Presentation: Hear Today, Gone Tomorrow

Psychological strategies for living well with hearing loss presented at the February 10, 2011 meeting of Canadian Hard of Hearing Association, Manitoba Chapter

By Dr. Lesley Graff PhD, CPsych, Associate Professor, Department of Clinical Health Psychology, Faculty of Medicine, University of Manitoba, and Lauren Yallop, MA, doctoral candidate, Department of Psychology, Faculty of Arts, University of Manitoba

Slides from presentation:

Learning Goals:

  • Identify phases of adjustment with a chronic health condition
  • Recognize the common challenges of living with hearing loss
  • Learn psychological strategies for managing the challenges of hearing loss

Background

#1 predictor of happiness?  View of health

21st century health problems – mostly chronic illnesses; focus is adjustment and disease management as no cure is available

Adjustment to chronic health conditions

  • Common experiences across many types of health problems
  • Over half of adult Manitobans have a chronic health condition; there are many common experiences, regardless of the health problem
  • Research has looked at how people adjust to these health issues.  Some work has been done that identifies phases of adjustment; with these phases it is important to note that there is no set time per phase; one may move back and forth between phases, and may move back to a previous phase with changing life circumstances.

Four Phases of Adjustment* (Fennel 2003)

1.  Realization (Crisis)

  • Can no longer deny problem
  • Something is wrong – fix it
  • Urgency for diagnosis/treatment

2.  Stabilization

  • More awareness/acknowledgement of symptoms
  • This is getting in the way
  • Try to return to ‘normal’

3.  Resolution

  • Realization it’s not going away
  • Learning how the condition behaves
  • Life despite the condition

4.  Integration

  • A ‘new normal’
  • The condition is only one part of life
  • Less impairment-focused effort

When do people tend to make changes? (Southall et al., 2010)

(1)  When feeling overwhelmed …
(Negative stress from the social and physical environment far outweighs a person’s resources)

Or

(2) When feeling hopeful … (Positive resources, for example peer support groups, far outweigh the negative stress)

It is hard work living with hearing loss

Consider all the different types of effort required to manage with a hearing loss:

  • Physical effort
  1. Posture adjustments to hear what one can; sitting on edge of seat
  2. Straining to understand
  3. Fatigue: effort to focus, or over stimulation with hearing aid
  • Mental effort
  1. Greater focus, attention needed; trying to fill in gaps (strong accent)
  2. Requires planning – good light/small groups/carpeted room?
  • Emotional effort
  1. Frustration, embarrassment
  2. Sadness (loss of meaningful sounds – loved one’s voice; music)
  3. Fear – will I miss important information (e.g., security)
  • Social effort
  1. Tune out – more isolated
  2. Have to be more assertive

 

For Family Too…

Research indicates:

  • Spouses experience as much frustration and anxiety as the person with the hearing impairment
  • Spouses describe
  • Difficulty communicating with their partner in background noise
  • Difficulty coping with the high volume of the television or radio
  • Having to respond on behalf of their partners
  • Having to repeat frequently during conversation

 

 

(Brooks et al., 2001; He’tu et al. 1993, 1988; Scarinci et al., 2008; Stark & Hickson, 2004; Stephens et al., 1955)

Psychological Impact

Compared to hearing peers, research has found that those with hearing loss have:

  • More depressive symptoms
  • Lower sense of mastery
  • More feelings of lonliness
  • Smaller social networks

These findings are similar across all age ranges

(Kramer et al., 2002; Corna et al., 2009; Nachtegaal et al., 2009)

Well-being & quality of life

  • Mental health and day to day functioning can be related to hearing loss in a dose-response pattern
  • Each increase in ‘dose’ of hearing capacity can correspond with an increase in level of psychological well being

(Strawbridge et al., 2000; Nachtegaal et al., 2009)

What can I do?

Two important steps:

  • Work fully with what is ‘out there’
  • Work fully with what is ‘in here’

What is ‘out there’?

Anything that improves hearing/communication capacity

  • Assistive technology such as hearing aids*; cochlear implants; phone texting, email, Facebook
  • TV/movie captioning, headsets at concerts/plays
  • Environmental improvements: Minimize background noise, good lighting

* Hearing aids can maintain mental functioning, thus improving quality of life (Corna et al., 2009; Cacciatore et al., 1999)

Why isn’t everybody doing it?

“Well when you see people that have glasses, and hearing aids, and a cane, you know decrepit is not far from one’s vocabulary … And having to admit it by something that’s visible externally … that’s what I mean by a stigma, Oh, he can’t hear either” … “I mean if you had a hearing aid … it was hanging right out there … that, I’ve got a handicap … and I don’t think anyone likes to come right out and say … I’m handicapped” … quote from qualitative study by Wallhagen, 2009

Stigma of Hearing Loss

three themes emerged in qualitative research about bias and hearing loss (Wallhagen, 2009)

  • I’m old; I’m broken; I don’t look good

These are obstacles to adjustment; these attitudes can impact the decision-making about the hearing loss, and affect:

  • Initial acceptance of hearing loss
  • Whether to be tested
  • Type of hearing aid selected
  • When and where the hearing aids are worn

What is ‘in here’?

This is all about who you are; how you approach a problem; what you bring to the ‘equation’

Psychological strategies: steps that address changes in control and self-worth related to the hearing loss can enhance psychological well-being (Corna et al., 2009; Cacciatore et al., 1999)

Putting Your Mind to Living Well

Individual level

  • Gain awareness of your personal biases; challenge your and others’ stereotypes
  • Assert your health needs
  • Self-care is important

Social level

  • Connect – you are not alone; Educate

Community level

  • Advocate

Individual Level: dealing with biases

The ABCs: assumptions + biases = challenge

Some examples:

  1. I’m sorry, I should be able to hear you
  2. Everything is so much work, I may as well not bother
  3. What’s the point of a hearing aid, if I can’t hear as well as I used to?

SELF CHALLENGE: Hearing aids will never replace what my ears can do, but they can help me stay connected without quite as much effort.

The ABCs: assumptions + biases = challenge

From others:

  1. Just be thankful you can still see
  2. You are only hearing what you want to
  3. You should just listen more carefully

CHALLENGE: You may not realize, but I’m already working as hard as I can to hear every word; my ears don’t hear as well as yours.

Assert your health needs

  • Connect to the right medical resources for assessment and treatment options
  • Keep informed about your options
  • Speak with those who have similar experiences
  • Persist to find the optimal treatment for you

Self-care

  • Managing the sress and strain means good self-care is important
  • Regularity of: meals, sleep, and exercise are especially relevant when you are living with a chronic health condition that takes such effort
  • Plan ahead for obstacles
  • Go at your own pace

Relaxation

Relazation training is effective for pain, sleep, stress; it acts through the autonomic nervous system and brain; it can be a useful component of self-care

Relaxation Takes Practice

Relaxation training teaches the body to relax physical tension and decrease aspects like heart rate and blood pressure, but it takes practice in order to trigger this relaxation response in the body.

Types of Relaxation

  • Includes diaphragmatic breathing, progressive muscle relaxation, imagery
  • Relaxation and stress release can also be achieved through meditation, hypnosis, yoga, tai chi

Social

Educate, share information with family/friends about your hearing loss and what you need to improve your communication with these important people in your life

Connect to others who ‘get it’

For example, the Hard of Hearing Association provides audiovisual assistance at their meetings to help you hear and understand all the information and discussion

Commnity

When you have energy, advocate for improvements at the local or even the national level

  • It may be something such as acknowledging community venues and restaurants that are hard-of-hearing friendly
  • Helping others is good for your health (Corporation for National and Community Service 2007)

When to see a psychologist

Of course, not everyone with a health change or hearing loss, for example, needs to see a psychologist; whether this type of health professional may be helpful for you depends upon:

  • Your familiarity with the toos introduced today, and other health problems, other supports
  • Your level of persistent anxiety, depression, distress

How psychologists might help:

  • They often work with stress management and problem solving regarding coping with chronic health challenges
  • Psychological therapies (e.g., CBT) for clinical depression and anxiety have good evidence for effectiveness (Bradelow 2007; Culpers 2009)

Clinical Psychology Services

Public access

  • Psychologists in hospitals/health regions
  • Usually need family physician or specialist referral
  • Typically wait of months; demand>resource

Private access

  • Extended health benefits; EAP; direct payment
  • May need family physician referral
  • List of registered providers with regulatory association of provincial society

Manitoba Psychological Society http://www.mps.ca

Summary of Key Points

In Conclusion:

  • When your health changes, there is a process of adjustment
  • Hearing loss can have a negative effect on your well-being … and your family’s
  • Use technology and information to enhance your ability to communicate
  • Challenge stereotypes – yours and other people’s
  • Living with hearing loss is tiring, so practice self-care and “recharge”; this includes approaches such as relaxation training
  • You are not alone, and helping others helps you too