Transcript: Mindfulness for Vertigo and tinnitus

Webinar series part 1


Welcome everybody. I’m really excited to be doing these webinars for mindfulness on vertigo and tinnitus.


I’ve been really lucky to have presented internationally at the British Society Audiology Conference and also nationally at the Audiology Australia Conference, where many of you may have done a workshop with me, and also with the Neuro-Otology Society Australia (NOTSA). This is a topic that is very dear to my heart and that really is based on where I’ve come through all of my studies over the last 12 years or even more really, I started mindfulness 17 years ago. So welcome to the webinar. My name’s Joey Remenyi and I’m a vestibular audiologist and mindfulness educator. I have a clinic based in Geelong (Victoria, Australia). That clinic is devoted to helping patients journey their recovery through vertigo and tinnitus.


I started my education with my psychology degree and I was fascinated with neuroscience and behaviour and helping people through the world of psychology. Then I moved into vestibular audiology where I did a masters thesis and a clinical internship at the Royal Victorian Eye and Ear Hospital, and the University of Melbourne Vestibular Investigation Unit. I was really fortunate that I was able to work with a collection of specialists who were devoted to vertigo and vestibular conditions. These were physiotherapists, vestibular audiologists, emergency doctors, neurologists and ear, nose and throat surgeons, and I’ve also been working with psychologists and psychiatrists who have a particular interest in this field. It’s been really great to get a rounded perspective and as a group really look at the multidisciplinary model of helping our clients through these symptoms of vertigo and tinnitus. My special background in mindfulness started as a teenager and I actually started a practice of one hour a day at the age of 19 for which I feel really fortunate. In my twenties I took on a formal apprenticeship which was one-on-one learning of yoga and mindfulness for 3 to 5 hours a day so that really was a huge learning curve and in many ways I found that apprenticeship more difficult than my master’s degree! I was really devoted to learning and fascinated by the art of yoga.


As I saw thousands of patients and clients coming through my clinic I was noticing a lot of concerns about “Why is my body like this?”, “Why do I hear this noise?”, “Why do I feel this way?” There was a pattern in what clients were saying and a lot of feelings of confusion, hopelessness and helplessness. Using my university degree and my understanding of neuroscience and vestibular audiology combined with the yoga and the mindfulness and the psychology background, it was really nice to melt those together and give clients options so they could learn the skills and tools to help them feel more safe and at home in their bodies. That’s really where this approach was refined year by year and it’s been wonderful to share that with my colleagues.


Part 1 in our webinar series today. We’re going to look at “What is mindfulness?” Some of you may already be practicing which is great, and some of you may be really curious and not quite sure what it is – we will cover that today. We’re going to dive right into “thriving” and this concept of thriving within uncertainty. Our clients and people experiencing vertigo and tinnitus are really living with a genuine uncertainty day-to-day and I myself have experienced vertigo multiple times, both benign paroxysmal positional vertigo which I’ve had on two separate occasions and I was really lucky to be able to treat myself and then get my colleagues to assess me and support me. I’ve also had vestibular migraine type vertigo as well. It can be really distressing and I totally understand. I actually heard my tinnitus first when I was studying audiology and reading about tinnitus and was just so focused that all of a sudden I thought “I can hear it!”. Again, that was helping me understand how our awareness and our focus really dictate what we’re perceiving in the world within us and around us. I’ve certainly had my own journey with these symptoms.


We’ll try some mindfulness skills and tools together today during the webinar and really look at how mindfulness can help us with uncomfortable feelings. Vertigo is this sensation that you’re moving when the world is not moving, so that could be rocking, tilting or spinning. Everybody describes vertigo differently so those of you listening may describe it in your own particular way and I think that’s a good thing as we are all different. The same with tinnitus – some people have it soft and mild, others extraordinarily loud and thumping, and at the end of the day what they have in common is these are uncomfortable feelings and we can’t run away from them, they’re inside of us. My clients and I are working together to use mindfulness skills and tools to help us hold this uncomfortable sensation and uncomfortable feeling and offer it some space and some kindness so we can actually treat it really gently and take it with us into our life and we can know that it’s uncertain and we don’t like it, but we can still move into that place of thriving and being the person that we want to be.


At the end of this webinar I would love to have some feedback and interaction so if you notice you’ve got questions you can jot them down on a piece of paper or just try to remember them and then towards the end I’ll check the chat box. I’ll also talk through some online programs that are available if you’re interested in learning these skills or if your clients are, and further resources and training.


Mindfulness in a nutshell is about learning skills to help us to really focus our mind and our brain on places that we choose on purpose. Purposefulness is fundamental to mindfulness. That means that when we’re mindful we’re deliberately putting our point of attention where we want it to be. That in itself is something we can practice. The other part of mindfulness is observation. We’re really training our mind to learn how to witness and observe with this curiosity, kindness and willingness. We’re moving away from the critical mind and shifting into this mind that says “Oh –  that’s interesting, I’m noticing I feel wonky”, “Oh – this is interesting, I’m noticing that my breath has changed” and so we’re learning to witness ourselves with openness to the changing moments.


We sometimes refer to this as the difference between “rigid” thinking (“I’m stuck, I hate this, I don’t want this”) and we’re moving into cultivating curiosity and kindness for our own inner world. Our inner world is what we perceive through our senses and of course that includes our touch system, our hearing, our balance. It includes our thoughts, emotions and our breath, so these are all things we can use to practice mindfulness with. Mindfulness is a way of life. It’s a practice which means you don’t just read about it – you learn by doing, and it impacts on our neural pathways.


Tomorrow night in part 2 of our webinar series we will be looking at the science behind mindfulness and I’m really getting into the neuroplasticity and how exciting it is that we can recover and we can repair our pathways, even if there has been permanent damage. The body can compensate and find new ways of analysing and filtering our information, so that is really exciting. We see it in our clients as they recover and improve.


I want you to close your eyes if you feel comfortable and I’m going to invite you to see if you can feel what you’re touching in the furniture underneath you. If you’re sitting down, I want you to feel into the chair that you’re sitting on and see if you can feel that in your sitting bones and in your legs. Get your mind to travel all the way down towards your feet and it’s like your brain is now focusing on the soles of your feet. See if you can feel the tactile touch of your feet against your socks, shoes, or the floor. This will be a different sensation for every participant listening because you’ll be in your own environment and you’ll all have your own inner world experience where your senses are unique to you. Some of you might be thinking “I can’t really feel my feet”, so you might want to try wiggling your toes, you might want to try pressing your feet down a little bit more firmly. Notice how what we’re doing here is we’re teaching the mind to become very focused on one simple thing which is just the soles of the feet. The more we practice focusing on the soles of our feet, the more that pathway from the feet to the brain becomes louder and stronger. By boosting our proprioception or our touch, by using our skin and muscle information, we are of course increasing our body awareness. This is really important for people who have balance disorders or conditions.


I want you to see now if you can shift your mind away from your feet and I want you to connect with all the people who are registered in this webinar. We’ve got about 30 people on the video webinar and then a number more who have logged in on their phone and there’s been over 120 people who are registered some of whom will be watching the replay, so we’re connecting with people past, present and future. See if you can use your focus and your mind to really feel that right now you’re a part of a community.  You’re a part of a community that deeply cares and is interested in both vertigo and tinnitus, either because they work with it and they want to know how they can best support their clients or you’re a part of our community because you experience the sensation and symptoms and you’re looking for support for your own recovery path. Take a moment to feel that you’re really not alone right now and there’s a lot of people who deeply care.


As you feel ready you can either keep your eyes closed and keep listening in to the webinar with this sense of quietness and inwardness, or you can open your eyes and come back and follow the PowerPoint slides.


When we go into our mindfulness we’re really training ourselves to feel within our inner world and connect with the present moment. The present moment could be an emotional connection like we just connected as a community, or it could be a physical connection – “Where are my feet right now? Where is the floor? Can I actually localise myself?” I was delivering a training on vertigo for some GP doctors recently and they were learning about vertigo and the patient recovery process. I was trying to explain what my role is as a vestibular audiologist and mindfulness educator. Medical doctors help with all of our blood tests, scans,and checking the cardio and the respiratory health and really making sure that we that our body itself is strong and healthy, so we’re looking into that from the medical perspective. By the time patients come and see me they may have already seen psychiatrists, psychologists, neurologists, ear nose and throat surgeons, physiotherapists – you name it! They may have even tried Chinese medicine doctors and massage and naturopathy and all sorts of things. By the time they come and see me we’re really looking at “How can I best be prepared for my symptoms?”


If you’re going to go for a trip to the snow – a drive up to the mountains to go skiing. How would you prepare for that? I’m betting you’d do research. You’d buy equipment, you’d want to be warm, you’d get all the skiing or snowboarding equipment you need, and you’d organise accommodation. If you think about it, if you go up there with no tools, no skills and no preparation, you’ll be really cold and you’ll be really lonely. You’ll be frustrated thinking “Everybody else is skiing and why can’t I do that?” Sometimes with vertigo and tinnitus symptoms I feel like people feel a little bit isolated and unprepared, and they’re looking at everybody else going “Why can they go to the pub and go to the parties and talk to people and I can’t?” The skills and tools I’m helping clients to learn are really getting what they need to be where they want to be and go where they want to go. It’s this idea of thriving within uncertainty. You can still go to the snow and you can still ski, but we have to get the tools to get us there.


In clinic patients will often report anxiety, depression, isolation, participation restriction (so they can’t do what they want to do) and postural tension, especially around the shoulders and the neck from trying not to get dizzy or move their head. Mindfulness really helps to drop into those feelings, to make space for feeling vulnerable and saying “Yes, I’m allowed to feel anxious. When I’m dizzy I lose orientation and I don’t feel safe, and it’s normal to feel anxious when you don’t feel safe”. We shift into this space of self-kindness and self-compassion and clients will often then notice the shift to calm. They’re supporting their natural emotions and responding and having tools to transition those emotions.


I had a client who wrote in – she is on her recovery path and she sent me a thank you email. I took a few snippets from the email where she says “When I get the dizziness and if I get the dizziness, I’m doing really well but I know I can calm myself”. That’s an action – she’s not waiting for a medicine to calm her or another person to calm her – she’s calming herself. It’s this feeling of being prepared and empowered. She said “I can refocus my attention so if I need to feel steady, I can find that steadiness. I can shift the way I use my body and I can wait for the attack to pass.” She’s got this package of preparation which somebody who hasn’t had vertigo or tinnitus might think “Well that sounds like common sense”, but I’m telling you in the heat of the moment it’s not so easy. It does require practice and support to get there. But, it’s really nice to know once you’ve got the skills you take them with you for life.


Thriving – you can learn a little bit about me here. We all thrive in different ways. I’m really curious to know, what does thriving look like for you? I don’t expect everybody here to want to surf or play the violin but these are things I have been doing since I was a kid. I love surfing – I love the ocean and being near nature  is really important to me. It’s part of my value system. Likewise with music, so connecting with people using music is really important to me and who I am as a person. Both of these things I actually quit (as you do!). I felt really inadequate as a 12 or 13 year old on my violin and I thought “You know, I don’t like doing this, I feel uncomfortable, I’m not good enough”, so I put it away and I quit. Then, in my late 30’s I got invited into a community string band and I had to pull out my violin. I had no idea if it even worked or if I could still play it – it had been 16 years since I had played it. I had to spend $900 on getting the whole thing fixed up with a new bow and a new case because it was falling apart. So I was really genuinely surprised and joy filled when I realised my brain could still remember how to play the violin! It blew my mind. The brain is really an amazing tool that we have sitting up here if we choose to really use it and experiment with what we’re capable of.


I actually used mindfulness skills to help me have the bravery to take the violin up again as an adult even though I felt silly, I felt hopeless – I used my mindfulness skills to feel vulnerable but to know that music is important to me and it was worthwhile. So I had to go through that process. The other thing was it was super loud so I had to use earplugs to protect my ears when I felt vulnerable with tinnitus. After practice and using these skills I no longer needed the earplugs and I could really enjoy my music – that was a big stepping stone.


With the ocean, the same thing happened. I got bullied as a teenager and so I pretty much quit because I didn’t feel safe in the water. It became a little bit more than just the rocks and the ocean and fear of getting injured – I actually then felt a social anxiety. There weren’t many girls back then (this was many moons ago) so the boys out there were a bit cheeky. I picked up surfing when I finished my study in Melbourne and moved back home. I had been away for 12 years. I decided to use surfing as one of my vestibular exercises. By surfing on the ocean we are challenging our brain and our ears to really fine tune the system, because surfing is so unstable and there are different accelerations and rotations that are very unpredictable. I was killing two birds with one stone in that I was able to practice my mindfulness skills in action in a way that was meaningful to me personally, and I was also able to engage in this vestibular rehabilitation in a way that was meaningful to me.


The last photo is me mucking around doing some yoga at my parents place and I was actually on a study break while I was building the online program that I’ve created. I wanted to put that up there because yoga is important to me. I’ve done it since I was a teenager and it is meaningful to me. I don’t expect it to resonate with everybody. If you’re expecting to log on to my online resources and learn lots of crazy yoga poses you will be bitterly disappointed, because it’s really not about yoga from the popular, known sense of it. What I teach clients is more about body awareness and self-compassion – that very gentle sitting, standing, walking, and daily actions that are meaningful to them.


The Spanish Kisses is a gorgeous story I have about a client who was over 85 and she was from a Spanish speaking country. Her goal, her version of thriving, was being able to meet and greet her family members and kiss them on each cheek (as we do in Europe). That was part of her therapy goal. I supported her through a six month support program. She was absolutely gorgeous to work with because I speak a little bit of Spanish, and she spoke a little bit of English, and between the two of us we had this “Spanglish” therapy session. I wanted to get across that mindfulness skills and tools are very appropriate for people of all ages and of all language abilities or educational backgrounds. This particular client couldn’t write confidently and we were writing out her exercises (every client I see has their own special home program) and it was quite hilarious because I’m trying to write in broken Spanish and she’s like “Well I can’t spell anyway!” which made me feel better. She had left school at a young age. These mindfulness skills and tools of self-compassion and holding vulnerability and knowing that “I’m going to feel a bit nervous when I lean to the side and kiss somebody” but because it’s meaningful to me I’m going to feel vulnerable and I’m going to take my home practices and I’m going to give it a go. It’s this idea of curiosity and openness and “I might be 86 or 87 years old but I can help my brain learn. I can still learn.” It’s this idea of feeling empowered. After we finished our 6 month support program when we were saying goodbye she said “Thank you”, and she gave me a kiss on each cheek. She was happy, she was thriving, and she said “I hope I never have to see you again.” This is what a lot of dizzy patients are thinking when they think “I hope I don’t go back to where I started.”


How do you thrive? This is a take home question for you to ponder. Often it is nice to stop and reflect and think about this because how we thrive is something that changes over time. Our values change. Being able to connect back into that is a really useful exercise. I think it’s important for all of us in this vertigo and tinnitus community to really understand and acknowledge that there is an underlying uncertainty. No medical specialist or miracle worker can predict how your body will respond tomorrow, which means tomorrow you could have severe vertigo. Tomorrow you could have severe tinnitus – it’s actually a possibility. We need to know “How do I stick to my goals and my values? How do I thrive in my community knowing that tomorrow could be really difficult?” We need skills and tools to support us with this underlying apprehension.


The marathon obstacle course is about a client who reached out to me recently. I saw her initially for benign paroxysmal positional vertigo which is the most common type of vertigo. It is when we have the little calcium particles free floating in a part of the ear, when they belong in a special part of the ear and living in jelly where they have a proper job to serve. Sometimes they fall out and float around. My role is to help patients learn which ear is affected and which canal. This lady had been to the emergency hospital and was really traumatized by the whole experience, which is understandable. She was treated and she said she did feel better after treatment but she was referred to a physiotherapist who wasn’t trained in vertigo. The physio gave her some exercises that got her flopping to her bed, back and forth, back and forth and my client was really anxious and she was doing it for five repeats per day. That exercise is not ear specific and it’s not really ideal for that condition, so unfortunately she ended up rattling those calcium particles around until she had multiple ears and multiple canals affected. She was now worse off. When she came to me she was exasperated, she was exhausted, she had lost her job, she had a number of life issues happening. I’m sure the people with vertigo and tinnitus out there will understand that when our symptoms are worse, life seems to be worse. It all seems to happen at once. I met her and I asked “What are your goals? How do you thrive?” She said “Look, I’ve sold my ticket for this marathon mud obstacle course and I was training for it for ages but I can’t do it – I cannot move my head and I can’t bend over.” I said “You know, if it feels ok with you I would love you to get your ticket back and keep that as one of our goals. I would love you to be able to do that obstacle course.” I said to her “We can treat this crystal condition – it’s not permanent. It’s not forever. I don’t know how long it’s going to take us to treat all your different canals.” We had one month. I said “Realistically, you may need to be prepared to do your obstacle course and run through the mud and hang and swing on ropes and climb, and there may be some dizziness. What we’ll do is I’ll teach you skills and tools that you can take with you through the obstacle course, so that if you’re dizzy and when you’re dizzy you can really be prepared and manage that and then just keep going.” When I got back in touch I said “How did you go?” and she said “Yeah I did it, I got a really good time.” It took her 7 hours and she was thrilled. She said she got dizziness for about 100 seconds in that 7 hours. She could have avoided that obstacle course, pulled back and created distance between herself and her goals, all for the sake of avoiding that 100 seconds of dizziness. Sometimes we have to look at the bigger picture and think “Am I prepared to feel uncomfortable and vulnerable a little bit for this bigger reward which is being able to do the things I want to do.” I was really proud of her, and if you’re listening – well done.


Often when we have our symptoms at our worst we’ve got this head where we’re like “Aaah! I can’t sleep, I can’t think, I’m exhausted! What if I lose my job? I can’t be a good mother, I can’t be a good parent” and there’s a constant feeling of inadequacy and confusion. Mindfulness is perfect for this mind state because it helps us to focus in and choose where we want to be. Part of our mindfulness practice could be to watch these thoughts and just say “Oh – that’s interesting, I’m having these thoughts that I’m a terrible person.” We’re watching them without necessarily holding onto them and really buying into them.


Many clients are stuck. It’s like there’s two sides of the fence and some people have been told, or  genuinely believe, that there is nothing they can do to get better and that they have to live with it. I don’t know why but somehow they’re very rigid on that and they just think that is a fact. As far as I’m concerned that is not a fact. There is always something you can do to help strengthen the networks in your brain and how your brain communicates with your balance organs, your spinal column and your body. Emotionally, we have a lot of control and choice. There is a lot we can do to manage the frustration too. My role is to help clients to really believe that they can do something, they can be prepared and they can trust their body to sort it out.


I have a picture of a brain up here and our brain is really capturing and filtering all of our information to help us feel stable, safe, and comfortable in the world. The balance organs live deep within the ears and they’re sending messages to the brain and the brain is sending messages back – it’s two way. Then we’ve got messages coming from our bodies, so this proprioceptive touch and muscle system makes up 35% of our balance system. Hypothetically, if you lost function in both ears through trauma or some type of illness or condition you could still ride your bike and perform basic daily functions using the balance through your legs, through your body and also through the visual system. We’ve actually got a lot of redundancy which means the body is prepared for some damage and it can adapt. Understanding this adaptation and recovery process is really important so we can support neuroplasticity. The science is showing that when we’re stressed or experiencing trauma or shock, the neuroplasticity stops. There is an inhibition of brain changing, which is where the emotional resilience and self support, I feel, is sometimes the key to helping patients with chronic symptoms recover. I have seen very severe tinnitus disappear in some clients and I have seen 30 years of chronic dizziness that has been a complete mystery to the medical world completely resolve back to close to nothing. Clients have told me they noticed the changes happening when when they started to really support themselves and stop expecting other people to fix them. It’s like shifting the paradigm where clients become a major team player in their recovery.


Have a think for yourself. Close your eyes and begin to feel. Ask yourself “How do I relate to my dizziness, to my tinnitus? How do I relate to my clients’ dizziness and my clients’ tinnitus?” Have that honest question with yourself. Remember, mindfulness is about being very purposeful. Have a think – do you believe that it’s possible for you to recalibrate your body and recover the wiring between your brain and your body and your sensory organs? Do you believe it’s possible for your clients to do that? Or is there a little part of you that’s resistant and saying “No way, that’s rubbish, absolutely not.” Then you’re noticing a little bit of the rigid thinking which we spoke about earlier. That’s ok – you’re allowed to notice rigid thinking. We all have moments of rigid thinking. Just drop in and think “How do I relate to my symptoms? How do I relate to my clients’ symptoms?” I want you to feel “How could it be if I truly believed at a very deep level that my clients can recover fully? They can feel comfortable in their bodies, and they can feel totally prepared. How would I feel if I felt totally prepared for my recovery process and to actually be totally recovered? How would that feel?” There’s a sense of possibility and openness – “Well what if?” Notice how there’s a nice feeling when we open up to this curiosity of “Well maybe tomorrow is my day!”


Avoidance behaviours are really common in people with unwanted feelings because we get the dizziness or the tinnitus and we say “Go away! I don’t want you!” The body reacts and it becomes stressed and tense. We can try and ignore it but it is not easy, and it is not always helpful. We can try and distract ourselves but it is exhausting. When we avoid things that make us dizzy or avoid things that exacerbate tinnitus, sometimes we are actually strengthening the dizziness and the tinnitus pathways. By creating variety in our movement and by creating variety in our emotional life and our social life that we can help the brain to reintegrate the balance messages and the tinnitus messages, to normalise them. If we keep on behaving like a dizzy person and being restricted, we will actually keep that restricted pattern reinforcing. If you think back to me surfing, I had to feel vulnerable and go out and paddle and support myself through that very vulnerable reintroduction to surfing, even though I was terrified. I was genuinely terrified for about a year. Suddenly, my body had relaxed into it and I could enjoy it. It’s a process.


When we are trying to avoid and hide these feelings it really is exhausting and I’m sure many of you would relate to that. It’s like we have to put on a brave face and people ask “How are you?” and you reply “Yeah yeah, I’m ok I’m good”, but really on the inside we’re feeling like we’re not at home in our body at all. This is where mindfulness can really come in as a daily practice, where we learn to focus in on what’s meaningful to us. What do we really want to do to help ourselves be the person we want to be? It’s proactive and helps us to focus in on our feelings, our thoughts, our activities, and to fine tune – is there anything about my life at the moment that’s actually holding me back? Is there anything that’s keeping me caught in stress and then making it difficult for my brain to rewire? It’s this idea of being reflective and focusing in and helping the brain to feel what’s happening in the present moment. When we’re connected to the soles of our feet, or connected to the sense of community, we’re no longer in that anxiety futurising catastrophes and we’re no longer in regrets or the past or those old memories. It really anchors us back into the here and now which can be a very calming and comfortable feeling because it’s genuinely safe.


I want you to close your eyes for a moment. One of the reasons we close our eyes is because it helps rest the brain. So, close your eyes and see if you can picture your thoughts running through your head at the moment. Think about it like you’re reading a karaoke screen and you’re watching your mind projected to the world for everybody to read. See if you can notice what’s running through your mind right now. This is a little mindfulness exercise.


I might be thinking “What if people can’t hear me through their computer speakers? What if this webinar is a total disaster?” Somebody else might be thinking “I’m curious to learn more about mindfulness. I’m curious to know how I could incorporate this in my home practice.” Other thoughts might be “Oh God, I’ve got to go get milk”, or it could be “I’m really worried about myself. I don’t feel right.” That thought might be repetitive daily, daily in and out. There are many ways we can practice mindfulness and noticing thoughts is one of them. Breath  is another – some people love connecting in with their breath and it’s really helpful for them as the breath is a key moderator of our repair system, the parasympathetic nervous system. Other people find the breath really stressful. In my online program I let people very much choose. If this doesn’t feel right for you, that’s fine. We’re all different and mindfulness can be used in a real variety of ways. Some of my favourite ways to use mindfulness are to connect with feelings and values, and then of course actions. We’re choosing to be the person we want to be. We’re choosing to give our loved ones kisses on the cheek, even if that might feel vulnerable for a short time.


This is just a little picture of what patients describe it feels like. If the orange bubble behind represented a client’s unwanted symptoms – anxiety, discomfort, dizziness, and tinnitus – when they start doing an activity that is key to their value system and helps them feel like the person they want to be, they’ll say that it’s like the symptoms get a little bit softer and they don’t notice them so much because they’re very focused on working in the shed, working with their woodwork, or very focused on a conversation with a very close friend, or they’re really engaged in a book, or whatever is meaningful to them – the brain gets so involved in that area that the volume is turned down in the other areas and that helps them to feel better and feel proactive.


This is a depiction of the brain. Different parts of our brain are responsible for different functions. We’ve got the balance brain and the visual brain and the motor sensory touch brain, hearing – in the front we’ve got our personality, thinking and planning brain. Right in the middle where the pink is we have our emotional processing brain – the limbic system, etcetera. When our emotions are working nicely and we’re feeling calm, relaxed and normal, the rest of the brain is able to communicate very efficiently so the messages are travelling nice and easily. When we’re feeling shock or trauma, we tend to shut down some of the other functions to focus specifically on the threat. So if a lion is chasing us, the brain might stop doing some functions that are not really essential and it will focus on running away from that lion. This is a survival mechanism.


From a dizziness and tinnitus point of view, if we got somebody to walk in a straight line in their home it would not be a problem. If we got them to walk the same distance on a plank that was elevated 20 metres in the air with the crowd of 100 people and they were filmed on international TV,  they would suddenly have the threat and the stress of the height (fear of height maybe) as well as performing in front of an audience and being recorded for future people to watch them. Suddenly they can feel very shaky and their balance is wonky and they’re not as coordinated, because the stress is playing a role in how the brain and the body communicate. This is important to understand because we need to look at our own personal sense of safety and comfort vs stress and panic, and look at how we can work realistically with our own day-to-day stresses to bring more and more calm, and more and more clarity into our actions and into our thought so we can really get the best for the brain at the end of the day. It’s a neuroplastic process. If we’re fearful of our dizziness and tinnitus and distracted or annoyed 24 hours a day we are actually really strengthening some of those stress pathways. It is really important to bear in mind that just getting tinnitus or dizziness can be very traumatic at the onset and then we need ways to feel into that trauma and process it.


The body is very good at processing emotions and mindfulness helps us to move from vulnerable, anxious and shocked to “Oh, well there’s no lion chasing me. That was a little false alarm so I can relax again.” We are able to modulate and regulate our emotions, which is a really great skill not only for our tinnitus or dizziness but also I’ve had clients say “This has helped with my job interview. It helped me with my relationships. It helped me in other parts of my life.”


“This was the first time that… I felt like I finally had a plan that I could hold onto when I felt most stuck. I felt better.” This was a comment from a man who had seen an ENT surgeon, psychologist, psychiatrist, audiologist, and he had tried hearing aids for his tinnitus. He came to see me for some mindfulness strategies and skills for program and he said this was the first time he felt like he had something he could really hold onto. We write the plan down on paper. He felt like he could do something – he had skills and strategies so that when it was really loud and aggravated he could hold onto his paper and read and follow and do something, and for him that sense of being proactive and participating in his recovery really helped him feel better. The tinnitus is still there but he feels better. It is really key to remember that mindfulness is very complementary to all the other treatments available, whether it be hearing aids, or physiotherapy, or psychology or surgery. Mindfulness is helping us contribute to the toolbox so we have more things to draw upon depending on what we need each day. Self support is one of my favourite parts of mindfulness and in the 12 week online program that I’ve built for my clients it’s really all about teaching them ways to explore self support, knowing that “no matter what I face today I can support myself through this” and that’s a really nice way to very quickly calm that emotional part sitting in the middle of the brain that we need to keep connected to in order to support our recovery. The idea is that we’re helping our clients to move from “I hate this – what if I never get better? I feel lonely and I’m confused and I can’t think clearly. I can’t do my job”, and we’re dropping into this space of “I can feel that you’re frustrated, and I can feel that you’re lonely and confused. I can feel that this is hard and I’m going to support you through this every step of the way because I’m here for you.” It is the sense of having an inner dialogue that’s developing self-compassion and the professionals who do mindfulness training with me, that’s what we’re looking at role modelling to our clients, is this mindfulness in self-compassion and self-kindness that we want our clients to take with them in their recovery process.


We’re moving from that space of catastrophe, worry and resistance (“No I don’t want my dizziness! No go away, I don’t want my tinnitus!”) and moving from that towards a sense of mindfulness that says “I can calm myself and I can be at home in my body. I’m ok. Even if I have dizziness, I’m ok.”


I might open up the chat box now if you have questions. While you’re typing your questions in about mindfulness for vertigo and tinnitus I’ll let you know a little bit about the program which some of you are interested in. I built this program for my rural and remote clients who couldn’t access therapy. It’s 12 weeks of step by step guidance to learning vestibular rehabilitation exercises alongside mindfulness. It’s all about exploring “How do I feel at home in my body? How do I support myself through my recovery process knowing that it is uncertain – I don’t know what tomorrow will bring.”  This is a way of feeling very connected to a community – having step by step guidance with audio recordings and videos. It’s been really exciting watching my local clients in Geelong use these tools and they love the recordings because when they have a bad day they just hit play and they instantly feel that sense of relief and “I’m not alone”. I’ve been reluctant to jump into technology and I’ve been really surprised by how effective it is. I have some clients who are living in Queensland, or country Victoria, and we connect for our one-on-one sessions either by video, like we’re doing now, or by phone or Skype depending on what works for people. It’s amazing how effective it is! I am very much a fan of telehealth and I encourage my clients to consider it. If they’re feeling that they can’t quite drive they can just call in from their bedroom and get the support to troubleshoot and to look at fine-tuning  their recovery program – whatever that means for them. You can rest assured I won’t give you surfing for homework or something like that, unless you’re already a surfer and then we might talk about it.


We’ve got a question here. “I have a patient who is scared about driving. I feel his fear is justified. How would I suggest he conquer this fear when suggesting that he allow himself to feel vulnerable would be dangerous in this situation?” Good question! I’ve had this come up in clinic and generally when you have active vertigo – so you’re genuinely dangerous and you don’t want to be on the road – you’ll have a little bit of an ease up. You’ll have a period where you’ll get nausea and a little onset of symptoms that are milder. Normally they’re 30 seconds or more. What I help my clients do is recognise when they’re in that vulnerable space but still able to pull over. Let’s say it happens suddenly and they’re driving, and then they get the early onset signs of their vertigo – I would teach them how to identify: “Am I safe? Am I early onset? Or am I unsafe?” Their mindfulness skills will be focused on the body sensations, and some people describe this as “I feel green”, “I feel triangle shapes”, some people use descriptions like “I feel sandy”, “I feel cement”, so we get really specific at knowing “When do I feel clear headed?”, “When can I trust my arms and legs?”, “When am I safe?”, versus “When am I early vulnerable?” and “When am I clearly unroadworthy?” Once they can categorise those they will feel much more empowered to make good choices.


I’ve had another question: “How do I know if my clients are ready for mindfulness?” This popped up as well at the Audiology Australia Conference. The best way to know is to ask them! Just let them know you’ve got training in mindfulness and could demonstrate some skills and tools for them if they’re interested. Or you might suggest that they read a book to learn more about it to see if they’re interested in it. You could ask if they’d like to try it and if it feels good you can do more of it, if it doesn’t then we can try something else.


Another question came through which was “How do you measure outcomes?” – I’ll be looking at getting some research with the online program but essentially rating scales, getting patients to rate how they feel, getting patients to see if they reach their thriving goals and also their perceived efficacy – how well do you feel prepared. I use rating scales or sliding scale. If you know anyone who has vertigo or tinnitus and you feel that they could benefit from learning these skills and tools, I encourage you to let them know that there is this online program. It was designed for rural and remote Australians but also city people are using it too, so if you know anyone who may benefit from this sense of community and group understanding this program is very accessible and affordable and I’m hoping that it really helps a lot of the people in our community.


Another question: “Does dietary salt intake contribute to vertigo?” That’s a great question and in the free starter kit (I hope you’ve all been able to access your resources on my webpage) is an interview with Dr Claire Iseli who specialises in Meniere’s. We talk about this and essentially it’s not hard and fast science but the ears are full of salty fluids so there is a possibility that diet and salt can impact on some people, but not everybody. We talk about this idea of trial and error. For example if you feel like tomatoes make you feel dizzy well then maybe tomatoes are your thing. It’s not always so cut and dry like a rule book. I’ve never met any two patients or clients with the same triggers – we’re always learning what does your body need and what is your body telling you.


We’re coming to the end of our time – does anyone have any further questions. If you’ve emailed me I will check them for tomorrow night’s webinar. I want to finish up by closing our eyes together and connecting into this community that we have – there are over 125 participants in this webinar. We’re in different countries, different continents. We all have different bodies, different sensations. Not one of us can predict tomorrow. If you’re enjoying being a part of this community I’m really grateful that you’ve turned up today and showed up. Go through the online resources and through tomorrow’s webinar, which will be part 2 on the science behind mindfulness. Take a moment to thank yourself for turning up and showing up – the first part of recovery is really just showing up. Saying “I’m here and I want support”. Well done for being a part of this webinar series today.