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Eric

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 #1 
Hello Dr. Nagler,

Three years have passed since the onset of my tinnitus. Over time I have found myself reacting less and less, and I sometimes go for periods of several hours entirely unaware of it.

These periods of unawareness happen at work (where I teach middle schoolers) and when I am out and about in the city where I live. My concern is that they almost never happen at home, where there are fewer distractions and where the ambient sound is quieter. When I am aware of my tinnitus, my negative emotional response is generally worse at home than it is elsewhere.

To be brief, my worry is that after three years my brain is more or less done habituating, and that—in regard to your 1–10 scale—I am "stuck" as a 2 outside the house and a 4 at home. (I was initially a 7 or 8.) I used to occasionally notice my generally-upward trend, but no more.

What observations have you made over the years in regard to the long-term course of habituation? Is three years possibly just the first segment of a longer process? Perhaps more improvement will happen on its own? Perhaps I should consider an active approach (CBT) to go further?


Thanks again,

Eric



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Eric
Dr. Nagler

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 #2 
Hello Eric. Thank you for your very interesting post.

Here is how I have come to see it ...

Habituation is an ongoing process rather than a state. I do not think it's a good idea to put a calendar on this sort of thing, especially since I am not so sure that anybody who has truly suffered from severe intrusive tinnitus ever fully habituates! Largely habituates? Yes. But fully habituates? I don't think so. In terms of where you stand, you have gone from a 7-8 to a 2-4. I suspect that back when you were a 7-8, if anybody had told you that at some point you'd be a 2-4, you would have been thrilled at the prospect!

I do not blame you in the least for wondering about pushing on, but perhaps first you should ask yourself why bother. I mean, Perfect is the enemy of Good ... and the way things stand now you are doing very well indeed.

Should you embark on a formal CBT protocol? Well, that's your call - but if you want your tinnitus to be "just a sound" to you, maybe you should try acting like it is just a sound instead of devoting time and effort to CBT and thereby giving it more credit than it deserves, which is ZERO as far as I am concerned. In other words, considering how far you have come - if you carry on your day as if your tinnitus were just a sound, in time it may become just a sound.

Hope this helps.

Stephen M. Nagler, M.D.

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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
dragonwisdom77

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 #3 
Dear Dr Nagler,

I fully agree with you about clinging to the thought that tinnitus will totally disappear as it may not and to just view  it as a sound. When I emailed you in early 2018 (tinnitus began in January 2018), I was not sleeping, I had been going on these tinnitus blogs, I was extremely depresses and had suicidal thoughts, I was unable to focus on my work, and I was extremely fearful that my life was ruined. At that time you mentioned habituation and I thought to myself that their must be another answer. Well, after a great deal of research and exploration with many other ways to deal with tinnitus on the net it turns out that your advice was the most practical and sane.  After about 5-6 months, I was able to habituate more, but it was still quite bothersome; however, I could feel improvement in the way I perceived it.  Within 10 months, I had habituated about 80-90% and when I was active I didn't notice it or I was aware of it, but it didn't really bother me that much. It was still a bit of a challenge as when I woke up in the morning the first thing I was greeted by was the loud, high pitched sound and also just before trying to get to sleep it would appear.  However, as time went on I decided not to fight it and just to learn to accept it as part of my life.   In November 2018, I had a bike accident and hit my head very forcefully into the pavement.  I went unconscious for about 2 minutes. Luckily I had a helmet on.  I was later diagnosed with a concussion and am now in the post concussion phase. My tinnitus went crazy. The pitch was extremely high and the level of sound was also extremely high.  I went into a state of depression for a few weeks, but then realized that I need to habituate myself to this new set of circumstance and now even though the tinnitus is much more high pitched and louder I have once again habituated to 80-90% and just accept the sound. Like you said, I have not totally habituated to it as I sometimes wish it would go away, but those thoughts are rare compared to the past where I was thinking about it every second of the day.  When you told me in early 2018 that even if the tinnitus got worse you could habituate to it I thought to myself this was absolutely ridiculous advice, but it was the best advice that I have ever received.  I am now living a life in which I just accept tinnitus as a sound and have accepted it.  As I write this email, my tinnitus is very loud and high pitched, but I no longer fight it or wish it to go away, but accept it as part of me.  Yes, there are times that I wish it would disappear, but that's just being human and I make a conscious effort to be aware of this fact and stay away from "why me, if only", statements, etc., and live a life as I had before tinnitus, but the main difference is that I have this sound in my head that is just a sound.  I wanted to share this email with others as it is possible to live with it. The habituation process will take time and it will be difficult, but it is very, very possible to accept the sound in your head and lead a "normal" life again.  I cannot thank you enough Dr Nagler for your advice which was truly life saving and life changing for me.
Dr. Nagler

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 #4 
Thank you for your post, dragonwisdom77, and for your generous comments. I am very glad to have played some small role in your recovery.

To all, just a gentle reminder:
This is strictly a Q&A board where you ask the questions and I provide the answers. I made an exception and allowed the above post because I felt it was highly instructive, but in the future comments and observations will not be approved for posting unless accompanied by a specific question. Thank you for your kind understanding.

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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