Saturday, July 23, 2011
Medical doctors hate to prescribe one of the puzzle pieces (benzodiazapenes) because the medications are tracked by pharmacies. Therefore the sufferer runs into a lot of resistance in getting a prescription they desperately need. If medical doctors only knew how little of a dose can go such a long way they might change their considerations even with pharmacy attention.
The other genre of medication most helpful for sufferer is antidepressants. Having seen some > 1000 people for tinnitus therapy and treatment I can tell you that it is tough to get someone back to silence without an SSRI like Zoloft/Prozac or next generation AD like Effexor (which just might be one of the most effective meds for depression as well).
Doctors have no trouble prescribing the A.D.'s as they aren't attended to by the pharmacist or her tracking meds.
The problem here is that A.D.'s alone typically don't do the trick. The benzodiazapene is usually required for the medication part of the puzzle. Which meds specifically?
It varies from person to person which is why the consult is crucial with therapist and MD/DO. Xanax, Klonopin, Ativan all have solid track records and are very inexpensive for clients.
Some Doctors argue that the meds in their generic form aren't as helpful as the brand names and that might be true, but we've had excellent success with alprazolam, clonazepam, and on and on along with the big brands.
We'll talk about them next time, so be watching.
Tinnitus Treatment info?
Monday, July 11, 2011
A number of people have written and asked this question and I do want to set the record straight for you then refer you to Tinnitus Therapy and Treatment Frequently Asked Questions for further information.
There have only been a few studies about cell phone use and tinnitus.
Because chronic tinnitus is often best understood as a "remembered sound loop" in the brain it's best to think of it in this regard. Consider when you have a song stuck in your head or you hear the door knock and no one is there. Chronic tinnitus, like other auditory misperception is almost always a function of memory, not otoacoustic emissions.
This is complicated for people who don't suffer from tinnitus to understand.
One study showed absolutely no connection between tinnitus and cell phone use.
Another recebt study showed correlation but not causation. This study claimed that EMF's were the offender.
That's possible but not likely. If it were true the number of tinnitus cases would have skyrocketed in the last decade. That hasn't happened. We'll keep watchiing and see if any further developments occur. Until then, it makes sense to not overuse cell phones for any number of safety reasons. But ultimately people have experienced onset of tinnitus for thousands of years and cell phones are merely two decades old...
Friday, June 24, 2011
For a current Tinnitus FAQTinnitus Answersis worth your time.
Sunday, April 20, 2008
Tinnitus and Chronic Illness
Did you know there are 12,000,0000 people suffering from maddening ringing in the ears (tinnitus)? I’ve done thousands of hours of research and spent over $11,000 in developing a complete multi-modal program to help these people. Why? Because, for almost three years I was one of "those people."
I spent nearly three years in noise hell. The Emergency Broadcast System went off in my head 24 hours per day, 365 days per year. It never ceased, until finally, it remitted in 1996. Since beginning my healing process that included generally unknown techniques of hypnotherapy, a surprising selection of medications, interventions from other professionals and lots of support, I was finally made well.
When I first began publishing about my success in working with clients suffering with tinnitus, over 100 hypnotherapists in this country hung their shingle out with the goal to help those with tinnitus, only to meet with failure at every corner because of the depth, breadth and complexity of the malady. These therapists sincerely believed, apparently, that because they were able to utilize trance for pain management and other challenges facing their clients, that they were able to assist those suffering from tinnitus, hyperacusis (sensitivity to sound), environmental illness (multiple chemical sensitivity) and other chronic illnesses like chronic fatigue syndrome.
Why did this group fail? Hypnosis doesn’t work unless the therapist knows exactly what to do. Optimistic and kind therapists simply overestimate the value of what is in their tool box. Although there are therapists that can help, they are few and far between. Only a few appear willing to take the time to learn and understand the suffering of people like you and me.
What would it take for you to help this suffering population gradually improve the quality of their lives? A hypnotherapist working with a person that suffers from tinnitus and other chronic illnesses is like a neurosurgeon doing brain surgery. The neurosurgeon is the highest paid of the surgeons. They earn hundreds of thousands of dollars per year. The hypnotherapist who is willing to invest about 50 hours of personal education and $500 in training materials can learn how to have a practice that easily yields $100,000 of income per year.
I read over 1200 articles from neuroscience, psychological publications and medical studies from all over the world. I learned that long term hypnotherapy is the most powerful adjunct in reducing tinnitus volume and suffering. Adjunct means that we aren’t going it alone. We are working in cooperation with medical doctors, psychiatrists, osteopaths, and physical therapists. The complexities of tinnitus suffering are daunting at first, but once an understanding is gained on how tinnitus (and other chronic illnesses) is generated and how it can be relieved and reduced, there is hope for your clients.
Each of my clients readies him/herself for 20 hours of consultation on other therapies I’ve encouraged with other professionals, hypnotherapy with me, and a complete understanding of how their chronic illness is generated and what they must do every day in order to improve their situation. Sometimes, with the assistance of their medical doctors, their psychologists and other professionals, as a team we are able to beat the unbeatable. People who suffer from chronic fatigue, tinnitus, multiple chemical sensitivity almost all begin to heal...a large majority to the point of remission. I want you to be able to help these people too.
"....and when you open your eyes the noise will have disappeared...," and it NEVER does. It can’t. Hypnotic suggestion and post hypnotic suggestions, reading a script of beautiful metaphors, simply won’t do anything for those suffering from chronic illnesses especially tinnitus.
The difference between my work and every other hypnotherapist is simple. When I was suffering to the point of suicide, I HAD to get better or I was going to end my life. My tinnitus was as loud as a rock concert. The emergency broadcasting system was going off in my head for 24 hours per day for 30 months. I HAD NO CHOICE but to get better. My discovery, which took 30 months of research (and still continues) and thousands of dollars, was that there was not just one solution to the tinnitus (or any chronic illness) problem. It was more than emotional, more than physical, more than spiritual and more than psychological. A multi-modal approach to healing was the key.
The Chronically Ill Can Begin To Heal
The process is at times frustrating. Time passes slowly. The chronically ill client needs to make a number of commitments. Working with chronic illness including tinnitus is far more complex than quitting smoking. He/she must commit money and time and the willingness to participate in far more than hypnotherapy if he/she is to regain wellness. It can take months or years to get well, as it did for me. Many people, unfortunately will only experience minor improvement...and for a few...none at all. Most, however, will achieve significant case gain, in time.
No one seems to listen to your chronically ill client. "Nothing can be done" is what he/she’s been told. The chronically ill client can’t be helped in 15 minute visits to his/her medical doctor. Even with appropriate medications, which are necessary in working with the vast majority of chronically ill clients, the medical doctor plays only a small but significant role in the healing process. This is one area where the medical community is open to the educated hypnotherapist working with their patients. The medical doctor simply doesn’t have the time necessary to devote to the chronically ill patient, and this is where you come in.
When it becomes common knowledge that you are working with the chronically ill and especially those with tinnitus you will find yourself swamped with requests for help within the year, should you choose to follow in this most rewarding path.
The Initial Interview
When your client arrives at your door, he/she is usually despondent. I always book a 120-150 minute session for the initial interview. This first meeting will cover the following:
1. Client assurance that most people do improve with time and dramatically so.
2. A 90 minute case analysis specially designed for the chronically ill client. (Write my office for information about this special analysis procedure.)
3. The signing of a statement understanding your credentials and non-licensure status.
4. Presentation of the basic plan for therapy which will include medication from a medical doctor, seeing other appropriate professionals in conjunction with you, including an osteopath, a physical therapist, a psychologist, a psychiatrist, a TMJ specialist, an ENT, an audiologist and possibly other professionals.
5. Explanation of the various hypno-therapeutic interventions you will be using including hypnoanalysis, ego state therapy, time line therapy, focusing exercises and numerous other rarely used techniques.
6. Explanation of the fear deconditioning process which will take place to reduce tinnitus distress.
7. Explanation of the processes of auditory habituation where external sound sources in their day to day life will be utilized to help create secondary sound sources for the brain to hear.
8. Explanation of medications like antidepressants and antianxiety medications that actually reduce not only distress but volume and how they can expedite the healing process.
9. Explanation of the questions and medical tests that need to be sought from the medical community to assist in the healing process.
10. Explanation of what tinnitus (or his/her chronic illness) is caused by and how you will be addressing the causes - physical and emotional.
11. Scheduling of weekly (two hour) appointments for the next 7-10 weeks to begin the healing process.
Your First Hypnotherapy Session
Having received medical records from the client assuring that there is no tumor causing the tinnitus (via MRI or CT scan) and that the blood chemistry and glucose levels are in balance, and having eliminated all other possible medical causes (of which there are many), you can then begin your first session of hypnoanalysis. Hypnoanalysis is a powerful therapeutic modality that allows the hypnotherapist to find emotional and physical causes of various symptoms. Hypnoanalysis is a lengthy and powerful process that takes weeks with the chronically ill. During this time the client will begin to experience less distress as the hypnoanalysis desensitizes the individual to his/her malady. With luck, there will be an emotional predisposition to the individual’s tinnitus, and hypnoanalysis will eventually uncover this background. The "aha" experience or that of "insight" can often make dramatic emotional improvement in the client’s symptoms and emotional outlook which is necessary to preface physical symptom improvement.
In later sessions over the coming months you will utilize other forms of hypnotherapy, continuing to pay attention to the results of the medications and other treatments that are underway. You normally will be acting as a coordinator for them. In the first few months the norm is to watch your client change from a deeply depressed or distressed state of mind to one of hope and optimism. In the ensuing months the client will begin, in most cases to experience symptomatic relief. There is no time frame that is predictable for any one case. If a client suffers from significant hearing loss, he/she will heal at a different rate than one with perfect hearing. The variables are many.
Hypnotherapist as Cheerleader
It’s true that during the healing process your client will experience setbacks and difficult days when he/she loses hope. You become the most important person in his/her life at times like this. You become cheerleader, biggest fan and supporter. You keep him/her going.
Then One Day....
....you will get the greatest phone call you will ever receive...this week..."I can’t make it today, I have to...." I love this phone call. The person is feeling better. He/she is beginning to heal and doesn’t have time to see you, the instrument of his/her healing. This phone call is what I look forward to with every client. It is always my goal to eventually say good-bye and hear the words of thanks and relief from my clients. It may have taken six months or two years but it is wonderful.
If every practicing hypnotherapist in America were to have a full schedule of 100 clients per year we couldn’t even begin to assist the most difficult cases or those who are suffering the most. Please, think about helping those only you, with just a little education and experience, can help to heal. What would the quality of your life be if you could start changing lives, one by one? How would you feel about yourself if you could see the faces of your clients as they cry with tears of joy because of the work and dedication you have given to them? I think you already know. I know I do.
Kevin Hogan suffered from tinnitus for 30 months. He sees approximately 100 clients per year with tinnitus, hyperacusis, chronic fatigue, multiple chemical sensitivity and other chronic illnesses. He has become a resource for thousands of sufferers across the world in assisting them to find help.
Looking For More Articles on Tinnitus Treatment? Visit Kevin Hogan Website.
Body Language Expert, Motivational Speaker, Influence, Persuasion, Sales Training
Friday, April 18, 2008
The patients and therapists never met face to face, only over the phone, said Ludman. Patients weren't always easy to reach by phone, and the therapists worked hard to reach them all. Therapists followed a structured protocol for psychotherapy. They encouraged the patients to identify and counter their negative thoughts (cognitive behavioral therapy), pursue activities they had enjoyed in the past (behavioral activation), and develop a plan to care for themselves.
"The patients participated more fully in psychotherapy and completed more sessions than do most depressed people in the community," said Ludman. Nationally, only about half of insured patients receiving depression treatment make any psychotherapy visit, and less than a third make four or more visits. By contrast, in this study, three in four patients completed at least six phone therapy sessions. This is striking, she added, because the study did not include people who were already in counseling or planning to be.
"Giving psychotherapy to people with depression who were not seeking therapy may help them significantly," said Ludman. Depression symptoms, including feeling discouraged and avoiding other people, can prevent people from seeking help. One in four depressed people who make appointments for in-person therapy are no-shows. "They slip through the cracks," she added.
Few of the patients who received phone-based therapy--even fewer than those who did not receive it--sought in-person therapy. "This suggests the phone-based therapy met their needs, without whetting their appetite for more," said Ludman. Phone-based therapy is more convenient and acceptable to patients than in-person psychotherapy, she said.
Next, Ludman said, the researchers plan to explore the combination treatment's cost-effectiveness and impact on work and home life. They also want to compare the effectiveness of phone-based treatment with that of in-person visits.
The National Institute of Mental Health funded the study. The other authors are Greg E. Simon, MD, MPH, and Michael Von Korff, ScD, senior investigators at Group Health Center for Health Studies; and Steve Tutty, MA, now a doctoral student in clinical psychology at Brigham Young University in Provo, Utah.
More Articles Coming Soon!
Wednesday, April 16, 2008
Therapy by phone is something I found remarkably effective when I worked with people who suffered with severe tinnitus. This study isn't about tinnitus though, it's about deprsesion.
Know what was discovered?
When people receive brief telephone-based psychotherapy soon after starting on antidepressant medication, strong positive effects may continue 18 months after their first session. So concludes a Group Health study in the April Journal of Consulting and Clinical Psychology.
This paper describes one more year of follow-up since a 2004 Journal of the American Medical Association (JAMA) report on the same random sample of Group Health patients.
"With close to 400 patients, this is the largest study yet of psychotherapy delivered over the telephone," said Evette J. Ludman, PhD, senior research associate, Group Health Center for Health Studies, the paper's lead author. "It's also the first to study the effectiveness of combining phone-based therapy with antidepressant drug treatment as provided in everyday medical practice."
Long-term positive effects of initially adding phone-based therapy included improvements in patients' symptoms of depression and satisfaction with their care, said Ludman. At 18 months, 77 percent of those who got phone-based therapy (but only 63 percent of those receiving regular care) reported their depression was "much" or "very much" improved. Those who received phone-based therapy were slightly better at taking their antidepressant medication as recommended, but that did not account for most of their improvement. And effects were stronger for patients with moderate to severe depression than for those with mild depression.
"We were surprised at how well the positive effects were maintained over time," said Ludman. "As with weight control, maintaining improvement is the hardest part of treating depression."
As is usual in clinical practice, the patients' primary care doctors diagnosed their depression and prescribed their antidepressants. Half of the patients also received eight sessions of telephone psychotherapy during the first six months, then two to four "booster" sessions in the second six months as well as medication follow-up and support from masters-level therapists.
Was it important to meet face to face?
To Be Continued... Check back soon!
Tuesday, April 15, 2008
I remember the day I woke up and the tinnitus was gone. It was Christmas time in 1995. After 30 months of living in hell it was silent that morning. The maddening noise would be completely gone for 8 months before recurring in August of 1996. Since then, it would come back perhaps a few times per month for a couple of hours at a time. (Usually at bedtime after a long and stressful day.)
By 1996, my life had taken a massive turn away from selling and into a life of seeing clients with tinnitus and helping them in my role of psychotherapist/hypnotherapist. It was indeed something I never intended to do, but when I “went silent” everyone wanted the answer for their situation. In response to the thousands of phone calls, e-mails, faxes and letters, I started writing articles and posting information about tinnitus relief on my website at Tinnitus FAQ. This article is the first update I’ve made to that information in over three years.
The purpose of this article is to share with you conclusions about tinnitus therapy and treatment based upon my experience with hundreds of clients and thousands of consultations and correspondences over the past six years. It’s not my intention to answer every question about tinnitus nor to give you a new scientific theory. This article tells you what I know is helping people turn the volume down. I’m also going to share with you some speculation as to future research and where more answers may be.
Where does tinnitus originate?
There is still a lot of question as to “where” tinnitus exists in the human body. The initial thought that many people have is that it is in the ear somewhere. There is no doubt in my mind that in some people, this is true. Perhaps otoacoustic emissions from the ear send noisy signals to the brain and that is tinnitus. Perhaps. The truth is, that in some cases that is indeed possible. There is one thing we can be certain about. In all cases tinnitus is experienced in the brain and interpreted by the brain. In other words, like physical pain, tinnitus is interpreted and to some extent generated in the brain. My experience of doing years of psychotherapy and hypnotherapy with people who suffer from tinnitus is that it can and often does go away with the right program, the right treatment plan.
Imagine that there are hundreds of highways in your brain (there are billions, but if you can imagine a map of your country with all of the interstate highways visible, that’s enough to understand this useful metaphor). These highways, when interconnected, form memory and allow you to think and create. There are probably no other thought centers in the body. There are probably no other creative thinking and centers in the body. The neural circuitry, the highways are where it’s all at.
Think of someone you love. Think about them in great detail. What they look like, sound like, maybe how they feel. Just do this for a moment before continuing.
Your “conscious self” just took an off ramp of reading this article to an image or sound or feeling or all three to someone you love. The “driver of your car,” the “you” of whoever you are went from reading this article to someone you love. It literally lit up an entirely different set of circuits and neural pathways in your brain.
Some of these highways have tinnitus “on them.”
Some of these highways do not have tinnitus “on them.”
Those two statements are certain. They are not hypotheses nor are they theories. Those statements are facts.
It’s also interesting to note that there is some evidence that some cases of tinnitus are caused by an instability of the structure of the cells in some parts of the brain.
Using different kinds of hypnosis I can report to you the results of years of experience with hundreds and hundreds of clients. (I am also drawing on case studies by my colleagues like Ron Stubbs, Dianne Olson and others.)
- In regression hypnosis, when clients are directed to times in their life when tinnitus wasn’t present, almost all clients do not hear their tinnitus while in trance.* This can be for periods of time up to two hours during our session work. During these two hours, most clients are not hearing their tinnitus at all. Their “selves” are driving themselves along highways that do not have tinnitus “on them.” This is consistently true. At least 70% and maybe as many as 90% report this experience.
*Trance refers to a focused state of attention where the client is only attentive to what they are directed to be attentive of. There is nothing mysterious about trance. If you cry at the end of It’s a Wonderful Life with Jimmy Stewart and Donna Reed, you were in trance because you dissociated from the real world and bought into the world of the Bailey’s and the evil Mr. Potter.
- In regression hypnosis, when clients are regressed to describe incidents of serious events where tinnitus volume is loud and distressing they almost always experienced increased tinnitus and distress. Upon relating these incidents many times in trance, the anxiety and helplessness of the client reduces and often the client experiences little or no anxiety to loud tinnitus while in trance.
- When clients are “brought out of trance” and are attentive to everything else in the world, their tinnitus tends to be louder (although this is not always true) for an hour or two then remits significantly, often to levels that are substantially quieter than when the client walked in the office.
- Long term results show significant gains in almost all cases. Now, this is a sticky point here. Clients who faithfully do their homework and practice all of the different focusing and self hypnosis exercises we assign do substantially better than those who fly into town for three days, leave and do nothing at home. Personal responsibility is critical.
- Meditation for people with moderate to severe tinnitus has proven largely ineffective.
- Hypnosis that relies on relaxation and calming techniques has almost no value when contrasted to guided imagery. But…
- Imagery is a distant second place when contrasted to the long term results of the hypnotic interventions of #1 and #2 above.
We have yet to have a documented case where a client improved dramatically after one session of hypnotherapy or psychotherapy. Generally speaking 15 hours of therapy or more is necessary. This should be obvious as it takes a long time to get those big 8 lane highways in the brain to atrophy into dirt roads that are rarely traveled. That is the goal of therapy by the way. The objective and focus of the therapist is always to a) desensitize the client to the sound of tinnitus and b) to teach the client how to focus on other experiences in life (past, present or future) that do not have “tinnitus on the highway.”
The good news is that most cases of tinnitus, regardless of cause improve with time, with therapy and lots of successfully completed homework.
The bad news is that there aren’t a lot of therapists out there that understand how to work with people who suffer from tinnitus.
More Good News: Approaches that Work
Clients continue to respond favorably to medications like Zoloft, Effexor, and Paxil. (antidepressants)
They also tend to respond as well or better to Xanax and Ativan. (anti-anxiety medications)
Clients have also reported positive results with Neurontin and Klonopin. (anti-convulsants)
In fact, the number of medications that help tinnitus sufferers reduce volume and suffering is so great that it is a shame that the FDA (to my knowledge) still hasn’t approved medications for tinnitus sufferers.
A medication that reduces the fear response will help extinguish the fear response to tinnitus and thus the amount of attention paid to tinnitus. (Thereby shrinking the 8 lane highway into 6 or 4 or fewer “lanes.”) Long-term use of anti-anxiety medication is probably warranted for most severe cases and the resulting fewer suicides and long term positive change will likely supercede the minor side effects and remote possibilities of addiction to said medications.
Those medications that reduce depression, obsession and compulsive behaviors will also continue to help those suffering with tinnitus. The SSRI’s tend to be most effective in my experience but other medications certainly can help as well.
Many people call and come complaining that their tinnitus is exacerbated by pressure on their forehead, different head positions and teeth clenching. When I hear this I immediately refer the person to an Osteopath.
For some reason, osteopathic treatment (intracranial sacral therapy) still seems to be effective in helping the majority of my clients that report these exacerbating elements. I can’t explain all of the reasons why, though I do have hypotheses. The human body generally responds well touch and feelings of connectedness. Perhaps there is some of this mind/body response in the client’s experience. Perhaps the human body can become so stressed and distressed that it changes brain chemistry. Perhaps the sphenomandibular ligament that connects the area of the ear drum to the jaw is causing some kind of pressure in the ear, like plucking a guitar string.
One client named John was planning to come to Minnesota to work with me a couple of years ago. I sent him to a local D.O. (doctor of osteopathy) and he never needed to fly here because regular treatments by his D.O. were all he needed for elimination of tinnitus. (I’ve had similar situations with clients I did telephone consultations with that I suggested other treatments like Prozac, Zoloft and Xanax.)
Tinnitus Retraining Therapy is a fancy phrase for auditory habituation. I’ve talked with many people who have improved by using sound generators. I’ve spoken with many others that couldn’t stand to have the little noise makers in their ears. What I have found nearly universal in acceptance by clients is listening to classical music, environmental sounds and new age music that both soothes and creates a secondary sound source for attention. Auditory habituation is a “must” in terms of tinnitus recovery and remission.
I strongly suggest all of my clients play music in the background all day long or at least keep a television on. Anything that provides about 50 decibels of sound will do the trick. For the people with severe hyperacusis, they will need to start at 40 decibels and work their way up over time to fifty decibels.
These Usually Don’t Help
As time has gone by, I have seen fewer cases of people improving from any kind of tinnitus sound with Ginkgo. For some time I thought ginkgo might be a significant part of the therapeutic regime for most clients. Today, I suggest clients talk to their medical doctor about ginkgo but I can’t recommend it evangelically as I did 5 years ago.
I’ve also seen very few cases of people improving with homeopathic remedies and acupuncture. None of the bogus drops and mail order “medications” showed any improvement that I could find.
Changes in diet rarely seemed to help anyone in my experience. The same is true for clients who have taken herbal potions and remedies.
In the long term, “they” almost certainly won’t find a single cure for tinnitus because tinnitus has so many etiologies (causes). Tinnitus is experienced in so many different ways that it seems like aggressive multimodal treatment programs will continue to be in the best interest of the “average tinnitus sufferer.” What these clients will find is that tinnitus can be greatly reduced in most cases through desensitization and alternative attention therapies.
For years I have advocated a multi-modal approach to tinnitus therapy and that has proven to be right on the mark. For the average client suffering with severe tinnitus, I recommend the following in order of importance.
- Talk to your doctor immediately about starting a fairly long term treatment plan with low doses of anti-anxiety medications like Xanax, Klonopin or Ativan.
- Talk with the same doctor about starting a fairly long term treatment plan with moderate daily use of SSRI medications.
- Listen to music or the television all day as background noise. Avoid silence and extremely loud places. If you can’t do this, see an audiologist and buy a pair of sound generators that are comfortable for you to wear.
- Begin hypnotherapy with someone who has a great deal of experience with tinnitus.
- Begin psychotherapy with someone who has a great deal of experience with tinnitus.
- Begin using self hypnosis tapes for alternative attention and focusing practice. Use the tapes every day. (We can help you with this: See our catalog.
- See an osteopath for 5 sessions. Usually after 5 sessions you know if this is one of the keys for you. Hint: Those clients with the best success are those whose tinnitus is much louder when they are lying down on the floor or in bed.
- Avoid support groups and other people who want to talk about their tinnitus all day long. Once you have an action plan, avoid others (unless you are a therapist or doctor!) who want to focus on their tinnitus. Tinnitus in some respects, is an “attention disorder.”
- Start living a life that is rich and filled with the things you love to do, today! If that tinnitus were a wake up call to happiness, today would be the day to answer the call.