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Tinnitus Retraining Therapy – TRT – A Review

Tinnitus Retraining Therapy (TRT) relieves suffering from tinnitus in approximately 85% of trainees, but it requires 12 to 18 months to become effective. Developed in the 1980s by Dr. Pawel Jastreboff at the University of Maryland, this therapy works through a process called habituation. TRT consists of two closely integrated and equally essential parts:

A) The use of sound therapy, and

B) Counseling by a knowledgeable professional.

To understand how TRT works, you first need to understand that tinnitus involves not just the ears, but multiple structures within the ears and brain.

Sound is collected by the external and middle ear as vibration, converted to electrochemical energy in the cochlea, and transmitted as nerve impulses along the acoustic nerve to specialized brain cells called auditory centers in the temporal lobes of the brain. Brain cells then interpret these nerve impulses as sound. It’s these interpretations that determine how you hear the sound. Even more significant, these and other centers in your brain determine the relative importance of that sound.

Think about this for a moment. Your conscious mind can pay attention to only a few hundred bits of information (stimuli) at any given instant. There are thousands of bits of information constantly bombarding you, some deemed by your mind to be more important than others. To avoid sensory overload, your conscious mind chooses to ignore stimuli not deemed threatening, stimulating, challenging, exciting, rewarding, essential to your survival or well being, etc. That is, your brain ignores things it considers unimportant, so you remain unaware of them until something changes to make them become important. Some of these bits consist of auditory (hearing) stimuli. Others are kinesthetic (touch,) olfactory (smell,) gustatory (taste,) and visual (sight.) The relative importance of each stimulus changes frequently, so the degree of attention you grant them also changes.

Any new stimulus will always be noticed and evaluated by our brains as to whether it presents a threat or warns of danger. Your mind learns to ignore any recurring stimulus that it considers unimportant. This is called habituation. One of the goals of TRT is to teach your brain to consider any remaining tinnitus so unimportant that you will automatically ignore it unless and until you choose to hear it. Pretty neat choice, huh?

A) Sound therapy in TRT consists of presenting a second or new intruding sound (NIS) to your ears, with that sound being far less intense than the tinnitus in your head. The NIS typically consists of a constant low level of white or pink noise, a balanced broad spectrum perceived as a gentle hissing. When a NIS is first presented, you notice it because it’s new, and the limbic system in your brain needs to determine if it’s threatening or warning of danger. Because this NIS is constant, innocuous, and fairly faint compared to other environmental sounds, your limbic system quickly determines that it’s not important, so it pushes it into the background. Your conscious mind then switches focus and actively listens for other sounds. In so doing, you ignore the NIS as though it doesn’t exist. This process is slow, but while training your mind to ignore this artificially induced, unimportant NIS, your mind also learns to ignore other unimportant sounds inside your head-your tinnitus. A word of advice: Tinnitus sufferers must avoid silence at all times. Beginning right now, keep some sound around you at all times-something you enjoy such as music, a waterfall, etc. Not loud, just at a “background” volume you find pleasant.

B) Professional counseling is an essential component of TRT. Studies have shown that sound therapy alone results in far less improvement for tinnitus sufferers than the combination of sound therapy and professional counseling. The primary aim of professional counseling is to remove negative emotions associated with tinnitus, such as anxiety, stress, and fear. Understanding the roles of the auditory system and brain plays an important part in removing fear surrounding tinnitus. 75% of all people with tinnitus automatically habituate the sound and generally ignore it. 85% of those who initially suffer show significant improvement following 12 to 18 months of TRT.

Along with anti-anxiety medications, TRT has become accepted by physicians in mainstream medicine as the treatment of choice for patients suffering anxiety from tinnitus. My issues with this therapy are the cost involved and the length of time required for relief.

Cost: TRT trainers typically recommend that a professional sound-generating device similar to a hearing aid be worn 24/7. These devices are quite expensive, often costing upwards of $2000. My personal experience is that patients can enrich their own environments with pleasing sound just as effectively and for far less money. This can be accomplished by playing soft music, white noise, or nature sounds on a CD, through a computer, via special CD-player pillows at night, or through sound generating devices from electronic or specialty stores such as Radio Shack or Brookstone.

Time: Patients typically require 12 to 18 months of TRT before obtaining maximum relief. Exceptions certainly exist, but it seems likely that the majority would spontaneously habituate the noise without costly therapy within this length of time. Any stimulus repeated day and night for this long will surely be determined to be non-threatening. As soon as this occurs, the conscious mind literally becomes bored with the noise and automatically begins to ignore it.

All emotions, including anger, fear, frustration, and anxiety reside in the subconscious mind. Counseling-like cognitive-behavioral therapy–involves direct communication between counselor and patient using words and diagrams-an activity of the conscious mind. Attempting to correct a subconscious problem with a conscious solution is like trying to paint a wall with a hammer. Picture this. It can be done, but is terribly inefficient because you are using the wrong tool for the job.

Hypnotherapy and relaxation techniques can relieve some of the anxiety associated with tinnitus, but require a therapist familiar with the causes of tinnitus itself. Very few of these exist. Results from general hypnosis alone are disappointing.

Energy psychology methods, such as EFT and Anxiety Relief Techniques® (ART) directly unhook the subconscious fear response from any stimulus or thought held in the conscious mind. In so doing, anger, fear, frustration, and anxiety associated with tinnitus can be eliminated within hours, rather than weeks or months. These methods utilize the body’s meridian system, and are similar to acupuncture only in this regard. Acupuncture alone is not generally effective for relieving fear and anxiety from tinnitus. EFT and ART are highly effective.

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