PSYCHOLOGICAL TECHNIQUES
The pyschological care of the person with tinnitus should always be considered along with medical and audiological opinions as part of an effective approach in managing tinnitus.
Psychological counselling, progressive relaxation training, biofeedback, bodywork, creative visualisation and hypnotherapy are aimed at outlining the terms of tinnitus management including the general benefits of relaxation, alleviation of stress and the more specific vascular effects secondary to the reduction of autonomic arousal. (House,1978; Lindberg et al 1988; Wilson et al,1992; Wilson and Henry,1993).
Such training, using a combination of the above techniques, generally takes a number of sessions depending upon the individual and his/her psychological reaction to the tinnitus.
Often the person with tinnitus displays bouts of depression, anxiety and somatic preoccupation which often presents significant disruption to everyday life, productivity and quality of work. The individuals disturbance represents differences arising from the individuals ability to cope, personality defence structure, social factors, severity of the tinnitus and related hearing problems. (House, 1981; Walsh, 1991; Dineen et al 1994).
Counselling is often required for anxiety, depression, withdrawal, anger, insomnia, sleep disturbance, irritability, feelings of helplessness and breaking the cycle of somatic preoccupation with the tinnitus. Some of the techniques used to deal with these problems are listed below:
1) biofeedback
2) bodywork
3) hypnotherapy
4) counselling and cognitive techniques including creative visualisation
BIOFEEDBACK
This tehcnique is used to inform the client, usually via special electronic measuring devices, of non conscious events. It is used to teach the sensations of relaxation and its physiological correlates; to decrease muscle tension, heart rate, respiration rate, blood pressure and so forth.
Muscle activity is measured by detecting the electrical activity which occurs when a nerve impulse triggers the contraction of muscle fibre. This impulse is known as a motor unit action potential and the detection and measurement of its activity is known as electromyography, EMG.
In a normal tense muscle, many of these potentials are occurring to maintain the contraction, and the average value of electrical activity is proportional to the force exerted by the muscle.
EMG helps clients learn control over muscle activity. This information is made available in either an auditory form - a varying rate of clicks or a warning tone, or in visual form - a metre or oscilloscope. With the aid of this information the client is able to identify small changes in muscle activity of which he/she is not normally aware. This improved perception considerably facilitates the achievement of control and relaxation (House, 1978; Duckro et al 1984).
Three surface electrodes are normally placed over the muscle of interest. Measurements are taken pre, during and post sessions. Sessions would typically last 30-50 minutes once per week and it would be recommended that the client practice the techniques on a daily basis for a minimum of 20 minutes so as to optimise the training effects.
As with all training procedures it is best if the client has realistic expectations of the treatment, and is at the same time sufficiently motivated at the outset. The technique is used as a supplement to other deep relaxation procedures.