New Trends in Tinnitus Management: An Interview with Dr. Jennifer Gans

Author: Brian Taylor, Au.D.

Download interview in PDF format

Based on recent reports, the prevalence of tinnitus among adults in the United States is estimated at 10% to 15%. For a variety of reasons, many of which are not well-understood, about 20% of those who experience tinnitus report their tinnitus to adversely affect their daily lives to the degree that clinical intervention is warranted. Historically, audiologists have relied on a variety of options, such as combination devices, cognitive behavioral therapy and hearing aids to manage patients ability to cope with tinnitus. A relatively recent tinnitus management method to hit the scene is Mindfulness Based Tinnitus Stress Reduction. Here to discuss MBTSR is Dr Jennifer Gans who is a pioneer in this approach to treating and managing tinnitus. Dr. Gans is a clinical psychologist specializing in the psychological impact of deafness, tinnitus, and hearing on well-being.

Brian: I’m fairly sure when most audiologists see the name Dr. Gans, they immediate think of dizziness and balance. I see that you’re not that Dr. Gans. Could you let us a little about your background and how you can be associated with the field of Audiology?

Jennifer: I certainly hope people don’t think of dizziness when they see my name, Dr. Jennifer Gans. But for better or worse, they might think of ringing in the ears. Tinnitus has been my area of specialty as a clinical psychologist for many years. What I bring to the field of audiology is an introduction to the healing benefits of mindfulness for the bothersome and chronic condition of tinnitus. Several years ago I became intrigued by the scientific study of mindfulness in the management of several health conditions from cancer to anxiety to chronic pain. It was then that my attention was drawn to learn what the research would bare when mindfulness was applied to tinnitus. At the time, little or no studies had been conducted in this area so I developed the 8-week Mindfulness Based Tinnitus Stress Reduction (MBTSR) skill-building course while at UCSF and conducted the first pilot study showingstunning results. The study found that practicing mindfulness skills greatly reduces the perceived burden and handicap of tinnitus. After completion of the initial eight-week MBTSR program pilot study, participants reported:
  • Decreased tinnitus annoyance and severity
  • Reduced anxiety, fear, and feelings of panic
  • Reduced depression and sleep difficulty
  • Reduced stress, tension, and irritability
  • Improved communication with loved ones
  • Increased relaxation and concentration
What’s more, the benefits were enduring, with greater improvement in tinnitus bother in the participants even after 12 months.

Brian: That’s a remarkable result. Can you share any studies that support that claim?

Jennifer: In 2013 I published a paper describing the Pilot Study that was conducted. We also wanted to see if the changes we saw in participants would last so we retested participants 12-month after the study and found that there tinnitus bother dropped even further over time. We had had no contact with the participants during this time so we were surprised and pleased to see that their tinnitus distress had gone down further. The follow-up study has been submitted for publication and should be out in early 2015. I am currently working on a larger randomized controlled study through the VA of Northern California. So we will have more studies to report shortly.

Here are a few comments made by participants in the 2013 study:
“I can go into the ringing now without going towards depression.”
“Tinnitus does not seem like a terrible curse anymore. It’s sometimes annoying but not insurmountable.”
“I am adapting the mindfulness process into my daily life. It has greatly helped me, not only to cope with tinnitus but also with my relationships, communication, patience, and anger-management. Yes it has been a big commitment time-wise, but so worth it.”

You can read more comments by MBTSR participants in the article listed above.

Brian: You had an article in the most recent Audiology Practices (Q3 2014 issue) that was really interesting. You provided a review of something called Mindfulness Based Tinnitus Stress Reduction (MBTSR). How does MBTSR work and what makes it different that other approaches?

Jennifer: As it stands now, there is no “cure” for tinnitus. But that certainly doesn’t mean that we can’t learn to manage the bothersome symptoms that interfere with living a full life. That is where the MBTSR course comes in. Utilizing the strength of a person’s own internal resources, MBTSR has been designed to help people in positive ways...with positive results. The 8-week course involves commitment and consistency involving up-to-date tinnitus education, breathing exercises, ‘awareness building’, gentle body movement, group discussion, and about 30 minutes of daily homework. This course is meant to be done in conjunction with any tools a person is currently using to help manage tinnitus (i.e., hearing aids, noise generators, doctor prescribed medication, and the like).

MBTSR teaches skills involved in mindfulness which embodies a process of focusing one’s attention and purposefully living in the moment as a means of relieving physical and emotional pain. A 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.

So, 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. “Special” in this context means not just an ordinary awareness, but rather with full consciousness of immediate experience, approached with curiosity, acceptance, openness to whatever arises, and a gentle self compassion towards one’s self.

In my experience, 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. Also, what about the times when no matter what we do, we just can’t get the ringing out of our ears? The course explains how we can embrace our experience even when tinnitus is at its most unpleasant: by leaning into our tinnitus, we can begin to see it for what it is, a benign, albeit unpleasant, body sensation.

Most other therapies for managing tinnitus instruct us to do just the opposite; to move away from the tinnitus sensation and ignore it the best one can. MBTSR acknowledges that sometimes ignoring tinnitus is an impossible task. So the MBTSR course is unique in that it takes us to where other therapies leave off; it teaches skills to live with less suffering especially at those times when no matter what we try the tinnitus bother just won’t go away.

The MBTSR course trains us in reaching a mental state achieved by focusing one’s awareness on present-moment experience, while calmly acknowledging and accepting the cascade of feelings, thoughts, and bodily sensations that arise as mental and physical events, to be observed just as they are.

Brian: MBTSR sounds a lot like transcendental meditation. How might MBTSR be different?

Jennifer: The biggest difference is that MBTSR is a structured skill building program designed in an 8-week adult-education format specifically for the person with bothersome tinnitus. While a mindfulness approach is the umbrella under which all skills in the course are taught, the meditation practice is only one facet of the training. The Mindfulness Meditation practice is used in the course as an “awareness building” tool. By building and strengthening neuronal growth and firing along attention pathways, like muscle fibers growing stronger after focused exercise, we build the brain’s ability to focus attention on the experience of the moment as it actually is without haphazardly allowing the mind to wander into stories and dark places which is common in the mind of the person with tinnitus. Transcendental Meditation (TM) is not specific for tinnitus. It is one of many types of meditation practice that allows the mind to self-transcend all mental processing altogether. There is no effort or attempt made whatsoever to direct attention. A state of self-transcendence arises also generally resulting in a more peaceful state. I have chosen Mindfulness as the tool for the Stress Reduction Program because I believe that the active approach to observing the totality of the mind and its wanderings, gives the person with tinnitus practice in letting go of old habits of making the sensation of tinnitus center stage overtaking all else that is in one’s experience in any given moment.

Brian: Mindfulness is a word seldom uttered in an audiology practice. What is mindfulness and how does it improve a person’s perception of tinnitus?

Jennifer: Kabat-Zinn describes mindfulness as “paying attention in a particular way: On purpose, in the present moment, and nonjudgmentally.” Practicing mindfulness is not as easy as it may seem, especially for people with tinnitus whose symptoms are often accompanied by fears that their condition may worsen, that their tinnitus may be a sign of a larger illness, or may indicate impending or progressive hearing loss.

A struggle may develop between the person and the tinnitus, which often leads to fatigue, depression, anxiety, difficulty sleeping, and interpersonal problems. Mindfulness-based therapies teach people how to change their relationship to tinnitus in an effort to lessen or eliminate this struggle.

Mindfulness, as it is taught in the MBTSR course, is simply the practice of bringing a “special” kind of awareness to each moment as it arises. But this special awareness is different from run-of-the-mill awareness. By “special” I mean an awareness with qualities of curiosity, openness, acceptance, non-clinging to judgment, and with a compassion for oneself. The MBTSR course teaches skills to live moment-to-moment with tinnitus by building, strengthening, and practicing this special kind of awareness. It may sound simple, but it certainly is not easy and takes consistent practice just like learning any new skill.

Many people with tinnitus come to believe that they are, in fact, their tinnitus. Mindfulness provides a simple but powerful route for getting ourselves “unstuck.” It can help us accept things that we cannot control, provide courage to change what we can, and reconnect us with our own wisdom and vitality. It is a way to take charge of the direction and quality of our own lives. The key is appreciating and cultivating an intimate relationship with the present by bringing awareness and care to each moment. MBTSR utilizes elements of deep-breathing, gentle yoga, relaxation, and attentional focus, and awareness building to reframe our relationship to or perception of tinnitus.

In a White Paper I published in July, I talk about what I believe is happening in the brain of the person with tinnitus and talk about research out of Harvard showing that the parts of the brain (Medial Pre-Frontal Cortex) that are needed for attention control, fear modulation, pausing and thinking before acting and many others, is actually larger in those with a strong meditation practice1. The MBTSR course capitalizes on this and teaches simple meditation skills to strengthen the part of the brain and leave the person better equipped to respond to tinnitus in a new more adaptive way.

Brian: How does a patient practice MBTSR?

Jennifer: MBTSR is a complete 8-week structured program so a person would practice the modules presented in the course in a specific sequence. There are eight 2-hour weekly instructional classes with each week including a video orientation to the week’s lesson, advanced and up-to-date tinnitus information and education, a mindfulness lesson, discussion questions, mindful movement and gentle yoga instruction, audio/video recordings of mindfulness meditation practices, and daily home-practice mindfulness skill building exercises. To make the MBTSR course available to the millions of people with bothersome tinnitus, I have created an online version of the MBTSR course that can be found at MindfulTinnitusRelief.com. This online course is a cloud-based program available anywhere, anytime from a home computer, laptop, tablet, or smartphone.

Brian: Can MBTSR be incorporated into an audiologist’s existing tinnitus approach? If so, how might that look?

Jennifer: We have created the MBTSR Education Partnership Program (EPP) that can be found at MBTSR.com. The Partnership Program was specifically created to allow audiologists and other hearing health professionals to run 8-week MBTSR classes in their own office or clinic using the EPP as a guide on how to run such groups. These audiologist-led local group sessions are designed to provide a “missing link” to augment and deepen the personal, online experience and help connect fellow tinnitus patients in ways that the online program, by design, simply cannot.

Brian: If audiologists want to learn more about MBTSR how might they do that?

Jennifer: There are several easy ways to learn about MBTSR. I’ve included some links below connecting you to MBTSR research, articles, blogs, and videos. I also can be contacted at jg@MindfulTinnitusRelief.com and am happy to answer any questions that readers may have. Here are some links:
MindfulTinnitusRelief.com
The MBTSR Blog
MBTSR YouTube Video
MBTSR Research    

Jennifer Gans, Psy.D., is the Founder and CEO of MindfulTinnitusRelief.com. She is a San Francisco-based clinical psychologist specializing in the psychological impact of deafness, tinnitus, and hearing on well-being. Dr. Gans is on the Board of Directors of the Tinnitus Practitioners Association (TPA), a non-profit professional organization dedicated to providing tinnitus and sound sensitivity care. She is a psychologist at the University of California, San Francisco (UCSF) and researcher at the VA of Northern California.