BODYWORK

This involves checks for muscle spasm, massage and the bringing on of deep relaxation. This is achieved by release of tension both physical and emotional via comfort through contact.

Massage has a select tranquillising effect. The fluid release effect (Kurz & Wittlinger, 1978) as used by Olympic trainers, allows stressed parts of the body to be super oxygenated while irritating acidic wastes are pressed out of the tissues through intricate capillary and lymphatic systems that wastes (e.g. histamines) must pass through to leave the body. Tissue in this area is replaced by oxygenated blood leaving the client refreshed, calm and energised.

Referrals for TMJ dysfunction and myofacial spasm that have an anxiety and tinnitus component can be assisted by massage to the upper back, trapezius, neck, head and face to bring on relaxation or to assist an angry client to verbalise their feelings.

COGNITIVE AND BEHAVIOURAL STRATEGIES

Creative visualisation is a cognitive technique that involves the development of a pattern of ideas or thought processes to relax the client and break the destructive pattern of somatic preoccupation and depression. One of the most common cognitive stress responses is "catastrophising" and overemphasising the consequences of negative events (Sarason et al 1986).

Through consciously induced states of relaxation, calming the mind and focusing its powers of relaxed concentration, the ability to relax is developed to let stressors go and view problems and difficulties from a different perspective.

HYPNOTHERAPY

There are many reports on the benefits of hypnotherapy as a management technique for persons with tinnitus, (Macleod-Morgan et al 1982; Brattberg 1983; Marks et al 1985).

This is sleep-like state induced artificially by the therapist and characterised by greatly heightened suggestibitlity. For this reason, the hypnotised individual shows extreme responsiveness to suggestions which are made by the therapist. Because the client is relaxed and more subject ot suggestibility under hypnosis, the state has been utilised for therapeutic purposes since the time of Charcot, Freud & Breuer.

The essential feature of hypnosis is that it induces an altered state of consciousness by means of a technique that effects attention, such as repetitive suggestion (Lankton & Lankton,1983). In hypno- therapy the client's passive altered state is used for active counter suggestion by the therapist.

TINNITUS RETRAINING THERAPY (TRT)

Since the development of the neurophysiological model of tinnitus (Jastreboff, 1990) traditional views about tinnitus have changed. This model stresses the importance of central auditory processing in the emergence of tinnitus and the psychological sequelae (eg.anxiety,depression,anger etc.) TRT concentrates on demystification of tinnitus. This is primarily a long-term course of curative treatment (up to 2 years) rather than a coping strategy. Two components are involved: psychological and prosthetic, the first aims at removing inappropriate beliefs and fears about tinnitus. The second component involves the fitting of a prosthetic device which introduces "low level noise". This gradually eliminates the brain's over-sensitivity to auditory neural signals. Initial results look promising with claims that large numbers of clients with tinnitus achieve positive results.