Mindfulness Tinnitus Relief – Jennifer Gans, PsyD

Jennifer Gans is a psychologist who helps patients with tinnitus. Jennifer focuses on mindfulness for tinnitus. In this episode, we talk about the cure for tinnitus, and whether waiting for a cure is helping or not.

Jennifer Gans, PsyD

It’s good to be here and talking about my favorite topic lately. So especially during the time COVID when it’s almost as if the volume of tinnitus has been turned up like the volume on a stereo. But you know, as you mentioned, I work both in my private practice and also through the mindfultinnitusrelief.com course with people that are struggling with bothersome tinnitus.

Ben Thompson, AuD

Yeah, we’re grateful that you chose to specialize in tinnitus. Being an audiologist myself, it’s an incredible asset to have someone like yourself, a psychologist dedicated to tinnitus. It’s an incredible asset for us. So thank you. Let’s talk about the cure for tinnitus. Some are waiting for it. There’s a lot of research and funding going into it from different groups, whether that’s the veterans, different biotech researchers. Is it worth waiting for a cure? You wanted to talk about this? I would think this is great for our audience to get into. So take the floor on this, what do you think?

Jennifer Gans, PsyD

Yeah, this is a very, very important topic. Because when something goes wrong, or something doesn’t feel right, in our bodies, we tend to go to a medical professional. And we want answers, you know, you walk into the doctor’s office, and you want a pill, a surgery, some sort of procedure to make whatever is bothersome, go away. And tinnitus is as you know, time and time again, I talk with patients that have come from their doctor, who just kind of shrugged their shoulders, looked at them and said, “I’m sorry, there’s nothing we can do for you go home and live with it.”

And so that’s the kiss of death for somebody with tinnitus. But so, yeah, I also am a very big believer that, you know, to help with anything that’s going on with us, it’s usually more than one thing that we need to do in order to help ourselves. So the approach that I have taken through mindfulness, using meditation to shift the brain, and then to help with habituation to tinnitus is a lot, we’ve done research for decades now and really haven’t come up with, again, that pill that procedure or what is satisfactory as a cure. But my argument is with, especially with tinnitus, that actually nothing’s broken. And so it’s a very unique thing that we go to our doctors with, and doctors, our doctors are trained to fix things. And so when somebody comes into their office, and they can’t fix what’s going on, or they can’t cure what’s going on, the doctor becomes anxious and and then the person with the tinnitus is kind of left feeling unsupported or uncared for. So my opinion is, is that the person with bothersome tinnitus, there’s nothing broken, there’s nothing to fix exactly.

It definitely involves a shift in perception and a shift in thinking and a shift in maybe certain parts of the personality that I think contribute to bothersome tinnitus. But so as it stands right now, we don’t have any quote unquote cure, but there’s many different things that we can be doing to help ourselves. Sound sensitivity, amplification, certainly a mindfulness approach. And so my argument is, if we can shift tinnitus from the bothersome category into the non bothersome category, well then, isn’t that a cure? So 50 million Americans, that’s the number that gets thrown out. And that’s just in the United States here. 50 million Americans experienced tinnitus, but about 16 to 17 million actually go to their doctor and they say, “What is this?”

And so then we have another 2 to 3 million that are so bothered by it that they can’t function. And so we have about 20 million Americans that are walking around the streets with tinnitus, but they’re not bothered by it. And so here we have two groups, we have the group that’s bothered, and some severely bothered by tinnitus, and those who have tinnitus, but they’re not bothered by it. And so in light of the fact that there is no cure, no pill yet. I mean, and I also open this up to researchers, I mean, maybe in the future, there will be that pill or that procedure. I mean, I have my opinions about why there might not be but you know, I’m like, right now, there’s no cure. And so my work is not, I’m not putting my energy towards curing tinnitus, but I am putting a lot of my energy or all of it to helping individuals shift their tinnitus from the bothersome to the non bothersome category.

Because like I said before, if you’re walking the streets of the United States here, with tinnitus, and it doesn’t bother you, then so what? And so that’s more the approach that I’m taking now. I mean, again, you know, who knows, in the future, there’s amazing researchers out there that are putting a lot of effort towards finding, you know, a cure as as you know, as it’s naturally defined, but my opinion is, is right now, there’s no cure. So let’s work with what we have. And we have something pretty amazing. Because again, I’m going to emphasize this throughout the entire talk here is if you have tinnitus, and it doesn’t bother you. Then so what?

Ben Thompson, AuD

Alright, so my two cents on this, let’s get into this, because we can have a nice discussion. So this argument, this idea that is shifting, bothersome, tinnitus to non bothersome tinnitus, is that good enough for to be considered a cure? I would disagree in this conversation. From my experience going very deep into the auditory domain, as an audiologist, what I found is that this psychological framing aspect of bad, neutral, good wherever we fall in that spectrum, that is probably the most important out of all this.

But underlying that there there are these baseline loudness levels of tinnitus. My thought was a condition like dizziness, where, for example, this is the first thing that came to mind. Dramamine helps dizziness, but it doesn’t cure it, but it does help the symptom of dizziness. So that is a pharmaceutical solution to help with dizziness, but it doesn’t cure it. So if there was something directly that impacted the auditory system like that for tinnitus, would that be good enough to be labeled a cure pharmaceutically? I’m not sure.

But silence is essentially non existent. Very few people have no tinnitus ever. So my perspective is that if there was some sort of pharmaceutical or surgical route that could reduce the loudness of someone’s tinnitus, that would change the world. Thoughts on this sort of back and forth?

Jennifer Gans, PsyD

Yeah, I’ve got a lot of thoughts on this. I love this conversation. All right. So let me let me just kind of peel away some of the things that you were mentioning here. First of all, they actually haven’t in the research found a correlation between loudness and bother. I was curious about that. Jastreboff researched this. He’s like, well, surely, you know, somebody with loud tinnitus must be much more impacted by their tinnitus than somebody with subjectively less loud tinnitus. And so he did a study, and what he found in his study was that actually, tinnitus, loudness did not determine the bother that the person was experiencing, which again speaks to the psychology that is behind tinnitus and our perception of unpleasant, you talk about good bad I talk about unpleasant, pleasant and neutral as being kind of the three states that that’s obviously very simplistic, but the three states that we can be in with any body sensations, so, so first off, yes, it would seem, but they in the research have not found that that’s actually the case.

So then the second thing that you’re that you’re talking about is where that you mentioned that someday there may be a cure, but if, but aren’t we looking for relief? Okay, and so, I think that a cure, you know, for maybe, you know, by technical purposes, yeah, it would be fun to find out what, you know, is going on in the brain, although I think we do know, what’s going on in the brain, you know, to turn off tinnitus. You know, really what we’re looking for is quality of life. Okay, so cure, like I always say to people, you know, if you want to know the temperature outside, you’re not going to take a ruler, even though a ruler is a form of measurement, you’re not going to go outside and, you know, test the temperature with that. And so we have to be very careful with the words we use, because semantics matter.

Okay, you know, how we talk about tinnitus can also be you know, as, as I talked about in my work also be kind of creating a story that gets wrapped around the tinnitus. That is the problem because tinnitus is a benign body sensation that the brain has misunderstood as something important to pay attention to. So what I’m finding in my work is that, you know, here’s tinnitus, but the story and the semantics that get wrapped around the tinnitus, or actually what the problem is. And so if we can unravel that, and allow the brain to do what the brain naturally does, which is habituate to benign body sensations, we then find that we’re able to shift our experience of tinnitus from the bothersome to the non bothersome category. So, you know, again, I think we’re talking semantics. Sure. I mean, is that a cured? Well, you know, do I ever say to somebody that you’re, many of the people I work with, actually will have and do have tinnitus for the rest of their lives, but they’re not bothered by it. And if you think about it, we have so many number of body sensations in our lives that are not pleasant, but, you know, we habituate to them.

Okay, and so tinnitus can be somewhat put into that category. And that, you know, we don’t always, you know, get to choose what body sensations that we’re going to experience. But if we cannot be bothered by it, then my opinion is, so who cares? And so I guess what I’m saying is that I’m seeing through my work through the program that I developed in and elsewhere, I mean, throughout the world, that there are people that are habituating to tinnitus, that they are shifting, they’re able to take this tinnitus, that’s front and center in their lives, and put it into the background where it deserves to be, just by shifting their perspective on the tinnitus and that can be where they place their attention that can be placed that can be how they understand you know, what tinnitus is and what it isn’t and the like.

Ben Thompson, AuD

I absolutely agree and I’m with you. My approaches to managing tinnitus are very in line with yours. And in terms of someone putting out the idea of a cure pharmaceutical surgical remedy to help tinnitus, it can be all or nothing thinking. And that’s one lesson to take away from this is that even if there is a cure for hearing loss, and that’s being researched simultaneously with tinnitus, is that it’s unlikely for it to be completely restored. It’s more of a game of marginal improvement. So, this psychological route of mindfulness or CBT, cognitive behavioral therapy, or other forms of Mind Body practices like meditation, etc. That is the easiest, the most attainable marginal improvement for tinnitus in these times. So tell us more about what else you’re working on. And we wanted to also bring up in this talk the, the personality of the standard tinnitus patient that you encounter, as well as the research that you recently completed. So tell us about the personality of the average person who comes to you who has tinnitus.

Jennifer Gans, PsyD

Okay, so that’s a great question. So for, you know, for the, again, the 1000s of hours that I’ve worked with people with tinnitus, I’ve started to notice things. And, you know, there’s usually some, we’re actually not even usually, I would say, pretty much all of the time, there’s something wonderful about the person with tinnitus, that is also what’s creating the problem, so to speak. Okay, so let me explain what I mean. So I frame this personality, or these aspects of this personality is incredibly positive. Okay. Because usually the things that are both the things that are making tinnitus, front and center are also the things that make a person very successful in especially in our culture. And so without further ado, I’ll mention what some of those qualities are.

So the person that comes to me, the person that I work with, usually always has these qualities about them of having an attention to detail, they tend to be a person who sees a problem, latches onto that problem, and doesn’t let go of that problem until it’s understood or resolved or fixed. So the person with tinnitus tends to be intense they are, you know, I don’t mean this in a diagnostic way, but they tend to have almost like an obsessive compulsive quality to the way they approach problems in their lives. Okay, so this is the personality that, you know, this is also something, you know, wonderful. I mean, everybody wants somebody in their lives, that spots a problem latches on to it and won’t stop thinking about it until they figure it out. I mean, these are wonderful qualities in a sense. But the problem is the same quality used towards tinnitus is always going to end in a dead end.

So this is, this is what I’m seeing with the patients that we have with tinnitus. And so you know, for a number of reasons that we’ve already talked about, and also reasons that well, for many reasons, bringing a mindfulness meditation approach to tinnitus is also something that can help us create some space between us and anything that’s happening in our environment, whether it be tinnitus, or COVID, or any other stressor in our environment, it helps us to get a little bit more space from it, so that instead of reacting to our events in life, we’re able to respond to our events in life. And so that is, you know, that could be the kind of the gate that opens the door to the habituation process for many people. And so I think that’s why CBT and mindfulness has gotten such amazing results in in research, and I’ll talk about the study that, that I just completed that I think it’d be interesting to discuss a little bit more.

So this ability to have a little bit more space in our lives helps us to choose how we’re going to respond to tinnitus. So in my private practice, and certainly in the course that I designed, mindful tinnitus relief, there’s really I often say this is my special sauce in the in the first session that I meet with people. My goal is to make a person less anxious about tinnitus, make them an expert in what tinnitus is and what it isn’t. And then based on what their lifestyle and choices are, find a management plan that works for them individually. So I developed this course called Mindfulness Based tinnitus stress reduction, which is, you know, sounds an awful lot like the program that Jon Kabat Zinn came up with mindfulness based stress reduction, and it is.

But what I’ve done is I’ve taken his principles in an eight-week course, and I have made it 100% specific to the person who’s struggling with bothersome tinnitus. So the name mindfulness based tinnitus stress reduction was born. That was the research that I did at UCSF was started in about 2013. And we found amazing results. And so what I’ve done since that time, is I flipped it into an online course so and what we have now is an eight week online course where people can both learn the things that I mentioned, you know, with videos and audio recordings and a lot of written material and activities. become an expert in what tinnitus is and what it isn’t, become less anxious about their tinnitus, but then also, in the eight weeks it creates a skill set in how to begin a mindfulness meditation practice.

Jennifer Gans, PsyD

I don’t know that if time allows for our talk today, but meditation and mindfulness meditation specifically in the research has shown that it strengthens or builds tissue in the prefrontal cortex, which is our reasoning, our ability to place our attention where we choose to go, our ability to modulate our fear and our emotions in general. And basically all the executive functioning that we, you know, we wish that our young kids could develop quickly. And so meditation practice helps to strengthen this area, but also quell or calm down the amygdala, which is the area of the brain that triggers our fight or flight response, our fear center, so to speak. And so I am very interested in helping somebody use knowledge to chill out our subconscious part of their brain that is reacting to tinnitus, rather than responding to it for what it is, which is a benign body sensation that the brain has misunderstood as important to pay attention to.

So moving along this online course, we had, again, with the in person course, we were seeing amazing results and did some research with that at UCSF. So now it’s time to look and see what the data tells us about this eight week online course. And so during, I guess it was March 25, I decided to make the course free for anybody across the world. So this being you know, an internet based or an online course, it has the reach across the world. And so I made the course free for anybody during the shelter in place period between March 25 and June 9. Anybody across the world was allowed to sign up for the course for free. And so luckily, we had as many as 677, people signing up for the course worldwide and taking the pre assessment. And so the results that we got from this, we really observed a large sample size of 677. And we measured these people that pre admitted at about three weeks into the course and then at the end at eight weeks. And then we’re now finishing up gathering the data of a six month follow up to see if the results of the course were enduring.

And so we found very significant results between the people that started the course, the results went down significantly. We use the tinnitus functional index and perceived stress scale as our measures to show tinnitus impact and perceived stress. So what we found is there were significant drop in people’s experience of tinnitus, distress and perceived stress, even at mid course, so we’re not talking, you know, three months, three years, we’re talking three weeks into taking this course, we’re seeing people making significant shifts in their tinnitus from bothersome to non bothersome. And then we looked at the post assessment, which is just eight weeks later, and we were seeing an even further drop. And then at six months, we found that of the people that were involved, that they were maintaining their lower their significant lower scores on the tinnitus, functional index and perceived stress scale. So I’m very excited about these results, because it’s really showing the efficacy and the effectiveness of healing from home. And this was particularly interesting during the time of COVID. Because, you know, we’re all realizing that, you know, we risk, you know, even leaving the house, you know, to go to see a doctor, you know, we need to find a way to heal from home.

And I think that what people are finding with tinnitus is that the responsibility has to be on the person with the tinnitus rather than the clinician that’s caring for them. They obviously are a guide. But ultimately, when a person takes the responsibility of their tinnitus into their own hands and starts to help themselves by changing their perspective on tinnitus and on and respond to tinnitus, rather than reacting to tinnitus, it really opens up the floodgates and allows the brain to do what the brain naturally knows how to do, which is habituate. So that’s in a nutshell, kind of where we are with this and you’re certainly happy to share the the results.

Ben Thompson, AuD

Yeah, thank you so much. Yeah, anyone who’s watching or listening, consider checking this out. I practice meditation myself, I can certainly recommend it personally. I’ve created meditations for those with tinnitus myself as well and I’ve gotten great feedback. So this course is a structured way to consider taking meditation as a tool to help with those cognitive parts that are potentially blocking someone getting better, as well as getting out of the head and relaxing into the body, the healthy parasympathetic nervous system, which we love, and we talk about a lot here up here.

Jennifer Gans, PsyD

If we can allow the brain to relax, you know, I often say that stress increases tinnitus bother and relaxation decreases tinnitus bother. So basically, when you’re looking for something to help you with tinnitus, if, you know if it stresses you out, your tinnitus is going to be more bothersome, if it relaxes you, your tinnitus will be less bothersome. And so, you know, I think about a symphony, and there’s never been a conductor that’s gotten up in front of their, their symphony and just started playing. They always get up there and they tune the instruments. And so what a meditation program or practice helps us with is to make sure that all parts of our brain are in symphony, playing at least in the same key so that we can begin to create that space that I talked about before so that we can start choosing to respond to tinnitus rather than react.

I’m happy to say that, you know, the numbers are showing this, this is what they were finding in the research. So, you know, as far as you know, where the future lies, you there’s definitely going to be a lot more research into this area and that what I hope for people until the cure comes until that pill or that surgery comes in whatever form. Helping yourself to shift tinnitus from bothersome to non bothersome. And to be able to walk this earth with more comfort with more ease should actually be the primary thing here because again, tinnitus is a benign body sensation. We’re not talking about cancer, we’re not talking about you know, ulcers and other stress related phenomenon. We’re talking about tinnitus, which luckily is benign. And so if we can allow it to just go into the background where it belongs, then that to me is is a bit of a cure.

Ben Thompson, AuD

It’s definitely a win. It’s definitely progress. Definitely worth energy to get to that result. And it usually doesn’t happen by itself. So this program, you’re explaining here, your program, is certainly a great resource. And to me, it represents a western medical program modality that’s based in eastern tradition. And in my personal journey, I connect with that very much of simple practices like meditation, performed consistently, along with changing the mindset of different psychological aspects, can really affect being present, it can reduce anxiety, stress and increase a sense of purpose and presence. So thank you for for all this work and the years of research that you’ve done leading up to this point. Where can someone find you if they’re looking to learn more about your course or to work with you one on one?

Jennifer Gans, PsyD

Well, it’s easy these days, simply go to mindfultinnitusrelief.com and you’ll be right there with the course and you can look at the introduction and look at some of the resources and make a decision if this is a good program for you. And I am working in individual individual therapy now because of COVID. Of course, I’m working through zoom so it can work with individually with people in California because that’s where I’m licensed. So, you know, if you’re needing some help in this area, I really encourage you to go to the course and see what you can do from the healing from home.

Ben Thompson, AuD

Thank you. “Healing from home.” That’s a nice little slogan. I like that. Well, Dr. Gans, always a pleasure. Thanks for joining us. This has been Episode 14 of the Pure Tinnitus and Hearing Podcast. And you are the first psychologist that has come on for the podcast. Thank you for that. Thank you for your generosity and on behalf of anyone who has used meditation to help with their tinnitus, thank you for being a pillar in that community.