How do you direct your attention to something else without ignoring the symptoms, but also without giving it too much attention?
To answer this question adequately, I need a specific example. There are lots and lots of examples of people working through this in real time in our Rock Steady monthly calls and those replays are available in the Rock Steady program from the moment you purchase, you get access to the full backlog of monthly replays and you’re welcome to join the live monthly calls once you’re part of the rock steady program and you can bring your own example and we can workshop that through together if it feels helpful. But for now I think it’s important to use words like allow, honor, and acknowledge. So if we do have unwanted or difficult sensations or feelings in the body, if we dismiss them, if we minimize them, if we invalidate them, we’re really just keeping ourselves locked. We’re staying in this kind of shame spiral and from a nervous system point of view, it’s keeping a lot of those symptomatic maladaptive cycles alive. So it really is very important that we don’t ignore, distract, minimize, dismiss, or invalidate what we’re sensing and feeling. It’s coming through us for us to feel. It’s not coming through us for us to ruminate on and dwell on and to get stuck on.
An example of how you could honor and acknowledge something is there is to maybe name it, speak it aloud, locate it in your body, give it a little bit of a description. You might say, “Look, it feels like the color purple. It feels twisted and knotted. It feels like it’s spinning to the left and I think it’s sitting behind my left ear.” So you can give it a bit of time. You might give it six breaths, you might talk to it, you might ask your body, “How can I support you in this feeling?” And then once you feel like you arrive at some kind of resolution or enough-ness, that could be when it’s time to say to the body, “I’m not abandoning you. I’m not dismissing you. I understand you feel this, but I also want to live my day now. It’s time for me to move on.” And I’m a big believer that if the body wants something from you, it will communicate that. You will get a message from your body in whatever way you access your inner world.
And you get a lot of practice with that in the rock steady program. So you may want to be with it, breathe into it, maybe give it six breaths just as an arbitrary example. Locate it, give it a bit of color and texture and describe it. So you’re really giving it time. You’re breathing into it. You’re speaking with it. You’re offering it support. And then you might find there comes a natural turning point where you’ve just had enough. You don’t feel like you need to be there anymore. Or perhaps if it started off as an irritation, agitation, frustration, or a fear emotion, perhaps it neutralizes and becomes more of a connection of relief of feeling listened to, feeling supported. And it will naturally actually shift, the emotion itself will guide you. And then you can start working on your desired sensations and perhaps shifting into where you want to place your attention. So like I say, there are lots of beautiful examples of this in the rock steady program, in the group call replays, which I highly recommend you listen to if you’re on this journey. They are so instructive and supportive and having that peer group support available with the group call replays is game changing.
My question is around hyperacusis, hyperacusis from acoustic shock recovery, I don’t find much info in the world for this. For three years I’ve had hyperacusis and hypersensitivity to sounds and vibration. So much so my eardrum or ear canal taps when there is sound or vibration. Can you help me understand what is happening here, I’m curious? I do find noise and vibration tricky and I’ve tinnitus on top of that, which responds to how much noise I’ve experienced in one day. For three years, I feel I’ve done the wrong thing and avoided noise really, but I’m an introvert and I love the peace and quiet so I crave and seek it even more now. I also have vestibular migraine and PPPD on top of all of this.
Well, I want to say that I think there, is in the medical world and in the audiology world, probably some disagreements on hyperacusis, acoustic shock, and tonic tensor tympani syndrome. But my understanding and my, I suppose, approach to healing these, I can explain with you, which is that so the brain and the ears are locked in this fight, flight, freeze situation where the nervous system is treating sounds as a threatening event. And there will be a reason for that, probably a very good reason. Maybe there was an acoustic shock situation. And from that point on the body has said, “Okay, from now on sounds are not safe. I’m just going to be super vigilant.” Now, we have mechanisms in the ears that protect us from loud sounds. We have little reflex muscles and tendons that actually draw in and contract during loud sounds, a little protective, really, reflexes that make the eardrum and the middle ear system hold on tight, just so there’s not too many vibrations passing through the ears unnecessarily.
So it’s healthy, it’s normal, but what is not healthy or normal is if that is engaged all the time and it’s overprotective and over responsive. So the good news is is the way we reverse this, this kind of anxious overprotective response, is through regulating the nervous system and learning how to self sooth and relax and respond really lovingly to sound so that the body can reverse that danger response and that threat response. So I hope that has answered your question that there’s often a truly… Perhaps for example, someone might be near a speaker that explodes or they’ve got a headset on and there’s a very loud, sharp sound and that’s the acoustic shock initiative, that’s what starts it. And then the brain logs all sounds are now dangerous and it starts to become overprotective. So we get a very tight jaw, we might get headaches, we can get funny mechanical sounds, which you describe, we can become sensitive to sounds and vibrations even at normal and very safe hearing levels so some people will want whispers. They don’t want sound at all. Sound just feels really threatening.
what we want to do is to reverse all of that. So this is about navigating and changing our relationship to sound. We want the brain to, once again, open the flood gates and welcome sound in safely because sound is safe. And we want to just simply disengage that anxiety system of the over protective reflex system in the inner ears around the middle ear system and the eardrum. So that’s a very mechanical skeleto-muscular place where the body’s affected. So I hope that helps answer your question because I think you were just interested to hear my perspective on hyperacusis, acoustic shock, and tonic tensor tympani syndrome. So I think the key is it’s reversible and it’s a very personal process.
Oh, the last thing I wanted to say for you was I wouldn’t necessarily say you’ve done the wrong thing. Don’t be hard on yourself. You’ve tried to protect yourself and you’ve avoided noise because that’s what’s felt nourishing and nurturing for you or perhaps you haven’t had any other options. So I think it’s okay that you’ve made those choices. And if we look at this from a more of a spiritual point of view, what if the body is actually saying, “I really want solitude. I want to go into that cave. I want time to myself. I’m overstimulated, I’m done with people for now.” And what if from a spiritual perspective, it’s this is your time in life to really go within and have quiet time. And that when you’re ready, the body will relax and open up and just invite you to want to join the world again.
Being an introvert, as you say, and loving the peace and quiet and craving it, you are allowed to give yourself that and part of your healing and part of your rock steady path, if you follow the rock steady program, could be actually finding your sweet spot and your balance between time alone, quietness, solitude, and then exposure to crowds and people and choirs and concerts and parties and train stations and that extroverted part of life and finding the balance of how much is nourishing for you in both directions, because I’m sure too much solitude might not feel quite right and then too much extroversion not quite right. So it’s about getting that balance.
And then one more thing is just to be really noticing if you’re making decisions based on fear, because that will keep the fear cycle locked. So really stepping back and using the Rock Steady program and the rock steady path to ask, “Is this bringing me closer to pleasure? Is this bringing me closer to my joy? Is this taking me toward my desired sensations?” Because then it’s not about fear. It’s about pleasure, joy, softening, relaxing, opening up. And these are all little micro nuanced subtle decisions and choices we make every day. So that would be my big tip there. But please understand it’s reversible. Your nervous system is flexible and adaptable and it can change as quickly actually, the problem can change as quickly as it started. So I hope that’s helpful.
My question is can one safely participate in choir orchestra, go to concerts or movies when they have tinnitus, hyperacusis, acoustic shock, or tonic tensor tympani syndrome, also referred to as TTTS?
So my first answer is I absolutely recommend that you safely participate in choirs, in music, in concerts, in orchestras, especially when it’s coming from a place of joy and engagement and loving connecting to your communities and enjoying being surrounded in that music and that sound scape. So sensory enrichment and reintroducing sounds that bring us pleasure and joy is hugely therapeutic for anyone with tinnitus. And for those of you with acoustic shock, hyperacusis, or TTTS, I think it’s absolutely recommended for you too. It’s beautiful to allow yourself to enjoy being flooded by these beautiful sounds that you are choosing to participate in.
But what I would say is pace yourself. Give yourself options to perhaps attend for five or 10 minutes and leave again. What else could you do? Give yourself opt outs, maybe take breaks so you might not want to be there the whole time. You might want to step in and out. You might want to bring a friend with you and let them know, “Hey, I’m very sensitive to loud sounds or even normal sounds. It really hurts my ears. I get stressed.” So what I would say if you’re feeling the anxiety, particularly with acoustic shock, hyperacusis, and TTTS, but honestly this is really relevant for tinnitus folks too because there’s an anxiety component of caring so much about ourselves and our hearing health that we don’t want to make it worse.
So what I would say is be resourced, have your self soothing tools. If you’ve got the Rock Steady program, look through the tools that are provided there that help you ground, that help you reclaim your safety, that help you self regulate, that help you find your steadiness and your center and use those tools before you go to the choir or the concert or the movies, use them while you’re in the movie or in the choir or in the concert and know when you’re feeling like you’ve had enough. You don’t have to get to the point of overwhelm and you don’t have to stay there. You have agency and choice. This is your body. You choose how much exposure you enjoy and feel safe for you in that day. And so because we’re building up, we’re teaching the brain that, “Oh, choir is safe,” and we’re teaching the brain the movies are safe, we need to build that trust. The brain’s learning, the brain’s going, “Oh, I’m not sure about this. This could hurt me.”
So especially around your tension, any tension around the head, shoulders, and neck, you want to have some strategies to release that muscular tension. I actually went to the movies recently and, being an audiologist, I had my watch measuring the decibel readings and I was feeling particularly sensitive that day and I was like, “This is really loud.” So I measured the volume and it was way over safe hearing levels. The audiologist in me was so angry that they would expose public to such loud sounds and I actually did go to complain and say, “This is not safe volume levels, I’m measuring it.” And anyway, so I think there is a little bit of public education to happen. So sometimes back yourself. It may be too loud and it is dangerously too loud.
But what happened was I went back in, I asked them to turn it down and whether they did or not was not in my control, but I went back into the movie and I was using my strategies. I was sometimes closing my eyes just to relieve some of the sensory input to my brain. I was body scanning. I was noticing if there was nervous tension or anxiety building up and I was meeting that with kindness and resolving it in real time. So it’s a little bit of if you don’t feel up for it, it’s okay to avoid it. You don’t have to expose yourself aggressively. You pace what you feel ready for. It’s all about remembering to connect into pleasure and joy because that’s what’s going to teach the brain and the ears that those sound pathways are healthy. They’re safe. They’re fine. From a physiological point of view, we want the signals coming from the sound collection in the ears that travels to the brain, we want the brain to tick all of those off as safe, healthy, and enjoyable.
And what has been happening in the past is when we hear sounds, we’re associating it with pain and with tinnitus and with unwanted abnormal outcomes so the brain’s being vigilant and responding to it in more of a stressor way. So that’s what we’re doing is we’re teaching those sounds to come over into the brain as safe and pleasurable. And that could take time, it might be instant. Some of you will hear this, go straight to choir and just have fun. And for others of you, it will be a slow, incremental practice of learning to release that anxiety, self soothe, and re-expose your body and your ears and your brain, choose sounds in a really healthy way. And of course, I think as per the movie example, just note, if it feels too loud for you, it actually might be too loud for you. So just be really realistic and listen to your body because you know you best.
Joey, can you get PPPD and vertigo when you have broken sleep?
My simple answer would be: yes. I don’t know if it’s a direct causal link, but certainly fatigue and being tired does lead to more active symptoms and it does disregulate the nervous system a bit when it’s commonly occurring. So I guess my response is: it doesn’t really matter what came first or what’s happening, I think, it’s just really healthy to perhaps invest some time and energy into nourishing and nurturing your sleeping patterns because the more rested we are, the more the nervous system can self-regulate and we can co-regulate with our loved ones, and we can begin to use neuroplasticity to build those new maps of finding steadiness.
So my two recommendations, if you’d like them, would be to be really graceful and gentle with yourself with regards to tiredness and fatigue. There is no shame. It’s not your fault. Lots of us lose sleep from time to time. And sometimes we cannot change or avoid that, especially if it’s with mothering young children, for example. So it’s okay to be tired, be really gentle and be aware of any shame spirals that are coming in to sort of aggravate an already tender time.
And secondly, if you’re in the rock steady program, try the sleep skills, try some of those body scanning tools that are aimed to replace sleep. So if we can’t force sleep and we can’t magically make sleep happen, what can we do as a sleep replacement and begin to use some of those tools and incorporate them, live by them and see if you can help reintroduce sleep, which is what I’m seeing in so many of my rock steady clients is they’re getting back a good night’s sleep and it’s no longer a problem anymore. So I think nurturing the tiredness and having skills and tools to replace sleep, and just trust that when you are ready, your body will bring back that beautiful sleeping pattern.
I’ve had high pitched tinnitus for three years now, and I’ve done a lot of changing, including changing my breathing, being more positive, being more mindful, going through times of joy, and more accepting of myself, yet through all of this, my tinnitus is so constant and steady. I know you’ve said it’s always changing, but mine doesn’t back off or lower in volume and it completely baffles me. I feel I’ve made such positive strides, but with no results and it’s very disheartening. Can you offer any insight?
So first of all, I want to say I feel like it’d be nice just to pause and celebrate where you are. And that really moves me directly into my response, which would be when we’re coming at things from a neuroplasticity point of view, it really is founded in non-judgment and meeting ourselves where we are bringing loving awareness to where we are. And if the tinnitus feels as though it’s not changing at all, which is honestly highly unlikely because it’s all about where our awareness is. If we think of our awareness as a torch in a dark room, I think saying that the tinnitus is unchanging and is constant and steady is like saying, “Well, the torch is not ever moving.” So if you learn how to move your conscious awareness around and start investigating your inner world and really getting in touch with your self head to toe and your feelings and your felt sense of the world, it will literally move allocation away from that tinnitus sound so the awareness is not so strongly pointed at the tinnitus sounds.
Therefore, just keeping it there and training yourself to get very curious and open and absorbed in other parts of you. Because there’s so much more to you than your tinnitus and the tinnitus is allowed to be there, absolutely. And we can bring a lot of loving awareness and loving kindness to supporting that and listening to that. But I think it’s also important to not get too bogged down and focused on whether it’s there or not. It’s there, okay. How can we honor it, acknowledge it, be loving toward it? So really remove that emotional loading of wanting to get rid of it and shift into navigating other parts of you. And the questions I would be asking is, “What brings you deep pleasure? What truly engages your attention and just so absorbs and immerses you that there’s no space for anything else?” And then you’ll begin to notice, “Oh, okay. So when I’m really focused on this conversation or when I’m really just loving the sense of sand against my toes, the tinnitus sound does change because more of my neural awareness is resource and allocated elsewhere over into that somatic sensory region where I’m feeling and sensing against my skin and that’s taking away that allotment over at the tinnitus areas of my brain.” So play with that and learn how to really move toward pleasure, joy, sensory enrichment.
And my second response would be just really notice if you’re being outcome focused, that somehow you want to change your tinnitus or you want to get rid of it. It’s there. It’s a part of you. It’s your body making sounds. It’s normal and healthy. You do not need to focus on it at all and trying to change it means you’re teaching the brain it’s important to you. Trying, putting any effort into the tinnitus is teaching the brain that you like it, you want it, you’re interested in it and is giving it more neural emphasis. So for example, if you’re changing your breathing for the purpose of changing your tinnitus, the motivation is keeping the tinnitus alive. If you’re trying to be more positive, whatever that means, so that you can try and change your tinnitus, again, A, viewing things as positive negative means you’re still coming from place of judgment, that things should be this way. So it’s not that things are positive or negative. Things just are as they are and we can learn to experience them and let life wash over us in a way that takes a much more allowing, we’re allowing, there’s an effortlessness of letting life wash over us however it comes and we’re not micromanaging the outcomes, we’re not premeditated about it.
And that’s essentially what mindfulness is. So some people use mindfulness in a way that I think is a bit skewed and is still aiming for an outcome, but true mindfulness means we’re unbiased, we’re nonjudgmental, and we’re completely open with a loving awareness and curiosity in the present moment. So if that means that tinnitus is there, that’s okay. It’s welcome. And if in the next moment the tinnitus is there, that’s okay. It’s welcome. But what else is there? My question would be, “How do we get mindful about other parts of you and how can you be really richly engaged and engrossed in learning about new parts of you?” Because perhaps if we’re used an analogy of doing a PhD, it almost sounds like maybe you’ve done a PhD in really focusing on your tinnitus and now it’s time to let that go and shift your awareness to deeply focus on other parts of you as a whole person.
So I hope I’ve answered your question. And I think part of… You’re definitely on the journey, I can see that in your question and so it’ll be really tweaking it to shift away from that focal point of tinnitus, which it sounds like it’s coming back to, “Well, it’s still there. It’s still there. It’s unchanging. It’s still there. I’m doing this, but it’s still there.” Well, what I would say to you is, A, read my book or, B, try my rock steady program if you haven’t already, because this question demonstrates to me that you’re just trying to get rid of it and that doesn’t work. That will keep the brain locked in firing the tinnitus signal because it’s all coming back to whether the tinnitus is there or whether it’s changing. And we need to really let go of that agenda and surrender, allow and have an effortless approach to experiencing life as it is. I hope that helps answer your question.
Our vertigo is linked to the inner ear signals, that are responding to different rotations and tilts and accelerations, and helping us to remain stable and make use of our balance. They are in direct communication with our eyes and there is a very quick neural arch — neural reflexes, from the inner ears to the eyes. They’re some of the most primitive and fastest reflexes in the body. So, the eyes and the ears are talking with each other and they’re talking very quickly. For some people, especially when they’re tired, when they’re exhausted, when they’re overwhelmed, when there’s a lot of emotional processing that perhaps has backlogged and needs sorting out, needs feeling through in those times, high stress, high trauma, etc., the vertigo and eye conflict eye movements can be exacerbated. So, we can feel like computer screens, busy situations, perhaps at a train station with lots of moving vehicles, crowded places, supermarkets with lots of colors aggravate us and our symptoms.
Eye movements and the sensation of vertigo do go hand in hand but it’s also part of your healing. Following the Rock Steady process and the Rock Steady pathway for healing eye related vertigo, you’ll find it’s all reversible. A lot of it comes down to pausing and listening to the body, learning how to best support our body, support your nervous system, understand your nervous system, and self-regulate so that you can then rebuild new normal pathways that have stable vision and a sense of steadiness in terms of our balance organs. So, the healing will be the Rock Steady path of using neuroplasticity to build new neural maps that function with healthy eye movements.
