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Oreille

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 #1 
Dear Dr. Nagler,

Hello Again from Alabama. 

I take the liberty to ask another question(s), but please let me know if I am overstaying my 'free questions welcome' and if it would be more appropriate to schedule a Skype talk with you. I just want to come prepared!

The Henry & Wilson book (you deserve a Congressional Medal of Honor for putting it on free access on your site!!) suggests in Chapter 7 different strategies for attention control techniques, which is what I am mostly struggling with at this time  together with anxiety and occasional loss of hope. They even conclude (page 124) that we try and find what approaches work better for us. 

I have found that 'mindfulness thinking' (observing a situation of stress without judgement) seems to come relatively naturally for me, better than, say, breathing-based relaxation (which actually kind of stresses me more !).  It is all kind of new for me so I am still exploring. I find however CBT to be also very helpful and although I am just starting, I am encouraged by it. 

My question(s): in your practice and experiences, are TRT & CBT the only two approaches that you recommend and have seen successful? Is the entire idea of habituation compatible with different approaches, maybe more 'meditative" than "cognitive"? Is it OK to integrate / mix together different approaches such as CBT and 'Mindfulness'?

Extra credit question ;-) : I have come across a technique called "Mindfulness Based Tinnitus Stress Reduction", have you heard of it/can you comment on it? It seems to be based on the Kabat-Zinn Mindfulness Model from U. Mass. Medical School, and there are publications around it: mindfultinnitusrelief.com/the-science.html  (hoping it is OK to post URLs). Although I am well aware that publishing is a proof that one can write more than a proof that one is right.  There are courses offered so there is definitely a commercial aspect to it, although every clinician deserves to make  a living. I don't know most of the Journals cited there. I am concerned that it lists for instance publications in a Journal actually named "Mindfulness"... even though is is published by Springer.  But it seems to resonate with what I have more or less empirically found to be natural for me. 

I thank you again for your time and opinions. All the very best from UAH.

Oreille

Dr. Nagler

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 #2 
Quote:
Originally Posted by Oreille
My question(s): in your practice and experiences, are TRT & CBT the only two approaches that you recommend and have seen successful? Is the entire idea of habituation compatible with different approaches, maybe more 'meditative" than "cognitive"? Is it OK to integrate / mix together different approaches such as CBT and 'Mindfulness'?

Habituation is a natural process. CBT, TRT, MBTSR (Mindfulness-Based Tinnitus Strress Reduction), TAT, PTM, and the rest of the alphabet soup of tinnitus are merely ways to facilitate habituation. I do not see it as a one-size-fits-all type of thing, although I do feel that TRT (done properly) is generally the most effective for those with truly severe (i.e., largely incapacitating) tinnitus. As far as "mixing" approaches goes, I am not a fan.

Quote:
Extra credit question ;-) : I have come across a technique called "Mindfulness Based Tinnitus Stress Reduction", have you heard of it/can you comment on it? It seems to be based on the Kabat-Zinn Mindfulness Model from U. Mass. Medical School, and there are publications around it: mindfultinnitusrelief.com/the-science.html  (hoping it is OK to post URLs). Although I am well aware that publishing is a proof that one can write more than a proof that one is right.  There are courses offered so there is definitely a commercial aspect to it, although every clinician deserves to make  a living. I don't know most of the Journals cited there. I am concerned that it lists for instance publications in a Journal actually named "Mindfulness"... even though is is published by Springer.  But it seems to resonate with what I have more or less empirically found to be natural for me. 

See above re MBTSR.

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
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