Treatment options for Tinnitus that work

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Tinnitus is defined as a subjective sound sensation which can include somatic contributions often related to no correspondence with cochlea engagement, but does not seem to be fully understood. (2) The term prolonged Tinnitus is considered when the presence of the sound lasts longer then 5 minutes .(1) It can have either a slow or sudden onset and has been described by patients as the experience of a variety of sounds such as ringing, crickets or whistling. (2) Research has shown that at least 10% of the population experience Tinnitus with and even higher rate in Australia of 30%. (1,2) There is a higher likelihood of increase of this symptom for people over the age of 65. (2)

Causes:

There can be many causes of Tinnitus. It often occurs in conjunction with other condition such as depression and anxiety, stress, sleep disruptions and negative experiences. (2) This shows that it is most likely a symptom of an underlying condition or event rather then an alone standing issue. (1) Insomnia, despair, frustration are also frequent psychological symptoms caused by tinnitus. (12) Since Covid-19 started, 32% of people asked, had an exacerbation due to psychological factors. (20, 25) Some articles referred to stress as a major factor in the cause and worsening of Tinnitus. (24, 25, 26). One journal even referred to Tinnitus itself, leading to increased stress reactions. (26)

Treatment:

It is recommended to get appropriate investigation, assessments and testing done by an Audiologist to determine whether the irritating sound was caused by a physical or neurological condition or if it has been induced through medications or illnesses. (2) Many different alternatives therapies have been created to stop or decrease Tinnitus. Some of them are biofeedback, soft laser, transcranial magnetic or direct current stimulation, wearable magnets, medications, acupuncture, surgical interventions, implantable devices and genetic therapy. (3) These interventions are almost all applied externally and even invasive. This is why Hypnotherapy, Neurolinguistic Programming (NLP), Thought Field Therapy (TFT) and tools from Brain Gym may be a better way of therapy. All those tools engage the mind and brain and only Brain Gym and TFT require external intervention in the form of movement and tapping of the meridians of the body. (12, 15). The above mentioned methods can be used in conjunction with other therapy such as Cognitive Behavioural Therapy (CBT) which is often offered by psychologists and councillors. (21). Hypnosis in particular has shown to have great results as an complementary therapy to CBT. (3) The patient has many options to choose from when it comes to management of Tinnitus but Hypnotherapy seems to be a result driven approach with positive outcomes. Below, therapy options and benefits of Hypnotherapy, NLP, TFT and Brain Gym are discussed.

HYPNOSIS

The application of hypnosis for Tinnitus began in the 1940’s, mainly addressing stress and anxiety.  Hypnotherapy directly focuses on the unconscious part of the brain and bypasses the critical facilities which may not make sense but has proven to be highly effective in terms of changing any behaviour, thought or believe, when applied by a skilled practitioner. (28) Upon my investigations I found that a limited amount of research had been conducted on the effects of Hypnotherapy and Tinnitus, however, all articles discovered, found satisfactory improvement when undergoing Hypnosis in individuals suffering from Tinnitus (4, 21, 22, 23). This may be because Hypnosis alternates the neuro connectivity between different brain regions. (3) Hypnotherapy can be used by itself or as complementary therapy, in addition to Cognitive Behavioural Therapy (CBT) for example, to learn new and better coping strategies. (3) Research suggests that Hypnosis can be more effective and has more positive long term outcomes then CBT. (21) CBT has found to even increase the symptoms when it was tested on people with ADHD. (21) Some of the subjects even reported that the effects of Hypnotherapy kept decreasing their symptoms even after a 6 months follow up. (21). Seyed Mahmoud Mirzamani et al. (2012) referred to hypnotherapy as an effective and useful way to reduce and treat depression, anxiety, and insomnia caused by tinnitus. This shows that traditional treatment methods may not be as effective as Hypnotherapy in the use to manage psychological components of Tinnitus. Hypnosis is even becoming an accepted complementary therapy in medical areas such as dental treatments ( 27) which shows its variety and effectiveness and should be considered when patients are experiencing symptoms which are not being managed well through other approaches.

NLP

Another or additional way to help patients with this sometimes debilitating sound experience can be Neurolinguistic Programming. It was developed in the 1970’s and has been gaining popularity even though it is not an officially accepted treatment modality by experts such as psychologists. (10, 11) Despite the fact that it was impossible to find any research on NLP and the effects on Tinnitus as a treatment, many different websites do promise relief with the use of NLP (6, 7, 8). This would make sense due to the fact that NLP engages all senses including auditory sound. (9) NLP is very effective in positively changing thoughts and behaviours in different types of anxiety and stress, on an unconscious level. (11) While the person is fully engaged in this process the subconscious mind is completely involved (10), and therefore has a similar way and effect then Hypnotherapy. In my experience, since Tinnitus is a perceived sound (2), this modality, when applied, has worked previously very well in combination with other therapies to increase and better the effectiveness and outcome. Within NLP there are many methods which can be utilised to achieve a different effect of a person such as anchoring and reframing which was even suggested as a beneficial tool for councillors (9).

BRAIN GYM

Brain Gym has been developed in the 1970’s and derives from educational kinesiology practices known and applied worldwide. (15) This method is a process based on the recall of movement and coordination from early developmental stages. (15) When completing research I came across an articles which completely discredited the positive effects due to the small amount of scientific research conducted, even though there is evidence which proofs the opposite. (16) Brain Gym movements have shown to change levels of concentration and focus, memory, academics: reading, writing, math, test taking , physical coordination, relationships, self responsibility, organisational skills, attitude and many more, equally in males and females. (14,15) One study found that engaging in specific movements at least 15 minutes per day over a school year, students and teachers noticed an overall 16.5 point increase of marks after introduction of Brain Gym compared with traditional teaching methods. (14) It also talkes about other evidence which shows an almost double improvement in reading compared to the children who did not participate. (14) Additional benefits are better mental processing (14), increased coordination with the ability to walk better and reduced depression. (17, 19) A study conducted research on 30 people who were either mildly (93.3%) or moderately depressed (6.7%) and found that 83.3% were able to achieve a level of no depression, the rest reported mild depression after incorporating Brain Gym movements.  (19) Other improvements such as levels of understanding to achieve goals, memory, solution focused approaches and solving tasks lead to a higher satisfaction and wellbeing. (18) Also, a 70% decrease of anxiety and 19% skill performance improvement was observed after 3 weeks of basic Brain Gym exercises. (18) All benefits may be due to gaining awareness, optimising flow of electromagnetic energy in the body and increasing oxygen to brain through certain movements. (19) The theory of Brain Gym is activating both sides of the brain but science still seems to be unsure why and how it works. (15, 17) Another journal article is theorising that the found improvement may be linked to any kind of movement rather then particular Brain Gym movements. (15) Regardless, strong improvements in areas of learning and quality of life have been observed but no direct reference of Tinnitus and Brain Gym was found. 

THOUGHT FIELD THERAPY

Thought Field Therapy or TFT is a technique which is often referred to as tapping. This therapy is based on stimulation of meridians and acupressure points of the body. (12) Usually getting rapid results for most people. (12) It can have immediately effects which is indicated by the clients subjective measurement utilising a scale from 0 to 10. (12, 13) TFT can be used for other problems such a chronic pain and vertigo, not only Tinnitus. (12) The triggers around tinnitus were easily and quickly controlled and decreased after only a total of 3 sessions, using tapping. (12) The benefit of this modality is that the patient does not need to understand the theory of behaviour but only needs to think about the problem whether its represented in a visual, kinaesthetic, olfactory, gustatory or auditory way. (13) Compared to CBT, Tapping dramatically decreased the severity of all patients presenting with anxiety, pre- menstrual syndrome, social phobia, insomnia, Post Traumatic Stress Disorder, Agoraphobia, procrastination and dysfunctional beliefs, and can address and reduce many more symptoms. (13)

Discussion:

When speaking to patients and clients I have noticed a common trend. Statements such as: I have been told that there is nothing I can do or I have tried all different types of interventions with no success, are often mentioned. This is why I, as the owner of The Transformed Mind, saw a need to get patients the answer and support they require to manage or oven overcome the debilitating sound of Tinnitus. This is done by engaging all their sense and addressing those through their unconscious mind. I have started to complete case studies in order to notice first hand the effects of my approach. By using hypnosis, tapping, NLP and Brain Gym movements I have created a program which allows the patient to address their physical condition from a subconscious psychological point of view and hopefully achieve relief. As above mentioned, there is positive evidence for each modality I have chosen for this program however, it is understood that not every individual may benefit from this and results may vary. It is simply another option which has been observed to provide quick relief. The program consists of up to 6 sessions, depending on the patients needs with the addition of homework in-between sessions.

References:

1

Meehan, T., Eisenhut, M. and Stephens, D. (2004) ‘A review of alternative treatments for tinnitus’, Audiological Medicine, 2(1), pp. 74–82. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=edb&AN=13073170&site=eds-live (Accessed: 11 July 2021).

2

Wise, K. and Ma, E. (2016) ‘Clinical Presentation of Tinnitus and a Review of, and Evidence Base for, Tinnitus Applications’, Perspectives of the ASHA Special Interest Groups, 1(7), pp. 43–56. doi: 10.1044/persp1.SIG7.43.

3

Folmer, R. L. et al. (2014) ‘Experimental, Controversial, and Futuristic Treatments for Chronic Tinnitus’, Journal of the American Academy of Audiology, 25(1), pp. 106–125. doi: 10.3766/jaaa.25.1.7.

4

Shirin Moghtaderi, Seyed-Mahmoud Mirzamani and Hadi Bahrami (2017) ‘The effectiveness of hypnotherapy in the treatment of subjective tinnitus’, Auditory and Vestibular Research, 21(4). Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=edsdoj&AN=edsdoj.285a26246804bad87e5242d4201eeac&site=eds-live (Accessed: 9 July 2021).

5

Seyed Mahmoud Mirzamani et al. (2012) ‘The Effectiveness of Hypnotherapy in Treating Depression, Anxiety and Sleep Disturbance Caused by Subjective Tinnitus’, Majallah-i taḥqīqāt-i ̒ulūm-i pizishkī-i Zāhidān, 14(9), pp. 76–79. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=edsdoj&AN=edsdoj.2282b3cfa8b747a99d35baab66a54262&site=eds-live (Accessed: 9 July 2021).

6

Website: https://www.audiologist.co.uk/hypnotherapy-and-nlp-as-tinnitus-cures/

7

website: https://anxietycontrolcenter.com/tinnitus-symptoms-healed-using-nlp-and-hypnosis/

8

Website: https://rewiringtinnitus.com/hearing-loss-tinnitus-relief/

9

Harman, R. L. and O’Neill, C. (1981) Personnel & Guidance Journal, 59(7), p. 449. doi: 10.1002/j.2164-4918.1981.tb00593.x.

10

Grimley, B. (2015) ‘NLP: Misunderstood by psychologists’, Sport & Exercise Psychology Review, 11(2), pp. 66–72. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=pbh&AN=109331097&site=eds-live (Accessed: 11 July 2021).

11

Lin, J. R. (2020) ‘Effectiveness of neurolinguistic programming in reducing anxiety and phobia’, Journal of biological regulators and homeostatic agents, 34(5), pp. 1863–1867. doi: 10.23812/20-151-L.

12

Pasahow RJ (2009) ‘Energy Psychology and Thought Field Therapy in the Treatment of Tinnitus’, International Tinnitus Journal, 15(2), pp. 130–133. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=ccm&AN=105063903&site=eds-live (Accessed: 12 July 2021).

13

Seidi, P. A. M. et al. (2021) ‘Applying Cognitive Behavioral Therapy and Thought Field Therapy in Kurdistan region of Iraq: A retrospective case series study of mental-health interventions in a setting of political instability and armed conflicts’, EXPLORE, 17(1), pp. 84–91. doi: 10.1016/j.explore.2020.06.003.

14

Kariuki, Patrick N.; Kent, Holly D., 2014. The Effects of Brain Gym® Activities and Traditional Teaching Strategies on Students’ Performance in Comprehension in a 4th Grade Classroom. 

15

Watson, Andrea; Kelso, Ginger L., 2014. The Effect of Brain Gym® on Academic Engagement for Children with Developmental Disabilities

16

Kroeze, K., Hyatt, K. J. and Lambert, M. C. (2016) ‘Brain Gym: Pseudoscientific Practice’, Journal of the American Academy of Special Education Professionals, pp. 75–80. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=eric&AN=EJ1129595&site=eds-live (Accessed: 7 July 2021).

17

Aafreen et al. (2017) ‘Correlation between Walking Tests and Psychological Factors after Brain Gym Exercise in Diabetic Individuals’, Indian Journal of Physiotherapy & Occupational Therapy, 11(4), pp. 57–62. doi: 10.5958/0973-5674.2017.00120.4.

18

Wolfsont, C. (2002) ‘Increasing Behavioral Skills and Level of Understanding in Adults: A Brief Method Integrating Dennison’s Brain Gym® Balance with Piaget’s Reflective Processes’, Journal of Adult Development, 9(3), p. 187. doi: 10.1023/A:1016052026435.

19

Wachidah Yuniartika, Kartinah Kartinah and Niken Enggal Dwi Astuti (2020) ‘Giving Brain Gym Using Booklets To Reduce The Level Of Depression Among Elderly In The Community’, Jurnal Ners dan Kebidanan Indonesia, 8(3), pp. 216–222. doi: 10.21927/jnki.2020.8(3).216-222.

20

Beukes, E. W. et al. (2021) ‘Coping With Tinnitus During the COVID-19 Pandemic’, American journal of audiology, 30(2), pp. 385–393. doi: 10.1044/2021_AJA-20-00188.

21

Hiltunen, S. et al. (2014) ‘Better long-term outcome for hypnotherapy than for CBT in adults with ADHD: Results of a six-month follow-up’, Contemporary Hypnosis & Integrative Therapy, 30(3), pp. 118–134. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=psyh&AN=2014-33813-002&site=eds-live (Accessed: 9 July 2021)

22

Shirin Moghtaderi, Seyed-Mahmoud Mirzamani and Hadi Bahrami (2017) ‘The effectiveness of hypnotherapy in the treatment of subjective tinnitus’, Auditory and Vestibular Research, 21(4). Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=edsdoj&AN=edsdoj.285a26246804bad87e5242d4201eeac&site=eds-live (Accessed: 9 July 2021).

23

Seyed Mahmoud Mirzamani et al. (2012) ‘The Effectiveness of Hypnotherapy in Treating Depression, Anxiety and Sleep Disturbance Caused by Subjective Tinnitus’, Majallah-i taḥqīqāt-i ̒ulūm-i pizishkī-i Zāhidān, 14(9), pp. 76–79. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=edsdoj&AN=edsdoj.2282b3cfa8b747a99d35baab66a54262&site=eds-live (Accessed: 9 July 2021).

24

Elarbed, A. (2021) ‘Measuring How Stress Impacts Tinnitus’, Tinnitus Today, 46(1), pp. 41–43. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=ccm&AN=149990811&site=eds-live (Accessed: 14 July 2021).

25

Hébert, S. (2021) ‘Is Stress a Tinnitus Trigger?’, Tinnitus Today, 46(1), pp. 36–37. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=ccm&AN=149990809&site=eds-live (Accessed: 14 July 2021).

26

Jukka Ylikoski et al. (2020) ‘Stress and Tinnitus; Transcutaneous Auricular Vagal Nerve Stimulation Attenuates Tinnitus-Triggered Stress Reaction’, Frontiers in Psychology, 11. doi: 10.3389/fpsyg.2020.570196.

27

CRONE, S. (2021) ‘The Use of Hypnosis to Facilitate Dental Treatment for a Patient with a Hyperactive Gag Reflex: Case Report’, Contemporary Hypnosis & Integrative Therapy, 35(1), pp. 17–20. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=ccm&AN=149339823&site=eds-live (Accessed: 14 July 2021).

28

BoVee-Akyurek, A., Erolin, K. and Chenail, R. (2020) ‘Ericksonian Hypnotherapy Resemblances in Solution Focused Brief Therapy’, Contemporary Family Therapy: An International Journal, 42(4), pp. 408–421. doi: 10.1007/s10591-020-09539-5.