hi Irene,
look out for
http://www.ucl.ac.uk/~rmjg101/tinnitus.html
(if you haven't already)
Regards,
Phil
--
-------------------------------------+----------------------------------
LFI Laboratorium fuer | walle...@mst.uni-hannover.de
Informationstechnologie | http://www.mst.uni-hannover.de/
Dipl.-Ing. Philipp von Wallenberg |
Schneiderberg 32 | Tel: ++49 511 762-5006
D-30167 Hannover Germany | Fax: ++49 511 762-5052
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Ken Moore
Philipp von Wallenberg wrote:
[snip]
> Hi Irene,
>
> look out for
>
> http://www.ucl.ac.uk/~rmjg101/tinnitus.html
>
> (if you haven't already)
>
> Regards,
> Phil
>
Actually the .html file has changed names a little, now its:
http://www.ucl.ac.uk/~rmjg101/tinnitus1.html
not much, but a new user might have a problem using it :-)
________________________________________________________________
Ken Moore cisco Systems
Hardware Engineer 170 W. Tasman Drive
kenm...@cisco.com Bld. E
voice: 408-527-2030 San Jose, CA 95134
Fax: 408-526-8959
http://www.geocities.com/SiliconValley/5205
________________________________________________________________
EGoffin201
I'm wondering if anyone shares my experience. Since joining this newsgroup
my "t" has gotten worse. I don't think it's because it is actually louder
or a higher pitch but because I think about it more and thus notice it
more often. This definitely ties to cognitive therapy but it is the
reverse unfortunately. I'm thinking unsubscribing to this group.
egoff...@aol.com
ka...@nslsilus.org
"Outside of a dog, books are man's best friend. Inside of a dog, it's too
dark to read."
Groucho Marx
Joosh
this newsgroup are understandably very scared and uncertain. I have
recently talked with a very happy person who suffers from severe tinnitus,
though, so I know it is possible to come to peace with oneself, even if
facing challenges like T. Unsuscribe if you feel it will help you, but
know that others are going through similar problems. I truly believe
healing of the spirit is possible!!
Check out "Full Catastrophe Living" by John Kabat Zinn. I've been
meditating for about a week and there seems to be a real change in my
attitude about T.
Yours,
Josh
Carol Morgan
>
>I can relate to what you're saying. I think many folks who respond to
>this newsgroup are understandably very scared and uncertain. I have
>recently talked with a very happy person who suffers from severe
tinnitus,
>though, so I know it is possible to come to peace with oneself, even
if
>meditating for about a week and there seems to be a real change in my
>attitude about T.
>
>Yours,
>
>Josh
Josh - Many people live with T "happily". But I really like your point
about finding peace with oneself. There is so much we don't understand
about the mind-body connection, but it seems to be common sense that
when we feel at peace, our bodies can heal more efficiently and perform
more effectively.
I've meditated off and on for decades (amazed that I could get old
enough to say that!), and it's a very useful skill to develop. It's
been beneficial for me, tho one case doesn't make a scientific
discovery!
Peace,
Carol Morgan