By Barry Keate
Barry Keate, has lived with tinnitus over 40 years and has published 150+ research articles on numerous aspects of tinnitus. He is an expert on the condition and a well-known advocate for those with tinnitus.
A recently emerging therapy called Mindfulness is based on ancient meditation techniques and has previously been shown to be helpful for those bothered by persistent tinnitus. A recent clinical study shows mindfulness offers a new and effective treatment for chronic tinnitus.
The most prevalent cause of tinnitus is hearing loss. In this case nerve bundles in the cochlea are damaged by loud noise, toxic medications or some disease conditions. There is no cure for the type of tinnitus caused by noise exposure and hearing loss. However, there are several therapies that help reduce the noise and aggravation of tinnitus including the practice of mindfulness.
Author’s note: The early part of this article is based on the work of Jennifer Gans, PsyD, a Clinical Psychologist at the University of California, San Francisco, as reported in Hearing Journal. (1) The latter part of the article details my personal experience with Mindfulness meditation.
Mindfulness Based Stress Reduction
Stress is a major trigger of increased tinnitus. So managing and reducing stress levels is critical for those living with tinnitus.
Mindfulness meditation is based on a meditative technique that was developed by Buddhists 2,500 years ago. Jon Kabat-Zinn, a biologist at the University of Massachusetts Medical Center, is largely credited with bringing Mindfulness meditation to modern medicine. The idea was to train medical patients in Buddhist meditative practices, but without the Buddhism.
Kabat-Zinn developed an 8-week treatment program, which he called Mindfulness Based Stress Reduction (MBSR). Participants attend an 8-week group session consisting of 2 ½ hour sessions one evening per week. An all-day session is held on a weekend between the sixth and seventh sessions. Participants are given instructional CDs and taught to use the meditation practices while at home for 45 minutes at least 6 days a week between group sessions.
Mindfulness meditation is a particular way of paying attention to the present moment – intentionally, and without judgment. This is practiced by focusing on something specific, such as one’s breathing. Thoughts, feelings and sensations come and go and Mindfulness meditation observes them but no judgment is placed and no efforts are made to modify them. Mindfulness is a state of active, open attention to the present. It is a way to live in the moment and awaken to new experience.
In some ways this is similar to Cognitive Behavioral Therapy however, CBT involves judging how rational, realistic or logical these thoughts are with the goal of replacing the irrational, unrealistic or illogical ones. Mindfulness meditation involves accepting these thoughts and feelings in a kind and non-judgmental manner then returning to the present. This change in perception facilitates coping strategies and results in reduction of stress.
This treatment has been clinically shown to be successful for conditions such as depression, anxiety, stress, fibromyalgia, chronic fatigue, psoriasis, symptoms associated with cancer, and pain.
One of the first studies to look at Mindfulness as a means of pain management demonstrated significant reductions in present-moment pain (58% reduction), negative body image (29% reduction), inhibition of activity by pain (30% reduction) and anxiety and depression (55% reduction). These reductions, with the exception of present-moment pain, were maintained for 15 months post-treatment for all patients.
Treatments used for pain management are of special interest to those who study tinnitus. This is because people with tinnitus and those with chronic pain share many similarities, such as perceived lack of control, problems with attention and focus, maladaptive coping strategies and catastrophic thinking. Dr. Gans began to look at Mindfulness meditation as a way to address the anxiety and distress of tinnitus.
Mindfulness Based Tinnitus Reduction
An early study, conducted in Wales, used a combination of Cognitive Behavioral Therapy and Mindfulness meditation to treat 25 people with chronic tinnitus. (2) Significant reductions in tinnitus were reported with 80% of patients reporting being better or much better at 4 and 6-month follow-ups. A weakness of this study was that the relative benefits of CBT and Mindfulness could not be determined.
Dr. Gans began a pilot study on Mindfulness-Based Tinnitus Reduction (MBTR) in her clinic. (3) The study involved seven tinnitus patients in an 8-week stress reduction course. The patients were assessed 12 months after completion of the study.
Gans and colleagues found that scores on the Tinnitus Handicap Inventory (THI) relating to social functioning, sleep, depression and anxiety had decreased immediately after the study and continued to decrease 12 months later. Patients averaged a THI score of 50.6 (moderate) on entering the program. This dropped to 41.7 after program completion and down to 22.8 (mild) after 12 months.
Perceptions of chronic tinnitus changed, with participants noting they felt an increased tolerance, acceptance and courage to live with it. People said that tinnitus no longer seemed such a dreadful curse. It was just another sensation that could be annoying but was not insurmountable. This was a very small, pilot study but the results were very encouraging.
A much larger 2018 study, also in the UK, enlisted 182 adults with chronic and distressing tinnitus at the Department of Psychology, University of Bath and University College London Hospitals. (4) The study’s lead author, Elizabeth Marks, PhD, states, “We compared Mindfulness-based Cognitive Therapy (MBCT) to relaxation therapy, a traditional treatment for people with chronic tinnitus to determine if MBCT was a better option than the current recommended practice. The study found that both treatments led to a reduction in tinnitus severity, psychological distress, anxiety and depression for patients.”
“However, the MBCT treatment led to significantly greater reductions in tinnitus severity than the relaxation treatment and the improvement lasted far longer.”
MBCT, taught by highly trained clinical psychologists, teaches patients to pay purposeful, present-moment attention to experiences, rather than trying to suppress those experiences. Practicing Mindfulness meditation in this way can cultivate a more helpful way of responding to tinnitus. People learn how to ‘allow’ and ‘accept’ tinnitus rather than having to ‘fight it’ or ‘push it away’. Mindfulness does not aim to change the nature or sound of tinnitus, but the therapy can lead to tinnitus becoming less intrusive, to a point where it is no longer a problem for people.
Mindfulness meditation has been accepted by the medical community for a number of chronic conditions. Mindfulness centers abound in cities throughout the United States. In my city, a major University has a Mindfulness clinic and there are several others locally.
Barry’s Personal Experience with Mindfulness Training
I first reported on Mindfulness meditation for tinnitus in 2015. I based this article on clinical studies reported on PubMed, a division of the national Library of Medicine. At that time, I had no personal experience with the technique. Now, in 2021, we have all undergone significant additional stresses from the pandemic lockdown and efforts to prevent COVID-19. I also have experienced additional stress from two surgeries I had during the past year. The surgeries were successful and I am in good health but have been suffering from anxiety for some time.
After my most recent surgery, the social worker at the hospital told me my psychological tests indicated I have been living with high levels of stress and anxiety. I was referred to a Clinical Psychologist for treatment. During my first session and several times after that the psychologist recommended mindfulness therapy for my stress and anxiety. The therapist told me this therapy is not something done for a short period but considered it to be a lifestyle program.
I began in early May, 2021 practicing mindfulness with the help of an online program. The sessions only last about 10 minutes and I was told to practice it once a day, every day. The program utilizes a speaker who leads me into a guided meditation. The object is to focus on the breath and be aware of the present moment. Progressive muscle relaxation is central to a successful session. Thoughts will interrupt this practice but I must learn to let those thoughts come and go without dwelling on them or following them. Return the mind to the present time and concentrate on the breath. Over time it becomes easier to concentrate without the constant interruption of the thoughts.
Since I have been practicing mindfulness meditation I have had a significant decrease in my stress levels. I am much calmer and able to handle difficult situations without overreacting to them. My blood pressure has decreased and my mood is much more upbeat.
Mindfulness meditation has been very helpful for me and I expect to become more adept at it in the future. It is also very enjoyable. I look forward to my daily session and leave it feeling uplifted and positive. I am very enthusiastic about this therapy and look forward to becoming better at it.
There are online programs available to use for mindfulness. The most effective one I have found for me is Calm (calm.com). There are literally thousands of different sessions available on a variety of subjects, such as stress reduction, better sleeping, confidence, and many more. I usually use the Daily Calm with Tamara Levitt. This program is very inexpensive, costing $70 per year.
We do not gain financially from referring people to this program but do so because I believe it is very helpful. There is also a free version available that people can begin with. Search YouTube for Mindfulness Meditation and a program with Tamara Levitt will show. This is a daily, 10-minute session centered on muscle relaxation and the breath which is very helpful. It is the same meditation every day and those who like it can sign up on the website for the more varied and specifically targeted meditations.
One of our goals at Arches is to help people with tinnitus stay informed on all potential therapies that will help them live a normal, fulfilled life.
Other Helpful Tinnitus Therapies:
1 – Acupuncture helps about 40% of tinnitus patients.
2 – Biofeedback and Neurofeedback train people to reduce stress and control involuntary functions of the body.
3 – Yoga produces GABA, a calming neurotransmitter in the brain.
4 – Hypnotherapy reduces stress associated with tinnitus.
5 – Proper Diet, including salt reduction, helps lower stress, blood pressure and tinnitus.
6 – Cognitive Behavioral Therapy reduces the aggravation of tinnitus.
These therapies can be helpful for many people with tinnitus. When used in conjunction with Arches Tinnitus Formulas, increased effectiveness can be expected. Arches Tinnitus Formula® incorporates our proprietary, trademarked ginkgo extract Ginkgo Max 26/7®, along with zinc picolinate and odor reduced garlic.
Ginkgo Max 26/7® is a more highly purified and concentrated ginkgo extract than any other available. It was designed specifically for people with tinnitus and contains higher levels of ginkgo flavone glycosides, terpene lactones, and bilobalide. Bilobalide is the component responsible for calming the mind and promoting neuronal health. This has been clinically proven to reduce tinnitus sounds for most people who use it. (5) (6) (7) Combined with Mindfulness meditation, these two treatments are a powerful combination therapy.
References:
1 – Gans, Jennifer J. Mindfulness-based tinnitus therapy is an approach with ancient roots. Hearing Journal November 2010, Vol 63; Issue 11: PP52-56. https://mindfultinnitusrelief.com/downloads/Mindfulness_based_tinnitus_therapy_is_an_approach.12-2.pdf
2 – Andersson G. Psychological aspects of tinnitus and the application of cognitive-behavioral therapy. Clin Psychol Rev 2001;22(7):977-900. https://pubmed.ncbi.nlm.nih.gov/12238249/
3 – Gans J, Cole M, Greenberg B. Sustained benefit of Mindfulness-Based Tinnitus Stress Reduction (MBTSR) in adults with chronic tinnitus: a pilot study. Mindfulness, Oct 2015, Vol 6, Issue 5, pp1232-1234. https://mindfultinnitusrelief.com/downloads/MBTSR_Pilot_Study.pdf
4 – McKenna L, Marks EM, Vogt F. Mindfullness-Based Cognitive Therapy for Chronic Tinnitus: Evaluation of Benefits in a Large Sample of Patients Attending a Tinnitus Clinic. Ear Hear, 2018 Mar/Apr;39(2);359-366. https://pubmed.ncbi.nlm.nih.gov/28945659/
5 – Holstein N. Ginkgo special extract EGb 761 in tinnitus therapy: An overview of results of completed clinical trials. Fortschr Med 2001 Jan 11; 118(4):157-64. https://pubmed.ncbi.nlm.nih.gov/11217680/
6 – Von Boetticher A. Ginkgo biloba extract in the treatment of tinnitus: A systematic review. Neuropsychiatr Dis Treat 2011;7:441-447. https://pubmed.ncbi.nlm.nih.gov/21857784/
7 – Arda HN, Tuncel U, Akdogan O, Ozluoglu LN. The role of zinc in the treatment of tinnitus. Otol Neurotol. 2003 Jan; 24(1):86-9. https://pubmed.ncbi.nlm.nih.gov/12544035/