It won’t be new as to anyone who has the condition that anxiety is an issue with those of us with tinnitus. And you won’t be surprised to learn that people with tinnitus are two to three times more likely than the general population to suffer from clinical anxiety, what is known as generalized anxiety disorder. But you might be surprised to learn how viewing anxiety as a habit can help you get it under control.
Dr Judson Brewer is a psychiatrist who has combined his interest in neuroscience and mindfulness to create interventions to address and alleviate some common sources of human suffering, for example, smoking, overeating, and, most recently, anxiety. Now if we were to play the game of which one does not belong, clearly we would strike anxiety from the list. However, Dr Brewer views anxiety as being of a piece with smoking and overeating in that they can all be viewed as habits. What is important about this classification is how Dr. Brewer brings mindfulness to working with habits and how this can be of help with our tinnitus anxiety.
According to Dr. Brewer, a habit can be viewed as having three components: a trigger, behavior, and reward or result. Let’s take something we can all relate to, the habit of looking at our phones. So I’m feeling a little bored and this is the trigger for my behavior, which is to look at the phone. As a result, I get a actual little hit of dopamine from reading some news or seeing a video I enjoy. Once the activity is marked in my brain as “pleasant,” this actually starts me on the spiral to continue to pursue the activity because as humans we pursue the pleasant (and avoid the painful). It’s not hard to see how this works for smoking and overeating but much trickier to try to apply this model to anxiety.
So let’s look at anxiety not related to tinnitus. Let’s say I’ve taken an exam and I am awaiting the results. If the outcome had some significance, I might well be anxious about the results and unable to stop thinking about them. According to Dr. Brewer, this behavior is best understand as a habit and best treated in the same way we treat these other habits.
So how is this a habit? While waiting for the test results as the obvious trigger. And in this case, the behavior is a physiological reaction in my body, known as fight or flight. This is an ancient response designed to get me ready for threats to my well-being by preparing my body and giving it extra energy so that it can either engage with the attack or run like crazy from it. This physical feeling is anxiety. The result is that I ruminate and worry about the situation. Now it might be hard to see rumination as a reward, which is why I use the term result as well. But it actually is a reward of sorts because ruminating actually gives me some feeling that I’m doing something about a situation. And this is what keeps the behavior going. It’s what Dr Brewer calls a habit loop.
So how do we use mindfulness to break out of a habit loop? Let’s start with smoking. We can determine two major mindfulness moves that Dr. Brewer invokes in working with smoking. First, he requires a smoker to really be mindful of the result of smoking, i.e., what does it feel like actually to smoke a cigarette. And here he has the smoker focus on the bad taste in the mouth, the smell of the smoke, the distressing recognition that he’s destroying his health. Notice, become aware, bring mindfulness to the activity. These are key. So once you have a full recognition of the result of your behavior, we are to use mindfulness in order to give the brain what he calls a bigger, better offer or BBO. Instead of picking up a cigarette, he has the smoker explore what it feels like to bring curiosity to the situation by exploring what the sensation of wanting to smoke feels like. Really bring awareness to the physical sensations. At the same time, the smoker is asked to conjure up compassion for himself in the struggle he is engaged in to quit smoking. Dr. Brewer’s contention is that curiosity and compassion are BBOs for the brain, alternate rewards that can compel us towards abandoning smoking in favor of them. And this isn’t just a theory. This is an evidenced-based program that has helped thousands of people quit smoking.
In his book, Unwinding Anxiety, he applies the same strategy to anxiety. First, we are asked to really bring awareness to the repetitive cycle of anxiety and worry we are stuck in. Notice the physical sensations that arise—the pounding heart, the uneasy stomach, the repetitive thoughts. Notice as well how empty this pattern is, how unsatisfying. Next, we are asked to come up with a bigger better offer (BBO) for the brain to focus on. And this BBO is curiosity. We open up and become curious to what’s happening to us rather than beating ourselves up for being stuck in this useless rumination loop. “Oh that’s interesting: my heart is pounding, my hands are sweaty, my stomach’s uneasy. Look at those dark thoughts I am telling myself.” And then add some compassion to the situation. How difficult is to struggle in this way. Surely, anyone in this situation would be uneasy. Perhaps I should lighten up on myself. When I tune my brain to curiosity and compassion instead of rumination in worry, it is simply a more pleasant place to land and this can become the new habit, breaking the cycle of anxiety.
We can certainly see this pattern with tinnitus. The sound of tinnitus is a natural trigger for activating the sympathetic nervous system into fight/flight (behavior) and the result is I end up worrying and ruminating about my tinnitus, which itself increases fight/flight causing even more worry and rumination. And on and on in a habit loop. So we are tasked instead of ruminating and worrying to become curious about the tinnitus and how we are reacting to it. What is my body doing? What thoughts am I having? What emotions are arising? This curiosity is a step in acceptance of the tinnitus, which is a necessary step towards habituation. Then we can bring a big dollop of self-compassion to our situation.
This is a perfect time to utilize what Kristin Neff, the godmother of the mindful self-compassion movement, calls the self-compassion break. First, bring mindfulness to your situation, which you have already started to do, by noticing the symptoms of anxiety. Say to yourself, “This is difficult.” Next, recognize that what you are undergoing is part of the human experience, that there are countless others (in the case of tinnitus 10% of the population) undergoing the same difficulties. So we tell ourselves, “others suffer like me.” Finally, we add self-compassion, asking ourselves: what can I do at this moment to reduce my suffering?
And we can begin to work with the components of tinnitus distress, for it is either a thought, an emotion, or a physical sensation that is bothering us. And we can now turn and work with these. Is my body responding to the sound? Perhaps I can do some breathing? Am I having catastrophic thoughts? Perhaps these are not exactly accurate and can be released. Am I having a distressing emotion? Emotions can be regulated.
By bringing curiosity and compassion to my situation, I can begin to deal with the actual elements of the tinnitus experience that are troubling me and reduce my suffering rather than exacerbate it by imagining extending infinitely into the future.
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