Phone Therapy for Depression? (part 1)

The great thing about studies is you find out what works and what doesn't, and often the results surprise you. And sometimes they demand that professionals and the astute make changes in the way they do business and in their life.

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!

Tinnitus: Looking Back and Looking Forward

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.)

1. 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.
2. 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.
3. 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.
4. 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.
5. Meditation for people with moderate to severe tinnitus has proven largely ineffective.
6. Hypnosis that relies on relaxation and calming techniques has almost no value when contrasted to guided imagery. But…
7. Imagery is a distant second place when contrasted to the long term results of the hypnotic interventions of #1 and #2 above.

The Goal of Tinnitus Therapy

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.

The Osteopath

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.)

Auditory Habituation

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.

The Future

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.

1. 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.
2. Talk with the same doctor about starting a fairly long term treatment plan with moderate daily use of SSRI medications.
3. 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.
4. Begin hypnotherapy with someone who has a great deal of experience with tinnitus.
5. Begin psychotherapy with someone who has a great deal of experience with tinnitus.
6. 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.
7. 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.
8. 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.”
9. 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.

Tinnitus, Pain and Visual Delusions: Repairing Perception Problems

You hear it (tinnitus), feel it (pain), see it (visual delusions). But you probably don't have to have these experiences.

12 years ago I woke up with tinnitus. 70-80 dB of h*ll. Talking with a dozen doctors and reading tons of medical literature boiled down to one thing: You are stuck with it. Get used to it.

Not possible. There was NO way I could live with the jet engine 24/7. In addition to medications and a whole slew of lifestyle changes, I started studying the brain. I got caught up by buying every textbook I could find on neurology, psychobiology and neurobiology.

I'll tell you one thing: We know 100 times more about the brain today than we did 12 years ago, but...the doctors still tell people there is nothing that can be done.

They tell that to people who taste metal, see delusions, have schizophrenia (paranoia w/delusions), feel chronic pain and have the nightmare of them all: tinnitus. And they are wrong.

It became clear that the brain has a "plasticity" to it. No, you can't reshape it like a piece of clay or silly putty, but the analogy was useful as I fought through the daily listening to the emergency broadcasting system.

The fact that the brain has this sort of "ability to change" at the cellular level was useful in constructing ideas to get rid of the tinnitus. Lots of the ideas failed. Some helped. Eventually, it worked.

The research that is now out confirms that most people's tinnitus is generated and "heard" in the brain, not the ear. Chronic pain doesn't need to be chronic, because the cells that store the chronic pain can be changed, and so on. None of this is easy or even simple. It takes a pretty complex set of changes to get the brain to not pay attention to tinnitus and then to simply not remember it. It takes time.

I've helped a lot of people accomplish this. Thousands who suffer with tinnitus. Fewer with chronic pain (like fibromyalgia). None of the standard methods of psychotherapy, hypnotherapy or any therapies worked. But by making changes to what actually changes what cells record, turned out to work.

Phantom limb pain experiences were the clincher for my persistence. Just the concept that someone could have a hand that burned or hurt or both...and the hand had been blown off or shot off 20 years before...that told me that it was possible to reverse-engineer the sensation, the perception and change it.

Today, this piece of research was released and it helps to explain in logical fashion what I discovered 10 years ago...but only could guess as to why....

Scientists have made the first recordings of the human brain's awareness of its own body, using the illusion of a strategically-placed rubber hand to trick the brain. Their findings shed light on disorders of self-perception such as schizophrenia, stroke and phantom limb syndrome, where sufferers may no longer recognize their own limbs or may experience pain from missing ones.

In the study published today in Science Express online, University College London's (UCL) Dr Henrik Ehrsson, working with Oxford University psychologists, manipulated volunteers' perceptions of their own body via three different senses - vision, touch and proprioception (position sense).

They found that one area of the brain, the premotor cortex, integrates information from these different senses to recognize the body. However, because vision tends to dominate, if information from the senses is inconsistent, the brain "believes" the visual information over the proprioceptive. Thus, someone immersed in an illusion would feel, for example, that a fake limb was part of their own body.

In the study, each volunteer hid their right hand beneath a table while a rubber hand was placed in front of them at an angle suggesting the fake hand was part of their body. Both the rubber hand and hidden hand were simultaneously stroked with a paintbrush while the volunteer's brain was scanned using functional magnetic resonance imaging.

On average, it took volunteers 11 seconds to start experiencing that the rubber hand was their own. The stronger this feeling, the greater the activity recorded in the premotor cortex.

After the experiment, volunteers were asked to point towards their right hand. Most reached in the wrong direction, pointing towards the rubber hand instead of the real hidden one, providing further evidence of the brain's re-adjustment.

Dr. Henrik Ehrsson says: "The feeling that our bodies belong to ourselves is a fundamental part of human consciousness, yet there are surprisingly few studies of awareness of one's own body."

"Distinguishing oneself from the environment is a critical, everyday problem that has to be solved by the central nervous system of all animals. If the distinction fails, the animal might try to feed on itself and will not be able to plan actions that involve both body parts and external objects, such as a monkey reaching for a banana.

This study shows that the brain distinguishes the self from the non-self by comparing information from the different senses. In a way you could argue that the bodily self is an illusion being constructed in the brain."

Disorders such as schizophrenia and stroke often involve impaired self-perception where, for example, a woman might try to throw her left leg out of bed every morning because she believes the leg belongs to someone else. Misidentification or unawareness of a limb arising from damage to the premotor cortex from a stroke is not uncommon.

Phantom limb syndrome is a disorder which can arise after amputation. Remedies that trick the brain into believing the limb has been replaced, for example by using a mirror to reflect the opposite healthy limb onto the amputated limb, exploit the brain's mechanism of self-perception.

Learn More About Tinnitus Reduction (Ear-ringing) Click here!

Tinnitus Treatment: A New Understanding Brings Hope For Tinnitus Relief and Your "Cure"

by Kevin Hogan

(This article is excerpted from the book, Tinnitus: Turning the Volume Down (Revised & Expanded)

Tinnitus, "the noise," is running through your brain on hundreds of highways called neural pathways. These neural pathways are roads between brain cells. The "intersections" in the brain’s highways are called synapses.

These intersections don’t actually touch each other. The open space between the cell arms is called the synapse. The highways are made up of axons and dendrites (which you really don’t need to know all that much about). One cell (neuron) sends information to another cell by sending an impulse from one cell to the next via a neuro-transmitter, much like a cellular telephone call. The phones aren’t connected by wires. We’ll talk a little more about these neurons and neurotransmitters in a moment.

It is also useful for you to understand about how people get depressed, feel stressed or become panicked or experience anxiety, and, how all of this relates to tinnitus.

Research into tinnitus suffering shows that what we call SPADE (an anacronym I coined in 1995 to consist of at least one of the following: stress, panic disorder, anxiety, depression, and/or emotional challenges) tend to predispose people to tinnitus (and of course other somatics as well). SPADE is a significant set of variables in determining who will experience suffering from tinnitus and who will not. SPADE is most likely a significant variable in who experiences tinnitus after exposure to loud noise or other physical stimuli. The emotional part of our brain, it appears, is critical in both the experience, suffering and relief from tinnitus.

There may be a stigma that goes with this line of thinking. If we acknowledge an emotional component to the onset and later suffering of tinnitus, we acknowledge that it is at least tangentially something that could be mistaken as a "mental illness." Because such terms are useless in the healing process, we will not concern ourselves with such labels. You can call anxiety a "brain cold" and "depression" a case of the "mind flu." The name doesn’t matter, getting better does. Our objective will always be the reduction and/or elimination of tinnitus. Period.

Tinnitus suffering is positively correlated to all the elements of SPADE.

For now, consider the insidious relationship between brain chemistry and stress, stress and depression, and all of these emotional states and tinnitus.

In SPADE, "the first factor" seems to be stress.

In 1993, Dr. G. W. Brown wrote that he discovered 84% of a large sample of depressed patients had experienced severe stress in the preceding year compared to 32% of control subjects. Drs. Anisman and Zacharko have suggested that the depletion of certain neurotransmitters (e.g., of dopamine, serotonin, and norepinephrine) that are associated with stress may leave an individual sensitized to subsequent stress and thus less capable of coping with it. They view the inability to cope effectively with stress as a major predisposing factor in depression. (Biopsychology, 1997, Allyn and Bacon Press)

Important studies involving patients with tinnitus reveal that depression precedes a significantly large numbers of tinnitus cases. People not suffering from depression develop tinnitus that produces suffering less regularly.

Therefore for at least a significantly large percentage of the patients suffering from tinnitus, we know that many were predisposed to tinnitus by depression and before that severe stress. Further, we know from various drug studies that anti-anxiety medications (Xanax) and anti-depressants (Pamelor) have been showing to reduce tinnitus volume in a significant number of patients. (76% and 43% respectively compared to 4% for a placebo.)

Anti- convulsants like Klonopin have also been shown to be successful in reducing tinnitus in large numbers of patients. Klonopin is regularly prescribed for individuals who suffer from anxiety, epilepsy and/or related seizures. Anti- anxiety and anti-depressant medications in general seem to help tinnitus sufferers reduce tinnitus volume and distress in significant numbers.

The beneficial effects for tinnitus reduction and distress reduction by these medications offer us our first clues as to the causes and potential elimination of tinnitus.

For many people with tinnitus, negative emotional experiences play a pivotal role in onset, suffering, and later, relief from tinnitus. Severe tinnitus challenges the emotional stability of even the most resilient individual. Tinnitus is far more than a simple hearing disorder. Tinnitus is a complex intermingling of deficient brain chemistry, phantom auditory perception, cell receptor damage, and/or negative emotional experiences (among other variables). Tinnitus sounds may be similar from person to person, but the cause, onset, volume and experience of that tinnitus can be very different. One modality of reducing tinnitus may work for some but it is becoming clear that a multi-modal approach to tinnitus reduction is going to be indicated for most individuals. (Effective therapy normally can include some or all of the follwing: auditory habituation, medication, osteopathic treatment and hypnotherapy.)

Stress, depression, panic disorder, and anxiety are like fertilized soil for a farmer. The farmer planting the crops can be likened to the physical stimulus that causes the tinnitus and makes it persist (grow) when in most people, without the fertile soil, it only lasts a period of time. Once the tinnitus is "planted" in the brain of stressed or depressed individuals, it grows and soon plateaus in volume.

The brain initially becomes aware of this noise and initially does not like the noise. The part of the brain that probably detects the potential negative impact of this noise is the amygdala. It does this by comparing the sound of the noise to other noises the brain has experienced in the past then determines whether action should be taken or not against the sound. (Unfortunately the amygdala cannot help us take action at reducing the noise.)

As the brain becomes accustomed to having the noise around, the noise is accepted as part of the daily experience of life. Tinnitus is often perceived as a threat to survival and the amygdala demands that it be found when the conscious mind notices it is "not there." (Have you noticed that when you awaken from a nap your tinnitus volume increases? For many, this is your brain’s way of trying to keep you alive. The tinnitus is as persistent as breathing and like breathing it will make sure the noise is detected if the brain has the tinnitus correlated to a survival issue in one manner or another.)

The brain does not think that tinnitus is "good." It simply is a survival issue. An intruding sound has been detected and a "sound loop" is created in the neural pathways that keeps the tinnitus perception intact. Long after the physical stimulation for the tinnitus is gone (a loud concert for example), the tinnitus persists. The brain continues to find the noise. This is what is meant when it is said that tinnitus is psychosomatic in nature even though the tinnitus onset was physical. Psychosomatic means that their is a significant emotional cause or relationship with a physical medical problem. In tinnitus, this is often but not always the case. You will soon discover that this relationship works to your advantage when you begin your daily regimen to reduce tinnitus volume and distress. Tinnitus in many people is like a paradoxical memory. With skillful therapeutic intervention, the brain can sometimes "forget" the tinnitus. Sometimes the forgetting is for minutes or hours. Sometimes the forgetting is for days or years. This is good news for the sufferer.

The continuation of noise (persistent tinnitus) is often not "necessary." If there is no evidence of significant sensorineural hearing loss, then the probability of tinnitus remission is significantly increased. The brain can be re-wired and re-programmed to stop playing the endless looping of tinnitus tapes. (Those with sensorineural hearing loss can also experience remission of tinnitus, but in our clinical experience, it is less often.)

More Articles Coming Soon!

Tinnitus FAQ's

• What about biofeedback and relaxation techniques?

Biofeedback is a subfield of hypnosis. Who relaxes or can relax when you have severe tinnitus?? I certainly couldn't. Most of my clients can't. Biofeedback is useful in stress reduction and there is evidence that shows that biofeedback, while less effective than hypnosis, is more effective than Elavil in tinnitus reduction. For people with mild to moderate tinnitus, relaxation oriented self hypnosis is very helpful. Most people with severe tinnitus can't come close to relaxing which is why I developed the Tinnitus Reduction Program. (See below for details.)

• What about acupuncture?

Not proven to help. (Though good for headaches according to recent research.)

• What about other herbs?

Not proven to help. Save your money.

• # What about vitamins and minerals?

Magnesium and zinc may help people deficient in these areas. Calcium might help. (It helps a lot of things believe it or not!) There is some reason to believe that B-Vitamins can help us cope with stress better. For most: Highly over rated, very expensive, and very likely won't help.

• # What about ear drops, and all of the remedies sold on the internet?

You mean the scams? They are ALL scams. Want a list of tinnitus scams? Type in tinnitus at google and look at the right hand column. All but two that I looked at today were a rip off. PLEASE save your money. If they have a remedy, they must have a double blind placebo study. Ask for it. (It doesn't exist.) Don't ask for testimonials. Ask for a double blind placebo study performed by an independent group. Again, there are none. Period.

• # What about chiropractic?

Maybe...For tinnitus, I would advise you to see a Doctor of Osteopathy (D.O.)

• # What about psychotherapists?

Same as hypnotherapists. Most are great people that just don't have the laser beam specialized knowledge to help tinnitus sufferers.

• What about medical doctors?

Most are just not knowledgeable about how to help tinnitus sufferers. I can't tell you how many times I've read a letter from a physician stating that the patient's tinnitus has no medical basis and therefore, there is "nothing more I can do". This is all preposterous. The medical doctor is one signature away from most people being 1/2 as loud in 90 days. There are MANY medications that can help you. Your medical doctor isn't obligated to work with you and you aren't married to your medical doctor. Become a proponent of getting well and seek the help of those who will help you. (Ask your doctor to stop off here for 10 minutes! Good doctors will take the time for you.

If you don't like your therapist or doctor, dump them. You need someone who will help you long term. Tinnitus isn't a sore throat or an ear ache. It's work. If they help you, keep them. Your M.D. should be knowledgable, willing to learn FROM YOU... what you are learning and that you are willing to perform some trial and error. Treating tinnitus isn't just science. There's quite a bit of artistry in the long term process. It isn't just hypnosis or Xanax or TRT. It's a long term relationship in a lot of cases...in most cases.

• # Jack Vernon of the ATA told me...do you agree?

Jack Vernon is the person who talked with me 13 years ago. Jack and I have spoken only that one time. Jack is very knowledgable about tinnitus. His approach is somewhat different in some respects. In others, we are very similar. If you have talked with Jack, follow his recommendations... Great human being.

• I've been thinking about suicide.

If a person has severe tinnitus and is suicidal, they should see a psychiatrist or medical doctor, get treated both therapeutically and pharmacologically, then call me after the above criteria have been met. This is my most common client. I've been where you are. It stinks. Remember: You will improve if you do those things that lead to improvement.

• How did you come to know so much about tinnitus when the rest of the world seems lost?

I had severe tinnitus for 2.5 years, finally figured how to get better with the unwavering assistance of Chris Coleman, Director of Hope for Hearing in California and others...Today I have no tinnitus. (I only do therapeutic consultation work with people who have tinnitus, and those consultations are coming to an end.)

My LONG TERM experience from beginning to elimination or substantial reduction with tinnitus sufferers is second to only a very few: I work with some of the most severe cases of tinnitus sufferers in the United States.

• Why write the book?

It's not possible to answer 20-30 e-mails and letters per day any more. Now someone can go to Amazon.com and for next to nothing get the basic answers I would give. Please, read the book first, then e-mail. Your questions will be much more fine tuned after reading the book. (You're going to waste $10,000 on scam approaches if you haven't already, please, spend $20 or go to the library for heaven's sake.)

• Do you hate getting all the e-mails?

No, I hate not being able to help and answer everyone personally. I spend 1-2 hours daily corresponding with whoever I can get to in the email box. It is not possible to do more, so forgive brevity if I can respond to you. People aren’t "bothering me." I do get down because I am not a non-profit organization with a staff of people to answer all the inquiries. Sometimes it makes literally me cry when I have to choose between my kids and my e-mail. I will always help but you need to be patient. Please do read the book and begin your self therapy as soon as possible.

• How can I get a copy of your book Tinnitus: Turning the Volume Down?

You can go to Tinnitus: Turning the Volume Down (Revised & Expanded)

If you'd like to read an excerpt from the book, click HERE

Tinnitus Treatment and Therapy FAQ

· What do people experience when they take anti-depressants and anti- anxiety medication?

Some people experience a locational change in their tinnitus. (That's the first very good sign I look for, by the way.) Some people experience a temporary increase in volume, which we would expect, and now I simply let the MD’s I work with know that this is actually likely and also almost certain to be temporary (a few days). Anti-anxiety's most common side effect seems to be drowsiness in my clients. Antidepressants most common side effect seems to be sexual reduction of pleasure which happens to about 4 in 10 of my clients.

What is most important is how it changes the brain in the long term. Antidepressants will reduce the amount of obsessing and compulsive checking to see if tinnitus is louder, quieter, different...or just to listen. I suggest measuring your tinnitus five times daily. Other than that, put attention externally. If you do this you are on the right road. Anti-depressants are likely to be a CRUCIAL piece of getting well. Get past the first 1-5 days of increased noise and you win.

Be stubbornly patient.

· Tinnitus is causing me disability. I can't function. Will you help me get compensation for medical purposes?

No. You want to get back to work or to some other work as quickly as possible. (A few days at most.) The people who get well from tinnitus are the people who are most grossly absorbed in major projects that require "spinning a lot of plates." This is part of the lifestyle changes we talked about earlier...

· What about ginkgo biloba?

My rule of thumb is this: If you have tinnitus that varies in volume during the day or is pulsatile, you may want to try ginkgo for a few months. Like the medications, it will take time to "kick in." Two, three months even before results begin. You should know there is no actual evidence to support ginkgo as a therapeutic tool for tinnitus. I am favorable to the use of it because of my personal experience and a few anecdotal reorts from clients. It's expensive. If money is an issue there are better places to invest in your tinnitus reduction. If money is no issue, I would (and did) see what happens over a few months.

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Tinnitus Treatment and Therapy FAQ

What about anti-depressants?

I think after Mark Sullivan, I was the first person to wave the anti depressant flag. Of course! In my opinion, an excellent choice for moderate to severe tinnitus suffering, if there are no contraindications. Some people say to start with Pamelor, but I would disagree and go with the SSRI’s like Zoloft, Paxil, Effexor, Celexa or Lexapro. Please read that last sentence again. I've had a lot of email from people who didn't get it right the first time.

Some of my clients have experienced tinnitus elimination with Prozac. But, prozac may have a small tinnitus side effect that is larger than placebo, granted not significant, but I’m conservative. I’d start with Zoloft or Lexapro, but I’m not an MD. MD's have no problem prescribing anti-depressants because they are not "tracked" thus you will have no problem here.

Pamelor has a proven track record. (I no longer encourage using it because of significant side effects.) The vast majority of my clients who have used tricyclics do get benefits from the tricyclics and even more from the SSRI’s... and of course you don't use them at the same time.
BUT Pamelor also has more impressive side effects than SSRI's and say, Effexor which is very helpful and has few side effects.

Antidepressants probably don't cause tinnitus to go down by themselves. It appears two things happen with these medications. First the "anti-OCD" effect of the medication seems to cause people to "quit checking" their tinnitus. Secondly, the medications do succeed in reducing depression which can be profound...and allow the person to return to normal life as quickly as possible.

NOTE: For most people that are going to improve, tinnitus will INCREASE when you take an antidepressant for the first few days or maybe even week or two. It comes back down. (You can try and keep the volume up by attending to it and avoiding the other things necessary to cause reduction!) This means the medication is doing it's job in the brain. Don't become upset when the volume increases. Assume it will. The medication is "plowing snow from the highways" in your brain. It takes time to clear paths so they are neat and clean. Give it a few days. I remember these few days myself...they drove me nuts and weren't easy...and they were worth every second.

More FAQ's Coming Soon!