“Everything is created twice, first in the mind and then in reality.”
― Robin Sharma, The Monk Who Sold His Ferrari: A Fable About Fulfilling Your Dreams and Reaching Your Destiny
The similarities between tinnitus and pain have long been noticed. Both are subjective sensations that may turn chronic, they are often accompanied by hypersensitivity in their respective sensory system, and overlapping brain changes have been observed. This neurobiological connection has been the basis of recent research.
In a 2015 article, Rauschecker et al proposed that tinnitus, or ringing in the ears, and chronic pain are the result of similar changes in two regions of the brain. These regions — the nucleus accumbens and the ventromedial prefrontal cortex — are both in the front of the brain, and may act as "gatekeepers" for sensory stimuli such as noise and pain, the researchers said. But in people with tinnitus or chronic pain, there's something wrong with this "gatekeeping" system. That means that instead of your brain ignoring the signals, that information is able to get through. "If you step back, you can see the similarity" between the two conditions, Rauschecker said. In both tinnitus and chronic pain, the body sends signals to the brain that really don't mean anything, he said. But these signals are not filtered out, as they normally would be.
Although at this point we are not able to engage the filtering mechanism for either condition, we do know that there is significant research demonstrating the ability of mindfulness to improve the quality of life of those living with chronic pain. In light of the neurobiological connection between the two phenomena, I believe many of these strategies can be applied to working with tinnitus. I have been delving into this issue recently and in October I will be taking a class through the University of Massachusetts Medical Center on Chronic Pain and Mindfulness. In the meantime, I have been reading You Are Not Your Pain: Using Mindfulness to Relieve Pain, Reduce Stress and Restore Well-Being by Vidyamala Burch. The book outlines how mindfulness can be used to work with chronic pain. I believe a lot of the advice can be applied as well to tinnitus distress. Three examples are below
Primary vs. Secondary Suffering
When it comes to chronic pain, Burch distinguishes between primary suffering and secondary suffering. The actual unpleasant sensations felt in the body is known as primary suffering. This is the raw data that is sent to the brain. By contrast, secondary suffering is made up of all the thought, feelings, emotions and memories associated with the pain. This might include anxiety, stress, worry, depression and feelings of hopelessness and exhaustion. The pain and distress you actually feel is a fusion of primary and secondary suffering. When it comes to tinnitus, the actual unpleasant sounds we hear constitute our primary suffering. Secondary suffering are all the thoughts and emotions we layer on top of this. Burch’s point is that primary suffering is inevitable. Whether it is chronic pain or tinnitus or heartbreak or cancer or the death of a loved one or a thousand different slings and arrows of life, pain in life (primary suffering) is inevitable. No one here gets out alive. Secondary suffering—the anxiety, stress, and worry we add to these events—is entirely optional. We endure secondary suffering by choice.
“If you have chronic health condition or suffer from stress, you cannot stop the triggering of unpleasant sensations,” states Burch. “But you can stop what happens next. You can stop the spiral of negative thoughts, feelings and emotions that drive the pain. It is possible to relate differently to your suffering. When you do so, you will find suffering (at least secondary suffering) evaporates.” This is the work of mindfulness and the same scenario can be applied to our tinnitus.
Doing vs. Being
In the book, Burch distinguishes between what she calls the "Doing" mode and the "Being" mode. The Doing mode is always trying to fix things, to solve problems. And in many things, this Doing mode is essential. As she writes, "It's a fantastically powerful process that helps you solve countless different types of problems, from navigating across a city to arranging a hectic work schedule. In a more refined form, it's how engineers design even more fuel-efficient cars and how doctors treat disease.” So when it comes to pain, the Doing mode tries to find a way for the pain to stop, which works fine except when it doesn’t, specifically when you are dealing with chronic pain. When it comes to chronic pain, the doing mode highlights the gap between where you are an where you want to be. And if where you want to be is pain free, then the doing mode is stumped. She writes: “You become fixated on the gap and are unable to escape, trapped like a rabbit in a car’s headlights. You end up torturing yourself with questions like : why does it hurst so much? What started it this time? Is it getting even worse? What have I done? Such open-ended questions increase anxiety, stress and depression…You end up thinking, It’ll get worse…I don’t know wat’s going on…Nobody knows what’s going on… my life will be ruined, maybe I’ll never get better.
If this doesn’t sound like a description of tinnitus, I don’t know what does. Thankfully, there is an alternative path, one which promises a much different outcome: the Being mode:
“The Being mode allows you to step back from your pain and suffering. It helps you break free of the tendency to overthink about your pain and suffering. It stops your thoughts from acting as a filter or a distorting lens and breaks the cycle that leads to anxiety, stress, depression—and ultimately more pain. It helps you to realize at the deepest of levels that you are not your pain.”
This is what Jon Kabat-Zinn describes as non-striving. It is an attitude that mindfulness inculcates in us and one that promises a different pathway to work with our tinnitus than struggling and fighting against it.
Blocking vs. Drowning
Burch distinguishes between two unpleasant states those in chronic pain find themselves in: Blocking and Drowning. The titles pretty much sum up the states. In blocking, one is devoting an enormous amount of energy to fighting the pain, while drowning consists of the sense of being overwhelmed by pain. These two states, which have obvious parallels with tinnitus, call for two different strategies.
In either situation, “the first thing to do is to notice what's happening. Bring mindfulness, awareness to your experience and notice it.”
If you notice that you are blocking the pain (or tinnitus) “soften your breath. . . because if one is blocking one is generally contracting around the breath in some way. So soften the breath and turn towards your experience with this softer more kindly attitude. Say hello to the thing it is you're running away from.”
If you notice you are drowning, “the practice is to broaden your perspective. So the image I use is like a lens on a camera. If you're drowning it's a bit like you zoomed on a close up lens. So you need to pull back to more of a wide angle lens on your experience, and maybe actively look in the moment for what's pleasant. There's always something pleasant. I've not yet found a single person who couldn't find at least something, you know, one tiny thing that's pleasant.”
She goes on to describe how when she was in the hospital after an operation that resulted in a serious infection, she tried practicing this: “I thought, ‘What's pleasant in my experience right now?’ I noticed the crisp sheets that I was lying on, and I thought, ‘Well that's pleasant! You know, I've got nice clean sheets on my bed.’ After that my experience changed.”