Thinking back to where the interest in integrating nature connectedness and tinnitus management began, two patients that I saw in my Audiology practice spring to mind; Claire and Liam*.
Claire presented with normal hearing but sudden onset persistent tinnitus. She was referred to me by the ENT Consultant as she was finding it hard to cope with the intrusiveness of her tinnitus.
Claire loved to walk. She had a special hill on the Quantocks where she would sit and watch the buzzards soar and the hues of the heather change colour with the seasons. But when her tinnitus started she felt a horror that she couldn't leave her tinnitus behind and that the tranquility of her special place was lost. Claire described feelings of grief. A grief for the loss of silence. Claire stopped walking.
We talked about this and discussed the potential mechanisms of tinnitus and this put her mind at rest as she had previously had difficulty in articulating to her family how much impact the tinnitus was having.
We talked about that impact. Tinnitus 'per se' had not stopped her from walking, in the same way as a leg injury might have, but the lack of control and feelings of her inability to change her condition led to the feelings of loss and grief.
Together we devised a programme of reconnection. We looked at using nature to maintain the joy in her life and over time Claire returned to her 'sit spot' and used it as a place to unwind and returned to her daily walks, which helped her physical and mental health. The intrusiveness of the tinnitus faded into the background.
A combined approach and habituation meant that Claire could now live well with her tinnitus.
Liam came to see me to have some hearing aids fitted, to help him to hear in noisy meetings and conferences with his high pressured job. Liam was very distressed by his tinnitus and felt that his hearing loss was the "least of his troubles". Liam, a dad of two boys had recently moved to the edge of the Somerset Levels for a quieter life living in the country. However for Liam the move had seemingly magnified his tinnitus. When he was living in town his tinnitus 'blended in' with the near constant traffic noise and was less intrusive and bothersome. Living on the edge of a sterile landscape with minimum birdsong and natural sounds, Liam's tinnitus had 'ramped up' and depression had set in as he had undertaken an expensive house move only to have tinnitus become an "ever present monster" that loomed large in his life, the more Liam thought about it. And Liam thought about it a lot.
After fitting hearing aids Liam was encouraged to visit a local wooded community space and get involved in a community group. A combined approach and again habituation meant that the impact that the tinnitus had on Liam's life greatly diminished. Liam felt that he could "control his tinnitus" by using his hearing aids and tapping into nature.
These aspects of change and control are hugely impactful on the ability of an individual to rehabilitate and live well with any long term health condition. As has been shown by Sirios et al (2006) [1] individuals that hold the belief that they can control ones own health showed less depression and had a greater sense of well-being. However, there are many health conditions where the sporadic nature and unpredictability of the onset of their symptoms can make it hard to live as enriched life as they would like.
As my interest in Rewilding has grown and to hear it's many vocal opponents citing concerns about loss of rural identity and the criticisms from neighbours that our land looks messy, these health and social themes of change and control are ever present again. One of the interesting features of Rewilding is that by allowing nature to take the lead and reducing human's control over the ecological processes many people feel anxiety and seek to resist change- to maintain the status quo- to maintain the internal locus of control.
'Locus of control' is the degree to which people believe that they, as opposed to external forces (beyond their influence) have control over the outcome. To surrender your internal locus of control of your land and trusting in nature takes a huge leap of faith.
When we now work with nature connectedness embedded in our tinnitus programmes, the wilder land, it's nature rich environment and 'living soundscape' (eg birdsong, tree noises, water flowing etc) inspires awe and joy, and is the most valuable resource for sound enrichment which is central to helping individuals to live better alongside their health condition.
* The names of the individuals have been changed to maintain confidentiality.
Reference:
Sirois FM, Davis CG, Morgan MS. "Learning to live with what you can't rise above": control beliefs, symptom control, and adjustment to tinnitus. Health Psychol. 2006 Jan;25(1):119-23.
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